The quality of the health and social response was good, given considerable uncertainty in the early months. The emergency response was particularly swift in the most vulnerable countries. Among countries with medium to high vulnerability to human capital and development losses, the World Bank financed an estimated $30 billion in the early health and social response to COVID-19—about 40 percent of the World Bank’s total commitments to COVID-19 in fiscal years 2020 and 2021. Staff globally and clients in countries worked tirelessly to support the response.

Although it is too early to observe outcomes, the evaluation points to promising evidence of early successes, such as the expansion of critical health and social protection capacities. The World Bank used its experience from past crises to respond quickly and effectively, and teams innovated and engaged in frequent dialogue to adjust actions. Operational flexibility facilitated rapid financing for the MPA, which was critical to expanding health support, and procurement was smooth, compared with past crises. World Bank country programs also drew on existing partnerships, crisis instruments, and regional projects to facilitate timely actions.

Nevertheless, and notwithstanding preparedness efforts over the years, the World Bank and many client countries were not adequately prepared for the crisis. Countries with better capacities to coordinate, monitor, and deliver local services (health and education, among others), robust human capital investments, and better public health preparedness were often able to address the crisis needs more comprehensively. Internal World Bank efforts were facilitated by already having operational support to human capital, gender, disease preparedness, existing data systems and partnerships, and crisis instruments in country portfolios.

The evaluation findings point to the value of focusing on pandemic and crisis preparedness efforts in countries in the World Bank, at the regional level, and with global partners.

• Prioritizing support in areas to protect against human capital losses. In the early COVID-19 response, there was an important emphasis on emergency health and social protection support. This needed to be quickly complemented with support for education, maternal and child health, and women and girls, which in some countries led to a secondary crisis of health and education loss and deepening gender inequalities. Countries needed the systems to continue to deliver and ensure the quality of these services during the crisis, for example, crisis-adapted platforms, such as for telemedicine and remote learning. Having systems in place that can ensure continued access to essential health, education, and gender-based services, in addition to emergency social protection, is important for protecting human capital, especially in vulnerable groups.
• Regional leadership and institutional capacities for crisis preparedness and crisis response. Regional organizations have an important role in convening leaders and technical actors in countries for policy dialogue, technical learning, cooperation, and problem-solving. Developing the capacities of regional organizations is key to facilitate learning and actions by countries and to expand preparedness capacities and rapid actions for crisis response.
• Preparedness in countries. Institutional capacities for crisis preparedness, such as functioning coordination structures, critical health service capacities, and data systems, are important for building strong preparedness.
• Internal preparedness of the World Bank. Partnerships, operational readiness (tools and flexibilities), and hands-on assistance need to be in place before a crisis. Country portfolios that include crisis instruments and support for human capital allow for quick access to financing and swift support to vulnerable groups in times of crisis, while maintaining the focus on longer-term human capital development. Also important for country portfolios was drawing on repurposed projects, regional projects, ASA, grants, and trust funds to enable quick early financing.
• Global alignment among partners. Global alignment and coordinated actions at the global level are important for good support to countries. In the early days of the response, the World Bank could have played a more decisive role at the global level regarding vaccines and to ensure that guidance to protect human capital was consistently part of the early global-level guidance on the COVID-19 response.

Recommendations

The findings from the evaluation inform four recommendations for ensuring stronger future preparedness.

Recommendation 1. Use the World Bank’s crisis recovery efforts to strengthen the resilience of essential health and education services to ensure that human capital is protected in a crisis.

Proposed Actions

• In health, build on innovations developed during COVID-19 to help countries strengthen telehealth and other platforms for continuing essential health services in an emergency. Help countries improve the quality of frontline services, including the availability of data to inform decisions for quality improvements. Services could be improved to better manage supplies, deliver vaccines, support health workers to deliver effective care, and ensure infection prevention and control measures. The availability and use of feedback from beneficiaries and coverage of vulnerable groups are also important. The World Bank could also help develop new capacities to deliver services, such as in psychosocial care.
• In education, draw on evidence and innovations of the COVID-19 response to strengthen platforms for continuous learning in a crisis. Strengthen community networks that have been established to support learning. To avoid learning losses, and facilitate knowledge building to uptake effective approaches to help children in and out of school catch up. Help countries develop approaches that increase the reach to vulnerable groups that may have been missed by remote learning. Strengthen monitoring of beneficiary feedback on the quality of learning.

Recommendation 2. Apply a gender equality lens to health and social crisis response actions across sectors.

Proposed Actions

• Develop actions across sectors (in health, education, urban, and social protection) for protecting women and girls from shocks, which can be drawn on in a crisis response. This is especially important in countries with high needs for addressing gender equality. Examples of areas to support gender equality include psychosocial support, sexual and reproductive health, income and asset accumulation, and community engagement.

Recommendation 3. Help countries strengthen regional cooperation and crisis response capacities for public health preparedness.

Proposed Actions

• Support regional organizations to facilitate cooperation, political leadership, and technical learning, especially in Africa. Such support could help strengthen preparedness in countries and regional mechanisms for crisis response, facilitate financing and technical partnerships, encourage innovation, and expand evidence to scale up effective approaches. Regional support could also facilitate evidence-based and data tools to help countries prioritize investments and monitor crisis response actions.
• Help countries strengthen national and subnational platforms to coordinate and deliver crisis interventions, such as One Health platforms, with greater emphasis on critical health services and demand-side activities, such as citizen engagement. At the national level, invest in platforms that coordinate action and prepare various sectors to take on specific roles in crisis. At the subnational level, invest in platforms that can reach local government and communities for disease surveillance, risk communication, delivery of health and social services, and monitoring support.

Recommendation 4. Build on the COVID-19 experience to strengthen the World Bank’s internal crisis preparedness so that it has the tools and procedures ready to respond in future emergencies.

Proposed Actions

• Review and expand operational flexibilities for processing new projects in crises and develop guidance on the effective use of instruments at different stages of crisis response. The World Bank could also explore innovative ways to strengthen the use of crisis instruments in countries, such as through support to communities, and expand guidance on hands-on assistance for citizen engagement and gender, learning from the provision of such support in procurement.
• Expand and strengthen the World Bank’s partnerships and instruments to enable coordinated financing, advance market commitments, and technical support that will help countries strengthen crisis preparedness. The partnerships could be at the global, regional, and country levels. They could include technical partnerships to expand knowledge for quality implementation of preparedness activities, partnerships with nongovernment and the private sector to support community-based implementation, feedback on services and use of technology, and global partnership for aligning financing, plans, and guidance to support countries.
• Strengthen tools to allow for the integrated management and frequent reporting of monitoring data on projects in World Bank portfolios.