Exploring the drivers of health and healthcare access in Zambian prisons: a health systems approach

Topp, Stephanie M., Moonga, Clement N., Luo, Nkandu, Kaingu, Michael, Chileshe, Chisela, Magwende, George, Heymann, S. Jody, and Henostroza, German (2016) Exploring the drivers of health and healthcare access in Zambian prisons: a health systems approach. Health Policy and Planning, 31 (9). pp. 1250-1261.

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Background: Prison populations in sub-Saharan Africa (SSA) experience a high burden of disease and poor access to health care. Although it is generally understood that environmental conditions are dire and contribute to disease spread, evidence of how environmental conditions interact with facility-level social and institutional factors is lacking. This study aimed to unpack the nature of interactions and their influence on health and healthcare access in the Zambian prison setting.

Methods: We conducted in-depth interviews of a clustered random sample of 79 male prisoners across four prisons, as well as 34 prison officers, policy makers and health care workers. Largely inductive thematic analysis was guided by the concepts of dynamic interaction and emergent behaviour, drawn from the theory of complex adaptive systems.

Results: A majority of inmates, as well as facility-based officers reported anxiety linked to overcrowding, sanitation, infectious disease transmission, nutrition and coercion. Due in part to differential wealth of inmates and their support networks on entering prison, and in part to the accumulation of authority and material wealth within prison, we found enormous inequity in the standard of living among prisoners at each site. In the context of such inequities, failure of the Zambian prison system to provide basic necessities (including adequate and appropriate forms of nutrition, or access to quality health care) contributed to high rates of inmate-led and officer-led coercion with direct implications for health and access to healthcare.

Conclusions: This systems-oriented analysis provides a more comprehensive picture of the way resource shortages and human interactions within Zambian prisons interact and affect inmate and officer health. While not a panacea, our findings highlight some strategic entry-points for important upstream and downstream reforms including urgent improvement in the availability of human resources for health; strengthening of facility-based health services systems and more comprehensive pre-service health education for prison officers.

Item ID: 44170
Item Type: Article (Research - C1)
ISSN: 1460-2237
Keywords: coercion, health services, health system, nutrition, prisons
Additional Information:

© The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

Funders: European Union (EU)
Projects and Grants: EU DCI-NSAPVD/2012/309-909
Date Deposited: 20 Jul 2016 04:47
FoR Codes: 42 HEALTH SCIENCES > 4203 Health services and systems > 420399 Health services and systems not elsewhere classified @ 70%
44 HUMAN SOCIETY > 4407 Policy and administration > 440706 Health policy @ 30%
SEO Codes: 92 HEALTH > 9205 Specific Population Health (excl. Indigenous Health) > 920599 Specific Population Health (excl. Indigenous Health) not elsewhere classified @ 45%
92 HEALTH > 9202 Health and Support Services > 920299 Health and Support Services not elsewhere classified @ 45%
94 LAW, POLITICS AND COMMUNITY SERVICES > 9402 Government and Politics > 940204 Public Services Policy Advice and Analysis @ 10%
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