Access to health care by inmates in Kenya: a study of Lang' ata women's prison and Nairobi remand/allocation

Abstract

The historical background of modem health care services took root from the colonial set up that was common in Africa and other developing countries at the beginning of the century. It was at this stage that sharp divisions emerged on the ability to access health care in the different socio-economic strata. All other health care facilities that were established after independence further perpetuated these inequalities as a result of which a large majority of the population could not access health care, as the health system was hospital-based. Prisons in Kenya were also established during the colonial era and the inequities in the provision of justice continued unabated. It is only in the last five years that reforms have been carried out in the prisons to ensure that the inmates' human rights are not violated and that the treatment conforms to the international instruments which Kenya has ratified.

This study identified the challenges that inmates faced while accessing health care while in confinement and how health care was provided. It sought to establish whether there were any notable differences in the health care provided amongst the male and females. The study also established the common ailments that afflicted inmates and endeavoured to ascertain whether the inmates considered the provision of health care adequate.

Since the largest health care provider in Africa and other developing countries is the state, the research sought to establish whether the state was able to cope with the demands of the entire population and the prisoners as a group with specific needs. Several extraneous factors were found to have had an effect on the entire health system, which in tum impacted on smaller health care systems such as prisons.

The study's theoretical orientation focused on the question of equity in the provision of health care amongst the inmates. This is because the lack of proper health care becomes a prominent feature of ill-health of a country's population. The focus of this study was the adult male and female inmates held in prisons falling between the ages of 18 - 40 years. The study was confined to the Nairobi province, which has prisons and custodial

institutions. This study was important because inmates are given no choice of the health care facility they would wish to attend. There was purposive selection of prisons in Nairobi area. A sample of 60 respondents was selected by way of convenience or haphazard sampling. The questionnaires were administered to 30 male and 29 female inmates and 8 key informants as 1 female inmate returned her questionnaire unanswered. The units of observation were the both male and female inmates who were in remand and those who had been convicted of their offences.

The study revealed that male inmates were worse off as far as health care provision is concerned. The male prison was congested and the medical personnel were unable to adequately cater for their medical needs. Several recommendations have been given as a guideline for enacting policies to remedy the imbalances of provision to health care amongst inmates.