[{"bbox": [96, 152, 1134, 205], "category": "Text", "text": "electricity systems and provide quality medical equipment and health supplies for maternal and childcare to 132 health centres."}, {"bbox": [96, 218, 1134, 378], "category": "Text", "text": "The EU is financing, under the AAP 2021, the PIMI III programme (2022-2025, EUR 10 million), which takes into consideration the achievements and challenges of the previous PIMI programmes that have supported maternal and child health (MCH) since 2013. A key aspect of the current PIMI phasing-out strategy towards UHC is the transfer of implementation methodologies, technical know-how and management procedures to the various regional and central structures of the Ministry of Health (MoH). This approach aims to ensure a solid appropriation of the programme by the State, guaranteeing the sustainability of the activities and the consolidation of its results."}, {"bbox": [96, 389, 1134, 499], "category": "Text", "text": "Bearing in mind the existing challenges, bottlenecks and lessons learned from past EU investments on health in the country, the Action intends to move from the provision of health services on behalf of the State, to an overarching approach based on capacity building, with particular emphasis on sustainability, ownership and complementarity with national and international partners' initiatives."}, {"bbox": [85, 523, 342, 555], "category": "Section-header", "text": "## 2.2 Problem Analysis"}, {"bbox": [96, 582, 334, 611], "category": "Section-header", "text": "**Short problem analysis:**"}, {"bbox": [96, 620, 1134, 861], "category": "Text", "text": "The country's health system faces persistent challenges related to low public spending, poor infrastructure, inadequate supply and distribution of health workers, inadequate clinical and managerial training systems, malfunctioning referral system, non-operational health-information systems, weak governance and inadequate management capacity and systems (such as budgeting, public financial management and human resources management). According to World Bank¹⁵ public spending accounts for about 20% of total health spending and is mostly used to pay staff salaries, while donors finance nearly 90% of the recurrent costs of the sector, including medicines and other critical health inputs. This situation generates serious obstacles to the achievement of UHC, namely the access of all to essential health services with no financial hardship. In this context of fragility, the main areas that have been identified as very critical are:"}, {"bbox": [135, 871, 850, 901], "category": "Section-header", "text": "**1- Evidence-based decision making and governance of the health system**"}, {"bbox": [96, 911, 1134, 1178], "category": "Text", "text": "The capacity of the MoH to allocate, mobilise and manage resources for the health system is weak. The internal funding comes from the General State Budget, which is almost fully absorbed in the payment of staff salaries. Existing resources are more concentrated at the central level, with little involvement from those responsible at the regional and community levels. The capacity to invest in infrastructure is almost non-existent, with MoH ending up carrying out small tasks within projects funded by external partners. External funding comes mostly from international aid through direct or indirect support for health programmes, and a large part of these resources do not pass through the Government's management instruments. The State does not exercise any control over the revenues of the health centres, which are essentially generated from payments made by patients for medical care, and these revenues are used for ordinary and extraordinary maintenance, the purchase of consumables and sometimes even to privately contract health staff."}, {"bbox": [96, 1189, 1134, 1323], "category": "Text", "text": "The capacity of the government both at the national and sub-national levels is not sufficient to ensure a well-established referral system, regular supervision, and efficient health service delivery. Lack of funds allocated for commodities such as drugs, medical equipment, water, energy, and major health infrastructure improvement/repairs hamper service delivery through drug stock-outs and idle equipment that need repairs and reliable energy to function."}, {"bbox": [96, 1334, 1134, 1548], "category": "Text", "text": "The National Institute of Health (INASA) was set up to respond to public health challenges, as the structure should manage the national health information system in order to gear the decision-making process. However, the PENSIS 2023-2027) reveals several constraints linked to data collection, both in terms of the sources that provide part of the routine information and in the different subsystems. Epidemiological surveillance data is not of the highest quality, despite the fact that it enables outbreaks to be detected, and routine data flow from health structures still needs to be better controlled. Despite efforts to implement the District Health Information System 2 (DHIS2) and harmonization into a single platform, the health information management system, including the surveillance system, is weak. Challenges identified include low reporting rates, poor quality of data, parallel reporting systems,"}, {"bbox": [85, 1596, 1080, 1646], "category": "Footnote", "text": "¹⁵ See Public Expenditure Review for Guinea Bissau, December 2022: https://documents1.worldbank.org/curated/en/099090723141535862/pdf/P17726604e686502e091f70c5b7833f486e.pdf"}, {"bbox": [1034, 1679, 1144, 1706], "category": "Page-footer", "text": "Page 6 of 26"}]