Centre for Infectious Disease Research in Zambia

Transforming Zambian Prisons through improving access to justice and health

Lead Organization

Centre for Infectious Disease Research in Zambia

Lusaka, Lusaka Province, Zambia

http://www.cidrz.org

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Project Summary

The prevalence of infectious diseases and substance abuse in Zambian prisons are higher than that of the general population. Over crowdedness (prisons are currently over 277% intended holding capacity), limited access to health services, poor nutrition and high-risk population contribute to this situation. We propose a 2-pronged approach to improving health; a) wide scale implementation of prison and legal reforms to reduce incarceration and re-offending and resultantly reduce overcrowding and b) health systems strengthening through development of human resource, clinical and laboratory capacity, nutrition, continuum of care, health information systems and supply chain and logistics management.Our project will scale up both operations and beneficiaries and will have a deep and intense impact in all incarcerated populations in Zambia. The legal and prison reforms will provide both short and long term solutions to overcrowding in correctional facilities whilst health systems strengthening will lead to sustainable gains in health care.

Problem Statement

“Contracting Disease, Dying or becoming Disabled is not part of the prison sentence” Incarcerated populations suffer higher rates of communicable diseases than the general population. In the Zambian adult prison population HIV Infections rates are 1.4 times higher than in the general population; tuberculosis is 3 times higher; hepatitis B is twice as high, and syphilis is 3 times higher than the general population. Additionally, rates of substance abuse are significant: 15% among adults and 23% among young (juvenile) offenders. Overcrowding, limited access to health services, poor nutrition and high-risk populations all contribute to this situation. Currently, Zambian correctional facilities are functioning at over 277% capacity with one facility reporting an occupancy of 715% above the recommended holding capacity. Overcrowding is attributed to a) high rates of incarceration, b) delayed case disposal for remandees, c) high rates of re-offending due to lack of education, limited employment, poor life skills post release and inadequate access to livelihood; rife drug abuse and undiagnosed and untreated mental health challenges. This renders the available preventive and curative health interventions less effective whilst negatively impacting human rights such as rights to health, food, water and sanitation, education and rehabilitation may be denied. It also further amplifies the human resource gap. Currently the prison population of 22,000 is being serviced by only 95 health staff including only 1 medical doctor. Efforts to improve health in correctional facilities must take a health systems strengthening approach while interventions targeting overcrowding must address the root causes of the problem.

Solution Overview

We will take a 2-pronged approach; a) prison and justice reforms to reduce incarceration and re-offending to address and b) health systems strengthening to address health issues. Under prison and justice reforms, we will scale up non-custodial sentencing including both diversion and community sentencing supervision to minimize incarceration. Access to education, knowledge and skills development and reintegration programs will be enhanced. At release, inmates will be supported with start-up business package as relates to their key skills or to complete their school. These efforts are expected to provide knowledge, economic and social empowerment to reduce re-offending. To strengthen the health systems, we will focus on 3 of the health systems strengthening building blocks; a) human resource for health where we shall support in-service training, b) service delivery where we shall focus on continuum of care both within and outside correctional facilities and strengthening clinical and laboratory capacity and nutrition and c) health information systems to promote continuity of care, monitoring and evaluation and to inform policy.We expect our project to have a deep and sustained impact on all incarcerated populations in Zambia. The legal and prison reforms will provide both short and long term solutions to overcrowding in correctional facilities. This will minimize the risk of transmission of disease, promote human rights, reduce overburdening of resources allocated to health, support transition from punitive to a correctional approach and also give offenders an opportunity to new beginnings upon release. Health systems strengthening will allow sustainability of gains in health care.

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Project Funders

  • EJAF 2018 - 2020
  • EU 2013 - 2017
  • CDC/PEPFAR 2018 - 2023

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