Establishment and evaluation of efficiency of the treatment model for managed detainees in provincialmunicipal hospitals (2011 2012)

1 INTRODUCTION 1. Rationale The heath care and treatment for managed detainees, re-educated offenders and prisoners is our Party and State’s humane policy. It shows the preeminence of socialist government, the moral tradition of the Vietnamese and the protection of human rights for detainees. Our Party and State have institutionalized policies via legal documents released by our State, Government and Ministry of Public Security. Nowadays, Police’s heath care systems are in every prison nationwide with one hospital and 128 medical stations for managed detainee. However, Police’s medical system hasn’t got specializes centers for prisoners. Every year, State-sponsored hospitals treat and examine tens of thousands of suspects sent from prison’s nursing homes. Nevertheless, in fact, there are many difficulties and challenges in such detainees’ heath care: the education management (testimony- compromission, making suicide, escaping from hospitals, which force to use many guards) putting bad impacts on other patients’ psychology and hospital professional activities because there are not any private medical areas for prisoners. Moreover, the heath care spending for such persons paid for the hospitals is higher than standard spending. Therefore, we carry out the study on “Establishment and evaluation of efficiency of the treatment model for managed detainees in provincial/municipal hospitals (2011 – 2012)” 2. Research’s goals 1. Describe the demand, the healthcare and treatment for the managed detainees. 2. Establish, implement and fundamentally assess the efficiency of healthcare model for prisoners in provincial/municipal general hospitals (2011 – 2012). 2 3. New contribution to scientific practical meaning - The thesis assesses the demand and the reality of treatment for prisoners in infirmaries inside detaining stations and hospitals. - Establish, implement and fundamentally asses the efficiency of prisoners’ healthcare model in provincial general hospitals. 4. Outline The thesis includes 138 pages (except for the references and table of content) and 4 chapters. Rationale 02 pages Chapter 1: Over view 31 pages Chapter 2: Research objects and methods 22 pages Chapter 3: Research outcome 46 pages Chapter 4: Discussion 34 pages Conclusion 02 pages Recommendation 01 pages Chapter 1 OVERVIEW 1.1. Managed-detainees demand for healthcare and the implementation 1.1.1. Managed-detainees demand for healthcare 1.1.1.1. Concepts and terms - Re-educational and managed detainees include: all offenders and prisoners at prisons as well as students at reformatories and re- education schools. - Detention places include: prisons, reformatories and re- education schools as well as all prisons and reformatories directly under the General Police Department for Criminal Enforcement and Justice Assistance. - Disease: According to WHO definition: "Disease is a state of physical and mental imbalance in the body caused by internal or external factors". 3 - Morbidity patterns: a morbidity pattern of a society, a community, a nation is a collection of all physical and mental imbalances caused by different factors in the community, society or nation in a certain time. 1.1.1.2. The prisoners’ demand for healthcare in some countries Every country has its numerous, flexible viewpoints and implementing ways in accordance with each stage and its development context. Additionally, prisoners in some countries around the world receive medical care not only at the prison medical statio but state- running hospitals as well. 1.1.1.3. Managed-detainees demand for healthcare in Vietnam - Recently, morbidity status, managed-detainees demand for healthcare are quite high because most of them have got sick before being arrested. The rate of prisoners suffering from drug addiction, tuberculosis, HIV/AIDS, hepatitis B, C is higher than that in outside communities (about 10 to 20 times). - The most popular cause of death of managed detainee is HIV/AIDS. The second most popular cause of death is pulmonary tuberculosis. They are typical characteristic of managed detainees’ morbidity pattern. Infectious diseases always make up for a huge part in such pattern. 1.1.2. Health care for managed-detainees 1.1.2.1. Health care for managed detainees in some countries in the world Healthcare for prisoners in some countries in the world, especially in developed countries, have gained many significant achievements. Healthcare for prisoners is different in different countries in both systems and implementations. Some countries have their own prison medical system which controlled by national medical agencies. However, most of countries have done the work of disease control in first days of prisoners in prisons and prison-arising disease management. 1.1.2.2. Healthcare for the managed detainees in Vietnam 4 The Ministry of Public Security (medical stations in the schools and reformatories under the Ministry) is primarily responsible for the healthcare for managed detainees. In addition, the Ministry’s hospitals are responsible for coordinating with the medical stations in prisons in: Examination, making consulting test, prevention and treatment of all diseases for the prisoners at district and provincial levels hospitals as well as in specialized hospitals, provided in the 2010 Law of Criminal Enforcement and several Decrees by the Government. This is specific characteristic of prisons in Vietnam that the work of healthcare is carried out by medical system under People’s Public Security Forces, in comparison with some other countries, it is implemented by prison medical system (under the Ministry of Justice). 1.2. The models of healthcare for managed detainees 1.2.1. The models of healthcare for prisoners in some countries around the world The responsibility of health care for prisoners is go to prison medical system. The Heads of prisons decide the disease prevention. In Poland, Egypt…, prisoners having dangerous diseases like HIV/AIDS, hepatitis are separately detained or transferred to national infectious diseases hospitals. Some countries, like Spain, Thailand…, arrange a special area for prisoners in state-running hospital. The arrangement should be carefully calculated to meet detention as well as treatment requirements of prisoners. 1.2.2. The models of healthcare for managed detainees in Vietnam 1.2.2.1. Some relating legal documents The Law on Criminal Enforcement No. : 53/2010/QH12; Decree No.89/1998/NĐ-CP and Decree No.64/2011/NĐ; Inter- ministerial Circular No.12/TTLB; Inter-ministerial Circular No.04/2010/TTLB-BCA-BYT; Decision No.910/2004/QĐ-BCA(X13); Decision No.799/2004/QĐ-BCA (H11). 5 1.2.2.2. Medical system in prisons in Vietnam - Ministry of Defense: the Ministry of Defense directs 21 prisons and temp-prisons, 54 remand homes with the scale of 10 persons/remand homes. - Ministry of Public Security directs 70 temp-prisons, 696 remand homes; 49 prisons, 6 re-educational school and 4 reformatories. Chapter 2 RESEARCH OBJECTS AND METHODS 2.1. Objects, materials, places and time of research 2.1.1. Research objects: The models of organizing medical stations, the level of treatment for managed detainees; Leaders of Healthcare Department, the Department of Tactic of the Ministry of Public Security, Criminal Investigation Department of The Ministry of Defense, the director boards of hospitals, leaders of prisons, the heads of prison infirmaries; medical staffs of the infirmaries and hospital giving treatment for managed detainees, prisoners received healthcare at hospitals. 2.1.2. Research materials In the research process, many materials are used such as: relating legal documents, reports, figures and summaries on health management, treatment of managed detainees. 2.1.3. Research places - Practical research places: in the practically examined hospitals at provincial and municipal levels, select 6/10 hospitals to implement the model of treatment center for managed detainees and evaluate the initial results of the operations: Dien Bien, Vinh Phuc, Hai Duong, Ninh Binh, Ha Dong, Binh Thuan. 2.1.4. Research time: 4 years (from 1/2009 to 6/2012) 2.2 Research Methods 2.2.1. Research design: The research used two main research designs: 6 - Cross-sectional study combined with quantitative, qualitative and descriptive retrospective research based on secondary data - Interventional study combined with building, implementation and evaluation of the models in selected general hospital in several provinces and cities. 2.2.2. Range of objects and object selecting: 26 hospitals (10 provincial/municipal general hospitals), 05 district hospitals, 05 specialized hospitals, 06 hospitals under the Ministry of Public Security); 31 infirmaries in prisons moving managed detainees to 26 research hospitals. The range of objects for sociological investigation: 100 medical staffs working in the prisons, 60 medical staffs of the hospitals; 100 leaders of the prisons; 170 managed detainees. 2.2.3. Research Methods - Descriptive retrospective method: the synthesis of health care for prisoners in recent years. - Cross-sectional descriptive method: A survey to describe practical issues related to research content. - Sociological method: Interviews 100 medical staffs working at the prison infirmaries and 60 medical staffs of the research hospitals; 100 leaders of prisons; 170 managed detainees. Consulting experts in scientific conference. - Methods of logic. - Methods of intervention. 2.2.4. The research variables and criterion for assessment Reality of health care for managed detainees (2009-2010): The number of managed detainees received health care, died, morbidity structures in infirmaries, hospitals; the number of managed detainees who were moved to hospitals… 2.2.5. Measures to control error: Designing a sufficient toolkit, encrypting votes, training investigators, checking votes before handling 2.2.6. Methods to handle research data: The data were handled by the medical statistics software such as Epiinfor 6.04, Excel. 2.2.7. Research morality 7 - This is a research about the structure on the treatment facility model for managed detainees in hospital. The process and result of research do not affect to the tasks, activities of the close-settings, hospitals as well as the psychology, health of the managed detainees, medical staffs of close-settings and hospitals, leaders of close-settings. - The interviewees participated in a voluntary way and the information collecting from individuals only used in research purpose, encrypted on computer and kept secret. 2.2.8. Research structure and participants Such topic is in the guidelines of the Party and State, Ministry of Public Security of Vietnam as well as is the office's task. In the process of implementation, such topic was supported and facilitated by the close-settings, hospitals as well as the staffs who are working in close- settings and hospitals. The postgraduate is responsible for such topic. 2.2.9. Limitations of topic - Due to conducting in different places, such topic did not have exploration with experts. - Interviewers involving such topic include the staffs of managed detainees, the medical staffs of close-settings as well as the leaders of close-settings, medical staffs and hospitals. The assessment ideas are mainly based on subjective opinions of each individual, thus the reliability of the opinions is limited. Chapter 3 RESEARCH OUTCOME 3.1. The demand scenario and health care service for the managed detainees (2009 - 2010) 3.1.1. The managed detainees’ demand scenario of health care (2009 - 2010) * Research on infirmary of 31 close-settings: - Currently, only detention camp bloc does not have special areas, meanwhile the prison has special area; the close-settings and reformatories have special areas: in term of prison bloc, there are 64 special areas/15 prisons; in term of close-setting bloc, there are 4 special areas/ 2 close-settings. In term of reformatory bloc, there are 2 special areas/ 1reformatory. The total number of medical staffs in close- 8 settings is 395 people including 78 doctors, 32 university pharmacists and the others are different majorities. - The following is assessment of close-settings’ leaders on medical staff scenario in close-setting infirmary: regarding insufficient facilities: the prison bloc accounts for 57.78%; the reformatory bloc accounts for 60%; the close-setting and reformatory bloc account for 46.67%: regarding sufficient facilities: the prison bloc accounts for 42.22%; the reformatory bloc accounts for 4%; the close-setting and reformatory bloc account for 53.33%. - The following is assessment of close-settings’ leaders on medical equipment quality: regarding good quality and sufficient requirements: the prison bloc accounts for 68.89%; the reformatory bloc accounts for 80%; the close-setting and reformatory bloc account for 46.67 %: regarding poor quality and insufficient requirements: the prison bloc accounts for 31.11%; the reformatory bloc accounts for 20%; the close-setting and reformatory bloc account for 53.33%. - The assessment of infrastructure in close-setting infirmary is as follow: regarding good quality and sufficient requirements: the prison bloc accounts for 77.78%; the reformatory bloc accounts for 65%; the close-setting and reformatory bloc account for 46.67%: regarding poor condition and insufficient requirements: the prison bloc account for 22.22%; the reformatory bloc accounts for 35%; the close-setting and reformatory bloc account for 53.33%. Times of outpatient, medicine supply and treatment for managed detainees in prison infirmaries have increased significantly for the past years. The disease pattern is as follow: regarding prison bloc: tuberculosis patient rate: 2009: 5.1%, 2010: 5.32%; HIV carrier rate: 2009: 7.1%, 2010: 6.8%; regarding reformatory bloc: tuberculosis patient rate: 2009: 7.21%, 2010: 7.14%; HIV carrier rate: 2009: 6.98%, 2010:5.98%. * Research on 26 hospitals: The total number of patient’s bed reserving for managed detainees in hospital is 497/8780 (making up 5.66%). 9 Accordingly, each of the Police Hospital spent about 20-24 beds; the Municipal/Provincial hospital spent about 22-24 beds, the District Hospital spent about 10-12 beds to treat for managed detainees. Under the technical level regulation of Ministry of Health: 80.7% of research hospitals are capable of diagnosis and treatment, 19.3% of research hospitals are incapable of diagnosis and treatment, so such hospitals have to sent patients to higher levels. - The rate of research hospital is capable of basic test to meet the requirements of diagnosis and treatment: Police Hospitals, Provincial/Municipal Hospitals and Departments: 100%; District hospitals: 60%. The rate of research hospital has laboratories for HIV test: Police Hospitals: 16.67%; Provincial/Municipal Hospitals and Departments: 53.33%. Such hospitals arranged 184 rooms with 497 patient’s beds and 65 isolation rooms. The 22/26 hospitals implemented in line with process 1, the rest was in line with process 2. - The total times of outpatient in hospital for 2 years from 2009 to 2010 was as follow: 67,137 times of patient; the total patients receiving treatment: 8,364 times; the total death: 886 people. The rate of tuberculosis patients increased over 2 years: 2009: 18.4 % and 2010: 23.71 %. The rate of HIV infected patients also increased over 2 years: 2009: 48.16% and 2010: 51.76%. Such rates are quite same in hospital levels. * In response to demand, health care service scenario for managed detainees: the health care demand of managed detainees in prison infirmaries and hospitals is very high. The disease patterns of managed detainees are mainly dangerous infectious diseases such as HIV/AIDS, tuberculosis and hepatitis The scenario of health care for managed detainees is still limited. The health care service for such objects in the hospitals has not concrete and united regulations. 3.1.2. Health care service for managed detainees (2009 - 2010) Despite of having no specific documents of health care service for managed detainees in hospital, the close-settings have still sent 10 prisoners to the State’s hospitals in area for treatment and examination. 100% of close-settings have infirmary for health care service for managed detainees. 100% of prison, close-setting and detention camp have special areas; 58.06% close-settings have special area. 3.2 Design, implementation and initial assessment of treatment facility model for managed detainees in Provincial General Hospital (2011-2012) 3.2.1. Propose treatment facility model for managed detainees in Provincial/Municipal General Hospital 3.2.1.1. Base on regulations and principles to propose model * Regarding regulations: The health care demand for managed detainees; the related legal documents; The inter-ministerial Circular No.04/2010/TTLB-BCA-BYT dated Aug 9/2010; The current demands in the area; The organization system of health care branch; The area of land reserving for treatment in hospitals; The detention tactics workings. * Regarding principles: the Police, Military Hospitals and civil medical service have to arrange special rooms for managed detainees in hospital; it is necessary to build a common treatment ward for managed detainees in hospital and a close-setting is responsible for management when there are a lot of close-settings in an area; It is necessary to build a private treatment ward for managed detainees in hospital when there is only one close-setting; It is essential to build particular treatment rooms, wards for managed detainees in Provincial/Municipal General Hospitals as well as several specialized hospitals, hospitals in district level; On the basis of the fact of each hospitals, the hospitals reserve treatment wards for managed detainees in an effective and united model; If the hospitals do not arrange construction land, they will create own units to treat for managed detainees; it is important to arrange the rooms in treatment ward such as: superintendent room, visitation room, male patient room, female patient room, infection room, treatment ward for offenders in reformatory; The hospitals arrange the construction [...]... wards, rooms for managed detainees are the beds of hospital; The medical staffs of hospitals treating for managed detainees in private wards, rooms of hospital need to have special subsidization 3.2.1.2 Functions and tasks of treatment ward reserving for managed detainees * In term of treatment function for managed detainees: The treatment ward has to ensure the health care service in line with specialty... care, initial medical treatment, epidemic prevention and other medical services 4.2 Establishing, deploying and initially reviewing effectively the treatment facilities model for the managed detainees in province hospitals (2011 - 2012) 4.2.1 Recommending treatment facilities model specialized for the managed detainees at city/province general hospital Building this model should follow below principles... – 2010) The demands for treatment to prisoners is very high and the number of prisoners in clinics and hospitals is increasing anually In clinics: the number in 2009 is 581.583 and that of 2010 is 660,046 In hospitals: the number in 2009 is 22,603 and that of 2010 is 25,284 The number of dead prisoners in hospitals in 2009 – 2010 is 886 people The popular diseases in these situations is mainly tuberculosis... while they are in hospitals The real fee to the hospitals including beds, techniques, tablets and medicals for treatments equipped by the Ministry of Public Security is equal to the usual regulated costs Therefore, the addition of beds in the treatment ward can reduce the payment of prisoners This can show the necessity of the building the treatment ward for prisoners, policies for health staffs, standards... organizational model on clinic for managed, detained objects in municipal/ provincial hospitals 3.2.3.1 Outcome of the first step of the organizational model on clinic for managed detainees in 6 municipal/ provincial hospitals Up to June 2012, there have 86/129 prisons, including: the prison bloc has 40/70 in Municipal/ Provincial General Hospitals; close-setting bloc has 46/59 in Municipal/ Provincial General Hospitals. .. standards of beds and eating modes due to the diseases for prisoners 4.2.3.2 Assessments on the operating treatment areas in Ninh Binh Province’s General hospital and Ha Dong City’s General hospital In Ninh Binh Province’s General hospital: this is the basic model that appropriates to the hospital having the space for building the model of 2 storey treatment ward In the one of Ha Dong City, the organization... rooms Therefore, managed detainees still fled away during the treatment in hospitals (8 subjects from 2011 to 2012) 13 In 2012, according to the prisons’ report, of the 1,896 beds, 1,065 infirmary beds are in the prisons, re-education centres, reformatories and 831 infirmary beds are in detention centers with 301 treatment rooms in the infirmary The total number of medical visits, medicines supply for managed. .. have the hospital at the final level for the prisoners 2 Building, operating and initially assessing the effectiveness of treatment modes for the prisoners in provincial/municipal general hospitals (2011 – 2012) Models: the treatment ward or unit includes 6 rooms (meeting room, room for police staff, man room, woman room, infectious room and room for prisoners) The cooperation between hospitals and. .. At the infirmary numbered 31 in prison: the health care system of the Ministry of Public Security for all managed detainees only stop at the prison infirmary level, currently has only 01 hospital for specifically treatment for managed detainees, it is Chi Hoa hospital, serving only the Ho Chi Minh Police Department’s prison with 120 patient’s beds, no final line to treat the managed detainees Therefore,... and 98-163 beds 4.2.3 The effectiveness of the model treatment for managed, detained prisoners in municipal/provincial general hospital 4.2.3.1 The initial effectiveness of the organization model on clinic for detained prisoners in 06 provincial/city multiple department hospital In the 6 hospitals operating the model, 03 ones have built the own treatment ward for prisoners; the 3 others do not have enough . than standard spending. Therefore, we carry out the study on Establishment and evaluation of efficiency of the treatment model for managed detainees in provincial/municipal hospitals (2011 – 2012) 2 implementation and initial assessment of treatment facility model for managed detainees in Provincial General Hospital (2011- 2012) 3.2.1. Propose treatment facility model for managed detainees in Provincial/Municipal. Functions and tasks of treatment ward reserving for managed detainees * In term of treatment function for managed detainees: The treatment ward has to ensure the health care service in line with specialty