research and development effectiveness evaluation model grassroots organization dedicated to the treatment of prisoners in hospitals some provinces - cities 2011-2012

However, the actual medical examination andtreatment for inmates at the hospital still faces many difficulties andshortcomings, such as management, custody information provision,suicide,

1 Urgency of PhD thesis

The management of health, health care, medical treatment forprisoners is a humanitarian policies of the Party and State Thisshows the superiority of the Vietnamese socialist state, the moraltradition of Vietnam and ensure the human rights of prisoners Partyand State have been institutionalized through the point of view of thesystem of the State, the Government and the Ministry of PublicSecurity

Currently, the health system has been deployed to police all theprisons in the country with 01 hospitals and 128 clinics forexamination and treatment of prisoners However, no medical policelast line to treat prisoners Every year, the state hospitals to medicaltreatment, regular checks for tens of thousands of prisoners by prisoninfirmary moved to However, the actual medical examination andtreatment for inmates at the hospital still faces many difficulties andshortcomings, such as management, custody (information provision,suicide, escape from the hospital, to more manpower to guard),affects the psychology of the other patients are treated by generalhospitals and specialized activities of the hospital has not been builtexclusively for the treatment of prisoners On the other hand, fundinghealth care and treatment for prison inmates that the direct payment

to hospitals is higher than specified Therefore, we conducted a

research topic: "Research and development effectiveness evaluation model grassroots organization dedicated to the treatment of prisoners in hospitals some provinces/cities (2011- 2012)”

2 Objectives of the study

1 Describe the situation and needs medical organizations, medical treatment for prisoners (2009-2010).

2 Develop, implement and evaluate the effectiveness of initial organizational model treatment facility for inmates in provincial general hospital (2011-2012).

3 New contributions to scientific practice of doctoral PhD thesis

- Thesis assess the situation and needs of organization healthcare and treatment for inmates at the prison clinic and hospital

- Develop, implement and evaluate the effectiveness of initialorganizational model treatment facility for inmates in provincialhospitals

4 Dissertation Layout

The dissertation consists of 127 pages (not includingreferences, appendices), the structure of 4 chapters:

Chapter 1 OVERVIEW 1.1 Demand and medical institutions, medical treatment of inmates

1.1.1 Demand for medical examination and treatment of prisoners

1.1.1.1 Some concepts and terminology

- Prisoners include detainees in detention centers, home detention,prisoners in the prisons, detention camps, campers facilities andstudent education reform schools

- Detention facilities include: Detention, detention centers,educational institutions, reformatories and detention The Prisons,detention centers, educational institutions, reform schools by theGeneral Department of Police Enforcement and Criminal JusticeSupport, Ministry of Public Security to directly manage

- Disease : According to the WHO definition: "Disease is theimbalance in the body and spirit under the influence of a range ofexternal factors and internal environment on the humanenvironment."

- Disease model: A model of social illness, a community, a nationthat would be a set of all the imbalances in the body and spirit underthe influence of these factors appear in different communities,societies, countries that in a certain period of time

1.1.1.2 Demand for medical examination and treatment of prisoners

in some countries in the world

So far, in every country there are concepts, how diverse,

flexible to suit each stage, the development context of the country.Inmates in countries around the world in addition to medicalexamination and treatment at the prison medical facility is in need ofmedical examination and treatment at the state hospital.

1.1.1.3 Demand for medical examination and treatment of prisoners

in Vietnam

- In recent years, morbidity, medical needs and treatment of prisoners

is very large Due to ill inmates from being caught in the community,particularly the rate of drug addiction, tuberculosis, HIV/AIDS andhepatitis B, C are very high compared to the community (about 10-

20 times)

- Causes of death in prison is mainly due to HIV/AIDS The maincause of death was tuberculosis 2 This is one of the characteristics ofthe disease model prisoner Infectious diseases are major proportion

of the morbidity of prisoners

1.1.2 The medical examination and treatment for prisoners

1.1.2.1 The medical examination and treatment for offenders in some countries in the world

Health care for prisoners in several countries around theworld, especially the developed countries have achieved significantaccomplishments Health care for prisoners in different countries,while others have held the prison health care system, but primarilydue to the state health sector undertaken and implemented methodsalso vary but mainly on management illness while in prison andmanage new epidemics arise from inmates in prison

1.1.2.2 The medical examination and treatment for prisoners in Vietnam

Responsibility for the medical examination and treatment forprisoners firstly by the Ministry of Public Security (the prisoninfirmary) assumed, the medical establishments of the Ministry ofHealth is responsible for coordination with the Health Ministryprison police: Physicals, examination assessment, prevention andtreatment for inmates at the hospital from district to provincial andspecialty hospitals are defined in criminal Law Enforcement in 2010and the Decree of the Government This is specific to the prison inVietnam, the medical examination and treatment by the medicalsystem police assume, in addition to a number of countries aroundthe world, medical examination and treatment for the inmates byprison medical assumed (Department of Justice)

1.2 The organizational model treatment facility for prisoners

1.2.1 The organizational model for the treatment of prisoners in several countries around the world

Medical examinations and treatment for inmates by prisonmedical assumed Disease prevention and disease prevention by thePrison Director decision Some dangerous diseases such asHIV/AIDS, hepatitis separate detention were transferred to hospitals

or infectious state such treatment in Poland, Egypt Some countrieshave organized arrangements for the treatment reserved for inmates

in state hospitals such as Spain, Thailand the layout is now suitable

to guarantee professional requirements and discover detention,treatment for offenders

1.2.2 The organizational model for the treatment of prisoners in Vietnam

1.2.2.1 Some legal documents related

Law enforcement Criminal: 53/2010/QH12 and Decree No.89/1998/ND-CP and Decree No.: 64/2011/ND; Joint Circular No 12/TTLB ; Joint Circular No 04/2010/TTLB-BCA-BYT , Decision No.:910/2004/QD-BCA (X13), Decision No.: 799/2004/QD-BCA (H11)

1.2.2.2 System organization of prison health care in Vietnam

- Department of Defense: Currently, the Ministry of Defencemanaged 21 prisons, detention houses 54 scale: 10/remand homes

- The Ministry of Public Security has 70 detention centers , 696 homedetention, jail 49 6 and 4 educational institutions reformatories

Chapter 2 SUBJECTS AND METHODS

2.1 Subjects, materials, location and duration of study

2.1.1 Study subjects: The organizational model treatment

facility, treatment services for prisoners; Leaders and HealthAdministration, the Bureau of the Ministry of Public SecurityBusiness, Criminal Investigation Department of the Ministry ofDefense; the Board of Directors of the hospital, the prison leadership,staff leadership of the prison infirmary, medical staff of the prisoninfirmary and hospital participated examination and treatment forprisoners, the inmate medical examination and treatment at thehospital

2.1.2 Material Research

In the research process using many materials such as legaldocuments relevant reports, data and documentation of the healthmanagement, health care, medical treatment for prisoners

2.1.3 Study sites

- Location of study situation: At 10 hospitals provinces/cities; 5district hospitals, 5 specialized hospitals; 6 police hospital; 31 prisons(13 detention centers, 15 prisons, 02 educational institutions,reformatories 01)

- Location of deployment models: From the hospital province/cityhas investigated the situation, choose 6/10 to the hospital deploymentmodel grassroots organization dedicated to the treatment of prisonersand evaluation initial performance: Dien Bien, Vinh Phuc, HaiDuong, Ninh Binh, Ha Dong, Binh Thuan

2.1.4 Time study: 4 year study period (from 1/2009 to 6/ 2012)

2.2 Research methodology

2.2.1 Study design: Thread 2 uses the research design:

- Cross-sectional descriptive study combined quantitative research,qualitative and descriptive retrospective based on secondary data

- Research interfere with the development, implementation andevaluation of effective organizational model treatment facility at thehospital provinces/cities selected

2.2.2 Sample size and sample: 26 hospitals (10 hospitals

provinces/cities, 05 district hospitals, 05 specialized hospitals, 06police hospital); 31 prisons infirmary doctor prisoner transfer,treatment in 26 hospitals studied

The samples for investigation socialistic 100 medical staffworking in the prison infirmary and 60 medical staff of the hospitalwere studied; 100 leaders studied prison, 170 prisoners

- Methods of logic

- Methods of intervention

2.2.4 The study variables and indicators for assessment

Situation of medical examination and treatment for prisoners(2009-2010): Total number of prisoners for medical examination andtreatment, mortality, morbidity structure at the clinic, hospital, totalnumber of prisoners moved medical examination and treatment at the

2.2.5 Measures to control bias: Design full kit, encryption votes,

investigator training, cleaning before check processing

2.2.6 Methods of data processing research: The data were

processed by the software biostatistics: 6.04 Epiinfor, Excel

2.2.7 Research Ethics

- This is the study of the organization of the base model for thetreatment of prisoners at the hospital, in the research process and theresults of the study did not affect the mission and activities of theprison and the hospitals as well as psychological health of theinmates, medical staff of the prison and hospital leaders prisons

- Those who were interviewed on a voluntary basis, the informationcollected from individuals only for research purposes, is encrypted onyour computer and confidential (secret)

2.2.8 Research organizations , research force participation

As the subject is in the policy of the Party and State , Ministry ofPublic Security as well as the agency's mission In the process ofimplementing threads , with the collaboration of researchersinvestigating the prison officials Subject has received support ,facilitated by the prison , the hospital and the staff working in prisonsand hospitals studied

2.2.9 Limitations of the study

- Due topic deployed in different locations so that researchinstitutions are not fully explored with experts

- Interviewers include prisoners, medical staff prisons, leaders of theprison medical staff of the hospital, the comments are mainly based

on personal subjective observations of each person, so the reliability

of the opinion is limited

Chapter 3 RESULTS 3.1 Current situation and needs medical organizations, medical treatment for prisoners (2009-2010)

3.1.1 Real situation needs examination and treatment of prisoners (2009-2010)

* 31 In the prison infirmary being studied:

- Currently the only team without detention camps organization,organized the prison camps, educational institutions, reformatoriesorganized subdivisions, campus: Block 64 distribution prison/15prison; Block 04 educational institutions have distributed/02education establishments Block has 02 distribution reformatoryreformatory Total number of health workers in prisons study is 395people, including 78 doctors, 32 pharmacists have a universitydegree, the rest of the other officers

- Evaluation of the leaders of the prison on the medical staff of theprison clinic: Lack of failing to meet the requirements: Prison Block:57.78 %; Bloc prisons: 60 %; Block institution education-reformschools: 46.67 % And sufficient to meet the requirements: PrisonBlock: 42.22 %; Block detention: 40 %; volume basis reformatoryeducation: 53.33 %

- Evaluation of the prison leadership in quality medical equipment:good quality and meet the requirements: Prison Block: 68.89 %;Block detention: 80 %, Bloc educational institutions-reformatory:46.67 % Poor quality and did not meet the requirements: PrisonBlock: 31.11 %; Block detention: 20 %; volume basis reformatoryeducation: 53.33 %

- Regarding the quality of the infrastructure of the clinic: Goodquality, meeting requirements: Prison: 77.78 %; detention: 65 %Base reformatory school education: 46.67 % Poor quality, not meetrequirements: Prisons: 22.22 %; detention: 35 % base reformatory

school education: 53.33 %.

Number of doctor visits, medication dispensing, treatment ofprisoners at the detention facility clinic increased much over theyears Morbidity: Prisons: TB ratio: 2009: 5.11 %, 2010: 5.32 %Percentage of HIV-infected patients: 2009: 7.1%, 2010: 6.8 %.Detention center: TB ratio: 2009: 7.21 %, 2010: 7.14 % Percentage

of HIV-infected patients: 2009: 6.89 %, 2010: 5.98 %

* At 26 hospitals studied: Total number of beds reserved for inmates

at the hospital is 497/8.780 (5.66 %) Accordingly, a police hospitalbed for about 20-24; Hospital province/city spends about 22-24 beds;district hospitals, specialists spend about 10-12 beds for the treatment

of prisoners In accordance with technical distribution of MOH: 80.7

% Research Hospital is capable of diagnosis and treatment, 19.3 %are research hospitals can not afford diagnosis and treatment shouldmust refer the patient to a higher level

- Proportion of hospitals are likely to study basic tests required tomeet diagnostic, therapy, hospital police, hospital provinces/cities,specialist 100 % of district hospitals: 60 % Rate of hospitallaboratory studies HIV testing regulations: Police Hospital: 16.67 %;provincial hospital, city, specialty: 53.33 % The hospital has 184rooms arranged with 497 patient beds and 65 isolation rooms Thereare 22/26 hospitals comply with the number 1, 4/26 hospitals complywith the number 2

- Total number of health care visits at 02 hospitals in 2009-2010: 67

137 respectively; hospitalized Total: 8,364 respectively, the totaldeath toll: 886 people TB rate increases over 02 years: 2009: 18.4 %and 2010: 23.71 % The rate of HIV-infected patients has increasedover 02 years: 2009: 48.16 % and 2010: 51.76 % This ratio isrelatively uniform in the line of treatment

* A compromise between the needs , status and clinic , treatment for prisoners: Demand for medical examination and treatment of

prisoners in detention facilities clinics and hospitals are great Theprison sentence illness mainly dangerous communicable diseasessuch as HIV/AIDS, Tuberculosis, Hepatitis meet the real situation

of medical examination and treatment at the clinic for prisonerdetention facility is not guaranteed Business medical examinationand treatment for prisoners in hospital no specific regulations,unified

3.1.2 Organizations examination and treatment for prisoners (2009-2010)

Although no specific guidelines on medical examinationsand treatment for prisoners at the hospital, but the detention facilitywas transferred to the object of the State hospitals in the area formedical examination, treatment, regular checks 100 % of thedetention facilities have clinics for medical examination andtreatment for prisoners 100% of prisons, educational institutions,reformatories chamber organized medical camps, division, campus,58.06 % detention facility organized medical camps chamber,division, campus

3.2 Develop, implement and evaluate the effectiveness of initial organizational model treatment facility for inmates in provincial hospitals (2011-2012)

3.2.1 Model proposed facility dedicated to treating prisoners provincial hospital/city

3.2.1.1 The grounds and principles for proposed model

- Pursuant to proposed model: Demand for medical examination andtreatment for prisoners , the legal documents related to Joint Circular

No 09/8/2010 dated 04/2010/TTLB-BCA-BYT Practical conditions

in the area; organized system of health care; Surface treatmentfacilities in hospitals , detention operations work

- Principle: The hospital police, military and medical residents to the

layout, room dedicated to treating prisoners in hospital; These placeshave a detention facility in the area that will build a general treatmentfor prisoners at the hospital and delivered to a detention facilitymanagement, where there is only one at the detention facility,construction of treatment reserved for prisoners in hospital, buildingparks, dedicated treatment rooms for inmates in provincial hospitals,cities and some specialized hospitals, district hospitals, depending onthe conditions of each hospital in the planning, land area hospital fordedicated to the treatment of prisoners of unified application modelbuilt to suit, the hospital can not arrange for the land they own tounitary treatment for inmates; Proposed layout of the rooms at thetreatment: Office staff warden protection, visitation rooms, patientrooms male, female patients division, department of infection,treatment area detention room built specifically for the suspect, thehospital arranged funds land to build parks, private treatment roomsfor prisoners in accordance with the provisions of the detentionbusiness, building a legal framework : Department of Health Circular-Defense-Police-Finance hospitals ensure state participation inmedical examination and treatment for inmates in charge of theprovince, in the sick bed, rooms dedicated to the treatment ofprisoners of hospital beds payroll; may request special mode revengefor the medical staff of the hospital for treatment for prisoners in theroom, private treatment in hospital.

3.2.1.2 Functions and duties of the treatment reserved for prisoners

- Functions for prisoner treatment: Ensure medical examination andtreatment as required of special expertise is dangerous infectiousdiseases such as TB, HIV/AIDS ; Without prejudice to the generaloperation hospital

- Functional performance of Detention: Ensure detention operations

as prisoners not to escape from the hospital, information provision,suicide

- Combined with hospitals: Do the administrative procedures,hospital billing, hospital transfer and strengthen the nutrient regimeand coordinate medical treatment for prisoners.

3.2.1.3 Organization , staffing models and layouts

+ With hospital only dedicated to the treatment room prisoners:

PATIENT TREATMENT ROOMS

(Detention A)

- Payroll organization: Organization and staff of a dedicatedtreatment zones are determined based on: decentralization tasks andtechnical expertise for a dedicated treatment area; held real situation ,the hospital's human resources, total of inmates treated at hospitals;disease situation, structure and characteristics of industrial sicknessdetentions

- Equipment: Medical equipment, instruments orderlies, weapons,tools, support, equipment and other activities

- Treatment Process: Process 1 (Daily medical staff of the departmentrelating to areas , treatment rooms dedicated to the treatment ofprisoners and the implementation of technical expertise)

- The coordination between hospitals and detention facilities: Based

on the opinion of the medical staff and the hospital, proposedregulations on coordination between hospitals and detentionfacilities: a contract liability, regular consultations and briefings 6months/time between hospitals and detention facilities

3.2.2 Development of the model

3.2.2.1 Circular Issued Ministry of Public Security and the Ministry

of Health

According to Joint Circular No 09/8/2010 dated04/2010/TTLB-BCA-BYT of the Ministry of Public Security,Ministry of Health guiding medical examination and treatment ofdetainees, prisoners, inmates, school birth in medical facilities andState According to the Ministry of Public Security for prisonerssuffering from serious illness, some hospitals has serious to moved tohigher levels of government, but this condition has not been met inmany years due to lack of funds in the construction of the hospitalroom So the situation is still prisoners fled away during treatment atthe hospital (In 2011-2012, had 8 prisoners )

In 2012, according to the report of the detention facility with1,896 beds, of which 1,065 beds to the prison infirmary, educationalinstitutions, reformatories and 831 of the infirmary bed detentioncenter with 301 treatment rooms at the clinic Total viewedexamination, distribution of medicines for the inmates to nearly 3million views, views of prisoner treatment in clinics in more than140,000 views and medical treatment

3.2.2.2 Deployment models in 6 general hospitals of provinces/cities

For a pilot implementation of the model, we selected sixhospitals of province/city represent regions of the country to organize

a dedicated treatment facilities for prisoners include: Dien Bien, VinhPhuc, Hai Duong, Ha Dong, Ninh Binh, Binh Thuan The police havebeen assigned to detention facilities in the area to coordinate with thehospital to arrange location, scale, funding for construction Theallocation of medical equipment and facilities of living, weapons,tools support guaranteed by the Ministry of Public Security

3.2.3 The effectiveness of the model

Evaluate the effectiveness of the model based on severalcriteria: Industrial Service Guarantee detention, examination andmedical treatment; assessment questionnaires, economic efficiencyand social

3.2.3.1 Initial results of operations of the model grassroots organization dedicated to the treatment of prisoners in 6 general hospitals of province/city

By the end of 6/2012 had 86/129co detention facility, inwhich the detention center is 40/70 in general hospitals provinces;prison 46/59 at the provincial hospital/city (32/46), district specialists(14/46) with a total of 1,896 beds 06 general hospitals in theprovince, the city layout, private treatment rooms with Circular 04,

89 arranged rooms with 206 beds diseases In the 02 years from 2011

to 2012 has treated 1,827 subjects turn, has responded to 18 detentionfacilities In 6 hospitals province/city conducted a pilotimplementation of the organization, a dedicated treatment room forprisoners: There are 3 hospitals organize the constructionspecification for the treatment of prisoners, 3 hospital not arrangeconstruction land should arrange separate unitary; 5 hospitals hadallocate funds to build, repair by the Ministry of Public Security, 1hospital provincial People's Committees are arranged constructioncost (Ninh Binh)