The health system accountability impact of prison health committees in Zambia

Topp, Steph, Sharma, Anjali, Chileshe, Chisela, Magwende, George, Henostroza, German, and Moonga, Clement (2018) The health system accountability impact of prison health committees in Zambia. International Journal for Equity in Health, 17. 74.

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Background: From 2013, the Zambian Corrections Service (ZCS) worked with partners to strengthen prison health systems and services. One component of that work led to the establishment of facility-based Prison Health Committees (PrHCs) comprising of both inmates and officers. We present findings from a nested evaluation of the impact of eight PrHCs 18 months after program initiation.

Methods: In-depth-interviews were conducted with 11 Ministry and Corrections officials and 6 facility managers. Sixteen focus group discussions were convened separately with PrHC members (21 females and 51 males) and non-members (23 females and 46 males) in 8 facilities. Memos were generated from participant observation in workshops and meetings preceding and after implementation. We sought evidence of PrHC impact, refined with reference to Joshi’s three domains of impact for social accountability interventions–state (represented by facility-based prison officials), society (represented here by inmates), and state-society relations (represented by inmate-prison official relations). Further analysis considered how project outcomes influenced structural dimensions of power, ability and justice relating to accountability.

Results: Data pointed to a compelling series of short- and mid-term outcomes, with positive impact on access to, and provision of, health services across most facilities. Inmates (members and non-members) reported being empowered via a combination of improved health literacy and committee members’ newly-given authority to seek official redress for complaints and concerns. Inmates and officers described committees as improving inmate-officer relations by providing a forum for information exchange and shared decision making. Contributing factors included more consistent inmate-officer communications through committee meetings, which in turn enhanced trust and co-production of solutions to health problems. Nonetheless, long-term sustainability of accountability impacts may be undermined by permanently skewed power relations, high rates of inmate (and thus committee member) turnover, variable commitment from some officers in-charge, and the anticipated need for more oversight and resources to maintain members’ skills and morale.

Conclusion: Our study shows that PrHCs do have potential to facilitate improved social accountability in both state and societal domains and at their intersection, for an extremely vulnerable population. However, sustained and meaningful change will depend on a longer-term strategy that integrates structural reform and is delivered through meaningful cross-sectoral partnership.

Item ID: 55218
Item Type: Article (Research - C1)
ISSN: 1475-9276
Keywords: prisons; health systems; accountability; health committees; Zambia
Copyright Information: This article is distributed under the terms of the Creative Commons Attribution 4.0International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.
Funders: European Union (EU)
Projects and Grants: EU DCI-NSAPVD/2012/309-909
Date Deposited: 27 Aug 2018 04:07
FoR Codes: 42 HEALTH SCIENCES > 4203 Health services and systems > 420311 Health systems @ 50%
44 HUMAN SOCIETY > 4407 Policy and administration > 440706 Health policy @ 25%
44 HUMAN SOCIETY > 4410 Sociology > 441001 Applied sociology, program evaluation and social impact assessment @ 25%
SEO Codes: 92 HEALTH > 9202 Health and Support Services > 920207 Health Policy Evaluation @ 30%
92 HEALTH > 9205 Specific Population Health (excl. Indigenous Health) > 920599 Specific Population Health (excl. Indigenous Health) not elsewhere classified @ 40%
92 HEALTH > 9204 Public Health (excl. Specific Population Health) > 920499 Public Health (excl. Specific Population Health) not elsewhere classified @ 30%
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