Curbing TB in Mongolian prisons

WHO/P. Virot
Medicines for tuberculosis

Mongolia is a model for the control of tuberculosis in prisons, thanks to the right policies, adequate funding and active collaboration between government ministries.

ULAANBATAAR, 5 NOVEMBER 2012 – In Mongolia, entry screening for tuberculosis is standard for the country's 6000 prison inmates, but this was not always so. Such a practical approach to tuberculosis control started a decade ago with a recognition by the country's prison service that TB was a pressing issue that could not be handled by prisons alone.

In 2002 a joint order from the ministries of health, justice and defence led to the formulation of a prison TB policy that spelt out the roles and responsibilities for TB detection and treatment. In addition, a funding and human resources boost in 2005 enabled prison hospitals to upgrade equipment and introduce system-wide screening. It soon showed results: in 2009, the number of reported cases dropped by nearly two- thirds compared to 2001.

Public health scourge

Despite successes in TB control, the disease remains a global scourge, and the Western Pacific Region is no exception, with 2 million new cases and 260 000 TB deaths a year. This situation is typically far worse in closed settings, such as prisons, where TB treatment and control are usually suboptimal. Globally, TB rates are 10 to 50 times higher among prisoners than among the general population. In Mongolia, the TB infection rate among prisoners was 18 times higher than the general population rate in 2001, but by 2009, it was only five times higher.

Interministerial cooperation was key, says Dr Nobuyuki Nishikiori, medical officer in the Stop TB unit of the WHO Regional Office for the Western Pacific. "Typically health and prison services don't work together, creating significant gaps in prison health care, and that's a big bottleneck. In Mongolia, they did work together. The results speak for themselves."

WHO assessment tool reveals progress

The improved TB figures emerged from a prison health services assessment using a tool developed by the WHO Regional Office. The assessment systematically examined health issues in prisons to identify ways to improve the situation.

"The assessment report is a very important document because it helped to define our strengths and weaknesses," says Dr Batbayar Ochirbat, Mongolia's National TB Programme manager. "We've had success in treating drug-susceptible TB, but we still need to improve on other issues such as drug-resistant TB and relapse."

The assessment recommended expanding the coordination between the prison and health services to the provincial level so that prisoners in more remote prisons can have the same standard of care as those in or near the capital, Ulaanbaatar.

Beyond TB control, there were also recommendations for provision of services to treat sexually transmitted infections, including HIV, as well as management of noncommunicable diseases, such as diabetes, and mental health services for both prisoners and staff.

Benefits beyond prison

Strong links between public and prison health systems can ensure that prisoners receive health services that are at least equivalent to those available in the wider community.

Ultimately, protecting prisoners' health has wider benefits. Healthy prisoners are less likely to carry communicable diseases to the community when they are released.

As well as being a good entry point for WHO to work with Mongolia on other aspects of health in prisons, documenting the success of the country's TB control measures in prisons has additional benefits for society at large.

"Next, we'll extend active TB case-finding to the homeless population and alcoholics, so prison hospital experience is helping other parts of society," Dr Ochirbat says.