Centre for Infectious Disease Research in Zambia, PO Box 30346, Lusaka, Zambia.
James Cook University, College of Public Health, Medical and Veterinary Sciences, Townsville, QLD, 4810, Australia.
Int J Equity Health. 2018 Sep 24;17(1):74. doi: 10.1186/s12939-018-0783-3.
From 2013, the Zambian Corrections Service (ZCS) worked with partners to strengthen prison health systems and services. One component of that work led to the establishment of facility-based Prison Health Committees (PrHCs) comprising of both inmates and officers. We present findings from a nested evaluation of the impact of eight PrHCs 18 months after programme initiation.
In-depth-interviews were conducted with 11 government ministry and Zambia Corrections Service officials and 6 facility managers. Sixteen focus group discussions were convened separately with PrHC members (21 females and 51 males) and non-members (23 females and 46 males) in 8 facilities. Memos were generated from participant observation in workshops and meetings preceding and after implementation. We sought evidence of PrHC impact, refined with reference to Joshi's three domains of impact for social accountability interventions - state (represented by facility-based prison officials), society (represented here by inmates), and state-society relations (represented by inmate-prison official relations). Further analysis considered how project outcomes influenced structural dimensions of power, ability and justice relating to accountability.
Data pointed to a compelling series of short- and mid-term outcomes, with positive impact on access to, and provision of, health services across most facilities. Inmates (members and non-members) reported being empowered via a combination of improved health literacy and committee members' newly-given authority to seek official redress for complaints and concerns. Inmates and officers described committees as improving inmate-officer relations by providing a forum for information exchange and shared decision making. Contributing factors included more consistent inmate-officer communications through committee meetings, which in turn enhanced trust and co-production of solutions to health problems. Nonetheless, long-term sustainability of accountability impacts may be undermined by permanently skewed power relations, high rates of inmate (and thus committee member) turnover, variable commitment from some officers in-charge, and the anticipated need for more oversight and resources to maintain members' skills and morale.
Our study shows that PrHCs do have potential to facilitate improved social accountability in both state and societal domains and at their intersection, for an extremely vulnerable population. However, sustained and meaningful change will depend on a longer-term strategy that integrates structural reform and is delivered through meaningful cross-sectoral partnership.
从 2013 年开始，赞比亚惩教署（ZCS）与合作伙伴合作，加强监狱卫生系统和服务。该工作的一个组成部分导致成立了以囚犯和官员为成员的基于设施的监狱卫生委员会（PrHC）。我们介绍了在计划启动 18 个月后对 8 个 PrHC 影响的嵌套评估结果。
对 11 名政府部委和赞比亚惩教署官员以及 6 名设施管理人员进行了深入访谈。在 8 个设施中，分别召集了 16 次 PrHC 成员（21 名女性和 51 名男性）和非成员（23 名女性和 46 名男性）的焦点小组讨论。在实施前后的研讨会和会议之前和之后生成了参与者观察的备忘录。我们寻求了 PrHC 影响的证据，并参考乔希的社会问责干预措施的三个影响领域进行了细化-国家（由设施内的监狱官员代表），社会（由囚犯代表）和国家-社会关系（由囚犯-监狱官员关系代表）。进一步的分析考虑了项目结果如何影响与问责制相关的权力，能力和正义的结构维度。
数据指向了一系列引人注目的短期和中期结果，对大多数设施的卫生服务的获取和提供产生了积极影响。囚犯（成员和非成员）报告说，通过提高健康素养和赋予委员会成员寻求正式补救投诉和关注的新权力，他们获得了权力。囚犯和官员将委员会描述为通过提供信息交流和共同决策的论坛来改善囚犯-官员关系。促成因素包括通过委员会会议更频繁地进行囚犯-官员沟通，从而增强了信任和共同解决卫生问题的能力。尽管如此，由于永久的权力关系倾斜，囚犯（因此委员会成员）的高周转率，一些负责人的在职人员的承诺程度不一以及预期需要更多的监督和资源来维持成员的技能和士气，问责制影响的长期可持续性可能会受到破坏。
我们的研究表明，PrHC 确实有可能促进国家和社会领域以及两者之间的社会问责制的改善，对于极其脆弱的人群而言。然而，持续而有意义的变革将取决于一个长期战略，该战略将整合结构改革，并通过有意义的跨部门伙伴关系来实施。
