Capacity-building strategies that support correctional and justice health professionals to provide best-evidenced based healthcare for people in prison: a systematic review

Background: The United Nations (UN) 2015 ‘Mandela Rules’ stipulates that people in prison will have access to equivalent healthcare to other community members. This expectation has challenged prisons in high-income countries to strengthen healthcare delivery to better meet the needs of the growing number of incarcerated First Nations and older, frailer people, many with complex healthcare needs. Yet little is known about correctional and justice health professionals’ (‘prison workforces’) capacity to identify and support people in prisons with complex healthcare needs. 

Aim: To identify the post-Mandela Rules strategies that have increased the prison workforce’s capacity to provide evidence-based healthcare. 

Methods: A systematic review. Three health and Criminal Justice databases were searched (2015-June 2024) to identify empirical data regarding the ‘individual’, ‘organizational’ and ‘community’ capacity-building strategies employed to improve the prison workforce's healthcare capabilities. Kirkpatrick's Model was used to assess the evaluation level, while Popay’s narrative synthesis was applied to the extracted data. Findings are reported according to the PRISMA Statement. 

Results: Of the 20 included articles, the highest level of evidence (level III) was generated by a mixed methods study, with most (n = 17) generating low-level (Level IV) evidence. Ten studies evaluated mental health behavioral capacity-building strategies, with limited attention given to other chronic illnesses, ageing, palliative care, or cultural needs. More complex capacity-building strategies that included individual, organizational, and community-level elements generated the best outcomes. The best individual-level capacity-building outcomes were more frequent (> 5 occasions) interactive health-related education delivered in partnership with external experts. However, the commonly employed capacity-building strategies were short didactic education sessions, which were less effective. 

Conclusion: If prisons are to meet the UN Mandela Rules’ aspirations, more impactful individual, organizational and community-level capacity-building strategies are urgently required. Transitioning to co-designed, interactive, culturally sensitive, evidence-based approaches is crucial if the prison workforce is to better recognize and effectively respond to the needs of more culturally diverse and older, sicker populations with complex healthcare needs. 

Trial registration: Prospero CRD42023410564.