The COVID-19 pandemic has unleashed a global health emergency and unprecedented economic crisis that has disrupted billions of lives and is jeopardizing decades of development progress. It is hitting the poor and vulnerable particularly hard – through illnesses, job and income losses, food supply disruptions, school closures and lower remittance flows. Recent poverty projections suggest that the social and economic impacts of the crisis are likely to be quite significant. The virus could push between 71 million and 100 million people into extreme poverty.¹

Although all countries are susceptible to pandemics like COVID-19, the poorest countries and most vulnerable populations are often the hardest hit. With limited resources and low government capacity, many of the poorest countries don’t have the health infrastructure necessary to prepare for disease outbreaks. While the European Union has around 3,500 doctors per 1 million people, the entire region of sub-Saharan Africa has only around 200 doctors per 1 million people.

When COVID-19 emerged as a global threat, the World Bank Group responded with the largest and fastest crisis response in its history. Over the next year, we will be providing up to $160 billion in financing tailored to the health, economic and social shocks countries are facing, including $50 billion of IDA resources on grant and highly concessional terms.

The Bank’s emergency operations have now reached more than 100 countries, home to over 70 percent of the world’s population. These operations are financing health and social programs, with a special focus on the poorest and most vulnerable people. 70% of these projects are in the world’s poorest countries supported by International Development Association (IDA), the World Bank’s fund providing zero- or low-interest loans and grants. Close to one-third of the COVID-19-related World Bank financing targets fragile and conflict-affected countries whose health systems have limited capacity to drive an effective response.

Around the world, leaders have pledged to “build back better” from the COVID-19 pandemic, and the World Bank Group is helping countries chart the path forward. The current crisis is a chance to ensure better preparedness to future disease outbreaks, including a possible resurgence of COVID-19. As we embark on the road to recovery, we must build an agenda centered around health security, pandemic preparedness, and country health system strengthening, particularly for the poorest and most vulnerable people – drawing on four emerging lessons for from the COVID-19 pandemic.

First, the COVID-19 pandemic has underscored the importance of investing in resilient health systems that can detect, identify, treat, and halt transmission. In short, it has highlighted the critical need to invest in better preparedness across all countries, rich and poor alike. And we must continue to work with countries to ensure community engagement during COVID-19 operations to foster community and citizen trust.

Second, the pandemic has unleashed a secondary health crisis due to disruption in access to essential, life-saving health and nutrition services – particularly for women and children in low- and lower- middle-income countries. A rapid survey of the 36 countries currently supported by the Global Financing Facility for Women, Children and Adolescents found that nearly half are already reporting life- threatening health and nutrition service disruptions that threatens to reverse years of progress in maternal and child health. These surveys are consistent with data we are getting from our partner governments in Liberia, Sierra Leone, and Mozambique on drastic declines in routine service delivery, including outpatient visits, immunizations, ante-natal care services and malnutrition counselling.²

Third, the crisis has exposed weaknesses in health systems that now face the dual challenge of responding to the outbreak and maintaining essential, life-saving services. These require considerable investment in quality health systems, with strong Primary Health Care (PHC) at the foundation.

Fourth, as countries slowly emerge from lockdowns, they must determine the best way forward for their health systems and economies in the face of great uncertainty. Understanding health financing resilience and ways to improve it will be critical for this process, particularly if countries are hit by second or third waves of COVID-19. We know that even before the crisis, people in developing countries paid over half a trillion dollars out-of-pocket for health care, causing financial hardship for more than 900 million people and pushing nearly 90 million people into extreme poverty every year.³ And even when health services are available, countries at all incomes levels often struggle to ensure health service quality and affordability.

We must also keep our focus on the immediate response, which remains a public health emergency. As scientists race to develop vaccines and therapies against COVID-19, global cooperation is needed to avoid fragmentation and duplication of efforts. The World Bank believes that fair and equitable access to safe and efficacious vaccines and therapies, when developed, is essential for all countries, including the poorest, to reduce the destruction caused by this pandemic, rebuild livelihoods, and set course toward recovery. Without country health systems, diagnostics, therapeutics and vaccines cannot be deployed and will not reach the people most in need.

More and better investments are necessary now to create stronger, more resilient, and more equitable health systems to save lives now, and prevent reversals in recent progress in reducing maternal and child mortality, ensuring that everyone, everywhere can access safe, quality and affordable health care.

The World Bank remains focused on helping to transform global commitments into tangible actions at the country level. Few partners are better poised to translate our shared global goals into local outcomes than parliamentarians, who serve as a crucial link between people on the ground and the national government. As legislators, they can monitor the government and implement meaningful policies and reforms to improve health systems, and as representatives of citizens, they can help us tailor programs and projects to the unique needs of their constituencies for more inclusive results.

We will continue to support countries and work hand-in-hand with stakeholders such as parliamentarians as they redouble their efforts to protect their citizens from the impacts of COVID-19 and build back stronger, faster, and more inclusively – for a brighter future for all.

This article is an extract taken from the Parliamentary Network publication ‘Just Transitions’. You can download a pdf version of the full document here.

1. https://www.globalfinancingfacility.org/emerging-findings-and-policy-recommendations-COVID-19
2. https://www.globalfinancingfacility.org/emerging-findings-and-policy-recommendations-COVID-19
3. https://www.worldbank.org/en/topic/universalhealthcoverage/publication/high-performance-health-financing-for-universal-health-coverage-driving-sustainable-inclusive-growth- in-the-21st-century