Improved access to health services to eliminate hepatitis C in Portuguese prisons

Portugal has introduced a new model of care for prison inmates, relocating health professionals from hospitals to the prisons themselves in order to provide critical on-site health care to viral hepatitis and HIV patients, and allowing access to care for inmates who were previously unable to visit hospitals due to complex security procedures.

Portugal started to treat hepatitis C with new medicines back in 2014, and with this new model of care for inmate patients, the country plans to diagnose and treat everyone who lives with chronic hepatitis C, eliminating this disease from prisons by 2020.

During the next months, the new approach to health-care delivery in prison establishments will be extended to other areas, namely mental health, primary health care and others. With this initiative, the Portuguese National Health Service (SNS) aims to leave no one behind by ensuring the same access, quality and equity of care to both inmates and all other Portuguese citizens.

In Portugal, the right of citizens to health protection and its achievement through access to the SNS is constitutionally protected. However, in the case of the inmate population, this access faces specific challenges due to constraints arising from their incarceration. As is often the situation across the globe, prison inmates experience a higher burden of infectious disease than the general public.

According to the new model, inmates will have access to medical and nursing consultations, blood tests and, if required, testing for liver fibrosis, a scarring of the liver tissue as a result of damage from chronic liver disorders, such as hepatitis. These can all be provided within a single day, avoiding the need for several trips to hospital. This strategy also aims to improve prisoner health care by building links with the health team, contributing to their reintegration.

“Portugal is at the international forefront of access to health in prisons,” stated Carina Ferreira-Borges, Programme Manager of the Prisons and Health Programme at the WHO European Office for Prevention and Control of Noncommunicable Diseases, who attended the ceremony on 16 July where the newly proposed model of work was signed by hospitals and prisons, in the presence of the ministers of health and justice.

Prisons as an opportunity for public health

The Portuguese health system recognizes prisons as an opportunity for public health, as the period of imprisonment can also be used to treat infectious diseases in individuals who would otherwise experience limited access or interrupted treatment cycles, due to situations such as extreme poverty and social vulnerability.

In this context, Portugal recognized the importance of designing and implementing a model for prevention, diagnosis and treatment of infectious diseases such as HIV and viral hepatitis in the prison population. This would be developed with a uniform and equitable national scope, and with full respect for the rights enshrined in the Universal Declaration of Human Rights and the Portuguese Constitution and supported by international law, in the resolutions of the United Nations General Assembly and the World Health Organization.

WHO considers the elimination of hepatitis C to be a public health priority on a global scale. These new treatment regimens, which in addition to being very safe and simple also deliver a success rate of over 95%, represent real progress towards achieving this goal.