Fighting tuberculosis (TB) in prisons is a smarter choice for governments from economic, social justice and public health criteria. In India, the government was asked to cough up INR 300,000 (>USD 6000) as compensation to be paid to the wife of the TB prison inmate who died inside Howrah Jail (source: The Times of India, 22 February 2011). Getting TB disease and dieing of it was not part of prison sentence. Although government tried to shun responsibility in the beginning, the inquiry conducted by the National Human Rights Commission (NHRC) brought forth the truth: there was clear negligence on part of the government to not provide TB treatment and care to this prison inmate. He died later of chronic obstructive pulmonary tuberculosis on 27 February 2007. His family had complained that he was not given proper medicine and was not allowed to consult an expert.
If governments are made to pay compensation to every person who dies of avoidable diseases like TB, one can imagine the financial crisis governments might soon be in. Add to this the cost of TB that spreads due to suboptimal infection control measures particularly in prison settings. From social justice point of view, people who are sentenced to prison terms, are not sentenced to get TB and other diseases and at times death due to these avoidable causes! Fighting TB clearly is a smart choice for governments!
There is no doubt that standard TB treatment and care should be made available to prison inmates who need it. But more important from public health point of view is infection control in congregated settings like those of prison in this case. The media coverage of this news from India doesn’t even mention infection control measures if at all they were in place. Standard infection control measures should be in place in prison settings, and every other congregated setting.
Why is health not a priority in prison settings? Some public health advocates believe that right to health is not recognized in prisons by governments. "Prison inmates are considered to be condemned people in the society, so the right to health is not considered in many countries. In few countries like South Africa, people have fought for the right to health and are able to push the government at all cost to access medication in prisons" said Fred Mwansa. "When you have right to health you can be able to sue the government when this right is violated. If leaders can show good will and consider right to health then we can say we are on the right track in achieving democracy. There should be a way by which the prison inmates should be protected by forming coalitions in prisons in order to fight this and reduce deaths. Universal Access to medication won't be achieved if the clause of right to health will not be implemented in all countries" said Fred Mwansa.
Not just TB, prison environment is usually considered to exacerbate the risk to myriad conditions. "There is a lot if negligence on the part of government on issues concerning prison inmates. Prisons are the most horrific places to ever be in, many have issues like overcrowding, which amplifies the risk of spread of communicable diseases like TB, there is poor medical services for jail inmates, very poor nutrition, horrific conditions of living, such as bedding, etc" said Kennedy Kassaza from Uganda. "There are hundreds, even thousands of death of prison inmates which are directly related to negligence on the part of governments, people whose relatives die in prisons due to negligence lack the legal means to hold governments accountable. If only people can get to know how and where to start from, to follow the legal procedures, in holding prison authorities and governments accountable, there would be many reforms in many government prisons" said Kennedy Kassaza.
"We call upon the Government of every state in India and all the agencies and related departments in this region to take priority measures and compensate the families of prison inmates who died of HIV, TB or from other opportunistic infections while languishing in prisons or during judicial custody in the jails while serving a term or even otherwise" said Ashok Sharma and Rajni Bhatt from Preserve' Society in Uttrakhand, India.
According to the World Health Organization (WHO), TB is not an unavoidable consequence of incarceration and can be controlled through the application of Stop TB Strategy based programmes and improvements in prison conditions. Effective TB control in prison protects prisoners, staff, visitors and the community at large. One can just wish if authorities are listening and implement the WHO guidelines in letter and spirit. (CNS)
(The author is the Director of CNS Stop-TB Initiative, and a World Health Organization (WHO) Director-General’s WNTD Awardee 2008. He writes extensively on health and development through Citizen News Service (CNS). Email: email@example.com, website: www.citizen-news.org )