[{"bbox": [96, 152, 1133, 259], "category": "Text", "text": "Action Plan III 2021-2025² in particular to its thematic area of engagement “Promoting economic and social rights and empowering girls and women”. It will also contribute to the implementation of the EU Global Health Strategy: Better Health for All in a Changing World³, the EU Strategy on the Rights of Persons with Disabilities, and the EU´s Action Plan on Human Rights and Democracy 2020-2024⁴."}, {"bbox": [96, 270, 1133, 378], "category": "Text", "text": "Within the Team Europe framework, the Action seeks complementarity with regional EU programmes, namely the Team Europe Initiative on National Public Health Institutes in Sub-Saharan Africa, which is part of flagship programme \"Strengthening health systems and capacities for pandemic preparedness, digital health and public health\" under the \"Global Gateway - Health Investment package\", presented at the 6th EU-AU summit in 2022⁵."}, {"bbox": [87, 392, 506, 423], "category": "Section-header", "text": "## 1.3 Zone benefitting from the Action"}, {"bbox": [87, 438, 893, 464], "category": "Text", "text": "The Action shall be carried out in Guinea-Bissau, included in the list of ODA recipients."}, {"bbox": [87, 491, 322, 523], "category": "Section-header", "text": "# 2 RATIONALE"}, {"bbox": [87, 558, 233, 584], "category": "Section-header", "text": "## 2.1 Context"}, {"bbox": [96, 603, 1133, 790], "category": "Text", "text": "Guinea-Bissau has a history of political and institutional fragility dating back to its independence from Portugal in 1974. Since then, four successful coups have been recorded, with another 17 coups attempted, plotted, or alleged. After 5 years of relative stability, the 2019 presidential elections were followed by a political crisis that ended in April 2020 with the Economic Community of West African States (ECOWAS) recognition of Umaro Sissoco Embaló as President of the Republic. Following a political crisis and the dissolution of Parliament by President Sissoco in May 2022, early legislative elections took place in June 2023. In December 2023, Parliament was dissolved and closed following a constitutional crisis, and a presidential initiative government was appointed."}, {"bbox": [96, 800, 1133, 1067], "category": "Text", "text": "With an area of 36,125 km² and a population of about 1.9 million spread over a continental portion and additional 88 islands, the county hosts a large variety of ethnic groups, languages, and religions. Guinea-Bissau has a tiny economy, with a gross domestic product (GDP) of $1.63 billion in 2022 ($775.83 per capita), according to official World Bank data. The countries Human Development Index is estimated at 0.461 and ranks 175th out of the 189 countries⁶, while real economic growth remains 4.2%⁷. Administratively, Guinea-Bissau is divided into 9 regions: Bissau, Bafatá, Biombo, Bolama-Bijagós, Cacheu, Gabu, Oio, Quinara, and Tombali; which are further divided into 36 sectors. The health sector, however, is divided into 11 regions including Bissau, and these 11 health regions are divided into 114 health areas, the closest level to communities. Even though the country can count on a network of 140 public health centres, only 40% of the population live within a radius of less than 5 kilometres from the closest primary health-care unit."}, {"bbox": [96, 1078, 1133, 1344], "category": "Text", "text": "The right to health is recognised in Guinea-Bissau under the country's Constitution. The National Health Development Plan (PNDS) considers that health is an integral part of socio-economic development and aims to improve the quality of life. However, the allocation to health as a proportion of the State budget is 8,9%, well below the 15% African Union (AU) target of Abuja Declaration of 2001, while Out of Pocket spending is quite high (64,4%). Existing resources are more concentrated at the central level, with little involvement from those responsible at the intermediate, regional and community levels. Hence, the reality of healthcare provision through the National Health System does not reflect the Constitution engagement and the main health indicators paint a rather disheartening picture. Estimated maternal mortality rate is 667/100.000 live births⁸, one of the highest in the world, and under-five estimated mortality rate is 74/1000 live births⁹, while the coverage of essential health services is around 40%. The utilization of obstetric services by pregnant women in Guinea-Bissau is significantly"}, {"bbox": [87, 1380, 656, 1405], "category": "Footnote", "text": "² https://ec.europa.eu/commission/presscorner/detail/en/IP_20_2184."}, {"bbox": [87, 1404, 950, 1429], "category": "Footnote", "text": "³ https://health.ec.europa.eu/publications/eu-global-health-strategy-better-health-all-changing-world_en."}, {"bbox": [87, 1429, 1101, 1477], "category": "Footnote", "text": "⁴ https://ec.europa.eu/info/law/better-regulation/have-your-say/initiatives/12122-Human-rights-and-democracy-in-the-EU-2020-24-action-plan_en."}, {"bbox": [87, 1477, 950, 1502], "category": "Footnote", "text": "⁵ https://international-partnerships.ec.europa.eu/system/files/2023-10/GG_Factsheet_Africa_Health.pdf."}, {"bbox": [87, 1502, 288, 1524], "category": "Footnote", "text": "⁶ UNDP, 2021 statistics."}, {"bbox": [87, 1524, 334, 1548], "category": "Footnote", "text": "⁷ World Bank, 2024 statistics."}, {"bbox": [87, 1548, 1140, 1596], "category": "Footnote", "text": "⁸ World Bank, 2023, Modelled estimates (WHO, UNICEF, UNFPA, World Bank Group, and UNDESA/Population Division). Trends in Maternal Mortality 2000 to 2020."}, {"bbox": [87, 1596, 1140, 1645], "category": "Footnote", "text": "⁹ World Bank, 2021, estimates developed by the UN Inter-agency Group for Child Mortality Estimation (UNICEF, WHO, World Bank, UN DESA Population Division)."}, {"bbox": [1035, 1680, 1143, 1705], "category": "Page-footer", "text": "Page 4 of 26"}]