Niger

Title II of the Constitution dedicated to human rights and duties includes two references to health-related rights. First, the right to health is referred to, along with other rights, in article 12. This article (12) provides a list of rights recognized under the conditions defined by law; these include the rights to health, healthy and sufficient food, drinking water, and education (non-exhaustive list). Second, a right to the enjoyment of the highest attainable standard of physical and moral health is recognized under article 13. It is specified that the State shall ensure the creation of conditions which are likely to assure to all, medical services and medical assistance in the event of illness. As for article 12, reference is made to the law to specify the implementation modalities.

Several provisions of the Constitution address the mandate for health. Article 99 provides the areas for which the law sets the rules. Several areas listed under this part, while not specifically relating to health, influence health systems' operation including, among other, taxation, creation of categories of public establishments, Statutes for Civil Service, General administration of the organization. Article 100 provides the areas for which the law sets the fundamental principles. This includes, among other, public health and hygiene but also related areas e.g., the free administration of local authorities, their powers and their resources, education and research, as well as population policy, housing policy, protection of the elderly and disabled people, protection of the environment, social security, transport, education and public and private partnerships (non-exhaustive list). Under article 103, matters that are not listed as falling under the scope of the law have a regulatory nature. Finally, article 172 of the Constitution provides areas that can be addressed as part of inter-statal cooperation agreements; this includes health.

There is a national strategy for UHC 2021-2030 ("Stratégie Nationale de la Couverture Sanitaire Universelle au Niger 2021-2030") whose goal is enable the Nigerien population to access quality health care and services, and to promote well-being for all at every stage of life (page 29).

The strategy identifies four strategic orientations, including improving health determinants, enhancing the quality and availability of health services, providing financial protection against health risks, and rationalizing health system financing. These orientations are further developed into a list of 11 strategic axes (pages 39 - 66).

The background and situation analysis sections of the document reference several legislative and regulatory documents. This includes the Law No. 2018-22 that outlines the fundamental principles of social protection and the Law No. 2019-062 of December 10, 2019, determining the fundamental principles of social inclusion for persons with disabilities (page 7). It also includes a series of decrees granting free access to health services for indigents, for children under 5 and women, for HIV treatment, for tuberculosis, for female cancers (pages 23-24). It also includes law creating the National Social security Fund (page 25). The strategy includes a summary table of the different legal and regulatory schemes providing health coverage (page 26) while an overview of the instruments governing budget management is provided page 64.

Under the section dedicated to strategic priorities (section 4, pages 39-66), legislative and regulatory actions are outlined. For example, the strategy emphasizes the need to implement the regulations on plastic waste (page 46), strengthen the pharmaceutical legislation and establish an Agency for Pharmaceutical Regulation (page 49), develop a legal framework to provide for a universal assistance and insurance system including the development of a UHI Law ("loi sur la couverture maladie universelle") (pages 62-63).

The main objective of the "Plan de Développement Sanitaire et Social (PDSS) 2022-2026" (Health and Social Development Plan 2022-2026) is to contribute to the improvement of the health and nutritional status of the population and to support demographic transition in Niger (page 98).

The PDSS 2022-2026 identifies several strategic priorities and objectives, including the improvement of governance and health financing, the enhancement of the availability and accessibility of quality health and social services, the strengthening of health and social protection for the general population and vulnerable groups, and improvement of fertility control (pages 98-99).

Section 4.1.1. of the provides an overview of legal provisions and legal frameworks of the health sector. The legal and regulatory sources listed in the section contain the following sources: Decree No 2021-319/PM of May 11, 2021, specifying the attributions of government members, Decree No 2021-325/PRN/MSP/P/AS of May 13, 2021, on the organization of the Ministry of Public Health, Population, and Social Affairs, Law No 2019-62 of December 10, 2019, and its application decree No 2021/539 MSP/P/AS of July 12, 2021, on the insertion of persons with disabilities, Decree No 2021-583/PRN/M SP/P/AS of July 23 adopting the Universal Health Coverage strategy, Decree No 2022-216/PRN/MSP/P/AS of March 17, 2022 determining the conditions and modalities of medical evacuation abroad, Law No 98-016 on the private practice of the health profession of June 15, 1998, Law No 97-05 of June 2, 1997 ratifying Ordinance No 97-002 of January 10, 1997 on pharmaceutical legislation, Ordinance No 93-013, relating to the public hygiene code, Decree No 2021-279 /PRN/ MSP/P/AS of April 29, 2021 adopting the national pharmaceutical policy, Decree No 2021-786/PRN/MSP/P/A of September 23, 2021 establishing the National Institute of Medical Assistance, Decree No 2022-539/PRN/MSP/P/AS of June 29, 2022 establishing the Nigerian Agency for the Regulation of the Pharmaceutical Sector (ANRP), Law No 2022-34 of July 11, 2022 determining the fundamental principles of health and public hygiene, Decree 2022-915 of November 30, 2022 adopting the statutes of the Nigerien Pharmaceutical Regulatory Agency (ANRP) (pages 49-50).

The same section outlines the necessity for revision, update and elaboration of the legislative arsenal for health by: the draft law on offences; the draft decree on the organization of central services and determining the responsibilities; the draft texts on the hospital reform; the draft implementing decrees of the law determining the fundamental principles of health and public hygiene (relating to pharmacy, public hygiene, private practice, etc.); the draft law on the fundamental principles of the protection of the elderly; and the decree on the transfer of skills and resources to local authorities in the field of health (page 50).

Furthermore, the implementation framework lists certain regulatory actions such as the establishment of various regulatory tools linked to the merger of the Ministry of Public Health and the Ministry of Population and Social Affairs (page 175); strengthening the legislative and regulatory framework for health research (page 177).