COVID-19: Challenging the resilience of health and education systems

Today, COVID-19 poses new threats to human capital accumulation. The pandemic has dramatically affected health, not only through its toll on human lives but also through potential long-term reductions in healthy functioning among survivors of the disease (Mahase 2020). School closures and the shift to remote learning have reduced access to education and may prove particularly damaging for children from disadvantaged backgrounds and for girls (World Bank 2020b). Along with these direct impacts, the pandemic is also affecting systems and people’s lives through indirect mechanisms, including disruptions in non-COVID-19 essential health services and sharp declines in family income following lockdowns (Corral and Gatti 2020).

The pandemic has affected both the supply of and demand for essential care, as providers have struggled to keep up with the care needs of patients with COVID-19; at the same time, many citizens have chosen to avoid health facilities, often forgoing needed care, in order to avoid potential COVID-19 exposure. Experience from previous epidemics suggests that the indirect effects on population health may ultimately cause greater harm than the virus itself (Elston et al. 2017). Evidence already indicates sharp drops in routine immunization coverage during COVID-19 (Jain et al. 2020). The impact on maternal and child health is expected to be especially severe. Early model predictions at the global level suggest a monthly increase in maternal and child mortality of up to 39 percent and 45 percent, respectively, attributable to COVID-19–related poor nutrition and interruption of essential health services (Roberton et al. 2020).

On the education side, there is a potential “lost generation” of learners, reflecting the direct threat of the crisis, the prolonged interruption of schooling, and expected increases in poverty (UNICEF 2020). Worldwide school closures due to COVID-19 are likely to worsen learning disparities, as disadvantaged families are less able to facilitate home-based learning for their children. Dropout rates have increased, and many students no longer benefit from nutritious school meals or the structure, social engagement, and general support afforded by schools (World Bank 2020b).

Although data on the pandemic’s impact on human capital are just trickling in, simulations show that the COVID-19 crisis may roll back a decade of hard-won human capital gains unless significant investments are made to protect human capital. With 26 million to 40 million additional people pushed into extreme poverty in 2020 (World Bank 2020c), disruptions in immunizations and other routine health services (WHO 2020), and widespread school closures (Human Rights Watch 2020), the COVID-19-induced risks are especially critical in Africa. The global economic downturn may also result in declining levels

of public revenue and rising levels of debt, which will increase fiscal constraints and make using resources wisely even more imperative.

Leveraging the crisis response to improve systems

Given these challenges, building the strength and resilience of health and education systems has taken on new urgency in Africa and elsewhere. Many governments have already begun building flexibility and adaptability into systems, both to provide services during the emergency and to ensure that systems are better able to respond to changing environments in the future.

Resilience has been defined as “the ability of people, households, communities, countries, and systems to mitigate, adapt to, and recover from shocks and stresses in a manner that reduces chronic vulnerability and facilitates inclusive growth” (USAID 2012). The current pandemic has shown variability in the adaptiveness of health systems. Many health facilities were underprepared for the initial wave of COVID-19 cases, with very limited capacity to provide critical care and little guidance on isolation and containment procedures. In addition, many lower-level facilities lacked adequate handwashing facilities, had little or no personal protective equipment, and did not have the necessary communication equipment (Sharma et al. 2020). Similarly, education systems have been strained by the abrupt shift to remote learning and have had to make quick decisions on when and how schools should remain open.

The current crisis highlights the centrality of health and education systems in saving lives and protecting the human capital on which economies depend. Countries now face the dual challenge of controlling the current outbreak and rebuilding systems capable of developing human capital and meeting citizens’ long-term expectations. As COVID-19 vaccines are being rolled out, governments can look toward a future after the pandemic and incorporate lessons from the crisis to build greater resilience into their systems. What steps should systems follow to build back better? What failings existed prior to the pandemic that can now be remedied? How can countries invest most strategically in services to protect and strengthen human capital for today and tomorrow?

Evidence to inform action

Tackling these challenges will require policy choices informed by evidence. Success in “building back better” will depend to an important degree on the quality and relevance of evidence available to inform policy makers’ decisions and stakeholders’ actions, including how to target resources for the highest returns. Therefore, measurement will play a crucial role in enabling countries to transform their health and education systems after the crisis.