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Zambia’s prisons health system receives boost

THE slogan ‘Good prisons gealth is good public health’ emphasises the important link between the health of prisoners and that of the outside community.
Historically, prisons do not enjoy the kind of health facilities the outside community does.
This is because the concept of incarceration was meant to subject an offender to misery as a form of punishment.
The prison environment was meant to remind the offender of their wrongdoing and make them feel the “heat”.
Imprisonment was meant to be punitive, and spending on quality healthcare services for inmates was out of question.
Society simply did not plan for prisoners’ health.
However, across the globe there has been a paradigm shift among those responsible for prisons and remand services, changing from a punitive to a correctional approach.
This change has necessitated the signing of international treaties relating to the treatment of offenders.
In Zambia, several interventions by both the Zambia Prisons Service (ZPS) and other stakeholders such as non-governmental organisations (NGOs) have been put in place to ensure the standards of health services in prisons are the same as those provided in the mainstream healthcare system.
One of the major interventions under the new approach was to amend the Prisons Act (CAP 97 of the Laws of Zambia) in 2004, which established the Zambia Prisons Service Health Directorate (ZPS-HD) in 2009.
This provided for a qualified and experienced medical doctor to provide management and guidance of prison health services; the first time this had happened in the history of the service.
The creation of this post reaffirmed the ZPS’s commitment to an “open-door” policy, meaning that NGOs were welcome to offer support aimed at improving health service delivery to inmates.
Although the establishment of a Health Directorate was a stepping-stone in an effort to strengthen health care in prisons, it did not provide a panacea to all the ZPS’s health challenges.
In short, it was not sufficient to adequately address serious health deficiencies facing the prisons.
In 2012, a service programme and associated research study conducted by a consortium of stakeholders, including ZPS, the National Tuberculosis Programme at the Ministry of Health and the Centre for Infectious Disease Research in Zambia (CIDRZ) found that the number of HIV cases and tuberculosis (TB) infections within the prisons were much higher than the national averages.
The study also highlighted that prisons were not isolated environments as once thought.
Infections within prisons spread to the general population because released inmates return to their communities and may infect their relatives or other members of the community.
Further, there were indicators that the ZPS lacked sufficient skilled health personnel, health commodities and supplies, and up-to-date health information to be able to deliver quality services.
The ZPS-MoH-CIDRZ study made it clear that an investment to strengthen prison health systems was required to protect the prison staff, the inmates, and the general public.
In 2013 CIDRZ again partnered with ZPS, as well as the United Nations Office on Drugs and Crime (UNODC) Zambia office on the European Union-funded Zambian Prisons Health Systems Strengthening (ZaPHSS) project.
Under the ZaPHSS project, action was quickly taken. In 2013 a Zambia Prisons Health System Strengthening (ZaPHSS) Framework was drafted as the starting point.
The document provides guidance on how the health systems in Zambian prisons would be strengthened, focusing on the priority areas of human resources for health, health commodities and supplies, and health information systems.
The ZaPHSS project is working on improving the ZPS health system by undertaking a number of activities.
These include supporting line ministries in their work to assess the current state of prison health services; determining priority areas for improvement and communicating them for action and conducting a research study to learn more about current prison health services to inform appropriate interventions.
Others are helping the ZPS-HD improve capacity for planning, coordination and implementation of quality health services and providing organisational and technical support, clinical training or other guidance to the ZPS-HD at the prison facility level.
In May 2014, CIDRZ conducted a week-long prison officer training of trainers (TOT) seminar in Kafue in Health needs assessment, TB screening, and monitoring and evaluation.
These officers then formed prisons health committees (PrHC) in 11 selected prison facilities in Southern, Central, Lusaka and Copperbelt regions and equipped them with knowledge on how to handle health issues at their respective stations.
The PrHCs comprise both prisons staff and inmates.
ZaPHSS has also supported discussions and negotiations focused on the formation or re-formation of health structures at all levels of government.
This includes at the national level between MoH, MCDMCH and MoHA; at the ZPS headquarters level focusing on ZPS-HD; and at the prisons facility level with a focus on the newly established PrHCs.
All stakeholders at each level have been enlightened on the challenges the Prisons Service is facing and what they can do to improve the prisons health system. For example, line ministries of MoH, MoHA and MCDMCH have the role to propose for increased ZPS funding through Cabinet, with the CAPAH parliamentarians supporting the allocations during debates of revenues and expenditure in parliament.
All these activities indicate how ZPS and its partners are moving in the right direction. With concerted efforts from all stakeholders there is now new hope for a once hopeless community.
The author is the assistant public relations officer in the Zambia Prisons Service.

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