[{"bbox": [97, 153, 1136, 311], "category": "Text", "text": "**widespread lack of skills and capacities puts the planning and delivery of adequate quality services out of reach in the current context. Both health systems and health services delivery capacity need to be strengthened** while, on a wider level, improved governmental responsiveness to citizen needs and development is vital. As identified in the context above, in addition to conflict and climate shocks, major challenges to health service delivery include **inadequate infrastructure and access**, a **dysfunctional referral system**, **weak human resources for health**, and **cultural, economic and financial barriers to health service utilisation**."}, {"bbox": [97, 337, 1136, 551], "category": "Text", "text": "**This action therefore aims to address these complex needs.** Recognising that health outcomes are almost fully dependent on external partners, the action will strike a balance between maintaining essential services while expanding and deepening systems support with the aim to strengthen public sector commitment, service delivery capacity, and health personnel skills. The action will focus on working with other long-term partners in South Sudan including financers like the World Bank, USAID, the Global Fund (for AIDS, TB and Malaria), GAVI, Canada, Sweden and the United Kingdom and implementers like International Organisation and Non governmental Organisations. Strengthening alignment and cohesion with other major partners will be a critical pathway towards strengthening government commitment and thus to the increased sustainability of system financing and delivery."}, {"bbox": [97, 577, 1136, 707], "category": "Text", "text": "South Sudan is one of the countries most affected by climate change. In particular public health is one of the sectors most impacted by it, as it exacerbates increasingly persistent health threats, such as malnutrition, accelerated and extended spread of Dengue fever, Yellow fever, Malaria and other waterborne diseases like Giardiasis, Cholera, Dysentery, and parasitic infection like schistosomiasis. It can also led to the potential appearance of new skin diseases."}, {"bbox": [97, 749, 1073, 804], "category": "Text", "text": "Identification of main stakeholders and corresponding institutional and/or organisational issues (mandates, potential roles, and capacities) to be covered by the action:"}, {"bbox": [97, 842, 273, 868], "category": "Section-header", "text": "### A) Right holders"}, {"bbox": [127, 870, 1136, 1132], "category": "List-item", "text": "* **South Sudan's population** – With more than half of the population living more than 5 kms away from a health facility, improving equitable access to health services is a major challenge in South Sudan. Malaria remains the leading cause of illness and death in the country accounting for 66.8% of outpatient consultations, 30% of admissions and about 50% of deaths⁸. Lack of access to clean water and poor hygiene practices make South Sudanese more likely to suffer from diarrhea. Respiratory infections are one of the three main diseases (together with malaria and diarrhea in South Sudan) due to the tough environment (floods, dust). Although health programmes implemented in South Sudan are addressing these three main diseases, they do not cover the entire population and, in addition, shortage of drugs are often observed. Finally, the last census of the population was made in 2008, leading to decision making based on outdated data."}, {"bbox": [127, 1136, 1136, 1346], "category": "List-item", "text": "* **Health workers (including community health workers)** – Health workers, including Boma health workers working at community level, are key actors. However, health workers do not receive their salary on a regular basis with delays occasionally reaching 6 months. Furthermore, salaries are extremaly low and hence, health workers rely on incentives paid by the international community. Finally, the volatile environment and the challenges to access areas during the rainy season limit access to some areas and even put their safety at risk. In addition, lack of institutes to train them affect the quality of service delivered and hence, their capacities need to be strengthened and there is a need to train and recruit more female Health workers."}, {"bbox": [127, 1350, 1136, 1456], "category": "List-item", "text": "* **Women and girls** – South Sudan has one of the highest maternal mortality in the world. Women and girls are often victims of Sexual Gender Based Violence (SGBV) and many early pregnancies are being reported. This puts girls' health at risk (i.e Sexually Transmitted Infections, miscarriages) and further discriminates them, as it affects, among others, their ability to attend to school and complete their education."}, {"bbox": [127, 1458, 1136, 1538], "category": "List-item", "text": "* **Civil Society** – At the moment civil society does not play an important role in the health sector. However, considering the lack of investment from the government in the health sector, civil society has a crucial role to play to advocate for increasing investment in the health sector towards the government."}, {"bbox": [97, 1565, 268, 1592], "category": "Section-header", "text": "### B) Duty bearers"}, {"bbox": [86, 1622, 512, 1644], "category": "Footnote", "text": "⁸ Malaria Conference, Juba South Sudan, 8-10 November 2022"}, {"bbox": [1038, 1681, 1144, 1705], "category": "Page-footer", "text": "Page 7 of 27"}]