Prison infrastructure and health protection

Prison buildings serve needs or purposes for which they were designed. Although the primary purpose of a prison is incarceration, detaining authorities have further obligations with regard to living and workplaces health and safety. They are in charge of providing basic structures to meet the needs of detainees and staff including medical quarantine, and features to assist the people with disabilities and the elderly.


Addressing specific health needs of women and accompanying children in the criminal justice system

At least 700 000 women and girls are held in penal institutions throughout the world, representing approximately between 2% and 14% of the total prison population. In Asian and Pacific countries, this percentage represents an average of 6% of the total population. This figure is increasing every year in greater percentages than the growth in national population levels.

These women often imprisoned with their children have specific needs that should be met within the detention settings. For this reason, in 2010 the United Nations Rules for the Treatment of Women Prisoners and Non-custodial Measures for Women Offenders (Bangkok rules) were launched. These rules aimed at addressing, clarifying and setting standards that should be applied to the treatment of women prisoners.


Collection of health data for evidence–based prison health management

Health Management Information Systems (HMIS) is the foundation of decision-making across all health system building blocks, and is essential for health system policy development and implementation. In prison healthcare systems, HMIS is often not well developed or used and hardly incorporated in national reporting system. This results in limiting the information about the morbidity and mortality of the detainee population. It consequently affects data generation, analysis and evidence-base decision making.


Healthcare costs: Prison Revenues and Expenditures

According to World Health Organization (WHO), health financing is concerned with how financial resources are generated, allocated and used in health systems. Health financing policy focuses on how to move closer to universal coverage with issues related to: (1) how and from where to raise sufficient funds for health; (2) how to overcome financial barriers that exclude many poor from accessing health services; or (3) how to provide an equitable and efficient mix of health services.

Securing sufficient budget for prison health services is a common challenge in many countries considering the scarce financial resources provided to the prison.


Tuberculosis and blood borne infectious diseases in prison

Detainees often come from groups at higher risk of certain infectious diseases than the general population. Prisons and places of detention pose particular risks for transmission of contagious diseases. Potential factors that could amplify contagious diseases includes: overcrowding, poor hygiene, inadequate nutrition, poor ventilation and sunlight. Furthermore, shortage of prison medical facilities and qualified health personnel explains the higher prevalence of contagious diseases in prisons. 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 diseases in prisons not only improve the health and quality of life of detainees, but is also an effective public health measure to prevent disease transmission among the general population.


Cardiovascular Diseases, Mental Health and Disabilities should receive increased attention

Most of the information on the prevalence of cardiovascular diseases, cancer, diabetes and physical and mental disabilities in prisons comes from high-income countries despite the fact that globally, 80% of deaths from these diseases are in low- and middle-income countries. Prisoners are vulnerable to ill health because of their background, environment, and behavior outside and inside prisons. Most of prison healthcare systems have little capacity in detecting, treating, preventing or correcting modifiable risk factors for NCD.

Although figures relating to the number of prisoners with disabilities worldwide are scarce, some studies indicate that due to the growing prison population in most countries and the significant increase of older prisoners in some, there is also an increasing number of people with disabilities in prisons.


Mechanisms of continuum of care

Continuity of care, also known as a through care system includes delivery of integrated health services for prisoners throughout the time they spent in custody and even beyond. Effective communication between the prison health services and health care providers in the community is essential to the success of medical interventions and treatment. This is central to good practice.

There is a significantly high turnover in the prisons. There are frequent movements in and out. As such managing continuity of care in such situations is complex and presents specific challenges. The vulnerable points of the system include prisoner moving into, or out of prison i.e. entry into custody, leaving and re-entering prison for court visits, transfer to another prison and release from custody.


Enabling technology and applications that could be used in prison settings, from simple to the most advanced

Telemedicine is the delivery in real time of health-related services and clinical supervision using telecommunication technology. It has great potential to improve access to care.

Today, many correctional institutions around the world are using telecommunications technology to facilitate health consultations between patients in custody and clinicians in the community. The benefits of establishing a telemedicine system are: improved access to specialists, reduced number of referred case and saving in escort costs, as well as decreased costs in prison system, improved security & safety of all personnel.

However, the downsides of telemedicine are: high cost of telecommunication equipment, technical training for health personnel, decreased human interaction between clinician and patients, restricted access of prisoners to the health services outside prison, and increased risk of breach of medical confidentiality.