Chad

Under the Constitution, Chad is a sovereign, independent, secular, social, one and indivisible Republic, separation between the State and religions is affirmed (article 1). The Country is organized into Administrative Units and Autonomous Collectivities whose autonomy is guaranteed by this Constitution (article 2).

Chapter 1 of the Constitution is dedicated to freedoms and fundamentals rights. While it does not include a right to health, it provides the right to a healthy environment (article 51).

Under article 132 of the Constitution, the law sets the fundamental principles for public health, social affairs and children's rights, as well as social security, organization of the general Administration and General Statute of the Civil Service (non-exhaustive list). Matters other than those falling within the scope of the law are of a regulatory nature.

The Law creates the National Health Insurance Fund called "Caisse Nationale d'Assurance Santé" (CNAS) (article 1). It is a public administrative establishment, with legal personality and administrative and financial management autonomy; it is placed under the supervision of the minister for public health (article 2).

The missions of the Fund (CNAS) are described in article 4 and include, among other, registration of employers and insured persons, collection of contributions, contracting, quality control of healthcare services, medical and administrative control.

A decree should be adopted to specify the other operating modalities for the Fund ("CNAS") (article 6).

A full chapter of the law (chapter III) is dedicated to the distribution of powers between the State and local entities in the area of health and social action. Competences are distributed across the region (article 10), the department (article 11), the commune (article 12) and the rural community (article 13). All competences that have not been specifically delegated under this law fall under the jurisdiction of the State and may be delegated at a later stage (article 57).

In the area of health, the region is responsible for the following: participation in the management and maintenance of regional hospitals; recruitment and management of support staff; enforcement of public health regulations; and participation in the development of the regional health map (article 10). In the area of health, the Department is responsible for the following: participation in the management and maintenance of departmental hospitals; recruitment and management of support staff; application of hygiene and sanitation regulations, participation in drawing up the departmental health map; and participation in national actions and in the implementation of local maternal and child protection initiatives.

In the area of health, the commune is responsible for the following: construction, equipment, management and maintenance of dispensaries; recruitment and management of support staff; enforcement of hygiene and sanitation regulations; participation in national actions and in the implementation of local and child protection initiatives; and participation in the development of the health map (article 12). The Rural Community receives the following powers: construction and management of community pharmacies; recruitment and management of support staff; enforcement of hygiene and sanitation regulations; monitoring village cleanliness and maintenance; and participation in national health initiatives and implementation of local and child protection initiatives (article 13).

The Law is structured around titles - the first provides for general provisions; the second addresses medicines; title 3 governs methods of practicing pharmacy, title 4 addresses other pharmaceutical and para-pharmaceutical products, title 5 addresses veterinary medicines while title 6 provides penalties.The last title provides for transitory and final provisions.

Under title 1, article 2 provides for the establishment of a National Medicines Commission whose powers and operation should be determined by Decree of the Council of Ministers. The Commission is responsible for issuing a prior opinion on all matters relating to medicines and other pharmaceutical products.

Title 2 governing medicines covers a wide range of issues including definitions (articles 3 to 12), medicines' registration (articles 15 to 23), pricing of medicines (article 24), advertising (articles 25 to 32), and medical prescription (articles 33 to 36). Title 3 on the practice of pharmacy refers to a National Order of Pharmacists (article 37), provides the general conditions for practicing pharmacy (articles 38 to 42), and addresses inspection of pharmacies (articles 43 to 51). Title 3 also provides rules to govern pharmaceutical manufacturing plants (articles 52 to 56), public and private wholesale distribution outlets (articles 57 to 64) and supply to the public in pharmacies, pharmaceutical depots, and hospitals, health centers and other health facilities (articles 65 to 83).