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 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.
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.