01.03.2012 Growing focus on prison health

BIG – combating infectious diseases in prisons. The aim of the BIG project launched in 2008 is to bring health care in penal institutions into line with that of the community. The experience gained with BIG has been positive, and therefore the project is now to be institutionalised on a sustainable basis.

Pictures Growing focus on prison health


Studies show that infectious diseases such as HIV, hepatitis or tuberculosis occur much more frequently in penal institutions than in the community. In 2008, the Federal Office of Public Health (FOPH), the Federal Office of Justice (FOJ) and the Swiss Conference of Cantonal Justice and Police Directors launched the BIG project in order to remedy this problem. The project pursues the following goals:
– minimise the risk of infections being transmitted in penal institutions
– minimise the risk of infections being transmitted from the community to within penal institutions and vice versa
– create equivalent standards of prevention, testing and treatment for infectious diseases in penal institutions and in the community
– create equivalent standards of drug abuse treatment in penal institutions and in the community
– ensure sustainability of the measures and tools developed

On the basis of these goals, four areas of activity were defined and appropriate measures put into effect:
1. Data gathering: Since 1 January 2011, a new form for reporting infectious diseases has enabled detailed surveys of the number and nature of infectious diseases diagnosed in prisons to be carried out.
2. Information and training: Work is currently in progress on two brochures that provide prison inmates and staff with information on infectious diseases, risk situations, protective measures and treatment options. In addition, a training course for prison staff is being developed in one canton as a pilot scheme. The aim is for the modules to be included in the syllabus of the Swiss Prison Staff Training Centre (SAZ) from 2013 on. Since spring 2011, the SAZ has offered an introductory course on law enforcement (including prison medicine) for staff who have not taken the basic SAZ training course.
3. Prevention, testing and treatment: In order to harmonise the medical care of inmates and also clearly define the roles of the different players involved, guidelines containing recommendations, standards and checklists on a range of medicine-related topics (e.g. admission forms or transmission of information) have been issued and made available to all prisons.
4. General structural conditions: Legal expert opinions have been sought in order to clarify the responsibilities of the Federal Government and the cantons. In addition, the problem of language barriers and of their negative consequences for the health of inmates has been analysed. A nationwide telephone interpreting service has been available to prison health staff since April 2011.

Recommendations on harmonising standards
The timeframe of the BIG project had originally been limited to the end of 2010. In the course of the project, however, it became clear that it would not be possible to guarantee the further development and dissemination of its products unless further action was taken. This was also true of the dialogue between the different players in prison medicine, nursing care and law enforcement. It was the BIG project that had actually initiated this interdisciplinary cooperation, which was greatly valued by all involved. Furthermore, it became obvious that more attention had to be devoted to prison healthcare in Switzerland as a whole and that the differences between the cantons with regard to prison health needed to be minimised as far as possible.
For these reasons, BIG is being continued for the time being. The current focus is on the “Recommendations for harmonising health care in Swiss penal institutions”. Both international and Swiss law lay down several binding norms that govern prison healthcare. But, as the expert legal opinions commissioned by the FOPH have made clear, what Switzerland needs is action to ensure that these norms are applied consistently. The recommendations supported by the Swiss Conference of Cantonal Justice and Police Directors and the Conference of Cantonal Health Directors are aimed at all the relevant players in the prison healthcare system. Their objective is not structural harmonisation (out of consideration for the organisational sovereignty of the cantons), but implementation and fleshing out of the substance of the legal basis in the everyday routine of the penal system. This includes clarifying the legal situation and responsibilities of the professionals working within the healthcare system. A further objective is to improve the knowledge and training standards of both staff and inmates with regard to health-related topics. This calls for the use of regularly updated training and information material that is coordinated and as uniform as possible.

Centre of excellence for prison health
One of the core recommendations is the creation of a Swiss centre of excellence for health issues in the penal system. The centre of excellence would secure the sought-after interdisciplinary dialogue in the long term and serve the cantons and institutions as an acknowledged platform for discussing health issues affecting penal institutions. An administrative link between this centre and the Swiss Prison Staff Training Centre (SAZ) is planned. It would be funded  in the same way as the SAZ, i.e. with percentage-based cantonal contributions geared to respective prison days.

Largely positive echo
Last October, an initial draft of the recommendations was submitted for consultation to the cantons, the intercantonal concordat authorities, the Conference of Swiss Prison Medical Officers, and the authorities responsible for penal institutions in Switzerland. A total of 35 cantonal authorities and organisations had commented on the recommendations by the end of 2011. They all welcomed the recommendations, the establishment of a centre of excellence and its affiliation with the SAZ. The only reservations were those expressed by some cantonal law enforcement authorities with regard to the proposed financing.
The BIG project will continue to have the support of the nine-member penal system and institutions commission of the Swiss Conference of Cantonal Justice and Police Directors. The recommendations and concept for the planned centre of excellence will be formally presented to the SAZ’s governing bodies. The dossier will then be examined by the Swiss Conference of Cantonal Justice and Police Directors at its autumn meeting.


Karen Klaue, BIG Project Manager, karen.klaue@bag.admin.ch

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