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World Bank Document Public Disclosure Authorized Social Assessment Report for Provision of Essential Health Services Project (PEHSP) Public Disclosure Authorized UNICEF South Sudan Public Disclosure Authorized 25 September 2020 Public Disclosure Authorized 1 This is a working document. It has been prepared to facilitate the exchange of knowledge and as part of a submission to the World Bank Group. The text has not been edited to official publication standards and UNICEF accepts no responsibility for errors. The designations in this publication do not imply an opinion on legal status of any country or territory, or of its authorities, or the delimitation of frontiers. 2 Table of Contents LIST OF ABREVIATIONS ............................................................................................................................4 EXECUTIVE SUMMARY ..............................................................................................................................5 1 INTRODUCTION .......................................................................................................................................7 1.1 Project rationale ............................................................................................................................................. 8 1.2 The PEHSP objectives .................................................................................................................................... 9 1.3 Security risks and mitigation measures ................................................................................................ 9 1.4 Objective of the Social Assessment ....................................................................................................... 10 1.5 Methodology .................................................................................................................................................. 10 1.6 Structure of the report .............................................................................................................................. 11 2 OVERVIEW OF THE HEALTH SECTOR IN SOUTH SUDAN ........................................................ 12 3 DESCRIPTION OF THE PROVISION OF ESSENTIAL HEALTH SERVICES PROJECT (PEHSP) ....................................................................................................................................................... 12 4 BASELINE SOCIO-ECONOMIC CONDITIONS OF THE PROJECT AREA ................................... 13 4.1 PEHSP operation areas .............................................................................................................................. 13 2.2 Health indicators ......................................................................................................................................... 14 4.4 Health and nutrition ................................................................................................................................... 15 4.5 Status of health facilities and services ................................................................................................. 16 4.6 Common social vulnerabilities in the population as they relate to accessing healthcare 16 4.6.1 Gender-based violence ........................................................................................................................................ 16 4.6.2 Displacement in project areas. ......................................................................................................................... 17 4.6.3 Ethnicity of healthcare professionals............................................................................................................ 18 4.6.4 Violence against communities ......................................................................................................................... 18 4.6.5 Additional challenges .......................................................................................................................................... 19 5 OVERVIEW OF POLICY AND REGULATORY FRAMEWORK ..................................................... 20 5.1 Government health policy ........................................................................................................................ 20 5.2 World Bank policies ................................................................................................................................... 20 5.3 UNICEF policies ............................................................................................................................................ 20 6 POTENTIAL SOCIAL IMPACTS AND MITIGATION MEASURES ............................................... 22 6.1 Social impacts ............................................................................................................................................... 22 6.2 Social Development and Monitoring Plan. ......................................................................................... 25 7 PUBLIC CONSULTATIONS AND DISCLOSURE .............................................................................. 30 7.1 Communication channels ......................................................................................................................... 30 7.2 Grievance redress and feedback mechanisms .................................................................................. 30 8 CONCLUSIONS AND RECOMMENDATIONS ................................................................................... 34 REFERENCES .............................................................................................................................................. 36 ANNEX 1: STAKEHOLDER ANALYSIS MATRIX (based on secondary data consulted) ..... 37 3 LIST OF ABREVIATIONS AAP Accountability to Affected Populations AIDS Acquired immunodeficiency syndrome ANC Antenatal care BHT Boma Health Team BPHNS Basic Package of Health and Nutrition Services CHD County health department CHW Community health worker CSOs Civil society organizations ENAP Every Newborn Action Plan FCV Fragility Conflict & Violence GAM Global acute malnutrition GBV Gender-based violence GoSS Government of South Sudan HIV Human immunodeficiency virus HMIS Healthcare management information system IEC Informational, educational and communications IDP Internally Displaced Person IP Implementing partner IPC Integrated food security phase classification LQAS Lot quality assurance sampling M&E Monitoring and evaluation MOH Ministry of Health NGOs Non-governmental organizations NHP National Health Policy OCHA Office for the Coordination of Humanitarian Affairs OP Operational Policy OTP Outpatient therapeutic programme PEHSP Provisions of Essential Health Services Project PHC Primary health care PHCC Primary health care centre PHCU Primary health care unit PoC Protection of Civilians PSEA Protection from sexual exploitation and abuse RMNCAH Reproductive, Maternal, Newborn and Child Health RRC Relief and Rehabilitation Commission RRHP Rapid Results Health Project SA Social Assessment SPLA Sudanese People’s Liberation Army SPLA-iO Sudanese People’s Liberation Army in Opposition SSDP South Sudan Development Plan SSEMF Security and Significant Event Management Framework TBA Traditional birth attendant UNICEF United Nations Children’s Fund UNMISS United Nations Mission in South Sudan USAID United States Agency for International Development WASH Water, sanitation and hygiene WHO World Health Organization 4 EXECUTIVE SUMMARY This document is the Social Assessment report for the Provision of Essential Health Services Project (PEHSP) to be implemented by UNICEF in the former States of Jonglei and Upper Nile, historically amongst the most conflict- affected states in South Sudan with the least investment in infrastructure, and most difficult to access physically. This project is intended to complement existing activities carried out by the Government and development and humanitarian partners. Its primary objective is to deliver low-cost, high-impact essential health services to the majority of the population, especially women and children, living in the two former States. This includes provision of maternal, neonatal and child health services, including basic curative services at primary level and provision of basic and comprehensive emergency obstetric and newborn care; procurement and distribution of essential medicines and supplies; strengthening systems for emergency preparedness and response and disease surveillance and outbreak response as well as for service quality improvement through training, supervision and coaching. This Social Assessment provides an overview of demographic, social, cultural and political characteristics of the vulnerable and disadvantaged groups in the participating states of the country. It highlights the project’s potential beneficial and adverse effects on the vulnerable and disadvantaged groups and how the positive impacts can be enhanced, and social risks managed. It focuses in particular on the current health services and outcomes in the two states, as well as the project’s potential impact on public health in target areas. The Assessment was informed by a desk study review of relevant documents and prior and informed consultations with vulnerable and disadvantaged groups that assessed whether there is broad community support for such activities. Jonglei and Upper Nile states are located in the North-East of South Sudan and, along with Unity state, they were the hardest hit since the Sudanese People’s Liberation Army (SPLA)
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