Establishment and evaluation of efficiency of the treatment model for managed detainees in provincialmunicipal hospitals (2011 2012)

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INTRODUCTION
1. Rationale
The heath care and treatment for managed detainees, re-educated
offenders and prisoners is our Party and State’s humane policy. It shows
the preeminence of socialist government, the moral tradition of the
Vietnamese and the protection of human rights for detainees. Our Party
and State have institutionalized policies via legal documents released by
our State, Government and Ministry of Public Security.
Nowadays, Police’s heath care systems are in every prison
nationwide with one hospital and 128 medical stations for managed
detainee. However, Police’s medical system hasn’t got specializes
centers for prisoners. Every year, State-sponsored hospitals treat and
examine tens of thousands of suspects sent from prison’s nursing
homes. Nevertheless, in fact, there are many difficulties and challenges
in such detainees’ heath care: the education management (testimony-
compromission, making suicide, escaping from hospitals, which force
to use many guards) putting bad impacts on other patients’ psychology
and hospital professional activities because there are not any private
medical areas for prisoners. Moreover, the heath care spending for such
persons paid for the hospitals is higher than standard spending.
Therefore, we carry out the study on “Establishment and evaluation
of efficiency of the treatment model for managed detainees in
provincial/municipal hospitals (2011 – 2012)”
2. Research’s goals
1. Describe the demand, the healthcare and treatment for the
managed detainees.
2. Establish, implement and fundamentally assess the efficiency of
healthcare model for prisoners in provincial/municipal general
hospitals (2011 – 2012).
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3. New contribution to scientific practical meaning
- The thesis assesses the demand and the reality of treatment for
prisoners in infirmaries inside detaining stations and hospitals.
- Establish, implement and fundamentally asses the efficiency of
prisoners’ healthcare model in provincial general hospitals.
4. Outline
The thesis includes 138 pages (except for the references and
table of content) and 4 chapters.
Rationale 02 pages
Chapter 1: Over view 31 pages
Chapter 2: Research objects and methods 22 pages
Chapter 3: Research outcome 46 pages
Chapter 4: Discussion 34 pages
Conclusion 02 pages
Recommendation 01 pages
Chapter 1
OVERVIEW
1.1. Managed-detainees demand for healthcare and the
implementation
1.1.1. Managed-detainees demand for healthcare
1.1.1.1. Concepts and terms
- Re-educational and managed detainees include: all offenders
and prisoners at prisons as well as students at reformatories and re-
education schools.
- Detention places include: prisons, reformatories and re-
education schools as well as all prisons and reformatories directly under
the General Police Department for Criminal Enforcement and Justice
Assistance.
- Disease: According to WHO definition: "Disease is a state of
physical and mental imbalance in the body caused by internal or

external factors".
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- Morbidity patterns: a morbidity pattern of a society, a
community, a nation is a collection of all physical and mental
imbalances caused by different factors in the community, society or
nation in a certain time.
1.1.1.2. The prisoners’ demand for healthcare in some countries
Every country has its numerous, flexible viewpoints and
implementing ways in accordance with each stage and its development
context. Additionally, prisoners in some countries around the world
receive medical care not only at the prison medical statio but state-
running hospitals as well.
1.1.1.3. Managed-detainees demand for healthcare in Vietnam
- Recently, morbidity status, managed-detainees demand for
healthcare are quite high because most of them have got sick before
being arrested. The rate of prisoners suffering from drug addiction,
tuberculosis, HIV/AIDS, hepatitis B, C is higher than that in outside
communities (about 10 to 20 times).
- The most popular cause of death of managed detainee is
HIV/AIDS. The second most popular cause of death is pulmonary
tuberculosis. They are typical characteristic of managed detainees’
morbidity pattern. Infectious diseases always make up for a huge part in
such pattern.
1.1.2. Health care for managed-detainees
1.1.2.1. Health care for managed detainees in some countries in the
world
Healthcare for prisoners in some countries in the world,
especially in developed countries, have gained many significant
achievements. Healthcare for prisoners is different in different countries
in both systems and implementations. Some countries have their own

prison medical system which controlled by national medical agencies.
However, most of countries have done the work of disease control in
first days of prisoners in prisons and prison-arising disease
management.
1.1.2.2. Healthcare for the managed detainees in Vietnam
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The Ministry of Public Security (medical stations in the schools
and reformatories under the Ministry) is primarily responsible for the
healthcare for managed detainees. In addition, the Ministry’s hospitals
are responsible for coordinating with the medical stations in prisons in:
Examination, making consulting test, prevention and treatment of all
diseases for the prisoners at district and provincial levels hospitals as
well as in specialized hospitals, provided in the 2010 Law of Criminal
Enforcement and several Decrees by the Government. This is specific
characteristic of prisons in Vietnam that the work of healthcare is
carried out by medical system under People’s Public Security Forces, in
comparison with some other countries, it is implemented by prison
medical system (under the Ministry of Justice).
1.2. The models of healthcare for managed detainees
1.2.1. The models of healthcare for prisoners in some countries
around the world
The responsibility of health care for prisoners is go to prison
medical system. The Heads of prisons decide the disease prevention. In
Poland, Egypt…, prisoners having dangerous diseases like HIV/AIDS,
hepatitis are separately detained or transferred to national infectious
diseases hospitals. Some countries, like Spain, Thailand…, arrange a
special area for prisoners in state-running hospital. The arrangement
should be carefully calculated to meet detention as well as treatment
requirements of prisoners.
1.2.2. The models of healthcare for managed detainees in Vietnam

1.2.2.1. Some relating legal documents
The Law on Criminal Enforcement No. : 53/2010/QH12;
Decree No.89/1998/NĐ-CP and Decree No.64/2011/NĐ; Inter-
ministerial Circular No.12/TTLB; Inter-ministerial Circular
No.04/2010/TTLB-BCA-BYT; Decision No.910/2004/QĐ-BCA(X13);
Decision No.799/2004/QĐ-BCA (H11).
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1.2.2.2. Medical system in prisons in Vietnam
- Ministry of Defense: the Ministry of Defense directs 21
prisons and temp-prisons, 54 remand homes with the scale of 10
persons/remand homes.
- Ministry of Public Security directs 70 temp-prisons, 696
remand homes; 49 prisons, 6 re-educational school and 4 reformatories.
Chapter 2
RESEARCH OBJECTS AND METHODS
2.1. Objects, materials, places and time of research
2.1.1. Research objects: The models of organizing medical stations, the
level of treatment for managed detainees; Leaders of Healthcare
Department, the Department of Tactic of the Ministry of Public
Security, Criminal Investigation Department of The Ministry of
Defense, the director boards of hospitals, leaders of prisons, the heads
of prison infirmaries; medical staffs of the infirmaries and hospital
giving treatment for managed detainees, prisoners received healthcare at
hospitals.
2.1.2. Research materials
In the research process, many materials are used such as:
relating legal documents, reports, figures and summaries on health
management, treatment of managed detainees.
2.1.3. Research places
- Practical research places: in the practically examined hospitals

at provincial and municipal levels, select 6/10 hospitals to implement
the model of treatment center for managed detainees and evaluate the
initial results of the operations: Dien Bien, Vinh Phuc, Hai Duong, Ninh
Binh, Ha Dong, Binh Thuan.
2.1.4. Research time: 4 years (from 1/2009 to 6/2012)
2.2 Research Methods
2.2.1. Research design: The research used two main research designs:
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- Cross-sectional study combined with quantitative, qualitative
and descriptive retrospective research based on secondary data
- Interventional study combined with building, implementation
and evaluation of the models in selected general hospital in several
provinces and cities.
2.2.2. Range of objects and object selecting: 26 hospitals (10
provincial/municipal general hospitals), 05 district hospitals, 05
specialized hospitals, 06 hospitals under the Ministry of Public
Security); 31 infirmaries in prisons moving managed detainees to 26
research hospitals.
The range of objects for sociological investigation: 100 medical
staffs working in the prisons, 60 medical staffs of the hospitals; 100
leaders of the prisons; 170 managed detainees.
2.2.3. Research Methods
- Descriptive retrospective method: the synthesis of health care
for prisoners in recent years.
- Cross-sectional descriptive method: A survey to describe
practical issues related to research content.
- Sociological method: Interviews 100 medical staffs working at
the prison infirmaries and 60 medical staffs of the research hospitals;
100 leaders of prisons; 170 managed detainees. Consulting experts in
scientific conference.

- Methods of logic.
- Methods of intervention.
2.2.4. The research variables and criterion for assessment
Reality of health care for managed detainees (2009-2010): The number
of managed detainees received health care, died, morbidity structures in
infirmaries, hospitals; the number of managed detainees who were
moved to hospitals…
2.2.5. Measures to control error: Designing a sufficient toolkit,
encrypting votes, training investigators, checking votes before
handling
2.2.6. Methods to handle research data: The data were handled by the
medical statistics software such as Epiinfor 6.04, Excel.
2.2.7. Research morality
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- This is a research about the structure on the treatment facility
model for managed detainees in hospital. The process and result of research do
not affect to the tasks, activities of the close-settings, hospitals as well as the
psychology, health of the managed detainees, medical staffs of close-settings
and hospitals, leaders of close-settings.
- The interviewees participated in a voluntary way and the
information collecting from individuals only used in research purpose,
encrypted on computer and kept secret.
2.2.8. Research structure and participants
Such topic is in the guidelines of the Party and State, Ministry of
Public Security of Vietnam as well as is the office's task. In the process
of implementation, such topic was supported and facilitated by the
close-settings, hospitals as well as the staffs who are working in close-
settings and hospitals. The postgraduate is responsible for such topic.
2.2.9. Limitations of topic
- Due to conducting in different places, such topic did not have

exploration with experts.
- Interviewers involving such topic include the staffs of managed
detainees, the medical staffs of close-settings as well as the leaders of
close-settings, medical staffs and hospitals. The assessment ideas are
mainly based on subjective opinions of each individual, thus the
reliability of the opinions is limited.
Chapter 3
RESEARCH OUTCOME
3.1. The demand scenario and health care service for the managed
detainees (2009 - 2010)
3.1.1. The managed detainees’ demand scenario of health care (2009
- 2010)
* Research on infirmary of 31 close-settings:
- Currently, only detention camp bloc does not have special
areas, meanwhile the prison has special area; the close-settings and
reformatories have special areas: in term of prison bloc, there are 64
special areas/15 prisons; in term of close-setting bloc, there are 4
special areas/ 2 close-settings. In term of reformatory bloc, there are 2
special areas/ 1reformatory. The total number of medical staffs in close-
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settings is 395 people including 78 doctors, 32 university pharmacists
and the others are different majorities.
- The following is assessment of close-settings’ leaders on
medical staff scenario in close-setting infirmary: regarding insufficient
facilities: the prison bloc accounts for 57.78%; the reformatory bloc
accounts for 60%; the close-setting and reformatory bloc account for
46.67%: regarding sufficient facilities: the prison bloc accounts for
42.22%; the reformatory bloc accounts for 4%; the close-setting and
reformatory bloc account for 53.33%.
- The following is assessment of close-settings’ leaders on

medical equipment quality: regarding good quality and sufficient
requirements: the prison bloc accounts for 68.89%; the reformatory bloc
accounts for 80%; the close-setting and reformatory bloc account for
46.67 %: regarding poor quality and insufficient requirements: the
prison bloc accounts for 31.11%; the reformatory bloc accounts for
20%; the close-setting and reformatory bloc account for 53.33%.
- The assessment of infrastructure in close-setting infirmary is as
follow: regarding good quality and sufficient requirements: the prison
bloc accounts for 77.78%; the reformatory bloc accounts for 65%; the
close-setting and reformatory bloc account for 46.67%: regarding poor
condition and insufficient requirements: the prison bloc account for
22.22%; the reformatory bloc accounts for 35%; the close-setting and
reformatory bloc account for 53.33%.
Times of outpatient, medicine supply and treatment for managed
detainees in prison infirmaries have increased significantly for the past
years. The disease pattern is as follow: regarding prison bloc:
tuberculosis patient rate: 2009: 5.1%, 2010: 5.32%; HIV carrier rate:
2009: 7.1%, 2010: 6.8%; regarding reformatory bloc: tuberculosis
patient rate: 2009: 7.21%, 2010: 7.14%; HIV carrier rate: 2009: 6.98%,
2010:5.98%.
* Research on 26 hospitals: The total number of patient’s bed
reserving for managed detainees in hospital is 497/8780 (making up
5.66%).
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Accordingly, each of the Police Hospital spent about 20-24 beds; the
Municipal/Provincial hospital spent about 22-24 beds, the District
Hospital spent about 10-12 beds to treat for managed detainees. Under
the technical level regulation of Ministry of Health: 80.7% of research
hospitals are capable of diagnosis and treatment, 19.3% of research
hospitals are incapable of diagnosis and treatment, so such hospitals

have to sent patients to higher levels.
- The rate of research hospital is capable of basic test to meet the
requirements of diagnosis and treatment: Police Hospitals,
Provincial/Municipal Hospitals and Departments: 100%; District
hospitals: 60%. The rate of research hospital has laboratories for HIV test:
Police Hospitals: 16.67%; Provincial/Municipal Hospitals and
Departments: 53.33%. Such hospitals arranged 184 rooms with 497
patient’s beds and 65 isolation rooms. The 22/26 hospitals implemented in
line with process 1, the rest was in line with process 2.
- The total times of outpatient in hospital for 2 years from 2009
to 2010 was as follow: 67,137 times of patient; the total patients
receiving treatment: 8,364 times; the total death: 886 people. The rate of
tuberculosis patients increased over 2 years: 2009: 18.4 % and 2010:
23.71 %. The rate of HIV infected patients also increased over 2 years:
2009: 48.16% and 2010: 51.76%. Such rates are quite same in hospital
levels.
* In response to demand, health care service scenario for
managed detainees: the health care demand of managed detainees in
prison infirmaries and hospitals is very high. The disease patterns of
managed detainees are mainly dangerous infectious diseases such as
HIV/AIDS, tuberculosis and hepatitis The scenario of health care for
managed detainees is still limited. The health care service for such
objects in the hospitals has not concrete and united regulations.
3.1.2. Health care service for managed detainees (2009 - 2010)
Despite of having no specific documents of health care service for
managed detainees in hospital, the close-settings have still sent
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prisoners to the State’s hospitals in area for treatment and examination.
100% of close-settings have infirmary for health care service for
managed detainees. 100% of prison, close-setting and detention camp

have special areas; 58.06% close-settings have special area.
3.2 Design, implementation and initial assessment of treatment
facility model for managed detainees in Provincial General Hospital
(2011-2012)
3.2.1. Propose treatment facility model for managed detainees in
Provincial/Municipal General Hospital
3.2.1.1. Base on regulations and principles to propose model
* Regarding regulations: The health care demand for managed
detainees; the related legal documents; The inter-ministerial Circular
No.04/2010/TTLB-BCA-BYT dated Aug 9/2010; The current demands
in the area; The organization system of health care branch; The area of
land reserving for treatment in hospitals; The detention tactics
workings.
* Regarding principles: the Police, Military Hospitals and civil
medical service have to arrange special rooms for managed detainees in
hospital; it is necessary to build a common treatment ward for managed
detainees in hospital and a close-setting is responsible for management
when there are a lot of close-settings in an area; It is necessary to build
a private treatment ward for managed detainees in hospital when there
is only one close-setting; It is essential to build particular treatment
rooms, wards for managed detainees in Provincial/Municipal General
Hospitals as well as several specialized hospitals, hospitals in district
level; On the basis of the fact of each hospitals, the hospitals reserve
treatment wards for managed detainees in an effective and united
model; If the hospitals do not arrange construction land, they will create
own units to treat for managed detainees; it is important to arrange the
rooms in treatment ward such as: superintendent room, visitation room,
male patient room, female patient room, infection room, treatment ward
for offenders in reformatory; The hospitals arrange the construction
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land to build particular treatment wards, rooms for managed detainees
according to legal regulations on detention; It is crucial to set up a legal
lobby namely inter-ministerial Circular of Health care – Public security
– Defense – Finance on the civilian hospitals and military hospitals
participating health care service for managed detainees in assigned area;
The patient’s beds in private treatment wards, rooms for managed
detainees are the beds of hospital; The medical staffs of hospitals
treating for managed detainees in private wards, rooms of hospital need
to have special subsidization.
3.2.1.2 Functions and tasks of treatment ward reserving for managed
detainees
* In term of treatment function for managed detainees: The
treatment ward has to ensure the health care service in line with
specialty requirements especially the dangerous infectious diseases such
as tuberculosis, HIV/AIDS as the same time, the activity of such
ward does not affect to overall operation of the hospital.
* In term of performance function of detention management
tactics: Assured detention management tactics avoid the offenders’
escape, information provision and suicide….
* In coordination with hospitals: Such ward does the
administrative procedures, hospital expenditures; send patients to higher
level; improves the nutrient regimen in line with each patient’s disease
as well as has close coordination in treatment with higher levels for
managed detainees.
3.2.1.3 Structure, staff and arrangement of models
- Name of model:
+ In term of the hospital having treatment own unit ward for
managed detainees:
PATIENT TREATMENT AREA
(Prison A - Detention camp B)

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+ In term of the hospital having particular treatment room for
managed detainees:
PATIENT TREATMENT ROOM
(Detention camp A)
- Staff structure: The structure, staff of particular treatment ward
based on: task and technical profession decentralization for particular
treatment ward; the scenario of structure and manpower in hospital; the
number of managed detainees receiving treatment in hospitals; the
situation of epidemic, disease patterns and detention tactics
characteristics.
- Equipment: Medical equipment, orderly instruments, weapons,
support tools and other necessary equipment.
-Treatment Process: Process 1 (Medical staffs of the related
departments come to the treatment wards, rooms for managed detainees
only to treat and implement specialized techniques).
- The coordination between hospitals and prisons: Based on the
opinion of medical staffs of prisons and hospitals, proposing regulations
on coordination between hospitals and prisons including reponsible
contract, regular consultation and handover each 6 months between
hospitals and prisons.
3.2.2 Deploy organizational model on clinic for managed, detained
objects in several municipal/ provincial general hospitals
3.2.2.1 Promulgate Interministrial Circular of the Ministry of Public
Security and the Ministry of Health
According to the Interministrial Circular No.: 04/2010/TTLB-
BCA-BYT dated 09/8/2010 of the Ministry of Public Security-the
Ministry of Health which guidelines prisoners, students at State health
facilities and according to the regulations of the Ministry of Public
Security, the managed detainees, who get serious, fatal diseases, will be

transferred to the High level State hospitals, but these situtations have not
been met in recent years due to lack of expense to construct hospital rooms.
Therefore, managed detainees still fled away during the treatment in
hospitals (8 subjects from 2011 to 2012)
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In 2012, according to the prisons’ report, of the 1,896 beds, 1,065
infirmary beds are in the prisons, re-education centres, reformatories
and 831 infirmary beds are in detention centers with 301 treatment
rooms in the infirmary. The total number of medical visits, medicines
supply for managed detainees is about 3 million times of peole, the
number of managed detainees are treated at the clinic are over 140,000
times of examinations and treatment.
3.2.2.2. Deploy organizational model on clinic for managed detainees
in 6 municipal/ provincial general hospitals.
In order to deploy the model, we chose 6 municipal/ provincial
hospitals which represent regions of the country to organize medical
facilities for managed detainees including: Dien Bien, Vinh Phuc, Hai
Duong, Ha Dong, Ninh Binh, Binh Thuan. The Ministry of Public
Security has assigned the regional prisons in coordination with hospitals
to arrange location, scale and expense to build. The arrangement of
medical devices, living equipment, weapons, support tools guaranted by
the Ministry of Public Security.
3.2.3 Efficiency of the organizational model on clinic for managed,
detained objects in municipal/ provincial hospitals
3.2.3.1. Outcome of the first step of the organizational model on clinic
for managed detainees in 6 municipal/ provincial hospitals
Up to June 2012, there have 86/129 prisons, including: the prison
bloc has 40/70 in Municipal/ Provincial General Hospitals; close-setting
bloc has 46/59 in Municipal/ Provincial General Hospitals (32/46),
districts (14/46) with a total of 1,896 beds. In accordance with Circular

04, 06 Municipal/ Provincial General Hospitals have diposed private
wards, treatment rooms including 89 rooms and 206 beds. From 2011 to
2012, 1,827 times of prisoners were treated that met the demand of 18
prisons. 6 Municipal/ Provincial General Hospitals conducted a pilot
organization on treatment wards, rooms for managed detainees: There
are 3 hospitals building the treatment wards for managed detainees
only; 3 hospitals building its own units due to lack of construction land;
5 hospitals funded to repair by the Ministry of Public Security; one
hospital funded to build by the Provincial People’s Committee (Ninh
Binh).
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The total times of prisoners have been treated in hospitals: 2009-
2010: 1,818 visits; 2011-2012: 1,827 visits; the total number of deaths
in hospitals: 2009-2010: 280 prisoners; 2011-2012: 281 prisoners; the
total number of fled prisoners in hospitals: 2009-2010: 2 persons (Ha
Dong); 2011-2012: zero person. Most prisons and hospitals have the
responsible agreement (79% & 90%); regular consultation and handover
(82% & 81.67%); hospital transfer as beyond technical ability, the
proper level (95% & 93.33%); discriminated prisoners (15%);
nondiscriminated prisoners (85%); uncooperative prisoners (16.67%);
no specific policies for the medical staffs of the hospitals (100% )
It is thought that there are measures strengthening the health care
for managed detainees including: Construction of private treatment
wards in hospitals (94.00% and 91.66%), design of coordination
regulations between prisons and hospitals (61% and 71.6%); healthcare
strengthening in infimary (47% and 61.66%); additional manpower
(56% and 75%) and healthcare strengthening in prison infirmary (47%
and 61.66%). The difficulties of healthcare for managed detainees: the
expenditure to pay for hospitals (81% and 91.66%), the management on
prisoners (68% and 78.33%); care and nurture (71% and 86.66%).

Prisons’ medical care: 170/170 (100%) rated as good. Private treatment
wards, rooms in hospitals: 170/170 (100%) rated as good. Private
treatment wards, rooms in hospitals: 97.64% is guaranted; 2.36% is not
guaranted. 67.64 % prisoners have separate rooms for treatment in
hospital and 32.36 % prisoners have to share room with other patients.
* Dien Bien Province’s General Hospital: it has arranged
consecutive rooms in the infections department of the hospital,
including 5 rooms and 11 beds. Medical devices have been equipped
under regulations. There are separate rooms for prisons in Dien Bien
Province’s Public Security. In 2011-2012, 84 times of prisoners were
treated and none of prisoners fled while being treated in the hospital.
* Vinh Phuc Province’s General Hospital: the treatment ward for
managed detainees only has been constructed with 8 rooms and 15
beds. This area does not have its own barrier. This ward has no separate
rooms for Vinh Phuc Province’s prison. Currently, there is 01 nurses
working in Vinh Quang prison. Rooms have self-contained toilets.
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Medical devices have been equipped under regulations. High hopital
expense is the biggest difficulty in this ward. In 2011-2012, 387
prisoners were treated, none of them escaped.
* Ha Dong City’s General Hospital: private unit is 500 square
meters in area, 20 rooms with 40 beds. Currently, the hospital has been
serving health care for prisoners in prison No.1, 3, T16 and Thanh Xuan
prison. From 2011-2012, Ha Dong City’s General Hospital has
examined 789 times of prisoners, 381 times of inpatients, no escaped
prisoners.
* Hai Duong Province’s General Hospital: it has used the entire
third floor of the Infection Department, including 10 rooms and 15
beds. Medical devices have been equipped. In 2011-2012, 462 prisoners
were treated, none of them escaped.

* Ninh Binh Province’s General Hospital: it has used a new solid
building of 2 storeys with the area of more than 2000 meters to treat for
managed detainees from 3 prisons: Ninh Khanh prison, reformatory
No.2 and the close-setting of Ninh Binh Province’s Public Security.
This builiding has 40 rooms and 150 beds account for 25% of all
hospital beds. This ward is under the direct management of Ninh Khanh
prison and its medical speciality is in the charge of Ninh Binh
Province’s General Hospital.
In the private treatment ward, here is the layout: the visitation
room, medical watch room, superintendent room, male patients’ room,
female patients’ room, infection room, private dining room for the
prisoners. Units and rooms have been designed with the steel protection
door. The patient rooms are designed according to the requirements of
professional detention: a locked iron gate, patient beds, electricity and
water supply, self-contained toilet and water heaters. In 02 years (2011-
2012), Ninh Binh province’s General Hospital examined 808 times of
prisoners, 557 times of inpatients, 60 dead cases, and no escaped prisoners
during their treatment in the hospital.
* Binh Thuan Province’s General Hospital: it has arranged the private
treatment for prisoners, including 6 rooms and 15 beds. Medical devices
have been equipped adequately. It was protected by barriers. In 2011-2012,
1,005 subjects were treated, none of them fled.
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3.2.3.2. Asses the model of wards, units for prisoners treatment only
in Provincial General Hospitals
In 6 provincial/municipal general hospitals which deployed the
private treatment ward for prisoners only, we saw 2 hospitals had
implemented and operated appropriately and effectively. Ninh Binh
Province’s General Hospital building has arranged the private treament
ward for prisoners only. Ha Dong City’s General Hospital has managed

the private unit to treat prisoners.
Chapter 4
DISCUSSION
4.1. Actual needs situation and health care services for the managed
detainee (2009 - 2010)
4.1.1. Managed detainee’s status and health care needs. (2009 - 2010)
- At the infirmary numbered 31 in prison: the health care system
of the Ministry of Public Security for all managed detainees only stop at
the prison infirmary level, currently has only 01 hospital for specifically
treatment for managed detainees, it is Chi Hoa hospital, serving only the
Ho Chi Minh Police Department’s prison with 120 patient’s beds, no
final line to treat the managed detainees. Therefore, when the managed
detainees sick which pass beyond the professional ability of the
infirmary, they will have to move to state hospitals for examination and
treatment in local location.
About the framework and medical personel of infirmaries: the
number of medical cadres stay mainly at prisons and close settings.
(379/395 medical cadres) . The number of doctors and universitarian
pharmacists stay at prison as well (97/125 doctors, 23/32 universitarian
pharmacists). Currently, all the close settings have no universitarian
pharmacists. Medical cadres are mostly physicians, nurses and
intermediate pharmacists. Prisons have the highest medical
cadres/infirmary percentage (18.86 person/infirmary) and close settings
have the lowest (6.61 person/infirmary). Similarly, the percentage of
universitarian pharmacists/infirmary are the lowest at educational center (no
universitarian pharmacists) and the highest at reformatories (2
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person/infirmary), then to prison (1.53person/infirmary). According to the
assessment of prison leaders, medical cadres is insufficient and did not meet
the required 57 % occupancy rate. Practically, according to regulations, the

number of medical cadres are enough, but mostly at intermediate level , the
rate of medical cadre have university degrees or more are lower , especially
doctors and universitarian pharmacists. Therefore, according to assessments,
only 43 % medical cadres meet the requirement.
About the medical equipment and means of transport of prison’s
infirmary : In recent years , with the investment of the Ministry of
Public Security, medical equipment of these prisons have been added,
but medical cadres have not been trained to use completely so they
cannot uphold the effectiveness of the equipment, training course
should be enhanced.
In seminars about medical organization initiating the prison, took
place at General Department of Logistics of the Ministry of Public
Security , there is a general agreement that medical cadres has raised
their medical ethics , working in a complicated environment , the
managed detainees are those who violate the law with full poach from
charges of national security , social order , economic crimes , narcotic
drugs and other extremely dangerous crimes…. ; objects are
Vietnamese and foreign nationals violate Vietnamese laws processed
according to the laws of Vietnam (2008: 296 objects ) .
About funds used for managed detainees’ health care: Medical
funds are allocated annually in line with the increasing of detention
scale and slippage in prices. Thus causing so much trouble for ensuring
health care in prison. Each year, funding for the examination of the case
at risk of HIV / AIDS with blood tests to detect HIV as stipulated in the
Joint Circular No. 05/2003/TTLT-BCA - BYT - BTC. Demand for
managed detainees’ health care at prison’s infirmaries is huge:
According to a survey, over 85% of prisoners in need of health care and
health worries. About the percentage of patient’s beds occupancy:
Although infirmaries have set up extra outside stipulation, bed
occupancy rate is still overloaded (prisons: 130.9 %; close settings: 147

%).
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Morbidity patterns of managed detainees at the infirmaries are
diversified and especially dangerous infection diseases, such as
tuberculosis, HIV/AIDS However, detecting prisoners which infected
with HIV/AIDS at close settings are not so often due to facilities and
funding difficulties. These close settings have to initiatively coordinate
with outside medical agencies to examine periodically and only do
blood test for some prisoners in high risk groups such as sex workers,
injecting drug addicts and HIV infected prisoners cannot be detected
completely. There is no expense for examination and specialized
medicines for drug addicts, HIV/AIDS, lack of medical equipment, such
as protective boots, gloves, masks Some countries in the world
recommend doing HIV test for prisoners right in prison like the USA.
Due to technical distribution and professional ability at
infirmary of those close settings, the number of prisoners who have
diseases which beyond professional ability will be transferred to state’s
hospital are rising every year ( 2009 : 2698 persons, 2010 : 3161
persons). The subjects were all transferred to provinces and city’s
general hospital, district hospitals and specialized hospitals near the
unit. Demand for professionals is huge, so these hospitals have received
and treat patients effectively and support for infirmaries and ensure
professional specialist. The primary destination when transfer a subjects
to receive treatment are city/province general hospitals. The percentage
of managed detainees infected with tuberculosis and HIV / AIDS in
detention is higher compare to the community, so educational
communication. Treatment and prevention activities have been
implementing and deploying by these prisons.
- In 26 Research Hospitals: All city/province general hospitals,
first class hospital of the Ministry of Public Security meets the basic

requirements for test, diagnosis, treatment for managed detainees and
follow technical distribution. Therefore, proposing building a special
treatment area for the managed detainees at city/province general
hospitals is appropriate to ensure professional requirements.
About human resources , infrastructure and health care process
for managed detainees in hospital : medical cadres have to coordinate
with hospital for objects treatment, organized medical examination and
19
treatment to each department in hospitals and carry out administrative
procedures between prisons and hospitals. Currently, no specific
regulations on medical staff working in the treatment are have been made.
There are 3-10 security officers for each specialized treatment area in
hospital, being on duty of guarding, escorting, protecting the medical staff
of the hospital come to perform medical examination and carry out
professional detention specialist. .
Main hospitals in which detainees transfer to are public hospitals
(42 in 2009 and 52 in 2010 ) and district hospitals (32 in 2009 and 25 in
2010) . There are some new Public security hospitals (Dien Bien police
hospital 7/5, Nam Dinh police hospital) and Chi Hoa hospital ( Ho Chi
Minh City Police Department ) are class III under the technical
distribution so they cannot meet specialized capabilities. When a
detainee transferred from a civil medical hospital to an upper-line
hospitals, these hospitals will take care of medical support while prisons
will keep an eye on them.
Morbidity patterns of managed detainees in hospitals and in
prison infirmaries is the same, mainly tuberculosis, HIV / AIDS and
other infection diseases. This result is similar to some research of
several countries around the world. In many countries, HIV/AIDS is a
major threat to prisoners’ health. HIV infection, hepatitis, pulmonary
tuberculosis and other sexually transmitted diseases create huge

challenges for prison management agency. In Spain, prisons have to
deal with drug smuggling in to jail by 2 ways: by prisoners or by the
family members of prisoners brought in, 25,9% of which injecting
drugs. The percentage of prisoners infected with HIV in prisons are
5,1% in 2000 and 1,5% in 2009
4.1.2. Organizing health care for managed detainees (2009-2010)
All prisons have an infirmary to take care of prisoners’ health.
Prison, educational areas and reformatories organize medical booths
into subdivision, classification and branches. About organizing health
care for prisoners: Medical staffs will examine and deliver medicines to
prisoners everyday. In severe cases, patient will be moved to central
infirmary. In case of necessity, the infirmary will transfer the patient to
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a local hospital for medical treatment. About range of treatment:
According to technical distribution of the Medical Department of the
Ministry of Public Security , prison’s infirmary take responsibility of
managing health care, initial medical treatment, epidemic prevention
and other medical services.
4.2. Establishing, deploying and initially reviewing effectively the
treatment facilities model for the managed detainees in province
hospitals (2011 - 2012)
4.2.1. Recommending treatment facilities model specialized for the
managed detainees at city/province general hospital
Building this model should follow below principles : Police,
Military and Civil hospitals should arrange rooms and areas specialized
for managed detainees; A joint treatment area will be set up for these
prisoners at places have lots of prisons, and administration
responsibility will be taken by one of these prisons; In places which
have only one prison, a specialized treatment room will be used for
managed detainees; Setting up treatment rooms and areas used only for

managed detainees at city/province general hospital, specialized
hospitals and district hospitals; Depending on the conditions of each
hospital and area that hospital used for building a specialized treatment
area to treat prisoners, that apply establishing the model consistently;
Hospitals which cannot arrange land budget, use a private unitary
treatment for managed detainees.
4.2.2 Implementing fundamental treatment model for prisoners, held
at some city/province general hospital.
4.2.2.1. Promulgating Joint Circular between the Ministry of Public
Security and the Ministry of Health
The Ministry of Public Security in collaboration with the
Ministry of Health to develop and sign an Joint Circular No.
04/2010/TTLB-BCA-BYT, August 8
th
2012, on health care guidelines
for persons in custody, detention, prisoners at state hospitals in order to
mobilize the support of local health care in medical examination and
21
treatment for managed detainees, ensuring professional work, human
rights and detention requirements.
4.2.2.2. Implementing the model in 06 city/province general hospital
Dien Bien, Vinh Phuc, Hai Duong, Ha Dong, Ninh Binh, Binh
Thuan, guaranteed to meet health care needs for 18 prisons, with 36-47
rooms and 98-163 beds.
4.2.3. The effectiveness of the model treatment for managed, detained
prisoners in municipal/provincial general hospital
4.2.3.1. The initial effectiveness of the organization model on clinic for
detained prisoners in 06 provincial/city multiple department hospital
In the 6 hospitals operating the model, 03 ones have built the
own treatment ward for prisoners; the 3 others do not have enough

space but organize the private units; 05 hospitals are invested by the
Ministry of Public Security to build and repair; 01 ones are invested by
the Provincial People’s Committee (Ninh Binh). The treatment area for
prisoners in Ninh Binh provincial general hospitals also organize the
kitchens for the prisoners and there are basical rooms for detention
center and education center. Specialisingly, provincial/municipal
hospitals have the conditions for doing tests, diagnosis and treating
diseases in all departments: internal, external, infectious and emergency
and recovery departments… therefore, the proposals for building the
specialised areas for prisoners is highly appreciated. In addition, the
responsibility for ensuring the the specialization in the treatment areas
is taken by the infectious department as the popular diseases of the
prisoners are tuberculosis, HIV/AIDS…
The considerable difficulty for the health staffs is the
uncooperativeness of the prisoned (16.67%), these imprisoned are
denationalised but they still have the right to be health treated.
Moreover, these prisoners are usually treated at high court such as life
imprisonment… and have got the serious diseases such as tuberculosis,
HIV/AIDS at the final stages, cancers… which leads to their
pessimistic, uncooperative attitude. The researches of staffs in hospital
show that only the staffs in infectious department receive the specific
and toxic support while the staffs in other departments also treat the
prisoners but do not receive these support which is the inequality in
policies for health staffs.
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About improving the treatments to prisoners: these are
reasonable ideas as once these treatment ward are completed, it can
meet the needs of imprisonment and treatment. In other hand, it has no
considerable influence to the general operation of the hospital,
especially to the patients treated in the same rooms with the imprisoned.

When there is no treatment ward for prisoners, the management to them
in hospitals is very difficult and requires many guardians as these
imprisoned can take the advantages of staying in hospitals to collusion,
suicide, or escape from the hospitals. The prisoners treated in hospitals
have their particular eating modes due to the diseases and the
regulations to these modes is very low in comparison to the real
demands and market prices (despite the support to the imprisoned from
detention camps and their relatives). The policemen have to buy food
for the prisoners while they are in hospitals. The real fee to the hospitals
including beds, techniques, tablets and medicals for treatments
equipped by the Ministry of Public Security is equal to the usual
regulated costs. Therefore, the addition of beds in the treatment ward
can reduce the payment of prisoners. This can show the necessity of the
building the treatment ward for prisoners, policies for health staffs,
standards of beds and eating modes due to the diseases for prisoners.
4.2.3.2. Assessments on the operating treatment areas in Ninh Binh
Province’s General hospital and Ha Dong City’s General hospital.
In Ninh Binh Province’s General hospital: this is the basic
model that appropriates to the hospital having the space for building the
model of 2 storey treatment ward. In the one of Ha Dong City, the
organization for private treatment ward in the context of lacking space
is also very reasonable and effective as proposed.
4.2.4. The completion of the treatment wards in provincial/muninipa
general hospitals
After assessing the effectiveness of the treatment wards, unit for
prisoners in 6 pilot general hospitals, it showed the high effectiveness as
proposed
CONCLUSION
23
1. Real demands and organization for treatment to prisoners

(2009 – 2010)
The demands for treatment to prisoners is very high and the
number of prisoners in clinics and hospitals is increasing anually. In
clinics: the number in 2009 is 581.583 and that of 2010 is 660,046. In
hospitals: the number in 2009 is 22,603 and that of 2010 is 25,284. The
number of dead prisoners in hospitals in 2009 – 2010 is 886 people. The
popular diseases in these situations is mainly tuberculosis (9.1 – 54.11%),
HIV/AIDS (43.29 – 51.2%), hepatitis B and C…
All prisons have their own clinics to treat the prisoners. The
prisons, educating centers have their own specific health areas. The
treatment system for imprisioned of the Ministry of Public Security is
only at clinic level and the human and technique in these areas are still
limited. About the scale of treatment: clinics are the basic health units
for initial health management and treatment, disease prevention and
other health activities. The only current one hospital for prisoners is Chi
Hoa hospital serving the prisons of HCM city’s Public Security with
120 beds. There is no hospital for final treating units for prisoners.
Therefore, when the clinics cannot treat for the extremely serious
diseases, the prisons will be transferred to other national hospital for
treatment which leads to the necessity to have the hospital at the final
level for the prisoners.
2. Building, operating and initially assessing the effectiveness of
treatment modes for the prisoners in provincial/municipal general
hospitals (2011 – 2012)
Models: the treatment ward or unit includes 6 rooms (meeting
room, room for police staff, man room, woman room, infectious room
and room for prisoners)
The cooperation between hospitals and prison: the hospitals is
responsible for ensuring their treatment specialisation and procedure
due to procedure I, the detention camps are responsible for prisoners,

building costs, equipment and beds (beds take for 3 – 5% of the
hospital)
24
Results: Having operating the models in 06 general hospitals at
provincial/municipal level including 3 ones with private areas, the 3
others with hospitals of 89 rooms and 206 beds, treating 1,827 people in
2011 – 2012. There are 2 private ones with intermediate staffs: Vinh
Phuc province’s General hospital and Ninh Binh province’s General
hospital.
The effectiveness of the model: Improving the treatment quality.
There is no situation escaping from the hospitals, considerably reducing
number of the guards, there is no influence to the operation of the
hospital and other patients.
The building of treatment wards for prisoners in provincial/municipal
general hospitals not only meet the needs of treatment but also that of
prison and highly appreciated.
RECOMMENDATION
1. Basically complete the building of treatment wards for
prisoners in provincial/municipal hospital until 2020.
2. The beds in treatment wards for prisoners and providing
policies to health staffs taking part in the treatment to prisoners.
3. Building legitimate lobby: interministrial circular among Public
Security – Defense – Health – Finance ministries in treating
prisoners in army and civilian hospitals.