National Preventive Mechanism ORGANIZATIONAL ASPECTS (GENERAL REVIEW AND RECOMMENDATIONS) OF THE PENITENTIARY HEALTHCARE IN GEORGIA (GENERAL OVERVIEW AND RECOMMENDATIONS) Reform in healthcare of the penitentiary system Status: healthcare and medical service in prisons, in the Georgian penitentiary system are administrated by the healthcare department of the Ministry of Corrections, Probation and Legal Affairs of Georgia. Since November 2012 this sphere is supervised by the Deputy Minister for Healthcare issues. In September, 2012 after the scandal in relation to the facts of torture in the Georgian penitentiary system it became clear that the Georgian penitentiary system, including medical department was in need of urgent and radical reform. After the government change in the country on the October 1st, 2012 elections leadership of the said ministry changed and a new strategy of healthcare reform of the penitentiary system and ways of its implementation were presented. The strategy encompassed all aspects of healthcare in the penitentiary system stipulated by international standards, as well as echoes positive ways of getting closer to the civil healthcare. Though we shall note that it does not take into consideration the major principle stipulated by international standards e.i. its complete transfer to healthcare system of the civil sector. Implementation of the aforementioned component in the strategy is extremely important, given the principle of independence of medical staff and taking into consideration international standards of torture prevention. It shall be noted that at this stage intervention of the civil sector into the penitentiary system is being done within the framework of the state program for tuberculosis control that to a certain extent improved standards of timely disclosure and prevention of those suffering from Tuberculosis. But this problem remains an acute challenge for the Georgian penitentiary system. Another example of the civilian healthcare intervention is the methadone program for drug addicts that were being implemented in the N8 establishment of the penitentiary system. It also started to operate in Kutaisi N2 establishment starting from 2012. In addition, penitentiary system medical personal were integrated into some civil-type healthcare training-components, certain rehabilitation programmes or psychiatric monitoring were also held. Though facts of torture and inhuman treatment that were revealed to the wide public in September 2012 and monitoring and crisis intervention conducted in the penitentiary system after the said crisis situation demonstrated that such small-scale measures are not enough for the process of making the penitentiary healthcare system civilian. And it creates high risks of violation of ethical standards for both local medical staff on spots and civilian medical personnel employed on services. Accordingly, it is recommended to present more close standing version of the Georgian penitentiary healthcare reform to international standards, stressing necessity of its transfer to the civilian sector and specifying work plan and timetable in this direction. Medical service subsidizing It should be noted that by the end of 2012 subsidizing of the medical service increased, and this was reflected on wages of medical personnel. We should note that the medical service of Georgian penitentiary system is subsidized through assignations in the state budget allocated to the Georgian Ministry of Corrections, Probation and Legal Assistance. While civil healthcare finances types of the medical service through budget funds allocated in the framework of assignations of the Ministry of Health, Labour and Social Affairs in accordance with the article 15 of the Georgian law on “Protection of healthcare”. In compliance with the first paragraph of article 45 of the Georgian law on “Patients’ rights” - “access to medical service for persons placed in the penitentiary establishment is carried out by state medical programmes” which in reality is not being implemented. As a result, we have a case of violation of the equivalence principle. The above problem again relates to the necessity of re-civilization principle of healthcare in the penitentiary system in Georgia. www.ombudsman.ge NPM Report