"They are trying their best": incarcerated individuals' assessment of general healthcare services in selected Ghanaian prisons

Susanna Aba Abraham; Francis Annor; Obed Cudjoe; Benjamin Kofi Anumel; Dorcas Frempomaa Agyare; Benedict Osei Tawiah; Florence Djoletoe; Raphael Adu-Gyamfi; Kwadwo Koduah Owusu; Anthony Ashinyo; Dorcas Obiri-Yeboah

doi:10.1186/s40352-024-00298-1

"They are trying their best": incarcerated individuals' assessment of general healthcare services in selected Ghanaian prisons

Health Justice. 2024 Nov 18;12(1):44. doi: 10.1186/s40352-024-00298-1.

Affiliations

¹ Department of Adult Health, School of Nursing and Midwifery, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana.
² Directorate of Research, Innovation and Consultancy, University of Cape Coast, Cape Coast, Ghana. francis.annor@ucc.edu.gh.
³ Department of Medical Laboratory Science, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana.
⁴ Laboratory Unit, Nsawam Prisons Hospital, Nsawam, Ghana.
⁵ Ghana Prisons Service, Health Unit, Senior Correctional Centre, Accra, Ghana.
⁶ National AIDS/STI Control Programme, Korle-Bu, Accra, Ghana.
⁷ Directorate of Research, Innovation and Consultancy, University of Cape Coast, Cape Coast, Ghana.
⁸ Department of Microbiology and Immunology, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana.

Abstract

Background: The World Health Organization (WHO) has indicated that the absence of prison health poses a threat to public health, making it important to safeguard access to quality healthcare for incarcerated populations. Although several studies have explored the quality of care in prisons, there is a dearth of empirical evidence on the perspectives of incarcerated individuals. This study investigated incarcerated individuals' perspectives and opinions on the general healthcare services in Ghanaian prisons.

Methods: Utilizing a qualitative approach, focus group discussions were conducted with 51 incarcerated individuals in five prisons sited in the Northern, Middle and Southern zones of Ghana. Thematic analysis following the tradition of Braun and Clarke was conducted. Four of the six constructs of the WHO Health Systems Framework - service delivery, health workforce, access to essential medicines, and leadership and guidance - were applied deductively to organise the data into themes and subthemes.

Results: Four themes were generated from the analysis: "Health service delivery", "Health workforce in prisons", "Access to essential medicines" and "Leadership; regulating healthcare services". Participants rated health services in prisons as below average compared to those available to the general population. The use of nurses as prescribers in prison infirmaries, though consistent with Ghana Health Service policy, seems to negatively influence prisoners' perceptions of the quality of the health workforce in prisons. Lack of basic equipment and essential medications at the infirmary for common endemic conditions such as malaria coupled with the bureaucratic processes required to access care outside of the prison also negatively affected incarcerated individuals' perceptions of the quality of health care.

Conclusions: Incarcerated individuals perceived that the quality of health services provided in prisons was inferior to that provided in the general population. Addressing challenges associated with the unavailability of essential drugs and equipment, improving the number of health staff, and addressing bottlenecks in accessing urgent care will enhance the experiences of incarcerated populations on the quality of care given.

Keywords: Ghana; Health service; Incarcerated individuals; Prisons; Quality.