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

Research objects: The models of organizing medical stations, the level of treatment for managed detainees; Leaders of HealthcareDepartment, the Department of Tactic of the Ministry of Pu

1 Rationale

The heath care and treatment for managed detainees, re-educatedoffenders and prisoners is our Party and State’s humane policy It showsthe preeminence of socialist government, the moral tradition of theVietnamese and the protection of human rights for detainees Our Partyand State have institutionalized policies via legal documents released byour State, Government and Ministry of Public Security

Nowadays, Police’s heath care systems are in every prisonnationwide with one hospital and 128 medical stations for manageddetainee However, Police’s medical system hasn’t got specializescenters for prisoners Every year, State-sponsored hospitals treat andexamine tens of thousands of suspects sent from prison’s nursinghomes Nevertheless, in fact, there are many difficulties and challenges

in such detainees’ heath care: the education management compromission, making suicide, escaping from hospitals, which force

(testimony-to use many guards) putting bad impacts on other patients’ psychologyand hospital professional activities because there are not any privatemedical areas for prisoners Moreover, the heath care spending for suchpersons 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)”

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 ofprisoners’ healthcare model in provincial general hospitals

4 Outline

The thesis includes 138 pages (except for the references andtable of content) and 4 chapters

Chapter 2: Research objects and methods 22 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 offendersand prisoners at prisons as well as students at reformatories and re-education schools

- Detention places include: prisons, reformatories and education schools as well as all prisons and reformatories directly underthe General Police Department for Criminal Enforcement and JusticeAssistance

re Disease: According to WHO definition: "Disease is a state ofphysical and mental imbalance in the body caused by internal orexternal factors"

- Morbidity patterns: a morbidity pattern of a society, acommunity, a nation is a collection of all physical and mentalimbalances caused by different factors in the community, society ornation in a certain time.

1.1.1.2 The prisoners’ demand for healthcare in some countries

Every country has its numerous, flexible viewpoints andimplementing ways in accordance with each stage and its developmentcontext Additionally, prisoners in some countries around the worldreceive 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 forhealthcare are quite high because most of them have got sick beforebeing arrested The rate of prisoners suffering from drug addiction,tuberculosis, HIV/AIDS, hepatitis B, C is higher than that in outsidecommunities (about 10 to 20 times)

- The most popular cause of death of managed detainee isHIV/AIDS The second most popular cause of death is pulmonarytuberculosis They are typical characteristic of managed detainees’morbidity pattern Infectious diseases always make up for a huge part insuch 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 significantachievements Healthcare for prisoners is different in different countries

in both systems and implementations Some countries have their ownprison medical system which controlled by national medical agencies.However, most of countries have done the work of disease control infirst days of prisoners in prisons and prison-arising diseasemanagement

1.1.2.2 Healthcare for the managed detainees in Vietnam

The Ministry of Public Security (medical stations in the schoolsand reformatories under the Ministry) is primarily responsible for thehealthcare for managed detainees In addition, the Ministry’s hospitalsare responsible for coordinating with the medical stations in prisons in:Examination, making consulting test, prevention and treatment of alldiseases for the prisoners at district and provincial levels hospitals aswell as in specialized hospitals, provided in the 2010 Law of CriminalEnforcement and several Decrees by the Government This is specificcharacteristic of prisons in Vietnam that the work of healthcare iscarried out by medical system under People’s Public Security Forces, incomparison with some other countries, it is implemented by prisonmedical 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 prisonmedical system The Heads of prisons decide the disease prevention InPoland, Egypt…, prisoners having dangerous diseases like HIV/AIDS,hepatitis are separately detained or transferred to national infectiousdiseases hospitals Some countries, like Spain, Thailand…, arrange aspecial area for prisoners in state-running hospital The arrangementshould be carefully calculated to meet detention as well as treatmentrequirements 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 CircularNo.04/2010/TTLB-BCA-BYT; Decision No.910/2004/QĐ-BCA(X13);Decision No.799/2004/QĐ-BCA (H11)

1.2.2.2 Medical system in prisons in Vietnam

- Ministry of Defense: the Ministry of Defense directs 21prisons and temp-prisons, 54 remand homes with the scale of 10persons/remand homes

- Ministry of Public Security directs 70 temp-prisons, 696remand 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 HealthcareDepartment, the Department of Tactic of the Ministry of PublicSecurity, Criminal Investigation Department of The Ministry ofDefense, the director boards of hospitals, leaders of prisons, the heads

of prison infirmaries; medical staffs of the infirmaries and hospitalgiving treatment for managed detainees, prisoners received healthcare athospitals

2.1.2 Research materials

In the research process, many materials are used such as:relating legal documents, reports, figures and summaries on healthmanagement, 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 implementthe model of treatment center for managed detainees and evaluate theinitial results of the operations: Dien Bien, Vinh Phuc, Hai Duong, NinhBinh, 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:

- Cross-sectional study combined with quantitative, qualitativeand descriptive retrospective research based on secondary data

- Interventional study combined with building, implementationand evaluation of the models in selected general hospital in severalprovinces and cities

2.2.2 Range of objects and object selecting: 26 hospitals (10

provincial/municipal general hospitals), 05 district hospitals, 05specialized hospitals, 06 hospitals under the Ministry of PublicSecurity); 31 infirmaries in prisons moving managed detainees to 26research hospitals

The range of objects for sociological investigation: 100 medicalstaffs working in the prisons, 60 medical staffs of the hospitals; 100leaders of the prisons; 170 managed detainees

- 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 inscientific 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 ininfirmaries, hospitals; the number of managed detainees who weremoved to hospitals…

2.2.5 Measures to control error: Designing a sufficient toolkit,

encrypting votes, training investigators, checking votes beforehandling

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

- This is a research about the structure on the treatment facilitymodel for managed detainees in hospital The process and result of research donot affect to the tasks, activities of the close-settings, hospitals as well as thepsychology, health of the managed detainees, medical staffs of close-settingsand hospitals, leaders of close-settings.

- The interviewees participated in a voluntary way and theinformation 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 ofPublic Security of Vietnam as well as is the office's task In the process

of implementation, such topic was supported and facilitated by theclose-settings, hospitals as well as the staffs who are working in close-settings and hospitals The postgraduate is responsible for such topic

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 specialareas, meanwhile the prison has special area; the close-settings andreformatories have special areas: in term of prison bloc, there are 64special areas/15 prisons; in term of close-setting bloc, there are 4special areas/ 2 close-settings In term of reformatory bloc, there are 2special areas/ 1reformatory The total number of medical staffs in close-

settings is 395 people including 78 doctors, 32 university pharmacistsand the others are different majorities.

- The following is assessment of close-settings’ leaders onmedical staff scenario in close-setting infirmary: regarding insufficientfacilities: the prison bloc accounts for 57.78%; the reformatory blocaccounts for 60%; the close-setting and reformatory bloc account for46.67%: regarding sufficient facilities: the prison bloc accounts for42.22%; the reformatory bloc accounts for 4%; the close-setting andreformatory bloc account for 53.33%

- The following is assessment of close-settings’ leaders onmedical equipment quality: regarding good quality and sufficientrequirements: the prison bloc accounts for 68.89%; the reformatory blocaccounts for 80%; the close-setting and reformatory bloc account for46.67 %: regarding poor quality and insufficient requirements: theprison bloc accounts for 31.11%; the reformatory bloc accounts for20%; the close-setting and reformatory bloc account for 53.33%

- The assessment of infrastructure in close-setting infirmary is asfollow: regarding good quality and sufficient requirements: the prisonbloc accounts for 77.78%; the reformatory bloc accounts for 65%; theclose-setting and reformatory bloc account for 46.67%: regarding poorcondition and insufficient requirements: the prison bloc account for22.22%; the reformatory bloc accounts for 35%; the close-setting andreformatory bloc account for 53.33%

Times of outpatient, medicine supply and treatment for manageddetainees in prison infirmaries have increased significantly for the pastyears 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: tuberculosispatient 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 bedreserving for managed detainees in hospital is 497/8780 (making up5.66%)

Accordingly, each of the Police Hospital spent about 20-24 beds; theMunicipal/Provincial hospital spent about 22-24 beds, the DistrictHospital spent about 10-12 beds to treat for managed detainees Underthe technical level regulation of Ministry of Health: 80.7% of researchhospitals are capable of diagnosis and treatment, 19.3% of researchhospitals are incapable of diagnosis and treatment, so such hospitalshave to sent patients to higher levels.

- The rate of research hospital is capable of basic test to meet therequirements of diagnosis and treatment: Police Hospitals,Provincial/Municipal Hospitals and Departments: 100%; Districthospitals: 60% The rate of research hospital has laboratories for HIV test:Police Hospitals: 16.67%; Provincial/Municipal Hospitals andDepartments: 53.33% Such hospitals arranged 184 rooms with 497patient’s beds and 65 isolation rooms The 22/26 hospitals implemented inline 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 patientsreceiving treatment: 8,364 times; the total death: 886 people The rate oftuberculosis 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 hospitallevels

* In response to demand, health care service scenario formanaged detainees: the health care demand of managed detainees inprison infirmaries and hospitals is very high The disease patterns ofmanaged detainees are mainly dangerous infectious diseases such asHIV/AIDS, tuberculosis and hepatitis The scenario of health care formanaged detainees is still limited The health care service for suchobjects 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 formanaged detainees in hospital, the close-settings have still sent

prisoners to the State’s hospitals in area for treatment and examination.100% of close-settings have infirmary for health care service formanaged detainees 100% of prison, close-setting and detention camphave 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 manageddetainees; the related legal documents; The inter-ministerial CircularNo.04/2010/TTLB-BCA-BYT dated Aug 9/2010; The current demands

in the area; The organization system of health care branch; The area ofland reserving for treatment in hospitals; The detention tacticsworkings

* Regarding principles: the Police, Military Hospitals and civilmedical service have to arrange special rooms for managed detainees inhospital; it is necessary to build a common treatment ward for manageddetainees in hospital and a close-setting is responsible for managementwhen 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 treatmentrooms, wards for managed detainees in Provincial/Municipal GeneralHospitals as well as several specialized hospitals, hospitals in districtlevel; On the basis of the fact of each hospitals, the hospitals reservetreatment wards for managed detainees in an effective and unitedmodel; If the hospitals do not arrange construction land, they will createown units to treat for managed detainees; it is important to arrange therooms in treatment ward such as: superintendent room, visitation room,male patient room, female patient room, infection room, treatment wardfor offenders in reformatory; The hospitals arrange the construction

land to build particular treatment wards, rooms for managed detaineesaccording to legal regulations on detention; It is crucial to set up a legallobby namely inter-ministerial Circular of Health care – Public security– Defense – Finance on the civilian hospitals and military hospitalsparticipating health care service for managed detainees in assigned area;The patient’s beds in private treatment wards, rooms for manageddetainees are the beds of hospital; The medical staffs of hospitalstreating 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: Thetreatment ward has to ensure the health care service in line withspecialty requirements especially the dangerous infectious diseases such

as tuberculosis, HIV/AIDS as the same time, the activity of suchward does not affect to overall operation of the hospital

* In term of performance function of detention managementtactics: Assured detention management tactics avoid the offenders’escape, information provision and suicide…

* In coordination with hospitals: Such ward does theadministrative procedures, hospital expenditures; send patients to higherlevel; improves the nutrient regimen in line with each patient’s disease

as well as has close coordination in treatment with higher levels formanaged detainees

3.2.1.3 Structure, staff and arrangement of models

- Name of model:

+ In term of the hospital having treatment own unit ward formanaged detainees:

PATIENT TREATMENT AREA

(Prison A - Detention camp B)

+ In term of the hospital having particular treatment room formanaged detainees:

PATIENT TREATMENT ROOM

(Detention camp A)

- Staff structure: The structure, staff of particular treatment wardbased on: task and technical profession decentralization for particulartreatment ward; the scenario of structure and manpower in hospital; thenumber of managed detainees receiving treatment in hospitals; thesituation of epidemic, disease patterns and detention tacticscharacteristics

- Equipment: Medical equipment, orderly instruments, weapons,support tools and other necessary equipment

-Treatment Process: Process 1 (Medical staffs of the related

departments come to the treatment wards, rooms for managed detaineesonly to treat and implement specialized techniques)

- The coordination between hospitals and prisons: Based on theopinion of medical staffs of prisons and hospitals, proposing regulations

on coordination between hospitals and prisons including reponsiblecontract, regular consultation and handover each 6 months betweenhospitals and prisons

3.2.2 Deploy organizational model on clinic for managed, detained objects in several municipal/ provincial general hospitals

3.2.2.1 Promulgate Interministrial Circular of the Ministry of Public Security and the Ministry of Health

According to the Interministrial Circular No.: BCA-BYT dated 09/8/2010 of the Ministry of Public Security-theMinistry of Health which guidelines prisoners, students at State healthfacilities and according to the regulations of the Ministry of PublicSecurity, the managed detainees, who get serious, fatal diseases, will betransferred to the High level State hospitals, but these situtations have notbeen met in recent years due to lack of expense to construct hospital rooms.Therefore, managed detainees still fled away during the treatment inhospitals (8 subjects from 2011 to 2012)