Politique Nationale de Santé 2019–2030

Objectives

The National Health Policy 2019–2030 provides a long-term framework for improving population health, advancing social justice and socio-economic development, and progressively achieving universal health coverage through equitable access to quality services and care, particularly for vulnerable groups.[1][2][3][4]The vision is a Central African Republic in which all social groups participate fully in and benefit from quality health services.[4]

• Organise the health system around primary health care, integrated and continuous care, community participation, decentralisation, accountable governance and evidence-informed, performance-based management.[2][5][3]
• Reduce maternal, neonatal, infant and adolescent mortality by two-thirds by 2030; ensure universal access to sexual and reproductive health services, information and education; reduce severe acute malnutrition by at least 60% and chronic malnutrition by 80%; raise exclusive breastfeeding to at least 80%; and attain at least 90% immunisation coverage for every antigen.[3]
• Reduce morbidity and mortality from communicable and non-communicable diseases by at least 30%; eliminate mother-to-child transmission of HIV; reduce HIV prevalence from 4.9% to 3.1%; reduce tuberculosis prevalence by 30%; and reduce malaria morbidity and mortality by at least 90%.[6]
• Eliminate or control priority diseases, including HIV/AIDS, tuberculosis, malaria, neglected tropical diseases, viral hepatitis, waterborne diseases, poliomyelitis and Guinea-worm disease; prevent epidemic-prone diseases; and strengthen preparedness and response to disasters and public-health emergencies.[7][6]
• Improve access to nearby, quality-assured services by extending geographical coverage, applying appropriate facility standards, implementing referral and counter-referral arrangements across four levels of care, and seeking health facilities within 5 kilometres of communities in every health district.[7][8]
• Strengthen health promotion, environmental health, nutrition, mental health, road safety, occupational health and safety, healthy lifestyles, behavioural-change communication and intersectoral action on social and economic determinants of health.[9][10]
• Improve the availability, affordability, quality and rational use of medicines, vaccines, diagnostic reagents, blood products and other health technologies, while increasing and more equitably distributing the health workforce.[7][11][12][13]

Implementation

Implementation is structured through two National Health Development Plans, subsector policies and priority programmes, which are translated into regional health development plans, district operational plans and health-centre and health-post micro-plans.[9][10][14]A programme budget and medium-term expenditure framework are intended to support implementation across these levels, although the supplied material gives no total cost or allocation.[10][14]

• Govern implementation through a multisectoral National Public Health Council, chaired by the President or Prime Minister and supported by the Ministry of Health secretariat, to define policy and strategy and oversee implementation; convene it annually, with extraordinary meetings where necessary.[14]
• Reform the Steering Committee as the Council’s operational arm, chaired by the Minister of Health, to coordinate implementation, technical and financial partners and thematic groups; meet quarterly and report to the Council.[14]
• Replicate public health councils and steering committees at regional and district levels, with district bodies led by the Sub-Prefect and district health officer respectively, and reform health-facility management committees accordingly.[15]
• Strengthen Ministry of Health leadership, equitable resource management, accountability, decentralisation and deconcentration at central, regional, district and hospital levels; delegate credits to operationalise districts and build the capacities of national actors.[6][16]
• Deliver services through fixed, outreach, mobile and community-based approaches, prioritising children, pregnant women, adolescents, people living in poverty and hard-to-reach populations; reinforce community capacity and frontline delivery of community-based care.[8][9]
• Expand financial protection through universal health coverage, mutual health schemes, micro-insurance and other insurance mechanisms; maintain targeted free care for vulnerable groups and priority services; and pursue innovative financing, including health taxes or levies, results-based financing and better use of global-health funding.[17][12][8]
• Increase and fully disburse the State health-budget share to at least 15%, consistent with the Abuja Declaration benchmark, while coordinating public, private and partner resources and reducing duplication.[11][12][18]
• Strengthen workforce recruitment, deployment, retention, protection and skills through regionalisation, contracting posts, incentives for remote and high-risk areas, task delegation, decentralised training, updated curricula and continuing professional development.[11]
• Establish infrastructure and equipment standards; construct, rehabilitate and equip facilities; improve maintenance, storage and distribution; and expand solar and renewable-energy solutions.[12]
• Build pharmaceutical and laboratory capacity through a viable central purchasing agency, regional medicine depots in all 16 prefectures, quality assurance, licensing, inspection, quality control, pharmacovigilance, laboratory networks, transfusion safety and action against falsified or illegally sold medicines.[12][13]
• Operationalise a unified national health information system with a single computerised database, updated procedures, strengthened coordination, regular studies and surveys, feedback to stakeholders and a national public health observatory.[16][19]
• Monitor implementation through integrated supervision, joint monitoring and evaluation, annual sector reviews, mid-term and final programme reviews, internal or external evaluations, population and facility surveys, public-expenditure reviews and national health accounts.[16][18][20]
• Align technical and financial partners with national and regional plans, apply aid-effectiveness principles, involve civil society and communities at all levels, and strengthen partnerships with public, private, traditional and international actors.[19][18][20]

Monitoring & Evaluation

The policy embeds monitoring, evaluation and accountability within results-based management, governance and implementation of national, regional and district health plans. It envisages routine supervision, joint monitoring and evaluation, feedback to stakeholders, regular sector reviews, programme and project reviews, surveys, public-expenditure reviews and national health accounts.[5][16][18][20]However, many strategic sections do not provide a consolidated indicator framework, baselines, reporting templates, evaluation schedule or named accountability reports.[3][6][16][19]

• Strengthen accountability, transparency, social oversight and regular controls over service and resource management at every level of the health system.[5][16][15]
• Activate monitoring and evaluation mechanisms for national and regional health plans, annual action plans and disease-specific strategies, supported by coordination, review and monitoring meetings.[16][19]
• Use annual sector reviews, mid-term and final programme and project reviews, and internal or external evaluations as needed.[18][20]
• Conduct Multiple Indicator Cluster Surveys, Demographic and Health Surveys, STEPwise risk-factor surveys, SMART surveys and Service Availability and Readiness Assessments to inform health-system and population-health assessment.[18][20]
• Strengthen epidemiological surveillance and response for communicable and non-communicable diseases, epidemics, disasters and public-health emergencies, including implementation of the International Health Regulations (2005).[21][22][9]
• Maintain immediate, weekly and monthly disease-notification categories through integrated disease surveillance and response.[23]
• Operationalise a unified National Health Information System with a single database, improved data analysis and feedback, updated procedures, district-level computerisation and a national public-health observatory.[24][19][11]
• Improve coordination of information from HIV, tuberculosis, malaria, humanitarian programmes and health facilities, including analysis disaggregated by health area.[24]
• Address fragmented data tools, excessive indicator-reporting burdens, shortages of qualified personnel, inadequate equipment, weak information technology infrastructure and limited financing for information systems.[25][24]
• Use outcome targets to assess progress towards 2030 objectives, including reductions in mortality, malnutrition and disease burden, and improvements in breastfeeding, immunisation, universal health coverage, community participation and emergency preparedness.[3][6]
• Require the national Steering Committee to meet quarterly and report to the National Public Health Council, while compiling regional council reports for annual Council meetings.[14][15]

Costing & Financing

Health financing is envisaged through state resources, external assistance, direct household payments, innovative taxes and levies, insurance mechanisms and better coordination of partner support.[26][17][12]The available material identifies pronounced dependence on external finance, low execution of planned public allocations, household financial hardship and several unquantified funding constraints, while most strategic actions lack costed budgets, expenditure projections or documented financing gaps.[26][17][11][12]

• Increase and fully disburse the State budget share for health to at least the 15% Abuja Declaration benchmark.[11][12]
• Address the approximately 10% health allocation in the 2019 Finance Law and the 5% execution of planned health allocations in 2018.[26]
• Reduce reliance on external assistance, which accounted for 96% of total health-financing commitments during 2017–2019, compared with 4% from government.[26]
• Mitigate financial barriers arising from household direct payments, which represented 43.7% of health expenditure in 2015 and were associated with catastrophic expenditure and impoverishment risks.[17]
• Develop financial-protection arrangements, including universal health coverage, mutual-health schemes, micro-insurance, health insurance, targeted exemptions and free care for vulnerable groups and priority conditions.[17][12][8]
• Explore taxes and levies on tobacco, alcohol, sugary drinks, mobile telephony, extractive industries, fuel and the road fund; expand results-based financing; and optimise global-health funding.[12]
• Prepare a health programme budget and medium-term expenditure framework to support national, regional and district planning and implementation.[10][14]
• Mobilise national and external resources, align partner financing with national plans, prevent duplication and improve equity and efficiency in allocation.[18][20]
• Provide sustainable public, private or public-private financing for medicines, vaccines, diagnostic reagents and other health inputs.[12][13]
• Address identified non-monetary financing constraints, including insufficient funds for intermittent preventive treatment for infants, mass yaws treatment and nationwide trachoma mapping, as well as medicine shortages and cost-recovery barriers to HIV testing.[27][28][29][30]
• Recognise that State financing for medicines and other health products totalled 2,044,050,000 Central African CFA francs in 2019, including 560,000,000 Central African CFA francs for the Central Purchasing Agency, which also had supplier debts exceeding one billion Central African CFA francs.[31]