Cote d'Ivoire

The first title of the Constitution is dedicated to rights, freedoms, and duties. It includes a right to access health care services provided along with the right to education (article 9). A right to a healthy environment is also provided for in the Constitution (article 27).

Under article 18, citizens have a right to information and a right to access public documents subject to conditions enacted by law. Civil society is recognized as one of the components of democratic expression that contributes to the nation's economic, social and cultural development (article 26).

The Constitution establishes areas for which laws are needed and those that can be addressed via regulations. Matters to be addressed by a law are identified in articles 101 and 102; other matters (those that are not specifically listed) fall into the regulatory area (art. 103). Cooperation in the area of health is furthermore identified as an area that can be addressed through African intergovernmental bodies (art. 125).

This Law includes 6 titles. The first provides general provisions including definitions, objectives, and scope of application of the law. The second title addresses the national health policy (general principles, objectives, and sectoral policies); the third title addresses health systems' strengthening and covers institutional framework, integrated health information system reform (article 36 to article 46), strengthened decentralization and deconcentration (article 47 to article 50). The fourth title is dedicated to health system's financing (article 51 to article 57). The fifth title relates to the offer and use of health services; under the offer of quality services are addressed infrastructure and equipment, qualified human resources, medicines and vaccines availability, health emergency management system, and private health sector promotion) (article 58 to article 75); under the increased use of services, quality of care plays a central role (article 76 to article 83); in the same title there are provisions regarding the diversification of the offer for services addressing, among others, traditional medicine, telemedicine, nuclear medicine etc. (article 84 to article 95). The 6th title is dedicated to the fight against diseases, and it identifies some priority diseases including malaria, HIV/AIDS, malnutrition, diseases with epidemic potential, pulmonary tuberculosis, non-communicable diseases, neglected tropical diseases (article 96).

Under article 100 of the law, the State guarantees the availability and free access to anti-tuberculosis drugs. Under article 101, women of birthing age and children under 5 have free access to vaccination services.

The National Health policy shall be developed by the State and implemented through a national health development plan covering a 5-years period (article 4 to article 7). Sectoral health policies are also provided for in various areas including for example, maternal and child policy, public hygiene, health and environment policy, pharmaceutical policy, tobacco control policy, community health policy, policy for hospital hygiene etc. (article 11 to article 35).

This law outlines two types of hospital facilities - public ones ("Etablissement Public Hospitalier") and private ones ("Etablissement hospitalier privé"). Most provisions included in this law relate to public hospitals (private hospitals are marginally addressed in article 49 to article 51 about delegation of public service missions). Title I of the law provides general provisions including definitions, scope, and objectives pursued by the law. Title II addresses public hospitals including its public service function (article 38 to 48). Title III provides the rules to establish, organize, and manage public hospitals (article 52 and next).

Title II includes two chapters. Chapter 1 of this title named "Public Hospital Facility" addresses, among other, its missions (article 6), rights and duties and responsibilities of users in public hospitals (articles 7 to 15), mechanisms to improve the quality of care (article 16 and article 17), supply of pharmaceutical products (articles 18 to 20), infection prevention and control (article 21), hospital information system (articles 22 to 24), telemedicine (articles 25 and 26), inter-hospitals cooperation (articles 30 to 33), local health care networks (articles 34 to 36) and collaboration with traditional medicine (article 37). Chapter 2 of the title named "Hospital Public Service" addresses among others, the type of hospitals providing public services (article 38), their role is contributing to the elaboration of the national hospital maps (article 41 and article 42) and in elaborating a hospital plan ("project d'établissment hospitalier") (article 43 to article 45). Chapter III speaks about delegation of hospital public service to private hospital facilities (modalities to be defined by decree under article 49).

Under title III of the law, a Public Hospital Establishment is a legal entity under public law with administrative and financial autonomy, its own assets and liabilities, and its own management resources, it is subject to the controls provided in the law; it is established by decree (article 52). There are three levels - primary, secondary, tertiary level public hospital establishment (article 53); the scope, missions, and referral systems are addressed from article 55 to article 57. Public Hospital establishments are under the technical supervision ("tutelle technique") of the minister responsible for health and under financial supervision ("tutelle financière") of the minister responsible for Economy and Finance (article 58). Performance contracts are established between the State and the Public Hospital Establishment (article 59). Governance structures for Public Hospital Establishment are provided under chapter IV and consist of two bodies (article 61): a guidance and supervisory board (articles 61 to 68) and a management body ("direction") (article 69 to 74). Financial regime is addressed in Chapter V under articles 75 to 82, while control is addressed under articles 83 to 87. Finally, chapter VI deals with human resources (articles 88 to 95) while the last chapter (VII) is dedicated to administrative sanctions.

An Authority for pharmaceutical regulation (Autorité Ivoirienne de Regulation Pharmaceutique - AIRP) is created under this law as an independent administrative authority with moral personality and financial autonomy (article 4).

The attributions of the Authority for pharmaceutical regulation are detailed across the law and address several areas including, among other things, the granting of authorization to practice, the granting of marketing authorization for pharmaceutical products, market surveillance and vigilance, inspection, and oversight, support to legislative and regulatory drafting for pharmaceutical products etc. (e.g., art. 5, art. 6, art. 7; regulatory areas are particularly covered from article 15 to article 39).

The law establishes a mandatory health insurance system consisting of a contributory scheme known as the basic general scheme, and a non-contributory scheme known as the medical assistance scheme, aimed at the economically weak or destitute as defined by decree (article 3). All people residing in the countries are subject to this universal health coverage scheme.

The law refers in several instances to implementing rules and regulations to specify various issues addressed by the law. For example, the law refers to a decree to provide the terms and conditions for registration (art. 4), the scope of services and medicines covered (article 7), the reference financial scale for healthcare cost reimbursement mechanisms (article 13), the care pathway (article 14), the terms and procedures for concluding agreements between the management organization and approved healthcare providers (article 17), the modalities for the medical control (article 25), the registration of individuals into the scheme (article 29), the conditions and procedures for opening, maintaining, suspending and closing entitlement to benefits (article 34), création of a social security institution ("institution de Prévoyance sociale") (article 35), rates, bases, methods and procedures for payment or collection of contributions (article 40), implementation control (art. 52) etc.

This decree creates a new directorate under the Cabinet : the Directorate for judicial affairs and litigation ("direction des affaires juridiques et du contentieux") (article 3 modified). The attributions for this directorate include, among others, providing legal advice on draft bills proposed by the ministry, reviewing and updating the existing text in collaboration with the Ministry, and monitoring the implementation of agreements made with the Ministry (article 12 modified).

This decree creates a new directorate under the General Directorate for Health and Public Hygiene: the Directorate for Family, Mother and Children's Health ("direction de la Santé de la Famille, de la Mère et de l'Enfant" ) made of 4 sub directorates (article 18 and article 24modified). The attributions for this directorate include, among others, developing and implementing a policy for developing nursing care for women and children, promoting the development, availability, and quality of nursing and maternal care on the national territory, promoting good practices for maternal and child health, and strengthening supervision of trainees nurses and midwives (article 24 modified).