Abstract

This article aims to characterize the work process of the prison health team in the state of Paraíba. This is an exploratory research, with a qualitative approach, carried out with two Prison Primary Care Teams in the state of Paraíba. Individual interviews were carried out with health professionals in order to elucidate the work process developed. The corpus consisted of 10 texts and was analyzed using the software Interface de R pour les Analyzes Multidimensionnelles de Textes et de Questionnaires (Iramuteq) and exposed through the Descending Hierarchical Classification (CHD) and the Similarity Analysis. The analysis of the corpus showed that there were 5,417 occurrences of words, spread in 1,090 forms, whose average occurrence was 5.97 words for each form. The Descending Hierarchical Classification analyzed 152 text segments, with 75% retention of the corpus, which resulted in the construction of four partitions and six classes, namely: attention to perceived needs; counseling activity; reception of PPL and family; difficulties related to the system; difficulties related to resources; and suggestion for professional training for EABP.

Key words:
Prisons; Workflow; Patient assistance team; Prisoners; Qualitative research

Introduction

The Prison Primary Care Team (EABP) must perform its duties with People Deprived of Liberty (PDL) in health units located in prison institutions, where they deliver care practices and regulate the continuity of care in the Health Care Networks (RAS). The inclusion of EABPs in Brazilian prisons occurred primarily with the National Penitentiary Health Plan (PNSSP) publication in 2003¹1 Brasil. Ministério da Saúde (MS). Secretaria de Atenção à Saúde. Departamento de Ações Programáticas Estratégicas. Plano Nacional de Saúde no Sistema Penitenciário. Brasília: MS; 2004. [acessado 2021 nov 2]. Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/cartilha_pnssp.pdf.

Currently, these health teams are regulated by the National Comprehensive Health Care Policy for People Deprived of Liberty in the Prison System (PNAISP). This state policy gathers the Health and Justice ministries. The policy aims to ensure the access of PDLs in the prison system to comprehensive care in the Unified Health System (SUS). To this end, its general guidelines are comprehensiveness, intersectoriality, decentralization, hierarchy, and humanization²2 Brasil. Ministério da Saúde (MS). Secretaria de Atenção à Saúde. Departamento de Ações Programáticas Estratégicas. Coordenação de Saúde no Sistema Prisional. Política Nacional de Atenção Integral à Saúde das Pessoas Privadas de Liberdade no Sistema Prisional. Brasília: MS; 2014..

The EABP must develop cross-sectional, intersectoral, and universal actions to ensure access and reception among the plural contingent of PDLs and must be considered as a tool for the implementation and universalization of the SUS, which may involve adults, foreigners, seniors, women, and their children, indigenous, lesbians, gays, bisexuals, transvestites, transsexuals, transgenders, queer, intersex, asexual, and others identified (LGBTQIA+), people with mental disorders or disabilities²2 Brasil. Ministério da Saúde (MS). Secretaria de Atenção à Saúde. Departamento de Ações Programáticas Estratégicas. Coordenação de Saúde no Sistema Prisional. Política Nacional de Atenção Integral à Saúde das Pessoas Privadas de Liberdade no Sistema Prisional. Brasília: MS; 2014..

In this sense, health professionals working in the prison system should receive different health needs and problems affecting PDLs. An epidemiological analysis of the health situation among PDLs in Brazil developed by the Federal University of Espírito Santo (UFES) underscored tuberculosis, dengue, HIV/AIDS, viral hepatitis, acquired syphilis, human anti-rabies care, leprosy, male urethral discharge syndrome, acute Chagas disease, various types of violence, and leptospirosis as the most prevalent diseases or treatments³3 Miranda AEB. Análise epidemiológica da situação da saúde na população privada de liberdade no Brasil: dados de bases de informação. Vitória: Editora da UFES; 2015.

4 Cordeiro EL, Silva TM, Silva LSR, Pereira CEA, Patricio FB, Silva CM. Prisoners' epidemiological profile: notifiable pathologies. Avances en Enfermería 2018; 36(2):170-178.^-55 Allgayer MF, Ely KZ, Freitas GH, Valim ARM, Gonzales RIC, Krug SBF, Possuelo LG. Tuberculosis: health care and surveillance in prisons. Rev Bras Enferm 2019; 72(5):1304-1310..

The information mentioned above may interfere with the implementation of actions. The evaluation of the work process among health professionals in the penitentiary system revealed that the quality of the services provided is negatively analyzed by the professionals who work in EABPs. This reality is related to failures regarding structural aspects⁶6 Silva JM, Nascimento MC, Aoyama EA, Lemos LR. The co-operation of the health team in the assistance provided tothe brazilian prison system. Rev Bras Inter Saude 2020; 2(2):70-74. and the setting and the processes developed in this scope, such as the lack of planning, the turnover of health workers, and the lack of career progression plans⁷7 Costa GMC, Barbosa ML, Celino SDM, Oliveira LV. Demographic profile and working conditions: health teams working in detention units. Rev Bras Pesq Saude 2014; 16(4):13-22..

This setting disregards what the SUS advocates and reaffirms the need to develop the PNAISP to its fullest extent and ensure the health of PDLs. Thus, understanding the EABP health professionals’ work process recognizes the gaps in the current national legislation. In the face of this concern, the guiding question of this research arises: “How is the EABP work process characterized against what is proposed by the PNAISP?” In this sense, this study aimed to characterize the penitentiary health team’s work process in Paraíba.

Methods

This exploratory, qualitative research was conducted with EABP in the state of Paraíba. Information from the last report of the National Penitentiary Department (DEPEN), an agency of the Ministry of Justice, mentions that Paraíba has 9,596 PDLs⁸8 Brasil. Ministério da Justiça (MJ). Departamento Penitenciário Nacional. Levantamento Nacional de informações penitenciárias INFOPEN. Brasília: MJ; 2014., with 19 penitentiaries, including the Penitentiary of Forensic Psychiatry. Ten EAPBs were implemented in male prisons and one team was included in a female prison.

The sample of this study consisted of one EABP that works in a female prison and another in a male prison, which were randomly selected. The inclusion criterion adopted for randomization was to have a complete primary composition (doctor, nurse, dentist, psychologist, and social worker), as recommended in the PNAISP²2 Brasil. Ministério da Saúde (MS). Secretaria de Atenção à Saúde. Departamento de Ações Programáticas Estratégicas. Coordenação de Saúde no Sistema Prisional. Política Nacional de Atenção Integral à Saúde das Pessoas Privadas de Liberdade no Sistema Prisional. Brasília: MS; 2014..

After selecting the two EABPs, individual interviews were held with the professionals of the health teams to collect information on the work process developed. In this stage, we adopted a two-part semi-structured interview roadmap. The first part addressed the sociodemographic and professional profile of the subject. In contrast, the second addressed open-ended questions on the understanding of work in the prison environment, legislation, implementation, organization, analysis, the composition of health activities, the attributions of the professionals involved in these actions, and the identification of perceived health impacts.

The responsible researchers in the prison units carried out the interviews on days and times scheduled with the direction of the prisons and health professionals. The corpus was analyzed with the software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires (IRAMUTEQ), using the Descending Hierarchical Classification (DHC) and Similarity Analysis of words in the text.

The DHC, also called Reinert’s method, aims to identify the ideas in the corpus. This type of analysis results in the establishment of classes, which correspond to text segments that, in the meantime, present words or forms similar to each other and different from the text segments of the other classes⁹9 Camargo BV. ALCESTE: um programa informático de análise quantitativa de dados textuais. In: Moreira ASP, Camargo BV, Jesuíno JC, Nóbrega SM, organizadores. Perspectivas teórico-metodológicas em representações sociais. João Pessoa: Editora da UFPB; 2005. p. 511-539..

In this way, the grouping of text segments, isolated in classes, corresponds to systems of discourse representation, graphically arranged through the dendrogram. This graph shows the partitions made in the corpus until reaching the final classes. Furthermore, it is noteworthy that the analysis by DHC must show minimum retention of 70% of the text segments to be valid for classifying textual material¹⁰10 Camargo BV, Justo AM. Tutorial para uso do software IRAMUTEQ [Internet]. 2016. [acessado 2022 jun 10]. Disponível em: http://www. iramuteq.org/documentation/fichiers/Tutorial%20IRaMuTeQ%20em%20portugues_17.03.2016.pdf.
http://www. iramuteq.org/documentation/f... .

The similarity analysis identifies the combined occurrences between the words, and its result is related to the connection between them, informing the level of relationship between the forms in the corpus¹¹11 Marchand P, Ratinaud P. L'analyse de similitude appliqueéaux corpus textueles: les primaires socialistes pour l'election présidentielle française. In: 11º Journées Internationales d'Analys Estatistique des Données Textuelles; 2012 jun 13-15; Liège, Belgique.. The corpus consisted of ten texts, whose segment retention was 75% and characterized by the variables of interest: professional category and EABP from the male and female penitentiary. The criteria adopted for the inclusion of the elements in their respective classes were frequency more significant than the mean occurrences in the corpus and association with the class determined by the chi-square value equal to or greater than 3.84, a setting that provides a margin of error < 0.05.

All research subjects were informed about the study and signed an informed consent form. Their identification consisted of using the letter “P” and a number corresponding to the order of the interview. Data collection began after authorization from the State Penitentiary Administration Secretariat in Paraíba (SEAP-PB) and approval by the Research Ethics Committee of the Federal University of Rio Grande do Norte, under CAAE 62825716.8.0000.5537.

Results

The analysis of the corpus derived from the interviews with the ten professionals who make up the EABP showed 5,417 words spread in 1,090 forms, whose mean occurrence was 5.97 words for each form. The Descending Hierarchical Classification analyzed 152 text segments, with a retention of 75% of the corpus, which resulted in the construction of six classes and four partitions (Figure 1).

Partition 1, formed by classes 4 and 3, reveals aspects related to the work of professionals in the EABP and corresponds to 32.5% of the analyzed content. There is a more significant development of care practices geared to the health needs of inmates and counseling.

Class 4 (19.3%) informs that the activities by the EABPs are visits, services, and follow-ups to solve emerging problems of this population; yet, such actions are often performed at the request of the PDLs. Nursing stands out as the most relevant professional category (p < 0.001), per the following excerpts:

Class 3 (13.2%) reveals another essential activity in the EABP work process - counseling - mainly related to HIV, in which the psychology service has been present (p < 0.001) and is exemplified by the professional’s statement.

Partition 2 (Figure 1), which is formed by class 6. It captures 14% of the content of the analyzed corpus and addresses aspects related to the activity of receiving the PDLs and their families, in which social workers have essential participation in the connection between these intramural and extramural axes (p < 0.001), per the statements below:

Partition 3 (Figure 1), formed by classes 2 (15.8%) and 5 (20.2%), corresponds to the highest capture of the analyzed text (36%) and points out the difficulties related to the work process developed by EABP professionals. Class 2 reports obstacles such as overcrowding and the presence of only one health team, as stated by the subjects:

Class 5 addresses other difficulties related to the prison system, which negatively affect the EABP professionals. These hardships refer to structural aspects, such as the lack of a vehicle and escort to carry out the referral and counter-referral in the Health Care Network (RAS), the inadequate physical spaces, and the lack of materials and supplies, mainly dental, as highlighted by the professionals:

To broaden the discussion on the subject and, thus, contribute to the involvement of stakeholders with prison health, partition 4 (Figure 1), revealed in class 1 (17.5%), refers to the suggestion of the professionals regarding subjects and other aspects that should be included in health training courses that would contribute to the work with the PDLs. We underscore the inclusion of curricular internships within the prisons and cross-sectional themes that should be addressed in the courses.

The similarity analysis (Figure 2) shows the lexical content resulting from the organization of words that reflect the EABP work process, aligned with the classes previously presented. The health team emerges as the central axis of care, in which the strong connection with the word “no”, expressed by the extensive connection line, highlights the hardships perceived by professionals, such as the needs regarding structure and processes, the difficulty related to escort, and the lack of inclusion of universities in penitentiary health units. The intense connection of the health team with the convict, represented by the thick line, shows the PDLs as the core of the professionals’ attention.

Discussion

The inclusion of EABPs works per the PHC guidelines. It emerges as a device to organize care among those deprived of their liberty within prison institutions and care networks, based on the perception of emerging needs of the population living in prisons in the country, besides performing all the care and practices under the responsibility of the multidisciplinary teams, such as health promotion and disease prevention, disease treatment, and rehabilitation to ensure comprehensive care²2 Brasil. Ministério da Saúde (MS). Secretaria de Atenção à Saúde. Departamento de Ações Programáticas Estratégicas. Coordenação de Saúde no Sistema Prisional. Política Nacional de Atenção Integral à Saúde das Pessoas Privadas de Liberdade no Sistema Prisional. Brasília: MS; 2014..

Health professionals must have a high degree of knowledge to work in the prison setting to provide comprehensive care to PDLs, given the high complexity of the care provided to this population concerning the diversity of diseases, conditions, and disorders that affect the incarcerated population. Therefore, the development of knowledge and skills is required to address the primary perceived health needs and the peculiarities involving the work in the correctional institution¹²12 Sanchez-Roig M, Coll-Camara A. Prison nursing and its training. Rev Esp Sanid Penit 2016; 18(3):110-118..

We should also emphasize that comprehensive care is related to multidisciplinary work, in which each professional in the health team contributes to fulfilling the subjects’ several needs. However, the discourses about the health team’s work process in the prison context evidence the effective and significant participation of nursing, psychology, social service, and dentistry in activities performed. However, the doctor’s figure did not emerge among the analyzed statements. We also identify that the health team professionals’ work is flawed.

This setting could be related to the biologicist culture that still permeates Brazilian health care. In this case, visits and prescriptions are part of a list of medical activities already expected by PDLs and professionals. In contrast, other activities, such as counseling and receiving convicts and their families, are less expected actions and, in this sense, cause a stir when they are performed.

Also, the results show a predominance of visits and care directed to the most prevalent diseases and conditions among the activities performed. The emphasis on the biologicist process to the detriment of harm reduction practices observed in this research corroborates what has been verified in other locations, where reality translates into health promotion and incipient disease prevention, even in the face of a significant reduction in illness observed among PDLs who participate in these activities¹³13 Sander G, Scandurra A, Kamenska A, MacNamara C, Kalpaki C, Bessa CF, Laso GN, Parisi G, Varley L, Wolny M, Moudatsou M, Pontes NH, Mannix-McNamara P, Libianchi S, Antypas T. Harm Reduct J 2016; 13(1):28..

On the other hand, reception and counseling actions are developed. The results show that they are performed in secrecy, with professionals calling the PDLs for a private conversation, ensuring respect and information confidentiality. The counseling activity on HIV - a prevalent disease in the prison system - reduces stigma, which is strongly felt by people who have HIV, whether internalized, perceived, vicarious, or enacted. As a result, counseling by trained professionals generates positive effects on PDLs infected with the virus as it facilitates the acceptance of the new condition, attenuating the feeling arising from the stigma and reducing discomfort regarding the treatment¹⁴14 Kemnitz R, Kuehl TC, Hochstatter KR, Barker E, Corey A, Jacobs EA, Repplinger MD, Ehlenbach WJ, Seal DW, Sosman JM, Westergaard RP. Manifestations of HIV stigma and their impact on retention in care for people transitioning from prisons to communities. Health Justice 2017; 5(1):7..

Reception activities are aimed at the PDLs, and the families of these people since the deprivation of liberty implies considerable changes in the life of convicts and their families, from the entry into a new environment, which involves changes in self-esteem, the pressure arising from criminal stigmatization, changing habits, and other biological, social and psychological changes that adversely affect the health of individuals and their families¹²12 Sanchez-Roig M, Coll-Camara A. Prison nursing and its training. Rev Esp Sanid Penit 2016; 18(3):110-118..

Thus, the reception must be considered an axis in the prison health work process. In this sense, establishing a professional-user bond, shown in the similarity analysis, is an essential condition for the activities of the health worker within the PHC principles and is related to contacting PDLs and their families and active listening, in an expanded care perspective, which aims to empower subjects, equity, and effectiveness of health strategies and actions¹⁵15 Dias AM, Rodrigues SO, Moreschi C, Greco PBT. Promoção da saúde de adolescentes em instituição de acolhimento: desafio para o enfermeiro. REAS 2019; 28:e532..

Health care for the population deprived of liberty must include comprehensiveness, intersectoriality, decentralization, hierarchy, and humanization as structuring axes to ensure the access of PDLs in the prison system to comprehensive care²2 Brasil. Ministério da Saúde (MS). Secretaria de Atenção à Saúde. Departamento de Ações Programáticas Estratégicas. Coordenação de Saúde no Sistema Prisional. Política Nacional de Atenção Integral à Saúde das Pessoas Privadas de Liberdade no Sistema Prisional. Brasília: MS; 2014.. Thus, we could infer that appropriately involving inmates in the care network contributes to the health of individuals and the community¹⁶16 Sidibe T, Golin C, Turner K, Fray N, Fogel C, Flynn P, Gould M, Knight K, Wohl D. Provider perspectives regarding the health care needs of a key population: HIV-infected prisoners after incarceration. J Assoc Nurses AIDS Care 2015; 26(5):556-569..

The comprehensive health of PDLs is also adversely affected by overcrowding⁵5 Allgayer MF, Ely KZ, Freitas GH, Valim ARM, Gonzales RIC, Krug SBF, Possuelo LG. Tuberculosis: health care and surveillance in prisons. Rev Bras Enferm 2019; 72(5):1304-1310., as pointed out in the results of this study. A large population deprived of liberty has to be attended to under an insufficient number of health professionals and inadequate conditions⁶6 Silva JM, Nascimento MC, Aoyama EA, Lemos LR. The co-operation of the health team in the assistance provided tothe brazilian prison system. Rev Bras Inter Saude 2020; 2(2):70-74.. This setting has negatively impacted the perception of subjects deprived of liberty regarding health care practices within prisons, as it reduces the service capacity¹⁷17 Topp SM, Moonga CN, Luo N, Kaingu M, Chileshe C, Magwende G, Heymann SJ, Henostroza G. Exploring the drivers of health and healthcare access in Zambian prisons: a health systems approach. Health Policy Plan 2016; 31(9):1250-1261..

Also, the scarcity of resources reflects on the work process of the health team among the health professionals working in the prison environment⁶6 Silva JM, Nascimento MC, Aoyama EA, Lemos LR. The co-operation of the health team in the assistance provided tothe brazilian prison system. Rev Bras Inter Saude 2020; 2(2):70-74.. The inadequate physical structure, the lack of a vehicle and escort to carry out the referral and counter-referral in the RAS, and the lack of materials and supplies, mainly dental, are highlighted.

Structural issues are an obstacle in the prison setting, resulting in the spread of diseases and lack of access to health services¹⁷17 Topp SM, Moonga CN, Luo N, Kaingu M, Chileshe C, Magwende G, Heymann SJ, Henostroza G. Exploring the drivers of health and healthcare access in Zambian prisons: a health systems approach. Health Policy Plan 2016; 31(9):1250-1261.. When considering the importance of the environment for health, creating healthy places in prisons was listed as a priority topic for research on prison health¹⁸18 Kouyoumdjian FG, Schuler A, McIsaac KE, Pivnick L, Matheson FI, Brown G, Kiefer L, Silva D, Hwang SW. Using a Delphi process to define priorities for prison health research in Canada. BMJ Open 2016; 6(1):e010125..

Furthermore, deprivation of liberty can and should be considered an opportunity for these subjects - usually in a state of socioeconomic and educational vulnerability - to access health care and improve their condition¹⁶16 Sidibe T, Golin C, Turner K, Fray N, Fogel C, Flynn P, Gould M, Knight K, Wohl D. Provider perspectives regarding the health care needs of a key population: HIV-infected prisoners after incarceration. J Assoc Nurses AIDS Care 2015; 26(5):556-569.. Thus, we should emphasize that they must respect the subjects’ autonomy and contribute to their empowerment.

The poor access to the network represents a significant and complex difficulty among the inmates, as it impairs the resolution of health problems of the incarcerated population. It also discredits the value of health actions regarding PDLs¹⁷17 Topp SM, Moonga CN, Luo N, Kaingu M, Chileshe C, Magwende G, Heymann SJ, Henostroza G. Exploring the drivers of health and healthcare access in Zambian prisons: a health systems approach. Health Policy Plan 2016; 31(9):1250-1261.. Nonadaptation of convicts’ security and transport protocols results in health care restrictions for these subjects. Thus, the existence of health services does not imply their effective care¹³13 Sander G, Scandurra A, Kamenska A, MacNamara C, Kalpaki C, Bessa CF, Laso GN, Parisi G, Varley L, Wolny M, Moudatsou M, Pontes NH, Mannix-McNamara P, Libianchi S, Antypas T. Harm Reduct J 2016; 13(1):28..

Furthermore, access can be regulated by the severity of the patients’ general condition or the presence of severe diseases. Thus, inmates diagnosed with acquired immunodeficiency syndrome (AIDS) or tuberculosis are assisted more frequently than inmates with more favorable clinical conditions⁵5 Allgayer MF, Ely KZ, Freitas GH, Valim ARM, Gonzales RIC, Krug SBF, Possuelo LG. Tuberculosis: health care and surveillance in prisons. Rev Bras Enferm 2019; 72(5):1304-1310..

Thus, the great challenge consists of the efforts of the prison authorities - represented by the unit’s general director and coordinators. They have significant participation and influence over providing services for a broad and profound involvement with correctional health care¹³13 Sander G, Scandurra A, Kamenska A, MacNamara C, Kalpaki C, Bessa CF, Laso GN, Parisi G, Varley L, Wolny M, Moudatsou M, Pontes NH, Mannix-McNamara P, Libianchi S, Antypas T. Harm Reduct J 2016; 13(1):28..

We should also underscore that health professionals’ activity in the prisons is permeated by obstacles of the very SUS, such as shortage of professionals, the deficient number and quality of care services, delayed emergency care, and the substandard or non-existent drug distribution, but also due to peculiarities of the prison environment, such as violence among PDLs and PDLs with prison security agents, which put all people who live or work in these institutions at risk¹⁹19 Minayo MCS, Ribeiro AP. Health conditions of prisoners in the state of Rio de Janeiro, Brazil. Cien Saude Colet 2016; 21(7):2031-2040..

Furthermore, although official publications report that 100% of Brazilian states are qualified to receive funds related to the implementation and maintenance of EABPs, the health coverage of this population is only 30%, which indicates the low speed of implementation of the state plans referring to the PNSSP and PNAISP. Furthermore, it is essential to increase the budgetary agenda geared to this plan to improve structural aspects and ensure adequate human and material resources for realizing universal, comprehensive, resolute, and continuous care²⁰20 Soares Filho MM, Gomes Bueno PMM. Right to health to Brazilian prison population starting the demographic study and recognition of vulnerabilities. Cien Saude Colet 2016; 21(7):1999-2010..

Finally, broadening the discussion on the subject can reduce the invisibility of PDLs and health professionals who work in the national prison system. One of the main possible paths is incorporating the theme into health training courses and developing curricular internships within the prisons.

According to the PNAISP, through the Ministry of Health, the Federal Government is responsible for encouraging and conducting training and education actions to disseminate the policy in the country²2 Brasil. Ministério da Saúde (MS). Secretaria de Atenção à Saúde. Departamento de Ações Programáticas Estratégicas. Coordenação de Saúde no Sistema Prisional. Política Nacional de Atenção Integral à Saúde das Pessoas Privadas de Liberdade no Sistema Prisional. Brasília: MS; 2014.. Furthermore, the National Curriculum Guidelines for undergraduate health courses - published in 2001 - mention that training should stimulate skills and competencies for professional team practice aligned with health services and the community²¹21 Brasil. Ministério da Educação (MEC). Conselho Nacional de Educação. Câmara da Educação Superior. Parecer CNE/CES nº 1.133, de 7 de agosto de 2001. Estabelece as diretrizes curriculares para os cursos de ciências biológicas. Diário Oficial da União 2001; 3 out..

Thus, higher education centers must assume responsibility for training health professionals to act per the Brazilian public health policies to strengthen the SUS and its guidelines.

Final considerations

The work process of the EABPs develops biologicist care practices - visits and referrals - that aim to meet the health needs of inmates as a structuring axis. Counseling activities are also developed, mainly among HIV/AIDS patients, and reception is geared to PDLs and their families, as recommended by the PNAISP. However, the statements of health professionals do not reveal actions aimed at other members of the prison community, such as penitentiary security agents and PDLs’ family members, who could also have their health needs met by health teams installed in prisons.

The main difficulties that emerge from the EAPB work process are related to the small contingent of health professionals to meet an overcrowded situation amid the inadequate physical spaces, where the number of vehicles and escorts to perform the referral and counter-referral in the RAS is insufficient, as are the materials and other supplies.

Given the training of health professionals within the national penitentiary context, we observe the need to conduct intramural curricular internships in prisons and an approach of cross-sectional themes - rights of PDLs and work in prisons - in higher education institutions.

The main limitation of this work is the need for an adequate place to hold interviews, which were sometimes performed in a place with some people movements and may have compromised the subjects’ discourse. There is also a noticeable need for more material published in the literature that assesses the implementation of the PNAISP in the country.

However, the results contribute to health education, as it elucidates aspects related to the health work process in prisons. The administrations of the state health and prison administration secretariats can employ the data that emerge from this research to solve the perceived obstacles that negatively affect the care provided. Moreover, health professionals can use the discussion undertaken in their planning.

Finally, we underscore the need to review the investments in health care for PDLs to ensure sufficient human resources, adequate structures, and satisfactory materials and supplies, under penalty of failing once again in comprehensive, resolute, and universal care.

References

Publication Dates

History