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3 lessons from past public health crises for the global response to COVID-19 (coronavirus)

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James Cooper, Sunday Bondo and Patrick Lappaya work together closely to take a sample swab to help determine the death of a women at C.H. Rennie Hospital in Kakata, Margibi County in Liberia on March 10, 2016. Image Credit World Bank
As the public health emergency of the novel coronavirus spreads globally, there is growing interest in how the international community can support countries’ responses to COVID-19 (coronavirus). By analyzing information from recent IEG evaluations of the World Bank Group’s response to public health crises, we identified three lesson areas that shed light on what works and where attention is Show MoreAs the public health emergency of the novel coronavirus spreads globally, there is growing interest in how the international community can support countries’ responses to COVID-19 (coronavirus). By analyzing information from recent IEG evaluations of the World Bank Group’s response to public health crises, we identified three lesson areas that shed light on what works and where attention is needed to deliver both an immediate and a long-term response to the current crisis. MOUNTING A RAPID RESPONSE: Flexible financial response mechanisms are critical for providing timely support and additional funds to address the impacts of a crisis. In 2011, the International Development Association, the World Bank fund for the world’s poorest countries, created a Crisis Response Window (CRW) to deliver timely support to eligible countries faced with severe crises stemming from natural disasters, economic shocks, and public health emergencies. A 2019 evaluation revealed that about half of CRW operations used the additional financing to rapidly scale up operations that were already underway, such as a 2017 allocation to the Republic of Yemen to cope with one of the world’s worst cholera outbreaks amid continuous conflict. In response to the COVID-19 pandemic, the World Bank has established a Fast-Track COVID-19 Facility to address immediate health and economic needs in countries.   Adapting existing operations and reacting quickly to new information can contribute to reducing project design time and to enhancing performance. The World Bank’s Avian Influenza response made use of broad project templates, which listed a wide array of options for governments to tackle the crisis. This contributed to reducing time spent on project design and approval The first phase of the COVID-19 response is organized under a flexible Multiphase Program Approach which will allow for the leveraging of existing operations and ongoing learning about the impacts of the pandemic and adapting the support to countries. Recent experience suggests that partnerships contribute to mitigating risks related to rapid project preparation.  While this can pose challenges to ensuring project quality, evaluations of CRW operations for crises showed that partnering with UN institutions can  mitigate this risk because of the specialized knowledge they bring, and their capacity to implement projects quickly and successfully. COVID-19 operations are being prepared in less than one week, which is unprecedented in the Bank's history. Cooperation and coalition building among countries can strengthen response performance and address longer-term needs. The Bank Group’s response to Ebola was coordinated with a coalition that helped organize the deployment of the necessary knowledge and skills across West African countries to prevent and control the spread of the disease. After Ebola, the Africa Centers for Disease Control and Prevention (CDC) was set up as a regional network to strengthen the continent’s public health institutions and response to disease threats and outbreaks.       Enlarge and download infographic CONTROLLING THE SPREAD: Real-time monitoring of communications and public awareness programs is important to ensure their effectiveness. It cannot be taken for granted that communications campaigns aimed at key segments of the population on hygiene and control are working. Experience from the Avian Influenza suggests that assessing the impact of communications and public awareness programs on behavior is important, to understand what might be needed to achieve the desired changes. The evidence gathered can inform any necessary course corrections in the communications strategies. Mobilization and coordination of civil society and grassroots groups is essential for effective disease monitoring, and case identification in countries. In the case of Avian influenza, weak networks between government and grassroots organizations in some countries meant that important information on cases was not reported for disease monitoring. This lack of timely and trusted access to community level information reduced the effectiveness of investments in the formal disease monitoring and surveillance platforms in some countries. In the case of Ebola, the mobilization of civil society groups was essential to communicate information on the disease and to trace contacts, with cellular phones a key tool. Investments in technology and equipment need to be balanced with capacity building of health workers and knowledge to support laboratory diagnostics. Technical training of health workers and systems for knowledge sharing and communication may be the most important and rapid way to build laboratory capacity and scale-up disease testing. Facility and equipment upgrades have proven to be more complex, expensive, and time consuming than initially projected. IMPLEMENTING A SUSTAINABLE LONG-TERM RESPONSE: Most World Bank operations in response to COVID-19 will go beyond the immediate emergency, creating opportunities for projects that also help countries address long-term risk reduction. Effective logistics will be critical for both the current and future public health crises. If a vaccine or efficacious antivirus for coronavirus becomes available, purchasing it for use by health workers or other vulnerable persons could be valuable, but logistics issues are key. The Avian influenza experience show the importance of logistics management of these supplies to ensure value added use of scarce funds, and access to vulnerable persons. Antiviral drugs have a limited shelf-life and in the case of Avian influenza large stockpiles of purchases drugs went unused even during outbreaks. The WBG and its partners can help strengthen preparedness plans and frameworks in countries with weaker health systems. Preparedness of the health system is the first line of defense. This was a main recommendation of IEG’s evaluation on World Bank Group Support to Health Services. Better staffed health services, protective equipment, laboratory diagnostics, clinical management, surveillance systems, and rapid contact tracing skills can all allow countries to mount more effective responses.   pictured above: James Cooper, Sunday Bondo and Patrick Lappaya work together closely to take a sample swab to help determine the death of a women at C.H. Rennie Hospital in Kakata, Margibi County in Liberia on March 10, 2016. photo credit: World Bank

3 lesson areas from past public health crises for the global response to COVID-19 (coronavirus)

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Myanmar CLR Review FY15-19

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This review of the World Bank Group’s (WBG) Completion and Learning Review (CLR) covers the period of the Country Partnership Framework (CPF), FY15-FY17, and updated in the Performance and Learning Review (PLR) dated June 2, 2017, which extended the CPF period by two years to FY19. This CPF followed the end-2012 Interim Strategy Note (ISN) that resumed WBG operations after a hiatus of about 25 Show MoreThis review of the World Bank Group’s (WBG) Completion and Learning Review (CLR) covers the period of the Country Partnership Framework (CPF), FY15-FY17, and updated in the Performance and Learning Review (PLR) dated June 2, 2017, which extended the CPF period by two years to FY19. This CPF followed the end-2012 Interim Strategy Note (ISN) that resumed WBG operations after a hiatus of about 25 years. To support the Government’s development efforts, the WBG implemented a major expansion of its activities (a seven-fold increase in the Bank’s portfolio), possibly beyond what the country could absorb. Nevertheless, this support contributed to good progress on farming productivity; on access to electricity, telecommunications, health, education, and finance; and on the business climate. IEG agrees with the lessons drawn by the CLR. These are reformulated and summarized as follows: (i) In an environment of constrained implementation capacity, projects with diverse objectives and multiple implementing agencies may become unwieldy and lead to delays in project implementation. (ii) A results framework that excludes the program’s cross-cutting issues will impede assessment of success in addressing these issues. (iii) Use of country systems, support of key reform champions, and joint analytical work are among the factors that build trust with counterparts and stakeholders. (iv) Access to and coordination of trust fund resources will encourage effective implementation and collaboration across development partners. (v) Good and timely data is critical for evidence-based policy dialogue and timely response to country developments. (vi) A “one WBG” approach is critical to leverage WBG instruments toward specific objectives such as access to electricity. Seventh, more careful attention to indicators, including their sources, baselines, targets and time frames will facilitate program monitoring. (vii) A “disconnect’ between written implementation rules and actual practices in Myanmar, e.g., on procurement, may cause implementation delays. IEG adds the following lesson: Joint Implementation Plans (JIPs5) can improve the effectiveness of the “one WBG” approach noted by the CLR lessons. WBG CPFs normally intend collaboration across the Bank, IFC, and MIGA, but more often than not, CPFs do not spell out how such collaboration is to happen. Myanmar’s CPF JIP to improve access to electricity helped ensure that joint work would materialize. IEG rates the CPF development outcome as Moderately Satisfactory and WBG performance as Good.

A global effort is needed to ensure all countries are ready to combat COVID-19 (coronavirus) with evidence

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A global effort is needed to ensure all countries are ready to combat COVID-19 (coronavirus) with evidence
Every government needs robust monitoring and evaluation (M&E) systems now more than ever to design effective policies.Every government needs robust monitoring and evaluation (M&E) systems now more than ever to design effective policies.

Making Choices about Evaluation Design in times of COVID-19: A Decision Tree

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Making Choices about Evaluation Design in times of COVID-19: A Decision Tree
Making Choices about Evaluation Design in times of COVID-19: A Decision Tree (enlarge & download as a PDF) Making Choices about Evaluation Design in times of COVID-19: A Decision Tree (enlarge & download as a PDF)

World Bank Engagement in Situations of Conflict (Approach Paper)

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The World Bank Group has made a strong commitment to addressing the development challenges associated with fragility, conflict, and violence (FCV) as part of its corporate goals. It situates this challenge at the core of its poverty reduction focus, especially since extreme poverty is rising in fragile countries. By 2030, it is estimated that over 50 percent of the world’s extreme poor will live Show MoreThe World Bank Group has made a strong commitment to addressing the development challenges associated with fragility, conflict, and violence (FCV) as part of its corporate goals. It situates this challenge at the core of its poverty reduction focus, especially since extreme poverty is rising in fragile countries. By 2030, it is estimated that over 50 percent of the world’s extreme poor will live in fragile and conflict-affected situations (FCSs). Achieving development outcomes in FCV countries is also critical for achieving the Sustainable Development Goals. The purpose of the evaluation is to examine the relationship among various modalities of World Bank engagement in situations of conflict and the achievement of development gains. The evaluation is designed to focus on how the World Bank is working differently in conflict-affected countries, why engagement decisions are made in different contexts, and what contributions the World Bank has made to development gains.

Upcoming Evaluation: World Bank Engagements in Situations of Conflict

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Syrian refugees are fleeing due to shelling in Latakia port city of Syria. Latakia, Syria, 15 February 2016.
This evaluation will assess the World Bank’s approach and support to countries in situations of conflict and provides evidence-based lessons to inform implementation of the World Bank Group Strategy for Fragility, Conflict, and Violence 2020–2025.This evaluation will assess the World Bank’s approach and support to countries in situations of conflict and provides evidence-based lessons to inform implementation of the World Bank Group Strategy for Fragility, Conflict, and Violence 2020–2025.

Adapting evaluation designs in times of COVID-19 (coronavirus): four questions to guide decisions

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Adapting evaluation designs in times of COVID-19 (coronavirus): four questions to guide decisions
A framework organized around four questions to address the ethical, conceptual, and methodological challenges that are affecting programmatic evaluation work during the COVID-19 pandemicA framework organized around four questions to address the ethical, conceptual, and methodological challenges that are affecting programmatic evaluation work during the COVID-19 pandemic

Digital Data Collection During #COVID-19 (Coronavirus)

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COVID-19 (Coronavirus) Response

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IEG Lesson Library: Evaluative Resources and Evidence to inform the COVID-19  Response
Past lessons for the current crisisPast lessons for the current crisis