Georgia: Prisons get new health system
ICRC prison health care expert Dr Eva Gerber-Glur explains how a careful assessment of inmates' health needs has resulted in a new health system for Georgia's prisons.
Why did the ICRC decide to launch a primary health care project in Georgia?
We supported Georgia's TB control programme in prisons between 1997 and 2009, and we facilitated inclusion of that programme in the national TB control programme. So we were looking at ways of making anti-TB work more sustainable and integrating it into general prison health care.
Back at the beginning of 2008, we conducted an assessment of health care in Georgian prisons. This revealed a number of shortcomings in basic medical services. Inmates generally received treatment in their jails from general practitioners, nurses with extra training and visiting specialists from outside the prison system. All of these staff required support from other specialists, such as pharmacists.
One of the main recommendations to emerge from the assessment was the introduction of a new prison health system, focused on inmates' real needs rather than their perceived needs.
Who did you work with?
Our main partner was the Ministry of Corrections and Legal Assistance (MCLA), the ministry responsible for the Georgian prison system. In conjunction with the MCLA, we launched a pilot primary health care programme in 2010, in two jails with differing populations and needs.
The first stage of the pilot programme involved training eight doctors and eight nurses in primary health care. They were then able to apply that training in the prisons where they worked. At the same time, we set up a multidisciplinary monitoring and evaluation team, to work alongside the newly trained staff and evaluate progress.
What have you achieved so far?
We've seen a lot of change since we launched the pilot projects. Medical and nursing staff have started to take a more proactive approach to care and have focused on what the patients really need. However, increased clinical competence and ambition, together with improved screening and diagnosis, has led to staff identifying needs they hadn't noticed before. That's one of the benefits of the pilot projects. But as time goes on, we expect to turn up fewer unrecognized needs and focus more on setting up systems to meet the needs we've found.
As well as identifying gaps in the provision of health care, the pilot programme has enabled us to identify the staff needed to provide primary health care and to draw up a list of essential medicines that will make it easier to calculate budgets in the future.
Can this one successful project guarantee proper health care for the inmates of Georgian prisons?
Clearly, a single project is not going to work miracles. Other factors are also important, as they affect the physical and psychological well-being of inmates. General conditions of detention such as access to fresh air, exercise, educational activities and regular contact with families are all very important.
The primary health care programme has significantly enhanced the health of inmates, as has the improvement in general conditions of detention.