Racial and gender discrimination, the migrant labor system, the destruction of family life, vast income inequalities, and extreme violence have all formed part of South Africa’s troubled past, and all have inexorably affected health and health services in prisons. In 1994, when apartheid ended, the health system faced massive challenges, many of which persist. (Coovadia 2009) asserted that public health system has been transformed into an integrated, comprehensive national service, but failures in leadership and stewardship and weak management have led to inadequate implementation of what are often good policies,
A public health system should include the governmental public health agencies, the healthcare delivery system, and the public health and health sciences academic, sectors that are heavily engaged and more clearly identified with health activities. Communities and their many entities businesses, employers, and the media as potential actors in the public health system play important, often dual, roles in shaping population health. However, businesses can and often do take steps to contribute to population health through efforts such as facilitating economic development and regional employment and workplace-specific contributions such as health promotion and the provision of healthcare benefits. Alleviating overcrowding by increasing the availability of non-custodial alternatives including community service and bail, and improving access to legal representation, are essential public health measures for TB prevention and control in South African prisons. African governments and international health donors should fund justice initiatives and other structural interventions to address TB in prisons and the general population in Africa. Tuberculosis in the 21st century is not a stand-alone disease. It is fundamentally linked to a range of constraints, environmental and socioeconomic factors. Effectively tackling the rising rates of tuberculosis in prisons in South Africa requires a suite of interventions underpinned by a rights-based approach to inmate welfare.
The media should feature a conduit for information and as a shaper of public opinion about health and related matters of the imprisoned. In spite of improved implementation of conventional tuberculosis control, considerable investment in a broader range of public health interventions, including infrastructure and staffing upgrades, cutting-edge tuberculosis diagnostics, and combination prevention for HIV, will be equally critical. The response to tuberculosis in prisons will be essential in tackling existing prison tuberculosis epidemics and will require high-level political support and financing. (Nyangulu et al 1997) posit that “the basic components of tuberculosis care in prisons are well recognized internationally”. Tuberculosis screening is recommended in prisons, and the WHO recommends entry screening for all inmates, self-referral for prisoners with tuberculosis symptoms, and mass screening in outbreak situations.
Despite challenges affecting South African prisons, the constitutional and legal framework for human rights in prisons is progressive. The South African Bill of Rights enshrines the rights to dignity, equality, and humane treatment of detainees, including access to justice, adequate accommodation, health care, exercise, food and water, and reading materials. Incarcerated peoples’ constitutional rights are supported by various statutes, policies, and regulations that provide minimum norms and standards for conditions in prisons and the treatment of people in prison. The South African courts first established that the state has a higher duty of care to incarcerated people for health services and determined and enforced the state’s obligation to deliver TB medication for free in prison. Key among these responses must be an improvement in prison infrastructure to reduce overcrowding for both male and female inmates. Strengthened implementation of conventional tuberculosis control activities must therefore be combined with a long-term investment in a broad range of public health interventions, including more up-to-date and sensitive point-of-care tuberculosis diagnostics.