HEALTH ORGANIZATION REGIONAL OFFICE FOR EUROPE WELTGESUNDHEITSORGANISAT ION REGIONALBÜRO FÜR EUROPA ORGANISATION MONDIALE DE LA SANTÉ BUREAU RÉGIONAL DE L'EUROPE ВСЕМИРНАЯ ОРГАНИЗАЦИЯ ЗДРАВООХРАНЕНИЯ ЕВРОПЕЙСКОЕ РЕГИОНАЛЬНОЕ БЮРО Network Meeting for Prison and Health EUR/08/5086972 Kyiv, Ukraine 14 November 2008 17 December 2008 Summary report 1. Welcome & Introductions Dr Andrew Fraser welcomed participants to the meeting and congratulated all concerned on a successful conference the previous day. Professor Natalya Kalashnyk also welcomed participants on behalf of the Ukraine State Department for Enforcement of Sentences. 2. WHO European Network for Prison and Health: current status and ongoing activities Dr Lars Moller updated participants on progress since the Slovakia meeting. The network now has 36 active members 14 from Western Europe, 13 from Central Europe and 9 from Eastern Europe. The Health in Prisons Guide was launched in Russian in February thanks are due to AFEW for editing, the Norwegian Ministry of Health for financial support and the Netherlands Ministry of Justice for printing the book. Dr Moller reminded participants that they can translate the Guide into their own language after submitting a formal request to WHO. It is now available in English, Russian, Italian, Albanian, Chinese, Farsi and Polish. The Trencin statement on Mental Health and Prisons was launched in London in June at an event hosted by The Sainsbury Centre. This year the work of WHO HIPP has been largely focused on women s health in prisons. Dr Moller thanked Ms Brenda van den Bergh for her literature review and background paper and Dr Alex Gatherer and Mr Paul Hayton for the first draft of the declaration. He also thanked all those present at the Round Table in London in June for their valuable contributions to the drafting process. It is hoped that the declaration can be launched in early 2009. Dr Moller stressed the importance of data collection via the prison health database and reminded participants that the WHO HIPP office is happy to 1
help with any inputting problems. WHO will be reviewing the database with a view to collecting data on fewer indicators than at present and one meeting between EMCDDA and WHO has taken place. Follow-up meetings will be planned during 2009. The WHO HIPP website has had 26,000 hits during 2008. It is noted, however, that the password protected area is not used much and WHO are considering whether to set up something on SharePoint in future to encourage greater participation by Members and as a way of sharing examples of best practice and asking for advice from other Members. At this point the meeting received a visit from General Danilov from the Ukrainian International Human Rights Defence Committee. His presentation underlined the country s commitment to the work of the project, the Network, and health of women prisoners within a human rights framework. 3. HIPP Action Plan 2008-2012 Mr Paul Hayton presented the Action Plan for 2008-2012 and made the following points: The Network has developed successful methods of working, giving us many solid achievements. We are on target for most objectives for 2008 Plans for 2009 are progressing well The expert group on women s health in prison worked particularly well and should be considered as a model for future work Partnership working is the strength of our Network We can always improve do we need fresh thinking or different approaches? In summing up, Mr Hayton said that the challenge for the Network is to think about what we do and how we can do it better with fresh thinking or different approaches. Participants would have a chance to explore this issue further in the working groups that followed. General discussion on the Action Plan followed. Mr Sean Duggan (Sainsbury Centre) asked if there were any plans to assess the impact of the Trencin statement on mental health in prisons. Dr Moller said that the impact could be evaluated if all MS provide data by using the prison health database. Dr Lucia Mihailescu (Romania) suggested that all future declarations or recommendations be accompanied by cost-effectiveness studies as she felt that this would be extremely helpful when presenting plans for changes/improvements to policy makers. 2
4. Group Work Participants divided into 5 working groups to consider the following questions/issues: How can the WHO HIPP network be improved? o Assuming HIPP continues to evolve and change, what does the group think we should consider, regarding new ways of working, communicating, and supporting each other. o What major barriers to progress are MS in the group facing, and what does the group think HIPP could best do to give them support in overcoming the barriers? The Prison Health Database: o Is it important to this group that the Prison Health Database exists? Very briefly: how useful was this year s event to group members? (Not more than 5 minutes) How can we carry forward the Declaration from our Kiev conference, and how can we get action and improvements in European MS based upon it? The main points/suggestions raised by the groups were: Future conferences should allow more time for Question & Answer sessions and sharing of best practice. Recipients of Best Practice awards should give presentations on their projects at the conference. Documents from WHO are sent to Health Ministries they are not always disseminated to the appropriate people within countries. Not all countries permit the publication of sensitive data on the WHO database. The database needs to be simplified, with a reduced number of indicators. WHO HIPP should consider establishing a Best Practice section on the website. New ways of encouraging communication between stakeholders should be considered, such as a web-based information exchange. Detailed guides and protocols should be produced to operationalise conference declarations. 3
A working group should be set up to devise a set of standards for prison health. We should consider producing an educational programme for primary care nurses in prison health. We need to consider the impact of declarations and evaluate their effectiveness. Mr Hayton will circulate a paper to address the issues raised and will also circulate information about the 2009 Best Practice Awards in January 2009. 5. Results of survey on Women s Health in Prison Ms Brenda van den Bergh and Professor Morag MacDonald presented the results of a survey carried out in July 2008 to gain an overview of the health of women prisoners and the health care provided for them in Europe. Twenty seven countries responded to the survey, 24 of which were Network members. The survey looked at the availability of healthcare services, basic hygiene and family contact. The results of the survey were used to prepare the background paper and inform the declaration. A summary of the results of the survey will be made available on the password protected area of the website. A number of issues were highlighted which need further research: Location and accommodation Visits Children in prison Availability of appropriate health services Services for those with mental health problems or problematic drug use including pre-release courses and throughcare. The need for protocols Preventive health care. 6. National Presentations Presentations on women s health in prison were made by: Latvia Russian Federation Slovenia Ukraine 4
Kosovo Dr Fraser thanked the speakers for a varied and interesting session and requested that copies of their presentations be sent to the WHO office for publication on the website. 7. European Commission TAIEX project Ms Katherine Moloney presented information about a potential funding opportunity for Member States, TAIEX, Technical Assistance and Information Exchange instrument of the Directorate General Enlargement within the European Commission. The main services offered by TAIEX are: Providing beneficiary countries short-term technical assistance and advice on translating EU legislation into national legislation and how this might be applied; Providing training and peer assistance to partner organisations, including in relation to the implementation of action plans and measures. TAIEX provides tailor-made services to meet requests for assistance from beneficiary countries, and meets all costs. Assistance can include: Seminars and workshops Expert missions sending experts to beneficiary countries Study visits officials from a beneficiary country travel to an institution in one of the EU Member States Peer-based assessment missions providing technical training and peer assistance to partner organisations within beneficiary countries. For further information, and application forms go to: http://taiex.ec.europa.eu 8. HIPP Focus 2009 Blood Borne Diseases and Health Security Dr Jose Manuel Arroyo Cobo gave a presentation about health promotion initiatives around HIV/AIDS and HCV in Spanish prisons. Approximately 77% of prisoners are drug users on entry to prison in Spain, with approximately 60% being drug addicts. For some, prison is their first contact with health care programmes. During the 1990s a number of health promotion initiatives and harm reduction measures were implemented to address the increasing number of prisoners with health problems associated with drug use. 5
Dr Arroyo Cobo explained a number of the initiatives such as a very successful peer education programme which trained prisoners as health agents. HIV, HCV, HBV and syphilis testing is now offered to all prisoners. Methadone maintenance and needle exchange programmes were also introduced, with 37 prisons now having needle exchange. A number of organisational changes were also made. Spanish prisons now have primary care services similar to those available in the community and responsibility for providing those services is soon to be transferred to local public health services. The result of these interventions is a decrease year on year in the incidence of HIV and the number of AIDS and TB cases. Dr Fraser thanked Dr Arroyo Cobo for his presentation which demonstrated clear evidence of the effectiveness of the interventions described. He said that this was an excellent example of what can be achieved in prison health. Professor Kalashnyk addressed the meeting as host of the event, offered her thanks to delegates and her country s enduring commitment to the subject of the meeting. 9. Closing Remarks Dr Fraser re-iterated the importance of the issue of women s health in prisons, and commented that the interests of children were highlighted in particular by many speakers, with some examples being given of how countries are addressing this. Dr Fraser said that the WHO work on women s health in prisons, culminating in the declaration, would be extremely welcome, particularly by smaller states, and acknowledged the involvement of Quakers International, UNODC, and the Northern Dimension in publishing important work on the subject. With regard to the HIPP Network, Dr Fraser thought that the Network was full of confidence and energy and members had shown their willingness to be involved in a variety of ways, such as special interest groups. The challenge for the Network at this point is to build on its strengths, to harness the enthusiasm and expertise which exists within it, and to be more outward looking. There were also a number of learning points which the Steering Group would consider, such as the desire for a more interactive conference and finding ways of communicating more effectively. Dr Fraser thanked everyone for their participation and enthusiastic support, and again thanked our Ukrainian hosts for their hospitality and their courageous decision to host this conference. 6