R2003D10617893

NAME: VIVIAN DAMALIE NABULYA

STUDENT ID NUMBER: R2003D10617893
COURSE NAME AND CODE: PRINCIPLES OF PUBLIC HEALTH (19999)
TITLE OF WORK: HEALTH NEEDS ASSESSMENT
DATE: 30/10/2020

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HEALTH NEEDS ASSESSMENT; A CASE OF INMATES IN UGANDA

Introduction

The prison population is an unequalled and an intriguing community with many health problems.
In a developing country like Uganda, health problems of the inmates have received skimped
attention from the policy makers and the public at large. These are people who are rejected by
society because of their criminal behavior, however when they are incarcerated, they are entitled
to medical services like any other community. (It is a human right). Due to incarceration, their
health issues are often neglected which account for their poor health. Therefore the intent is to
have a better perception of the health needs of inmates and to include them in planning and
formulating health policies of the entire population.

Discussion

Inmates are a group of people who have broken the law and are sent to prison to serve their
sentences as punishment to the offences they committed. However with growth and
development, toppled with changing trends, the Prisons service is focusing more on being
correctional than being punitive. The Uganda Prisons Service (UPS) is responsible for safe
custody of inmates nationwide while placing human rights at the centre. There are over 222
prison facilities country wide and the inmate population is about 35000 inmates where 5% are
female while the remand prisoner’s account for 56.6% as indicated in UNODC report of 2008.
As a result of the increasing inmate population, there are high levels of congestion in all prisons
country wide. This accounts for the easy spread of diseases like HIV/AIDS, Tuberculosis and
Hepatitis B, therefore a necessity to conduct health needs assessment on this particular group.

Population Characteristics

Geographical location

Uganda is located in the eastern part of Africa, it is a landlocked country bordered by Kenya in
the east, Tanzania in the south, Rwanda in the South West, Democratic Republic of Congo in the
west and South Sudan in the North. Uganda is divided into 134 districts. And each of the districts
has not less than one prisons administration. Therefore prisons administration covers the entire
country and there is a total of 254 prisons (Uganda Prison Service Survey., 2019.)

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Number of Inmates

Uganda has a total population of 42.72 million people, inmate population share only 0.2 %.
( Uganda Bureau of Statistics, 2018). With the increasing population, the number of inmates is
expected to increase as it has been the trend in the past years as indicated in the table below;

Table 1

Year Total prison population

2000 21700
2002 21900
2005 26126
2008 28337
2010 30312
2012 34940
2014 42330
2016 51354
2018 53033

A LINE GRAPH SHOWING THE TREND OF PRISON POPULATION, UGANDA

60000

50000

40000

30000

20000

10000

0
2000 2002 2005 2008 2010 2012 2014 2016 2018

Fig. 1 shows the trend of the prison population over the past years, this indicates congestion in
prisons since the structures in place, meant to accommodate them aren’t expanding.

Age and Gender distribution:

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Table 2: Population estimates by category, age and sex, 2018 (Statistics, Uganda Prisons Service,
2018).

Female
Age Male Female Male on on Male Female
group convicts convicts remand remand debtors debtors Total Percentage

15-19 2,369 94 3,378 121 0 0 5,962 12.19

20-24 5,987 213 6,256 241 17 2 12,716 26.01
25-29 5,278 171 5,298 208 31 14 11,000 22.5
30-34 3,510 169 3,571 137 60 16 7,463 15.26
35-39 2,198 101 2,288 110 62 16 4,775 9.77
40-44 1,257 87 1,295 76 49 18 2,782 5.69
45-49 804 66 826 70 33 18 1,817 3.72
50-54 464 53 464 44 27 8 1,060 2.17
55-59 241 16 239 20 13 4 533 1.09
60-64 148 17 167 18 12 1 363 0.74
65-69 116 8 99 8 2 0 233 0.48
70-74 49 7 44 3 2 2 107 0.22
75-79 18 4 23 1 1 0 47 0.1
80-84 9 1 7 2 0 0 19 0.04
85-89 7 0 4 0 0 0 11 0.02
90-94 2 0 2 0 0 0 4 0.01
95-100 1 0 1 0 0 0 2 0

Table 2 shows prison population estimates by category, age and sex of 2018. It can be observed
that the male are involved more in crime than the female. Furthermore, these are between ages of
20-24 years, perhaps the high levels of unemployment may account for the increasing numbers
of young people in custody.

Ethnicity and religion

Table 3; Prison population estimates by category and nationality

Category Convicts Remands

Ugandans 22810 24536
Rwandese 324 216
Congolese 143 111
Tanzanian 50 52
Kenyan 58 34
Other African 67 67
Others 13 05

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(Statistics, Uganda Prisons Service, 2018).

Table 3 shows the prison population estimates by population group, category and nationality
(Uganda Prisons Services Statistics.2018). It indicates that most of the inmates are of Ugandan
origin and those outside Africa are the least in number.

Population trends: patterns over a period of time

It should be noted from the above demographics, that the inmate population is most likely to
increase in the incoming years. As the nation population is increasing due to different factors like
favorable climate, fertile soils, presence of peace and security, favourable refugee reforms etc.,
the numbers of people incarcerated automatically are increasing as well. Therefore a need for
consistent medical services in the prisons.

Language and Literacy

Uganda is rich in local languages, however the common languages used in prisons are Luganda,
Swahili and English. Majority of the inmate population do not know how to write or read thus
high illiteracy levels in all the prisons.

Health Status

Prison Capacity and Occupancy rate

Inmates are entitled to live in a good and healthy environment, however because of insufficient
funds from government, the structures aren’t improved upon or expanded hence leading to
congestion in prisons. Prison capacity refers to the number of inmates a prison can hold within a
space of 3.6m2. (Uganda Prisons Service Statistics, 2018). Table 4 shows high levels of
overcrowding in prison cells across all regions in the country. The national Occupancy Rate in
2017 was 293 percent meaning that there are 293 inmates in every space meant for 100 inmates.

Table 4; Prison Capacity and Occupancy rate by the region from 2013-2017

Prison Capacity Occupancy rate

Region 2013 2014 2015 2016 2017 2013 2014 2015 2016 2017
Kampal 2,224 1,720 1,720 1,720 1,720 359 409 383 403.6 367.0
a 3,110 3,964 4,077 4,045 4,053 260 256 273 310.0 303.8

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Central 3,696 3,970 3,951 4,005 4,005 170 173 196 225.3 210.0
Eastern 2,375 2,616 2,738 2,833 2,883 262 262 302 348.0 329.0
Norther 3,740 3,787 4,031 4,009 4,069 270 301 293 321.4 308.1
n 15,14 16,057 16,51 16,61 16,68 254 264 276 308.5 293.1
Western
5 7 2 0
National
(Statistics, Uganda Prisons Service, 2018).

Table 4, shows that Kampala region has the highest prison occupancy rate (367 percent)
compared Eastern region had the lowest rate (210 percent).

Mortality Data

The inmate mortality rate is relatively low compared to the whole population countrywide.
However due to the poor living conditions of inmates in prisons, they are exposed to various
health issues that affect their well-being. These are; access to medical treatment when sick, poor
diet, psychological torture among others.

Table 5; Number of deaths of inmates by sex from 2013-2017

Year Male Female Total

2013 223 3 226
2014 228 5 233
2015 183 5 188
2016 203 5 208
2017 255 7 262
(Statistics, Uganda Prisons Service, 2018).

Table 5 indicates a slight increase in the proportion of prison deaths from 0.4 percent in 2015 to
0.5 percent in 2017. (Uganda Prisons Statistics, 2018). Nevertheless, the mortality rate of
inmates is not alarming.

Morbidity Data

With living conditions of congestion in prisons, one cannot doubt that there are no illnesses
among inmates. Life is at risk due to the growing numbers of inmates, they suffer from various
illnesses.

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HIV/AIDS is the most common disease among inmates, it accounts for the biggest percentage in
the prison population. HIV prevalence of prisoners is at 11.2% for males and 13% for females,
the overall figure is double the average HIV population prevalence that stands at 6.4% in the
general population in the 2005 AIDS Indicator Survey. (UNDOC Report, 2008).

Table 6 shows the prevalence of HIV related infections among inmates.

Infection Males Females

Hepatitis B Virus 7.2% 3.7%
Herpes simplex virus (HSV) 69.1% 42.6%
Hepatitis C (HCV) 7.0% 6.7%
Malaria 4.7% 2.6%
Syphilis 5.0% 4.0%
Tuberculosis 4.6% 3.2%
(Uganda Prisons Fact Sheet, 2018)

As seen from Table 6, Herpes Simplex Virus (HSV) has the highest prevalence among inmates
and malaria having the lowest prevalence. From the above, these are infectious disease indicators
that are present in all prisons all over the country.

Behavior measures

While in prison, inmates socialize with each other and eventually develop some risky habits to
their health like drug abuse, tattooing and homosexuality. 9.8% of inmates have reported to have
used drugs before in order to get high.

Table 7;The type of drugs used by inmates

Type of Alcoho Marijuan Khat Opium Cocain Glue Petrol Heroin Other
Drugs used l a (Mairungi e (Sniffing) (Sniffing e drugs
) )
Drug ?? 35.6 7.4 15.2 9.8 4.9 8.4 7.2 13.6
usage(%age
)
(Uganda Prisons Fact Sheet, 2018)

Table 7 shows that Marijuana is the most commonly used drug in prisons simply because it’s
cheaper and can be easily accessed.

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Table 8; Type of instruments prisoners used to tattoo themselves.

Instrument Razorblade Needle Thorn Wood Others Nails Cooper

wire
Number 180 156 74 71 66 63 53
of people
(Uganda Prisons Fact Sheet, 2018)

Table 8 indicates that razor blades are the most commonly used instrument prisoners use to
tattoo their bodies.

Homosexuality

This is common in most prisons countrywide, however the data shows that homosexuality is
common among the males, men having sex with men (MSM). Inmates engaged in MSM stands
at 6.5% and most prevalent in those aged under 20 years (8%).

Health Inequalities

Table 9; Literacy rate among the prison population

Year 2009/2010 2012/2013 2014 2015 2016/2017

Male 39 36 33 33 33
Female 26 24 28 22 30
(Statistics, Uganda Prisons Service, 2018).

Table 9 shows the literacy levels among inmates and the male have a higher literacy than the
female.

Table 10; Poverty Estimates

Region Poverty Estimates (%)

Kampala 2.6
Wakiso 2.7
Central 12.7
Eastern 35.7
Northern 32.5
Western 11.4
(Uganda Bureau of Statistics, 2017)

Table 10 shows the poverty estimates in Uganda, it indicates the estimates region by region, with
the eastern region having high poverty levels.
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Local factors affecting health

The environment is important in this case, the environment where inmates lives is not that good.
They live in congested cells, spread of diseases is easy, hygiene and sanitation becomes problem
as well.

High poverty levels among inmates. When they fall sick and the prison health services has failed
to manage such cases, their relatives are contacted for support. However because they also can’t
afford the treatment, the inmate ends up dying in custody.

High rate of recidivism, The Uganda Prisons Service defines recidivism as the number of re-
offenders expressed as a percentage of the total number of convicts admitted in a given period.
The higher the recidivism rate, the higher the congestion levels in prisons.

Limited funding from government. The prisons administration depends on government funding
in order to keep inmates safe in custody. However, little funds are received making it difficult to
deliver services to inmates especially medical services.

Lack of support from friends and relatives. Majority of inmates in custody do not receive
visitors. For example, an ailing inmate who needs treatment and prisons administration can’t
afford such treatment, and if he doesn’t have any relatives, his condition will worsen and
eventually death.

Understanding the information collected.

Inmates have a higher prevalence of HIV than the national population. This is as a result of
congestion that involves sharing of sharp object like razor blades, there is also limited or no
privacy in the prison which prompts some positive inmates to avoid treatment of HIV, the male
to male unprotected sex in the prison cells hence high spread of the HIV virus.

According to the Uganda Prisons Services Statistics Report in 2018, it shows that in the year
2000, there were only 21,700 inmates in custody, however with the growing population of
Uganda, the inmate population increased as well, bringing the inmate population to 53,033 in
2018.

The prison population thereby comprises mostly of young people and their health status is worse
than the general population than would be expected for their age. The rest who are elderly, their

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health status deteriorates each day because of the conditions in prisons. In addition, many more
factors contribute to their health such as smoking, abuse of alcohol or drugs, mental health and
medical comorbidities. (LaMonaca et al, 2018)

Whatever the health issues that the national population is facing, the inmates in prisons face
twice or thrice as much therefore the inmates’ health needs must be taken into proper
consideration and prioritize services for this vulnerable group.

Deciding on the priorities for action

Each prison in the country receives inmates to serve their sentence, an average of 12 inmates per
day. This therefore calls for the responsible authorities to take charge of their well-being and
health as they are admitted into the prison.

On admission, it is recommended by the U.N standard Minimum Rules for the treatment of
prisoners, 2015, that inmates should be subjected to a medical examination to ascertain their
health status. HIV/AIDS and Tuberculosis should be mandatory, must be tested and screened
before joining the rest of the inmate population to avoid further spread.

Action plan

Since the provision of health care for inmates is limited, the government of Uganda needs to
partner with relevant Non-Government organisations to support and improve service delivery in
the prisons. Providing health services solely would be a big burden to the institution hence the
need to partner.

By so doing, projects to improve on the health of inmates would be implemented. The well-being
and health status of inmates would become a priority. There would be adequate supply of
medical supplies, medical examination on admission could be done instantly, fumigation in
congested cells would be done, nutritional supplements included in diet, implementation of
communicable disease education, prevention, and treatment; improving care for chronic
conditions; providing targeted cancer screening ; increasing the availability of addiction and
mental health treatment; providing better supervision to reduce physical and sexual assault.

On the other hand, formulation policies that could reduce incarceration could improve health
status among prisoners. There would be decongestion in prison cells with projects like

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community service that would reduce the numbers in prisons. Creating more space in the prison
cells thus improved health status.

Conclusion

Health care in prisons is not satisfying as the outside community because of poor access and
poor quality of health services, thus deterioration of health status (Geitona M, Milioni SO, 2016).
However positive changes in inmate health care can be made. There can be an introduction of
more effective interventions and reforms aiming at meeting prisoners health needs. This can only
happen when there is a cordial relationship between the prison administration, legislators and the
health department at large.

References

1. Adams, D.L and Leath, B.A. (2002) ‘Correctional health care: Implications for public health
policy’91(15).

2. Berkman, A. (1995), Prison health: the breaking point. Am J Public Health. 1995;
85(12):1616–1618.

3. Freudenberg, N. (2001) ‘Jail prisons and the health of urban populations: a review of the
impact of the correctional system on community health.’ J Urban Health. 2001; 78(2)

4. Geitona, M. and Milioni, S.O. (2016), ‘Health status and access to health services of female
prisoners in Greece: a cross-sectional survey’, 2016 Jul 11; 16:243. .

5. Glaser, J.B, Greifinger, R.B. (1993), Correctional health care: a public health opportunity. Ann
Intern Med. 1993; 118(2):139–145.

6. Heidar,i E. Dickinson, and C. Newton, T. (2006), ‘An overview of the prison population and
the general health status of prisoners.’

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7. Jacobi, J.V, (2005), ‘Prison health, public health: obligations and opportunities.’ Am J Law
Med. 2005; 31(4):447–478.

8. LaMonaca K, et al. (2018), ‘Prisoner health status at three rural Haitian prisons’. Int J Prison
Health. 2018 Sep 10; 14(3):197-209.

9. Macalino, G.E, et al. (2009) ‘Prevalence and incidence of HIV, hepatitis B virus, and hepatitis
C virus infections among males in Rhode Island prisons.’

10. Manzoor, S. (2003) ‘Women behind bars: health needs of inmates in a jail.’ J Pak. 2003 Mar;
pp13 (3):184

11. Restum, Z.G, (2005),’ Public health implications of substandard correctional health care. Am
J Public Health. 95(10):1689–1691.

12. Uganda Prisons Service Statistics and Survey Report, 2018.pp 11(3)

13. Uganda Bureau of Statistics Abstract of 2018. Pp 59(4).

13. United Nations Office on Drugs and Crime Report on HIV/AIDS prevalence in Uganda
Prisons, 2008.

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