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

• Author: Terrylyn Baffoe-Bonnie,Kwasi Awuah-Werekoh,Augustine Adomah-Afari,Samuel Kojo Ntow
• Date: 01 December 2021
• DOI: 10.1177/00328855211060334
• Published date: 01 December 2021
• Subject Matter: Articles

Male Prisoners’

Perspectives of Access

to Quality Health Care

at a Prison Inf‌irmary

in Ghana

Augustine Adomah-Afari

1

,

Samuel Kojo Ntow

2

,

Kwasi Awuah-Werekoh

3

,

and Terrylyn Baffoe-Bonnie

4

Abstract

This study assessed factors that inf‌luence 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.

Keywords

Ghana, access to health care, male inmates, prison inf‌irmary, prisons health

care, quality of care

1

University of Ghana, Legon, Ghana

2

West African Recue Association, Takoradi, Ghana

3

Ghana Institute of Management & Public Administration, Accra, Ghana

4

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.

Email: afari@ug.edu.gh, augustineafari@yahoo.co.uk

Article

The Prison Journal

2021, Vol. 101(6) 699–716

© 2021 SAGE Publications

Article reuse guidelines:

sagepub.com/journals-permissions

DOI: 10.1177/00328855211060334

journals.sagepub.com/home/tpj

Introduction

The World Health Organization def‌ines 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) def‌ined 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 inf‌luence 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 inmates’release

(Binswanger, et al., 2011). Topp, et al. (2016) demonstrated a def‌iciency 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 qualif‌ied personnel and inability to pay for health services rendered—all

of which affect the quality of health service provided to inmates in Zambia.

Some researchers have conceptualized access to health care and identif‌ied

determinants that affect it, including health systems, health providers, and indi-

vidual and population factors (Levesque, Harris, & Russell, 2013). Levesque

et al. (2013) def‌ined 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 fulf‌illed. They also outlined the f‌ive dimensions

of accessibility as approachability, acceptability, availability, affordability, and

appropriateness. These f‌ive dimensions, in turn, interact with f‌ive 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 & Alkaa’ida, 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)