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Publication
Collapse and Recovery: How the COVID-19 Pandemic Eroded Human Capital and What to Do about It
(Washington, DC: World Bank, 2023)Worldwide, the COVID-19 pandemic has been an enormous shock to mortality, economies, and daily life. But what has received insufficient attention is the impact of the pandemic on the accumulation of human capital—the health, education, and skills—of young people. How large was the setback, and how far are we still from a recovery? Collapse and Recovery estimates the impacts of the pandemic on the human capital of young children, school-age children, and youth and discusses the urgent actions needed to reverse the damage. It shows that there was a collapse of human capital and that, unless that collapse is remedied, it is a time bomb for countries. Specifically, the report documents alarming declines in cognitive and social-emotional development among young children, which could translate into a 25 percent reduction in their earnings as adults. It finds that 1 billion children in low- and middle-income countries missed at least one year of in-person schooling. And despite enormous efforts in remote learning, children did not learn during the unprecedentedly long school closures, which could reduce future lifetime earnings around the world by US$21 trillion. The report quantifies the dramatic drops in employment and skills among youth that resulted from the pandemic as well as the substantial increase in the number of youth neither employed nor enrolled in education or training. In all of these age groups, the impacts of the pandemic were consistently worse for children from poorer backgrounds. These losses call for immediate action. The good news is that evidence-based policies can recover these losses. Collapse and Recovery reviews governments’ responses to the pandemic, assessing why there was a collapse in human capital accumulation, what was missing in the policy architecture to protect human capital during the crisis, and how governments can better prepare to withstand future shocks. It offers concrete policy recommendations to recover losses in human capital—programs that will end up paying for themselves in the long term. To better prepare for future shocks such as climate change and wars, the report emphasizes the need for solutions that bring health, education, and social protection programs together in an integrated human development system. If countries fail to act, the losses in human capital documented in this report will become permanent and last for multiple generations. The time to act is now. -
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Silver Opportunity: Building Integrated Services for Older Adults around Primary Health Care
(Washington, DC : World Bank, 2023)We live in a rapidly aging world, in which people who are age 60 and older outnumber children under the age of five. This book reveals large and growing gaps in care for older adults in countries at all income levels and shows how to leverage reforms for improving health outcomes for older adults and create healthier, more prosperous communities. Aimed at policy makers and other health and development stakeholders who want to promote healthier aging, Silver Opportunity compiles the latest evidence on care needs and gaps for aging populations. It argues that primary health care should be the cornerstone of integrated service delivery for older people, but that primary health care systems must first build their capacity to respond to older people's health needs. It presents an original framework for policy action to advance primary health care–centered, integrated senior care; documents the experiences of pioneering countries in delivering community-based care to older people; and provides recommendations for decision-makers. The framework presents four policy levers with which to improve health care for seniors—financing, innovation, regulation, and evaluation and measurement—or FIRE. Finally, the book posits that by acting now, countries can leverage population aging to accelerate progress toward health equity and universal health coverage. -
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The Quality of Health and Education Systems Across Africa: Evidence from a Decade of Service Delivery Indicators Surveys
(Washington, DC: World Bank, 2021-11-18)Have teachers mastered the subject matter they are teaching? Can doctors accurately diagnose and treat critical health conditions? Are schools and health facilities sufficiently stocked with needed equipment and supplies? Are they sufficiently supported and staffed to optimize learning and health care outcomes? For the past decade, the World Bank’s Service Delivery Indicators (SDI) surveys have collected nationally representative data in countries across Africa to answer these questions. The surveys aim to measure the quality of services where they meet citizens: in schools and health facilities. The Quality of Health and Education Systems Across Africa: Evidence from a Decade of Service Delivery Indicators Surveys identifies areas of achievement and constraint in service delivery, shedding light on how service delivery may foster or stunt human capital accumulation. SDI surveys show that schools and health clinics across Africa are still falling short in some critical areas. The delivery of primary care services is very heterogenous between and within countries. Many health facilities lack the basic necessities to provide proper care, such as essential medicines, basic diagnostic equipment, and adequate water and sanitation. Moreover, health care providers’ ability to diagnose and treat common health conditions correctly is low and distributed unevenly. Health personnel’s absence from health facilities remains a concern across the surveyed countries. Learning is low, and, not unlike health care, levels of student learning vary significantly across countries: less than half of grade 4 students can recite a simple sentence or perform basic mathematical operations. This deficient learning is correlated with teachers’ low levels of content knowledge and sub-par pedagogy skills. Some schools are also missing crucial inputs, such as blackboards or private and gendered toilets, and struggle with high pupil-teacher ratios. Despite these challenges, success stories in both sectors illustrate the quality of service delivery that could be achieved and showcase the dedication of teachers and medical staff across Africa. By studying data from thousands of facilities, considering the local context, and drawing insights from the literature, this book offers important insights for how countries can strengthen health and education systems and build back better in the wake of the massive disruptions brought about by the COVID-19 pandemic. -
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Ebb and Flow, Volume 2: Water in the Shadow of Conflict in the Middle East and North Africa
(Washington, DC: World Bank, 2021-08-23)The Middle East and North Africa Region encapsulates many of the issues surrounding water and human mobility. It is the most water-scarce region in the world and is experiencing unprecedented levels of forced displacement. Ebb and Flow: Volume 2. Water in the Shadow of Conflict in the Middle East and North Africa examines the links between water risks (harmful outcomes related to water, from droughts and floods to lack of sanitation), conflict, and forced displacement. It aims to better explain how to address the vulnerabilities of forcibly displaced persons and their host communities, and to identify water policy and investment responses. Contrary to common belief, the report finds that the evidence linking water risks with conflict and forced displacement in the region is not unequivocal. Water risks are more frequently related to cooperation than to conflict at both domestic and international levels. But while conflict is not necessarily a consequence of water risks, the reverse is a real and concerning phenomenon: conflict amplifies water risks. Since 2011, there have been at least 180 instances of intentional targeting of water infrastructure in conflicts in Gaza, Libya, the Syrian Arab Republic, and the Republic of Yemen. Forcibly displaced persons and their host communities face myriad water risks. Access to safe drinking water is a daily struggle for millions of forcibly displaced Iraqis, Libyans, Palestinians, Syrians, Yemenis, and international migrants in the region, heightening public health risks. Tanker trucks often help fill the gap; however, significant issues of water quality, reliability, and affordability remain. Host communities also face localized declines in water availability and quality as well as unplanned burdens on water services following the arrival of forcibly displaced persons. The reality of protracted forced displacement requires a shift from humanitarian support toward a development approach for water security, including structured yet flexible planning to deliver water services and sustain water resources for forcibly displaced persons and their host communities. -
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Ebb and Flow, Volume 1: Water, Migration, and Development
(Washington, DC: World Bank, 2021-08-23)Migration shapes the lives of those who move and transforms the geographies and economies of their points of departure and destinations alike. The water sector, and the availability of water itself, implicitly and explicitly shape migration flows. Ebb and Flow, Volume 1. Water, Migration, and Development presents new global evidence to advance our understanding of how fluctuations in water availability, as induced by rainfall shocks, influence internal migration, and hence regional development. It finds that cumulative water deficits result in five times as much migration as water excess does. But there are important nuances in why and when these events lead to migration. Where there is extreme poverty and migration is costly, water deficits are more likely to trap people than induce them to migrate. Water shocks can also influence who migrates. Workers leaving regions because of water deficits are often less advantaged than typical migrants and bring with them lower skills, raising important implications for the migrants themselves and receiving regions. Cities are the destination of most internal migrants, but even here, water scarcity can haunt them. Water shortages in urban areas, which lead to so-called day zero events, can significantly slow urban growth and compound the vulnerability of migrants. No single policy can be completely effective at protecting people and their assets from water shocks. Instead, the report puts forth a menu of overlapping and complementary policy options that target both people and places to improve livelihoods and turn water-induced crises into opportunities for growth. A key message is that policies that focus on reducing the impacts of water shocks must be complemented by strategies that broaden opportunities and build the long-term resilience of communities. Doing so will give individuals more agency to determine the best outcome for themselves and to thrive wherever they may choose to locate. -
Publication
The Human Capital Index 2020 Update: Human Capital in the Time of COVID-19
(World Bank, Washington, DC, 2020-09-16)Human capital—the knowledge, skills, and health that people accumulate over their lives—is a central driver of sustainable growth and poverty reduction. More human capital is associated with higher earnings for people, higher income for countries, and stronger cohesion in societies. Much of the hard-won human capital gains in many economies over the past decade is at risk of being eroded by the COVID-19 (coronavirus) pandemic. Urgent action is needed to protect these advances, particularly among the poor and vulnerable. Designing the needed interventions, targeting them to achieve the highest effectiveness, and navigating difficult trade-offs make investing in better measurement of human capital now more important than ever. The Human Capital Index (HCI) is an international metric that benchmarks the key components of human capital across economies. It was launched in 2018 as part of the Human Capital Project, a global effort to accelerate progress toward a world where all children can achieve their full potential. Measuring the human capital that children born today can expect to attain by their 18th birthdays, the HCI highlights how current health and education outcomes shape the productivity of the next generation of workers and underscores the importance of government and societal investments in human capital. The Human Capital Index 2020 Update: Human Capital in the Time of COVID-19 presents the first update of the HCI, using health and education data available as of March 2020. It documents new evidence on trends, examples of successes, and analytical work on the utilization of human capital. The new data—collected before the global onset of COVID-19—can act as a baseline to track its effects on health and education outcomes. The report highlights how better measurement is essential for policy makers to design effective interventions and target support. In the immediate term, investments in better measurement and data use can inform pandemic containment strategies and support for those who are most affected. In the medium term, better curation and use of administrative, survey, and identification data can guide policy choices in an environment of limited fiscal space and competing priorities. In the longer term, the hope is that economies will be able to do more than simply recover ground lost during the current crisis. Ambitious, evidencedriven policy measures in health, education, and social protection can pave the way for today’s children to surpass the human capital achievements and quality of life of the generations that preceded them. -
Publication
Fragility and Conflict: On the Front Lines of the Fight against Poverty
(Washington, DC: World Bank, 2020-02-27)Fragility and conflict pose a critical threat to the global goal of ending extreme poverty. Between 1990 and 2015, successful development strategies reduced the proportion of the world’s people living in extreme poverty from 36 to 10 percent. But in many fragile and conflict-affected situations (FCS), poverty is stagnating or getting worse. The number of people living in proximity to conflict has nearly doubled worldwide since 2007. In the Middle East and North Africa, one in five people now lives in such conditions. The number of forcibly displaced persons worldwide has also more than doubled in the same period, exceeding 70 million in 2017. If current trends continue, by the end of 2020, the number of extremely poor people living in economies affected by fragility and conflict will exceed the number of poor people in all other settings combined. This book shows why addressing fragility and conflict is vital for poverty goals and charts directions for action. It presents new estimates of welfare in FCS, filling gaps in previous knowledge, and analyzes the multidimensional nature of poverty in these settings. It shows that data deprivation in FCS has prevented an accurate global picture of fragility, poverty, and their interactions, and it explains how innovative new measurement strategies are tackling these challenges. The book discusses the long-term consequences of conflict and introduces a data-driven classification of countries by fragility profile, showing opportunities for tailored policy interventions and the need for monitoring multiple markers of fragility. The book strengthens understanding of what poverty reduction in FCS will require and what it can achieve. -
Publication
Healthy China: Deepening Health Reform in China
(Washington, DC: World Bank, 2019-03-28)The report recommends that China maintain the goal and direction of its healthcare reform, and continue the shift from its current hospital-centric model that rewards volume and sales, to one that is centered on primary care, focused on improving the quality of basic health services, and delivers high-quality, cost-effective health services. With 20 commissioned background studies, more than 30 case studies, visits to 21 provinces in China, the report proposes practical, concrete steps toward a value-based integrated service model of healthcare financing and delivery, including: 1) Creating a new model of people-centered quality integrated health care that strengthens primary care as the core of the health system. This new care model is organized around the health needs of individuals and families and is integrated with higher level care and social services. 2) Continuously improve health care quality, establish an effective coordination mechanism, and actively engage all stakeholders and professional bodies to oversee improvements in quality and performance. 3) Empowering patients with knowledge and understanding of health services, so that there is more trust in the system and patients are actively engaged in their healthcare decisions. 4) Reforming public hospitals, so that they focus on complicated cases and delegate routine care to primary-care providers. 5) Changing incentives for providers, so they are rewarded for good patient health outcomes instead of the number of medical procedures used or drugs sold. 6) Boosting the status of the health workforce, especially primary-care providers, so they are better paid and supported to ensure a competent health workforce aligned with the new delivery system. 7) Allowing qualified private health providers to deliver cost-effective services and compete on a level playing field with the public sector, with the right regulatory oversight, and 8) Prioritizing public investments according to the burden of disease, where people live, and the kind of care people need on a daily basis. -
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Monitoring Global Poverty: Report of the Commission on Global Poverty
(Washington, DC: World Bank, 2017)In 2013, the World Bank Group announced two goals that would guide its operations worldwide. The first is the eradication of chronic extreme poverty -- bringing the number of extremely poor people, defined as those living on less than 1.25 ppp-adjusted dollars a day, to less than 3% of the world population by 2030. The second is the boosting of shared prosperity, defined as promoting the growth of per capita real income of the poorest 40% of the population in each country. Last year, UN member nations agreed in New York to a set of post-2015 Sustainable Development Goals (SDG), the first and foremost of which is the eradication of extreme poverty everywhere, in all its forms. Both the language and the spirit of the SDG objective reflect the growing acceptance of the idea that poverty is a multi-dimensional concept that reflects multiple deprivations in various aspects of well-being. That said, there is much less agreement on the best ways in which those deprivations should be measured; and on whether or how information on them should be aggregated. This report advises the Bank on the measurement and monitoring of global poverty on two areas: • What should be the interpretation of the definition of extreme poverty, set in 2015 in Purchasing Power Parity (PPP)-adjusted dollars a day per person? • What choices should the World Bank make regarding complementary monetary and non-monetary poverty measures to be tracked and made available to policy-makers? The World Bank plays an important role in shaping the global debate on combatting poverty, and the indicators and data the Bank collates and makes available shape opinion and actual policies in client countries, and, to a certain extent, in all countries. How we answer the above questions can therefore have a major influence on the global economy. -
Publication
Deepening Health Reform in China: Building High-Quality and Value-Based Service Delivery
(Washington, DC: World Bank, 2016-07-22)At a meeting in July 2014 in Beijing, we committed to working together on a flagship report that would help set the direction for health sector reform in China. This report, Deepening Health Reform in China, is the result. Using the successful model offered by previous flagship reports like China 2030 and Urban China, this report primarily offers a blueprint for a new direction for China’s health sector. The report’s main theme is the need for China to transition its healthcare delivery system toward people-centered, quality, integrated care built on the foundation of a strong primary healthcare system.