A/HRC/31/57/Add.2 from natural causes including malaria, TB, and HIV/AIDS). However, at least one prisoner reported that it is not uncommon for inmates to die in prison. 47. Ankaful employs two full-time nurses who work from Mondays to Saturdays and most serious cases are transferred to hospital. In the infirmary, the Special Rapporteur observed one patient who had suffered from a stroke and appeared to require more extensive medical attention than available. Authorities reported having one vehicle for transport to hospital in lieu of an ambulance. The only medicines that could be seen in the dispensary were paracetamol and blood tonic, and records of regular medical examinations of prisoners upon entry were not provided. 48. The Special Rapporteur acknowledges the implementation of a specialized medical outreach project in April 2014 at Nsawam Prison, whereby several mobile van clinics provided free medical examinations and screenings to inmates, under the auspices of the Ministry of Health. Such provisional measures, while necessary and welcome by way of emergency interim services, cannot be used in place of the development of well-funded, staffed and well-equipped infirmaries, or the provision of medical care in line with minimum international standards in all places of detention. He urges the Ministry of Health to deliver on its commitment to deploy a resident physician and nurses, to refurbish the surgical theatre at, and provide ambulances to, Nsawam, and to implement such measures throughout the country. 49. The Ministry of Health reported that the level of staff competence is generally inadequate to meet the needs of large prisons, and that referrals to hospitals are complicated by transport problems, which often means that prisoners do not receive treatment. The Ministry does not provide most medicines directly to prisons: these are rather purchased by the GPS directly from Central Medical Stores, oftentimes on credit. Medication for HIV/AIDS and tuberculosis is provided for free by the Ministry. Under the National Health Insurance Scheme, prisoners are automatically classified as indigent, but nevertheless required to individually register for the Scheme. While the Special Rapporteur acknowledges periodic initiatives by the Ministry of Gender, Children and Social Protection in collaboration with the National Health Insurance Authority to register inmates, he finds that the coverage ought to be extended automatically to all detainees in the State’s custody. He notes with great concern that, as acknowledged by authorities interviewed, the Service lacks the necessary funds to pay for the renewal of the National Health Insurance premium for both inmates and officers, which threatens to prevent them from accessing services in general hospitals; and that existing credit arrangements remain tenuous as institutions continue to withdraw, or threaten to withdraw, services to inmates due to unpaid bills. The prevalence rate of TB and HIV in prisons remains alarming, and partnerships, such as that between groups like the Planned Parenthood Association of Ghana and the GPS, to tackle current challenges are welcome. 50. Lamentable physical conditions, lack of resources, and overcrowding result in extremely poor sanitation and hygiene conditions in prisons, which lack even “basic toiletries like soap and disinfectants,” according to the Prisons Service Council. The Special Rapporteur heard complaints of deplorable sanitation, bedbugs, and the spread of diseases. At Nsawam, as few as four showers existed per block, with inmates reportedly permitted to take one shower per week; showers frequently do not work, and buckets of water are used instead. Those with access to a toilet must share it with more than 100 others, and toilets often overflow with excrement. The delegation was troubled to hear reports that it is not uncommon for prison officers to contract diseases, which in a few cases have led to loss of life. 14