INTRODUCTION 1. Urgency of PhD thesis The management of health, health care, medical treatment for prisoners is a humanitarian policies of the Party and State. This shows the superiority of the Vietnamese socialist state, the moral tradition of Vietnam and ensure the human rights of prisoners. Party and State have been institutionalized through the point of view of the system of the State, the Government and the Ministry of Public Security. Currently, the health system has been deployed to police all the prisons in the country with 01 hospitals and 128 clinics for examination and treatment of prisoners. However, no medical police last line to treat prisoners. Every year, the state hospitals to medical treatment, regular checks for tens of thousands of prisoners by prison infirmary moved to. However, the actual medical examination and treatment for inmates at the hospital still faces many difficulties and shortcomings, such as management, custody (information provision, suicide, escape from the hospital, to more manpower to guard), affects the psychology of the other patients are treated by general hospitals and specialized activities of the hospital has not been built exclusively for the treatment of prisoners. On the other hand, funding health care and treatment for prison inmates that the direct payment to hospitals is higher than specified. Therefore, we conducted a research topic: "Research and development effectiveness evaluation model grassroots organization dedicated to the treatment of prisoners in hospitals some provinces/cities (2011- 2012)” 2. Objectives of the study 1. Describe the situation and needs medical organizations, medical treatment for prisoners (2009-2010). 1 2. Develop, implement and evaluate the effectiveness of initial organizational model treatment facility for inmates in provincial general hospital (2011-2012). 3. New contributions to scientific practice of doctoral PhD thesis - Thesis assess the situation and needs of organization health care and treatment for inmates at the prison clinic and hospital. - Develop, implement and evaluate the effectiveness of initial organizational model treatment facility for inmates in provincial hospitals. 4. Dissertation Layout The dissertation consists of 127 pages (not including references, appendices), the structure of 4 chapters: Background: 02 pages Chapter 1. Overview: 33 trang Chapter 2. Subjects and Methods: pages Chapter 3. Results: pages Chapter 4. Discussions pages Conclusions: pages Recommendations: page 2 Chapter 1 OVERVIEW 1.1. Demand and medical institutions, medical treatment of inmates 1.1.1 . Demand for medical examination and treatment of prisoners 1.1.1.1. Some concepts and terminology - Prisoners include detainees in detention centers, home detention, prisoners in the prisons, detention camps, campers facilities and student education reform schools. - Detention facilities include: Detention, detention centers, educational institutions, reformatories and detention. The Prisons, detention centers, educational institutions, reform schools by the General Department of Police Enforcement and Criminal Justice Support, Ministry of Public Security to directly manage. - Disease : According to the WHO definition: "Disease is the imbalance in the body and spirit under the influence of a range of external factors and internal environment on the human environment." - Disease model: A model of social illness, a community, a nation that would be a set of all the imbalances in the body and spirit under the influence of these factors appear in different communities, societies, countries that in a certain period of time. 1.1.1.2. Demand for medical examination and treatment of prisoners in some countries in the world So far, in every country there are concepts, how diverse, 3 flexible to suit each stage, the development context of the country. Inmates in countries around the world in addition to medical examination and treatment at the prison medical facility is in need of medical examination and treatment at the state hospital. 1.1.1.3. Demand for medical examination and treatment of prisoners in Vietnam - In recent years, morbidity, medical needs and treatment of prisoners is very large. Due to ill inmates from being caught in the community, particularly the rate of drug addiction, tuberculosis, HIV/AIDS and hepatitis B, C are very high compared to the community (about 10- 20 times). - Causes of death in prison is mainly due to HIV/AIDS. The main cause of death was tuberculosis 2. This is one of the characteristics of the disease model prisoner. Infectious diseases are major proportion of the morbidity of prisoners. 1.1.2. The medical examination and treatment for prisoners 1.1.2.1. The medical examination and treatment for offenders in some countries in the world Health care for prisoners in several countries around the world, especially the developed countries have achieved significant accomplishments. Health care for prisoners in different countries, while others have held the prison health care system, but primarily due to the state health sector undertaken and implemented methods also vary but mainly on management illness while in prison and manage new epidemics arise from inmates in prison. 4 1.1.2.2. The medical examination and treatment for prisoners in Vietnam Responsibility for the medical examination and treatment for prisoners firstly by the Ministry of Public Security (the prison infirmary) assumed, the medical establishments of the Ministry of Health is responsible for coordination with the Health Ministry prison police: Physicals, examination assessment, prevention and treatment for inmates at the hospital from district to provincial and specialty hospitals are defined in criminal Law Enforcement in 2010 and the Decree of the Government. This is specific to the prison in Vietnam, the medical examination and treatment by the medical system police assume, in addition to a number of countries around the world, medical examination and treatment for the inmates by prison medical assumed (Department of Justice). 1.2. The organizational model treatment facility for prisoners 1.2.1. The organizational model for the treatment of prisoners in several countries around the world Medical examinations and treatment for inmates by prison medical assumed. Disease prevention and disease prevention by the Prison Director decision. Some dangerous diseases such as HIV/AIDS, hepatitis separate detention were transferred to hospitals or infectious state such treatment in Poland, Egypt Some countries have organized arrangements for the treatment reserved for inmates in state hospitals such as Spain, Thailand the layout is now suitable to guarantee professional requirements and discover detention, treatment for offenders. 1.2.2. The organizational model for the treatment of prisoners in Vietnam 5 1.2.2.1. Some legal documents related Law enforcement Criminal: 53/2010/QH12 and Decree No. 89/1998/ND-CP and Decree No.: 64/2011/ND; Joint Circular No. 12/TTLB ; Joint Circular No. 04/2010/TTLB-BCA-BYT , Decision No.: 910/2004/QD-BCA (X13), Decision No.: 799/2004/QD-BCA (H11). 1.2.2.2. System organization of prison health care in Vietnam - Department of Defense: Currently, the Ministry of Defence managed 21 prisons, detention houses 54 scale: 10/remand homes. - The Ministry of Public Security has 70 detention centers , 696 home detention, jail 49 6 and 4 educational institutions reformatories. 6 Chapter 2 SUBJECTS AND METHODS 2.1. Subjects, materials, location and duration of study 2.1.1. Study subjects: The organizational model treatment facility, treatment services for prisoners; Leaders and Health Administration, the Bureau of the Ministry of Public Security Business, Criminal Investigation Department of the Ministry of Defense; the Board of Directors of the hospital, the prison leadership, staff leadership of the prison infirmary, medical staff of the prison infirmary and hospital participated examination and treatment for prisoners, the inmate medical examination and treatment at the hospital. 2.1.2. Material Research In the research process using many materials such as legal documents relevant reports, data and documentation of the health management, health care, medical treatment for prisoners. 2.1.3. Study sites - Location of study situation: At 10 hospitals provinces/cities; 5 district hospitals, 5 specialized hospitals; 6 police hospital; 31 prisons (13 detention centers, 15 prisons, 02 educational institutions, reformatories 01). - Location of deployment models: From the hospital province/city has investigated the situation, choose 6/10 to the hospital deployment model grassroots organization dedicated to the treatment of prisoners and evaluation initial performance: Dien Bien, Vinh Phuc, Hai Duong, Ninh Binh, Ha Dong, Binh Thuan. 7 2.1.4. Time study: 4 year study period (from 1/2009 to 6/ 2012) 2.2. Research methodology 2.2.1. Study design: Thread 2 uses the research design: - Cross-sectional descriptive study combined quantitative research, qualitative and descriptive retrospective based on secondary data. - Research interfere with the development, implementation and evaluation of effective organizational model treatment facility at the hospital provinces/cities selected. 2.2.2. Sample size and sample: 26 hospitals (10 hospitals provinces/cities, 05 district hospitals, 05 specialized hospitals, 06 police hospital); 31 prisons infirmary doctor prisoner transfer, treatment in 26 hospitals studied. The samples for investigation socialistic 100 medical staff working in the prison infirmary and 60 medical staff of the hospital were studied; 100 leaders studied prison, 170 prisoners. 2.2.3. Research Methodology - Retrospective method described: General medical examination and treatment for inmates in recent years. - Cross-sectional descriptive method: A survey to describe practical issues related to research content. - Sociological Methodology: Interviews with 100 medical staff working in the prison infirmary and 60 medical staff of the hospitals studied; 100 leaders prisons, 170 inmates. Scientific seminar, consult experts. - Methods of logic. - Methods of intervention. 2.2.4. The study variables and indicators for assessment Situation of medical examination and treatment for prisoners (2009-2010): Total number of prisoners for medical examination and treatment, mortality, morbidity structure at the clinic, hospital, total number of prisoners moved medical examination and treatment at the 8 hospital 2.2.5. Measures to control bias: Design full kit, encryption votes, investigator training, cleaning before check processing 2.2.6. Methods of data processing research: The data were processed by the software biostatistics: 6.04 Epiinfor, Excel. 2.2.7. Research Ethics - This is the study of the organization of the base model for the treatment of prisoners at the hospital, in the research process and the results of the study did not affect the mission and activities of the prison and the hospitals as well as psychological health of the inmates, medical staff of the prison and hospital leaders prisons. - Those who were interviewed on a voluntary basis, the information collected from individuals only for research purposes, is encrypted on your computer and confidential (secret). 2.2.8 . Research organizations , research force participation As the subject is in the policy of the Party and State , Ministry of Public Security as well as the agency's mission . In the process of implementing threads , with the collaboration of researchers investigating the prison officials . Subject has received support , facilitated by the prison , the hospital and the staff working in prisons and hospitals studied . 2.2.9. Limitations of the study - Due topic deployed in different locations so that research institutions are not fully explored with experts. - Interviewers include prisoners, medical staff prisons, leaders of the prison medical staff of the hospital, the comments are mainly based on personal subjective observations of each person, so the reliability of the opinion is limited. 9 Chapter 3 RESULTS 3.1. Current situation and needs medical organizations, medical treatment for prisoners (2009-2010) 3.1.1. Real situation needs examination and treatment of prisoners (2009-2010) * 31 In the prison infirmary being studied: - Currently the only team without detention camps organization, organized the prison camps, educational institutions, reformatories organized subdivisions, campus: Block 64 distribution prison/15 prison; Block 04 educational institutions have distributed/02 education establishments. Block has 02 distribution reformatory reformatory. Total number of health workers in prisons study is 395 people, including 78 doctors, 32 pharmacists have a university degree, the rest of the other officers. - Evaluation of the leaders of the prison on the medical staff of the prison clinic: Lack of failing to meet the requirements: Prison Block: 57.78 %; Bloc prisons: 60 %; Block institution education-reform schools: 46.67 %. And sufficient to meet the requirements: Prison Block: 42.22 %; Block detention: 40 %; volume basis reformatory education: 53.33 %. - Evaluation of the prison leadership in quality medical equipment: good quality and meet the requirements: Prison Block: 68.89 %; Block detention: 80 %, Bloc educational institutions-reformatory: 46.67 %. Poor quality and did not meet the requirements: Prison Block: 31.11 %; Block detention: 20 %; volume basis reformatory education: 53.33 %. - Regarding the quality of the infrastructure of the clinic: Good quality, meeting requirements: Prison: 77.78 %; detention: 65 % Base reformatory school education: 46.67 %. Poor quality, not meet requirements: Prisons: 22.22 %; detention: 35 % base reformatory 10 [...]... unit dedicated to the treatment of prisoners in Ninh Binh hospitals and Ha Dong General hospital At the Ninh Binh general hospital of province: This is the basic model fit the hospital can be arranged for the construction of land dedicated to the treatment of prisoners at the hospital with the treatment model 2 floors has recommended In Ha Dong general hospital: The menu layout with the conditions of the. .. with the Ministry of Health building and signed 04/2010/TTLB-BCA-BYT Circular of the Ministry of Public Security of the Ministry of 9/8/2010 at the Health Ministry guiding the medical examination treatment of detainees, detention, prisoners, the camp staff education institutions, students reformatory hospital in the State to mobilize the support of local health care in medical examination and treatment. .. Issued Ministry of Public Security and the Ministry of Health According to Joint Circular No 09/8/2010 dated 04/2010/TTLB-BCA-BYT of the Ministry of Public Security, Ministry of Health guiding medical examination and treatment of detainees, prisoners, inmates, school birth in medical facilities and State According to the Ministry of Public Security for prisoners suffering from serious illness, some hospitals. .. implement and evaluate the effectiveness of initial organizational model treatment facility for inmates in provincial hospitals (201 1-2 012) 3.2.1 Model proposed facility dedicated to treating prisoners provincial hospital/city 3.2.1.1 The grounds and principles for proposed model - Pursuant to proposed model: Demand for medical examination and treatment for prisoners , the legal documents related to Joint... evaluate the effectiveness of initial organizational model treatment facility for inmates in provincial hospitals (201 1-2 012) 4.2.1 Model proposed facility dedicated to treating prisoners in hospital province/city To build the model ensures a balance of principles: The hospital police, military and civilian health care needs to the layout, room dedicated to treating prisoners in hospital; These places... specific to the medical staff of the hospital (100%) The idea that the measures to strengthen the examination and treatment of prisoners include: Construction of private treatment at a hospital (93.00% and 91.66%), building regulations and coordinate detention facilities and hospitals (61% and 71.6%); Strengthening medical examination and treatment at the clinic (47% and 61.66%); Adding manpower (56% and. .. arranged funds land to build parks, private treatment rooms for prisoners in accordance with the provisions of the detention business, building a legal framework : Department of Health Circular -Defense-Police-Finance hospitals ensure state participation in medical examination and treatment for inmates in charge of the province, in the sick bed, rooms dedicated to the treatment of prisoners of hospital... such as restrictions on land devoted to the application model for the treatment of prisoners in hospital is appropriate in Ha Dong as recommended 4.2.4 Completing the base model dedicated to treating prisoners in hospital province/city After assessment of the activities of the area, the unit dedicated to the treatment of prisoners in 06 hospitals province/city pilot deployment model, has ensured request... implementation and deployment - At 26 hospitals studied: All hospitals in provinces, cities, first class hospitals of the Ministry of Public Security to meet the basic requirements for testing, diagnosis, treatment of prisoners and the distribution technical levels Therefore, the proposed construction of the treatment reserved for inmates at provincial hospitals/ cities is to 23 ensure appropriate professional... authorities In Spain, the prisons are faced with the phenomenon of smuggling drugs into the prison in two ways: by inmates after carrying out work in the home or by offenders included in the group 25.9 % are drug addicts inject drugs The rate of HIV/AIDS infected prisoners in detention in 2000 was 5.1 %, in 2009 was 1.5 % 4.1.2 Organizations examination and treatment for prisoners (200 9-2 010) 24 All . " ;Research and development effectiveness evaluation model grassroots organization dedicated to the treatment of prisoners in hospitals some provinces/ cities (201 1- 2012)” 2. Objectives of the study 1 Demand and medical institutions, medical treatment of inmates 1.1.1 . Demand for medical examination and treatment of prisoners 1.1.1.1. Some concepts and terminology - Prisoners include detainees. Department of Health Circular -Defense-Police-Finance hospitals ensure state participation in medical examination and treatment for inmates in charge of the province, in the sick bed, rooms dedicated to