Questions/Answers

Thailand currently has the sixth largest number of prisoners in the world, the third in Asia, and the first in ASEAN according to statistics of prisoners nationwide. According to the Department of Correction, it was found that all prisons have more than 1 - 3 times the standard that a prison could accommodate. In 2017, Roi Et prison had 2,230 prisoners and increased to 3,896 in 2020, which is 2.5 times greater than the actual capacity and the density is 2.3 persons per square meter. Of the majority of the prisoners, 93.12% are male, some are pregnant with 3 and a child of 5-month-old. With limited areas and resources, the lack of healthcare personnel for prisoners and the lack of accessing health services causes illness among prisoners. For example, in 2017, there were 39 Psychiatric patients, which increased to 63 in 2020. The prisons have no health surveillance system that can detect illness. Patient’s data collection is done manually in notebooks, therefore it cannot be analyzed in epidemiological data. Prison staffs were not familiar with the surveillance system which resulted in the failure to record patients. When outbreaks occurred, it took a long time to control which caused more financial loss. This objective of this project is for prisoner to be able to receive better government services, as they are vulnerable group. Therefore, there is a need for preventive measures and control risks within prisons according to preliminary rights. This can be done by developing a system for collecting health information in prisons through a joint effort between correctional and public health agencies. The inclusion of information technology systems to record health conditions instead of manual recording helps to better manage and promote health of prisoners as well as develop a prison environment that is conducive to good health.

This project is developed as a response to the healthcare needs for prisoners through illness and health management information in the prison. The aim is for prisoners to be able to receive equal remediation, supervision, control and protection as those outside. Through the government’s collaboration with prison health volunteers, the team intend to analyze needs of prisoners and find tools to develop working processes. By applying the information technology system to the workings of government agencies, the aim is to create faster working process by reducing steps and redundancy. The ultimate goal is creating healthcare for prisoners with easy-to-use technology.

The integration of government agencies is a driving force towards the attainment of sustainable development goals. Integrating prisoners’ health databases to improve the quality of the service system in prison, is consisted with SDGs No1.3, 3.3, 3.4, 3.8 3.d,5.1, 5.6 and 10.3. The Office of Disease Prevention and Control 7, Khon Kaen (ODPC7) is the main agency responsible for integrating the health database and overseeing the surveillance system. ODPC7 is also responsible for investigating and liaising between other government agencies, private sectors, prisoners and communities to achieve the goal of periodic monitoring and evaluation for sustainable disease control. Patients’ data will be forwarded to the health data center, where other government agencies and other public organizations can access under a security system which requires a level of confidentiality. This database links treatment information between prisons and provincial, district and sub-district hospitals that will enable sick prisoners to receive consistent cares and maintenance until they return home in accordance with the policy "Send healthy people back to society." The program also promotes the healthcare among female prisoners by enhancing the screening for HIV, breast and cervical cancer as well as other maternal and child diseases.

This project is based on the 20-year National Strategy (Public Health) of Thailand, which aims to transform a long-term strategy into sustained actions on the integration of cooperative and sustainable basis to increase access to health services for disadvantaged populations. The project also enhances information management of surveillance and disease control systems, appropriate resources to continuously and improve the quality of life. Most of the prisoners at Roi Et prison are heads of the family, so when they are released with a healthy physical condition, they can work and contribute to the society in accordance with the “Rachathun Punsuk” program.

The initiative of systematic integration of information allows each prison to examine the prisoners' right to healthcare. In order to response the needs of prisoners to receive faster treatment, telemedicine systems are used in the prison’s treatment to reduce a congestion and waiting time for treatments. Telemedicine also reduces the complications from a delay treatment. Moreover, dental units are installed in prison which allows all prisoners of all genders and ages to receive an equal care. In accordance with the principles of human rights that a person should receive equal healthcare, regardless of their status as prisoners. The organization of information transferring system between prisons, in case of prisoners’ relocation to the nearest healthcare facility, is also implemented for continuity in follow-up treatment. In addition, all healthcare facilities can now search prisoners' medical records using their national ID, name and surname. This allows the prisoners to receive correct treatments in accordance with the Thai government policy. "We will not leave anyone behind."

A new technology was applied to manage information. This enables Roi Et Prison to plan in order to serve female prisoners more efficiently especially in some specific healthcare services such as HIV and TB screening, Non Communicable Disease, Psychiatry, Breast cancer, Cervical cancer and pregnancy cares. Also, there are arrangements such as healthcare services, food supply, vaccination and organized activities are tailored to fit pregnant prisoners’ needs. For both male and female prisoners, they will be screened for COVID-19. Separated rooms are provided for prisoners with contagious diseases. All prisoners are vaccinated against influenza once a year.

Results obtained from the integration of prisoners’ health database in Roi Et provincial prison and from relevant agencies result in a systematic transferring of information which creates an efficient surveillance system. This affected 4 target groups: 1) prisoners who are allowed to access health services.The database reduces procedures and waiting time for treatment as well as alleviates the severity of disease due to delay of treatment. This improvement in healthcare provision is in line with human rights principles that human beings are entitled to basic rights. 2) Prison healthcare staffs who will be able to analyze data to detect disease outbreaks in prisons and response quickly to outbreaks to limit broad impacts. This reduces a burden of preparing reports of the performance to the central department. 3) Healthcare personnel who will have fast and up-to-date information and can plan tailored operations. Moreover, the data is sent to the central data center where government agencies, private sectors and the public can access the information. 4) General public who will benefit from a reduction of risks of infections from prisoners after they return to the society. Moreover, healthcare services are provided by local healthcare workers through the information system.

The operation, under the concept of continuous development, is divided into 4 phases as follows: Phase 1: In 2016, there were 2 outbreaks in Roi Et provincial prison in 6 months apart, there was no concrete surveillance reporting system. As a result, more than 300 cases were found, so the Public Health Office was asked to investigate the disease. The ODPC7 tried to use the excel program so that prison staffs could collect data. Phase 2: In 2017, there was a delay in reporting the disease due to the insufficient numbers of staff and the lack of knowledge on data analysis. Therefore, developing prison healthcare volunteers’ potential to assist healthcare personnel for analyzing data was crucial to work more efficiently in real time. Later, it was found in excel program that there was unable to verify the eligibility of the treatment. Phase 3: In 2018, ODPC7, Roi Et prison, Roi Et hospital and Roi Et Provincial Health Office held a meeting to find solutions. The Five Operational Strategies were set up as follows: Strategy 1: Integrating the operations of network partners by using strategies of participation. Strategy 2: Database development, the HosXp program was used to store data, solve the limitation posed by the usage of Excel (data cannot be connected to the database outside the prison or forwarded via e-mail to the provincial, district and country level data centers) Strategy 3 Capacity building of prison healthcare staffs using the Communicable Disease Control Unit (CDCU) curriculum with on the job training. Strategy 4 Screening new prisoners. Strategy 5 Monitoring and evaluation. Phase 4: From 2019-2020, the performance evaluation, dissemination of the results and expanding the project to other 5 prisons were carried out. A study site was set up by ODPC7 for other prisons in other regions.

The main obstacle is the lack of internet access, making it impossible to transfer data from the prison to the epidemiological data center. Data exported by copying and sending once a day. The solution to the problem is to create an internet connection between the hospital and the prison. However, there is an off-line system in the prison, meaning that staff can use the internet only when they have access to the network. The sender is the officers with a password to use only, showing a strictly prohibition to use the internet for other purposes.

The implementation of the HosXp program for the prisoner’s data collection in Roi Et prison, the first prison at recording prisoners'data using a computer program, would provide efficient data management and reduce data redundancy. This program is the same program as the ones outside the prison. Because the prison is a security zone which has the highest level of confidentiality and security, there is never been a prison where this program was used before. Introduction of the program in the prison came from the idea of creating connection to the database of healthcare services outside the prison.

Using HosXp to store information in prison not only results in a development of a data storage system using a computer operating system but also enhances a quality of caring in the prison. In order to make the database practical, it is imperative that the prison modifies its data collection process to be compatible with database from other healthcare providers outside. prisoners' health data can be reported to the country's health data center. The success of this development has resulted in other prisons being able to realize the importance of using computer programs for data storage.

The technology adapted to store prison health data could lead to the development of treatment through telemedicine and a fast track system of transferring prisoners to hospital. The ability to notify news of the outbreak through Line group chats and forward information via e-mail is the improvement of system implementation in accordance with the 4G bureaucratic policy that requires technology to be used in a development of work. Also, it can response needs of the target audiences and network partners as well as introduce the technology to other organizations to emphasize its importance.

The ODPC7 has expanded on the development of computer system database to other prisons in Thailand and ASEAN countries with similar contexts. Organizing a training program that includes study visits to other agencies, where there are manual systems, both at the provincial level and the Office of Disease Prevention and Control in other districts in order to study the operational processes to apply the computer system database in their responsible areas. Also, healthcare staffs and healthcare volunteers from Roi Et Prison are guest speakers of the training program to share the knowledge and operation techniques. Moreover, staffs and volunteers could give a consultation through Line application and email address after the training program

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In this project operation, a sharing of information and human resources was between 4 agencies as follows: 1. the ODPC7 who has expertise in surveillance and control of disease and work as the main body for database development, 2. Roi Et prison staffs and prison health volunteers who were responsible for patient’s information gathering, 3. Roi Et Provincial Hospital and 4. Public Health Office who sent specialists to install and instructed the use of the HosXp program. A budget of this project was included in the National Budget Plan which was sufficient for the operations every year.

A development of healthcare personnel’ potential, training substituted volunteers, continuous monitoring and evaluation, creating instruction manuals for patient care, creating a flow and systematic report, is sustainable in a term of establishing a systematic operation. The data’s flow is sent to the data center then backed up daily and published on a website. Government agencies and private sectors can access the information, which can determine appropriate surveillance, prevention and control measures. Moreover, business travelers gained more confidence and satisfaction in working (98.5%). Also, the database operation was convenient for prison staffs and their satisfaction increased from 30% to 100%.

Si

The ODPC7 together with Roi Et provincial health office established the prison performance assessment criteria by conducting an assessment of the quantity: evaluations of numbers of outbreaks, death rate and new patients rate, and the quality: disease screening, health surveillance, information transferring system and health promotion. The assessment was divided into 4 areas: 1) outcome 2) impact 3) value 4) satisfaction assessment. Target groups assessed were 500 prisoners, 50 prison staffs and 30 healthcare personnel.

The indicators and tools were adapted from the assessment tool of the Joint Investigate Team and the Situation Awareness Team of the Department of Disease Control. There were 11 indicators including 1) number of patients at that time 2) duration of treatment 3) number of deaths 4) duration of disease control 5) numbers of epidemic outbreak 6) method for data collection 7) duration of eligibility for treatment 8) reporting period 9) reporting preparation methods 10) presentation situation information 11) reduction in cost of treatment. The evaluation was done by comparing the performance before and after the implementation of the project.

The satisfaction in the development and utilization of the database was 98.5% from interviewees of 500 inmates and 100% satisfied from staffs in all 4 departments. The database was more convenient and time efficient way to manage information than manual data gathering. It could be performed by one person in less than an hour. Moreover, outbreaks could be detected at the earliest. As a result, the disease could be controlled at the earliest and reduced the risk of spreading among other inmates. During 4 years of operation, a number of patients infected was found to be significantly reduced, from 25 cases of tuberculosis, 55 of AIDS, 1,050 of throat infections 45 of scabies in 2017 down to 8, 55, 493 and 20 cases respectively in 2020. Also, it was found that the number of patients infected overall decreased by 50.97%. In the event of a prison outbreak in 2018, 356 cases of infection were found while in 2020, only 20 cases were found, presenting a 94.38% decrease. The decrease in numbers of patients also resulted in 500,000-baht reduction in the cost of healthcare.

Before implementing the project, there was no integration among departments. After jointly developing this project, the departments joined operations as follows: 1) Office of Disease Prevention and Control 7, was the main agency in procuring budget, set up meeting to clarify operational guidelines, trained prison healthcare staffs who were in the job training program, created an operational manual, created information flow to be used as a guideline for the operation, initiating potential developing program for prison healthcare volunteers, monitoring and evaluation the project. 2) Roi Et prison was responsible for updating data in the program HosXp, sending information via e-mail to the data center, screening new inmates and participating in potential developing program for prison healthcare volunteers 3) Roi Et Hospital was responsible for installing HosXp program and instructing a usage and being a mentor to prison healthcare staffs 4) Roi Et Provincial Public Health Office was responsible for bringing the data into the surveillance report, sending the information to ODPC7 and participating in the project evaluation.

Prior to the project development, the ODPC7 created an analysis of the inmates and relevant officials’ healthcare needs, by gathering information from all sectors and used them for the project development. The executives of all related departments realized the importance and started jointly developing the project together by providing supports for both personnel and operational budget. Inmates who were directly stakeholders of this project, assumed the role of prison health volunteers. They undertook processes of health surveillance, detection of abnormal symptoms of inmates, recording an information and reporting results of the surveillance to their supervisor. They also participated in the project evaluation process by partaking in the evaluation of the qualitative data of the project. Old inmates who were due to be released from the prison with working experiences would pass on the knowledge to newly-arrived inmates. As for the people in the community, especially families of the inmates, participated in the surveillance program to prevent and control any health hazards from released inmates. When something went wrong, inmates’ communities and families were responsible for informing healthcare personnel to proceed as appropriate.

Bringing information technology to work is the process that increases the efficiency of work, allowing the working process to be on par with other agencies from all sectors involved. Establishing the primary healthcare unit in the prison and the public sectors' access to the information can also is essential. The use of the same data collection program as the one in primary healthcare units outside the prison is important because once the prisoners are released, there is a continuity in their health records. The information transferring with other healthcare departments uses the national ID numbers. The data collection system, in a form of HosXp program in the prison, is appropriate for the context. The implementation of database recording is another valuable and sustainable lesson in the future. This program will be of use most once it works via the internet in conjunction with the installation of a surveillance program so that prisons can report incidents of outbreaks themselves. Moreover, the news of the outbreaks could be informed in the web. Lastly, the database can be utilized by the Department of Disease Control for surveillance, disease control and as a supporting factor for sustainable continuity.