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Health care practitioners in prison face the challenge of providing high standards of health care within the unique peculiarities and restraints of the prison environment. The strict adherence to principles of medical ethics by the prison health care staff and the knowledge and acceptance of these principles by the whole prison community not only results in ethical conduct but also yields practical professional advantages such as guidance in situations of conflict, promotion of confidence and avoidance of misunderstandings. The internationally consented conventions, declarations and recommendations relevant on medical ethics in prison are presented and their basic principles ‐ the primary task of the prison doctor, access to a doctor, equivalence of care, patient’s consent and confidentiality, preventive health care, humanitarian assistance, professional independence, professional competence ‐ are discussed. In addition, the personal obligation of the prison doctor for ethical reflection and decision making in individual ethical issues not covered by the quoted documents and in ethically controversial issues is emphasized. A training course and published guidelines for ethical conduct in prison health care are recommended.

The quality and relevance of what happens in prisons are measurably improved once prisons are seen, and have to act, as an integral part of society and the community. The provision of health care has benefited a great deal from the involvement of national and local agencies whose professional expertise is in health and education. HM Inspectorate of Prisons (HMIP) has developed the World Health Organisation's concept of a ‘healthy prison’ (WHO, 1998) to judge the treatment of prisoners and the conditions in which they are held against four core criteria. Partnership working between the Prison Service and NHS was formalised in April 2000, and the majority of prisons have transferred the commissioning of health care to the NHS. This paper considers the challenges and developments of partnership working in improving health outcomes for prisoners, and identifies future improvements.

In the last four years health services in public sector prisons in England have undergone a period of rapid reform and modernisation. Before this, prisoners' health care was characterised by over‐medicalisation, isolation from the NHS, and lack of education and training for health care staff. As part of this process of reform, responsibility for funding and commissioning these services has moved from the Prison Service to the National Health Service (NHS). The results so far seem encouraging. Services are better funded, standards have improved and there is significant progress in developing a strong partnership between the key partners ‐ the Prison Service and the NHS ‐ at national and local levels. These reforms address human rights and the aim of the Prison Health Unit, that prisoners should be able to expect their health needs to be met adequately by services that are broadly equivalent to services on offer in the community. Some learning points for other countries are considered. An equivalent strategy for the modernisation of public sector prisons in Wales is being developed by the Welsh Assembly Government.

The standard of health care in prisons should be equivalent to that provided in the community. Prison populations are multiply disadvantaged and primary health care practitioners in prisons routinely face organisational and ethical challenges which are rare in community‐based general practice. This raises the question of whether doctors working in prisons consider they would benefit from additional clinical skills or training, the range of prison‐specific competencies they consider important and what they would like to see included in induction programmes. Through a series of semi‐structured, faceto‐face interviews with doctors and health care managers working in prisons, this study sought to identify views on the training needs for doctors working in prisons. Practitioners demonstrated that induction processes were varied and fragmented and that delivering primary care in prisons raised additional clinical and organisational challenges. Relationships with prisoner patients were generally good. Few ethical issues were raised by this small sample, with the exception of confidentiality. However, aspirations towards equivalence were tempered by tensions between custodial needs and clinical requirements, and more research should be directed to the ways practitioners negotiate this interface. Induction programmes should ensure that all practitioners receive practical and ethical guidance to help them address these tensions.

Background. High and variable rates of attendance at GP consultations in prisons are observed. The aim of the study is to have a clearer understanding of social factors influencing inmates’ help‐seeking behaviour and demand for primary health care. Methods. A qualitative study was carried out in five Belgian prisons (three Dutch‐speaking and two French‐speaking). Twenty‐five male inmates were interviewed face‐to‐face and 18 caregivers (7 nurses and 11 GPs) in focus groups. Results. Five main social factors explain inmates’ help‐seeking behaviour and demand for primary health care: (1) inmates’ negative perception of imprisonment increases help‐seeking behaviour; (2) inmates use their rights to health care as strategies to maintain some form of control over their lives; (3) the doctor’s role distorts expression of need and demand; (4) health professionals’ control over inmates’ lives creates mistrust and a controlling therapeutic relationship; and (5) lack of alternatives to health care. These factors are mutually dependent and cause a confrontation in the inmates’ and clinicians’ agendas. Conclusion. The most important recommendation is to understand what the inmates are really seeking in their demands. This information can be used to develop appropriate alternatives in terms of human support and well‐being facilities. The therapeutic and security roles of health care workers should be separated, in order to increase the trust that is central to the therapeutic relationship between them and inmates.

This paper explores the health rights of prisoners as defined in international law, and the mechanisms that have been used to ensure the rights of persons in detention to realise the highest attainable standard of health. It examines this right as articulated within United Nations and regional human rights treaties, non‐binding or so‐called soft law instruments from international organisations and the jurisprudence of international human rights bodies. It explores the use of economic, social and cultural rights mechanisms, and those within civil and political rights, as they engage the right to health of prisoners, and identifies the minimum legal obligations of governments in order to remain compliant with human rights norms as defined within the international case law. In addressing these issues, this article adopts a holistic approach to the definition of the highest attainable standard of health. This includes a consideration of adequate standards of general medical care, including preventative health and mental health services. It also examines the question of environmental health, and those poor conditions of detention that may exacerbate health decline, disease transmission, mental illness or death. The paper examines the approach to prison health of the United Nations human rights system and its various monitoring bodies, as well as the regional human rights systems in Europe, Africa and the Americas. Based upon this analysis, the paper draws conclusions on the current fulfilment of the right to health of prisoners on an international scale, and proposes expanded mechanisms under the UN Convention against Torture and Other Cruel, Inhuman or Degrading Treatment to monitor and promote the health rights of prisoners at the international and domestic levels.

High quality health-care delivery is not only the governments’ responsibility but also every prisoner’s right. Health care in prison and, particularly, of Iranian prisoners is increasingly important topic because of the rising number of the prison population. This paper aims to explore health-care managers’ perspectives and experiences of prisons and the barriers to health-care delivery in Iranian prisons.

A qualitative research design was conducted in Iran from October 2018 to August 2019. The participants consisted of 51 health-care managers (50 men and one woman) from Iranian prisons. A combination of face-to-face (N = 42) and telephonic (N = 9) semi-structured interviews were used because of the geographical distribution of the respondents. The first part of the interview guide consisted of demographic characteristics, and the second part consisted of three main open ended-questions. Interviews were recorded and transcribed, and thematic descriptive analysis was used to interpret the data.

The barriers to health-care delivery in Iranian prisons were categorized into four main topics: human resources, financing, facilities and barriers related to the health-care delivery process. Data synthesis identified the following themes for barriers to human resources: barriers to human resources planning (with eight sub-themes); barriers to education (with three sub-themes); and motivational barriers (with seven sub-themes). Moreover, barriers to financing consisted of five sub-themes. The barriers to facilities consisted of barriers related to physical infrastructures (with two sub-themes) and barriers related to equipment (with six sub-themes). Finally, barriers to the health-care delivery process included the following themes: communication barriers (with six sub-themes); legal barriers (with five sub-themes); and environmental-demographic factors (with seven sub-themes).

Identifying the barriers to health-care delivery in Iranian prisons plays a critical role in the improvement of planning, decision-making and the health-care delivery process.

In the past, health management in Geneva's six post‐trial prisons had been variable and inconsistent. In 2008, the unit of penitentiary medicine of the Geneva University Hospitals was mandated to re‐organize and provide health care at all six prison facilities. The specific aim of this paper is to outline the example as a practical solution to some of the common challenges in unifying the structure and process of health services across multiple small facilities, while meeting European prison health and local quality standards.

Geneva's post‐trial prisons are small and close to one another in geographical proximity – ideal conditions for the construction of a health mobile team (HMT). This multidisciplinary mobile team operated like a community ambulatory care model; it was progressively launched in all prison facilities in Geneva. The authors incorporated an implementation strategy where health providers partnered with prison and community stakeholders in the health delivery model's development and adaption process.

The model's strategic initiatives are described along the following areas, in light of other international prison health activity and prior care models: access to a health care professional, equivalence of care, patient consent, confidentiality, humanitarian interventions, and professional competence and independence.

From the perspective of the HMT members, the authors provide the “lessons learned” through this experience, especially to providers who are working on prison health services reform and coordination improvement. The paper particularly stresses the importance of partnering with community health stakeholders and prison staff, a key component to the approach.

Prisoners are supposed to receive health care that is equivalent to that provided in the community. There is a high prevalence of mental ill health in prisons, and prisoners tend to have complex needs. Prison mental health care has received only limited attention until recently. The impact of the new in ‐reach teams appears to have been positive, but primary mental health care is weak across the prison estate and the vast majority of prisoners with mental health problems still receive little or no service. The development of prison mental health care has not been evidence‐based and there has been no policy implementation guidance that compares to that provided for reforms in services for the wider community. There is no model for prison mental health care and the role of the prison mental health practitioner is not well defined, nor is the health care workforce prepared for the task.

The Sub-Saharan African (SSA) region remains at the epicentre of the HIV epidemic and disproportionately affecting women, girls and prisoners. Women in prison are a minority group and their special health needs relating to gender sensitivity, reproductive health, their children and HIV/AIDs are frequently neglected. Our study responded to this need, and aimed to investigate the issue.

A qualitative study using focus group discussions and key informant interviews explored the perspectives of women in prison, correctional officers, correctional health professionals and non-governmental organisations around prison conditions and standards of health care while incarcerated in a large female prison in Zimbabwe. Narratives were transcribed and analysed using thematic analysis.

The three key themes that emerged are as follows: “Sanitation and hygiene in the prison”, “Nutrition for women and children” and “Prison-based health services and health care”. Divergence or agreement across perspectives around adequate standards of sanitation, hygiene, quality and adequacy of food, special diets for those with health conditions, access to health care in prison and the continuum of care across incarceration and community are presented.

Understanding prison environmental cultures which shape correctional staff’s understanding and responsiveness to women in prison, environmental health conditions and access to health care are vital to improve conditions and continuum of care in Zimbabwe.

Policy and technical guidance continues to emphasise the need for research in SSA prisons to garner insight into the experiences of women and their children, with a particular emphasis on the prison environment for them, their health outcomes and health-care continuum. This unique study responded to this need.