Evaluation of an intervention to decrease delays in external health care delivery to prisoners in a correctional facility in Lebanon Public Deposited

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  • March 20, 2019
  • El Takach, Habib
    • Affiliation: Gillings School of Global Public Health, Department of Health Policy and Management
  • Health care delivery in prisons is not similar to that in an open community. Constraints exist which may jeopardize the capacity of in-house physicians to provide quality care, or the timely delivery to prisoners of care needed outside. Obstacles to delivery of adequate care to prisoners in the specific context of the Roumieh incarceration center in Lebanon have been identified through an analysis of the current functioning of that system. The purpose of this study was to evaluate an intervention that aimed at decreasing delays in external health care delivery to prisoners at Roumieh. The delay time had usually been from 2 to 4 weeks, a period perceived to be deleterious for the well-being of prisoners. This study aims at evaluating the reform in terms of shortening the delays without inducing fictitious demands for care. Ultimately, shorter transfer delays will impact positively on prisoners' health, thus, fulfilling the moral mandate of a correctional system towards all incarcerated persons. The study followed a before-after design. Two indicators: 1) the timeliness of transfer, and 2) the number of requests for external health care were measured for transferring patient prisoners to an external health care provider before and after the implementation of the reform. The indicators were collected during a period of 18 months starting November 1st, 2007 and ending May 30th, 2009. External health care requests in the month of August 2008 during which the new policy was implemented were excluded from the data analysis. Furthermore, the evaluation of the intervention was only based on the analysis of non-urgent cases. Upon the implementation of the reform, the delay between the problem report and approval of requested medical services has shortened for all types of healthcare needs (radiology, laboratory, and hospitalization). However, the intervention did not yield the shortened delay expected between problem report and administrative request for all types of healthcare needs. Furthermore, the delay between the realization of healthcare services and reporting results to the polyclinic from the external health care provider has shortened for radiology unlike laboratory, and the delay between the administrative request approval for hospitalization and admission has shortened. Although the reform targeted shortening delay across all external health care needs, the implementation yielded unexpected administrative consequences such as an increase in the frequency of requests for outside transfers. Upon the implementation of the reform, the total number of requests has increased for laboratory and radiology investigations but has decreased for hospitalization. This study has also evaluated whether there was evidence of discrimination based on age, duration of incarceration, education, or type of disease following the implementation of the reform and who benefited more from the reduction in waiting time for external care services. This study found no evidence of discrimination in delaying health services or requesting health services based on nationality, educational attainment, age, unit or duration of incarceration. The implementation of the reform had a direct impact not only on the welfare of prisoners but also on the system of delivery of health care services in prisons. Planned administrative reforms are rare in Lebanon, and when they are initiated, they often fail to reach their goals. Failure of administrative reforms is even more pronounced in military structures such as the ISF administration in particular in the administration of prisons in Lebanon. These structures are notoriously more rigid than civilian public administrations, and the chain of command is strictly adhered to, which may discourage any budding attempt at change. That the command approved and supported this particular change is a clear indication of a new direction decided by the ISF in favor of improving the living conditions of prisoners and upholding their basic human rights.
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  • "... in partial fulfillment of the requirements for the degree of Doctor of Public Health in the Department of Health Policy and Management, Gillings School of Global Public Health."
  • Paul, John
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  • Chapel Hill, NC
  • Open access

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