Access to a quality healthcare among prisoners – perspectives of health providers of a prison infirmary, Ghana

• Published date: 05 December 2019
• DOI: https://doi.org/10.1108/IJPH-02-2019-0014
• Pages: 349-365
• Date: 05 December 2019
• Author: Terrylyna Baffoe-Bonnie,Samuel Kojo Ntow,Kwasi Awuah-Werekoh,Augustine Adomah-Afari
• Subject Matter: Health & social care,Criminology & forensic psychology,Prisoner health,Sociology,Sociology of crime & law,Public policy & environmental management,Policing,Criminal justice

Access to a quality healthcare among

prisoners –perspectives of health

providers of a prison infirmary, Ghana

Terrylyna Baffoe-Bonnie, Samuel Kojo Ntow, Kwasi Awuah-Werekoh and

Augustine Adomah-Afari

Abstract

Purpose –The purpose of this paper is to explore the influence of health system factors on access to a

quality healthcare among prisoners in Ghana.

Design/methodology/approach –Data were gathered using different qualitative methods (interviews and

participant observation) with staff of the James Camp Prison, Accra. Findings were analyzed using a

framework method for the thematic analysis of the semi-structured interview data; and interpreted with the

theoretical perspective of health systems thinking and innovation.

Findings –The study concludes that health system factors such as inadequate funding for health services,

lack of skilled personnel and a paucity of essential medical supplies and drugs negatively affected the quality

of healthcare provided to inmates.

Research limitations/implications –The limited facilities available and the sample size (healthcare workers

and prison administrators) impeded the achievement of varied views on the topic.

Practical implications –The paper recommends the need for health policy makers and authorities of the

Ghana Prison Service to collaborate and coordinate in a unified way to undertake policy analysis in an effort to

reform the prisons healthcare system.

Social implications –The national health insurance scheme was found to be the financing option for

prisoners’access to free healthcare with supplementation from the Ghana Prison Service. The study

recommends that policy makers and healthcare stakeholders should understand and appreciate the reality

that the provision of a quality healthcare for prisoners is part of the entire system of healthcare service delivery

in Ghana and as such should be given the needed attention.

Originality/value –This is one of few studies conducted on male only prisoners/prison in the context of

Ghana. It recommends the need for an integrated approach to ensure that the entire healthcare system

achieves set objectives in response to the primary healthcare concept.

Keywords Prisoners, Quality of care, Health system, Health providers, Access to healthcare,

Prisons healthcare

Paper type Research paper

Introduction

The establishment of good administrative systems and procedures can lead to efficient management

of limited resources in prisons. Their health systems could as well be improved as such efficient

management aids in the collection of appropriate information to enhance training and research

(Tapscott, 2006). The Revised Standard Minimum Rules for the treatment of Prisoners also known as

the Nelson Mandela Rules provides regulations and standards specific to the quality of healthcare in

prisons, noting that healthcare services should be provided by the country’s National Health Service

rather than by prison authorities or judicial institutions (United Nations, 2018).

The total number of incarcerated persons in Ghana was estimated at 13,955 with a prison

population rate of 48 per 100,000 of the national population as of October 2017; predominantly

males and about 1.2 percent females (Prison Studies, 2018). The increase in prison population

Received 26 February 2019

Revised 16 April 2019

2June2019

Accepted 5 June 2019

The authors wish to acknowledge

the contributions of all the people

who made this study possible.

This research was sponsored by

the authors without any third-party

funding.

Terrylyna Baffoe-Bonnie is

based at the Department of

Health Policy, Planning and

Management, University of

Ghana, Accra, Ghana.

Samuel Kojo Ntow is based at

Family Medicine, West African

Rescue Association,

Takoradi, Ghana.

Kwasi Awuah-Werekoh is

based at Business School,

Ghana Institute of Management

and Public Administration

(GIMPA), Accra, Ghana.

Augustine Adomah-Afari is

based at the Department of

Health Policy, Planning and

Management, University of

Ghana, Accra, Ghana.

DOI 10.1108/IJPH-02-2019-0014 VOL. 15 NO. 4 2019, pp. 349-365, © Emerald Publishing Limited, ISSN 1744-9200

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without commensurate increase in prison infrastructure naturally leads to overcrowding; the

occupancy level based on the official prison capacity was 141.7 percent making Ghana the 56th

most overcrowded in the world (Prison Studies, 2018).

It is open knowledge that the prison population suffers from certain health conditions and

generally has a poor health status (Binswanger et al., 2009). A study observed a higher

prevalence of HIV and HCV in correctional facilities and prisons than in the general population of

Ghana (Adjei et al., 2007, 2008). Telisinghe et al. (2014) concluded that undiagnosed tuberculosis

and HIV prevalence was high in prisons in South Africa as well. This could be attributed to the fact

that awaiting trial prisoners were highly prone to drug-sensitive and drug-resistant TB in South

Africa (Robertson et al., 2011).

A challenge yet to be addressed was whether both healthcare workers and prison inmates had

knowledge of some of the health risks (infectious diseases) that prisoners might be predisposed

to while incarcerated. A study in Nigeria proved that “despite the fact that many of them

[prisoners] knew the modes of transmission, many indulged in high-risk behaviors of AIDS

transmission”(Odujinrin and Adebajo, 2001, p. 191). A further study among healthcare workers

of Nigerian prison service health facilities in Kaduna State Command found a statistically

significant relationship between knowledge and practice of injection safety in relation to cadre of

staff, staff that had training on injection safety and years of experience of the staff, respectively

(Onyemocho et al., 2013).

However, research has demonstrated a deficiency in health system factors that affect the quality

of health services provided to prison inmates in Zambia, including lack of essential medical

equipment and medications necessitating external referrals, lack of qualified personnel and

inability to pay for health services rendered (Topp et al., 2016). Similarly, Solomon et al. (2014)

reported that Nigerian prisons are characterized by inhumane conditions and overcrowding. This

leads to a deplorable health situation among inmates. It is also argued that problems with the

provision of quality care to inmates in Nigerian prisons include the inadequacy of healthcare

personnel, facilities and systems. Others are the “lack of healthcare policies and standard

operating procedures, corruption in the criminal justice system and bureaucratic bottleneck”

(Solomon et al., 2014, p. 152). These make continuity of care difficult to maintain because

records are essentially non-existent; prisoners are not aware of their clinical diagnosis and health

staff do not communicate with those on the outside (see Kripalani et al., 2007).

Most of the prisons in Sub-Saharan Africa (SSA), especially Ghana, do not have well-structured

healthcare facilities (see Adjei et al., 2007, 2008). The lack of a structured relationship between

the prison system and the national health system has a negative impact on the provision of quality

healthcare to prisoners, especially in Ghana (Sarpong et al., 2015). Although there are infirmaries

in some of the prisons in Ghana, these usually lack stockpiles of essential medicines, equipment,

technologies and other medical consumables necessary for providing quality healthcare to

prisoners (see Adjei et al., 2007, 2008). This means that this combination of factors

identified results in prisoners remaining undiagnosed upon release. The result of a relatively weak

surveillance system means cases remain unidentified, thereby heightening the rate of

contamination or infection of the general population on their release (Binswanger et al., 2011).

Arguably, the prison population would benefit from quality healthcare if there was provision of

suitable health amenities within the prisons and effective linkages with other levels of the

healthcare system. For instance, some researchers suggest that to ensure an uninterrupted and

quality healthcare system among prisoners, there should be a need for policy makers to re-

evaluate the present healthcare policy. This could be achieved by facilitating easy access to

medical facilities by patients, including prisoners (see Solomon et al., 2014).

Similar to other SSA settings, the health system in Ghanaian prisons is generally under-

researched (see Adjei et al., 2007, 2008; Topp et al., 2016). It is important to note that the majority

of the Ghanaian prison population (86 percent) is male (Prison Studies, 2018). Therefore, this

study explored the influence of health system factors on access to quality healthcare among male

prisoners at the James Camp Prison (JCP). The paper argues that it is important for health policy

makers and Ghana Prison Service authorities to collaborate and coordinate in a unified way to

undertake policy analysis in an effort to reform the prison healthcare system in the country.

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