More than 11.5 million people are incarcerated worldwide, and a number of them are released back into their communities with ongoing healthcare needs. Evidence from Uganda and other low- and middle-income countries shows that weak referral systems, poor coordination between prison and community health services, and limited reintegration support leave many former prisoners at risk. Governments should move beyond prison-based healthcare alone and ensure continuity in care after release. Investing in such an approach will strengthen health systems, reduce preventable disease burden, and ensure that one of society’s most marginalized populations is no longer left behind.
The idea of universal health coverage is to ensure that everyone has access to quality health services without financial hardship. Despite global progress in expanding healthcare, millions of people remain excluded from essential services.
Among the most overlooked are people transitioning from prison back to their communities. While many countries have strengthened healthcare within prisons, continuity of care after release remains a critical gap. Closing this gap is not only a matter of equity but also a practical public health innovation that can strengthen health systems, reduce preventable disease, and accelerate progress toward the Sustainable Development Goals (SDGs).
The need for action is increasingly urgent. The World Health Organization (WHO) estimates that approximately 4.6 billion people worldwide still lack access to essential health services. Within this broader global health challenge, more than 11.5 million people are incarcerated worldwide on any given day, according to a 2026 report by Penal Reform International . Prison populations experience disproportionately high rates of HIV, tuberculosis (TB), viral hepatitis, mental illness, substance use disorders, and other chronic diseases. Although many countries have improved healthcare within prisons, treatment often becomes fragmented once people return to their communities, increasing the risk of poor health outcomes and disease transmission.
Healthcare during and after prison
Ironically, imprisonment often provides the first opportunity for many people to receive mandatory comprehensive health screening and treatment. During incarceration, individuals are supposed to be diagnosed with HIV, TB, hypertension, diabetes, and other chronic conditions and begin appropriate treatment. However, these health gains are frequently lost because health systems rarely provide structured support for continuity of care after release.
Evidence consistently shows that the weeks following release are among the highest-risk periods for former prisoners. A 2024 scoping review found that people released from prison have greater healthcare needs than the general population but often make limited use of primary healthcare services after release. The review also shows that coordinated transition programs including pre-release planning, enhanced primary care, and community support improve healthcare utilization and reduce avoidable healthcare costs. The authors of the review also highlight the limited evidence from low- and middle-income countries, emphasizing the need for locally generated research and context-specific solutions.
Research on HIV care demonstrates the value of coordinated transition systems. A retrospective cohort study found that individuals who successfully linked to HIV care shortly after release were significantly more likely to achieve viral suppression than those experiencing delays.
Other studies from the National Institutes of Health (NIH) in 2026 and WHO in 2023 demonstrate that peer navigators and multidisciplinary support empower justice-affected individuals to rebuild their lives for a new beginning and improve treatment adherence and care retention among individuals with serious mental illness in the criminal justice systems.
These findings suggest that continuity of care depends less on individual motivation than on effective coordination among prisons, health facilities, and community-based support to bridge the gap between prison and community care.
Broader health systems research reinforces these lessons. A report to the United States Department of Health and Human Services identifies discharge planning before release, uninterrupted access to medications, transfer of medical information, coordinated referrals, and integration with health financing systems as essential practices for successful healthcare transitions. Although developed in a high-income context, these principles of continuity, coordination, and person-centered care are highly relevant for resource-constrained health systems.
Evidence from Uganda
Uganda reflects many of these global challenges. The Uganda Prisons Service has strengthened prison healthcare through partnerships with the Ministry of Health and other development partners, expanding access to HIV, TB, and other essential services. However, continuity of care after release remains a significant challenge. Former prisoners frequently encounter stigma, poverty, unemployment, transport barriers, health and poor coordination between prison health units and community health facilities, increasing the risk of treatment interruption and loss to follow-up.
A national prison health survey conducted by Makerere University School of Public Health, the Uganda Prisons Service, and the Ministry of Health found that tuberculosis prevalence in prisons is eight times higher than in the general population and that HIV prevalence remains disproportionately high among prisoners.
These findings are consistent with the evidence from The Uganda National Medical Alliance for Prisoners’ Support (TUNMAPS). Research conducted among prisoners and released prisoners in Masaka and southwestern regions of Uganda, finds that many people struggle to remain engaged in healthcare after release despite receiving treatment while incarcerated. Health challenges are compounded by social exclusion, limited family and community support, unemployment, and inadequate reintegration services.
In response, TUNMAPS has developed a strategy to bridge socioeconomic gaps between marginalized communities and the incarcerated population. This framework promotes a coordinated prison-to-community continuum of care through structured referrals, community follow-up, psychosocial support, and partnerships with local health facilities. This approach reflects international evidence showing that healthcare continuity is most effective when health and social reintegration are addressed together.
What next for healthcare policy around the world?
The key lesson here is that public health innovation should extend beyond digital technologies. Social innovations, including standardized referral pathways, peer navigators, community health workers, integrated health information systems, and stronger collaboration among correctional services, civil society organizations and ministries, departments and agencies can significantly strengthen continuity of care while making better use of existing resources.
For policymakers the evidence is clear: universal health coverage should explicitly include prison-to-community healthcare transitions within national health strategies. Governments should establish standardized discharge planning before release, strengthen referral systems, linking prisons to community health facilities, integrate prison health into national health information systems while protecting patient confidentiality, invest in community-based organizations that support continuity of care, and finance implementation and discovery research to identify scalable models suited to resource-limited settings.
Universal health coverage cannot be truly universal if healthcare ends when a prison sentence ends. Strengthening continuity of care to bridge the gap between prisons and communities protects prior investments in prison healthcare, improves treatment outcomes, reduces preventable disease transmission, and builds more resilient health systems. This ensures that people leaving prison remain connected to care and supports essential public health policy, a necessary tool and step toward achieving the commitment to leave no one behind.
This is part of a special debate on Public Health Innovation by GlobalDev at the Global Development Network (GDN), done in collaboration with the Health AI for All Network (HAINet) and the Social Innovation Hub for Health in LAC (SIHILAC).
