Delivering health care for prisoners in Zimbabwe
Join the SCTG as we celebrate UHC Day to promote health for all. Throughout our 12 Days of UHC series, SCTG members and partners share insights and lessons from their organizations on how self-care is part of the solution to achieving our goal — build a safer and healthier future and health systems that serve and protect us all.
By Clive Ingleby, Teclah Ponde and Anne Sorensen, VSO International
“All people have the right to quality health care… Health for All is not a long-term wish, but an urgent priority to build a safer, healthier future… People and communities who have been historically marginalized must come first…”
Commitments to universal health coverage (UHC) should include vulnerable prisoner populations. According to the Global Prisons Trend 2020 report, more than 11 million people are imprisoned globally. The overwhelming majority of them come from socially and economically disadvantaged backgrounds.
Prison health remains a much neglected but serious public health issue and ensuring that the health rights of prisoners are addressed in any national health care strategy and delivered through the health system poses a huge challenge in most countries, but is essential for countries to address in order to achieve UHC. Prisons are challenging environments due to overcrowding, poor ventilation, unreliable power and water supplies and infrastructural neglect. Tuberculosis (TB), sexually transmitted infections (STIs) including HIV, substance misuse and mental illness are widespread in prisons around the world.
At Mutimurefu Prison, with an average population of 700 inmates located in Southern Zimbabwe, prisoners have been empowered to address their own health concerns through self-care. VSO and Batanai HIV and AIDS Support Organisation (BHASO) have implemented a prisoner-led, self-care health and education volunteering programme to:
- Reduce prison officers and offenders’ risk of contracting HIV and other STIs by increasing their knowledge about transmission and encouraging attitudinal and behavior change;
- Offer education, support and treatment to those living with HIV and other illnesses and promote positive living;
- Support the Voluntary Counseling and HIV Testing Programs offered by Zimbabwe Prisons and Correctional Services to ensure greater uptake amongst both officers and inmates;
- Strengthen attempts to prevent the spread of COVID-19.
64 peer educators (5 female inmates, 54 male inmates and 10 officers) have been trained with the aim of building a more resilient health care system in Mutimurefu Prison. Services they deliver include psychosocial support and counselling, referral for HIV testing, and cell-based care in the form of supporting antiretroviral (ARV) treatment adherence, providing bed baths and feeding sick inmates. Educators even provide counselling to spouses of inmates who have tested HIV positive to support them to get tested and begin treatment.
Peers undertake sexual and reproductive health (SRH) and HIV sensitisation and awareness campaigns within the facility by using sporting events, posters, choral music, and poetry. As a result, HIV has been destigmatized so that inmates living with HIV now talk openly about their positive status. In response to COVID-19, peer educators have used similar self-care approaches to educate the prisoner population about how to prevent and control infection and to recognise and refer those with symptoms to health care providers.
What began as a health programme has successfully integrated an education component that directly contributes to inmates’ rehabilitation and successful reintegration. Mutimurefu Prison has a shortage of qualified staff to provide academic tuition to inmates. Nine of the peer educators with sufficient skills are providing tutoring in reading and writing, mathematics, economics and business studies to inmates are then able to sit for public examinations. This work has continued despite the COVID-19 pandemic. One of the peer educators at the prison remarked, “We are the only school that was not affected by Covid-19 in that we did not close hence our students are prepared to write their examinations as we have had schooling all year round.”
The volunteer peer educators are essential frontline health and education providers within the prison setting who are making a difference in their own and their fellow prisoners’ lives. Prisoners now have access to basic health information and can advocate for their own care and treatment. Making sure prisoners are aware of their health needs, know their health status, and are equipped to practice self-care are essential elements for any country working to achieve UHC.
Peer educators are gaining experience, knowledge and skills that will benefit them when they are released. Noted one peer educator, “Peer education gave me purpose in a seemingly purposeless environment.” Another said, “The community where I come from knows that I was a very violent person. Being a peer educator taught me to be patient with people, to listen carefully before I speak and to let go of some arguments. I am sure when they see me they will not believe the person I have become.”