AN ASSESSMENT OF HEALTH CARE DELIVERY SYSTEM FOR INMATES IN THE NIGERIAN CORRECTIONAL FACILITY

AN ASSESSMENT OF HEALTH CARE DELIVERY SYSTEM FOR INMATES IN THE NIGERIAN CORRECTIONAL FACILITY

CHAPTER ONE

INTRODUCTION

1.1       Background of the Study

Prisons are often referred to as correctional and/or reformatory center. They are places/facilities where offenders are kept for either punishments or as they await trials at the courts of law. A correctional centre according to Mc-Corkle and Korn (1954) quoted in Obioha (2011) is a physical structure in a geographical location where a number of people live under highly specialized conditions, utilize the resources and adjust to the alternatives presented to them by a unique kind of social environment that is different from the larger society in so many ways.

A correctional centre is neither expected to be exactly a bed of roses as the inmates are there for penal purposes nor supposed to be a bed of thorns and thistles meant to snuff life out of the occupants. As Eva (2015) noted, the Nigeria correction facility, among others in Nigerian Justice System perform three basic functions of; keeping safe custody of convicted persons and suspects as well as execute sentences passed on individuals by the courts, ensuring the reformation and rehabilitation of inmates through moral training, education and offering them opportunities to develop other potentials and skills for effective reintegration into the society on discharge and ensuring the welfare of inmates through the provision of good health care, feeding, clothing and recreational facilities in order to create the enabling environment for reformation and rehabilitation programmes.

Despite Nigeria’s progress on democratic, economic and political reforms, Nigeria’s prisons are yet to make appreciable impact on the welfare of the inmates. A recurring debate within contemporary academic circles, criminologists, health workers and prison experts, is to ensure an appropriate health template for proper prison administration that will reflect its objectives. Even though crime and other vices need to be deterred, it should be to the extent that inmates health should be adequately taken care of during and after imprisonment; it is therefore needful to be logical and rational in terms of health delivery while in custody.

Seven years into the new millennium, health for all prison inmates in Nigeria and many African nations has remained mirage. Recent assessment of African Prison Health systems indicates a gloomy picture of weakness in performance (African Regional Health Report, 2006). The inability to provide quality and equitable access to prison health care services through much reliance on western health care framework have further widening the existing health inequalities in many African countries and the Nigerian prisons in particular. This scenario has also the poor and the rich, urban and rural dwellers, inmates and the “free” at different axis of the production spectrum of health care delivery in Nigeria. A good example of this unfavourable equation becomes obvious when the health of special groups like the prisoners is critically examined (Health in African Prisons, 1999).

Healthcare services to the general population in Sub-Saharan African is of a major concern and many countries in the region are grabbling with the stark reality of improving services especially to the vulnerable populations due low health budgetary allocation by the governments and the unwillingness  on  their    part  to  make  available  requisite  personnel  to  carry  out  healthcare services. This reality is more among the prison populations who are most vulnerable with no choice to decide on who provides them with healthcare services and are left to the least the government could do. The prison health population is also more problematic given their general low income status and vulnerability to high drug use and infections compared to the general population. Healthcare service accessibility is defined in terms of individual person‘s ability to obtain requisite healthcare when needed with least hindrance in terms of finance and geographic distance.

The number of prisons globally is on the increase so is the number of health problems prisoners bring along with  them  [Watson  et  al., 2004]. The very purpose for  which  the prisons  are designed: punishment, correction and rehabilitation of prisoners to the community may run in conflict with the aims of health care [Watson et al., 2004]. The number of health problems prisoners bring to prison is huge and usually surpasses the prevalence in the general population [Watson et al., 2004; Her Majesty‘s Prison Service, 2001]. Take for example, the number of prisoners in the United States (US) with mental health problems is 90% with many also having a substance abuse problem, 80% of prisoners smoke and hepatitis B and C rates of infection are higher than in the general population. Problems of HIV positive and self-harming are also high [Watson et al., 2004; Her Majesty‘s Prison Service, 2001]. High number of prisoners also suffers from chronic diseases like asthma and heart disease. A study conducted on New York City adults, has it that asthma rates were twice as high for people with a history of incarceration–12.7 percent as opposed to 6.2percent for those without a history of incarceration [Emily et al., 2010]. Those who had been imprisoned with history of asthma were more likely to suffer an asthma attack or go to the emergency department not considering if the patient had access to primary care or health insurance [Emily et al., 2010].

Evidence has linked major determinants of health in modern populations to socioeconomic, political and cultural factors and as such inequalities in health have remained problematic across cultures, socio-economic class, gender or ethnicity (Bambra et al., 2005). In the social sequence of events, prison inmates are most times from the poorest sectors of the society, and suffer more from inequitable access to effective health care services. This experience also exacerbates existing health problems of inmates (de viggiani, 2007). Hence, the current drive towards realizing the health related millennium development goals requires more forceful drive from the Nigerian government. Health is political and the power exercised over it is part of the wider economic, social and political system (Bambra1, et al., 2005). Thus, achieving both qualitative and quantitative health among special groups like prison inmates may be far from realization going by the slow attitude of prison officials and the government in particular in addressing the health needs of prisoners. Hence, this paper attempts a sociological discourse of prison health within the social context producing it. This was done by discussing prison health in Nigeria as a social product. This project therefore is an assessment of health care delivery system for inmates in the Nigeria correctional facilities.

2.2       Statement of the Problem

Globally, the correctional population has been in constant fluctuation. Today, the global correctional population stood at over 11 million. Out of this, a total of 73, 314 inmates are in Nigeria (Penal Reform International, 2020). The government has the responsibility of providing quality and accessible healthcare services to inmates. This concern has been largely emphasized by the UN, WHO, and other agencies concerned with inmate welfare to be in equality with the health services provided in the community. Most importantly, the (UN Minimum Standard for the Treatment of Offenders) Nelson Mandela Rules (2015) and the most recently amended Nigerian Correctional Service Act (2019) were very much explicit on the provision of a comprehensive healthcare delivery in the prison. These instruments provided guidelines for an all-round provision of standard healthcare to all inmates devoid of preferential considerations from the point of entry to discharge. This is however, not the situation in many countries across the globe, Nigeria inclusive. However, the PRI report documents over 124 correctional facilities that exceeded their maximum rate of occupation. It shows how the rising figures of incarceration in is driven by a punitive approach to criminal justice where high and costly correctional sentences are favoured over non-custodial alternatives, invariably resulting in poor health services delivery for the inmates.

A survey of Nigerian corrections over the years by Amnesty International (2010, 2015 and 2017) revealed the deplorable condition of the prisons and the health services available. They revealed that inmates’ rights are flouted and that many correctional facilities in Nigeria are overcrowded with evident poor sanitation and that health care facilities are lacking. In fact, the Amnesty International finding shows that corruption is prevalent in the corrections and it affects virtually the running of the system. This corruption ridden system, especially as it affects health care, has also been reported by the Prisoners Right and Welfare Action (PRAWA) (2017). Corrections are closed environments, characterized by constant surveillance aimed at preventing inmates from escaping or inflicting harm on fellow inmates and other correctional stakeholders within the facility. Given the limited and strictly regulated access from the larger community, corrections around the world are largely isolated from the larger society, with the very existence of inmates easily forgotten by the general public. In most places around the world, collective monitoring of facilities is weak or even absent, with little or no involvement of other non-state actors, especially civil societies, in the delivery of services in correctional facilities especially those associated with healthcare. It is against this background that this study was undertaken to provide insight into the health care delivery system for inmates in the Nigerian correctional facilities.

1.3       Objective of the Study

The main objectives of the study are to examine health care delivery system for inmates of the Nigeria prison. Other specific objectives of the study include;

1. To examine the health condition of prison inmates.
2. To assess the benefit to effective health care delivery in Nigeria prisons.
3. To examine the Nigerian prison reforms.
4. To examine the challenges to achieving an effective health care delivery system for prison inmates.
5. To recommend ways of improving health care delivery in Nigeria prisons.

1.4       RESEARCH QUESTIONS

1. What are the health conditions of prison inmates in Nigeria?
2. What are the environmental conditions of Nigeria prisons?
3. What are the Nigerian prison reforms that would improve health care delivery?
4. What are the challenges to achieving an effective health care delivery system for prison inmates?
5. What are the ways of improving health care delivery in Nigeria prisons?

1.5       SIGNIFICANCE OF THE STUDY

The study would greatly benefit the Nigerian prison service and the federal government as it would reveal the benefits of effective health care system and the challenges of achieving effective health care system in Nigerian prisons across the country. the study would also be of immense importance to students, researchers and scholars who are interested in developing a further study on the subject matter.

1.6       SCOPE/LIMITATION OF STUDY

This research will be limited to Owerri Prison Headquarters and Owerri state prisons. The researcher encountered problems in the course of the study, the problem ranges from financial constraints following the fact that the researcher is a student and there was no extra funding from the outside world for this project.

Also getting approval from the prison management to carry out research on their prison took time, due to the bureaucratic process in the prison. Nevertheless, the outcome of this research work is not hampered by the mentioned limitations.

1.7       DEFINITION OF TERMS

I. The prisoner: is a person proved guilty of a crime alleged against him/her and legally sentenced to punishment of a confinement in a prison. In other words a prisoner is a person sentenced to penal servitude.

II. Prison: a prison is a building designated by law or used by the sheriff for the confinement or detention of persons who are judicially ordered to be kept in custody.

According to Lectric Law library lexicon (2003) a prison is a place where persons are confined or restrained from personal library. It can also be regarded as a correctional detention or penal faculty. Hence the prison is often referred to as a correctional institution where offenders are confined or punished.

III. Reformation: (mostly called reforms) this refers to measures calculated to impact moral improvement in a person’s character so that he will be less inclined to re-offer the future. (Ahire 1990)

IV. Rehabilitation: This refers to the post release effort to make it easier for the offenders to resettle in a society (Ahire 1990)

V. Warder: A person who works as a guard in a prison, and also responsible for supervising and making sure rules are obeyed.

VI. Assumptions: A thing that is thought to be true or certain to happen but is not proved.

VII. Constable: A police officer of the lowest rank.

VIII. Community: The people living in one place, district or country considered as a whole.

IX. Psychological evaluation: This is an examination into a person’s mental health by a mental health professional such as a psychologist. A psychological evaluation may result in a diagnosis of a mental illness. It is the mental equivalent of physical examination.

X. Government: A group of people governing a country or state.

XI. Penal servitude:  A state of being forced to work for others and having no freedom