STATE OF HEALTH CARE IN KANO CENTRAL AND GORON DUTSE PRISONS IN KANO STATE, 2016.

BY

1AHMAD HASSAN AHMADDepartment of Sociology,

Federal University Kashere, P.M.B 0182, Gombe State, Nigeriaahmadhassan724@yahoo.com +2348036569153

&2MOHAMMED BELLO

African Center for Innovative Research and Development, Kano State, Nigeriapdc137yahoo.com +2348067061591

AbstractHealthcare is the right of all individuals whether free or incarcerated. This has been clearly echoed in the revised version of Nigerian Prisons Standing Order (2011), the revised United Nations Standard Minimum Rules for the Treatment of Offenders popularly known as the Nelson Mandela Rules for the Treatment of Offenders (2015) and World Health Organization guide for healthcare delivery in prisons which were used as basis of assessment in this study. The study utilized both quantitative and qualitative methods in collecting data from convicted prisoners and awaiting trial inmates, healthcare officials in the prisons and officials of NGOs, FBOs and CBOs involved in healthcare delivery in the prisons. A total of 350 inmates were proportionately selected across convicts and awaiting trial inmates using Stratified Sampling technique as suggested by Wiseman’s 1999 table of sample size. The study revealed some shortfalls especially in the area of assessing prisoner’s health condition and associated risks before admission into the prison. The findings also show that illnesses such as malaria, diarrhea, high blood pressure and tuberculosis are highly prevalent in Kano central and Goron Dutse prisons.______________________________________________________________________________ Key Words: Healthcare, Delivery, Prisons, Inmates

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Introduction

Several years into the millennium, with the termination of the Millenium Development Goals

(MDGs) and the subsequent introduction of the Sustainable Development Goals (SDGs), the

global call for health for all is still yet to be achieved. Various assessments of health care system

in Africa show a serious deficit in terms of healthcare delivery to the rising African population

despite the enormous transformations in recent decades (African Regional Health Report, 2006;

World Health Organization 2010, 2012). This is further aggravated by the inability to provide

quality and equitable access to health care services where they are mostly needed especially in a

closed system like the prison. This is even more obvious when the health condition of a special

group like the prisoners is examined. Prisoners around the world constitute one of the most

marginalized and vulnerable populations (Walmsley, 2011). People who spend time in prison

will usually return to the wider community and their health care needs both inside and outside of

prison is an important issue worthy of consideration, as is the provision of adequate healthcare to

meet these needs.

A review of epidemiological assessments demonstrates that many diseases, illnesses and long-

term conditions are over-represented in the prison population showing that this group faces a

myriad of health challenges. Thus, the prison setting is one of the most challenging for health

care, health protection and the problem related to the prevention of spread of diseases,

particularly HIV/AIDS, sexually transmitted infections (STIs) and other diseases such as

Tuberculosis (TB) and Malaria. It is on the basis of this that the World Health Organization

(WHO) issued the Moscow Declaration in 2003 calling for integration or at least close working

relationships between national health care and prison health services.

Further to WHO’s call, the United Nation’s Minimum Standard Rules for the Treatment of

Offenders which was revised in 2015 and now known as the Nelson Mandela Rules for the

Treatment of Offenders has clearly stated that; In every institution there shall be available, the services of at least one qualified medical officer who should have some knowledge of psychiatry. The medical services should be organized in close relationship to the general health administration of the community or nation. They shall include a psychiatric service for the diagnosis and, in proper cases, the treatment of states of mental abnormality.

In relation to above, in relation to healthcare in prisons, section 48 of the Nigerian Prisons

Standing Order (2011) also stated that; each prisoner shall be seen by the medical officer in-

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charge upon arrival in prison, the aim of which is to conduct a thorough assessment to ascertain

the state of the prisoner’s health for immediate and subsequent action when the need arise.

In line with the positions above, state of healthcare in prison is a measure to assess the degree to

which healthcare is adequately provided to those behind the bars. This position therefore

informed the direction of this study to assess the state of healthcare in Kano Central and Goron

Dutse prisons in Kano state.

Literature Review

The Concept of Healthcare

The word health means different things to different people, depending on the situation. Over the

years different concepts of health have been proposed and used. There have been series of

debates nurtured by different interests, including managers of health services, critical observers

of the health scene and medical sociologists.

Various conceptions of health have been advanced after Hippocrates. Popular among these

definitions is that put forth by the WHO (1948) that “health is a complete state of physical,

mental and social wellbeing, not merely the absence of disease or infirmity”. This definition

according to Jimoh and Razum (2014) is wholistic and covers the major components of health.

These for them include;

- The physical component which is used to refer to the soundness of the body which is the

most important determinant of health. Thus, health entails in the orderliness of the

individual’s biological components which is largely determined by laboratory and clinical

examinations.

- The social component represents the behavioural aspect of human health. In this regard,

health entails in establishing a network of social interaction and the ability to meet up

with the demands of social roles and expectations. Impliedly, inactivity in the social

network represents a form of pathology.

- The mental component takes account of the psychological and emotional status of an

individual, the maladjustment of which constitutes an infraction in health or the

manifestation of illness. This implies that an individual’s inability to comprehend,

manage and make meaning of any situation indicates a poor health status.

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A cursory look at the WHO definition, it suffices to term it as utopian and unrealistic. The

unrealistic nature of the definition is rooted in the use of the word “complete”. It is unlikely that

anyone would be healthy for a significant period of time (Awofeso, 2012).

Healthcare Provision in Prisons

A number of authorities have attempted to explain what constitutes health and health provision to

people in general and those under incarcerations or any other form of detention in particular. The

UDHR in Article 25 provides that ‘everyone has a right to adequate health and wellbeing of

himself and of his family’. Thus, healthcare should be provided right from the time of admission

and during imprisonment and inmates should be regularly examined by a physician and be

detained in humane and clean accommodations (United Nations, 2005).

In order for prison systems to be managed in a humane manner, national policies and legislation

must be guided by the numerous international standards developed to ensure that the human

rights of prisoners are protected and that their treatment as a priority is aimed at ensuring their

social reintegration (United Nations Office on Drugs and Crime, 2012). The UNODC further

stated that;

“The medical services of the institution shall seek to detect and shall treat any physical or mental illness or defects which may hamper a prisoners’ rehabilitation. All necessary medical, surgical and psychiatric services shall be provided to that end”

From the above, healthcare service provision in prisons revolves around the allocation of

adequate medical infrastructure for the benefit of inmates; prompt management of their medical

conditions by qualified health officers, accommodations in a healthy and clean environment and

also the provision of quality food. In providing medical care, prison administration is expected to

provide those services that are commensurate with what the general public is entitled to. In her

own opinion, (Bloom, 2008) observed that the tenets of health rights services to be granted to

inmates is defined by the extent to which the government and prison authorities are able to

provide within prisons those health services normally provided to the general populace.

State of Health and Healthcare in Nigerian Prisons

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Prisoners, in comparison to other members of the society are worse off as they often bring a

range of health problems to prison. They are also at risk of a number of health problems while in

prison (Watson et al., 2004). They further identified a range of health problems common among

prisoners as follows: Mental health; Substance abuse and Communicable diseases. A number of

these health related problems have also been confirmed in some Nigerian prisons (Ibikunle and

Gloria, 2014).

Basically, the state of health care delivery in Nigeria has further plunged prisoners’ health into

jeopardy. Nevertheless, there are chances that many of the mental health problems may be under

diagnosed in Nigeria. Some studies have confirmed the vulnerability of prisoners with mental

health problems becoming problematic to correctional staff and other prisoners than prisoners

without mental health problems (Hilton and Simmons, 2000; Hoptman et al., 2007). Such

empirical studies are still lacking in the Nigerian context. Studies on mental health issues in

Nigerian prisons have become crucial in providing empirical evidence on which prisons reform

could be achieved. An appraisal of the mental health policy in Nigeria by Odebiyi (1999)

revealed a general poor social attitude from the government and other stakeholders towards the

mentally ill.

Substance abuse is common among those sentenced to prisons (Watson et al., 2004). There are

few research efforts on substance abuse and control among prisoners in Nigeria. At the prison

yard, some prisoners may have become exposed to substance abuse through their interactions

with other inmates and where such is not the case, prison staff may at times aid or facilitate the

flow of hard drugs to the prisoners.

While HIV/AIDS seems to have taken a center stage compared to other communicable diseases,

other infections are also prevalent among the prison population. Empirical evidence on

communicable diseases among prison population revealed sexually transmitted infections

including HIV/AIDS as the leading disease. An estimate in a study by Amnesty International

(2008) shows the prevalence rate of sexually transmitted infection including HIV/AIDS, to be 20

times greater than that of the general population.

In a study of the plight of aged inmates across two prisons in Ogun state, South-West Nigeria,

Ojo and Okunola (2014) reported that elderly inmates face more critical problem when it comes

to health provision in prisons.

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Implicit in above is that, for individuals with complex health problems the prison environment is

largely unsuitable for improved health outcomes and their general wellbeing. This points to the

possibility of an increased potential for psychological damage from high noise levels and

unpredictable and often violent neighbours; and an increased potential for ill health from poor

ventilation and having to sleep on a thin mattress with a restricted bedding allowance.

Methodology

Data was obtained from primary and secondary sources. The primary sources of data are the key

respondents from a selection of inmates who are the direct beneficiaries of health services in the

prisons, healthcare officials in the prison and non-state actors involved in prison healthcare

delivery. Secondary sources of information for this study were obtained from stored information

at various resource outlets (published and unpublished dissertations, online journal articles and

textbooks) in the form of documents. A total of 355 respondents were sampled for this study.

Thus, the following are the breakdown of the size of the respondents;

Category of Respondents SizeInmates 350Non State Actors (MSSN, CAN, Network for Justice) 3Prison Health Workers 2Total 355Source: Field Survey, 2016 The sample size above was derived using a revised Wiseman (1999) table of sample size which

suggested that in a population of 3000-3499, the sample size should be 341. More so, the study

employed stratified sampling technique in drawing respondents among the inmates, where the

researcher identified the strata of interest (convicted and awaiting trial inmates). Given the size

of the inmates from the two prisons as at the time of data collection which was 3,172 inmates put

together, the respondents were proportionately selected from the two prisons as follows;

P = Population of the study, P1 = Population of first prison, P2 = Population of second prison.

Thus, P = P1 + P2 (1732 + 1440 = 3,172). Therefore, the required percentage of respondents

from Kano Central prison were computed as follows; 1732 × 100/3172 = 55% and the required

percentage of respondents from Goron Dutse prison were computed as follows; 1440 × 100/3172

= 45%. Therefore, selecting the respondents on proportionate grounding as a result of disparity in

the number of inmates in the two prisons under study, 55% (194) of the respondents were drawn

from Kano Central prison while 45% (156) other respondents were drawn from Goron Dutse.

More so, the selection of the elements was done with the help of some prison staff.

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Results and Discussions

Table 1: Respondents Medical History on Arrival in PrisonMedical history on arrival in prison Frequency PercentageMedically fit 281 80.3Medically unfit 69 19.7Total 350 100.0Source: Field Survey, 2016

Table 1 above shows the distribution of responses elicited on the medical history of the

respondents upon arrival in prison. It shows that a significant majority of the respondents, over

(80%) reported being medically fit upon their arrival in prison while (19.7%) other respondents

reported being medically unfit upon their arrival in prison.

Table 2: The Nature of Respondents Medical Condition on Arrival in PrisonMedical Condition

Frequency Percentage

Cough 19 27.5Malaria Fever 21 30.4Scabies 9 13.0Typhoid fever 20 29.1Total 69 100Source: Field Survey, 2016

Table 2 above, shows the distribution of the responses of those who reported being medically

unfit upon their arrival in prison. It shows that (30.4%) of the respondents reported having

malaria fever upon arrival in prison, (29.1%) of the respondents reported having typhoid fever,

and (27.5%) of the respondents reported having cough while (13.0%) other respondents reported

suffering from scabies upon their arrival in prison.

Table 3: Whether Respondents Were Medically Assessed on Arrival in PrisonResponse Frequency PercentageYes 350 100.0No 0 0Total 350 100.0Source: Field Survey, 2016

Table 3 above presents the responses elicited on whether the respondents were medically

assessed upon arrival in prison. It shows that all the respondents answered in affirmation that

they were subjected to medical screening upon their arrival in prison. Impliedly, the health

condition of inmates is given attention as part of their admission process.

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In the in-depth interview conducted with a respondent in Kano Central prison, he stated that;Most people come to prison with healthcare concerns especially drugs and sex related offenders. It is however part of the many requirements for admission into prison to have them undergo series of medical test to ascertain their real health status or condition especially as it concerns infectious and contagious diseases that can easily be transmitted in a crowded place like the prison. (IDI: 2016).

Table 4: Medical Conditions for Which Respondents Were TestedHealthcare Services Frequency PercentageMental Health Assessment Yes 90 25.7

No 260 74.3Total 350 100.0

Dental Health Assessment Yes 192 54.9No 158 45.1Total 350 100.0

Self-harm Assessment Yes 20 5.7No 330 94.3Total 350 100.0

Blood Test Yes 209 59.7No 141 40.3Total 350 100.0

Eye Test Yes 216 61.7No 134 38.3Total 350 100.0

Hearing Test Yes 127 36.3No 223 63.7Total 350 100.0

Stool/Sputum Test Yes 141 40.3No 209 59.7Total 350 100.0

Suicide Risk No 350 100.0Total 350 100.0

Infectious Diseases Test Yes 141 40.3No 209 59.7Total 350 100.0

Drug Dependence Test Yes 39 11.1No 311 88.9Total 350 100.0

Source: Field Survey, 2016

Table 4 above shows the distribution of the various medical conditions for which the inmates

were tested upon their arrival in prison as part of the operational guidelines for healthcare

delivery in prisons. It shows that about (25.7%) of the respondents reported to have been

mentally assessed while (74.3%) of the respondents were not assessed as such, over (54%) of the

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respondents were rendered dental health assessment while (45.1%) other respondents were not

examined for dental health. Few respondents, about (5.7%) reported being assessed for self-harm

tendencies while majority of the respondents, (94.3%) reported not receiving any form of

assessment related to self-harm tendencies and (59.7%) of the respondents reported that their

blood sample was tested while (40.3%) of the respondents were not tested as such.

Further to above, over (61%) of the respondents reported being examined for eye defects while

(38.3%) of the respondents reported that they were not examined for eye defects. More so,

(36.3%) of the respondents reported been assessed for hearing defects while (63.7%) of the

respondents were not assessed as such, and (40.3%) of the respondents had their stool/sputum

tested while (59.7%) of the respondents reported not having any medical test associated with

stool/sputum. Meanwhile, none of the respondents reported been assessed for suicide risk.

However, where (40.3%) of the respondents reported being tested for infectious, (59.7%) other

respondents were not tested as such and majority of the respondents (88.9%) reported not being

tested for drug dependence while few other respondents, (11.1%) reported being tested for drug

dependence upon arrival in prison.

Implicit in the responses above is that, there seems to be some level of adherence to operational

standards of healthcare delivery. However, critical issues associated with healthcare in prison are

no doubt accorded little or no attention especially as it finds expression in lack of thorough

assessment of inmates concerning drug dependence, self-harm tendencies and suicide risk all of

which no doubt should have form an important component of healthcare delivery in prison.

The respondents interviewed in Kano Central and Goron Dutse prisons shared similar responses

on the kind(s) of medical screening conducted on inmates. They stated that; It is a requirement that upon arrival in prison, inmates should be thoroughly examined for medical defects. This cut across mental health, eye, hearing, infectious disease, drug dependence among others. However, emphasis is more on eye test, infectious diseases. More so, specific attention is given to HIV/AIDS, tuberculosis and hypertension. This is due to the persistent need for care and close watch on those suffering from these life threatening conditions. (IDI: 2016).

Table 5: Whether Respondent’s Consent Were Sought Before the TestResponse Frequency PercentageYes 319 91.1No 31 8.9Total 350 100.0Source: Field Survey, 2016

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Table 5 above shows the responses elicited on whether the inmate’s consent was sought before

the conduct of any medical examination. It shows that an overwhelming majority of the

respondents (91.1%) affirmed that there consent was sought before the examination while few

other respondents (8.9%) do not affirm as such. Impliedly, inmate’s right to consent for

healthcare assessment is given consideration in the prisons.

Corroborating the responses above as it was stated by respondents in Kano Central and Goron

Dutse prisons stated that;

It is a standard for inmates to be informed on the need to have them medically examined before admission into prison. In other words, no inmate is forcefully examined before admission into prison. Their consent is therefore sought before conducting any form of medical examination. We do this in compliance to the fact that losing their liberty does not amount to losing their right to the best healthcare service possible. (IDI: 2016).

Table 6: Nature of Illness Suffered by Respondents in the PrisonMedical Conditions Frequency PercentageMalaria fever Yes 221 78.9

No 59 21.1Total 280 100.0

Diabetes Yes 29 10.4No 251 89.6Total 280 100.0

Diarrhea Yes 149 53.2No 131 46.8Total 280 100.0

Headache Yes 141 50.4No 139 49.6Total 280 100.0

High blood pressure Yes 107 38.2No 173 61.8Total 280 100.0

Cough/Tuberculosis Yes 141 50.4No 139 49.6Total 350 100.0

HIV/AIDS Yes 8 27.9No 202 72.1Total 280 100.0

Source: Field Survey, 2016

Table 6 above shows the distribution of responses elicited on the nature of illnesses suffered by

respondents in the prison based on multiple choice of options. It shows that 78.9 percent of the

respondents reported suffering from malaria fever, very few respondents 10.4 percent reported to

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have suffered from diabetes, 53.2 percent of the respondents reported to have suffered from

diarrhea and 50.4 percent of the respondents reported to have also suffered from headache. More

so, 38.2 percent of the respondents reported to have suffered from high blood pressure and 50.4

percent of the respondents reported suffering from cough/tuberculosis while 27.9 percent of the

respondents reported suffering from the dreaded HIV/AIDS virus. This implies that there is the

prevalence of different health problems in the prisons.

Responding to the question on the kind(s) of illnesses that are mostly found among prisoners, the

healthcare officials in Kano Central and Goron Dutse prisons both stated that;

It is no doubt the prison environment is congested, especially in Nigeria where non-custodial options are rarely utilized in the criminal justice system. Given the state of prison congestion, there is high prevalence of illnesses such as malaria, tuberculosis and diarrhea in most cases. (IDI: 2016).

Table 7: Nature of Treatment Given to the RespondentsNature of Treatment

Response Frequency Percentage

Admission Yes 128 45.7No 152 54.3Total 280 100.0

Test Yes 170 60.7No 110 39.3Total 280 100.0

Injection Yes 178 63.6No 102 36.4Total 280 100.0

Drugs Yes 230 82.1No 50 17.9Total 280 100.0

Referral Yes 69 24.6No 211 75.4Total 280 100.0

Source: Field Survey, 2016

Table 7 above shows the distribution of the responses elicited on the nature of treatment given to

those who reported to have fallen sick in the prisons based on multiple choices of options. It

shows that majority of the respondents (82.1%) were given drugs in the course of their treatment,

(63.6%) of the respondents reported taking injection in the course of treatment and (60.7%) of

the respondents reported to have undergone some medical test as part of their treatment. Also,

(45.7%) of the respondents reported being admitted as part of their treatment while few other

respondents (24.6%) reported being sent on referral to hospitals outside the prison to receive

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treatment. Implicit in the responses above is that the prison has in place the requisite resources

for the treatment of inmates in the event of illness. They however refer critical medical cases to

hospitals outside the prison setting.

Discussions

Concerning the state of healthcare in Kano Central and Goron Dutse prisons, this study reveals

that while some of the inmates come to prison with certain healthcare concern and many others

took ill in the prison, there are provisions for containing such healthcare concerns. This finds

expression in the availability of medical professionals in the prisons who diagnose and attend to

the medical needs of the inmates after gaining the consent of the inmates, admissions, tests,

drugs and referral to hospitals outside the prisons for serious healthcare concerns. However,

there is an evident level of neglect in the conduct of assessment on some critical healthcare

issues such as mental health, suicidal tendencies and drug dependence upon the arrival of

inmates to prison.

From the findings, illnesses are very much prevalent in the prison. Most prevalent illnesses as

reported by the inmates include malaria fever, diarrhea, high blood pressure, cough/tuberculosis,

scabies and HIV/AIDS. In line with this finding, Agunbiade (2010) reported that there is the

prevalence of illnesses, infections and other communicable diseases among the prison population

in Nigeria. This also confirms the WHO (2014) report on the state of health in African prisons

that prisons are a breeding ground for the prevalence of acute and chronic illnesses such malaria,

typhoid fever, scabies and other skin infections as well as the life threatening HIV/AIDS and

tuberculosis. Although, there is a little compliance to the provisions of the instruments guiding

healthcare delivery in prisons, there is however a reflection of non-compliance especially as it

concerns the absence of screening for critical healthcare issues such as hepatitis, mental health,

dental health, drug dependence and self-harm tendencies. In this regard, Obioha (2011) noted

that healthcare delivery in Nigerian prisons fall short of UN standards for the treatment of

prisoners, the worst conditions of which constitute ill-treatment.

Conclusion

The main aim of imprisonment is to reform and rehabilitate offenders that are confined to the

four walls of the prison. However, the provision of a comprehensive healthcare to the inmates in

prison is beyond any reasonable doubt central to an effective reformation. This was clearly

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recommended in the Nigerian Prison Standing Orders (2011) and the UN Minimum Standard for

the Treatment of Offenders as revised (2015). Accordingly, the following conclusions are drawn:

Healthcare delivery in the prisons (Kano Central and Goron Dutse) is below the minimum

standard and the NPS Act (2011) and do not augur well with the complex reformation needs of

the inmates. In this regard, it is apparent that poor healthcare delivery in prisons can destroy the

essence for an individual is sent to prison. Prison populations have a disproportionately high rate

of people suffering from different healthcare problem, many pre-dating prison and others

developing or worsening when inside due to poor conditions and lack of comprehensive care.

Recommendations

The provision of effective, accessible and sustained healthcare services to inmates is

undoubtedly the most important aspect of prison reforms. This is more so given the fact that

prison conditions have tended to violate inmates’ right to health. Taking into consideration the

findings of the study, recommendations are offered with focus on the role of the government,

NGos, FBOs and CBOs on the contribution to make to promote healthcare delivery for inmates

in prison and their general welfare. Given the findings of this study therefore, the following

recommendations are offered for a better prison healthcare delivery:

1) The federal government of Nigeria, as the custodian and the chief financier of the prisons,

through its relevant agencies such as the Nigerian Prison Services and the Federal

Ministry of Health, needs to revisit the issue of healthcare delivery in custodial settings.

This finds expression in the fact that a comprehensive healthcare delivery in prisons will

add much more than value to the rehabilitation and reformation need of the inmates.

Specifically, requisite resources for promoting effective healthcare delivery as stated in

the UN minimum standard, the WHO guide and the Nigerian Prison Standing Orders

(2011), should be channeled to the prisons.

2) The general welfare of prisoners should be seen as a national priority. In this regard

therefore, well-meaning individuals, philanthropists, NGOs, FBOs, CBOs, corporate

bodies and organizations should be charged on the need to contribute to the promotion of

welfare of inmates in prisons. This can be achieved through the active participation of the

National Orientation Agency through the media.

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