A multi-stakeholder situation assessment of COVID-19 disease preparedness and mitigation measures in a large prison complex in Malawi

• DOI: https://doi.org/10.1108/IJPH-10-2021-0105
• Published date: 15 February 2022
• Date: 15 February 2022
• Pages: 199-219
• Subject Matter: Health & social care,Criminology & forensic psychology,Prisoner health,Sociology,Sociology of crime & law,Public policy & environmental management,Policing,Criminal justice
• Author: Vincent Jumbe,Victor Mhango,Adamson Muula,Ruth Kaima,Luntha Rosemary Chimbwete,Apatsa Mangwana,Benjamin Msutu,Lisa Tembo,Charlotte Bigland,Stephanie Kewley,Marie Claire Van Hout

A multi-stakeholder situation assessment

of COVID-19 disease preparedness and

mitigation measures in a large prison

complex in Malawi

Vincent Jumb e, Victor Mhango, Adamson Muula, Ruth Kaima,

Luntha Rosemary Chimbwete, Apatsa Mangwana, Benjamin Msutu, Lisa Tembo,

Charlotte Bigland, Stephanie Kewley and Marie Claire Van Hout

Abstract

Purpose –Prisons in the sub-SaharanAfrican region face unprecedented challengesduring the COVID-

19 pandemic. In Malawi,the first prison system case of COVID-19 was notified in July 2020.While prison

settings were included in the second domestic COVID-19 response plan within the Law Enforcement

cluster (National COVID-19preparedness and response plan, July–December 2020), they wereinitially

not included in the K157bn (US$210m)COVID-19 fund. The purpose of the study was to assess prison

preparedness,prevention and control of COVID-19 in Malawi.

.

Design/methodology/approach –A multi-method situation assessment of the COVID-19 response

and human rights assurance of prisoners and staff was conducted in a large prison complex in

Malawi. Qualitative research underpinned by the Empirical Phenomenological Psychological (EPP)

framework consisted of interviews with key informants such as prison health personnel, seniorprison

staff, penal and judicial policymakers, government and civil society organisations (n= 14) and focus

group discussions with consenting male (n= 48) and female prisoners (n= 48) and prison wardens

(n= 24). Prison site visits were supported by detailed observations based on the World Health

Organisation Checklist for COVID-19 in pr isons (n= 9). Data were collected and analysed

thematically using the EPP stepwise approach and triangulated based on Bronfenbrenner’s model

conceptualising COVID-19 as a multi-level eventd isruptingthe prison eco-system

.

Findings –The results are presented as MICRO-MESO level individual and community

experiences of incarceration during COVID-19 spanning several themes: awareness raising and

knowledge of COVID-19 in prisons; prison congestion and the impossibility of social distancing;

lack of adequate ventilation, hygiene and sanitation and provisions and correct use of personal

protective equipment; MESO-MACRO level interplay between the prison community of prisoners

and staff and judicial policy impacts; medical system COVID-19 response, infrastructure and

access to health care; COVID-19 detection and quarantine measures and prisoner access to the

outside world.

Originality/value –This unique situation assessment of the Malawian pris on system response to

mitigate COVID-19 illustrates the dynamics at the micro- level whereby prisoners rely on the state

and have restricted agency in protecting themselves fr om disease. This is due to severe structural

inadequacies based on low resource allocation to pris ons leading to a compromised ability to

prevent and treat disease; an infirm and congested infrastr ucture and bottlenecks in the judicial

system fuelling a continued influx of remand detainees leading to high overcapacity. Multi-pronged

interventions involving key stakeholders, with pri son management and line Ministry as coordinators

are warranted to optimise COVID-19 interventions and future disease outbreaks in the Malawian

prison system.

Keywords Prisoners, Malawi, Human rights, Infectious disease, COVID-19, Mandela rules

Paper type Research paper

(Informationabout the

authorscan be found at the

end of this article.)

Received 12 October 2021

Revised 4 January 2022

11 January 2022

Accepted 13 January 2022

Funding statement: The Global

Challenges Research Fund

(GCRF) Small Grants Scheme

2021, Liverpool John Liverpool

John Moore’s University, 2021.

Grant holder: Professor Marie

Claire Van Hout.

First and foremost, The author

acknowledge all study

participants, both male and

female

prisoners, prison wardens and

officers at the selected large

prison complex and all key

informants, without whose kind

permission, this study would

never have been successful.

We also thank the Leadership

of Prisons in Malawi for giving

us permission to conduct this

study.

DOI 10.1108/IJPH-10-2021-0105 VOL. 19 NO. 2 2023,pp. 199-219, ©Emerald Publishing Limited, ISSN 1744-9200 jINTERNATIONAL JOURNAL OF PRISONER HEALTH jPAGE 199

Background

On 11 March 2020, the COVID-19 (a respiratory illness caused by SARS-CoV-2) outbreak

was declared by the World Health Organisation (WHO) to constitute a pandemic [World

Health Organization (WHO), 2020a]. Detention settings worldwide as high-risk

environments for communicable disease faced incredible challenges during that time in

mitigating COVID-19 (UNODC, 2020;WHO, 2020b;Beaudry et al., 2020). On 25 March

2020, the UN High Commissioner for Human Rights called on States to instigate

decongestion measures as a critical component of their overall COVID-19 response

[OHCHR, 2020; United Nations Office on Drugs and Crime (UNODC), World Health

Organization (WHO), UNAIDS and Office of the High Commissioner for Human Rights

(OHCHR), 2020; Amon, 2020]. Presidential pardons, early and emergency release

schemes and amnesties were implemented in many countries (Simpson and Butler, 2020;

Lines et al., 2020). Prisoners livingin congested prisons and those with chronic ill health are

especially at risk of severe COVID-19 disease (Beaudry et al., 2020). The United Nations

Office on Drugs and Crime (UNODC), WHO, DIGNITY and Penal Reform International

technical guidance on tackling COVID-19 and human rights assurances [World Health

Organization (WHO),2020b, 2020c;UNODC, 2020;Penal Reform International(PRI), 2020;

DIGNITY, 2020] were promulgatedin 2020.

In Africa, where prison capacity is stretched, it is estimated that one million people are

deprived of their liberty with, on average, 42% in pre-trial detention (World Prison Brief,

2020). The threat of COVID-19 is immense, particularly to the health and safety of those

living and working in African prisons (and their families) and is exacerbated by colonial

infrastructure, historical poor conditions of detention and low government resourcing of a

COVID-19 response in its prison systems (Nkengasong and Mankoula, 2020;Muntingh,

2020;Van Hout, 2020a,2020b,2020c, 2020d;Nweze et al., 2020;World Prison Brief, 2020;

Lucero-Prisno, 2020;Van Houtand Wessels, 2021).

On 25 May 2020, a group of human rights organisations submitted letters to the Southern

Africa Development Community (SADC) and its Member States highlighting the severe

deficits in the prison system during COVID-19 (SADC, 2020). Following the first case

notification in Egypt, from 5 March to 15 April 2020, COVID-19 spread across 23 Southern

and East African countries (except Lesotho) (Muntingh, 2020). The African Commission on

Human and Peoples’ Rights (ACHPR) released several documents outlining effective

human rights-based responses to COVID-19 including in prisons (African Commission

on Human and Peoples’ Rights (ACHPR), 2020a, 2020b). By 26 May 2020, however,

prisons in South Africa, Sierra Leone, Algeria, Kenya, Cameroon, Morocco, Ghana, Egypt,

Democratic Republic of Congo and Guinea confirmed cases of COVID-19 (Prison Insider,

2020). There is little transparent and publicly available data on COVID-19 positivity rates,

deaths and recoveries in African prisons (with the exception of South Africa) and little

information provided on the profile of those released during prison decongestion measures

(Muntingh, 2020;Nweze et al.,2020). Prison situations were also volatile due to the lack of

disease mitigation, continued intake of remand detainees and existing poor conditions of

detention, with riots and protests by staff and prisoners reported in many African states

(Prison Insider, 2020;Van Hout,2020c;Van Hout and Wessels, 2021).

We report here from Malawi, where commentaries have underscored the threat of COVID-

19 as a public health crisis due to its overburdened health system and political and

economic challenges (Patel et al.,2020;Sonenthal et al.,2020). The National COVID-19

Preparedness and Response Plan was launched in March 2020 with a budget of US$28m

and the first three COVID-19 cases were notified on 2 April 2020 in Lilongwe (Ministry of

Health, 2020;Patel, 2020; United Nations Malawi COVID-19 Update, 2020; Mzumara,

2021). The Malawi Government declared a state of disaster on 20 March (United Nations

Malawi, 2020, COVID-19 Update); however, this was subsequently blocked in the High

Court (News 24, 2020;Muntingh,2020).

PAGE 200 jINTERNATIONAL JOURNAL OF PRISONER HEALTH jVOL. 19 NO. 2 2023