A multi-stakeholder situation assessment of COVID-19 disease preparedness and mitigation measures in a large prison complex in Malawi

Abstract

Purpose Prisons in the sub-Saharan African region face unprecedented challenges during the COVID-19 pandemic. In Malawi, the first prison system case of COVID-19 was notified in July 2020. While prison settings were included in the second domestic COVID-19 response plan within the Law Enforcement cluster (National COVID-19 preparedness and response plan, July–December 2020), they were initially not included in the K157bn (US$210m) COVID-19 fund. The purpose of the study was to assess prison preparedness, prevention and control of COVID-19 in Malawi.. Design/methodology/approach A multi-method situation assessment of the COVID-19 response and human rights assurance of prisoners and staff was conducted in a large prison complex in Malawi. Qualitative research underpinned by the Empirical Phenomenological Psychological (EPP) framework consisted of interviews with key informants such as prison health personnel, senior prison staff, penal and judicial policymakers, government and civil society organisations (n = 14) and focus group discussions with consenting male (n = 48) and female prisoners (n = 48) and prison wardens (n = 24). Prison site visits were supported by detailed observations based on the World Health Organisation Checklist for COVID-19 in prisons (n = 9). Data were collected and analysed thematically using the EPP stepwise approach and triangulated based on Bronfenbrenner’s model conceptualising COVID-19 as a multi-level event disrupting the prison eco-system. Findings The results are presented as MICRO-MESO level individual and community experiences of incarceration during COVID-19 spanning several themes: awareness raising and knowledge of COVID-19 in prisons; prison congestion and the impossibility of social distancing; lack of adequate ventilation, hygiene and sanitation and provisions and correct use of personal protective equipment; MESO-MACRO level interplay between the prison community of prisoners and staff and judicial policy impacts; medical system COVID-19 response, infrastructure and access to health care; COVID-19 detection and quarantine measures and prisoner access to the outside world. Originality/value This unique situation assessment of the Malawian prison system response to mitigate COVID-19 illustrates the dynamics at the micro-level whereby prisoners rely on the state and have restricted agency in protecting themselves from disease. This is due to severe structural inadequacies based on low resource allocation to prisons leading to a compromised ability to prevent and treat disease; an infirm and congested infrastructure and bottlenecks in the judicial system fuelling a continued influx of remand detainees leading to high overcapacity. Multi-pronged interventions involving key stakeholders, with prison management and line Ministry as coordinators are warranted to optimise COVID-19 interventions and future disease outbreaks in the Malawian prison system.

Using COVID-19 to Address Environmental Threats to Health and Leverage for Prison Reform in South Africa, Malawi and Zimbabwe

“…During the COVID-19 pandemic, the public health literature on African prison responses focused on preparedness as it related to testing capacity, quarantine practices and personal protective measures to mitigate disease spread. Multi-stakeholder situation assessments of prison health responses (including those led by the author, a public health specialist) in these countries are reported elsewhere (Jumbe et al 2022;Mhlanga-Gunda et al 2022;Van Hout and Wessels 2021a). This article combines the right to health as narrowly defined by a prisoner's right to access non-discriminatory equivalent health care, with a broader focus on assessing normative standards of detention.…”

“…Despite best efforts, the operationalization and coverage of COVID-19 action plans in prisons were compromised by lack of government prioritization of prison health in domestic health budgeting and reliance on prison systems largely funded by the Ministries of Justice to support their own prison health response, insufficient resourcing and extensive mismanagement of COVID-19 funds in the three countries. This led in many instances to systemic deficits in basic standards of care of prisoners during COVID-19, poor coverage of disease mitigation measures, inability to provide sufficient PPE, testing and medical isolation capacity, and ad hoc reactive approaches to (potential) COVID-19 clusters (Jumbe et al 2022;Kateta 2021;Mhlanga-Gunda et al 2022;Van Hout and Wessels 2021a). The legacies of post-colonial criminal justice systems and dated infrastructures in South Africa, Malawi and Zimbabwe were aggravated by COVID-19 disaster measures.…”

“…Of crucial importance in all three countries was how prison congestion (particularly during mealtimes and at night during cell lockdowns) exacerbated attempts by officials to achieve basic standards of disinfection and disease control (for example air flow, ablution, sanitization, PPE). Screening and systems to medically isolate new committals were insufficiently implemented due to haphazard screening, delays in COVID-19 test reporting and the lack of accommodation capacity to ensure medical quarantine of new committals, and those who were sick (Jumbe et al 2022;Mhlanga-Gunda et al 2022;Van Hout and Wessels 2021a).…”

“…The closure of the Maula prison female wing in July 2020 in order to open a COVID-19 isolation centre resulted in the large scale transfer of 71 women with infants, including remand detainees to rural prisons far away from family and legal support (Pensulo 2020;Southern African Litigation Centre 2020;Van Hout 2020c). Visitation restrictions were documented as severely disadvantaging prisoners who are dependent on family and civil society supports of food, soap and clothing (Guta 2021;Jumbe et al 2022;Van Hout 2020c).…”

“…In all three countries, COVID-19 disaster measures worsened systemic deficits in the standards of care, and environmental conditions of detention were reported to be grossly inadequate. There were reports of regular failures of ablution facilities incurring faeces and other bio hazard contamination, lack of heating, ventilation and access to fresh air, lack of sufficient supplies of clean water for drinking, cooking and cleaning purposes, power outages and inadequate disinfection capability (lack of soap, disinfectant, detergents) in many South African, Malawian and Zimbabwean prisons (Jumbe et al 2022;Mhlanga-Gunda et al 2022;Van Hout and Wessels 2021a). In all three countries, UN agencies and civil society attempted to backfill the insufficient prison system response by providing PPE (especially masks), disinfection products, hand sanitizer, masks and cleaning detergents (Chikoti 2020;DCS 2020b;Muntingh 2020).…”