Home > The WHO Prison Health Framework: a framework for assessment of prison health system performance.

World Health Organization Regional Office for Europe. (2021) The WHO Prison Health Framework: a framework for assessment of prison health system performance. Copenhagen: WHO Regional Office for Europe.

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Maintaining the best health and well-being of people in prisons can benefit everyone, making communities safer and avoiding excessive costs for local economies. With this aim, WHO/Europe published a new Prison Health Framework that aims to standardize data collection and help any country of the WHO European Region assess their prison system. Many people have their first contact with health services upon incarceration, making prisons a unique opportunity to increase universal health coverage. To improve care provision in prisons, it is crucial to first systematically consolidate health data collection in detention facilities.

People in prisons are more vulnerable
On any given day, more than 1.5 million people in the European Region are living in prison, and over 11 million people are incarcerated globally. The health profile of people in prison is very diverse and complex, but one thing unites them: the detained are more vulnerable to health risks than the general population. Moreover, health risks in places of detainment can be amplified by risk factors for incarceration, including lack of income and social protection, low educational attainment, job insecurity, poor working-life conditions, food insecurity and poor housing.

“It makes perfect sense to create prison systems that ensure that people in prisons get the same health care as people in the outside communities. This means the same variety of services and of the same quality, with the safeguard that all these services are accessible to all free of cost,” said Dr Filipa Costa, Health Policy Specialist at the WHO European Office for the Prevention and Control of Noncommunicable Diseases, one of the experts who developed the new Prison Health Framework. “If we want to be able to develop evidence-based policies and implement change in our prison systems, we need first to be able to assess where we stand,” added Dr Costa.

Framework for a better prison environment
The new WHO Prison Health Framework allows Member States of the Region to assess how fair and cost-efficient health care is in their detention facilities – and to take the needed steps to improve or redesign the system. Inspired by existing WHO frameworks to monitor and measure health-care delivery in a standardized way, the new Prison Health Framework has been developed to fully capture the specificities of prisons and other places of detention. The overall goals of the Framework are to improve health in prisons (in terms of level of care as well as equity), to enhance social and financial risk protection and to make prison systems more responsive and effective.

Cross-cutting principles
The WHO Prison Health Framework is structured around 3 main building blocks:

  • system-level aspects of prison health care
  • provision/delivery aspects of prison health care
  • health outcomes.

The Framework allows authorities to understand how prison environments and health behaviours can translate into health outcomes. It also helps to objectively assess the impact of investing in prison health-care delivery. There are also 2 cross-cutting principles that are associated with these building blocks, which have been identified as specific to the prison context: “adherence to international standards for human rights and good prison health” and “reducing health inequalities and addressing the needs of special populations”. Both these cross-cutting principles align with the WHO European Programme of Work 2020–2025 –“United Action for Better Health in Europe”. The WHO Prison Health Framework will improve assessment of prison health system performance and the quality of data collected by the periodic Health in Prisons European Database (‎HIPED)‎ surveys, which aim to inform progress in achieving equivalence of care for people living in prison.

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