Portugal proposes integration of prison health into its National Health Service

Portugal has made a bold move towards better health for all by including prisons and other detention facilities into the country's National Health Plan. The first step on that road is an official proposal from 3 ministries to gradually merge prison health services and national health services into one. The proposal is deeply rooted in Portugal's Constitution and the European Convention on Human Rights and reflects WHO's fundamental values.

Closing the health-care gap

Portugal's National Health Plan is a strategic document that identifies major health challenges in the country and establishes a programme of action to be adopted in priority areas over the next few years. The plan covers the entire population of the country, in line with the Constitution and relevant governmental decrees, ensuring access to the National Health Service not only for the general population, but also for those in prisons and other detention facilities.

To turn this vision into reality, the Portuguese authorities created a working group that published an official proposal in April 2024, which was signed by the Minister of Health, the Minister of Justice and the Minister of Science, Technology and Higher Education. In it, the group are proposing the transfer of detention facilities' health-care systems from the Ministry of Justice to the Ministry of Health. This shift in responsibility is recommended by WHO and the United Nations Office on Drugs and Crime (UNODC) as a preferred model. It has already been implemented in several countries in the WHO European Region.

"People in prison are frequently overlooked when it comes to health care, often excluded from programmes available to the general public across the WHO European Region. Colorectal cancer screenings and opioid agonist treatment are just some examples," said Dr Carina Ferreira-Borges, Regional Advisor for Alcohol, Illicit Drugs and Prison Health, WHO/Europe.

"According to recent WHO data, upon release, less than 50% of Member States provide a support service to help people leaving prison to register with community health services, while less than 40% provide people with medication for all health conditions. So, every step towards closing this health-care gap is crucial."

A 6-pillar approach

Portugal's working group proposes a comprehensive prison health plan built on 6 pillars:

• Health protection and promotion: this focuses on prevention with measures like hygiene materials distribution, tobacco-free environments, promoting physical activity and healthy eating, and investing in health education and peer support.
• Early detection and prevention: this prioritizes early intervention with cancer and infectious disease screenings, vaccination programmes, HIV prophylaxis interventions and other initiatives.
• Continuity of care: this ensures uninterrupted access to health care with measures guaranteeing all necessary medical care during incarceration and upon release, covering all areas of medical need.
• Social reintegration: aligned with the WHO's broader health definition, this pillar focuses on social reintegration through education and training opportunities to ease the transition back into society.
• Information systems and technology: this aims to modernize health data management systems for improved efficiency and communication between health-care providers.
• Research: this dedicates resources to research efforts for generating evidence-based best practices in prison health care.

"This ambitious plan outlines 108 specific actions to transform health care within Portugal's detention facilities," said Filipa Alves da Costa, a public health consultant for the WHO/Europe Health In Prisons Programme (HIPP), who observed the working group. "Portugal has already begun implementing key aspects, such as telehealth services and electronic medical records. Importantly, the working group's proposed strategy establishes a clear 2030 deadline and a monitoring mechanism to ensure timely progress."

A commitment to human rights and public health

The integration of prison health into the country's National Health Service has the potential to improve the lives of incarcerated individuals in Portugal and strengthen public health overall, leading to fewer cases of noncommunicable diseases and fewer premature deaths.

This initiative reflects Portugal's dedication to upholding human rights and ensuring access to quality health care for all citizens, including those in prisons. This was expressed by representatives from the country at a 2023 conference organized by WHO/Europe, which emphasized the importance of health policies that address the needs of vulnerable populations.

"The proposed measures address well-documented needs, and their value for Portugal is undeniable. We are positive that the suggested actions will do public good when the new government emerges after the current election process," said Professor Henrique de Barros, Head of the WHO Collaborating Centre on Behavioural and Social Determinants of Noncommunicable Diseases.

The measures will help Portugal to fulfil its commitments in the context of the United Nations Sustainable Development Goals (SDGs). For instance, SDG 3.4 calls for reducing the premature mortality from NCDs by one third by 2030 - through prevention and treatment and promoting mental health and well-being.

To support Member States on that road, WHO/Europe has launched the "Race to the finish" campaign with a focus on progress made towards the fulfilment of NCD-related SDG targets.

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