1 Reaching the most marginalised VSO’s Prisons work in Southern Africa Clive Ingleby Lead Adviser – health, HIV and AIDS June 2016

2 “It is said that no one truly knows a nation until one has been inside its jails. A nation should not be judged by how it treats its highest citizens, but its lowest ones.” Nelson Mandela Nelson Mandela

3  Prisons amongst the most neglected places in terms of health service provision  In Southern Africa HIV infection rates in prisons are significantly higher than that of the general population. (UNODC 2013)  Rates of disease such as TB, STIs and hepatitis are unacceptably high  Female prisoners and adolescent and juvenile males are at particular risk of sexual coercion and violence as evidenced by VSO research in Malawi  The sharing of needles, tattooing equipment and razors increases the risk of HIV infection  Prisoners viewed with suspicion by the rest of society  Governments are reluctant to invest money in health or rehabilitation.  Up to 33% of prisoners are on remand only.  Most prisoners are eventually released back into society with little support Background – why prisoners and why prison health? HIV rates LesothoMalawiMzbiqueSwazilandTanzaniaZambiaZim National23.6%11%16%25.9%5.3%13.5%14.3% Prisons32.1%24%24.5%34.9%6.2%27.4%28%

4 Implemented by VSO Regional Health and AIDS Initiative for Southern Africa (RHAISA) in partnership with UNODC, local civil society, prisons and Ministries of Justice/Departments of Correctional Services Origins in small scale prison projects and research implemented by VSO in Malawi, South Africa, Mozambique Long process of sensitisation to build support – parliamentarians, ministries, donors, UN and voice of ex offenders Implemented across 7 countries: Malawi, Zambia, Zimbabwe (first 3 focus countries for first 3 years) to be extended to Lesotho, Mozambique, Swaziland and Tanzania Funding support from Swiss Agency for Development and Cooperation (SDC) - potentially £11 million over 10 years Combination of capacity building of civil society organisations and prison settings themselves (to improve health services for prisoners) and high level advocacy Promoting Human Rights and Access to Health Services in Prisons in Southern Africa

5  Improving clinical health and HIV service delivery through better prison medical facilities, drug supplies, training of medical and prison staff  Building capacity of civil society organisations and prisons through use of VSO International Volunteers eg. organisational development and M&E  Support to CBOs working directly with prisoners and ex-offenders to deliver complementary services eg. providing volunteers in social work (psycho social support), livelihoods training (to create prison nutrition gardens)  VSO created the Southern African Network on Prisons of influential individuals to lobby policy makers and national governments to adopt SADC minimum standards on prison health (eg. Festus Mogae – former head of state Botswana, David Parirenyatwa – Zimbabwe Minister for Health, Callista Mathurika, former first lady of Malawi)  Engaging with ex offenders and raising their voice at national level through supporting them to be members of Prisons Technical Working Groups  Working with SADC Parliamentary Forum and building the capacity of Southern African Parliamentarians to lobby for implementation of national policies on prison health, supported by short term VSO ‘Political Volunteers’ and ‘eminent volunteers’. A holistic approach

6  The target group itself – very limited support to date and few organisations prioritising prisoners  Evidenced based – combination of research and experience in prison settings  Collaborative working with civil society, ministries of Justice, prisons, UNODC and SDC – also complimented by additional funding from Big Lottery in Zimbabwe  Drawing on different strengths of each partner:  UNODC: leading on clinical health service provision in prisons  VSO: leading on capacity building of partners, nutrition, psycho social support, rehabilitation and advocacy  Partner CBOs and prison settings: complimentary service delivery, access to prisoners and sustainability  Regional approach – working across 7 countries ultimately and maximising opportunities to share learning What makes the work in prisons innovative?

7 Thank you