ACSA BIENNAL CONFERENCE ENHANCING COMMUNITY RESPONSIVE CORRECTIONAL SERVICE DELIVERY IN AFRICA HEALTH RIGHTS IN PRISONS BY REGINA OMBAM HEAD STRATEGY DEVELOPMENT NATIONAL AIDS CONTROL COUNCIL - KENYA

HEALTH IN PRISONS Prisons are a true representation of the society and can act as a disease reservoir, therefore good prison health is good public health Good Prison administration with support from other stakeholders has resulted in a significant drop in morbidity and mortality not only within the prisons settings but also in the host communities.

KENYAN CONTEXT In Kenya the Prisons Service has been in existence since 1911 as a department within the Office of the Vice President and the Ministry of Home Affairs It is headed by the Commissioner of Prisons and the service is mandated through an Act of Parliament

ROLE OF KENYA PRISON SERVICE Containing and keeping offenders in safe custody Rehabilitation and reformation of offenders Facilitation and administration of justice by producing offenders in courts of justice Training of young offenders in Borstal Institutions and Youth Corrective Training Centres Provision of facilities for children aged 4 years and below accompanying their mothers in prison Recruitment , training and development of suitable human resource for the provision of service

DISTRIBUTION OF PRISONS Kenya has 107 prisons, with over 250,000 inmates annually with a daily unlock of 50,000 Kenya have 312 children accompanying their mothers Kenya has 2 Borstal Institutions with a population of 350 each

HEALTH SITUATION IN KENYAN PRISONS This looks at the general living conditions of inmates from the point of view of accommodation, clothing, food, nutrition, public health management, water and sanitation, wellness, rehabilitation programmes among others Five years back and before all inmates and staff who needed medical attention were referred to the Ministry of Health facilities. Scope of health service delivery was curative.Facilities that were already constrained from the point of view of infrastructure, personnel, commodity supply , accessibility and logistics

In 2006, the Kenyan Government decided to create a Directorate of Prisons Health Service that was mandated with the responsibility of promoting the health of inmates and staff and ensuring that the environment they occupy is a healthy one This directorate was given a medical vote head within the ministry of home affairs An open door policy was adopted in the prison settings that saw issues of health and human rights integrated through support from Govt and development partners that resulted in key positive changes in administration, infrastructure, personnel and commodity supply of health care in prison settings

HUMAN RESOURCE CAPACITY NON-UNIFORMED HEALTH PERSONNEL Medical Officers 7 Seconded Paramedics 117 TOTAL 124

Uniformed Officers Medical Officers 2 Clinical Officers 18 Nursing Officers 34 Lab Technologists 6 Physiotherapists Oral Health Officers 5 Public health Officers 4 Pharmaceutical Technologist Radiographers Dental Techs 1 Nutritionist Medical Engineer Health records and Information officers TOTAL 80

HEALTH SERVICE DELIVERY The prisons in Kenya currently offer both curative and preventive services See a sudden shift to an increase in the scope of health care delivery in prisons Curative – Outpatient, Inpatient,labaratory, X-ray, dental and ENT services Preventive- Health education and hygiene, examination of food handlers, routine inspection of prisons, waste management and sanitation, water and food quality control, spraying and fumigation

HIV AND AIDS The Kenyan HIV situation is both generalized and concentrated. Prisons population as one of the sources of new infections (KMOT 2008) The Kenya HIV and AIDS prevalence is 6.3% (KDHS 2009) Prevalence rate among inmates is 8.2%, Females 19.3% and Males 5.5% TB prevalence rate in Kenya stands at 298 per 100,000 populations while the inmates rate is 76 per 10,000

CURRENT TB/HIV STATISTICS Inmates Staff Community No of TB Patients 160 8 19 No of HIV Patients 2124 39 191

HIV/AIDS INMATES STAFF&FAMILY COMMUNITY TOTAL Male Female CARE 1003 142 7 5 72 54 1278 TREATMENT 911 68 18 9 36 29 1071 1914 210 25 14 108 83 2349

Kenya prisons established an AIDS Control Unit in 2004 which has seen the prisons department undertake HIV programs under the following broad program areas Prevention of new infections Improvement of quality of life for the infected and affected persons Capacity building Research Program Management and Support Monitoring and Evaluation

Using HIV and AIDS as an entry point to the overall health service delivery in Prisons, the Prisons ACU has now established a data centre that monitors HIV related illnesses within the prison settings With support from development partners the ACU has been able to train counsellors, peer educators and has been able to train its staff in the directorate on ART, PreP, ARV Management, TB/ STI, Syndromic Management , Injectable Drug and Substance use and abuse We have seen renovations of health facilities into comprehensive care centres, nutritional support , diet supplements and a rise in voluntary medical male circumcision among staff and inmates

IMPACT OF HIV AND AIDS As an entry point to improved health service delivery in prisons the epidemic too has caused additional strain on already constrained resources in the area of food and nutritional services, accommodation, clean water, waste disposal ,clothing , rehabilitation programmes in prisons There is an urgent need to redefine our HIV strategies that focuses on long term impacts with the overall aim of improved health care for the community

OUTCOME OF IMPROVED PRISON HEALTH We will see efficient and effective prison health administration that will result in improved public health, security, reduced morbidity and mortality, increased capacity of prison health human resource, effective contribution to country’s health policies touching on health infrastructure, financing , system strengthening and strategic information.

SUSTAINABILITY Even as we advocate for better health in prisons we need not lose sight of sustainable programs. As correctional services we have to look into the future of our institutions so that we sustain gains that have been made so far in the health of our inmates and staff. We have to look at domestic innovative ways of sustaining our programs by ensuring we have adequate domestic financing of our programs through the Government Planning and budgeting processes, we must initiate and promote more public /private collaboration partnerships, work on a social health insurance scheme for inmates and staff Health facilities within prisons to be upgraded and accredited to a health insurance fund and expand coverage that takes into account mental illness as well as condemned and long sentence prisoners.

ACKNOWLEDGEMENTS Wish to acknowledge the Commissioner of Prisons, Kenya and his team for providing me with the relevant information that enabled me to put this presentation together.