covered (high blood pressure, diabetes, sickle cell disease and cancers) are being developed with the organization of sensitization missions in the eight regions of Niger. iii) The national plans and policies adopted and implemented by the State in response to the requirements spelt out under Paragraphs 67 (6) to (18)2, particularly the plans aimed at ensuring access by all to adequate medical care and treatment in the event of sickness or accident. This includes the proximity of the individual to affordable and quality health services. 167. Currently, public sector service delivery is being ensured by a network of health care facilities structured into three hierarchical levels: - at the operational level, health delivery relies on 72 health districts with 1,063 Integrated Health Centres (IHCs), 94 of which are run by doctors and 2,401 health huts. First referral health care is ensured by 33 District Hospitals (DHs), 27 of which have functional operating blocks. Note should be taken of the impending opening of five new District Hospitals which have been provided with operating blocks; - at the regional level, second referral health care is ensured by seven (7) Regional Hospitals (RHs), seven (7) Mother-and-Child Health Centres (MCHCs) and five (5) Regional Blood Transfusion Centres (RBTCs), and - the central level has five (5) national hospitals, one (1) national maternity referral facility and ten (10) national referral centres. 168. Pre-hospital care in case of accidents and other health emergencies as well as the medically assisted transportation of patients are ensured by the Emergency Medical Assistance Service (SAMU). From 2016 to 2018, the SAMU carried out more than 2,500 trips during which 2,797 patients were assisted. 169. In addition to the public facilities, health care is also provided by public health establishments under other public agencies (e.g. Army health services and the health centres of the CNSS); There are also a total of 348 private establishments, including 52 clinics and polyclinics, 71 medical practices, 41 doctor’s offices, 179 treatment rooms, 2 not-for-profit private hospitals (SOMAIR and COMINAK), two (2) private specialist orthopaedic and ophthalmological trauma centres and one private faith-based hospital. 170. The State is also working to implement other strategies to ensure access to affordable and quality health care services by all. This deals with (i) the conversion of the CSs into CSIs; (ii) the continuation of free health care for children under five, people with disabilities and women who have undergone caesarean section; (iii) posting of doctors to the rural areas; (iv) strengthening of community-based strategies, and (v) strengthening of the implementation of certain health care services as advanced, mobile and open strategies. 171. According to the results of the annual sectoral review, the slight increase in health infrastructure which rose from 48.33% in 2016 to 50% in 2018 has not had a significant impact on health coverage. 172. Half of the population of Niger continues to travel more than 5 kilometres to access basic health care services. The issue of equity of access to health care between the urban and rural areas is still crucial. iv) Legislative and other measures taken to ensure that any form of privatization of the health sector does not threaten the availability, accessibility, acceptability and quality of the health products and services facilities. 173. Measures taken in this area concern:  strengthening of the regulatory framework for the exercise of the medical and para-medical 43