IN PRISON SETTINGS

FOR HEALTH CARE

PUBLIC POLICIES

Chief National Cabinet of Ministers Ministry of Justice, Security and Human Rights Ministry of Health Ministry of Social Development

Presidency of the Nation

IN PRISON SETTINGS
Interministerial work experiences at Federal Prisons of Argentine Republic

FOR HEALTH CARE

PUBLIC POLICIES

Jefatura de Gabinete de Ministros

Ministerio de

Justicia, Seguridad y Derechos Humanos

AUTHORITIES AND COMMITED ORGANIZATIONS Dr. Anbal FERNNDEZ Dr. Juan MANZUR Dr. Julio ALAK

CHIEF OF THE CABINET OF MINISTERS NATIONAL HEALTH MINISTRY MINISTRY OF JUSTICE, SECURITY AND HUMAN RIGHTS MINISTRY OF SOCIAL DEVELOPMENT Dr. Martn VZQUEZ ACUA Lic. Alberto CALABRESE Dr. Alicia GILLONE Dr. Horacio CATTANI Dr. Patricia LLERENA Lic. Eva GIBERTI Dr. Mnica CUARRO Dr. Alicia KIRCHNER

NATIONAL COMMITEE ON PUBLIC POLICIES FOR THE PREVENTION AND CONTROL OF TRANSNATIONAL ILLEGAL DRUG TRAFFICKING, ORGANIZED CRIME AND CORRUPTION NATIONAL HEADOFFICE OF THE FEDERAL PENITENTIARY SERVICE Dr. Alejandro MARAMBIO AVARIA

ORGANIZATIONS WORK TEAMS

HEALTH MINISTRY Dr. Juan Sylvestre Begnis, Consultant of the Health Ministry

Lic. Daniel Caponni, National Head Office of Community Medicine, Lic. Mnica Cerutti, in charge of the Coordinating Unit of the Health Ministry Dr. Claudio Bloch, Aids and Std Director, Lic. Silvana Weller, Lic. Alejandro Diaco, Lic. Vanesa Kaynar, Lic. Julia Reechi, Marisa Sadi, Dr. Carlos Falistocco, Dr. Claudio Ziaurritz. Dr. Sergio Arias, former Coordinator of the National Program for Tb, Lic. Maria Belen Herrero, Dr. Silvia Ramirez Lijo, Lic. Soledad Beltrame. Lic. Paula Ferro, Coordinator of the National Program for Sexual Health and Responsible Procreation, Dr. Albertina Paganini, Ofelia Musacchio. Dr. Perla Prigoshin

Dr. Graciela Ventura, Coordinator of the Remediar Program, Dr. Jorge Massi, Lic. Cristina Ratto, Lic. Roberto Armagno, Lic. Julieta Citate, Lic. Santiago Repetto Dr. Yago Di Nella, National Director of Mental Health and Addictions, Dr. Antonio Di Nanno, Lic. Ines Torres, Lic. Mayda Panossian, Dr. Ernesto Serrano, Lic. Miriam Sola Dr. Ana Speranza, National Director of Maternity and Infancy. Lic. Nora Corso, Lic. Mara Ins Diana, Dr. Alicia Gianinni, Dr. Marta Reybaud

Dr. Guillermo Williams, National Director of Sanitary Regulations and Quality of Health Services, Dr. Cecilia Santa Maria Dr. Horacio Echenique, Epidemiology Director, Lic. Carla Vizzoti, Lic. Andrea Graziadei

Dr. Silvina Arrosi, Scientific Coordinator, Dra. Rosa Laudi, Executive Coordinator, Dr. Martha Ferradas of the Program for the Prevention of Cervical Uterine Cancer. MINISTRY OF SOCIAL DEVELOPMENT Lic. Paola Vesvessian, Infancy, Adolescence and Family Secretary, Dr. Gabriel Lerner Undersecretary of Rights of the National Secretariat of Infancy, Adolescence And Family, Lic. Silvia Slimovitz, Gustavo Piantino and Lic, Delia Carro, Lic. Maria Gabriela Molina National Coordinator of Family Programs. NATIONAL HEADOFFICE OF THE FEDERAL PENITENTIARY SERVICE Inspector General Julio Cepeda, Inspector General Raul Flores both of them as General Directors of Correctional Regime, Prefect Dr. Adrian Petruzzi, Principal Director of Treatment, Dr. Daniel Palliano and Dr .Hector Paz Soria both as Health Directors Dr. Daniela Arcuri, Lic. Mariana Reino, Consultants of the National Director of the Federal Penitentiary Service

All rights reserved. The text of this document is available in english and Spanish, the english version was translated by the Translation Department of the Federal Penitentiary Service, by Trad. Publ. Mara Cristina Jakowiuk and Trad. Lit. Lucila Alejandra Martnez. This document has been compiled by Dr. Daniela Arcuri.

PRESENTATION The Argentine Republic throughout the 1994 reform

of the National Constitution has incorporated with constitutional Human Rights, which are part of the constitutional body. The National Government takes as an essential axis

hierarchy by the article 75, clause 22, international instruments of in its policies the promotion and assurance of Human Rights in their freedom and other rights that act as their support, such as the right of life, of physical integrity and of health care. insures the highest possible level of physical and mental health Cultural Rights), which would provide, in a prison setting, the same universality and equivalence). In this constitutional frame, it has been a concern not prison settings and guarantees the dignity of persons deprived of only the protection of health, but also the support of a policy that (art. 12 of the International Covenant on Economic, Social and quality of health that the rest of the community have (principle of prisons as a public policy and necessary for the Ministry responsible for the Public Health to assume the responsibility and

dictate the protocols by which prevention and assistance in prisons must be guided. Moreover, coordination must exist among the

At first stage, it was crucial to consider health in

different government agencies to guarantee the right to health care, as well as social inclusion of inmates. Drugs and coordinate Justice, Security and Human Rights, Health and the Scientific Consultant Committee for Control of Illegal Traffic in Narcotic and Psychotropic Substances and improve the prevention, treatment (nowadays depends on the Chief of Cabinet of Ministers), they signed the framework agreement of cooperation in order to rehabilitation, throughout the implementation of programs, inclusion (education, work and social development). On the one hand, in order to modify the health activities and plans on integral policies for health care and social mechanisms for the people deprived of their freedom, the creation different Ministries involved. and Complex Crimes Therefore, on the 29th.July 2008, the Ministries of

penitentiary paradigm and guarantee health post-penitentiary Freedom Situation" has been proposed, which coordinates the on 29th December 2009, it was signed an Agreement for Cabinet Ministers, the Ministry of Justice, Security and Human Rights, the Ministry of Health, the Ministry of Social Development On the other hand, being Argentina a federal country,

of "Inter-Ministerial Office for the Social Inclusion of People on

Cooperation and Assistance in Prisons, of which the Chief of the and the Provinces of Salta, Mendoza, Tierra del Fuego and Buenos Aires; the Committee on Public Policies for Prevention and Control

of Transnational Illegal Drug Trafficking, Organized Crime and Corruption was the technical consultant. Ministry of Health is the one who establishes the strategies for assistance and prevention in prisons, through coordinated actions our country by the International Covenants of Human Rights. with the Ministries of Justice, Social Development, Work and Education, enabling the access of persons deprived of their freedom to health, in accordance with the obligations assumed by Finally, this change of state policies, that is that

Buenos Aires, August 2010. Dr. Anbal D. FERNNDEZ

Chief of the Cabinet Ministers

INTRODUCTION The fact that a person should be imprisoned does not imply the suppression of rights and safeguards inherent to human dignity. Dignity is guaranteed by our Constitution and the Pacts and Conventions on Human Rights and it is this circumstance that obliges the State to act as surety and to promote rights to people in a prison setting, these rights should include the right to life, the right to physical integrity, to dignity, to access to health care and others that support them. This is the reason why, all interventions inside prisons should take into consideration the field where they are applied and they should mainly consider the lacks of this type of institutions and the intra-mural violence. The State is responsible for the health care of imprisoned people and because of this it should provide the same kind of protection it provides to the rest of the population, baring in mind the physical and economic impediment to fulfil this right together with the principles of equity and universality.

We believe that health issues of the penal population should be considered as public policies and should be jointly coordinated by the Ministry of Justice of each jurisdiction and the Agency responsible for Public Health and for Social Inclusion (Social Development, Education and Work).

In the Argentine Republic the system for prison management is bipartite. On the one hand the structure of the national system gave birth to the creation of the Federal Penitentiary Service depending on the Ministry of Justice, Security and Human Rights and on the other we find the provincial systems. According to Article 5 of the National Constitution each Argentinean province is autonomous and because of this they have created its own penitentiary service or transit units for the custody of prisoners under their jurisdiction.

The detention of people and their housing will take into consideration the jurisdiction where the crime is committed and the nature of the crime, that is to say people will be housed in provincial facilities for ordinary crimes committed in provincial territory and in the federal prison system if they committed a federal crime or if it was committed in national territory.

This work was done in the Federal Penitentiary Service. This organization has a real housing capacity of ten thousand three hundred and eighteen inmates and it houses nine thousand three hundred fifty five inmates of which seven hundred ninety-six inmates are female1.

Source of Information: Weekly Summary of Penal Population dated May 26th, 2010. Judicial Head Office of the Federal Penitentiary Service. Capacity 10318. General Total: 9355, Pre-trail 5060, Convicted: 4243, Unfit to plead 51. Later Incapacity: 1.Over a total of 513 young adults (18-21 years old), 796 women

out of which 7 are pregnant, 48 are mothers and are housed with 50 children.
2

The health care system within federal prisons consists of Low Complexity Medical Services distributed in each facility and coordinated by the Health Head Office depending on the General Head Office of Correctional Regime.

The Federal Penitentiary Service has thirty five penitentiary facilities distributed through out the Argentine Republic and divided by regions2.

Regions: Metropolitan: made out of the following facilities: Federal Penitentiary Complex I Ezeiza, Federal Penitentiary Complex II Marcos Paz, Federal Penitentiary Complex of the Autonomous City of Buenos Aires, Complex for Young Adults of Marcos Paz, Correctional Institute for Women (Unit 3), Penal Colony of Ezeiza (Unit 19), Central Psychiatric Service for Men (Unit 20), Penitentiary Centre for Infectious Diseases (Unit 21), Central Psychiatric Service for Women (Unit 27), Judicial Detention Centre (Unit 28), Penal Federal Transit Unit (Unit 29), Federal Detention Centre for Women Nuestra Seora del Rosario de San Nicols (Unit 31) and Penal Federal Institute of Campo de Mayo (Unit 34). Northwestern: Federal Penitentiary Institute Nuestra Seora del Rosario del Ro Blanco y Paypaya (Unit 8), Saltas Federal Penitentiary Institute Seor y Vrgen del Milagro (Unit 16), Federal Prison of Jujuy (Unit 22), Federal Prison of Salta (Unit 23), Penal Federal Institute Colonia Pinto (Unit 35). North eastern: Northern Regional Prison (Unit 7), Formosas Jail (Unit 10), Penal Colony of Presidencia Roque Saenz Pea (Unit 11), Penal Colony of Candelaria (Unit 17), Penal Federal Institute Colonia Pinto (Unit 35). Central: Penal Colony of Santa Rosa (Unit 4), Penal Colony Subprefecto Miguel Rocha (Unit 5), Correctional Institute for Women Nuestra Seora del Carmen (Unit 13), Open Correctional Institute of General Pico (Unit 25) and the Institute for Young Adults Dr. Julio Antonio Alfonsn (Unit 30). Southern: Penal Colony of Viedma (Unit 12), Esquels Jail Subalcaide Abel Rosario Muoz (Unit 14), Ro Gallegos Jail (Unit 15). For more information please check www.spf.gov.ar

The Medical Staff who works in the above mentioned Medical Services has a penitentiary career and also works parttime in Public Hospitals. Nowadays the number of professionals and assistants is of six hundred and fifteen for nine thousand three hundred inmates.

Before the signing of the agreement Justice with Health and Health for Inclusion, each Medical Service used heterogeneous criteria towards the policies of the Health Ministry, interventions were directed by urgency and demand 3 and there was no real doctor-patient relationship. While in the year 2008 both Ministries strengthen the access to fulfil the right of inmates for an integral health, a strong and sustained political will was necessary for this reform to take place. The Consultant Committee of the Cabinets Head Office and of the National Head Office of the Federal Penitentiary Service have been key actors in the identification and visualization process that enabled the understanding of Health issues inside prisons and made it a central topic of the agenda.

The most prevalent pathologies detected on inmates are: respiratory infections, hypertension, dermopathies, and digestive disorders. Health Head Office of the Federal Penitentiary Service. Year 2009.

The contributions made in the year 2008 by the United Nations Office on Drug and Crime on prevention and treatment of HIV/AIDS and addictions were fundamental, together with the ones made by the United Nations Latin American Institute for the Prevention of Crime and the Treatment of Offenders on correctional regime. Many of the observations, suggestions and recommendations made by both institutions have been taken into consideration for this work.

As background for this process we can highlight, the improvement of detention conditions that enabled inmates access to health, the prioritization of health on imprisoned people and the identification of all the factors that make the access to it difficult.

In the first phase a sensitization work was done within the penitentiary staff in order to reduce some of the prejudices of the officers and transform them into agents that will enable and facilitate change. The change of paradigm consisted on inverting the logic of most of the penitentiary managements prioritizing, at present, the health issue over the security one. This is the reason why by stating the needs on sanitary issues on federal prisons together with the confluence of all competent areas and the decision of inclusion of the penal

population into public policies, this is the first time and integral and inter-disciplinary study is done in the Argentine Republic.

SIGNATURE OF THE FRAMEWORK AGREEMENT BETWEEN THE HEALTH MINISTRY AND THE MINISTRY OF JUSTICE, SECURITY AND HUMAN RIGHTS ON COOPERATION AND ASSITANCE. On July the 29th, 2008 the framework agreement on Cooperation and Assistance was signed between the Health Ministry and the Ministry of Justice, Security and Human Rights. This agreement included the National Committee on Public Policies for the Prevention and Control of Transnational Illegal Drug Trafficking of Organized Crime and Corruption as surety, its aim was to implement sanitary policies issued by the latter in facilities depending on the Federal Penitentiary Service and to refer released people to medical centres in order to continue their treatment.

On April de 2nd, 2009 the Complementary Agreement for the implementation of the Program on Mental Health and Addictions was signed; and on May the 6th, 2009 the agreements for the implementation of the Programs on TB control and Remediar (pun on words between Remedy and Argentina) + networks, were signed. In order to negotiate this agreement before the Health Ministry, a Coordinating Unit of Penitentiary Health was organized.

On October the 22nd, 2008 Complementary Agreements were signed in order to establish the following programs: HIV/AIDS and Sexually Transmitted Diseases, Mother and Child, Eye Health and Blindness Prevention, Sexual Health and Responsible Procreation.

This Unit was created inside the Community Medicine Head Office depending on the Undersecretary of Community Health.

It must be highlighted that after the signing of the agreement, September 2008, all parties involved have been regularly meeting in order to establish strategic planning, monitoring and supervision of all the implemented strategies within the jurisdiction of the Federal Penitentiary Service. This experience has been systematized and documented in records in which all decisions and activities related to this subject are stated as constancy. PRIMARY HEALTH CARE4: Argentina considered Primary Health Care (PHC) as a key strategy in order to achieve Health for everyone in the year 2000. This aim was established by the World Health Organization (WHO), in the Declaration of Alma Ata of the year 1978 to which Argentina together with other countries agreed. This line of work was indicated to the Medical Services of the Federal Penitentiary Service by express recommendation of the National Health Ministry throughout its health policies.

Health is not an end in itself, for the individual or for society, but a condition of full life. We can not live in full if work is a load, if the house is a cave and if health is just another provision of the worker Dr. Ramn Carrillo.

In March 2009 the promotion of the prevention campaigns started in all penitentiary facilities and had the support of the National Health Ministry.

From the year 2008 to December 2009, under the agreements above mentioned, the following training courses and meetings to strengthen the sanitary teams in facilities of the Metropolitan Area and the interior of the country took place sponsored by the National Health Ministry: 1. HIV/AIDS, 2. REMEDIAR, 3. SEXUAL HEALTH AND RESPONSIBLE PROCREATION, 4. TB, 5. MOTHERHOOD AND INFANCY, 6. EPIDEMIOLOGY, 7. BIO ETHICS AND HUMAN RIGHTS. These up-dates have reached 90% of all medical professionals and assistants and have the transversal axis of sensitization on Professional Ethics and Human Rights and were dictated by a member of the National Consultant Committee of the Cabinet of Ministers. In October,2009, in the meeting to introduce the progress regarding the Agreement on Cooperation between the Ministries of Justice and Health it was established that the officers of the Federal Penitentiary Service should undergo specialized training on First Aids and Emergency.

It was also agreed on the implementation of a Program for Promoters of Community Medicine that will offer training for

inmates in diverse issues involving health care and also for their families.

This program was designed under the basis of the axis of the ATAMDOS Program developed in Buenos Aires province in 1989 and Program Pairs and Health Mediators applied in the Prison Service of Spain and its general aim is to train Health Promoters inside the correctional facilities, the idea is that this promoters share their knowledge and experiences with their companions and turn themselves into agents of processes of collective Health and in this way, improve the quality of their lives and of their families.

The Health Ministry could give a monthly 200 pesos scholarship to each of the assistants during the three months period of the course, and the Federal Penitentiary Service is considering paying wages to the people who work as Promoters of Community Medicine in the correctional facilities they are housed in. This will be done through out the ENCOPE5. IMPLEMENTATION OF THE PROGRAMS

REMEDIAR + NETWORKS

Institution of Technical and Financial Cooperation of Federal Penitentiary Service.

The Program FEAPS - Remediar6 consists of the provision of 64 essential medicines in order to respond to all consultations of primary level of attention. The Program consists of a strict record of all diagnostics, medical prescriptions, and stock control with a monthly send for the update of the medicines needed by the Medical Service.

As a first measure 87.5% of the Medical Services of the Correctional facilities have been trained. In the Metropolitan area7, the Medical Services of all these facilities have received the tenth delivery of Remediar.

In September, 2009, 25 professionals were trained in the north eastern region8, afterwards in the month of November these
6

The Remediar Program distributes medical kits to 6500 primary Health Care centers in all the country. For more information please contact www.remediar.gov.ar.
7

I.E the following facilities: Federal Penitentiary Complex I Ezeiza, Federal Penitentiary Complex II Marcos Paz, Federal Penitentiary Complex of the Autonomous City of Buenos Aires, Complex for Young Adults of Marcos Paz, Correctional Institute for Women (Unit 3), Penal Colony of Ezeiza (Unit 19), Central Psychiatric Service for Men (Unit 20), Penitentiary Centre for Infectious Diseases (Unit 21), Central Psychiatric Service for Women (Unit 27), Judicial Detention Centre (Unit 28), Penal Federal Transit Unit (Unit 29), Federal Detention Centre for Women Nuestra Seora del Rosario de San Nicols (Unit 31) and Penal Federal Institute of Campo de Mayo (Unit 34).

Towards the end of the year 2009, the Program started to supervise and audit the Medical Services that had received medicines and in the month of May, 2010 it will offer to professionals an update of rational use of medicines. In the months of April and May 2010, the Program Remediar started to make the logistics of the deliveries of inputs of the

At present, all the facilities mentioned before have received medical kits with essential medicines for the treatment of the most common pathologies, such as acute respiratory diseases, diabetes and hypertension, among others.

facilities started receiving its corresponding medical kits. In November, 2009 the update training was given to 20 professionals of the North Western Region.9 In December, 2009 training workshops took place in Southern and Central Regions10

Northern Regional Prison (Unit 7), Formosas Jail (Unit 10), Penal Colony of Presidencia Roque Saenz Pea (Unit 11), Penal Colony of Candelaria (Unit 17), Penal Federal Institute Colonia Pinto (Unit 35).
9

Federal Penitentiary Institute Nuestra Seora del Rosario del Ro Blanco y Paypaya (Unit 8), Saltas Federal Penitentiary Institute Seor y Vrgen del Milagro (Unit 16), Federal Prison of Jujuy (Unit 22), Federal Prison of Salta (Unit 23), Penal Federal Institute Colonia Pinto (Unit 35).
10

Penal Colony of Santa Rosa (Unit 4), Penal Colony Subprefecto Miguel Rocha (Unit 5), Correctional Institute for Women Nuestra Seora del Carmen (Unit 13), Open Correctional Institute of General Pico (Unit 25) and the Institute for Young Adults Dr. Julio Antonio Alfonsn (Unit 30), Penal Colony of Viedma (Unit 12), Esquels Jail Subalcaide Abel Rosario Muoz (Unit 14), Ro Gallegos Jail (Unit 15).

Program of Sexual Health and Responsible Procreation to the following female facilities: Federal Penitentiary Complex I, Correctional Institute for Women (Unit 3), Correctional Institute for Women Nuestra Seora del Carmen (Unit 13), Federal Prison of Jujuy (Unit 22), Federal Prison of Salta (Unit 23), Central Psychiatric Service for Women (Unit 27) and the Federal Detention Centre for Women Nuestra Seora del Rosario de San Nicols (Unit 31). HIV/AIDS and SEXUALLY TRANSMITTED DISEASES The Program of HIV/AIDS and Sexually Transmitted Diseases has trained 11 more than 300 professionals and medical assistants in its three strategic approaches12.

Access for people with HIV/AIDS to its corresponding treatment. Access for all imprisoned people to condoms, independently of intimate visits; to information and direct access or collect to the 0-800 line.

Access to the HIV Test with its corresponding advice, consent and information.

11

In the Metropolitan Area the training was done in November and December, 2008. In the interior of the country the planning was divided by regions: North Western: august, 2009; North Eastern: September, 2009; Central: December, 2009 and Southern: December, 2009.
12

The transversal axis of the Program is to reduce discrimination and stigma.

This Program provides continuous antiretroviral medicines, reagents for screening and prevention inputs- condoms, brochures, posters, among others- and visits the facilities in the metropolitan area in order to check and verify the fulfilment of the strategic approaches.

In this sense and as a result of the consensus between Health professionals of the metropolitan area and the team of the AIDS Head Office, posters have been displayed; brochures and condoms have been distributed to the inmates according to the mechanism that best suited the characteristics of the facilitymedical and educational staff are giving workshops for imprisoned people within the jurisdiction of the Federal Penitentiary Service. Additionally, in the month of November, 2009; the Health Head Office of the Federal Penitentiary Service has participated in a workshop on handling epidemiological data. This workshop was directed by assistants who make monthly assessments and statistical measurements on the subject. As a second phase, the adjustment of all measures taken is projected; this will be done through out the supervision of the established protocols, the execution of workshops for professionals in the areas of Social Welfare, Education and Penitentiary. Workshops for inmates are also planned.

MOTHERHOOD AND INFANCY: After the signing of the agreement, the Program for Mothers and Infants has established the patterns for child development and also provides milk powder to the children that live together with their mothers in federal prisons.

The authorities of the program appointed three professionals to visit the Federal Detention Centre for Women Nuestra Seora del Rosario de San Nicols (Unit 31) and together with the Units team offered a workshop to strengthen the motherchild bond. This workshop is held inside the housing places since October 2008 and its aim is to teach the inmates to reflect on their mothers role, to teach up bringing patterns such as feeding, games, sleep and potty training, among others.

Some examples of the taken commitment is the participation of the National Director of Motherhood and Infancy Dr. Juan Reichenbach; on April, 17th, 2009 he gave this workshop where 50 inmates of the mother floor attended; on May 20 th, 2009 he attended a meeting with the paediatricians of the Federal Detention Centre for Women Nuestra Seora del Rosario de San Nicols (U. 31), during the meeting he made recommendations for the strengthening of the quality of attention given to children inside prisons.

These interventions derived in the participations of the Units team in the thematic conference on strengthening of the topics dealt with.13

On December the 11th, 2009, the team of Child Development together with the team and authorities of Unit 31 conducted an activity for the mothers and their children with the participation of a recreation technician depending on the Ministry of Social Development. The technician gave as a present three trunks full of toys for the children living there. TB CONTROL: The Program for TB control has the following aims:

GENERALS:

SPECIFIC (STRATEGIC):
13

Reduce morbidity caused by TB Reduce the transmission of the tuberculosis infection. Reduce the resistance of the Mycobacterium tuberculosis to the anti-tb medicines.

On September 11th, 2009 the First National Meeting on Child Development was held with the sponsorship of the Health Ministry. The Alcaide Mayor Sonia Alvarez, Dr. Clemente Berardi and the interdisciplinary team of the Federal Detention Centre for Women Nuestra Seora del Rosario de San Nicols (U. 31) participated. From the 6th to the 7th of November, 2009 this same team participated in the Meeting on Up bringing of children from a different point of view held in the city of Mendoza and sponsored by the Program for Mothers and Infants.

Strengthen the strategy STOP TO TUBERCULOSIS in all the countrys jurisdictions. The strategy includes the following approaches: 2. Cope with MDR TB and HIV TB together with other problems 1. Apply the DOTS/TAES quality strategy.

This Program has trained together with the HIV/AIDS Program and the Sexually Transmitted Diseases Program, more than 160 doctors and assistants who work in the facilities of the metropolitan area14.

Establish a centralized working approach of the main areas according to the magnitude of the problems.

6. Promote research (operative and epidemiological)

5. Empower the cases and society about TB and its role

4. Get the health staff involved

3. Strengthen health systems

14

The update workshop held on May the 8th and 15th, 2009 had the honour of Dr. Palmero and Dr. Colinos participation; they lectured about detection and treatment of this pathology.

During the month of July, 2009, after the training of the staff in charge of the clinical cases of Tb and its follow up; it was agreed that anti-Tb medication will be delivered to the Federal Penitentiary Service for its later distribution to the different penitentiary facilities. In order to coordinate the provision of reagents and lab inputs, regular lab supervisions of three facilities take place.

Due to the application of the strategy Stop Tuberculosis, a draft resolution has been sent in order to be considered by the Program of Control of Tuberculosis in April 14th of the year 2009. Strictly Supervised Abbreviated Treatment15 for the development of strategies of the Program. During the last days of December of the year 2009, the available information about incidence and prevalence of

Regarding the Units of the interior of the Country, training activities were done in the regions: North East (September 2009), North West (November 2009), Central and South (December 2009)

15

Compare with the page of the World Health Organization: http://www.who.int/tb/strategy, and the document Building on and enhancing DOTS to meet the TB-related Millennium Development Goals which the draft is based on. It is available at http://whqlibdoc.who.int/hq/2006/WHO_HTM_STB_2006.368_eng.pdf.

Tuberculosis has been collected and analyzed and it has been recommended:

To carry out an active search of cases during the year 2010 in specific correctional facilities.

To adapt the National System of Health Monitoring in order to include the Federal Penitentiary System as an additional jurisdiction of notification of cases and their control, with the supply of passwords and access for users for the online system. In March of the year 2010, the system has been adapted and passwords were given to the Institution in order to enter the information, in a decentralized way, in each of the correctional facilities. To train the health professionals who are in charge of the notifications of cases.

To implement the latest Technical Norms of Tuberculosis Treatment, and supply the Guide for the Tuberculosis Monitoring in prison settings of Latin America and Caribbean of the Pan-American Health Organization. In the middle of the year 2010, it will be provided the notification of the cases under the system of online information of the module of Tuberculosis of the National System of Health

To develop joint activities in order to make specific brochures for prison settings and the publication of an Epidemiological Bulletin.

Monitoring, due to this measure the health professionals have been trained in two workshops.16 EYE HEALTH AND BLINDNESS PREVENTION: This Program provided the linkage with the effectors from the public sector in the cases of cataract surgery is indicated.

In June of the year 2009, there was an interaction with authorities, not only the provincial ones, but also the ones from hospitals, in order to assist patients with cataract diagnosis.

In the cases of cataract and glaucoma, an assessment was applied so that the Eye Health Program and Blindness Prevention can provide the inmates a corrective surgery and medicines in the second case. The following are the results of the before mentioned report:17 672.5 ophthalmologist consultations monthly 308.7 glasses orders monthly

They took place in Santa Fe, in the National Institute of Respiratory Diseases Dr. Emilio Coni, during February 24th. and 25th. of the year 2009. On the other hand, we also attended the workshop carried out in Mar del Plata during June 23rd. and 24th. of the year 2009. 17 Source: Federal Penitentiary Office National Headquarters. Information 2009.

16

177 cases of cataract, surgery has been required in 90%. 105 cases of glaucoma

MENTAL HEALTH AND ADDICTIONS: In accordance with the recent creation, in the month of April of this year, of the National Head Office of Mental Health and addictions, the inter-ministerial commission is waiting for the organization of structure and allocation of resources in order to take the corresponding measures in accordance with the directives of this new Head Office. Specially, in the layout of addiction treatment policies adapted to the specific needs of prison settings.

Nevertheless, it is important to point out that the Program of Mental Health and Addictions visited some prisons and specially, those institutions of specific assistance in cases of mental health, with the approval of the changes made at the Central Psychiatric Service for Men (U.20) and the Central Psychiatric Service for Women (U.27).18

18

It is important to point out that in February 2010, the National Plan of Mental Health in Prisons was approved, which coordinator is the author of the changes made in Prison 20. For more information, please see the Annual Management Report 2008. National Head Office of the Federal Penitentiary Service. Available at www.spf.gov.ar.

In February of the year 2009, and after many meetings held at the Ministry of Health in order to discuss the mental health assistance in prisons, we decided to visit the Federal Penitentiary Complex I Ezeiza in order to make an assessment of the necessities of the young adult inmates housed in the Housing Place IV, after that in the month of April of the year 2009, a draft was made for the implementation of a Day Center in the Housing Place IV of the Federal Penitentiary Complex I.

In June of the year 2009, a draft related to the training in mental health for penitentiary staff was sent for the consideration of the Federal Penitentiary Service, its aim was to make the staff in direct contact with the inmates, participate in the detection of symptoms and have the necessary tools in order to facilitate their work. The mentioned draft is under the consideration of the National Health Ministry19 SEXUAL HEALTH AND RESPONSIBLE PROCREATION: The Sexual Health and Responsible Procreation consists in, not only the delivery of methods of contraception, such as the oral,
19

In April of the year 2010, a visit was arranged with the group of teachers to the Federal Penitentiary Complex I, in order to have a meeting with the authorities and evaluate the necessities. The draft was designed for fifty members of the penitentiary staff and it has been decided its implementation in this complex for the staff of the housing places III and IV

Since the year 2006, the group of people working in the program has monitored its performance in the Correctional Institute for Women (U.3) with a participation of 59 inmates.

Also, the interaction of the people working in the Program with the ones from the Medical Services of the prisons for female population has been enhanced and since 2008 they have been supplying methods of contraception and information brochures in all the prisons of metropolitan area.

It is important to stand out that in April 1st. of the year 2008, this program has been implemented in prisons for women population.20

breastfeeding; injectable; and barrier method - IUD; but also it is required the counseling service and the opportunity to make the ligature of the fallopian tubes or vasectomy in public hospitals according to the Law 25673, related to the creation of the Program and the Law 26130 of methods of surgery contraception.

Moreover, it has been implemented a training course for 50 professionals in the Federal Penitentiary Complex I Ezeiza and Federal Detention Centre for Women Ntra. Seora del Rosario de
due to the high rate of suicides in the young adult population assessed as conflictive ones. 20 See Resolution N 652/08 of the National Head Office of the Federal Penitentiary Service.

Together with the programs of HIV/AIDS, Tuberculosis and Remediar, training courses have been offered in the following areas: the North Western area in the month of November and the Central and Southern area in the month of December of the year 2009. The schedule designed for the year 2010 is the following: To offer workshops to promote sexual and reproductive rights of women and men deprived of their freedom. To supply training courses and sensitize the penitentiary staff in gender and sexual and reproductive health. To coordinate with other programs of Ministry of Health and as from other ministries to implement joint activities with inmates and prison staff.

San Nicolas (U.31), more than 40 female inmates received the benefits of such measure.21

PROGRAM FOR THE PREVENTION OF CERVICAL UTERINE CANCER: The strategy of the program is focused on the prevention of cervical uterine cancer using the Papanicolau test. According to

21

It is important to point out that most of the inmates ask for methods of contraception different from condoms when they have conjugal visits. Bear in mind that forty five per cent of the women housed under the jurisdiction of the Federal Penitentiary Service are foreigners.

regular research carried out by this program, cervical uterine cancer is the second most commonly diagnosed cancer in women aged 35 64 years, and it has been proved that it is possible to prevent 80% of the incidence and mortality of this pathology. The diagnostic test to women deprived of their freedom it will be provided by the program and also the referral of samples for cytology test at enabled laboratories, the treatment will be indicated as a result of a diagnosis of pre cancerous lesions. The activities scheduled for the year 2010 are the following: To visit different prisons to assess the necessities of the medical area.22

To sensitize and promote the information related to cervical uterine cancer for the gynecologists, medical and prison staff. To offer joint workshops, with the medical staff and women inmates so that they can be more aware of their rights. To carry out a general medical check-up of the prison population in order to detect cases, with the supply of the material for the samples and the cytology in the enabled laboratories of public hospitals.

WORKSHOPS RELATED TO BIO ETHICS AND HUMAN RIGHTS Together with the before mentioned training courses, workshops related to bio ethics issues and human rights have been developed with the medical staff, this has to do with the physicianpatient relationship in a prison setting. ones: The topics covered during the meetings are the following Duties of the medical staff in prison settings Health rights of the inmates Physician-patient confidentiality Medical history Hunger strike relationship, informed consent and

Medical research in prison population

Protocol of Istanbul and the complaints of physical abuse and torture that inmates can suffer from.

EPIDEMIOLOGY: Throughout the Head Office of Epidemiology, the inmates housed under the jurisdiction of the Federal Penitentiary Service
Currently being applied.

22

are receiving doses of vaccines: yellow fever, flue, tetanus, the mandatory plan for children housed with their mothers in prison, among others, and these vaccines are not only for inmates but also for the penitentiary staff.23 In February of the year 2010, and in order to be ahead of the possibility that inmates could suffer from influenza A H1N1, we have asked for and consequently received from the National Health Ministry, three thousand eight hundred doses of vaccines for inmates and staff in the risk group.24 In April of the year 2010, we have required seven thousand additional doses to the Health Ministry, because the inmates population, who had not received the vaccines, could be in the risk

22 In the month of February of the year 2009, five thousand doses of vaccines against yellow fever were delivered for the staff and inmates of the North Western area. In March and September of the year 2009 we delivered vaccines from the mandatory plan for 50 children approximately, housed in the Federal Detention Center for Women Nuestra Seora del Rosario de San Nicols (Unit 31). In April of the year 2009 we delivered nine thousand flu vaccines and six thousand tetanus vaccines for inmates and also for the staff. In May of the year 2010 the authorized doses for the inmates were the following ones: 590 tetanus, 2106 tetanus adult gamma globulin, 5356 hepatitis B, 195, pneumococcal polyvalent vaccines, 50 antihaemophilus influenza, 50 triple bacterium vaccines, 2495 adult double, 1142 yellow fever, 20 typhoid fever, 100 chickenpox, 200 rubella, 80 viral double, 60 measles, 70 human antirabic. 24 The Health Ministry has considered as risk groups: all pregnant women at any time of pregnancy. Women with babies under six months. All children between 6 months and 4 years inclusive, children and adults between 5 and 64 years old with chronic diseases (respiratory, heart, renal, diabetes ones). Medical staff and adult people with morbid obesity with a body mass in kg (BMI) higher than 40.

group, bearing in mind the transportation of inmates, admission and visitors, apart from the fact of taking this as a prevention tool.

In May of the year 2010, due to a decision of the Ministries of Justice and Health, an Agreement of Cooperation and Assistance has been signed in order to receive the help of the Security Forces to control this epidemic in frontiers and in organizations with a constant movement of people.

These measures have been successful in the cases of influenza A H1N1 and dengue fever. In the first case, in June of the year 2009, we followed instructions for the prevention of influenza A H1N1, in accordance with the protocols established by the National Health Ministry. The following are the implemented measures:

Joint agreement with the Committee of Crisis of the Ministry of Health. Resolution 1349/09: It establishes the isolation of suspected cases and notification proceedings. In addition, it was also established: The use of temperature sensors for the detection of symptoms. Delivery of antiviral oseltamivir to the Medical Services from the Health Ministry. The prescription of the antiviral was based on medical criteria and on specific instructions of the Ministry, e.g. HIV patients. Chemo-prophylaxis of contacts.

It is important to highlight that, the Head Office of Health of the Federal Penitentiary Service has only detected fourteen suspected cases in the peak of the pandemic and they received the corresponding medication immediately. In May of the year 2010, the Federal Penitentiary Service had a stock of antiviral medication for the treatment of influenza A H1N1 and the risk group has received the vaccination.

Agreement made with the inmates to reduce the number of visits during the peak of the pandemic.

In the case of dengue fever, in August of the year 2009, there has been an implementation of instructions regarding the detection, prevention and assistance in dengue fever cases, in anticipation of possible cases in spring-summer seasons. The Federal Penitentiary Service has been provided with Guides of Dengue Fever for the people working in health groups, distribution of brochures and posters for the sectors with movement of people. Moreover, information talks were organized for staff and inmates. INTERVENTION PROTOCOLS: In order to reduce the bureaucratic delays and facilitate accessibility, in September of the year 2008, we have established with the Head Office of HIV/AIDS and Sexually Transmitted Diseases, the proceedings for the authorization of medication, HIV, viral load and CD4 tests.

At present time, the tests for CD4 and viral load are being required once a year -the Head Office of AIDS authorizes three diagnoses per patient during a year -, this has reduced the required time from three months to fifteen days. The tools of intervention used are: training workshops, monitoring and discussion of obstacles visits and the contact of the medical chief with the representatives and group of work of each program, as well as, the meetings held by the authorities, where the problematic issues are addressed in an interdisciplinary way.

The Protocols of prevention, diagnosis and treatment of HIV/AIDS were established in July of the year 2009 in order to ensure the effectiveness of the strategies applied by the Head Office of AIDS. It is mandatory to make workshops related to HIV/AIDS and STD, the distribution of condoms to the inmates -it does not matter if they have conjugal visits or not-, the distribution of brochures, the facilitation of access to the telephone line 0-800SIDA of the Ministry of Health, the notification of the results,25 the incorporation of strategies in order to join the treatment and in the case of transportation or release of the inmate, the provision of medicine for thirty days and the delivery of medical history summary. It is being evaluated in the National Program for the Monitoring of Tuberculosis, a draft resolution in order to establish protocols of prevention, assistance and treatment of Tuberculosis,
Even if they are positive or negative ones.

25

taking into account the strategy of treatment directly observed in accordance with the recommendation of the World Health Organization.

Another measure implemented is the disposition of monitoring and control of the patients that are released from the Penitentiary Center for Infectious Diseases (U. 21) and are rehoused in prisons with common regime. It was specifically required the fulfillment of the recommendations specified in the medical history, the referral for special treatments including addiction treatments- and the realization of a clinical ateneo, carried out by the team of the Medical Service. In the month of November of the year 2008 and due to the express recommendation of the National Director of Sanitary Regulations and Quality of Health Services, grids of categorization and qualification of health facilities have been sent to all prisons.26

26

Resolution N 1262/06, dated 08/31/06 for inpatients health facilities, Resolution N 1414/07, dated 10/30/07 for health facilities with or without highly complex admittance and Resolution N 1108/08, dated 10/07/08 for Centers of Primary Health Care.

ASSESSMENT OF THE EXPERIENCE AND INCLUSION OF NEW PARTICIPANTS: One of the objectives of the monthly interministerial meetings is just the assessment of planned actions, and if it is needed, the correction of the execution.

Nevertheless, the task of global systematization is carried out once year with the authorities that formed the Interministerial body in charge of the execution of the Framework Agreement of Assistance and Cooperation. In May of the year 2009, it took place the First Meeting of Penitentiary Health with the attendance of participants responsible of the system of reference and counter-reference of the inmates released from prison, also ten representatives from Patronatos de Liberados (Organization for the Patronage of People released from Prison) attended the mentioned meeting. Thus, it was carried out the Meeting for the Articulation of Policies for citizens in prisons settings that regain their freedom.

The mentioned meeting took place in October 20th. of the year 2009, and the participants were: Scientific Advisory Committee of Cabinet Chief, from the National Health Ministry, from the National Ministry of Social Development, from the Ministry of Justice, from the National Head Office of the Federal

Penitentiary Service and the National Head Office of Social Rehabilitation in the framework of the inclusion as participants of the Agreement concluded in February of the year 2009 with the Ministry of Justice, Security and Human Rights, Justice with Health, Health for inclusion.

The organizations involved are: the Leadership of the Cabinet of Ministers, throughout the National Committee on Public Policies for the Prevention and Control of Transnational Illegal Drug Trafficking of Organized Crime and Corruption; the Ministry of Justice, Security and Human Rights, throughout the National Head Office of the Federal Penitentiary Service and the National Head Office of Social Rehabilitation, the Health Ministry, the Ministry of Labor, Employment and Social Security, the Ministry of Social Development specially the National Secretariat of Infancy, Adolescence and Families-, the Ministry of Education, and the National Secretariat of Culture.

The objective of the interministerial articulation is to establish measures of integral assistance to those families that live in extreme social vulnerability and are affected by the abuse of narcotics, as well as, to promote and strengthen the participation of children and adolescents and their families in local communities networks, specially those low social risks locations, for the elaboration and implementation of community strategies of prevention and support in order to avoid the violation of those rights and/or restore the violated ones. At the beginning, the work consisted on a report related to what the Families Plan had been doing with the families of the

inmates, and the barriers to be overcome regarding the addresses of the inmates in the Federal Penitentiary Service, in order to address the issue.

The National Ministries of Social Development and Health can access to this database in order to support the implemented measures.

On the other hand, in the area of the National Head Office of Social Rehabilitation, it was created the Interministerial Office of Social Inclusion, where it will be implemented the database with the names, addresses and family situation of all the inmates housed in the facilities under the jurisdiction of the Federal Penitentiary Service.

The data is provided by the Federal Penitentiary Service and by the social workers of the National Head Office of Social Rehabilitation who make interviews to the families of the inmates in order to know about their necessities, composition, problems of education, health, work, among others. Moreover, this work also participates in the National Council for Coordination of Social Policies.27

27

It has been created by Decree N 357 dated February 21st. of the year 2002, amended by the Decree N 78, dated December 20th. of the year 2007, the National Council for Coordination of Social Policies in order to make a the plan and coordination of national social policy in order to improve the government management, throughout the lay out of policies and coordinated and integral courses of action, optimizing the resource

During the meeting, there was an exhibition of the results reached so far, regarding the implementation of the Agreement with the objective to achieve the participation of the Provincial Penitentiary Services for the application of this experience in their penitentiary services.28

National and provincial deputies, foreing representatives, authorities of the Ministries of Justice and Health, penitentiary authorities of the Federal Penitentiary Service, Provincial Penitentiary Services and medical groups attended the event.

In November of the year 2009 the First National Event of Penitentiary Health organized by the Commission of Health of the Chamber of Deputies of the Nation, National Ministries of Justice and Health, sponsored by the Chief National Cabinet of Ministers and the United Nations Office on Drugs and Crime.

allocation. In accordance with the article 3 of the Decree N 78/2007, the National Council for Coordination of Social Policies is composed by the Ministries of SOCIAL DEVELOPMENT, OF WORK, EMPLOYMENT AND SOCIAL SECURITY, OF EDUCATION, OF SCIENCES, TECHNOLOGY AND PRODUCTIVE INNOVATION, OF HEALTH, ECONOMY AND PRODUCTION, OF JUSTICE, SECURITY AND HUMAN RIGHTS, OF FEDERAL PLANNING, PUBLIC INVESTMENT AND SERVICES AND BY THE NATIONAL SECRETARIAT OF INFANCY, ADOLESCENCE AND FAMILY. 28 This participation together with the application in the Federal Penitentiary Service represents the 65% of the approximately sixty thousand people who are deprived of liberty in the Argentine Republic.

At the closing date of this report, nine provinces of the republic have implemented this experience in their respective penitentiary systems.

JGM Chief National Cabinet of Ministers

Av. Julio A. Roca 782 C1067ABP Ciudad Autnoma de Buenos Aires Repblica Argentina Tel. (54 11) 4331 1951 to 59 www.jgm.gov.ar