The FINANCIAL — It’s seven o’clock in the morning in Conakry, the capital of Guinea. Dr. Haba Eveline arrives at the COVID-19 Treatment Center. As soon as she enters, she washes her hands before starting her daily shift. A mother of five, she leads the Risk Management Unit which is now open 24/7. She is one of the frontline health workers helping her country fight the COVID-19 (coronavirus) pandemic. “As a doctor, I am a fighter and I am proud to bring my experience to the response against this pandemic,” she said.
Long before the first cases of the virus surfaced in Guinea, the country, with support from the World Bank and the international community, had devised a response strategy. It was therefore equipped with knowledge gained from combating the Ebola epidemic in 2014-2016. For other countries however, COVID-19 brought disruptions in health systems and uncertainty about what would be next.
Describing the precautionary measures recommended by health workers, Qamara, a resident in a village west of Jalalabad city, Afghanistan said: “They advised us to use masks and gloves and wash our hands frequently with soap and water.” Governments struggled to contain the spread of the virus and looked for emergency solutions. The World Bank Group responded immediately.
An emergency response to save lives
Within just a few weeks, we prepared a global COVID-19 emergency health response, working closely with national teams, the World Health Organization (WHO), UNICEF and other international partners.
Building on our accumulated experience with health crises over the past 20 years, we mounted the fastest and largest crisis response in our history.
Health care workers in Afghanistan. © World Bank
Our first operations focused on strengthening health systems to tackle the immediate challenges of COVID-19. In countries ranging from Afghanistan and Haiti to India, Mongolia, and Tajikistan, our financing brought more medical staff onboard and ensured that they were well trained and equipped to deliver emergency care. In countries like Ecuador, we helped ensure that public outreach messages to citizens on prevention and protection were quickly disseminated. In Djibouti and Ethiopia, we provided more resources to fight the pandemic in the long-term, by strengthening and building the capacity of the national health system.
Through a combination of new projects, restructuring and emergency components of existing projects, and deployment of our disaster finance instruments, the World Bank Group’s response is targeted in four key areas: saving lives, protecting the poor and vulnerable, ensuring sustainable business growth, and working to build a more resilient recovery.
Today, we are making good progress on the 15-month target of providing up to $160 billion in surge financing to help address the health and economic impacts of the pandemic– including $50 billion of new resources from the International Development Association (IDA) for the poorest countries. Our emergency health support has so far reached 111 operations. 30 percent of these cover 900 million people in countries affected by conflict, fragility and violence—where the most vulnerable populations live.
Altering the course of the pandemic with vaccines
In March 2020, the World Bank Group was already one of the first organizations to begin thinking about the rapid development and scale-up of COVID-19 vaccines, bringing together key partners to discuss fair and equitable access to vaccines, once available, for developing countries.
We are providing a financing package of up to $12 billion to help low- and middle-income countries finance the purchase and distribution of COVID-19 vaccines, tests, and treatments.
While purchasing vaccines and receiving treatments are straight forward, ensuring that they are deployed and reach those who need them the most is much more complicated. The pandemic compounded a problem that existed already before.
Across the globe, it highlighted the urgent need to strengthen health systems that showed a lack of sufficient trained health workers, limited storage and transport capacity of vaccines to store and ensure cold chain to remote areas, and in some countries, inadequate number of health centers equipped for vaccinations.
To tackle these challenges, the World Bank Group is helping countries assess their readiness to deploy vaccines, identify and address any challenges, so they are equipped to deliver the vaccines and treatment fairly, efficiently and safely.
Working with the private sector, the International Financial Corporation (IFC) –our private sector arm– launched a Global Health Platform, through which we will support companies in delivering health products and services – including vaccines – to developing countries.
“The international community must respond quickly and decisively to save lives and protect the delivery of these essential services as part of a robust recovery from the pandemic.” Muhammad Pate, World Bank Global Director, Health, Nutrition and Population ｜ Director, Global Financing Facility for Women, Children and Adolescents (GFF)
Strengthening countries’ health systems
Well before the unprecedented crisis, the consequences of weak health systems were visible in countries’ health results. The pandemic put the spotlight on what happens when resilient, high-quality primary healthcare is not in place.
Many countries realized that their hospitals were unprepared and underequipped when COVID-19 struck. In communities, under-resourced surveillance networks failed to promptly detect the spread of the virus. Shortages of supplies and equipment left health workers without protective gear. System fragmentation hampered the efficient flow of patients, staff, and supplies.
Given the intersection of these challenges and the rapid nature of this crisis, the World Bank’s emergency support focused the procurement of new intensive care beds and ventilators, strengthen testing laboratories, and other life-saving medical equipment and materials.
In Georgia, the Bank helped the Ministry of Health purchase 1,185,000 polymerase chain reaction tests (PCR) and 1,247,000 Rapid COVID-19 test kits to strengthen public health laboratories and epidemiological capacity. At the end of September 2020, an average of 9,000 PCR tests and 1,700 rapid tests were being performed daily.
In Yemen, six central public-health laboratories have opened, and 930 health professionals have been trained in COVID-19 case management.
By strengthening countries’ health systems, our operations are also addressing the secondary health crisis triggered by significant disruptions in essential, lifesaving services, particularly for women, adolescents and children.
A crisis within a crisis, COVID-19 is exposing an underlying structural inequality that has already left many behind.
As Dr. Muhammad Pate, Global Director of Health, Nutrition, and Population at the World Bank said, “These disruptions confirm our early warnings that secondary health impacts caused by COVID-19 are putting at risk many years of hard-fought gains in women’s and children’s health and nutrition. The international community must respond quickly and decisively to save lives and protect the delivery of these essential services as part of a robust recovery from the pandemic.”
The Global Financing Facility for Women, Children and Adolescents (GFF) has been playing a key role complementing the Bank Group COVID-19 response in supporting its 36 partner countries providing both technical and financial assistance to protect and support the continuation of essential health services for women children and adolescent health while responding to the pandemic.
According to our estimates, global extreme poverty is expected to rise this year for the first time in a generation. COVID could push up to 150 million people into extreme poverty (defined as living on less than $1.90 a day) by the end of 2021.
Preparing countries to fight the pandemic and build better
The pandemic is stressing the need to invest in comprehensive preparedness and prevention within countries and across borders.
Using our global expertise, we are helping Sub-Saharan African countries fight by building on the lessons and systems put in place during the Ebola outbreaks. For example, Guinea was prepared when the first case was registered because it had a strategy, infrastructure and knowledge gained from combating Ebola.
We are working with and funding regional centers of excellence that make scientific contributions including sequencing the COVID-19 genome. Some of these include: the Regional Disease Surveillance Systems Enhancement Program (in West and Central Africa), the Africa Center for Disease Control (Africa CDC), the East Africa Public Health Laboratory Networking Project, and the West African Health Organization (WAHO).
We are assisting countries in their efforts to prevent, detect and respond to COVID-19, while strengthening national public health preparedness systems. We are also restructuring, redeploying, and reallocating some existing resources in financed projects.
In India, the health emergency project is upgrading the disease surveillance system, strengthening preparedness for disease outbreaks and revamping infectious disease hospitals.
Adapting the emergency operations to context and epidemic status of a country, the support to East Asia and Pacific region have been tailored to address specific needs. In Mongolia, for example, the Bank is strengthening capacities for a multi-sectoral response, particularly the interface of environmental, veterinary, and public health services to contain the spread of new viruses of animal origin at their source.
In addition to the growing human and economic toll, the pandemic brought social isolation, bereavement, financial hardship, and interrupted health care services – which are negatively impacting the mental well-being of people.
In many countries, including Cambodia, Guatemala, Lesotho, Liberia, Mali, Marshall Islands, Morocco, Niger, Nigeria, Republic of Congo, and Sri Lanka, Bank projects are supporting psychosocial interventions to help people deal with the negative psychological effects from stressors such as lockdowns, self-isolation and quarantines, infection fears, inadequate information, job and financial losses, and stigma and discrimination.
Engaging local communities
With increased poverty, climate change, food shortage, COVID-19 is having the most devastating impact on poor and marginalized groups. The World Bank is tackling this by using all existing platforms to reach the most vulnerable.
Working through community-driven development programs to provide cash and resources quickly to communities, the World Bank’s support is targeting migrants, the disabled, women, unemployed youth, the elderly, and indigenous peoples.
Through these operations, we are using technology and innovations to ensure people have the information they need about the coronavirus.
In Afghanistan, for example, we are working with communities to share COVID-19 prevention messages through WhatsApp and telegrams to reach the people most disproportionately impacted by the crisis, including displaced people, those with disabilities, poor women, and nomads.
To fight the pandemic, community outreach is playing a crucial role with front-line health workers. Local communities and traditional leaders serve as critical links to the whole community. They help improve public understand of the treatment, dispel misinformation and noncompliance with health instructions and medical guidelines.
Reflecting on his experience combatting the Ebola virus in the Democratic Republic of Congo, Professor Muyembe, the eminent Congolese virologist who discovered the Ebola virus in 1976 and the current Ebola and COVID-19 response coordinator in his country says: “We have seen the importance of community engagement and awareness-raising campaigns to get people to understand the gravity of the situation and get involved.”
While these examples provide a glimmer of hope, much more is needed. The pandemic continues to take a toll across most of the globe, with many countries already battling a second wave.
As vaccines trials are progressing, we will continue to be flexible and agile in our health response, while saving lives and supporting the next phase of our country responses.
The profound impacts of the health crisis stress on the need to achieve universal health coverage to allow countries to protect and invest in their people and build a resilient future.
Going forward, the World Bank’s work will focus on strengthening health systems. It will soon release a new report that contributes evidence and analysis to a growing consensus that health leaders will achieve best results if they build system reforms around primary health care.
Working with partners
Future preparedness, prevention, and crisis responses must be global and collaborative. Not a single country can do this alone with adequate control, much less prevent the type of emergency the world is now experiencing.
To help address a global challenge like a pandemic, we need to work together. Over the next 100 days, we hope to help at least 100 countries get ready to deploy COVID-19 tests, treatments, and vaccines.
As part of the Access to COVID-19 Tools Accelerator (ACT-A), we are partnering with GAVI, CEPI, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and WHO to ensure global, equitable access to COVID-19 vaccines, tests and treatments for the poorest and most vulnerable countries. Our $12 billion financing is fully aligned with the ACT-A principals and goals.
Governments can use our funds to purchase vaccines and treatments through the COVAX facility. It will ultimately be up to countries to decide where to spend this financing and through what channels.
While many challenges and uncertainties lie ahead, we need to move forward and help countries to make health systems stronger, while recognizing the need to be flexible to adapt our approaches and self-correct when needed. This is what we believe in and what we are doing at the World Bank.