A/HRC/25/60/Add.1 in the prison system, and that there is a need to undertake large-scale farming to improve inmates’ welfare. 46. There is generally a very low standard of equipment and many of the prison kitchens consisted only of large pots used to produce porridge in the morning and banku (corn or cassava dough) or a thin soup that would often be served both for lunch and dinner. 47. The Special Rapporteur received numerous complaints from inmates regarding the quantity of food they were given, but the most frequent complaint was about the quality. He observed an apparent repetition of the dishes provided and an almost total absence of fruit, vegetables or meat. It appears that inmates rely heavily on their families to supplement their food in order to avoid malnutrition. 48. The food at the Ankaful maximum security prison was better than that of other prisons owing to additional funds not attributed to the food budget being available. Nsawam prison supplemented the standard meals with additional vegetables that inmates grew on land within the facility. Medical care 49. All inmates are registered under the national health insurance scheme and entitled to health-care services. However, in practice medical services provided in prisons fall far short of what international law requires. They are carried out not by doctors but by medical assistants, who are overstretched and so underequipped that even the most basic equipment and medicines are lacking. 50. Owing to harsh prison conditions, many inmates showed signs of illnesses that are preventable and treatable. A number of inmates with health problems or disorders requiring urgent hospitalization had experienced delays or been denied such treatment. Dental care was non-existent. Some inmates had obvious mental disturbances that required neuropsychological or psychiatric care. There are no staff specifically focused on mental health and “the problem and level of mental ill-health in prison is poorly documented”.6 Mentally ill inmates are not routinely identified and therefore not transferred to general or psychiatric hospitals. 51. The then Acting Director-General of the Prisons Service openly acknowledged the problem of attracting and retaining health providers, especially mental health-care personnel, and was engaged with the Ministry of Health, the international community, NGOs and religious groups to try to address shortcomings. Prison officers have been sent on health-related courses in order to provide health-care services to inmates (A/HRC/25/WG.6.14/GHA/1 para. 21). 52. The Special Rapporteur observed that in Ankaful and Nsawam prisons there were screening programmes for inmates upon arrival. However, even the newest facility, Ankaful, had only a visiting medical doctor. The Special Rapporteur interviewed a number of the recent arrivals at the diagnostic centre at Nsawam and other detainees, who stated that they had not been examined by a medical doctor, physically or psychologically. In fact, Nsawam, the most populated prison, has no medical doctor on the staff, even parttime. Nsawam does have a segregated area where detainees are held if it is suspected that they are ill, but as routine screenings upon entry by a doctor are rare to non-existent, an examination is only undertaken when obvious symptoms appear. 53. The Special Rapporteur welcomes the establishment of the contagious disease prison in Ankaful (capacity 60 inmates). However, this centre is unable to treat the number of detainees in the penitentiary system who are suffering from tuberculosis, malaria, 6 10 “Prisoners are bottom of the pile”, p. 24.