By: Commissioner Clement Kainja, Malawi Prisons Service 23 rd July 2018

1. Prison Management Reforms in Malawi: A tool to Improve Prison Health (SRHR) and Response to HIV. By: Commissioner Clement Kainja, Malawi Prisons Service 23rd July 2018 19/07/2018 1

2. Overview of Malawi Prisons • Established under section 17: 163 of the constitution of Malawi • Has 28 prison establishments . • Runs halfway house program in partnership with Prison Fellowship Malawi- accommodates 60 inmates. • Currently, the prisons are housing around 15000 prisoners • Estimated holding capacity has been 6700. 19/07/2018 2

3. HIV SITUATION AND RESPONSE • From 2007, major support has been through the National AIDS Commission • HIV and AIDS Mainstreaming project: Targeting both prisoners, prison staff and families • UNODC support started in 2010. • Supported study on Prevalence and Risk Factors for HIV, STIs and TB Prisons in 2011. 19/07/2018 3

4. Prevalence and Risk Behaviour Study of HIV, STI and TB • Average HIV Prevalence 27.5% in 2011 • High in Central Prisons at 41% ( Female =42%), Medium prisons at 23% and small prisons at 19%. • Risky behavior leading to HIV spread in prisons, propagated by lack of space (Congestion), and food among other basic amenities. • Structural arrangements in the prisons which permitted mixing of untried and convicts or young and older inmates in some prisons. 19/07/2018 4

5. Challenges to Prison Health Care and Response to HIV • Prison health facilities were limited in terms of human resource, infrastructural and financial resources. • Lack of adequate policy to guide implementation of prison medical service delivery including mental health service; • Lack of laboratory and pharmaceutical support 19/07/2018 5

6. Challenges to Prison Health continue • Poor Surveillance system within prison for timely emergency response to infectious conditions. • Lack of health related data to guide policy development . 19/07/2018 6

7. Response following Survey supported by UNODC • Formation of Prisons Steering Committee (Health/Nutrition TWG and Human Rights/Rehabilitation TWG ). • Most partners responded to address Health and HIV challenges in Prisons • Development of Normative Guidelines for HIV, TB and STIs in prisons by UNODC 19/07/2018 7

8. MSF Health personnel providing health care services to inmates 19/07/2018 8

9. Response following Survey supported by UNODC contin’d • Introduction of “ Three Phase Intervention Model of Health Care in Prisons” ( Entry, Stay and Exit Screening) in Central Prisons ,based on SADC Minimum Standards. • Reporting of the 90:90:90 on HIV and TB in 3 Central Prisons where partners are working. • Prevalence of HIV in 2018 in Intervention Central Prisons reducing to between 19 and 24% from operation data (Versus 41% in 2011 Survey). 19/07/2018 9

10. Existing GAPs for Response to Health (SRHR including HIV) Quick assessment in 2016 by Prisons and UNODC, showed Existing GAPS to Health and HIV • Extreme levels of overcrowding • Inadequate nutrition among prisoners including the sick 19/07/2018 10

11. Existing GAPs for Response to Health (SRHR including HIV) cont • Poor or non-existing Health/SRHR service delivery in most medium and small security prisons. • Limited data to guide programming/Policy • Old infrastructure for accommodation and lack of the same for healthcare delivery 19/07/2018 11

12. Old/Dilapidated prison health care infrastructure 19/07/2018 12

13. Response to the Existing GAPS through a Project supported by UNODC Extreme Levels of Overcrowding • Supported Review of Legislation ( Prison Act and Sentencing guidelines): Reports almost Ready. • Strengthen functions of the Prison Inspectorate 19/07/2018 13

14. Response to the Existing GAPS through a Project supported by UNODC continued • Introduction of bunk beds in most prisons very soon • Redistribution of prisoners within prison system • Introduce and Improve use of alternatives to custodial sentencing 19/07/2018 14

15. Response to the Existing GAPS cont Inadequate nutrition among prisoners including the sick • Develop sustainable food production and distribution systems. • Renovation/ Outfitting of Institutional kitchens and food storage facilities • Undertook baseline Health and SMR assessment of Prison Institutions • Develop Improved Monitoring strategy for Prison Conditions. 19/07/2018 15

16. Inmates struggling to get their food portion at a prison kitchen 19/07/2018 16

17. SUPPORT IRRIGATION FARMING

19. Response to the Existing GAPS continue Poor or non-existing Health/SRHR service delivery in most medium and small security prisons. • Integration of Prison health into district public health to improve delivery and continuity. • District Prison Coordinators appointed with Terms of Reference. • Scale Up/ Support “ 3 Phase Intervention Model of Health Care in Prisons. 19/07/2018 19

20. Participants to a Consultative Meeting on Health Support to Malawi Prisons by District Health Offices and Central Hospitals 19/07/2018 20

21. Response to the Existing GAPS continue Poor or non-existing Health/SRHR service delivery in most medium and small security prisons. • Renovation/upgrading of selected prison clinics • Provide/Improve Water, Sanitation and Hygiene facilities in prisons 19/07/2018 21

22. Conclusion • Response to HIV and provision of SRHR services in prisons need to consider all the Social determinants of health through addressing the systemic challenges facing the prison system in Malawi. • A Collaborative approach with relevant Ministries such as Health and other partners in Health delivery is vital 19/07/2018 22

23. Thank you Merci beaucoup Zikomo kwambiri 19/07/2018 23