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1. GOVERNANCE AND LEADERSHIP for prison health

Prison health policies, standard operating procedures and inter-sectoral coordination

Also known as stewardship, it is one of two cross-cutting building blocks and provides oversight and guidance for developing an efficient prison health system.

To ensure that detainees have access to health care of an appropriate standard, good leadership and governance requires both political and technical action to provide prison health policies and strategies, legal regulatory frameworks, organizational and administrative structures. It also requires a partnership building with links to the ministry of health and non-governmental agencies, and inter- ministerial coordination.

This building block ensures that appropriate regulations and standard operating procedures are fairly enforced. It focusses on system- design and health outcomes, and allows accountability with close monitoring of the health system performance.


Accuracy of data, problem analysis, planning effective interventions

HMIS is the second cross-cutting building block of a health system. It provides a basis for understanding needs and serves as a starting point for planning, management and decision-making in health facilities and organizations.
HMIS produces regular reports on health statistics, and can support the development of health surveillance systems and response capacity.

Prison health authorities, public health officials, policy-makers in governments need a functioning health management information system and accurate data that can ensure the production, analysis, dissemination and use of reliable and timely health information.

Prison health data – ideally integrated into the national reporting system - are necessary to establish priorities, draft budgets, and design cost-effective health interventions, both on a regular basis and during public health emergencies.

HMIS involves three domains of health information: on health determinants, on health systems performance and on health status (morbidity, mortality) and inequalities within the prison population.


Substance use disorders, mental health and communicable diseases

Provision of primary health care is the basis of a prison health system, as it is for the public health system that serves the community outside prisons. Primary health care in prison includes: i) medical examination on entry, ii) management of communicable diseases, ii) management of non-communicable and chronic diseases, iv) antenatal and post-natal care, v) dental and eye care, vi) mental health care, including treatment for substance use disorders and vii) health promotion and prevention of diseases.

Care for drug users

According to UNODC world drug report 2011, some 210 million people use illicit drugs each year globally, and almost 200,000 of them die from drugs.1

Drug dependence is a public health concern as it affects not only individuals, but also their families, friends, co-workers and communities. It generates crime, violence, social, cultural and economic problems and health consequences, especially mental health, and the rapid spread of infectious diseases like HIV/AIDS and hepatitis, most common cause of mortality among drug users. Various studies have indicated that globally, the percentage of people in prison with drug problems, ranges from 40 to 80 percent amongst offenders entering prison and is on the increase.

Roughly, 50 to 70 percent of prisoners in Indonesia, Malaysia, Myanmar, the Philippines, and Thailand are in jail for drug- related crimes.2

Some half a million drug users are held annually in compulsory detention centers in China and Southeast Asia, according to estimates from the United Nations Office on Drugs and Crime (UNODC).3

The imprisonment of drug users without any other alternative measures (rehabilitation programs) and treatment lead to overcrowding in prisons, which impose the challenges to the authorities in term of security, space, water, sanitation, food and healthcare. Prisons can be one of the spreading spaces for drug use because of boredom and lack of activities, establishing the social relationships and passing their drug habits in prisons.

If there are no linkages to community services and no continuity of care, chances of relapse to drug use are high after release, that in turn impose those people to end up in imprisonment. To break this cycle, treatment and rehabilitation of drug dependence with the involvement of community may be more effective than imprisonment.4

Mental health care

A high number of people with severe mental health disorders enter detention facilities all over the world. In many cases, adults with mental illnesses enter detention with a history of chronic health problems, unemployment, homelessness, financial instability, drug use and other high–risk behaviors. According to some studies, the prevalence of personality disorders in prison settings may raise to 75%.

Mental health care within places of detention including referral to mental health services, is usually inadequate, and where it does exist, it is often sole focused on psychiatric care. The mental health needs of different groups of detainees such as women, children and young people, older prisoners, prisoners from minority ethnic or cultural groups and foreign detainees, may not be properly addressed. Furthermore, as conditions in detention facilities are not conducive to good mental health, all detainees are at risk of experiencing a decline in their mental state.

For detainees who require medication as part of their mental health care, a break in treatment may have extremely adverse effects and lead to a rapid deterioration of their psychological state. Detention systems may not be able to obtain necessary medications and/or may fail to ensure the continuity of medical care when detainees are transferred from one place to another and / or after they are released. Mental health treatment and care need to address all the detainees’ needs, including their social needs, and be psychological in nature.

Where appropriate, mental health services working with the criminal justice system should prevent people with mental health problems from entering prison and divert them either to community– or hospital-based services.

Management of communicable diseases

Prisons and places of detention pose particular risks for the transmission of contagious diseases. Potential factors that could amplify contagious diseases in prisons and places of detention include: overcrowding, poor personal hygiene, poor food handling and hygiene, inadequate ventilation, inadequate sunlight in the cells, limited facilities for diagnosis, treatment and medical isolation, lack of qualified health personnel in prisons and higher prevalence of contagious diseases in prisons. People in prisons and places of detention often come from groups at higher risk of certain infectious diseases (e.g. Tuberculosis, HIV/AIDS, hepatitis) than the general population.

Prisons are confined environments for prisoners but remain porous for spilling contagious diseases to the community due to contact with prison staff and visiting community members, and after release.

Effective prevention and control of communicable disease in prisons not only improve the health and quality of life of detainees, but is an effective public health measure to prevent disease transmission among prison staff, visiting families and the general population.