Assessment of Factors Influencing Access to Quality Healthcare among Inmates at the James Camp Male Prisons, Greater Accra

Abstract

Background: In Ghana, the incarceration rate is estimated at 48/100,000 and rising. The health of the Prisoner is known to have enormous public health significance but appears to be of poorer quality globally due to unhealthy prison conditions and prisoner characteristics. Objective: This study was done to examine factors influencing access to quality healthcare by Inmates of the James Camp Male Prisons. Methods: A mixed methods approach was applied to collect data. A structured quantitative questionnaire was used to obtain information from two hundred prisoners using a total population sampling to select participating prisoners. Qualitative interviews were conducted with purposively selected health providers and administrators, including an observational checklist at the health facility. Chi square test was used to analyse the quantitative data. A level of significance was set at p<0.05. Qualitative interview data was analysed using Framework analysis and themes were developed for the discussion. Quantitative Results: Overall, access to healthcare was rated poor to moderate with the greatest barrier to access being affordability of health services. Logistic Regression analysis conducted at 95% Confidence interval showed that apart from religion (p= 0.039), no other client/prisoner factors were found to have an influence on the inmate’s access to health. Gap analysis was done between inmate expectations and perceptions of health provider factors to determine quality. There was an overall negative gap due to expectations exceeding the perception (1.24). The greatest gap was in the responsiveness dimension (1.46) with the lowest gap in the tangibles dimension (1.09). Health system factors such as inadequate funding for health services, lack of skilled personnel and a paucity of essential medical supplies and drugs negatively affected the quality of healthcare provided to inmates. Qualitative Findings: The qualitative findings indicated that overall access to healthcare by inmates was poor due the following: unavailability of adequate health facilities in the prison, incomplete use of medical examination and health certificates, poor medical records system, lack of skilled health personnel, inadequate supply of medical equipment, supplies and drugs, problems with referrals and external reviews, and selective remuneration and welfare packages for health workers due to administrative structure of the prison service. The national health insurance scheme was the financing options for prisoners’ access to free health care.