[{"bbox": [96, 152, 1135, 340], "category": "Text", "text": "40% of child mortality occurs in the first month of life⁴. Most deaths are due to perinatal causes, inadequate care during infancy and/ or preventable diseases exacerbated by nutritional insecurity and exposure to a range of risks such as poor hygiene and water quality. One in three children is stunted while the maternal mortality ratio is estimated at 1,150 maternal deaths per 100,000 live births,⁵ one of the highest in the world. Less than a third of pregnant women receive minimum antenatal care and fewer than half of women deliver in a health facility⁶. The prevalence of modern contraceptives is estimated at less than 4% among all women, despite a large unmet need for family planning. Women in South Sudan have a 1 in 18 lifetime risk of dying from maternal causes.⁷"}, {"bbox": [96, 350, 1135, 561], "category": "Text", "text": "State institutions in South Sudan are unable to respond to this humanitarian situation and to meet the basic needs of the citizens. In 2021, South Sudan was ranked by Transparency International as the most corrupt country in the world. The public financial management system is opaque. Since independence and despite support, the government has been unable to establish a strong, transparent and robust culture of administrative efficiency based on rigorous procedures and institutions. The country's income is overly dependent on oil revenue which accounts for 90% of government revenue but as there is no sovereign wealth fund, income is not transparent and is often allocated away from agreed budget commitments. Most basic services to support individuals are provided through international aid."}, {"bbox": [96, 575, 1135, 868], "category": "Text", "text": "South Sudan is one of the world's most vulnerable countries to climate change. Four consecutive years of unprecedented and atypical flooding have led to mass displacement and the loss of livelihoods with serious, longterm consequences for health and for people's access to basic health services. Social and economic determinants of health play a large role in health outcomes. Due to lack of investment in infrastructure, water and sanitation infrastructure is extremely weak where it exists at all. For example, more than 50% of health facilities do not have functioning water points and hence neither patients nor staff can access safe water. Waterborne and water-related diseases (malaria for example) are common in South Sudan exacerbated by a lack of good hygiene practices (for example, handwashing among children which reduces transmission of respiratory infections, a leading cause of death). This action thus aims to increase functioning water and sanitation infrastructures through construction and rehabilitation of water points and latrines at health facilities level as well as improving hygiene practices through health education."}, {"bbox": [96, 879, 1135, 1172], "category": "Text", "text": "The health sector in South Sudan thus faces a range of enormous challenges. Since independence health service delivery has been heavily supported by donors delivered through NGO implementing partners. Efforts have focused on providing a basic package of health and nutrition services through public (government) facilities to save lives and this has helped to reduce preventable deaths among children. However, sustainability is weak in the current context. In 2019, WHO estimated that total per capita expenditure on health in South Sudan was US$23, of which only 16% was from the government, 55% from external aid and 24% from out-of-pocket spending. Such a low public sector contribution reflects a weak commitment towards the sector and its development. This has put a lot of pressure on the donor community to fill the gaps and prioritize service provision over other equally important aspects of health system strengthening and quality improvement. Therefore, a sustained and gradually growing government contribution in financing the health sector is seen as critical for ensuring better system governance and sustainability."}, {"bbox": [85, 1198, 340, 1228], "category": "Section-header", "text": "## 2.2 Problem Analysis"}, {"bbox": [96, 1258, 334, 1284], "category": "Section-header", "text": "**Short problem analysis:**"}, {"bbox": [96, 1284, 1135, 1443], "category": "Text", "text": "South Sudan has some of the worst health indicators in the world, particularly for women and girls. Moreover, gains achieved are largely due to external partner funding and service delivery. Weak government health sector stewardship, limited public sector health financing, and limited sectoral accountability have contributed to a largely donor financed and led health sector. The government's budget allocated for health remains extremely low while its execution is not transparent or predictable. Budget implementation in health is lower than the already low budget allocation."}, {"bbox": [96, 1469, 1135, 1523], "category": "Text", "text": "As a relatively new state, South Sudan has weak governance and financing institutions generally. Its regulatory and legal environment is fragile, public budgeting and financial governance is insufficient and a"}, {"bbox": [85, 1567, 712, 1587], "category": "Footnote", "text": "⁴ World Bank Data Bank: https://data.worldbank.org/indicator/SH.DYN.NMRT?locations=SS"}, {"bbox": [85, 1587, 469, 1607], "category": "Footnote", "text": "⁵ South Sudan | Data (worldbank.org) accessed July 2022"}, {"bbox": [85, 1607, 306, 1627], "category": "Footnote", "text": "⁶ Household Health Survey 2020"}, {"bbox": [85, 1627, 523, 1646], "category": "Footnote", "text": "⁷ https://data.unicef.org/countdown-2030/country/South-Sudan/1/"}, {"bbox": [1038, 1681, 1144, 1705], "category": "Page-footer", "text": "Page 6 of 27"}]