[{"bbox": [96, 152, 1134, 205], "category": "Text", "text": "over 3 million children suffering from severe malnutrition, of which 650,000 severe acute malnutrition according to Humanitarian Needs Overview (HNO) 2022."}, {"bbox": [96, 231, 1134, 469], "category": "Text", "text": "The Sudanese context, in which large part of the population is deprived of a basic Human Right – the right to health – requires a response that spans across all its supply and demand side dimensions. On the one hand, support to decentralised health systems is critical to shore up resilience of the communities in protracted crises. As Sudan continues to face an increasing range and intensity of shocks and stresses – including conflict, economic pain, food and nutrition insecurity, and political uncertainty – the ability of decentralized systems to manage emergency preparedness and response at a local level will also be increasingly critical. On the other hand, with poverty on the rise, and with sustained socio-cultural barriers affecting health-seeking behaviours in the country, demand-side solutions should be sought, ensuring that knowledge and awareness, behavioural, as well as financial difficulties are addressed."}, {"bbox": [96, 495, 1134, 631], "category": "Text", "text": "The need to support primary health care and nutrition at decentralised settings is consistent with EU priorities for Human Development. The Action is supporting and complementing the EU Flagship of Food security and nutrition in Sudan. Support to health care is an important enabler for this objective. It is targeting SDG 3 (Good Health and wellbeing) and contributes to a number of other SDG, notably SDG 2, 5, 6, 10 and 16. The Action is also contributing to the implementation of the Global Gateway strategy of the EU for Africa."}, {"bbox": [85, 676, 341, 708], "category": "Section-header", "text": "## 2.2 Problem Analysis"}, {"bbox": [96, 723, 1134, 881], "category": "Text", "text": "Short problem analysis: Sudan's health system struggles with both supply and demand-side challenges to health care access for its population. On the supply-side, severe underfunding, gaps in staffing, infrastructure, equipment, medicines, and supplies, lack of clarity over roles and weak management capacities at the locality level pose challenges to efficient service delivery. On the demand-side, poverty combined with high out-of-pocket expenditures on health and adverse traditional practices and believes hinder access to the health care services available."}, {"bbox": [96, 908, 1134, 1070], "category": "Text", "text": "These deficiencies leave 50% of people without access to appropriate primary health care services and 81% of the population lacking access to a functional health centre within two hours' walk from their homes. One fifth of the population does not have access at all to any health facility. Furthermore, healthcare financing deteriorated further due to the economic challenges arising from inflation and the impact of COVID-19. People residing in IDP and refugee camps with their host communities are still reliant on humanitarian actors to provide basic health services and support their communities with the needed medical supplies."}, {"bbox": [96, 1094, 1134, 1359], "category": "Text", "text": "IDPs and refugees are among the most vulnerable groups with regard to access to basic services, healthcare and nutrition. More than 3 million IDPs live in Sudan, many have for a long time been in camps or in camp-like protracted situations with low access to communal infrastructure and health services. IDPs, refugees, and returnees as well as other internal migrants are particularly vulnerable to impacts of economic crisis, including loss of purchasing power and reduction in public service availability. Limited access of IDPs and refugees to land for farming as well as the 50% food assistance ration cut by the WFP in June 2022 for refugees who arrived more than 2 years ago risks to further exacerbate malnutrition for refugees and IDPs living in camps or outside camp settings. In addition, conflict-related sexual violence committed against women is widespread. Internally displaced women and girls face heightened risks of sexual violence in and around the camps, including while engaged in livelihood activities⁵"}, {"bbox": [96, 1385, 1134, 1547], "category": "Text", "text": "Since its inception, total coverage under the National Health Insurance Fund (NHIF) increased from 34.8% in 2014 to 81.3% by December 2020 while coverage among the poor has increased from 38.9% in 2014 to 71% in 2020. However, the number of accredited health units is not sufficient to cater for the needs of the population. Almost 67.38% of health expenditures are still “out-of-pocket”. Despite the principle of free treatment (all NHIF members having unlimited access to a range of primary health services at public and private health facilities by using their NHIF card), less than 2% of the population receive free care and 92% pay for drugs."}, {"bbox": [85, 1618, 499, 1646], "category": "Footnote", "text": "⁵ s_2021_312.pdf (securitycouncilreport.org)"}, {"bbox": [1037, 1680, 1144, 1706], "category": "Page-footer", "text": "Page 6 of 26"}]