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HEALTH CARE IN PRISON

1. INTRODUCTION

Health care unit core functions:

Primary health care and referral to level 11 & 111 services

Including specialist and support services

Dental/oral health services

Nutrition services

Hygiene- personal and environmental

Communicable diseases such as TB, STD & HIV/AIDS, etc

Health education and health promotion

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•

INTRODUCTION

Pharmaceutical services

Challenges:

Overcrowding : Spread of infection eg. TB and skin infections.Hygiëne Maintenance : Overworked sewerage system, insufficient toilet facilities. Inadequate clothing and bedding.The need for clothing for the awaiting trial offendersHIV/AIDS and TBProvision of medical and dental services (visiting doctors)Increasing emphasis on prevention and promotive health care and positive health seeking behaviourReaching a target of 75% PHC training amongst nurses

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2. STATISTICS Prisoner population:

•30 April 2000 : 172 2711 (72 % overcrowding)

•31 March 2001 : 170 595 (68 % overcrowding)

•No significant long term effect of 2000 bail releases and advancement of approved parole dates

Admission to outside hospital:

1998 : Public hospital : 4880, Private : 2244

1999 : Public hospital : 5559, Private : 589

2000 : Public hospital : 5907, Private : 62

2001 : Public hospital : 1760, Private : 10

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HIV/AIDS (KNOWN CASES)

April 1995 : 572

April 1996 : 709

April 1997 : 948

April 1998 : 1418

April 1999 : 1857

April 2000 : 2981

April 2001 : 4105

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TUBERCULOSIS

AVERAGE PER MONTH:

1999: 1504

2000: 1693

2001: 1899

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DEATHS

DEATHS NATURAL UNNATURAL TOTAL1995 186 60 2461996 211 72 2831997 327 75 4021998 534 81 6151999 737 61 7982000 1087 73 11602001 269 11 280

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STAFFING

Nurses Financed Posts : 661

Nurses Filled Posts : 559

Nurses Vacant : 102

A ratio of 306 offenders to 1 nurse.

Staffing norms: workload indicators: acute, chronic, clinic/OPD, inpatient head count,etc. Prisons: 200:1

Caterers : Financed Posts : 571

Filled Posts ; 534

Vacant : 37

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STAFFING (Continue)

Pharmacists : Financed Posts : 38

Filled : 15

Vacant : 23

Difficulty to recruit pharmacists - remuneration package

Provincial Heads : Financed Posts : 18

Filled : 14

Vacant : 4

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STAFFING (Continue) Currently there are 160 doctors visiting prisons in South Africa as at May 2001 (Sessional doctors)

True picture: understaffing with some prisons not having doctorsWork study investigation was conducted: 9 Posts were created for big centers : Johannesburg, Pretoria, St Albans, Pollsmoor, Grootvlei, Durban Westville, PietermaritzburgPosts not finacedGauteng Department of Health : Interdepartmental Service agreement with DCS paying for previously free district surgeon services Autonomous Provincial Departments of Health with own priorities and therefore DCS’needs not a priorityState Expenditure’s opinion: DOH still responsible for health of prisoners. No functional shift. A national policy

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PRIMARY HEALTH CARE

•Shortage of nurses. 24 HRS Facilities.

•Difficulty in training due to staff shortages

•Limited scope of practice (South African Nursing Council, Section 38A Nursing Act).June 2001 Nursing Symposium and other processes will address the scope of practice.

•15 % of nurses are trained in Primary Health Care. Ideally: 75%, DOH

•After release community services for continuity of care: linking up with other service providers and improving referral system

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PHC (continue)Training of nurses in Occupational Health & Safety for promotion of health and safe work environment.

Research into prison health services and HIV/AIDS following 2000 SA and US Conference. DCS, MRC & Amory University: System-wide research into health care services, research capacity building workshops, and training of offender peer educators.

National Nursing Symposium 27-29 June 2001 to redefine the role of nurses within the context of humane detention. To identify policy gaps and indicators. To explore current health needs.An array of topics: nurses, training/education institutions, DOH, former offenders and NGOs

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PHC

HEALTH PROMOTION AND PREVENTIVE SERVICES ARE CRITICAL ACTIVITIES IN PHC.

LIMITED HEALTH RESONNEL WITH MORE FOCUS ON CURATIVE CARE,

CHANGING ROLE OF NURSES TO ASSUME MORE CLINICAL RESPONSIBILITIES OF PHYSICIANS AND THEREFORE THE NEED FOR CAPACITY BUILDING.

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PHC

SKILLS DRAINAGE TO PRIVATE SECTOR AND OTHER COUNTRIES A REALITY.

DIFFICULT TO RECRUIT AND REATAIN HEALTH AND OTHER PROFESSIONALS.

A TENDENCY FOR URBAN PREFERENCE.

RELIANCE ON DEPARTMENT OF HEALTH WHOSE SERVICES ARE ALSO OVER-STRETCHED.

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PHC SOME OF OUR PRISONS ARE LOCATED IN RURAL AREAS AND THEREFORE DIFFICULT TO ENSURE PROPER ACCESS TO HEALTH CARE AT ALL TIMES.

INTERDEPARTMENTAL RELATIONS-DCS AND DOH PHARMACISTS SERVICE DCS.

COMPULSORY COMMUNITY SERVICE FOR PHARMACISTS RELIEF SHORTAGE OF PAHARMACISTS.

DEVELOPMENT OF BUILDING NORMS FOR HEALTH CARE FACILITIES IN CONSULTATION WITH DOH FACILITY PLANNING

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PHC

PROMOTION OF MENTAL HEALTH AND PREVENTION OF MENTAL ILLHEALTH:

PROMOTION OF SOCIAL FUNCTIONING AND MENTAL WELL-BEING AND SPIRITUAL ENLIGHTENMENT

INCLUDING PROGRAMMES FOR SUBSTANCE ABUSE

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CHOLERA OUTBREAK

DURBAN WESTVILLE

•Experienced an outbreak of cholera - offenders affected

•Situation under control

•In partnership with Kwazulu Natal DOH, WHO and Local Authority - outbreak was controlled

•Treated : 861

•Confirmed cases : 17 Death : 2

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CHOLERA OUTBREAK

SEVONTEIN :

•1 Case treated in external hospital and cured, March 2001

MEASURES IN PLACE IN ALL PRISONS:

•Health education

•Proper food hygiene

•Kitchen inspection

•Medical examination of foodhandlers (staff and prisoners)

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•Medical examination of prisoners from cholera area.

•Food samples on raw and cooked food

•Water and sewerage samples

•Floor swabs

•Liasing with DOH and local authority

•Proper refuse and sewerage disposal

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HIV/AIDS PREVENTIVE MEASURES

•Policy review

•Health awareness e.g Youth Day commemorations

•Partnership : SACMA, NGO, DOH, IDC, etc.

•STD Management

•Care and Support

•Voluntary testing and counseling

•Inter-disciplinary approach

•Condom availability

•HIV prevalence survey to map the trend

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NUTRITION

CHALLENGES

•Overcrowding and implementation of 3 meal sessions per day according to Correctional Services ACT 111, of 1998

•Delabitated kitchen facilities

•Understaffing

MEASURES IN PLACE

•Review of ration scales : female, juveniles

•Training : 101 caterers trained since January 2000

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•Development of training manuals : foodhandlers and cleaning procedures

•2001 Planning: - Review policy

- Measures to implement

3 x meals

- Continuation of training

- Workshops in provinces

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OCCUPATIONAL HEALTH AND SAFETY

Health and safety of offenders and personnel

An audit of DCS facilities( workshops, farms, abattoirs, cells and hospitals was conducted in MAY 2000 by NCOH and Department of Labour to assess compliance with Occupational Health and Safety policies

Report was presented to DCS

Training commenced: North West and Western Cape

Further presentation to the Management Board

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HEALTH BUDGET

2000/2001 Allocated : R581 802 000

Expenditure : R514 205 524 (97,3 %)

2001/2002 Allocation : R551 215 000

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CONCLUSION

NOTABLE CHANGES IN AN ATTEMPT TO MOVE AWAY FROM EARLIER PRACTICES WHERE HUMANITARIAN LAWS WERE NOT OBSERVED IN THE TREATMENT OF PRISONERS

A HEALTHY AND WELL-REHABILITATED PRISONERS CONTRIBUTES MEANINGFULLY TO HIS COMMUNITY AND TO HIMSELF

A HOST OF KEY ISSUES AND CHALLENGES AFFECTING THE DELIVERY OF HEALTH SERVICES