1. 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

2. 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.

3. 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

4. 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

5. 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

6. 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

7. 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

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

9. 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

10. 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

11. 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

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

13. 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

14. 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

15. 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

16. 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

17. 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.

18. 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.

19. 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.