Dr. Edozie Felix
> Until 1990, there were less than ten doctors in the Prisons Service across the country
> The Prison Service lacks a proper template for health data collection
> Certain privileges are denied most inmates because they are awaiting trial
> In a cell meant for 20 people, you have about 100 people
Against the backdrop of the poor inmates’ health and overcrowding of Nigeria’s correctional centres, Public Health Physician and Dermatologist, Dr. Odiah Edozie Felix, who was Nigeria Prisons Medical Corps and retired in 2013 as a Controller of Prisons tells Africa Health Report’s Gom Mirian that policy issues and poor funding, among others, are affecting the timely delivery of healthcare services in these centres
A new report on the Summary of Inmate Population by Convict and Persons Awaiting Trial as of October 4 2021 revealed that the facilities hold 37% more inmates than it is designed to. The Nigeria Correctional Service (NCS) data shows that Nigeria’s correctional centres can only hold 50,083 inmates but they currently hold 70,056 inmates.
Going into detail, Dr. Odiah Edozie Felix affirms that indeed the overcrowding of inmates has exerted pressure on healthcare facilities in the NCS. He explains: “In terms of drugs, the service cannot handle all the drugs requirement of the inmates due to cost. Most inmates, especially those on trial, do not have family members visiting them so they have to buy some drugs on their own and often they have no cash.
“Drugs also are centrally purchased at the Prisons headquarters in Abuja and distributed to over forty-five prisons across the country on a PUSH basis. What quality of drugs you may ask? There are many problems militating against drug acquisition in prison service.
“No budget will ever be enough for the purchase of drugs in prison service because the prison population is very dynamic. Prison facilities can double its inmates due to any unexpected circumstances, so the budget for the purchase of drugs should be open-ended.
“This is an election period where any one day could have more than three hundred people arrested in one swoop into a facility already overcrowded with those awaiting trials.
“Such a situation overstretches the budget for drug purchases. So this is just the situation with drug purchases in the Prisons Service.
“The issue of enough medical staff is a big problem now in Prison Service. As I mentioned earlier before 1999 there were only about ten or fewer Medical Doctors in the entire service.
“From then we saw an upsurge in doctors willing and recruited to work in the Prisons Services greatly.
“The issue of brain drains especially affects medical practitioners. This has affected the Prisons Service greatly.
“In the last six months, about three Medical Doctors left the service, citing lack of promotion for Medical Doctors, insensitivity of the service to the working environment of the health personnel and lastly continuous misunderstanding between the head of the Medical directorate who has no medical education and the senior medical officers premised on improper administration of the directorate based on limited Medical knowledge on the part of the hand of the directorate.
“These misunderstandings give rise to the moral assassination. A medical Doctor cannot be promoted beyond the rank of Assistant Controller General of Prisons while someone with a degree or HND in religious studies, history, library science, et cetera can aspire to be Controller- General and Deputy Controller General.
“I am in no way looking down on these qualifications I have mentioned but this is grave injustice to those medical doctors who spent nothing less than six to seven years graduating as a medical practitioner and extra ten years to acquire the specialized qualifications.
“Where, if not in prison service, can that happen? I spent almost ten to eleven years in the rank of Controller because they say we have only one slot as doctors to be promoted to even the Assistant Controller General, talk more of Deputy or Controller General.
“Are these not enough to send the doctors packing? I spoke to one of the directorate heads about a doctor who is threatening to leave the service and all she said to me was that she couldn’t care less.
“Where do all these lead us? The issue of your juniors being promoted ahead and above you will cause more doctors to leave the service.
“In conclusion, lack of motivation, roles and the systems, are demotivators for doctors in the Prisons Service, and they affect negatively the medical staff strength of the service.
“The worst of all is the inability of the service to pay medical doctors their medical allowance arrears approved by the federal government since 2010. The system is frustrating the Doctors as much as they can for reasons best known to them”, he said.
Your narrative considerably mirrors what obtains in several other national institutions, especially in the arena of funding and data-based planning. What do you consider the way forward?
The former Controller of Prisons stated that: “Major issues and problems militating against the healthcare needs of inmates across the country are the same problems we face as free citizens.
“Yes, the first thing that comes to mind is the lack of adequate funds, but my question about this is, what has been done with the little funds allocated to this sector?
“How have we utilized the little funds given? At times I attribute these problems to a lack of proper planning arising from poor management of the Health Information Management System that should provide us with appropriate, verifiable, correct, timely data for planning and implementation of health interventions.
“The Prison Service lacks a proper template for health data collection. Those handling these data are not trained or lack the basic knowledge of what data is all about.
“Health care needs of inmates are issues that should be handled with dispatch. They are issues on the front burner. We have been really lucky that the experienced medical staff are dedicated and work with almost absolutely nothing.
“There are countless instances that out of compassion we had, to part with our money to provide drugs to these inmates. This is because you can’t sit and watch a patient die.
“After all, he can’t afford five to ten thousand naira to buy medication. Again having to balance the prison’s regimen and that of an inmate requiring some either investigation or X-ray or special care outside the prison is a very big problem.
What about the United Nations’ minimum rule for the treatment of offenders?
“Well, most of the inmates are awaiting trial, which means that certain privileges are not extended to them, in terms of freedom of movement, etc. So such persons are not allowed outside the prisons until their cases are heard in the count. They constitute the biggest problems for the medical staff that are faced with the problem of loyalty to their paymaster by keeping to the prison’s laws and loyalty to their professional oath.
“Another problem is the problem of congestion. In a cell meant for twenty people, you have about one hundred people. This impacts negatively the health of inmates.
“Diet is a major factor. It is almost impossible for inmates to be given a diet prescribed by the physician because self-feeding is against the law except with special permission from the prison authorities.
“The inmates also more often than not, do not keep to the treatment regime. This is also due to their regimented feeding system while serving time, the issue of having their relatives help buy their medication is a big problem.
“Most of them don’t even have relations who come to visit. This is a big problem also. Also, here is their lifestyle. It is said that old habits die hard. Some of them find it difficult to part with their very unhealthy lifestyle and these impacts negatively on their health needs”, he explained.
According to former Controller of Prison: “The main challenges we have in prisons include but are not limited to inadequate equipment and working tools, where they are available, they are obsolete lack of maintenance and this is unfit for the purposes they are meant for.
“There is a shortage of staffing of different cadres, like mental health specialists, social workers etc.
“There are no funds for the training of staff in the budget. There is no government support for the Prisons service from the government’s public health sector and the referral linkages and the cost of care for the inmates are weak.
“Using the above assessment tools, I will rate the general condition of the health facilities in the prisons as fair.”
It’s on record you initiated some key efforts that triggered some off-shore interventions, especially in Tuberculosis management in the health facilities of prisons….
“In 2012, I approached my colleagues heading the National Control Program on Tuberculosis and senior technical advisor of KNCV Tuberculosis Foundation Netherlands respectively, to come and assess some of our prisons’ health facilities and see where they can help in improving the general health services in the prisons.
“The response I got was phenomenal. From 2012 until 2016 even after I had retired, they helped in upgrading health facilities in prisons across the country. The national program on TB control in collaboration with KNCV undertook the training of health staff across all the prisons in the country.
“Millions of naira was spent on this project. They also provided technical assistance to health officers in the service; KNCV undertook the upgrade of the laboratories across the country providing them with lab equipment such as the microscope, workstations where they didn’t exist, reagents etc.
“Also a health template was developed for the admission of inmates to provide comprehensive health information about each inmate. These are kept in individual files for reference as the case may be. The National Control Program on Tuberculosis (TB) then headed by Dr. Segun Obasanya included our health officers and doctors in most of their training programs for their continuous medical education for optimal performance.
“While Dr. Mustapha Gidado was elevated from senior technical advisor to country head of KNCV TB foundation in Nigeria, he increased his assistance to Nigeria Prison Medical services.
“He proposed the introduction of the WHEEL OF LIFE / HEALTH by the prison service to help cover the prisons that do not have medical doctors and senior nursing staff across the country.
“He also promised to provide support for the implementation and sustenance of this project. Guess what? The prison authorities never showed interest and that is where they are to date.”
Speaking further on other health issues, Dr. Felix said: “Looking at the inmates at a glance, the first thing you notice is their fragile and unhealthy looks. He queried why that was so and provided a revealing response.
His words: “The fragile and unhealthy looks of the inmates I must tell you are a thing of the past. This was the case in the 80s not now. Then the government allocation for the feeding of an inmate was about one hundred to one hundred and fifty nairas (N100-N150) per day.
“You should realize also that this issue of congestion in the prison service is a very big problem. I think as of today their feeding allowance is N750 only. That’s why they are looking robust, well-fed, and well-kitted.
“Even people want to commit a crime and be sent to prison where he/she will be well fed (Laughs).
“Most importantly, until 1990 there were less than ten (10) Doctors in the Prisons Service across the country. So before an inmate could access any quality health service he had to wait for a Doctor to be invited from the government hospital and that could take days if not weeks.
“The year 1990 was a turning point in the history of improved quality, accessible and affordable if not free medical services to prison inmates and staff in general.
“It ushered in about twenty (20) newly recruited medical Doctors and several experienced nurses and other paramedics like, pharmacists, health technology graduates, laboratory technologists, you name it. That changed the health status greatly of the prison inmates.
“Though there are still administrative problems militating against the smooth, timely delivery of health care services to the inmates.
“I think I have been able to address the issue of the fragile and unhealthy look of prison inmates in the past. Other factors, not mentioned here also contribute to their fragile and unhealthy look.”
