[{"bbox": [96, 152, 1135, 260], "category": "Text", "text": "low, since only 45% of the deliveries take place within health facilities. The disproportionate burden of disease borne by women of childbearing age combined with their specific needs for access to sexual and reproductive health care of standard quality means that women are much more exposed to the weak health system than men. Their needs deserve extra attention and concentrated efforts by the State¹⁰."}, {"bbox": [96, 270, 1135, 564], "category": "Text", "text": "Guinea-Bissau is classified by the World Health Organization as one of the 30 high-burden countries for tuberculosis and HIV co-infection. Poor immune systems as a result of HIV infection or weakened by poverty have made it difficult to slow down the progression of tuberculosis, and new cases continue to climb (although mortality rates have remained relatively stable since 2016). Women are disproportionately affected by HIV (prevalence among adolescent girls and young women is three times that of their male counterparts), and retention in treatment remains challenging. In 2019 the life expectancy at birth was 60.2 years, and six of the 10 top causes of deaths were infectious diseases¹¹. However, this trend is projected to significantly decrease in the next 10 years and particularly for diseases such as HIV and tuberculosis¹². In addition to that, Guinea-Bissau is predisposed to epidemics and natural disasters and although these are seasonal, they heighten the levels of unpredictability. These include the recurrence of cholera outbreaks and the threat of cross-border spread of diseases such as Ebola and yellow fever."}, {"bbox": [96, 576, 1135, 791], "category": "Text", "text": "Poor health service conditions, especially in the country's rural areas, impact disproportionally negative on women. Bissau-Guinean women bear on average five children (6.8 in rural areas), without access to basic infrastructure of water, sanitation, electricity and transport¹³. Regarding the situation of people with disabilities, a UNICEF Situation Analysis of Children's Rights and Wellbeing in Guinea-Bissau, 2019 observed that, although Guinea-Bissau signed and ratified the United Nations Convention on the Rights of Persons with Disabilities (CRPD) in 2014, demonstrating a commitment to the rights of persons with disabilities, this was yet to be translated into specific policies or plans. According to the data made public, there are 11,584 people with disabilities in all regions of the country¹⁴."}, {"bbox": [96, 802, 1135, 934], "category": "Text", "text": "Overreliance on cashew nut production, high vulnerability to climate change impacts and environmental degradation translate into widespread food insecurity and a high prevalence of malnutrition, particularly among children, rural women, older people and people living with HIV, tuberculosis or disabilities. However, reduced fiscal space leaves fewer resources for pro-poor government spending and many vulnerable groups are unable to access basic health services."}, {"bbox": [96, 947, 1135, 1134], "category": "Text", "text": "These figures reflect a chronic inability of the health system to provide basic health care. This is coupled with political events such as frequent coups, heavy political interference in the management of health facilities and weak leadership. In addition, there is poor execution of an already constrained budget due an extremely tight fiscal space. The chronic scarcity of funds and political instability has led to frequent disruptions in public health service provision, stockouts of essential medical products and inconsistent mechanisms for training and deploying health personnel. In the absence of a sound governance, health workers have resorted to embezzling funds and running the health system without any supervision or sanction."}, {"bbox": [96, 1146, 1135, 1306], "category": "Text", "text": "In terms of health system governance, two pillar and guiding strategic instruments have been drawn up for Guinea-Bissau based on the National Health Policy, approved in 2017. These instruments, defined in accordance with SDG 3, are the PNDS 2023-2028 and the National Health Human Resources Development Plan 2023-2032 (PNDRHS), both validated by the Council of Ministers in June 2024. In 2023, the second National Strategic Plan to strengthen the health information system (PENSIS 2023-2027) was developed and the Global Fund is engaged in supporting the implementation of part of the interventions."}, {"bbox": [96, 1317, 1135, 1452], "category": "Text", "text": "The EU's partnership with Guinea-Bissau in the health sector has a long history. It is currently developed along two main lines: support for primary health care, with an emphasis on maternal and child health, and support for the governance of the health system, with particular attention to improving mechanisms for planning, financing and management of human and material resources, including the supply and distribution of medicines. The EU health programme contributed to equip 5 regional hospitals and 7 health centres with water supply and solar"}, {"bbox": [87, 1524, 794, 1550], "category": "Footnote", "text": "¹⁰ UNDP Guinea-Bissau Gender Analysis | United Nations Development Programme"}, {"bbox": [87, 1550, 432, 1572], "category": "Footnote", "text": "¹¹ World Health Statistics (who.int), 2019"}, {"bbox": [87, 1572, 912, 1598], "category": "Footnote", "text": "¹² Guinea-Bissau | Institute for Health Metrics and Evaluation (healthdata.org) accessed 9 May 2022"}, {"bbox": [87, 1598, 794, 1622], "category": "Footnote", "text": "¹³ UNDP Guinea-Bissau Gender Analysis | United Nations Development Programme"}, {"bbox": [87, 1622, 1093, 1646], "category": "Footnote", "text": "¹⁴ Launch of database of persons with disabilities in Guinea-Bissau | United Nations Development Programme (undp.org)"}, {"bbox": [1034, 1680, 1144, 1706], "category": "Page-footer", "text": "Page 5 of 26"}]