Topp Stephanie M, Moonga Clement N, Mudenda Constance, Luo Nkandu, Kaingu Michael, Chileshe Chisela, Magwende George, Heymann Jody S, Henostroza German
College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, 4812, Australia.
Centre for Infectious Disease Research in Zambia, PO Box 30346, Lusaka, Zambia.
Int J Equity Health. 2016 Sep 26;15(1):157. doi: 10.1186/s12939-016-0449-y.
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.
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.
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.
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.
在低收入和中等收入环境中，探索狱中女性健康结果驱动因素的研究基本缺失。本研究旨在识别并检验影响赞比亚女囚犯健康及医疗服务可及性的结构、组织和关系因素之间的相互作用。
我们对四个监狱的23名女囚犯、21名狱警和医护人员进行了深入访谈。囚犯采用多阶段抽样设计选取，先有目的地选择监狱，然后在牢房内随机抽样牢房和女性囚犯。主要采用归纳主题分析，以复杂适应系统理论中的动态相互作用和涌现行为概念为指导。
我们确定了三个因素对健康和医疗服务可及性产生的复合且总体负面的影响：i）系统性健康资源短缺，ii）对男性囚犯健康需求的隐性优先排序，iii）狱警和囚犯主导的长期且未受抑制的受害模式。具体而言，女性获得医疗服务的情况受到以下因素相互作用的影响：内部诊所的缺乏、男性囚犯享有有限交通选择的特权、女性狱警对囚犯医疗请求的反应迟钝。囚犯不同的财富状况和获得家庭支持的机会，以及高级“特殊阶段”囚犯的任命，进一步加剧了这些相互作用，使得较贫穷或权力较小的人长期受到侵害。
这种以系统为导向的分析揭示了赞比亚女囚犯的健康和医疗服务可及性如何受到囚犯健康资源不足、行政偏见以及普遍存在的组织和囚犯文化的影响。研究结果凸显了迫切需要投资改善医疗服务可及性的结构，同时也需要进行干预以改革组织文化，这种文化塑造了狱警对女囚犯健康需求的理解和反应。
