BURLINGTON, Vt. — The World Bank’s efforts to move large amounts of funding quickly to help countries respond to the COVID-19 pandemic have left some groups worried that marginalized populations might fall by the wayside when it comes to designing and implementing those projects.
In April, the World Bank’s board of executive directors approved its first group of emergency support operations, part of a plan to mobilize $160 billion over the course of 15 months — by June 2021.
Groups that have followed the design and implementation of these fast-track projects are raising concerns that project documents are not adhering to requirements that they specifically identify marginalized populations; that project consultations are falling short on including civil society representatives; and that the projects don’t consistently address cost barriers that prevent some people from accessing health services.
Their concerns highlight the difficult balancing act required by a pandemic that demands rapid and large-scale assistance for lower-income countries, and the importance of an inclusive, consultative approach that ensures the most vulnerable are not excluded from accessing care.
“Traditionally, there hasn’t been as much scrutiny in health projects, because people think that they don’t have the same amount of risk as, say, an infrastructure project,” said Rachel Burton, social inclusion director at the Bank Information Center, a group that tracks multilateral development banks.
As funding activities in support of the COVID-19 response transition from words into action, our analysis of funding data is transitioning with it. Here's the latest.
“But obviously, in this case, with the COVID-19 health response, the fact that you’re potentially leaving people out of project design and not creating ways in which all marginalized groups will be able to benefit is huge, and the consequences could be dire if we’re not including all of these groups,” Burton said.
World Bank officials counter that the entire point of the fast-track approach is to reach vulnerable countries with the support they need as quickly and at as large a scale as possible. They say they operate according to the bank’s environmental, and social framework, and note that there are grievance mechanisms available for those with concerns about project implementation.
“We have mounted what is probably the largest crisis response that the World Bank Group has ever put together,” said Mamta Murthi, the bank’s vice president for human development.”
“This is being done at a point of time when all of us are working from home, and government counterparts are working from home. Actually just the scale of what we’re doing and the speed with which it’s being put together is unprecedented,” Murthi added.
Murthi said to facilitate the fast-track process, the bank has used a standard template for project design, but she added that should not be taken as a sign that projects have ignored the bank’s environmental and social framework, which requires consultation with communities and aims to mitigate negative impacts.
“The purpose of the template is actually so that nothing is forgotten,” Murthi said.
“The World Bank’s response to the pandemic has been rapid and substantial, but it also has significant gaps.”— Katie Malouf Bous, senior policy adviser, Oxfam
BIC has looked at a handful of fast-track projects in detail, and they are not convinced that governments are consistently looking at the disaggregated impact on each disadvantaged or vulnerable group that the bank’s policies require, Burton said.
In the Philippines, for example, BIC works with an organization focused on persons with disabilities, and their review of a bank-supported project raised concerns about whether enough was being done to ensure that this population would be able to access services like COVID-19 testing.
“In the project documents we weren’t really seeing the specificity that we wanted to see in terms of how the project was being designed in such a way that persons with disabilities would be able to benefit and there would be no barriers to them receiving that benefit,” Burton said.
When BIC raised this concern, the bank said it would be addressed during the implementation of the project, which Burton described as “a huge problem.”
“It’s very difficult to change projects when they’re already running. It’s easier to change a project during design,” she said.
Burton noted that in some of the countries where BIC works with partner organizations, they have been successful in ensuring that civil society representatives of marginalized groups are included in virtual consultations about a project.
“Thinking about countries where we’re not working, or where we don’t have active partners who are really pushing on this, we’re very concerned that nothing is happening,” she said.
Oxfam has also analyzed the emergency health projects that are part of the World Bank’s COVID-19 Strategic Preparedness and Response Program. They found that as of June 30, only 8 of the 71 projects they reviewed made any attempt to eliminate or suspend out-of-pocket fees for health care — a barrier to access the World Health Organization has said should not apply during the COVID-19 response.
“The World Bank’s response to the pandemic has been rapid and substantial, but it also has significant gaps,” Katie Malouf Bous, Oxfam’s senior policy adviser, wrote to Devex by email.
“If people can’t afford testing and care for COVID-19 and other critical health needs, the disease will continue to spread unchecked and more people will die. Most of the countries the Bank is supporting with this financing have prohibitive fees for healthcare and so it’s imperative that the Bank help them to eliminate these in line with the clear guidance from the World Health Organisation,” she added.
Murthi, from the World Bank, also emphasized the need to ensure that low-income and marginalized populations are included and specifically considered in the design of COVID-response projects.
“We all know that the pandemic is having a more devastating impact on poor and marginalized groups. You wouldn’t have effective project design if you didn’t do that,” she said.
While affirming that the fast-track projects have all operated under the bank’s environmental social framework, she also noted that the basic premise of the fast-track response is to assist those who are most vulnerable.
Through these projects, the bank has focused on community engagement, Murthi said, to ensure people have the information they need about the virus.
The bank has worked to secure medical and personal protective equipment, including for fragile and conflict-affected states such as Yemen and the West Bank-Gaza. The bank has also helped countries scale up social safety nets by improving cash transfer systems and other means of reaching people affected by the pandemic.
“Having supervised these projects myself as a task team leader, even if you’re not in the middle of a once-in-a-100-year pandemic, you don’t get everything right,” Murthi said.
“That’s precisely why a grievance-redress mechanism exists, so that you can improve as you go along,” she added.