Chad

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 main objective of the National Health Policy 2016-2030 (Politique Nationale de Santé 2016-2030) is to provide the population with universal access to quality, comprehensive, integrated, continuous, and person-centered health care to contribute effectively to the socio-economic development of Chad (page 33).

The policy identifies several priorities and objectives, including reducing maternal, infant and neonatal mortality rates, eliminating major diseases, promoting mental health, and achieving universal health coverage by 2030 (pages 33-34).

The introductory and situational analysis parts refer to legislative and regulatory documents. For example, the Constitution of the Republic of Chad is highlighted as the foundational legal document that underpins the National Health Policy, emphasizing the right to life (Page 9). The law on the pharmacy, the hygiene code and the code of medical ethics are mentioned while highlighting the need to continue and accelerate efforts for health legislation strengthening in various areas including hospital reforms, and regional health schools (Page 17). Additionally, the policy discusses the need for legislative reforms in hospital management and the establishment of regional health schools to enhance healthcare delivery (Page 17).

Chapter IV of the policy is dedicated to strategic orientations and refers to a number of legal and regulatory actions including, among others, the acceleration of health reforms by improving the time taken to adopt laws and regulations (hospital reform, health school reform, pharmaceutical sector reform, private sector, universal health coverage) (strategic orientation 1, page 35), improvement in the centralization of reference documents including laws (strategic orientation 2, page 36), adoption of legislation to govern traditional medicine (strategic orientation 18, page 39), establishment of the National Agency for Pharmaceutical Regulations (strategic orientation 19, page 40), and strengthening of the institutional and regulatory framework for community health (strategic orientation 21, page 41).

The main objective of the National Health Development Plan 2022-2030 (Plan National de Développement Sanitaire (PNDS 4) 2022-2030) is to ensure that the population of Chad has universal access to quality, comprehensive, integrated, continuous, and person-centered health care, thereby contributing effectively to the socio-economic development of the country (pages 15, 119).

The PNDS 4 identifies several priorities and objectives to be achieved by 2030, including improving governance and leadership in the health sector, increasing the health budget to 15%, enhancing the density of health personnel, expanding functional health infrastructure coverage, operationalizing the DHIS2 in all health districts, ensuring the availability of essential health products, reducing maternal and child mortality, eliminating mother-to-child transmission of HIV, and reducing the prevalence of tuberculosis and malaria (pages 15, 119-122).

The plan lists several legislative and regulatory documents, including the Law No 02 of March 2, 1961 establishing a licensing system for beverage outlets and certain establishments (Loi No 02 du 2 mars 1961 instituant un régime des licences pour les débits de boissons et certains établissements ), Decree No 2835/PCMT/PMT/MSPSN/2022 prohibiting the importation, manufacture, possession, circulation, sale, supply and consumption of all adulterated alcoholic beverages in Chad (Décret No 2835/PCMT/PMT/MSPSN/2022 portant interdiction de l’importation, de la fabrication, de la détention, de la circulation, de la vente, de l’offre et de la consommation de toutes les boissons alcoolisées), Law No. 10 of 2010, promulgated on June 10, 2010, on tobacco control (Loi No 10 de 2010,promulguée le 10 juin 2010 portant lutte antitabac), Decree No 1522/PR/MSP/2019 of September 11, 2019, prohibiting smoking in public places (Décret No 1522/PR/MSP/2019 du 11 septembre 2019, portant
interdiction de fumer dans les lieux publics), Decree No 1523/PR/MSP/2019 of September 11, 2019, preventing interference by the tobacco industry in health policies (Décret No 1523/PR/MSP/2019 du 11 sept. 2019, portant prévention de l’ingérence de l’industrie du tabac dans les politiques de santé), Order No 420/PR/MSPSN/SE/DGM/DGTLMPS/DMTNT/PNLTAD/2020, of September 20, 2020, on the labelling and packaging of tobacco products in Chad (L’arrêté No 420/PR/MSPSN/SE/DGM/DGTLMPS/DMTNT/PNLTAD/2020, du 20 septembre 2020, portant étiquetage et conditionnement des produits du tabac au Tchad (page 33). Furthermore, under the UHC context, the plan lists such documents as the law No 035/PR/2019 of August 5, 2019, establishing Universal Health Coverage in Chad (loi No 035/PR/2019 du 5 aout 2019, instituant une Couverture Santé Universelle au Tchad), Law No 026/PR/2020 of December 31, 2020 creating the National Health Insurance Fund (CNAS) in Chad (Loi No 026/PR/2020 du 31 décembre 2020 créant la Caisse Nationale d’Assurance Santé (CNAS) au Tchad), Decree No. 0577/PCMT/PMT/MSPP/2021 on the organization and operation of the CNAS of October 15, 2021 (Décret n°0577/PCMT/PMT/MSPP/2021 portant organisation et fonctionnement de la CNAS du 15 octobre 2021) (page 40).

The situational analysis included in Part 2 refers to the establishment of a Legislation Directorate in 2018 tasked to draft and propose health-related legislation and regulations and oversee implementation. While referring to some legislative developments, specifically in the pharmacy sector, the Plan points out the lack of application of the legislation due to a lack of implementing regulations (sections 2.1.1; 2.5.2.6). Part III providing the strategic orientations refers to several legal and regulatory actions including, among others, the creation of a compendium of health legislation to support the monitoring of their implementation (page 136, action 1.1.1.), the adoption and implementation of the legislation for the health map (result 3.1, page 158, and page 217), strengthening of legislation in the pharmaceutical sector – several actions listed under it (result 1.3, pages 161 to 163, page 219), and legislation to govern traditional medicines (page 219, action 1.2.1).