Healthcare Challenges in the Implementation of TB Infection Prevention and Control at Harare Central Prison, Zimbabwe, 2019-2020

Abstract

Worldwide, overcrowding in prisons has led to communicable diseases like Tuberculosis (TB). Zimbabwe is no exception to the problem, with Harare Central Prison (HCP) – one of the largest prisons in Zimbabwe with more 1500 inmates, having serious challenges of TB among inmates. Healthcare workers and Prison Officers face the challenges in the implementation of Tuberculosis Infection Prevention and Control (TBIPC) at the institution. This study assessed the healthcare challenges curtailing the implementation of TBIPC guidelines of the World Health Organization by healthcare workers at Harare Central Prison. An analytical cross-sectional study on 69 purposively selected informants from among prison officers and nurses was conducted based on a semi-structured questionnaire. Further, the study interviewed key informants from among senior management to identify possible recourse on the issues raised by the informants. Findings from senior management were analyzed based on grounded theory. Epi Info 7.2 was used to analyze the data. The questionnaire assessed availability of materials for TBIPC such as face masks and respiratory ventilators, availability of national guidelines, training on TBIPC as well as administrative challenges hindering TBIPC. The mean age was 39±9 years (IQR=22—55 years). Overall, 40 (58%) of the respondents reported having inadequate materials for TBPIC at the prison. All respondents confirmed that they had access to TBIPC guidelines but complained that the TBIPC guidelines were not clear to them particularly on issues that relate to policy clarity for their practice of TBIPC. Twenty-eight (40.6%) claimed that they had not received training on TBIPC. Fifty-five (79.7%) reported having administrative challenges inclusive of accessing materials for TBPIC when they needed them. Senior management reiterated that trainings on TBIPC are needed but the lack of staff hinders the pace of training. The senior management confirmed the to clarify the policy on TBIPC during the training. Furthermore, the senior management encouraged the health care workers to lobby for installation of better TBIPC equipment at the prison. In conclusion, the gaps identified in this study are important for policymaking. Efforts to improve the availability of TBIPC guidelines; TBIPC training, clarity of policies on TBIPC and addressing the administrative constraints are urgently needed.