Abstract
BACKGROUND: The World Health Organization (WHO) has indicated that the absence of prison health poses a threat to public health, making it important to safeguard access to quality healthcare for incarcerated populations. Although several studies have explored the quality of care in prisons, there is a dearth of empirical evidence on the perspectives of incarcerated individuals. This study investigated incarcerated individuals' perspectives and opinions on the general healthcare services in Ghanaian prisons. METHODS: Utilizing a qualitative approach, focus group discussions were conducted with 51 incarcerated individuals in five prisons sited in the Northern, Middle and Southern zones of Ghana. Thematic analysis following the tradition of Braun and Clarke was conducted. Four of the six constructs of the WHO Health Systems Framework - service delivery, health workforce, access to essential medicines, and leadership and guidance - were applied deductively to organise the data into themes and subthemes. RESULTS: Four themes were generated from the analysis: "Health service delivery", "Health workforce in prisons", "Access to essential medicines" and "Leadership; regulating healthcare services". Participants rated health services in prisons as below average compared to those available to the general population. The use of nurses as prescribers in prison infirmaries, though consistent with Ghana Health Service policy, seems to negatively influence prisoners' perceptions of the quality of the health workforce in prisons. Lack of basic equipment and essential medications at the infirmary for common endemic conditions such as malaria coupled with the bureaucratic processes required to access care outside of the prison also negatively affected incarcerated individuals' perceptions of the quality of health care. CONCLUSIONS: Incarcerated individuals perceived that the quality of health services provided in prisons was inferior to that provided in the general population. Addressing challenges associated with the unavailability of essential drugs and equipment, improving the number of health staff, and addressing bottlenecks in accessing urgent care will enhance the experiences of incarcerated populations on the quality of care given.