In the face of the COVID-19 pandemic, many countries are seeking World Bank financing for emergency response projects from its $14 billion COVID-19 support package. Most of these projects will immediately serve to bolster the needs of countries’ health systems to cope with the virus, yet they will soon be followed by additional projects aimed at addressing the economic downturn resulting from the pandemic. The World Bank should carefully consider how projects in both the health response and economic recovery phases of its support package address the needs of marginalized groups.
Phase I: Emergency Health Response
In designing its COVID-19 emergency health projects, the Bank should:
Engage with marginalized groups and provide essential information
While countries need funding and resources urgently to cope with the impacts of COVID-19, the fast track nature of these World Bank projects means that there is little time to meaningfully engage with communities and stakeholders. Less extensive consultations that don’t explicitly target input from marginalized groups -- such as women, children, persons with disabilities, the LGBTQI community, racial, ethnic and religious minorities, and indigenous peoples, among others -- increase the risk that these groups could be excluded from accessing project benefits and ultimately leave them even more vulnerable to being left behind.
In general, most countries are seeking funds in order to, among other things, improve the availability of medical supplies; strengthen disease surveillance systems; and implement public education and behavior change interventions to promote behaviors like hand-washing and social distancing. This type of vital information about how COVID-19 spreads and how to reduce transmission is especially important for marginalized groups who might be at even greater risk for infection, such as those living in orphanages, institutions, residential schools, or those relying on others for personal care such as persons with disabilities. It must be available in a variety of accessible formats, such as large print, Braille, and in local languages, and from different outlets, including social media, radio, and newspapers, so that it can reach the entire population.
Restructure projects with marginalized groups in mind
The main goal of the health emergency response projects is to limit the spread of COVID-19 in each country, improve the country’s ability to respond to the pandemic, and broadly strengthen each country's emergency preparedness. The components of these projects vary depending on the needs of each country, but all of them will have elements that require the Bank and its clients to consider how marginalized groups will be able to benefit. The focus on project benefits is especially important in projects that were originally designed for a specific population, such as women, children, and adolescents, but are being restructured and must now take into consideration those most vulnerable to COVID-19, such as the elderly. For instance, restructured projects under the Global Financing Facility (GFF), focused on reproductive, maternal, neonatal, child and adolescent health and nutrition (RMNCAH-N), must continue to provide vital RNMCAH-N services, such as those for pregnant women, as well as COVID-19 response services that are not at odds with each other. A strong COVID-19 response is critical but cannot be at the expense of RNMCAH-N services.
Assessments that underscore the risks to each marginalized group, including those groups that would not have previously been touched by these RMNCAH-N or other targeted projects as they were originally designed, play a fundamental role in highlighting how all who are vulnerable to COVID-19 can benefit, since this may be a different population from those benefiting from RMNCAH-N or other specific programming. For example, an elderly man would not be touched by a RMNCAH-N project, but with a RMNCAH-N project being restructured for COVID-19 response, it is imperative that his needs and particular vulnerabilities to COVID-19 be taken into consideration and supported. It is also important that this information about project restructuring be shared with civil society organizations (CSOs) in-country, such as those that are part of the GFF CSO platform, so that CSOs know where additional money is being reprogrammed to address COVID-19 and can continue to hold the GFF and the Bank accountable. In addition, project teams should incorporate alternative forms of stakeholder engagement now that in-person consultations and gatherings are not feasible. In designing and planning for stakeholder engagement, teams should consider how to reach marginalized groups using methods of engagement that are safe, trusted, and accessible to them.
Avoid day-to-day health disruptions that disproportionately impact marginalized groups
In addition to managing prevention and treatment of the virus itself, many of the Bank projects also seek to avoid day-to-day health disruptions caused by the extra burden health care facilities are experiencing from COVID-19. Studies show from the 2014-2015 Ebola outbreak that more people died from failures to provide day-to-day health care than from Ebola, and the same could be true for the current pandemic. Projects, such as those for the Democratic Republic of Congo and Ghana, include “health system strengthening” components that will support countries’ existing health care systems and maintain essential community services. But special attention must be paid to making care accessible to the most marginalized, who already face obstacles in getting care and medicines, especially in countries with lockdowns that make getting vital medication like antiretroviral drugs very difficult and dangerous. Marginalized groups will be hurt disproportionately by overburdened health facilities, some of which might not even be accessible for persons with disabilities.
Differentiate between marginalized groups
In designing any health project, it is important that the World Bank and country governments consider the needs of marginalized groups, such as access to quality, non-discriminatory basic health services, affordable food and water in the community, and supports for those at-risk of sexual exploitation or abuse and survivors of gender-based violence, so that they receive the project’s intended benefits. The LGBTQI community, for example, are exposed to specific health-related risks and have certain health needs different from the general public, and these needs may need to be addressed differently for different groups. It is even more important during a time of crisis to look at the differentiated impacts of projects on marginalized groups so that they have access to the essential supports and services being provided by Bank projects. This means that project documents must specifically reference each “disadvantaged and vulnerable group” and identify how each group will benefit from a project.
Phase II: Economic Recovery
Additionally, marginalized groups are disproportionately impacted by the economic crisis that has resulted from the consequences of the pandemic and must remain a central focus of all economic recovery projects. As such, in designing these projects, the Bank should:
Keep in mind that marginalized groups will be most acutely impacted
Individuals who are the most marginalized are at a higher risk than others of losing their employment during the crisis. While many government agencies and private companies have suspended collecting fees for water or have agreed to not cut off vital water taps in communities in the short term, those who are unable to pay for water when fees return face having to travel long distances for affordable water and are at a higher risk of violence. Once schools reopen, the economic crisis will also have a significant impact on school attendance since many children and youth might be engaged in child labor so that their families can afford basic necessities. Additionally, children and youth often drop out of school when they are unable to pay school fees or for transportation to and from school, mid-day meals, and school uniforms. This will most likely be exacerbated for children and youth with disabilities, indigenous children and youth, and girls. To account for marginalized groups being more vulnerable to poverty and unable to meet basic needs, the Bank must place even more of an emphasis than usual on the possible social impacts of projects on each marginalized group, and on how these projects will address the needs of the most marginalized rather than just the needs of certain sectors or industries.
Maintain the focus on marginalized groups regardless of lending instrument used
Marginalized groups are also at significant risk for being overlooked or discriminated against in Bank projects aimed at mitigating the economic crisis, especially if these projects are not subject to the Bank’s Environmental and Social Framework (ESF), such as policy based lending. For example, projects that provide unemployment benefits to citizens of countries could exclude non-citizens who would also benefit from unemployment compensation. Projects that create additional paid sick leave could also ultimately leave out those who have temporary jobs or participate in informal employment that do not entitle them to benefits like sick leave, which women are more likely to have. As we have seen in some social safety net projects, marginalized groups like persons with disabilities are sometimes unable to meet the conditionalities of cash transfer projects due to inaccessible health or education systems, leaving them unable to benefit from poverty reduction projects. Project objectives must address the specific barriers to project benefits for each “disadvantaged and vulnerable group,” as defined in the ESF, and for those projects not subject to the ESF, disbursement linked indicators or prior actions, like policy or institutional changes, must be inclusive of marginalized groups and assess how they will not leave behind those that are even more vulnerable to poverty.
The World Bank can add significant value to the global efforts to mitigate the worst impacts of the COVID-19 pandemic. But it is critical that the World Bank make reducing the disproportionate burden the pandemic places on the poorest and most marginalized a critical component of its emergency response projects.
This article is co-authored by Rachel Bergman.