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Lessons from Ebola for the fight against Covid-19 (Coronavirus)

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16 January 2019 - Beni, Democratic Republic of Congo.  Health workers put their gloves on before checking patients at the hospital. Photo credit: World Bank / Vincent Tremeau
The World Bank’s support for countries facing deadly Ebola outbreaks contain some pertinent lessons for the current fight against COVID-19—and responses to future disease outbreaks. Collateral benefit Building incident management system capacity in countries for one disease benefited responses to other risks. For example, an established polio incident management Show MoreThe World Bank’s support for countries facing deadly Ebola outbreaks contain some pertinent lessons for the current fight against COVID-19—and responses to future disease outbreaks. Collateral benefit Building incident management system capacity in countries for one disease benefited responses to other risks. For example, an established polio incident management system in Nigeria made it possible to effectively control an Ebola outbreak in that country in July 2014. The efforts against Ebola from 2014 to 2019 ranged from collaboratively planning the World Bank’s response across countries, to support for addressing mental health and nutrition issues at the start of the response and improving school hygiene to ensure the safe return of children after the crisis was over. The World Bank Group’s Independent Evaluation Group extracted the Findings for COVID-19 from the World Bank’s Support to Address Ebola Outbreaks from a rapid review of the institution’s support for addressing Ebola outbreaks in Liberia, Guinea, Sierra Leone (2014–16), and the Democratic Republic of Congo (2017–19). Local and national coordination The World Bank helped set up joint monitoring with the government and other partners of the outbreaks and response, with monitors in the communities using smartphones for real-time data tracking and for patient feedback. The World Bank also strengthened information sharing from the response at the local level, both across countries and within countries. These were useful ways to improve the coordination of emergency operations efforts at all levels. Another component was emergency budget support to governments, to ensure that they could carry out their Ebola response plans. For instance, in Guinea, at a time when tax revenues were reduced because of Ebola and a decline in mining revenues, a World Bank project contributed to national Ebola-related spending to finance treatment centers, training of health workers, and national sensitization campaigns. Financial incentives for frontline workers also were critical in scaling up the response to the West Africa outbreaks. The World Bank supported training of more than 30,000 health workers, who along with volunteers, took on tasks ranging from early case detection to safe burials. At the height of the epidemic, approximately 40,000 community health workers and other volunteers received a graduated rate of compensation, depending on the risk category assigned to their role. Emergency workers, frontline health works and others, also benefited from a formal hazard payment system. These payments depended on a transparent and accountable financial incentives system, which included a list of beneficiaries, a reliable cash transfer system, and routine monitoring and reporting. The World Bank supported improved contact tracing, under which more than 37,000 community health workers and other volunteers were deployed for door-to-door communication and case identification in Guinea, Liberia, and Sierra Leone. This surveillance required support at the community level, from stakeholders including traditional and religious leaders, women, and youth. Also critical was a comprehensive database of contacts, to track the number of cases and provide analyses of trends in the outbreak. Laboratory and treatment response Access to laboratory testing at community level—such as local facilities with equipment and trained technicians to conduct timely testing—was crucial to identify Ebola cases. This access to local testing in “hot spot” areas of the outbreak allowed quick collection of samples, to avoid the risk of further transmission. The World Bank supported improvements in laboratory capacities in Guinea, Liberia, and Sierra Leone. Furthermore, cross-border collaboration and networking among laboratories in this subregion helped improve their weak diagnostic capacities. However, during COVID-19, these countries often requested funds for the same supports as during Ebola: improvements to surveillance, laboratory capacities, and health workforce recruitment and training. Thus, investments in these response systems should be preserved and built on between outbreaks. In late 2014, more than 50 Ebola treatment centers were needed and only 16 were operational. Therefore, Ebola patients tended to remain at home, which led to further transmission among families. The World Bank supported the establishment of community treatment centers, where infected patients could be isolated and receive basic care. The organization also provided drugs, protective gear, and other medical supplies and helped set up logistic hubs, jointly used by all partners to stock supplies. Initially, procurement of supplies through United Nations agencies was not fast enough. Therefore, direct contracting of local medical supply providers should be used in emergency situations. Related health and nutrition issues The Ebola crisis absorbed funds originally allocated for maternal and child health. World Bank measures to ensure the continued use of essential health services during the outbreak included providing free medical supplies for non-Ebola illnesses, reimbursing travel costs or offering transport to health facilities, providing psychosocial support and food and nutrition assistance, and improving water and sanitation in health facilities. These helped overcome the population’s fear of using health services. Also, efforts in Sierra Leone supported by the World Bank to encourage closer links between traditional and modern health system providers, and to train health care workers in cultural sensitivity, improved access to health care. World Bank mental health interventions were designed to reduce depression, decrease stigma, and increase levels of trust at the community level. The institution supported services ranging from treatment at mental health facilities to community healing dialogues for more than 20,000 people in Liberia, and psychological services provided by more than 1,000 trained community volunteers in Guinea. Nutrition challenges arose because quarantines, travel restrictions, and fear of infection complicated efforts to organize farming teams, prepare fields for planting, maintain a steady supply of seed, and market produce. As a result, hungry farming families resorted to eating seed intended for the next cropping cycle. World Bank measures included food support: people in quarantined areas and affected households received food, and children in Guinea were fed at school. However, there was no protection for the planting season. Support to assure access to food and prevent undernutrition of children must be part of emergency planning at the onset of a pandemic. Lessons from Rebuilding after Ebola Support for teacher training and improvements in school classrooms and sanitation expedited the safe return of students. Flexible grants and cash transfers helped support vulnerable households and geographic areas affected by Ebola. This included funds for safety nets, orphanages, female-headed households, reopening of schools, and seed and fertilizer for farmers. Short-term employment helped vulnerable groups recover their assets and reengage in services. Continued support to improve surveillance, laboratory capacities, and health workforce training for preparedness between epidemics. Support to recover essential health services and strengthen the continued delivery of services in the re-emergence of the epidemic, such as in areas of immunization, and improving reproductive, maternal, neonatal, child, and adolescent health services. Continued support for public financial management reform opportunities that emerge from the pandemic. Support to restore the agriculture planting seasons and child nutrition to prevent the deepening of undernutrition in communities. Pictured above: 16 January 2019 - Beni, Democratic Republic of Congo. Health workers put their gloves on before checking patients at the hospital. Photo credit: World Bank / Vincent Tremeau

What have we learned from the World Bank’s Support to Address Ebola Outbreaks?

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image that reads What have we learned from the World Bank’s Support to Address Ebola Outbreaks?
What have we learned from the World Bank’s Support to Address Ebola Outbreaks? What have we learned from support for Ebola outbreaks? Over the past five years, Ebola has seized global interest in relation to the threat of widespread disease outbreaks. This video summarizes the findings from a rapid review of the World Bank’s support for Ebola outbreaks between 2014 and 2019, with the objective Show MoreWhat have we learned from the World Bank’s Support to Address Ebola Outbreaks? What have we learned from support for Ebola outbreaks? Over the past five years, Ebola has seized global interest in relation to the threat of widespread disease outbreaks. This video summarizes the findings from a rapid review of the World Bank’s support for Ebola outbreaks between 2014 and 2019, with the objective of informing the coronavirus (COVID-19) pandemic response and future crisis responses. Read more about the findings in IEG's Covid-19 Lessons Note: Findings for COVID-19 from the World Bank’s Support to Address Ebola Outbreaks    

Addressing groundwater depletion: Lessons from India, the world’s largest user of groundwater

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pictured above: Women draw water from a well in the drylands of Jaisalmer, Rajasthan, India. By Yavuz Sariyildiz via Shutterstock (November 9, 2014).
India is home to 16% of the world’s population, but only holds 4% of the world’s freshwater resources. Not only is water scarce in India, but the extraction of groundwater has been on the rise for decades. Since the 1960s, the government’s support for the “green revolution” to ensure food security has increased the demand for groundwater for agriculture. Rapid rural electrification combined Show MoreIndia is home to 16% of the world’s population, but only holds 4% of the world’s freshwater resources. Not only is water scarce in India, but the extraction of groundwater has been on the rise for decades. Since the 1960s, the government’s support for the “green revolution” to ensure food security has increased the demand for groundwater for agriculture. Rapid rural electrification combined with the availability of modern pump technologies has led to an increase in the number of borewells to meet that demand. Over the last 50 years, the number of borewells has grown from 1 million to 20 million, making India the world’s largest user of groundwater. The Central Groundwater Board of India estimates that about 17% of groundwater blocks are overexploited (meaning the rate at which water is extracted exceeds the rate at which the aquifer is able to recharge) while 5% and 14% , respectively, are at critical and semi-critical stages. The situation is particularly alarming in three major regions – north-western, western, and southern peninsular. Groundwater pollution and the effects of climate change, including erratic rainfall in the drier areas, put additional stress on groundwater resources which serve about 85% of domestic water supply in rural areas, 45% in urban areas, and over 60% of irrigated agriculture. Current overexploitation rates pose threats to livelihoods, food security, climate-driven migration, sustainable poverty reduction and urban development. The World Bank has been working with the Government of India to enhance groundwater management in affected areas. The lessons below stem from the experience of World Bank groundwater management projects in India, and are part of a broader IEG evaluation of the World Bank’s support for sustainable and inclusive natural resource management.   Integrated demand and supply side solutions offer the best option for sustainable use. IEG case studies in Rajasthan, Telangana and Andhra Pradesh showed that the success of supply-side measures, such as watershed management programs, aquifer recharging and tank rehabilitation activities, did not lead to sustainable use in the absence of demand-side action. Measures such as surface water harvesting through farm ponds and check-dams, the installation of water-efficient irrigation systems (e.g. more efficient drips and sprinklers) and growing less water intensive crops, need to be integrated on the demand side for improved management and reduced depletion. Weak regulatory action to limit demand for groundwater can hinder the success of programs in reversing groundwater depletion. Weak regulations result in the expansion of groundwater irrigated areas and drilling of additional wells. This can more than offset water savings created by demand-side measures, or the water increases created by supply-side measures, leading to further depletion. The government of India regulates groundwater exploitation in water-stressed states through “notification” of highly overexploited blocks that restrict development of new groundwater structures (except those for drinking water). However, only about 14% of the overexploited blocks in the country are currently notified. Local level regulatory action in all threatened blocks before they reach the “overexploited” stage is vital to avert depletion. Strengthening community participation and rights in groundwater governance can improve groundwater management. World Bank projects in peninsular India, where more spread out and specifically defined hydrological sites prevail, were successful on several fronts by implementing the Participatory Groundwater Management approach (PGM). The PGM approach empowers communities in a defined aquifer area by providing governance rights, community awareness, capacity development, and knowledge and motivation for social regulation and the implementation of coordinated actions. However, there are limits to the success of the PGM approach. It did not work when local institutions were weak, supply-side interventions failed to replenish groundwater or when tanks failed to store water due to recurrent droughts, leading to increased overexploitation. The approach is also unlikely to work in areas with extensive alluvial aquifers that require coordination among large numbers of users. World Bank interventions support local institutional capacity for groundwater governance, but such institutions are often not viable after the end of the project. Two local institutions are mainly involved in groundwater management in India: Water User Associations (WUA) and groundwater management committees (GWMC). WUAs are formal institutions with a wider mandate to manage irrigation systems (surface and groundwater) and have budget allocations for maintaining the systems and collecting user charges. In contrast, GWMCs are informal groups created through World Bank–supported projects to facilitate PGM. These committees become dormant and dysfunctional once projects close. The key institutional challenge for groundwater governance is strengthening local institutions and helping the informal groups to remain viable during the post-project phase. Power subsidies for pumping groundwater accelerate the depletion of aquifers in stressed areas. Several states affected by depletion of groundwater provide free or heavily subsidized power (including solar pumps) for pumping groundwater for irrigated agriculture. This creates perverse incentives that enable overexploitation and depletion of scarce groundwater resources. In the long-run, sustainable groundwater management will depend on cross-sectoral reforms to address the water-energy-agriculture nexus and providing the right incentives to resource users. This requires better coordination of policy, market and regulatory measures as well as repurposing current distortive public support to more climate-smart solutions. Strengthening World Bank analytical support and investments in these directions would be useful for future. Groundwater extraction has allowed rural families to reduce short-term vulnerability but may incur trade-offs and increase the risk of depletion and ultimately increase vulnerability in the long term. Increased access to groundwater resources and extraction allows households to boost agricultural production in the short term. Many farm households owning wells indicated that their vulnerability is lower partly because of income growth and diversification and buffers provided by social safety nets. However, without sufficient regulation or replenishment of aquifers, the increased access to and use of groundwater for irrigation could lead to declining water tables and increasing water scarcity, which risks escalating long-term vulnerability. pictured above: Women draw water from a well in the drylands of Jaisalmer, Rajasthan, India. By Yavuz Sariyildiz via Shutterstock (November 9, 2014).

So, you want to reduce fiscal and financial vulnerabilities to better prepare for the next crisis?

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Image of man holding an umbrella to shield from the sun. Adapted from shutterstock
Proactively strengthening institutions for crisis preparedness can make the difference between whether a country bounces back quickly from an unexpected shock or struggles for years to regain its footing.Proactively strengthening institutions for crisis preparedness can make the difference between whether a country bounces back quickly from an unexpected shock or struggles for years to regain its footing.

Addressing Country-Level Fiscal and Financial Sector Vulnerabilities

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Addressing Country-Level Fiscal and Financial Sector Vulnerabilities
This evaluation assesses World Bank Group support to client countries to build resilience to exogenous shocks. Proactively reducing fiscal and financial sector vulnerabilities and strengthening frameworks and institutions for crisis management can make the difference between whether a country bounces back quickly from an unexpected shock or struggles for Show MoreThis evaluation assesses World Bank Group support to client countries to build resilience to exogenous shocks. Proactively reducing fiscal and financial sector vulnerabilities and strengthening frameworks and institutions for crisis management can make the difference between whether a country bounces back quickly from an unexpected shock or struggles for years to regain its footing.

World Bank Support to Aging Countries

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shutterstock/ Ja Crispy
This evaluation is the first at the Independent Evaluation Group to assess the World Bank’s contribution to diagnosing client countries’ demographic issues related to population aging. This evaluation is the first at the Independent Evaluation Group to assess the World Bank’s contribution to diagnosing client countries’ demographic issues related to population aging.

Benin: Ninth and Tenth Poverty Reduction Support Credit (PPAR)

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Benin was a low-income country with a gross domestic product per capita of $1,291 at the time of preparation of the Poverty Reduction Support Credit (PRSC) 9 and 10 series in 2014. Its economy was driven by agricultural production (of cotton in particular) and reexport and transit trade with Nigeria. As a result, Benin’s economy was vulnerable to trade policy changes or economic downturns in Show MoreBenin was a low-income country with a gross domestic product per capita of $1,291 at the time of preparation of the Poverty Reduction Support Credit (PRSC) 9 and 10 series in 2014. Its economy was driven by agricultural production (of cotton in particular) and reexport and transit trade with Nigeria. As a result, Benin’s economy was vulnerable to trade policy changes or economic downturns in Nigeria. The development objectives of this series were to: (i) promote good governance and high-quality public financial management, and (ii) strengthen private sector competitiveness. Ratings for the Ninth and Tenth Poverty Reduction Support Credit project are as follows: Outcome was moderately unsatisfactory, Risk to development outcome was substantial, Bank performance was unsatisfactory, and Borrower performance was not applicable. This assessment offers the following lessons: (i) Relevant lessons from previous operations need to be taken on board when designing new DPF operations. (ii) Prior actions need to be substantive, that is, be critical to reforms with value added. (iii) The World Bank should design projects with a clear understanding of the likely “winners and losers;” failure to do this makes it more likely that projects will not be implemented as planned or sustained over time. (iv) Distributional impact analysis from DPF-supported reforms should inform the design of operations.

What do cities need to grow equitably, sustainably and build resilience?

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City view of Bogotá, Colombia on January 11, 2016. Photo © Dominic Chavez/World Bank
Cities will be home to 2 billion new residents by 2045. Accommodating this growth will require large-scale development of land in and around urban areas. For lower‐income cities, this will be challenging since they tend to grow through slums and other informal settlements. Along with a  lack of adequate and equitable access to public services and economic opportunities, slum residents Show MoreCities will be home to 2 billion new residents by 2045. Accommodating this growth will require large-scale development of land in and around urban areas. For lower‐income cities, this will be challenging since they tend to grow through slums and other informal settlements. Along with a  lack of adequate and equitable access to public services and economic opportunities, slum residents   are more vulnerable to diseases, especially highly communicable ones such as COVID-19, and they are likelier to bear the brunt of natural disasters associated with using land that is environmentally sensitive, unprotected, or more susceptible to  disasters. In 2014, an estimated 880 million urban residents lived in slum conditions, compared with 792 million in 2000 (UN 2019). This number is likely to keep growing unless urban spatial expansion is planned and managed well.   IEG recently assessed the World Bank’s support to client countries on managing urban expansion, particularly through its work on land administration, land‐use planning, and land development. These three key factors determine how urban areas grow. Land administration Land administration is the process of establishing, recording, and disseminating information about the ownership, value, and use of land and its associated resources. Making available such fundamental reference information through wider records systems is key towards recognizing a continuity of property rights and ensuring the security of tenure. This, in turn, will motivate households to invest in dwellings and contribute towards creating functioning land markets, which are crucial for the development of cities. World Bank support to land administration is successfully strengthening property rights through land titling, which contributes to land market development. However, countries eligible for IDA, the World Bank’s fund for the poorest countries, have faced challenges with land titling and land records data management systems, which, in turn, affects their ability to develop land markets. This is partially due to limited technical capacity locally and issues related to political economy. Government planning and policies regarding land administration may not be sufficiently adapted to the local context, including the diverse and, sometimes, conflicting political and economic incentives and motivations that are at play at the local level. The political economy around land administration laws is often complex, and the time taken to reform them typically goes beyond the duration of related projects, and at times, political cycles. Land‐use planning Land-use planning helps regulate the use of space, focusing not only on the physical aspect, but also the economic functions, social impact, and the location of different activities within the urban environment. One of the critical functions of land-use planning is the allocation of land to private and public uses, including infrastructure and services. World Bank support to clients on land-use planning has generally been successful, but it rarely supports implementing land-use planning tools that focus on preventing the emergence of new slums or informal areas. This is critical to managing urban spatial growth. The Bank has been encouraging the establishment of independent planning agencies, which help develop preventative approaches, but it has not provided the operational support that is needed for such agencies.  Land development Land development is the transformation of land through investments and this evaluation assessed it through two components: first, urban upgrading, which is the improvement of conditions in existing slums and preventing the growth of new ones, and second, urban transport, which includes integrating transportation with land use. These components shape how land is used and how its use evolves over time, in turn, defining how productive and inclusive cities will become in the future.   World Bank support to land development has been generally successful, but Bank projects on urban upgrading have tended to focus on upgrading existing slum areas and improving the access of slum-dwellers to infrastructure and housing. It has focused less on preventing the emergence of new slums and informal areas. On urban transport, because of the traditional focus on mobility and access, the Bank’s support does not systematically consider land prices and land markets. Excluding land market assessments from urban transport projects leads to underestimating the total economic benefits of these projects as well as not fully accounting for the benefits and opportunities that an increase in the value of land offers to various income groups, especially those from lower-income segments.    There is also a lack of systematic geolocation of the World Bank’s investments, which further limit the Bank’s ability to support countries in assessing changes in land use, increases in land values, and the associated distributional impacts. Lessons learned and way forward There are three specific areas where the World Bank can enhance its support to countries in managing their urban spatial growth. Adopting a framework that links determinants of urban expansion with strategies for managing it, in an integrated way: The framework could act as a reference for the design and delivery of the Bank’s lending and analytical work on urban spatial growth. The framework could reflect the approach of the Planning, Connecting, and Financing Cities report, the World Bank Group housing framework, the transport-oriented guidelines and recent findings from Pancakes to Pyramids: City Form to Promote Sustainable Growth report. Adopting preventive approaches in addition to curative ones: This could be done by securing rights of way and financing basic infrastructure in emerging neighborhoods to accommodate new urban dwellers. The World Bank should support the use of public transit, walking, and cycling as primary modes of transportation. It should also expand the use of land‐based planning tools and approaches, such as scenario planning, which is a process to support informed decision-making helping urban planners navigate future uncertainties. Identifying and recording precise project locations and collecting land market data: The World Bank should strengthen its data collection protocols and increase the use of technologies such as the Geo‐Enabling Initiative for Monitoring and Supervision and the Smart Supervision Application. It should also improve the collection of land market data, including mainstreaming land market assessments in World Bank investments in urban areas. When countries manage well the factors that determine urban expansion, it can lead to fewer slums, efficient and resilient use of land, functioning land markets, and integrated urban transport systems. These, in turn, will ensure that the expansion in urban areas occurs in ways that are sustainable, efficient, and equitable. The World Bank Group will need to adopt new approaches, frameworks, and technologies that enhance its ability to support clients, especially IDA countries, on urban expansion. This will contribute directly to Sustainable Development Goals 1 and 11, which address the need for equitable, inclusive, and sustainable use of and access to economic resources, including land, and will help the World Bank Group respond more effectively and efficiently to the twin goals – poverty reduction and shared prosperity. In addition, this will also support countries in managing their urban expansion in ways that consider the infrastructure and services that are needed to help them be more resilient towards chronic stresses and future shocks, such as pandemics and natural disasters. This will facilitate the World Bank Group’s goal of green, resilient, inclusive development. Read IEG's Evaluation: Managing Urban Spatial Growth World Bank Support to Land Administration, Planning, and Development   pictured above: City view of Bogotá, Colombia on January 11, 2016. Photo © Dominic Chavez/World Bank

Managing Urban Spatial Growth

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Contrasting the rapid growth of informal settlements  and high rise buildings in the city of Salvador, Brazil—taken with a drone January 2021—by Johnny Miller / Unequal Scenes
This evaluation offers IEG’s first systematic assessment of the World Bank’s support to the management of urban spatial growth. This evaluation offers IEG’s first systematic assessment of the World Bank’s support to the management of urban spatial growth.

The World Bank Group’s Experience with the IDA Private Sector Window: An Early-Stage Assessment

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Employees of Vita Foam working in Freetown, Sierra Leone on June 19, 2015. Photo © Dominic Chavez/World Bank
This report is an early-stage assessment of the World Bank Group’s experience with the International Development Association (IDA) Private Sector Window (PSW).This report is an early-stage assessment of the World Bank Group’s experience with the International Development Association (IDA) Private Sector Window (PSW).