Aims Child sexual abuse in Africa is common with increasing numbers seeking professional care. In well-resourced countries a one-s top centre (OSC), where different agencies (health, social services, counselling, police and justice) operate together in one building, is an ideal way to care for survivors. The suitability of the OSC model has not been evaluated in low-income settings. In 2013, we evaluated the services offered within a recently established OSC in Malawi to determine the: proportion of children that receive services in accord with national guidelines factors that encourage or discourage the use of the service perceptions of quality of child protection services amongst users and providers

Methods In this prospective, exploratory study between August 2012 and June 2013, the experiences of consenting consecutive service users were evaluated 3 months after attending the OSC. Of 228 CSA survivors seen, 59 were lost to follow up and 62 did not consent leaving 107 participants who completed questionnaires. Semi-structured interviews (SSI) were held with 25 guardians of survivors and with 10 service providers representing all agencies involved. Interviews were transcribed and common themes identified.

Results 82% of survivors received health services in accord with guidelines, 84% counselling, 54% police and 29% social welfare services. 18% received all services as they should. The majority of guardians (75.8%, n = 107) were satisfied with the services received. In SSI (n = 25), factors encouraging use of the service were fear of HIV (19 of 25), seeking justice (3/25), need for counselling (2/25), fear of pregnancy (1/25) and verification of rape (5/25). Discouraging factors were concerns about corruption (9 of 25), negligence by police (3/25), sentence too short (3/25) and when post-exposure prophylaxis was not provided (2/25). Lack of transport impaired social services delivery.

Conclusion The OSC model is an appropriate means to deliver high quality care to CSA survivors in Malawi. Fear of HIV encourages use of the service. Perceptions of corruption and negligence amongst the police discourage clients; lack of transport reduces the effectiveness of the service.