Comoros

The right to health for citizens is enshrined in article 42 of the Constitution located in the title dedicated to rights and duties (title II). In the same article, reference is made to the duty of the State to assure a national health service that is general and hierarchical and to encourage and support the participation of the community in the different levels of health services as well as public and private health initiatives. In addition, article 43 provides a right for citizens to a healthy and ecologically stable environment.

The Constitution provides a list of areas for which the islands (local level) act in consultation with the Union (Federal Level). This includes the construction, equipping, maintenance, and management of the establishments and personnel of basic health (article 103).

The main goal of the National Health Policy 2015-2024 (Politique Nationale de Santé 2015-2024) is to improve the health status of the Comorian population through a performant and equitable health system (page 23).

The document identifies several priorities and objectives, including ensuring universal access to comprehensive health services, strengthening governance, leadership and partnerships, and improving resource management within the health system (pages 24-25).

The policy references several legislative and regulatory instruments. In particular, chapter 1.3 on governance and leadership outlines the legislative framework for health by detailing such documents as the Constitution of Comoros of 2001 which recognizes health as a fundamental right, as well as the referendum law revising the Constitution, promulgated by decree No 09-066/PR. The health sector is governed by Law No. 94-016/AF, which outlines the general framework of the health system, and Law No. 11-001/AU of March 26, 2011, which constitutes the Public Health Code. This code, promulgated by Decree No. 11-141/PR of July 14, 2011, sets out the legal rules applicable to health activities and structures, ensuring the protection and promotion of public health (pages 14-15).

Priority issues, underlined under part II of the policy, include the lack of implementing regulations for the Public Health Code, the insufficient application of regulations providing for public health interventions as well as insufficient dissemination of key texts. Reference is also made to the need to strengthen private sector regulations (page 20). Under its objective 2, the policy proposes an action to effectively implement the legislative and regulatory framework of the health sector (page 24).

The main goal of the National Health Development Plan 2022-2026 (Plan National de Développement Sanitaire 2022-2026 (PNDS)) is to improve the health and well-being of the Comorian population by reducing morbidity and mortality, with the effective participation of the population and local authorities and the central and decentralized structures of the Ministry of Health (page 75).

The PNDS identifies an overarching objective of improving the health and well-being of the Comorian population through an efficient and equitable health system. The three strategic objectives of the policy are as follows: ensuring universal access to comprehensive health and nutrition services and care; strengthening governance, leadership and partnership; and improving resource management (page 75).

In the background and situation analysis sections, the document references several legislative and regulatory frameworks that shape the health sector in Comoros. The Constitution of 2001, with its subsequent revisions, underscores the political and administrative stability necessary for implementing health policies (page 11). The Law N° 11-006 (Loi N°11-006/AU du 02 mai 2011) outlines the administrative and territorial organization of the Union of Comoros, which impacts the distribution and management of health services (p. 12). The Public Health Code ("Code de la Santé Publique") of 2020 provides the legal basis for public health policies and the implementation of health reforms (p. 9).

The plan outlines specific actions related to laws and regulations to achieve its goals. For instance, it emphasizes the need to implement the Public Health Code by developing application texts and ensuring compliance with health standards (p. 9). The Law N°04-006 (Loi N°04-006/AU) of 10 November 2004 governs the status of health personnel, highlighting the importance of human resource management in the health sector (p. 65). The Décret N°17-105/PR and Loi N°17-012/AU focus on establishing a universal health coverage system, aiming to reduce financial barriers to healthcare access (p. 70).