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HEALTH CARE IN PRISON

HEALTH CARE IN PRISON. 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

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HEALTH CARE IN PRISON

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  1. HEALTH CARE IN PRISON • 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. INTRODUCTIONPharmaceutical servicesChallenges: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

  3. STATISTICSPrisoner 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. 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. TUBERCULOSISAVERAGE PER MONTH:1999: 15042000: 16932001: 1899

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

  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. 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. 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

  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. 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. 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. 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. PHCSOME 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. PHCPROMOTION OF MENTAL HEALTH AND PREVENTION OF MENTAL ILLHEALTH:PROMOTION OF SOCIAL FUNCTIONING AND MENTAL WELL-BEING AND SPIRITUAL ENLIGHTENMENTINCLUDING PROGRAMMES FOR SUBSTANCE ABUSE

  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. 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. 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. 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. 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. 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. OCCUPATIONAL HEALTH AND SAFETYHealth and safety of offenders and personnelAn 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 policiesReport was presented to DCSTraining commenced: North West and Western CapeFurther presentation to the Management Board

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

  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

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