How can the World Bank improve COVID-19 Emergency Response and vaccination projects in Latin America and the Caribbean?

As the World Bank supports the COVID-19 recovery and vaccine rollout in Latin America and the Caribbean, it must hold governments accountable to equitable vaccine distribution, prevent the centralization of COVID-19 health services in urban areas, and include marginalized groups in project design and implementation to advance an inclusive COVID-19 response. Failure to do so risks exacerbating existing inequalities in the region.

The COVID-19 pandemic and its associated economic and social impacts have hit Latin America especially hard, exacerbating existing social and economic disparities. Upcoming World Bank-funded vaccine projects have the potential to increase health inequalities if the Bank does not prioritize the inclusion of Indigenous Peoples, Afrodescendants, LGBTQI individuals, persons with disabilities, rural communities, and other marginalized groups in vaccine rollouts. Throughout Latin America marginalized groups are frequently ostracized and their governments often do not listen to their concerns nor include them in government programs, increasing inequality and discrimination towards marginalized groups. 

BIC worked with partners in El Salvador (AMATE/COMCAVIS TRANS) to monitor the Bank’s COVID-19 Emergency Response project in El Salvador and with CEGSS in Guatemala to monitor the Bank’s COVID-19 Emergency Project in Guatemala. Our partners highlighted that the pandemic has revealed numerous weaknesses of the regional health systems such as a lack of protective equipment, testing and medical supplies, hospital beds, cold chain equipment, and health worker training. 

The Bank expects to provide USD $160 billion to Borrowers globally to support COVID-19 response projects, and a great share of this funding is being directed to COVID-19 response and vaccination projects in Latin America and the Caribbean. To prevent these projects from contributing to the further marginalization of women, children, LGBTQI individuals, and persons with disabilities in Latin America, the Bank should:

  1. Push for increased transparency in the implementation of COVID-19 emergency and vaccination projects. The Bank needs to actively supervise its COVID-19 response and vaccination projects to avoid excluding marginalized groups from project benefits. As Latin America has one of the highest corruption levels in the world and low government transparency levels, there is a high risk that governments are not disclosing information that civil society needs to hold their governments accountable. The Government of El Salvador has marked the national COVID-19 vaccination rollout plan and the vaccine procurement process as “reserved information,” meaning that local communities and organizations do not have access to this information. In Guatemala, neither the Bank nor the Borrower disclosed the original stakeholder engagement plan in Spanish or other local languages, making it difficult for marginalized groups such as Indigenous Peoples to access project information and actively engage throughout the project cycle. Disclosure of information represents one of the biggest challenges in the region. Clear and equitable vaccine distribution plans are fundamental to the success of the COVID-19 Additional Financing projects. The Bank needs to regularly monitor whether COVID-19 vaccination plans are being publicly disclosed, diligently implemented, and raise concerns with Borrowers when irregularities arise.
  2. Prevent centralization of COVID-19 health services in urban areas and specialized consultative care hospitals. In both of the COVID-19 emergency response projects in Guatemala and El Salvador, the Bank is centralizing COVID-19 project investments in urban areas. Centralizing COVID-19 efforts at specialized consultative care healthcare institutions in urban regions in Latin American countries could increase social inequalities and exacerbate other social issues such as migration, poverty, and gender gaps. Since most local hospitals in rural and remote areas do not provide COVID-19 related services or lack the supplies to do so, communities inhabiting territories far from the capital’s metropolitan area have to make costly journeys that can last several hours to receive specialized care in urban areas. The Bank must recognize that centralizing its COVID-19 investment in urban specialized healthcare institutions could harm tens of thousands of families who reside far from urban areas and experience greater obstacles to access specialized health services. 
  3. Increase inclusion of marginalized groups in consultations during project design and implementation. To promote meaningful consultations around project design and implementation, the Bank should work with Borrowers to amplify the voices of rural and marginalized communities. In the El Salvador COVID-19 project, the Bank and Borrower did not include LGBTQI communities throughout the country in consultations, and in Guatemala they did not inform communities and marginalized groups about the implications of the project, so they were not aware of their right to access project benefits. Both in Guatemala and El Salvador, the Bank has not made the COVID-19 projects’ communication and dissemination strategies accessible for marginalized communities. Communication strategies need to be culturally inclusive, sensitive, and accessible for marginalized groups so that campaigns reach all social sectors and do not replicate prejudices, stigmas, or re-victimize populations. Furthermore, it is not clear how the Bank processed feedback and concerns gathered during consultations or incorporated it into the COVID-19 projects. The Bank needs to work with Borrowers to follow up with the civil society organizations that participated in the consultations and include their feedback in the project design and implementation. Civil society and marginalized groups can better hold their governments accountable and understand how to access project benefits when the Bank prioritizes their input.  

For the Bank to effectively respond to the COVID-19 pandemic, it needs to hold governments accountable to an equitable vaccine distribution plan, provide vaccination access to people in rural and remote areas, and include marginalized groups in the consultations throughout the project lifecycle. The Bank should see COVID-19 response and vaccine projects as an opportunity to build inclusive, robust health systems that include marginalized groups so that countries can respond better and more equitably to emergencies and health challenges in the region. 

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