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1、E1739DecentralizedHealthSystemDevelopmentProject(DHSDP)EnvironmentalandSocialAssessmentFramework(AdoptedfromtheCDFGuidelinesforEnvironmentalandSocialAssessment)IntroductiontoEnvironmentalIssues1.1BackgroundThemaindevelopmentobjectivesoftheDecentralizedHealthSystemDeve
2、lopmentProject(DHSDP)istomeettheurgenthealthissuesandneedsinthewaraffectedandunderdevelopedareasofNorthSudanincludingtheThreeAreasbyprovidingbasichealthservicesincludingtherequiredsocialandeconomicservicesandinfrastructure.Thisemergencyprojectaimstoimproveaccesstobasi
3、chealthcareservicesinfourconflict-affectedandpoorstatesbysupporting,rebuildinganddevelopingthedecentralizedhealthsystem,withparticularfocusonhealthfinancingreform.Withinthetargetstates,wherepublicsectorprimaryhealthcare(PHC)servicesexist,theyarehamperedbyinsufficientf
4、undingwhichleadstopoorlypaidandmotivatedstaff,insufficientequipmentandpharmaceuticalsupplyandgenerallypoorqualityservices.Further,accesstoservices,particularlybythepoor,islimitedduetouserfeesanddrugprices,alongwithgeographic,socialandgenderfactors.Aswell,inmanypartsof
5、thesestates,particularlytheThreeAreas,governmenthealthservicesarenotpresentandthelimitedcurrentservicesareprovidedbynon-governmentalorganizations(NGOs).TheemergencyprojectwillsupportimmediateimprovementsinPHCservices,focusingonunderservedregionsincludingtheThreeAreas,
6、byinjectingresourcesintoexistingpublicsectorhealthservices,contractingservicedeliverytoNGOs,andprovidinghigh-impacthealthinterventionstohouseholds.TheprojectwillalsoreconstructanddevelopkeyinputstothePHCsysteminthefourstates,investinginstateandlocalhealthadministratio
7、ncapacity,healthhumanresources,infrastructureandequipment.Atthesametimeasworkingtoimproveservicesintheseconflict-affectedareas,theprojectwilladdressthecrucialsystem-widepolicyissueofsustainablefinancingofPHCservicesunderthedecentralizedsystem,withtheobjectiveofchannel
8、inggreaternationalgovernmentresourcestowardssecondaryandprimaryhealthcareservicesforwhichthestatesandlocalitiesareresponsibl
