Lesotho

The Constitution does not enshrine a right to health per se (this right is not included in the list of rights and freedoms listed in Chapter II). However, reference is made to health protection under the Principles of State Policy (chapter III). These principles (including health protection) are identified as not enforceable by court. These principles shall guide the authorities and agencies of Lesotho in the performance of their functions (article 25).

There is no specific reference in the constitution to mandate for health. According to Section 70 of the Constitution of Lesotho 1993, the parliament is the highest legislative authority, but it can authorize other entities or individuals to create laws that have legal force. The term "legislation" in the Constitution refers specifically to laws that have been approved by both houses of parliament and have received the King's assent, as outlined in Section 78(1) of the Constitution. However, the Constitution allows parliament to delegate its legislative power to other bodies, as per Section 70(2). These bodies can then create laws that have the force of law, such as ministerial orders, ministerial regulations, government gazettes, and municipal bylaws.

The main goal of the National Health Policy 2017 (NHP 2017) is to reduce morbidity and mortality, and contribute to the attainment of improved health status among the people of Lesotho (Page 14). The overall objectives of the National Health Policy (NHP 2017) are to reduce morbidity, mortality and human suffering among the Basotho; reduce inequalities in access to health services; and strengthen the pillars of health system (page 17).

The policy is organized around six policy orientation and policy measures: health service delivery; health workforce; health information and research; medical products, vaccines and health technologies; health financing; and leadership and governance (pages 17-21).

In the "Situation Analysis" section, the policy discusses the Public Health Order of 1970, which is yet to be replaced by a new Public Health Bill (Page 11). It also references the Mental Health Act (1964) and the Mental Health Bill (2014) as part of the legislative framework for addressing mental health issues (Page 10). The Medicines and Medical Devices Control Bill is mentioned as a necessary regulation for the proper management of medicines and medical devices (Page 11).

Several policy measures include legal and regulatory actions. For example, under leadership and governance, the following actions are referenced: ensure timely revision of all policies and laws; ensure health legislations, standards, regulatory framework are well disseminated and enforced; advocate for the passage of health bills (page 21). References to legislation strengthening are also found for the health workforce (objective 6, e.g., regulate, accredit, and certify national educational institutions, support legislations and regulations to govern the conduct of health professionals, page 19) and for medical products, vaccines and, health technologies (main priorities, page 13 e.g., strengthen regulation of medicines to tackle the problem of substandard and counterfeit medicines, page 11). The Monitoring and Evaluation Framework includes several indicators relating to legislation including compliance with the International Health Regulations and the number of Health bills passed (page 24).

The main goal of the "National Health Strategic Plan 2018/19 - 2022/23" is to reduce morbidity and mortality and contribute to the attainment of improved health status among people of Lesotho (page 47).

The plan identifies six strategic objectives including: ensuring equity in access to good quality health services at all levels of care; ensuring availability of equitably distributed, well-trained and motivated health workforce to deliver effective health services; improving ICT and eGovernance systems and infrastructure for timely, relevant, accurate and complete health information and health research development; increasing access to quality and safe health technologies, including medical devices, laboratories, medicines, and vaccines; ensuring an equitable, efficient and sustainable health financing system that protects people from financial catastrophe and impoverishment because of using health services; strengthening leadership and governance, partnerships and improving community ownership and participation (page 50).

The background and situation analysis sections reference several legislative and regulatory challenges including the lack of resources to support the implementation of adolescent health interventions (page 19), the lack of national legislation to enforce the WHO FCTC (page 23), the lack of a regulatory framework on alcohol (page 23), outdated legislation for road safety not covering mobile phone use and child safety measures (page 24), the lack of human resources to implement the legal instruments governing health information and research (page 28), slow enactment process of Medicine and Medical Device Control Bill which has resulted in the absence of Medicine Regulatory Authority and poor regulation of medicines (page 32). Other challenges highlighted by the Plan are the large number of health bills and strategic documents (plans) in various stages of development suffering from lack of coordination and resulting in fragmentation in the implementation of programmes and weakened accountability (page 39), weak regulation of traditional and alternative health services and medicines (pages 42, 45), absence of regulation and monitoring to tackle the problem of substandard and counterfeit medicines including monitoring of private pharmaceutical services and absence of medical regulatory authority (page 44), or slow process of reviewing and getting bills to be ratified into law (page 45).

The plan includes several references to legislative and regulatory strategies and reforms. Some are general - i.e." Ensure health legislations, standards, regulatory frameworks are revised, well disseminated and enforced" (under objective 6.1, page 57), others relate to specific legal reforms e.g. for medicines towards the establishment of a Medicines Regulatory Authority (page 55).