Central African Republic

The Constitution (promulgated in 2016) provides that the State guarantees everyone the right of access to public health care facilities and the benefit of appropriate medical treatment provided by trained professionals with the necessary equipment. A new Constitution was promulgated in 2023, the official text was however not retrieved from online sources.

A new constitution was promulgated in 2023. However the official text could not be retrieved from online sources.

The main goal of the "Politique Nationale de la Santé 2019-2030" is to ensure equitable access to quality health services for the entire population, with a particular focus on vulnerable groups, and to contribute to the development of a healthy human capital capable of supporting the socio-economic progress of the country (page 52).

The document identifies several priorities and objectives, including, among other things, reducing maternal, neonatal, infant, and adolescent mortality rates by two-thirds, ensuring universal access to sexual and reproductive health services, reducing malnutrition rates, achieving high vaccination coverage, and improving the performance of the national health system (non-exhaustive list) (pages 53-54).

In the situation analysis section (part II), the Policy provides an overview of the main legislative instruments governing health namely the Law No. 89.003 of March 23, 1989, which sets the general principles for public health, and the Law No. 03.04 of January 20, 2003, which establishes the Hygiene Code. Other relevant instruments include the Ordinance No. 82/027 governing the practice of medical professions, the Decree No. 18.014 of August 12, 2018 which organizes the Ministry of Health and Population, the Decree No. 94.336 of September 24, 1994, on the pricing of public health services, and the Decree No. 00.173 of July 10, 2000, which amends the allowances for public health personnel.

The situation analysis section further highlights that the existing health legislation is outdated, fragmented, and not well-known among stakeholders, necessitating the urgent development of a comprehensive national public health code to address these gaps and align with international standards. Many health-related areas lack legal regulation, such as end-of-life care, euthanasia, and the fight against social issues like alcoholism, smoking, prostitution, abortion, and road accidents. The current legal texts are incomplete, outdated, and inadequate for protecting and promoting public health in line with the Universal Declaration of Human Rights and the Constitution (page 33-34). Other challenges pointed out include the lack of implementing rules and regulations for the Law n°12 002 governing traditional medicines (page 41). Initiatives ongoing at the time of the Policy development included updates to the pharmaceutical legislation (pages 33 and 39).

The section providing for strategic orientations (part X, page 54), emphasizes several legal and regulatory actions to undertake including: the update of national health documents including laws and the public health code (page 55), the update of legislation governing traditional medicine (page 59), the strengthening of the institutional and regulatory framework for community health (page 62) and, the enhanced implementation of the Hygiene code (page 62).

The national Health Development Plan ("Plan National de Développement Sanitaire (PNDS III) 2022-2026") was developed to implement the National Health Policy. Its main objective is to contribute to improving the social and health living conditions of the Central African population, without any form of exclusion, by 2026 (page 76).

The PNDS III identifies four strategic axes: strengthening health governance, improving the resilience of the health system, enhancing the quality and accessibility of health services, and combating emerging and re-emerging diseases, including pandemics like COVID-19 (page 76).The legislative and regulatory framework is detailed in the PNDS III and includes a wide array of texts including: the Constitution guaranteeing the right to health, the Law n°89.003 setting the General Public Health Principles, the Labor Code (Law No. 04.004), the Hygiene Code (Law No. 0304), the Water Code (Law No. 06.001), the Reproductive Health Law (Law No. 06.005) and the Child Protection Code (Law No. 20.016) (for the full list see page 74).

In the strategic framework section, the PNDS III outlines specific actions to enhance legal and regulatory frameworks across all areas of the health system. This includes, among other things: strengthening the legal and institutional framework (page 78, actions 1.1.1 and 1.1.3), creating a normative framework for research (page 80, action 1.7.1), reforming the legal framework for the pharmaceutical sector including traditional medicines (page 83, action 2.4.1), strengthening and implementing measures regarding the International Health Regulations (page 89, action 4.3.1). Specific issues encountered in the area of pharmaceutical legislation are detailed page 55 and include the lack of implementing texts, the lack of an integrated information system for logistics, the lack of specific procurement procedures, and weaknesses of the pharmaceutical regulatory authority. Additionally, there are issues with the control and inspection of pharmaceutical establishments, an inadequate supply chain, centralized blood product distribution, a shortage of qualified personnel, and insufficient market control to prevent the sale of counterfeit medications.