Browsing by Author "Kaingu M"

Now showing 1 - 3 of 3

Exploring the drivers of health and healthcare access in Zambian prisons: a health systems approach.
(2016-Nov) Topp SM; Moonga CN; Luo N; Kaingu M; Chileshe C; Magwende G; Heymann SJ; Henostroza G; Centre for Infectious Disease Research in Zambia, PO Box 30346, Lusaka, Zambia.; ZPS Headquarters, PO Box 80926, Kabwe, Zambia.; Centre for Infectious Disease Research in Zambia, PO Box 30346, Lusaka, Zambia; James Cook University, School of Public Health Medical and Veterinary Sciences, Douglas, QLD, 4810, Australia, globalstopp@gmail.com stephanie.topp@jcu.edu.au.; Fielding of Public Health, University of Los Angeles, CA, 90095-1772, USA.; Centre for Infectious Disease Research in Zambia, University of Alabama at Birmingham, PO Box 30346, Lusaka, Zambia.; C/-CAPAH, National Assembly Parliament Buildings, PO Box 31299.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
BACKGROUND: Prison populations in sub-Saharan Africa (SSA) experience a high burden of disease and poor access to health care. Although it is generally understood that environmental conditions are dire and contribute to disease spread, evidence of how environmental conditions interact with facility-level social and institutional factors is lacking. This study aimed to unpack the nature of interactions and their influence on health and healthcare access in the Zambian prison setting. METHODS: We conducted in-depth interviews of a clustered random sample of 79 male prisoners across four prisons, as well as 32 prison officers, policy makers and health care workers. Largely inductive thematic analysis was guided by the concepts of dynamic interaction and emergent behaviour, drawn from the theory of complex adaptive systems. RESULTS: A majority of inmates, as well as facility-based officers reported anxiety linked to overcrowding, sanitation, infectious disease transmission, nutrition and coercion. Due in part to differential wealth of inmates and their support networks on entering prison, and in part to the accumulation of authority and material wealth within prison, we found enormous inequity in the standard of living among prisoners at each site. In the context of such inequities, failure of the Zambian prison system to provide basic necessities (including adequate and appropriate forms of nutrition, or access to quality health care) contributed to high rates of inmate-led and officer-led coercion with direct implications for health and access to healthcare. CONCLUSIONS: This systems-oriented analysis provides a more comprehensive picture of the way resource shortages and human interactions within Zambian prisons interact and affect inmate and officer health. While not a panacea, our findings highlight some strategic entry-points for important upstream and downstream reforms including urgent improvement in the availability of human resources for health; strengthening of facility-based health services systems and more comprehensive pre-service health education for prison officers.
Health and healthcare access among Zambia's female prisoners: a health systems analysis.
(2016-Sep-26) Topp SM; Moonga CN; Mudenda C; Luo N; Kaingu M; Chileshe C; Magwende G; Heymann JS; Henostroza G; University of Alabama at Birmingham, Birmingham, AL, USA.; College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, 4812, Australia. globalstopp@gmail.com.; ZPS Headquarters, PO Box 80926, Kabwe, Zambia.; College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, 4812, Australia.; School of Public Health, University of California, LA, Los Angeles, CA, USA.; c/- CAPAH, National Assembly Parliament Buildings, PO Box 31299, Lusaka, Zambia.; Centre for Infectious Disease Research in Zambia, PO Box 30346, Lusaka, Zambia. globalstopp@gmail.com.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
BACKGROUND: Research exploring the drivers of health outcomes of women who are in prison in low- and middle-income settings is largely absent. This study aimed to identify and examine the interaction between structural, organisational and relational factors influencing Zambian women prisoners' health and healthcare access. METHODS: We conducted in-depth interviews of 23 female prisoners across four prisons, as well as 21 prison officers and health care workers. The prisoners were selected in a multi-stage sampling design with a purposive selection of prisons followed by a random sampling of cells and of female inmates within cells. Largely inductive thematic analysis was guided by the concepts of dynamic interaction and emergent behaviour, drawn from the theory of complex adaptive systems. RESULTS: We identified compounding and generally negative effects on health and access to healthcare from three factors: i) systemic health resource shortfalls, ii) an implicit prioritization of male prisoners' health needs, and iii) chronic and unchecked patterns of both officer- and inmate-led victimisation. Specifically, women's access to health services was shaped by the interactions between lack of in-house clinics, privileged male prisoner access to limited transport options, and weak responsiveness by female officers to prisoner requests for healthcare. Further intensifying these interactions were prisoners' differential wealth and access to family support, and appointments of senior 'special stage' prisoners which enabled chronic victimisation of less wealthy or less powerful individuals. CONCLUSIONS: This systems-oriented analysis revealed how Zambian women's prisoners' health and access to healthcare is influenced by weak resourcing for prisoner health, administrative biases, and a prevailing organisational and inmate culture. Findings highlight the urgent need for investment in structural improvements in health service availability but also interventions to reform the organisational culture which shapes officers' understanding and responsiveness to women prisoners' health needs.
Mapping the Zambian prison health system: An analysis of key structural determinants.
(2017-Jul) Topp SM; Moonga CN; Luo N; Kaingu M; Chileshe C; Magwende G; Henostroza G; a College of Public Health, Medical and Veterinary Sciences, James Cook University , Townsville , QLD , Australia.; e School of Medicine, University of Alabama at Birmingham , Birmingham , AL , USA.; c Coalition of African Parliamentarians Against HIV/AIDS (CAPAH) , National Assembly Parliament Buildings , Lusaka , Zambia.; b Centre for Infectious Disease Research in Zambia , Lusaka , Zambia.; d ZPS Headquarters , Kabwe , Zambia.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
Health and health service access in Zambian prisons are in a state of 'chronic emergency'. This study aimed to identify major structural barriers to strengthening the prison health systems. A case-based analysis drew on key informant interviews (n = 7), memos generated during workshops (n = 4) document review and investigator experience. Structural determinants were defined as national or macro-level contextual and material factors directly or indirectly influencing prison health services. The analysis revealed that despite an favourable legal framework, four major and intersecting structural factors undermined the Zambian prison health system. Lack of health financing was a central and underlying challenge. Weak health governance due to an undermanned prisons health directorate impeded planning, inter-sectoral coordination, and recruitment and retention of human resources for health. Outdated prison infrastructure simultaneously contributed to high rates of preventable disease related to overcrowding and lack of basic hygiene. These findings flag the need for policy and administrative reform to establish strong mechanisms for domestic prison health financing and enable proactive prison health governance, planning and coordination.