[{"bbox": [95, 151, 1133, 312], "category": "Text", "text": "The National Medical Supplies Fund (NMSF), in spite of its strong capacities in supply chain management at federal and state levels, has insufficient capacities to cover the “last mile” resulting in delays of delivery. Particularly in remote areas, availability of medicines is limited. Moreover, at facility level, inadequacies of current infrastructure affect the storage and management of vaccines and medicines. In 2020, essential medicines were accessible in only 43% of health facilities, while only 33% able to provide all main components of primary care, with services particularly limited in conflict-affected regions."}, {"bbox": [95, 336, 1133, 550], "category": "Text", "text": "Additionally, Sudan is experiencing a shortage of health workers with an average ratio of only 0.76 health personnel (doctors, nurses and midwives) per 1,000 population, while the WHO target requirement for universal health coverage is 4.45 health personnel per 1,000 population (HNO 2022). The workforce has been depleted by severe brain drain, low staff retention and high emigration of healthcare workers. Unofficial surveys estimate that over half of Sudanese doctors' practice abroad due to political instability, low wages, and poor-quality training opportunities. Other health workforce challenges include an unbalanced skill mix and inequitable geographical distribution of workers. Despite over 70% of the population residing in rural areas, 70% of health workers work in the urban areas, with 38% working in the capital."}, {"bbox": [95, 575, 1133, 734], "category": "Text", "text": "Women and children are disproportionally affected by Sudan's fragile health system given their - on average - greater need for care as well as the poor health policy mapping and system gaps impeding the implementation of quality reproductive, maternal, neonatal, and child health programmes in Sudan. Poor and inequitable access to Reproductive, Maternal, Neonatal and Child Health (RMNCH) services leaves an estimated 1.5 million women with limited access to life-saving reproductive services, and over 2 million children missing their routine vaccination doses (HNO 2022)."}, {"bbox": [95, 760, 1133, 922], "category": "Text", "text": "Meanwhile, the demand-side of Sudan's health system at decentralised level is adversely affected by a combination of factors including knowledge and awareness about health and nutrition, adverse traditional practices, and chronic poverty. The fact that people are not always aware when and how to seek the right kind of care, that - particularly women - on average tend to forego needed care during pregnancy, and the limited resources available to many families, affects behaviours among the population with negative impacts on their health and nutrition status. High out-of-pocket payments add to demand-side challenges to access care."}, {"bbox": [95, 946, 1133, 1186], "category": "Text", "text": "The States targeted under this Action all face significant challenges in terms of vulnerability levels as well as access to health and nutrition services and the inability of the State health systems to provide to them. Nearly all of the States targeted are affected by conflict and have largely rural vulnerable populations, often with vast distances between health facilities. The damage to facilities as well as lingering mis-trust between the population and the central government has meant over a decade of under-investment in primary care as well as health personnel in these States. The area of Khartoum State targeted is a long-neglected semi-urban locality outside of Khartoum city with large numbers of vulnerable residents, IDPs, and refugees. The 2022 HNO identified all targeted areas as being top severity score (4 of 5, the highest of any State) in the health sector, with at least 1 in 5 people in all targeted States unable to access basic primary health care services."}, {"bbox": [95, 1211, 741, 1239], "category": "Caption", "text": "**Table 1. Key demographic and health indicators in targeted states**"}, {"bbox": [95, 1237, 1130, 1591], "category": "Table", "text": "<table><thead><tr><td>STATE</td><td># IDPs, refugees, Returnees</td><td>Total People in Need – Health &amp; Nutrition</td><td>% People in Need among total population</td><td>% women who attended 4 ANC visits (target = 90%)</td><td>Global Acute Malnutrition Rate (by WHZ; 10% is emergency threshold)</td><td># Skilled health personnel per 100,000 population</td><td># Doctors per 100,000 population</td></tr></thead><tbody><tr><td>Khartoum</td><td>305,684</td><td>432,840</td><td>27%</td><td>74.3</td><td>16.13</td><td>48</td><td>23</td></tr><tr><td>North Darfur</td><td>1,263,125</td><td>548,327</td><td>22%</td><td>40.19</td><td>19.46</td><td>62</td><td>17</td></tr><tr><td>Central Darfur</td><td>627,449</td><td>451,025</td><td>26%</td><td>42.28</td><td>15.28</td><td>16</td><td>3</td></tr><tr><td>South Darfur</td><td>1,031,265</td><td>1,014,428</td><td>27%</td><td>55.26</td><td>16.43</td><td>10</td><td>1</td></tr></tbody></table>"}, {"bbox": [1036, 1679, 1142, 1704], "category": "Page-footer", "text": "Page 7 of 26"}]