Male Prisoners’ Perspectives of Access to Quality Health Care at a Prison Infirmary in Ghana

AuthorTerrylyn Baffoe-Bonnie,Kwasi Awuah-Werekoh,Augustine Adomah-Afari,Samuel Kojo Ntow
Published date01 December 2021
Date01 December 2021
Subject MatterArticles
Male Prisoners
Perspectives of Access
to Quality Health Care
at a Prison Inrmary
in Ghana
Augustine Adomah-Afari
Samuel Kojo Ntow
Kwasi Awuah-Werekoh
and Terrylyn Baffoe-Bonnie
This study assessed factors that inuence accessto quality health care among a
prison populationnearing its release in Ghana. A structured quantitative ques-
tionnaire was administered to 200 inmates using a total population sampling.
Gap analysis was performed between inmate expectations and perceptions of
health provider factors to determine quality. There was an overallnegative gap
due to expectations exceeding perceptions. This article recommends that a
policy documenton the health and welfare of inmates be developedand imple-
mented to improve their access to quality health care.
Ghana, access to health care, male inmates, prison inrmary, prisons health
care, quality of care
University of Ghana, Legon, Ghana
West African Recue Association, Takoradi, Ghana
Ghana Institute of Management & Public Administration, Accra, Ghana
Korle-Bu Teaching Hospital, Accra, Ghana
Corresponding Author:
Augustine Adomah-Afari, University of Ghana School of Public Health, College of Health
Sciences, JRP8 +PW9, Accra, Ghana.
The Prison Journal
2021, Vol. 101(6) 699716
© 2021 SAGE Publications
Article reuse guidelines:
DOI: 10.1177/00328855211060334
The World Health Organization denes a health system as all the activities
whose primary purpose is to promote, restore, or maintain health. The
World Health Organization (WHO, 2018; Kok et al., 2017) dened a
health system as a social institution in which health worker performance is
shaped by transactional processes between different actors. Many researchers
have noted the necessity of a well-functioning health system in dealing with
poverty, illness, and disease burden (Coker, Atun, & McKee, 2004; Atun,
2012). Atun (2012) emphasizes the need for health system innovations gen-
erally, but acknowledges that there are challenges to understanding how
these innovations could be effectively introduced to interact with health
system variables to inuence health outcomes.
It appears that most prisons worldwide, especially in Sub-Saharan Africa
in general and Ghana in particular, do not have well-structured health care
facilities (Adjei, et al., 2007, 2008). This presupposes that prisoners could
harbor certain health conditions over time before they are released into the
general population. Since correctional surveillance systems are relatively
inadequate in identifying such cases, it means that this can heighten the
rate of contamination or infection in communities upon inmatesrelease
(Binswanger, et al., 2011). Topp, et al. (2016) demonstrated a deciency in
health system factors, such as a lack of essential medical equipment and
medications in prisons that necessitate external referrals, as well as a lack
of qualied personnel and inability to pay for health services renderedall
of which affect the quality of health service provided to inmates in Zambia.
Some researchers have conceptualized access to health care and identied
determinants that affect it, including health systems, health providers, and indi-
vidual and population factors (Levesque, Harris, & Russell, 2013). Levesque
et al. (2013) dened access as the opportunity to identify health care needs, to
seek health care services, to reach, obtain or use health care services, and to actu-
ally have the need for services fullled. They also outlined the ve dimensions
of accessibility as approachability, acceptability, availability, affordability, and
appropriateness. These ve dimensions, in turn, interact with ve corresponding
abilities of the population namely: the ability to perceive, the ability to seek, the
ability to reach, the ability to pay, and the ability to engage to generate access.
Other methods of assessing quality health care include the service quality
(SERVQUAL) scale or model: Tangibles, Reliability, Responsiveness,
Assurance, and Empathy (Parasuraman, Zeithaml, & Ber ry, 1985; Van
Iwaarden et al., 2003; Alrubaiee & Alkaaida, 2011). Importantly, the clients
assessment is nontechnical, as they cannot assess the technical aspects of
health care provision. However, the health provider factors that could affect
700 The Prison Journal 101(6)

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