1. 1 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

2. 2 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 offenders HIV/AIDS and TB Provision of medical and dental services (visiting doctors) Increasing emphasis on prevention and promotive health care and positive health seeking behaviour Reaching a target of 75% PHC training amongst nurses

3. 3 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

4. 4 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

5. 5 TUBERCULOSIS AVERAGE PER MONTH: 1999: 1504 2000: 1693 2001: 1899

6. 6 DEATHS DEATHSNATURALUNNATURALTOTAL 199518660246 199621172283 199732775402 199853481615 199973761798 20001087731160 200126911280

7. 7 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

8. 8 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

9. 9 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 doctors Work study investigation was conducted: 9 Posts were created for big centers : Johannesburg, Pretoria, St Albans, Pollsmoor, Grootvlei, Durban Westville, Pietermaritzburg Posts not finaced Gauteng 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 priority State Expenditure’s opinion: DOH still responsible for health of prisoners. No functional shift. A national policy

10. 10 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

11. 11 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

12. 12 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.

13. 13 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.

14. 14 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

15. 15 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

16. 16 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

17. 17 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)

18. 18 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

19. 19 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

20. 20 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

21. 21 Development of training manuals : foodhandlers and cleaning procedures 2001 Planning:-Review policy -Measures to implement 3 x meals -Continuation of training -Workshops in provinces

22. 22 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

23. 23 HEALTH BUDGET 2000/2001 Allocated : R581 802 000 Expenditure : R514 205 524 (97,3 %) 2001/2002Allocation : R551 215 000

24. 24 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