July 14, 2011

IV. Recommendations

We need resources. But it would be unfair on my part to really stand up and complain we can’t improve the situation because there are no resources. There are many things we can do without resources.
—Prison medical authority, Uganda Prisons Service, March 11, 2011

Improving health in Ugandan prisons will require significant changes on the part of the Uganda Prisons Service, and will also require improved coordinated efforts of the Ugandan government, civil society, and international agencies and donors. Some reforms are resource-neutral; those that are not are crucial to the realization of the rights of prisoners and are the responsibility of both the national government and international donors.

To the President of Uganda

Issue direct orders to the UPS to stop the use of compulsory prison labor by private landowners or prison authorities and to halt the use of abusive punishments

Order an independent inquiry into corruption and use of compulsory labor in the UPS and hold those responsible for the illegal use of forced prison labor accountable

To the Uganda Prisons Service and Ministry of Internal Affairs

Immediately:

  • Issue direct orders to stop the use of compulsory prison labor for private landowners and prison authorities
  • Investigate and demand accountability for funds raised through prison labor
  • Align prison labor practices with Uganda’s international legal obligations by:
    • Halting the use of remand prisoners for labor
    • Preventing labor for any private entities, whether by convicts or remands, unless with their consent and with fair remuneration
    • Providing male convicts between 18 and 45 engaging in prison labor with terms similar to those free laborers receive in terms of hours worked, conditions of work, and remuneration
  • Reform prisoner disciplinary systems by:
    • Declaring a zero tolerance policy on the beating of prisoners effective immediately and warning that officers and inmates judged to have inflicted corporal punishment will be prosecuted and punished
    • Discontinuing the practice of stripping inmates naked, handcuffing, beating, or holding them in water while in isolation confinement and punish officers found to have engaged in such practices
    • Ensuring detainees are able to send confidential complaints to the Uganda Human Rights Commission and other organizations and that all prison officials are aware of this right and do not interfere with it
    • Investigating all complaints of abuse against inmates suspected of or charged with same-sex sexual conduct and taking appropriate action against those found responsible for such abuse
  • Carry out regular monitoring visits led by headquarters and medical staff, with better defined indicators and targets for prison inspectorate monitors, to ensure the health and well-being of prisoners throughout the country and a halt to corrupt labor practices
  • Ensure that conditions of confinement meet international standards, including by taking immediate action to improve basic prison conditions by:
    • Providing food of improved nutritional content, including rations for children, and additional rations for pregnant prisoners; prisoners with HIV, tuberculosis, and other health conditions requiring nutritional supplements; and inmates engaging in hard labor
    • Providing prisoners with basic necessities including adequate uniforms, blankets and mattresses, soap, and toothbrushes
    • Providing prisons insecticide to spray regularly for mosquitoes
    • Ensuring separation of convicted and unconvicted detainees
  • Address prison health by:
    • Instructing all OCs to accept primary responsibility for inmate health, including facilitating inmates’ access to community or prison referral health facilities, with disciplinary penalties for failure to do so
    • Creating guidelines to ensure that inmates receive health screenings prior to transfer to rural prisons and that ill inmates are not transferred to prisons lacking adequate healthcare facilities
    • Scaling up TB screening to all inmates entering prison, and all existing inmates, through targeted surveys, sputum analysis, and, if needed, chest x-ray evaluation
    • Offering voluntary HIV counseling and testing to all inmates entering prison and all existing inmates
    • Ensuring prompt initiation of treatment at either community- or prison-based facilities for those with confirmed HIV or TB
    • Establishing guidelines for referral of all prisoners with confirmed HIV or TB to regional units and ensuring patients on treatment are not transferred away from prisons with treatment capacity
    • Establishing clear guidelines for moving patients into and out of TB isolation, with regular checks to ensure that isolation is appropriate
    • Ensuring prisoner inclusion in testing and treatment programs for drug-resistant TB
    • Providing condoms to all prisoners and prison officers
    • Providing HIV prevention, treatment, and care education, including information and sensitization on harm reduction and safer-sex practices in the context of same-sex sexual conduct at each prison to increase condom acceptance
    • Creating guidelines on mental health evaluation and care for the prison system, and the transfer of inmates in need of mental health evaluation or treatment to prisons with such capacity
    • Making mental health services available on the basis of free and informed consent
  • Seek and allocate funding for the prison budget to ensure conditions consistent with international standards, without reliance on income from private landowners
  • As more resources become available:
  • Address prison health by:
    • Establishing the presence of a trained health worker at each prison, with a minimum consistent supply of essential medications and the capacity to conduct TB and HIV testing and who can evaluate prisoner health complaints, including women’s, and facilitate access to prison referral or community hospital facilities
    • Conducting health screening of all prisoners upon entry and at regular intervals
    • Establishing TB and HIV treatment capacity and accreditation at a minimum at each regional referral unit
    • Implementing HIV voluntary counseling and testing for pregnant inmates as part of a comprehensive system of prenatal care, offering prevention of mother-to-child transmission of HIV where appropriate
    • Improving prenatal and postnatal care and addressing pregnant women’s nutritional needs
    • Developing mental health services for upcountry prisons and expanding those at regional prisons to include psychosocial treatment
    • Improving transport from prisons without health units to public health facilities and regional health units
    • Developing a comprehensive health information management system with timely and complete reporting by all prisons nationwide
  • Improve prison conditions by:
    • Renovating prison facilities to provide every detainee with a bed and mattress of his or her own, and adequate space, light, and ventilation
    • Ensuring an adequate supply of clean water, and that prisoners are provided with wood or charcoal to boil water free of charge
    • Constructing a sufficient number of sanitary toilet and bathing facilities for the current number of inmates
  • Increase the UPS’ focus on rehabilitation and reintegration through:
    • Increasing the availability of education programs
    • Facilitating consensual paid work of a rehabilitative nature
    • Improving community reentry programs

To the Ugandan Parliament and Ministry of Finance

Amend the Penal Code Act to decriminalize consensual sexual conduct among adults

Allot sufficient funding for the budget for Ugandan prisons to ensure conditions consistent with international standards without reliance on the income generated by the forced labor of unconvicted or physically unfit inmates

To the Ugandan Judiciary and Ministry of Justice

Address corruption and bribery in the system by requiring bail hearings to be conducted in open court instead of in camera

The Rules Committee should issue a Practice Direction for bail with conditions and guidelines for reasonable bail amounts, given income levels in Uganda

Instruct judges that the constitution guarantees bail after 60 days for non-capital offences and 180 days for capital offences and that there is no minimum amount of time required for prisoners to remain on remand before they are eligible for bail

Sensitize judges to the benefits of community service options and assure prisoners through agreement with prosecutors and magistrates that their decision to plead guilty on consideration of a promise of community service will actually result in community service sentences

Establish guidelines on time limits within which partially heard trials must be resolved or dismissed due to failure of witnesses or complainants to appear

For defendants who claim to be under 18, request and accept evidence of age and do not order detention of children with adults

Devise a functional legal aid system to ensure that defendants have access to a lawyer, provided by the state if they cannot afford one, from the time of arrest

To the Uganda Ministry of Health

Ensure a consistent supply of essential medications at health clinics countrywide

Ensure prisons receive a reliable supply of medications from the national drug stores

To the Uganda Police Force

Observe the constitutional requirement that all suspects be taken to court and charged within 48 hours of arrest

  For suspects who claim to be under 18, request and accept evidence of age and do not order detention with adults

Stop police sweeps to arrest people on spurious charges of “rogue and vagabond”

Stop police brutality against suspects by promptly investigating, charging, and prosecuting instances of unlawful force against suspects

Issue guidelines on police bond and track the implementation of these guidelines

To International Agencies, Donors, and Nongovernmental Organizations

Continue funding efforts to reduce the case backlog, with emphasis placed on appropriate legal assistance, more judges, and more sessions

In the short term, ensure the direct delivery of health service provision in prisons including TB and HIV testing and treatment programs; women’s health; and mental healthcare programs on the basis of free and informed consent

In conjunction with any current or future funding to the UPS, set clear preconditions for funding including that:

  • Reliance on income from forced labor as currently implemented is halted, as are beatings and physical abuse
  • Prison OCs need to take responsibility for prison health and stop denying prisoners access to care at community- or prison-based medical facilities
  • Prisoners with confirmed disease need to be transferred to and kept at facilities where they can receive treatment

In the long term, support the scaling up of the prison medical directorate to provide each of the services detailed above

Develop community reintegration programs, halfway houses, and microfinance initiatives to assist prisoners with reentry and decrease the risk of recidivism