Improving access to healthcare services in prisons of Thailand

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Access to healthcare services in prisons was the key theme of the monthly NGO Forum in November 2008 organized by the Health & Development Networks (HDN) and Thai AIDS Treatment Action Group (TTAG).

The number of people in prisons who are testing positive for HIV is alarmingly rising. Moreover the living conditions in prisons often exacerbates the risk to contract a range of infectious diseases and the quality of healthcare services available for people in prisons is also not optimal.

According to the Bureau of Epidemiology in Thailand, the number of people living with HIV in prisons is 5,333 in the year 2008. These people living with HIV in prisons require quality AIDS-related treatment, care and support services on an ongoing basis.

"It is very difficult to work in prisons - both developing systems in prisons for healthcare service provision and for advocacy are equally challenging. There are not enough healthcare providers in prisons and the financial crunch further impedes the health services in prison-settings" said Mr Boonniam Wongjaikam, Coordinator of TTAG.

There are only 2 nurses and 1 psychologist to cater to healthcare needs of around 1,300 prison inmates in female Chiang Mai prison. The situation is no less grim in male Chiang Mai prison with just 4 nurses to cater to the healthcare needs of 4,000 prison inmates. The health budget for every inmate in prisons is approximately Thai Baht 136 (USD 3.8), which is certainly not enough to provide quality healthcare services in prisons.

TTAG has been advocating for increasing access to general healthcare services for all hard-to-reach communities, including those in prisons. TTAG has been mobilizing different stakeholders to cooperate in this effort to improve access to essential medicines for those who may need it most. TTAG also emphasizes on mobilizing the people in prisons themselves to advocate for their needs.

In the prisons of Thailand, the inmates include not only Thai people but also ethnic minorities and migrant workers from Lao, Myanmar and Cambodia.

"Initially when we go to the prison, we just invest time talking to the female Burmese prison inmates to establish a relationship of trust. Many-a-times it is very comforting to the inmates to talk to someone in their native language. We play games with them and eat traditional food together. Only once the relationship exists, we can collectively begin identifying issues in their lives as inmates in prisons like those related to hygiene, sexual and reproductive health, mental health and support" said Ms Namishin Jate from MAP Foundation who has extensive experience of working in prisons.

"Prison inmates receive health information regularly and participate in trainings, all in Thai language only. So Burmese inmates cannot understand or benefit from these initiatives optimally. Burmese inmates look up to us to come to them to provide information and for other needs. These Burmese inmates have expressed their need to have more information on HIV/AIDS in language they can easily comprehend" said Ms Namishin Jate.

"TTAG works in male Chiang Mai prison and aims to help establish a support group of people living with HIV in this prison, who may also be health volunteers to strengthen public health programmes in prisons. In the female Chiang Mai prison, TTAG aims to work with the inmates in providing information about sexual and reproductive health" said Boonniam.

"Presently Chiang Mai is just a pilot area for TTAG. There are some staff members who are working in Chiang Mai Male Prison and Chiang Mai Female Prison. We hope that in the future we can contribute towards developing health systems in prisons for the whole country" said Boonniam.

"Currently we are trying to strengthen health systems in prisons by working on HIV and TB, and gradually hope to expand to provide care for other health needs too" said Boonniam.

"There are around 4,000 prisoners in Chiang Mai Male Prison with 4 nurses. There are no doctors rather just nurses in this prison. As per the Thai law, only doctor is permitted to provide treatment to cure patients, so it is very difficult to improve healthcare in prisons without a doctor. If any organization is interested in working in prisons, then the approval often takes long time" said Mr Visanukorn Yasamood, who is a nurse in the Chiang Mai male prison.

"We have three methods to find new possible cases of HIV in prisons: talking with new prisoners, treating tuberculosis patients and treating seriously ill patients. Until now in Chiang Mai Male Prison, we do now have any policy to provide antiretroviral treatments (ART) to people living with HIV (PLHIV) but there are some PLHIV who are on ART right now" said Mr Visanukorn Yasamood.

Access to healthcare services for PLHIV in prisons is not easy because of many restrictions like not having enough healthcare providers in prisons and budgetary constraints. Also not having any policy to support access to healthcare services for inmates in prisons is an impediment. However there are some civil society-led pilot initiatives to advocate for and increase the access to healthcare services in prisons, which should be used as a role model to develop health systems in prisons across the whole country.

"All people have equal rights to healthcare services, even if they are in prisons. The major impediment of not having supportive policies to develop quality health systems in prisons can be overcome by cooperation from different stakeholders committed to building and scaling up health systems in prisons" said Mr Channarong Wongwichai from AIDSNet foundation who was the moderator of this month's NGO Forum.

For further information contact: Duangkamol Donchaum Tel. 66 0 53449 055 Ext: 101 Email: duangkamol@hdnet.org

Keywords: NGOForum, PressStatement/Nov2008