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).
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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,
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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

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
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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.
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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

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
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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

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
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school education: 53.33 %.
Number of doctor visits, medication dispensing, treatment of
prisoners at the detention facility clinic increased much over the
years. Morbidity: Prisons: TB ratio: 2009: 5.11 %, 2010: 5.32 %
Percentage of HIV-infected patients: 2009: 7.1%, 2010: 6.8 %.
Detention center: TB ratio: 2009: 7.21 %, 2010: 7.14 % Percentage
of HIV-infected patients: 2009: 6.89 %, 2010: 5.98 %.

and treatment for prisoners in hospital no specific regulations,
unified.
3.1.2. Organizations examination and treatment for prisoners
(2009-2010)
Although no specific guidelines on medical examinations and
treatment for prisoners at the hospital, but the detention facility was
transferred to the object of the State hospitals in the area for medical
examination, treatment, regular checks. 100 % of the detention
facilities have clinics for medical examination and treatment for
prisoners. 100% of prisons, educational institutions, reformatories
chamber organized medical camps, division, campus, 58.06 %
detention facility organized medical camps chamber, division,
campus.
3.2. Develop, implement and evaluate the
eectiveness of initial organizational model
treatment facility for inmates in provincial
hospitals (2011-2012)
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 Circular
No. 09/8/2010 dated 04/2010/TTLB-BCA-BYT. Practical conditions
in the area; organized system of health care; Surface treatment
facilities in hospitals , detention operations work.
- Principle: The hospital police, military and medical residents to the
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layout, room dedicated to treating prisoners in hospital; These places
have a detention facility in the area that will build a general treatment
for prisoners at the hospital and delivered to a detention facility

hospital billing, hospital transfer and strengthen the nutrient regime
and coordinate medical treatment for prisoners.
3.2.1.3. Organization , staffing models and layouts
- Model name:
+ For the hospital, the unit dedicated to the treatment of prisoners:
PATIENT TREATMENT AREAS
(Prisons A - Detention B)
+ With hospital only dedicated to the treatment room prisoners:
PATIENT TREATMENT ROOMS
(Detention A)
- Payroll organization: Organization and staff of a dedicated
treatment zones are determined based on: decentralization tasks and
technical expertise for a dedicated treatment area; held real situation ,
the hospital's human resources, total of inmates treated at hospitals;
disease situation, structure and characteristics of industrial sickness
detentions.
- Equipment: Medical equipment, instruments orderlies, weapons,
tools, support, equipment and other activities.
- Treatment Process: Process 1 (Daily medical staff of the department
relating to areas , treatment rooms dedicated to the treatment of
prisoners and the implementation of technical expertise).
- The coordination between hospitals and detention facilities: Based
on the opinion of the medical staff and the hospital, proposed
regulations on coordination between hospitals and detention
facilities: a contract liability, regular consultations and briefings 6
months/time between hospitals and detention facilities.
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3.2.2. Development of the model
3.2.2.1. Circular Issued Ministry of Public Security and the Ministry
of Health

medical treatment; assessment questionnaires, economic efficiency
and social.
3.2.3.1. Initial results of operations of the model grassroots
organization dedicated to the treatment of prisoners in 6 general
hospitals of province/city
By the end of 6/2012 had 86/129co detention facility, in
which the detention center is 40/70 in general hospitals provinces;
prison 46/59 at the provincial hospital/city (32/46), district specialists
(14/46) with a total of 1,896 beds. 06 general hospitals in the
province, the city layout, private treatment rooms with Circular 04,
89 arranged rooms with 206 beds diseases. In the 02 years from 2011
to 2012 has treated 1,827 subjects turn, has responded to 18 detention
facilities. In 6 hospitals province/city conducted a pilot
implementation of the organization, a dedicated treatment room for
prisoners: There are 3 hospitals organize the construction
specification for the treatment of prisoners, 3 hospital not arrange
construction land should arrange separate unitary; 5 hospitals had
allocate funds to build, repair by the Ministry of Public Security, 1
hospital provincial People's Committees are arranged construction
cost (Ninh Binh).
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Total number of times prisoners are treated in hospitals:
2009-2010: 1,818 respectively; 2011 to 2012: 1,827 respectively. The
total number of deaths in hospitals: 2009-2010: 280 inmates; 2011 to
2012: 281 prisoners. Total fled in hospitals: 2009-2010: 2 prisoners
(Ha Dong); 2011-2012: no subjects fled the hospital. Most detention
facilities and hospitals contract liability (79% & 90%) Mode
briefings, regular consultations (82% & 81.67%); Moving beyond the
hospital by specialists subjects, the same route (95% & 93.33%);
prisoners have been discriminated against (15%), non-discrimination

police remand Vinh Phuc province. Already, the site has arranged 01
nurses working on the payroll of Glory camp. Hospital rooms feature
the closed toilet. Home medical equipment have also been equipped
as specified. Most difficult with this area is that the higher the paying
patients. In 2011-2012, 387 views multi treat prisoners, no prisoners
would flee.
* Ha Dong general hospital: Private Block has an area of about 500
m2, 20 rooms with capacity of 40 beds. Currently, the hospital has
served the medical examination and treatment for the inmates of the
camp: the detention center No. 1, 3, T16 and traij Thanh Xuan prison.
From 2011-2012, Ha Dong General Hospital has examined 789
prisoners respectively, for 381 inpatient visits, no inmates escaped
from the hospital.
* Hai Duong general hospital of province: The hospital entire
layout of the infectious disease department 3rd floor, including 10
rooms and 15 beds. Medical equipment has been well-equipped. In
2011-2012, has treated 462 prisoners, no prisoners would flee.
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* Ninh Binh general hospital of province: had spent in the hospital is
a 2 storey concrete building, new building with an area of over 2000
m2 land for private treatment for prisoners of three detention
facilities: Ninh Khanh prison, reformatory schools and detention of
two police Ninh Binh province. This particular area has 40 treatment
rooms and 150 beds disease accounted for 25% of the size of the
hospital bed. Name of this particular treatment area is managed
directly Ninh Khanh prison's hospital and Ninh Binh province
responsible for the medical professional work.
In the private treatment room layout: visitation room, live
room, health room staff warden protection, room, male patients,
female patients rooms, infection prevention, private dining room for

at the clinic level detention facility, currently only 01 hospitals for to
treatment for prisoners Chi Hoa hospital only to serve its own police
detention center of Ho Chi Minh City with 120 beds, tertiary- not to
treat prisoners. So, while the inmate disease beyond clinical expertise
will be transferred to the state hospital in the area for examination
and treatment.
Organization, staffing medical staff at the clinic: Total of
health workers mainly in mass detention and mass detention
(379/395 health workers). The number of doctors and pharmacists are
also concentrated in jail (97/125 physician 23/32 pharmacists).
Currently, the detention center is no research pharmacists. Health
workers are mostly nurses and pharmacists school. Percentage of
medical/clinical highest in the prison block (18.86 person/clinic) and
lowest in the detention block (6.61 persons/clinic). Similarly, the
percentage of physician/clinic of the prison block has the highest
proportion ( 3.53 persons/clinic) and lowest in the detention block
(1.46 persons/clinic). However, the proportion of
pharmacists/Infirmary lowest educational institutions (not
pharmacists) and highest in reformatories blocks (2.00
persons/clinic), and then to block camp cell (1.53 persons clinic).
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According to the comments of the leaders of the detention facility on
the medical staff is insufficient and did not meet the required
percentage of 57 % . In fact the number of health workers but enough
structure in accordance with medical staff primarily intermediate
level, the percentage of healthcare staff have university degrees or
more lower , especially doctors and pharmacists university degree.
Therefore, the assessment only 43 % of health workers and meet all
requirements.
Regarding medical equipment and means of transport of the

testing for inmates with HIV/AIDS in the detention is not regular
basis due to physical conditions, financial difficulties and the
detention must actively coordinate with outside health agencies
periodically testing and sampling conditions only blood tests for
some prisoners in high-risk groups such as sex workers, injecting
drug addicts can not detect the number of prisoners with HIV in
detention . No funding drug tests and specific treatment for inmates
addicted to drugs, HIV/AIDS, lack of medical facilities protection
service rooms such as boots, gloves, masks A number of countries
around the world and propose conduct HIV tests for inmates at the
prison in the U.S
Due to technical distribution and qualifications at the clinic
the detention facility, inmates must move beyond disease expertise to
hospitals in the state for medical examination and treatment have
increased over the years (2009: 2698 people, 2010: 3,161 people) in
all detention facilities under study. The prisoners were transferred to
the hospital all the provinces, cities, district hospitals and specialized
hospitals near where the unit was stationed. The demand is huge
referral, so the receiving hospital doctor, effective treatment and
support for the work of the clinic for treatment and to ensure
detention operations. When moving objects away mainly treated in
hospitals provinces/cities. Rate prisoners with TB and HIV/AIDS in
the detention facility is higher than the community, to the media, peer
education, prevention and medical treatment of custodial care facility
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

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
(2009-2010)
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All detention facilities have clinics for medical examination
and treatment for inmates. Bloc prisons, educational institutions,
reformatories chamber organized medical camps, division, campus.
The organization of the medical examination and treatment of
prisoners in detention facilities: Daily medical staff to medical, drug
development in the cell chamber and medical camps. In severe cases,
the clinic moved to the center. In case of necessity, the clinic will
move objects local hospital for medical examination and treatment.
Regarding the scope of cure: According to technical decentralization
of the Department of Health, Ministry of Public Security, the clinic's
detention facilities as health service facility for health services
management, health care, initial treatment , sanitation and other
public health work.
4.2. Develop, implement and evaluate the effectiveness of initial
organizational model treatment facility for inmates in provincial
hospitals (2011-2012)
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 have
many detention facilities on a province will build a common
treatment for prisoners at the hospital, and delivered to a detention
facility management, where there is only one at the detention facility,