1. Justification and Background
In 1995 the World Health Organization and the member states of the European Regional Office launched their "Healthy Prisons" project. It was aimed at prison inmates and focused on health promotion through three key components: mental health, drug addiction, and transmittable diseases.
In light of the interest shown by the Ministry of Justice and Human Rights and the Ministry of Health, the Pan American Health Organization proposed implementing a similar program in Argentina.
In order to further explore this program and with a view toward making it available within the Federal Penitentiary Service (known by its Spanish abbreviation, SPF), in 1999 the Argentine office of the Pan American Health Organization appointed an experienced Canadian consultant, Ms. Sandra Black, to work with a team of representatives from each of the aforesaid institutions on drawing up a proposal for implementing a Healthy Prisons Plan in the SPF's facilities.
Under an agreement signed by the Ministry of Justice and the Ministry of Health, preparatory meetings were held prior to the program's implementation.
The project is both plural and complex, in that it involves the Ministry of Health's health education, oral health, and Lusida programs, the National Women's Council, SEDRONAR, and, from the Ministry of Justice and Human Rights, the secretariat and undersecretariat for criminal policy and prison affairs. As a result, high levels of efficiency in its implementation are required.
2. Target Population
The Federal Penitentiary Service has 37 facilities: 27 detention centers and 10 municipal jails (temporary accommodation).
The SPF has a total number of inmates of 8,053 (as of 2002.02.22), of whom 770 (9.56% are women).
The facilities comprise prisons for persons facing trial (the most numerous, located in the vicinity of the capital), prisons for convicts (maximum or medium security facilities; open and semi-open prisons), and establishments for young adults and specialized assistance facilities (psychiatric care for men and women, for infectious diseases, and the federal specialized treatment center for young adults).
All these prisons are addressed by the project - be it through the distribution of printed information packs, or by hosting a workshop or lecture for teachers, inmates, and prison staff.
The specific selection of operations for each unit was defined at the start of the project. Since it accounts for 50% of the SPF's prison population, emphasis was given to the city of Buenos Aires and its surrounding areas.
The different operations have benefited or will benefit:
- Inmates housed in Federal Penitentiary Service facilities.
- 63 inmates who are mothers with children, housed in Units 3 and 31 (Ezeiza) and Unit 13 (La Pampa).
- 500 health promoters who keep personal contact with inmates.
- 150 teachers responsible for elementary education classes in prisons.
3. Guiding Principle of the Program
To develop, within the facilities of the Federal Penitentiary Service, a healthy environment that upholds the human, ethical, and legal rights of the inmates housed therein and of federal prison personnel.
To implement primary health care practices and policies during all stages of inmates' detention at the facilities of the Federal Penitentiary Service, in order to ensure the development of a healthy environment, help minimize the negative impact of disease on individuals and the community, and guarantee mental, physical, and environmental wellbeing.
5. Basic Program Guidelines
- Respecting the dignity and human rights of all members of prisons community.
- Upholding the conviction that the social readaptation of inmates is possible, making them law-abiding citizens.
- Believing that its human capital is the strength and greatest resource available to the SPF in pursuing its goals.
- Building a new culture of communication that allows dissemination of the health information needed to pursue these policies.
- Sharing experiences with SPF units from different parts of the country.
6. Main Lines of Action
- Respecting the right to health of the inmates housed in SPF facilities, by encouraging doctor-patient relations and providing them with adequate information, education, and care.
- Implementing primary health care practices and policies during all stages of detention in SPF facilities.
- Developing training programs for health workers and personnel in general.
- Identifying opportunities for horizontal communication among SPF staff members, and involving them in decision-making.
- Providing the conditions needed to ensure the safety of SPF personnel in the workplace.
- Encouraging the computerization of medical information, by encouraging staff to make use of it and providing the resources needed for its implementation.
7. Program Activities and Methods
1. Prevention of infection by HIV/AIDS. The method used involved awareness-raising sessions that provided information about HIV transmission and prevention. SPF personnel were informed about biosafety problems during prisoner transfers or in day-to-day contacts with inmates. Visits were made to the different areas of the facilities where the training took place, in the company of the directors or other officials, to decide where the posters and condom dispensers were to be placed. Stickers bearing a toll-free telephone number for questions about AIDS and HIV infection were distributed.
2. Information and ideas about gender issues and discrimination, domestic violence, reproductive health, and preventing genital and breast cancers. A classroom session was held to air ideas about gender issues and their impact on the everyday lives of the women and young people of both sexes housed in SPF facilities, and increase their awareness of the problems of domestic violence.
3. Training for health workers and general personnel on drug addiction issues, and for inmates on addiction prevention. The central principles of the exercise were to dispel prejudices that exist regarding additions, to encourage reflection about different levels of consumption of addictive substances, and to share damage reduction techniques.
4. Encouragement of healthy behavior patterns, by providing ideas and methods for health protection and promotion. These educational undertakings were based on encouraging positive attitudes and behavior patterns toward health care on the part of the prison community. Training for oral health and promoting hygiene standards and preventive techniques.
5. Flu shots for inmates and prison staff: a preventive task that has been ongoing for the past two years, thanks to vaccines provided by the Ministry of Health.
PROPOSALS FOR THE YEAR 2002
In light of the activities carried out during 2001 and the lessons learned, the following plans have been drawn up:
- Producing printed materials, graphics, and texts to complement the technical information provided in teaching sessions and to support future presentations.
- Monitoring events led by the teachers who were trained during the first phase.
- Completing implementation of the project in the SPF units located in the Buenos Aires surrounding area and around the interior of the country, where work has not yet started.
The program was launched in March 2001, and the first stage concluded in December 2001.
- 58 workshops and lectures on health promotion issues were held, averaging two events per week every week.
- 16,000 HIV/AIDS prevention leaflets were distributed, and ten condom dispensers, holding 10,000 condoms, were installed.
- 80% of women inmates were administered pap smears and colposcopy tests.
- Flu shots were offered to 100% of inmates, 100% of prison staff, and to retired personnel.
- This phase covered the following units: Detention Institute No. 2 in the city of Buenos Aires; Federal Penitentiary Complex No. 1 in Ezeiza; Penitentiary Complex No. 2 in Marcos Paz; the Ezeiza Correctional Institute; the Women's Correctional Institute and the Federal Women's Detention Center, both in Ezeiza; and the federal complex for young adults in Marcos Paz.
Prison, as an institution, is total and enclosed. In such a specific universe, protecting the mental and physical health of inmates is of particular importance, although being in prison also increases their vulnerability.
The state must protect the physical and mental integrity of prison inmates, and it must punish cruel and inhuman treatment that makes the conditions of their detention harsher.
This programs aims to create a healthy environment inside prisons, which is something both inmates and prison workers need.
The National Plan is centered on inmate health, in the conviction that detainees are members of a community from which they come and to which they will return when they are released. Consequently, the success of this plan will increase the wellbeing of society as a whole.