Health Issues in Prisons and the Status of MEDCOR

Meeting report

CORRECTIONAL SERVICES PORTFOLIO COMMITTEE

19 June 2001
HEALTH ISSUES IN PRISONS AND THE STATUS OF MEDCOR


Documents handed out:
Health care in prisons
Status of Medical Aid of the Department

SUMMARY
The Committee agreed that the Medical Aid Scheme should be organised in such a way that those who earn more should pay more to the Scheme. In that way they would be subsidising those who are earning less. They noted that the livelihood of the Scheme should depend on those people who earn more. Otherwise the taxpayer will have to pay more for those who earn more. The Committee agreed that they should assist with all suggestions in drafting a new document.

The second part of the presentation dealt with the status of health care in prison. One of the challenges facing the Department is to establish the cause /causes of the spread of HIV/AIDS and other infectious diseases in prisons. The Department also discussed how to deal with the issue of rape in prison. The spread of infectious diseases was partly attributed to overcrowding. It was stressed that the Department should accept responsibility for the rehabilitation and safe custody of prisoners.

MINUTES
Medcor Report

Mr Bloem (ANC) asked when the interim board was established. He also asked how long the board will operate for. Further he asked what would happen to members who have retired but are still in the Medical Aid Scheme of the Department.

Mr Ngubo replied that the interim board of trustees was established at the beginning of this year and its duration will be extended until such time as the principal officer is appointed. The principal officer will be responsible for disbanding the interim board and forming a permanent board for a period of three years.

Mr Ngubo, in reference to retired members, explained that retired members and those that retire in the future will be expected to contribute.

Ms Seaton (IFP) was concerned that the contributions to the Scheme seemed very low.

Mr Ngubo said the low contributions were based on salaries of those people who receive less than R1000 per month as their take home income. If the rules change and the premiums increase, these people will be discouraged from joining the Scheme.

Ms Mathabile (ANC) pointed out that there are different categories in the Department. She asked if the National Commissioner will also contribute R75 to the Scheme. She asked how much the Department will contribute and how the Department agreed on a certain amount.
These questions did not appear to be answered.

Mr Maziya (ANC) wanted to know the difference between the Medical Scheme and Medical Aid. He said that traditionally they were used to the Medical Aid Scheme.

Mr Ngubo replied that this Medical Aid (Medcor) is based on the Medical Schemes Act and its roles are in line with that Act. He said the previous Medical Aid that they had was wholly subsidised by the Department and there was no contribution from members.

Mr Maziya asked what was meant by late registration and the ensuing penalties.

Mr Ngubo said that late registration refers to those persons who did not register for the Medical Aid Scheme whilst they were in good health. Late registration occurs where a person registers once they have been involved in an accident or become sickly. The purpose of the penalties is to discourage people from joining the Medical Aid Scheme only when they develop ailments.

Mr Maziya remarked that he thought Medical Aid membership was obligatory when a person became employed. He said he could not understand how there could be late registrations.

Mr Ngubo responded that according to the rules of the Medical Aid a person has a choice either to join or not to join the Medical Aid of the Department.

Ms Seaton asked how many employees the Department has considering the Department is paying R580 million to the Scheme.

Mr Ngubo replied that there are 33 000 members on the Departments Medical Aid Scheme. Some members of the Department are are not members of the Scheme. If the Department includes the number of retired members, there are 110 000 members.

Mr Durand (NNP) said he was concerned that the fund would not be sustainable considering the impact of HIV/AIDS. Further, Mr Durand pointed out that for many years members of the Department have received free Medical Aid. He insisted that the amount that members are required to contribute is still very little considering the cost of medical expenses. People who are highly paid prefer specialists and private hospitals for medical treatment. This means that the taxpayer is expected to pay large sums of money for people who earn more. He urged the Department to normalise the Medical Aid Scheme as soon as possible.

Mr Bloem said that the Committee should consider why the Department decided to change the Scheme. The Committee was very concerned about the level of corruption in the Department. Mr Bloem said that the Committee should rather assist the Department by coming up with suggestions to rectify the situation rather than identifying all the problems.

The chairperson reiterated that those who earn more should be expected to pay a higher contribution. He added that it is totally unacceptable for a person who earns in the region of R12 000 to pay a R75 Medical Aid contribution. He emphasised that the contribution should be proportional to a persons salary.

The Acting Deputy Commissioner, Ms J Sishuba, said that the Department would incorporate the Committee’s comments in a revised report on Medcor.

Health Care in Prisons
Ms Makgoro (Director of Health and Physical Care, Department of Correctional Services), presented the challenges facing the Department in terms of prison health care. She focused on the problems caused by overcrowding – specifically the spread of infectious diseases. She said that maintaining a hygienic environment is becoming a problem because of overcrowding in the prisons. [For more details please refer to the attached document.]

Discussion
Mr Dyani (ANC) referred to the report that said that there was a shortage of pharmacists. He asked how much the Department pays pharmacists compared to other Departments.

Ms Makgoro responded that in most cases salaries range from R63 000 per annum. In other Departments, salaries range from R63 000 to R88 000 per annum. She said the salaries offered in the Correctional Services Department are most likely to attract people who have just qualified from college or university. People with more experience would look for better offers.

Ms Ngaleka asked why it is difficult for the Department to recruit nurses.

Ms Makgoro replied that the Department is in the process of advertising vacant posts for nurses. She indicated again that attracting some of these professionals is difficult because of the salaries the Department offers them. She added that other countries are prepared to pay nurses better salaries. In effect, nurses prefer to go to those countries.

Mr Dlamini (ANC) wanted to know how many of the HIV/AIDS infections inside prison are caused by existing prisoners as opposed to new prisoners. He also asked how many women and men have contracted HIV/AIDS, respectively.

Ms Makgoro replied that prisoners come from outside the prisons. She said that the increase in HIV/AIDS infections is evidence of the growing number of infections outside the prisons. The only statistics they have are based on results from voluntary testing or those cases where health workers advise prisoners to go for testing. Prisoners are encouraged to go for tests.

Ms Makgoro added that she did not have figures on the number of HIV/AIDS infections in men and women respectively. She said that their information management system needs to be reworked to indicate HIV/AIDS infections in terms of gender.

Mr Dlamini asked what the Departments position is on the use of condoms in prisons.

Ms Makgoro responded that condoms are distributed in prisons. She suggested that the Department conduct research to find out whether prisoners do actually use these condoms. She added that staff members also take condoms and hence accurate research is necessary.

Mr Dyani asked the Department why it thought the number of HIV/AIDS infections had escalated in prisons. He also asked why the number of respiratory diseases is so high.

Ms Makgoro replied that the escalation of HIV/AIDS infections and other diseases could be attributed to overcrowding. Respiratory diseases are common in overcrowded areas and could be caused by congestion in cells. Other prisoners have respiratory diseases because they are HIV positive.

Ms Ngaleka referred to the report and asked what the Department meant when it said that that the implementation of three meals a day is becoming difficult because of overcrowding.

Ms Makgoro indicated that a Management Board decision has been taken to address the problem of two meals. In terms of the Correctional Service Act 111 of 1998, prisoners should be given three meals per day; there should be less than four and half-hours between meals and not more than fourteen hours between the evening meal and breakfast.

Ms Ngaleka asked to what extent prisoners are exposed to cold, especially in winter. She pointed out that the presentation highlighted the need for clothing for awaiting trial prisoners. She asked how this problem affected the sentenced prisoners.

Ms Makgoro said prisoners are offered jerseys and they are also given sufficient bedding for winter. The Department should insist that all provincial authorities ensure that there is sufficient supply of clothes for winter. There should also be a monitoring mechanism to ensure that prison authorities do order winter clothes.

Ms Seaton asked whether prisoners are still given two meals in the afternoon - lunch and supper combined. There was no direct response to this question.

The Chairperson said that at one prison they asked if prisoners can keep their second meal to eat during normal time, where they are given two meals simultaneously. The prison authorities said they do allow this. The members of the delegation suggested that this should be standard in all prisons.

Mr Maziya asked what mechanism the Department has to protect other prisoners from being infected with HIV/AIDS. She suggested that perhaps all prisoners should undergo tests.

Mr Dyani intervened and said that Ms Makgoro could not be expected to respond to that suggestion because that issue is outside the purview of the Department. Parliament and the government should decide on whether compulsory testing should be conducted. However, currently the Constitution does not allow it and this means it cannot be done.

Ms Cupido (DP) referred to the point in the presentation which stated that in 1998 2244 prisoners were admitted to private hospitals and the number dropped drastically in 2001. She asked who carried these costs and why some prisoners were sent to public hospitals and others sent to private hospitals.

Ms Makgoro replied that prior to 1999 prisoners were sent to private hospitals for normal illnesses such as flu. Sometimes this was for security reasons because the security staff argued that going to public hospitals like Baragwanath was more risky for them. The security staff contended that public hospitals provided more of an opportunity for prisoners to escape. The Department introduced a policy in July 1998 which states that a prisoner may only have access to a private hospital if his/her life is in danger.

Ms Seaton asked whether health officials from the Department check health conditions regularly to ensure that they are adequate.

Ms Makgoro responded that they do have check policies in the Department and checklists. The checklist indicates what needs to be checked, for example kitchens, cells, toilets and whether the prisoners are clean.

Mr Dyani said he had the impression that overcrowding made maintaining the necessary hygienic standards in prisons impossible.

Ms Makgoro replied that the Department is able to address prisoners health issues, however, she said overcrowding is a contributory factor. Despite overcrowding, efforts are taken to maintain the desired hygienic standards.

Ms Sishuba said Correctional Services is trying to translate what she termed humane detention, which is a new constitutional imperative, into practice. She said there is much staff education that is needed. They need to empower custodial members not to wait for Ms Makgoro’s team to come, but to identify issues themselves and address them.

The Department must also address issues relating to rape in prisons. She said that the Department is considering international practices – an Australian book defines rape as it exists among men because of the force that is used. She said that the Medical University of Southern Africa (MEDUNSA) has requested that it conduct a study on forced sexual practices in prisons. Most of the rapes in prisons are not reported because of fear of reprisals, so this study will help to inform the Department of forced sexual practices inside prisons.

Ms Sishuba insisted that the Department is responsible for safe custody of prisoners. She said that most members of the Department were trained in the old paradigm. Fewer members joined the Department after 1994. She said that this issue must also be addressed.

In conclusion the Chairperson suggested that young offenders be separated from adult offenders because when the older prisoners take advantage of the younger offenders. She said that even first time offenders should be separated from old offenders.