Rwanda

Under the Constitution, all Rwandans have a right to good health (chapter IV Human Rights and Freedoms, art. 21). The Constitution further refers to the duty of the State to mobilise the population for activities aimed at good health and to assist them in the realisation of those activities (chapter V Duties of the State and of citizens, art. 45).

The Constitution does not specifically address competencies over health matters. Throughout the Constitution, the matters governed by organic law and by (ordinary) law are enumerated. For example, organic laws govern the following: conditions and modalities for conducting elections (art. 2, 80, 83, 100); number, boundaries and structures of administrative entities (art. 5); Rwandan nationality (art. 25); modalities for the establishment and functioning of political organisations (art. 54); functioning of each Chamber of Parliament (art. 66; art. 73); benefits of the President (art. 113) and Cabinet members (art. 123); general provisions governing public institutions (art. 139) (non-exhaustive list). Laws govern, among others, the following: organization and functioning of decentralized authority and the Capital city (art.6 and art. 7); conditions, formalities, and consequences of marriage (art. 17); conditions for free primary education (art. 20); modalities of concession, transfer and use of land (art. 35); organisation of national service (art. 48); modalities for protecting, conserving and promoting the environment (art. 53); state of siege and state of emergency (art. 136); organisation, functioning and jurisdiction of Courts (art. 152), State Finance (art. 162); taxes (art. 164) (non-exhaustive list). Finally the Constitution provides that the President of the Republic enacts presidential orders in listed matters (art. 112). The hierarchy of law is addressed under article 95.

The main goal of the Rwanda Health Sector Policy 2015 is to ensure universal accessibility to equitable and affordable quality health services for all Rwandans, covering preventative, curative, rehabilitative, and promotional services (Page 1). 

The policy identifies several priorities and objectives, including improving demand, access, and quality of essential health services; strengthening policies, resources, and management mechanisms of health support systems; enhancing health service delivery systems; and reinforcing health sector governance mechanisms (Page 15).

The policy references several legislative and regulatory documents such as Law No 74/2013 establishing Rwanda Food and Medicines authority and determining its mission, organization and functioning (page 8), the Constitution of Rwanda that sets the right to health (page 13), Law No 87/2013 determining the organization and functioning of decentralized administrative entities in relation to the health governance system (page 26). 

The policy outlines specific actions relating to laws and regulations. For example, under objective on improving demand, access and quality of essential health services, the policy establishes the need to regulate emerging and re-emerging infectious disease control measures; and provides for the revision of regulations and procedures to enhance the involvement of private sector in training, service provision and management of health services (page 17).

In terms of occupational safety and health (OSH), the policy provides for the integration of OSH into different health sector legislations and development of OSH specific regulations for the health sector (page 19). The policy also identifies the strengthening of health product regulatory and monitoring systems as one of priorities in addition to the establishment of a Rwanda Food and Medicine Regulatory Authority (pages 20-21).

The main goal of the Health Sector Strategic Plan V (July 2024 - June 2029) is to accelerate progress toward the realisation of universal health coverage and other health-related sustainable development goals and ensure equitable improvement of health outcomes through evidence-based prioritization of high-impact interventions (page 8). The Health Sector Strategic Plan V identifies 5 key strategic pillars and 2 enablers. They are: Pillar 1: Health workforce; Pillar 2: Health Infrastructure Modernization; Pillar 3: Quality of Health Care through Primary Health Care; Pillar 4: Health Security and Public Health Emergency Management; Pillar 5: Research, Innovation, Biomanufacturing, Regulation, and Digitalization; Enabler 1: Health Financing; and Enabler 2: Leadership and Governance (pages 6-7). 

The introductory section of the Strategic Plan does not list references to health legislation or regulation.

Pillar 3 on "Quality of Care Through Primary Health Care" lists several legislative and regulatory interventions provided as part of the Health Sector Strategic Plan V. Under priority P3.P3 "Sexual and reproductive health and rights and gender-based violence", it is planned to expand the access to and availability of comprehensive abortion services by revising the existing ministerial order on abortion to allow the provision of comprehensive abortion care services in health centers, facilitated though tele-health and task-shifting strategies (page 24). Priority P3.P5 "Non-communicable disease prevention and control" lists an action to establish and strengthen policies and regulations addressing risk factors, along with actions on immunization and early treatment of infections (page 26). With regard to the improvement of the quality of health care services, a new law on health services will be developed to address the lack of proper and up-to-date regulatory frameworks for clinical care as listed under priority P3.P10 on "Specialised medical services" (page 28). Furthermore, the Essential Medicines List will be revised every two years and the Standard Treatment Guidelines - every four years (page 28).

Health regulation is identified as a priority under the Strategic Pillar 5 "Research, innovation, biomanufacturing, regulation and digitalization" with objective P5.05 "Ensure regulatory system is in place" (page 30). Specifically, the regulatory frameworks will be updated and optimized to strengthen the registration process for food and drug products as listed under priority P5.P7 "Food and drug regulation" (page 31). Training and capacity building are planned for the Rwanda Food and Drugs Authority as well as other stakeholders involved in the regulatory process (page 32).

Finally, under Enabler 2 on "Leadership and Governance", laws, guidelines and regulations are listed as the means to strengthen leadership and increase accountability (page 33).