A series of briefs on Leadership in Times of Crisis produced by the Harvard Ministerial Leadership Program as part of its outreach to and support of participating Ministers and senior officials.
Preparing for Vaccine Delivery in Africa
On February 17 the Harvard Ministerial Leadership Program and the United Nations Economic Commission for Africa co-hosted a webinar with some of Africa’s most experienced leaders on what practical steps governments should be taking now to organize across government and in communities to meet public expectations that vaccines will be equitably distributed and accessible. Panelists include: H.E. Ellen Johnson Sirleaf, former President of Liberia; Hon. Awa Marie Coll-Seck, Minister of State, former Minister of Health; and Social Action of Senegal; Hon. Cristina Duarte, UN Special Advisor on Africa, former Minister of Finance of Cabo Verde.
1 - Leading Through Times of Crisis
Ministers play a critical leadership role in times of crisis as they need to ensure public confidence in the government and its leaders, while planning and directing an effective response. The advent of the novel coronavirus is an enormous global crisis and threatens every country on a variety of levels. the challenge for Ministers will involve keeping populations safe, calm, and cooperative. There is also an opportunity for Ministers to act proactively and demonstrate sound leadership. below are some key pointers to support ministerial leadership through this period of crisis:
1. Know what you are dealing with: Collect all relevant data, take time to review it, and ensure you have a clear picture of the situation. Time is of the essence, but hurried action can lead to missteps so take time to ensure you have the full picture. This can be a scary step, but it is important to drive decision making, communication, and effective stewardship through a time of crisis.
2. Continuously evaluate the situation from the balcony: Maintain a high-level view of the situation and, while it is likely necessary for you to dig into the details with your team, always ensure you are able to see the big picture and use it to inform your decision making. Regularly return to ‘the balcony’ to ensure you are always aware of the context in which your decisions are being made.
3. Be an active listener and communicator: Listen to the advice you want to hear and the advice you do not want to hear. Often unpopular advice is the advice most worth hearing and considering as a leader – whether or not you decide to take it. Similarly, be a calm, honest, and positive communicator with your team and with your general population. If you choose, designate a single person to be the key point of communication so that a relationship of trust can be built with that person. Given that ‘social distancing’ strategies are likely to be part of your plan to combat this virus, effective communication will be critical to mobilizing collective action and implementing your strategic plan.
4. Stay flexible to deal with this as an adaptive challenge: The situation may change rapidly and often – you cannot be married to a single strategy. At some point you may not have optimal data to inform critical decisions. You may also realize that an initial course of action did not have the impact you hoped. Continuously review the most current data, assess trends, and be humble enough to change course and/or to admit mistakes if needed.
5. Collaborate: You are not in this alone. Work together with your fellow Cabinet Ministers, but also feel free to reach out to your Harvard Ministerial peers and resource members from other countries to learn from their approaches or advice.
2 - How to Communicate Effectively
Effective communication during a crisis is always necessary, but it is of particular importance in battling COVID-19 because public engagement and compliance are crucial. Leaders have a principal responsibility to communicate truth and facts, dispelling myths and misinformation. Accuracy and consistency are essential to establishing public trust and confidence in the credibility of their leaders and the message. Effective communication is an essential part of the effort to combat the pandemic and should not be coincidentally regarded or casually executed. Below are a series of steps that can be taken to ensure you have an effective communication strategy to underpin your country’s pandemic response:
1. Develop a strategic communications plan tailored to your country’s needs: A clear organizational communication plan is critical to ensuring people have the facts, understand their situational risk, and are educated about measures to curtail infection. Identify the objectives of your communication strategy based on your country’s situation, community knowledge, and response priorities. For each objective, identify the key audience that needs to be targeted, decide on the most appropriate ‘messenger’ for the target audience, as well as the channels to be used (consider the use of social media, influencers, and other alternatives in addition to traditional media). Also consider the role of various stakeholders like churches, mosques, trade unions, etc. Determine the financial and human resources needed to sustain the communication effort over many (6-18) months. Review the available information, education, and communication materials from the World Health Organization and other credible organizations and adapt them to your needs (see links for potential resources below).
2. Coordinate to ensure optimal national coverage and public awareness: Establish coordination mechanisms to allow for rapid communication at local, regional, and national levels across different sectors, ministries and civil society. Develop a communications flowchart mapping the principal points of communication contact across the country to ensure optimal national coverage and message filtration to the remotest communities. Ensure that communication is occurring in both directions, i.e. you are able to spread your message, but also able to hear what is happening outside of your own ‘bubble’.1. Develop a strategic communications plan tailored to your country’s needs: A clear organizational communication plan is critical to ensuring people have the facts, understand their situational risk, and are educated about measures to curtail infection. Identify the objectives of your communication strategy based on your country’s situation, community knowledge, and response priorities. For each objective, identify the key audience that needs to be targeted, decide on the most appropriate ‘messenger’ for the target audience, as well as the channels to be used (consider the use of social media, influencers, and other alternatives in addition to traditional media). Also consider the role of various stakeholders like churches, mosques, trade unions, etc. Determine the financial and human resources needed to sustain the communication effort over many (6-18) months. Review the available information, education, and communication materials from the World Health Organization and other credible organizations and adapt them to your needs (see links for potential resources below).
3. Monitor the impact of your efforts: Because the battle against COVID-19 will require sustained effort over many months, it is important to monitor through on-going public research the impact of government messaging on different communities’ knowledge, attitudes, and perceptions, with a specific focus on high-risk populations. Rapid qualitative assessment tools to obtain this information can be found here. Take note of characteristics that can strengthen or hinder future communication efforts, e.g. communication patterns and channels, language, religion, or influencers. Be on the lookout for misinformation and rumors so that they can be quickly refuted with facts. Accuracy and consistency are essential to the plausibility of your message. Monitor the objectives of the strategy and their outcomes to track impact and ensure progress or motivate course correction where needed.
4. Trust your instincts as a leader: You are going to have to make hard decisions in the coming months about how and what you communicate with your people. Can effective communication persuade the level of community action you need or is a more rigid ‘lockdown’ enforcement necessary to coerce cooperation? Is it worth sugarcoating the situation to keep people calm or highlighting the risks to motivate adherence to the restrictions? Keep telling people what you need them to do and what may be coming next so they are ready to adjust with your guidance. Validate their feelings of resistance, anxiety, stress, and fear with your own. Be honest about what you do know and sometimes about what you don’t yet know. Oftentimes, messaging can be more impactful than the decisions that are being messaged about – so choose your words wisely and allow the humanity in you and your government to come through.
3 - The Role of The Health Minister in the COVID-19 Response
The COVID-19 pandemic is an unprecedented global challenge, but it presents an opportunity for Ministers of Health to step up and take charge at this time of crisis. Here are some tactical points to guide and encourage Health Ministers as they lead their country’s battle against COVID-19. Most importantly, although the Health Minister naturally has the lead in tackling a public health crisis, the rapidly escalating scale of the COVID-19 pandemic demands a whole government response if countries are to effectively curb the impact. The Health Minister needs to show the ability to work collaboratively across government and sectors:
1. Ensure there is a strategy with actions prioritized based on the stage of the epidemic and the country’s current reality: The Minister of Health must proactively take charge of the response relying on data-based decision making to inform a national response strategy. The Minister should prepare a response plan tailored to their context and update the plan as the situation evolves. Be honest about the situation. If your initial strategy does not achieve the desired impact, change course. For countries with few to no cases, the focus could be on
strengthening their surveillance systems, lab testing capacity, and infection and prevention control measures for healthcare providers. Whereas in a country with more cases, the objective might include movement restrictions, social distancing and mitigating economic impact. Early pre-emptive preparation is the best approach for ensuring success.
2. In the midst of so much uncertainty and ambiguity, provide strategic clarity: It is important for public understanding of the country’s strategy and getting the whole government on board to clearly lay out the vision for the response, including data-backed scenarios for the intended outcomes of various restrictive measures. Leverage local and global expertise, knowledge and resources, including experts, who have faced similar challenges and other decision makers who are able to deploy resources (financial, human, technical) required to execute on the actions discussed. To foster clarity, lead the synthesis and translation of evidence and knowledge to guide the country’s response in the short term and in the long term.
3. A focused and dedicated central coordination team is needed: In such a crisis, ‘business as usual’ in the health ministry and across government will not suffice. It is important to have a trusted and highly skilled team, that is 100% devoted to this effort. Different versions of this exist, e.g. Delivery Units, Emergency Operations Centers (EOC) and Data Control rooms. Whatever form it takes, key capabilities required include data management, analytics, problem-solving technical leadership and coordination. In addition, the team should have mechanisms to track, monitor, forecast, and test the impact of initiatives deployed in real-time and be ready to adjust strategy. The bottom-line is no matter how good the delivery team, there is no substitute for strong, clearheaded leadership from the Minister of Health.
4. Create a high-level multisectoral governance structure and response, with support from the Head of State: Interventions to control the epidemic require action and alignment across government, including finance, security, education, customs, transport, along with the private sector. Direct access by the Health Minister to the President or Prime Minister to provide needed support is critical. In addition, collaborate with private sector and civil society partners (e.g. telecommunication– Viamo’s mobile solution for COVID-19 response) who have established initiatives to respond to the crisis and can help government in its efforts.
5. Manage communication and promptly address any misinformation: Effective communication is an essential leadership tool. The Health Minister should be a trusted, authoritative source of factual and credible information. Keep the public frequently updated on the state of things in the country and show empathy with people’s fears and distress. Tailor information to various stakeholders and use a variety of media platforms. Quickly countering misinformation is important.
6. Focus on iteration rather than perfection: Despite having excellent strategies, one needs to prepare for unexpected outcomes. Given the constantly changing nature of this epidemic, focus less on getting everything planned perfectly, but more on making accommodation for iteration. Implementation might not be perfect and could be somewhat messy, but the Minister should be intentional about this and embed learning in the strategy.
Interview with Dr. Kelechi Ohiri, Former Special Advisor to the Minister of State for Health, Nigeria
4 - Insights from Liberia's Campaign to Contain the 2013-2016 Ebola Crisis
Between 2013-2016 the world faced a significant threat from the global spread of a major outbreak of Ebola centered in three West African countries, Liberia, Sierra Leone and Guinea, resulting in about 12,000 deaths in those countries. There are important lessons to be learned from those who were at the center of the response to that global health emergency that apply to the fight to contain the spread of COVID-19. One of the primary lessons learned is the important role Ministers play in periods of crisis as the principal advisors to the President or Prime Minister. It is impossible to over-estimate the role of political leadership in responding to a pandemic. How a country responds and whether it keeps the pandemic under control will depend on the quality of its political leadership. Below are six pieces of advice learned from Liberia’s fight to contain Ebola that can be of value for Ministers in responding to COVID-19:
1. Make a comprehensive plan: This plan will be subject to periodic revisions and adapted to the changing situation, but a plan is necessary. Even if only a portion of the plan is implemented, the planning process itself will enhance the response. Pay attention to what your neighboring states are doing, share information, and adapt your plans accordingly.
2. Responses should be community-focused: The crisis is a test of the health system, the governance and administrative capacity of the state (especially in how it organizes itself to respond), and the depth of its social cohesion. What begins as a health crisis will expose weaknesses in governance capacity and make exacting demands on the state’s reservoir of social capital. Compliance with movement bans and other behavior changes require trust in the government. In a few African countries where this trust is lacking, governments have resorted to coercion. In Liberia, we made the same mistake at the outset of our response. We course corrected and a community-focused response evolved producing a far better result.
3. Social capital is built over time and cannot be manufactured in times of crisis: Governments must therefore tap other repositories of trust to get compliance from their citizens. Religious and traditional leaders, popular culture stars – musicians, sports personalities and film actors – sometimes have greater credibility and should be incorporated into the response architecture.
4. Testing is vital: Even for states with limited resources, you have to invest upfront in testing, and reach out to partners who can assist. Expansive testing allows us to move quickly to the next step, which is isolation to break transmission chains.
5. Isolation must be the top priority to break the transmission chain: Expansive testing allows us to catch even asymptomatic carriers and isolate them from the general population. We can then trace their contacts and place them under observation. Without testing, isolation, and contact tracing, we will not be able to break the transmission chain. Along the way, people get frustrated with the social distancing rules. It is incumbent on the government to maintain vigilance, continually keep the public informed about the facts of the pandemic and the reasons for continued restrictions.
6. Specialized clinic sites must be in place: In places where healthcare systems are fragile preemptive containment of citizens who test positive for COVID-19 or are suspected of having been exposed to the virus is important. Select a site, be it an existing hospital, tent hospital or other disused facilities so that as soon as anyone reports symptoms related to the virus, they go directly to specialized clinics. In the past month, Mozambique has followed this path and set up 4,000 tents to handle flu, cough, cold and any diseases with flu-like symptoms including the COVID-19.
Interview with W. Gyude Moore, former Minister of Public Works, Liberia
This brief was prepared for the Harvard Ministerial Leadership Program by W. Gyude Moore, former Minister of Public Works, Liberia.
5 - The Role of the Minister of Education Leading the Response to the COVID-19 Pandemic
The Minister of Education has a unique responsibility during the current COVID-19 pandemic to lead an extraordinary effort to keep children learning, even when regular in-class instruction is suspended. Continuing education while the country battles this public health crisis should be central to the government’s COVID-19 strategy. Below are some guiding principles for Ministers of Education as they lead during this time of crisis:
1. Establish a Plan for Continuing Education During the Crisis: The Minister of Education must act in concert with the whole government strategy for combating the COVID-19 pandemic. Many countries have already suspended schooling for extended periods as part of their strategy. This is an essential public health measure, but a huge disruption to education. Depending on how long the suspension of regular schooling is likely to go on, alternative forms of distance education need to be considered and quickly put in place. Failure to establish a degree of continuity for pupils will set them back educationally and raises the risk that some might not return to school when the crisis is over. The Minister of Education has got to step-up with an innovative vision for keeping pupils learning while out of school. The Minister’s ability to clearly communicate the plan and what is expected of teachers, students and parents is key to getting everyone to cooperate.
2. Identify the Appropriate Distance Learning Method for your Context: Where regular schooling is suspended, distance learning options need to be instituted. The form of distance learning will depend on the most accessible technology. On-line learning is the ideal for optimal student interactivity, but many students in resource deprived situations do not have access to laptops or computers. Television and radio have long been used as education support platforms and now can be adapted to full-time learning. There is a great deal of experience in the use of interactive radio education and educational television, educational materials to support parents, and instructional materials directly for students. For example, Mexico has a rich experience with educational television. The global nonprofit Hundred.org, whose mission is to identify and curate educational innovations, has compiled a toolkit with innovations which might help support alternative education during this pandemic. [Links to additional resources below]
3. Support the Teachers and Parents: Suspension of regular schooling and the switch to modalities of distance learning is as disconcerting for teachers as is it is for students. The Minister must win the confidence and cooperative support of teachers to ensure the success of the continuing education plan. This can be done by ensuring the clarity of the plan and expectations of teachers, providing curricula support materials and teaching tools, consulting with teachers and their union leaders, and empathizing with their distress at dealing with an unfamiliar method of educating, even while they too take measures to protect themselves and their families from infection. Parents also need to understand what is expected of them in supporting their child’s education while school is suspended. Most parents have no experience of ‘home schooling’ and would also benefit from supportive teaching tools geared for them.
4. Things Are Not Normal: How long the current crisis will endure is not known. Predictions are that the impact on most countries could be profound. Anticipating that things may not be normal any time soon, the Minister of Education must consider how students will be graded based on distance learning outcomes, and importantly how these outcomes will be established. Setting up a system for monitoring how many students are engaged in distance learning programs and the educational value of what they are learning is key to course correction and future planning.
5. Consider the Socio-economic Consequences: Many countries maintain school-based feeding programs and for many students this is their principal source of daily nutrition. The nutritional implications for children are obvious, but could be made more intense by the fact that the economic disruption resulting from the COVID-19 crisis could impoverish many already poor families. Ministers of Education should consider how to maintain feeding programs for out of school students. This is an area where civil society organizations could be helpful. Also, it is important to recognize that parents may not be able to afford school fees, uniforms or other schooling-related costs. The government’s main goal should be to ensure students continue in education and a more liberal attitude to fees, etc. may be necessary.
Interview with George K. Werner, Former Minister of Education, Liberia
This brief was prepared by the Harvard Ministerial Leadership Program with input from:
George Kronnisanyon Werner, former Minister of Education, Liberia
Fernando Reimers, Harvard Graduate School of Education
Paul Skidmore, Founder and CEO, Rising Academy Network
6 - How to Create a Rapid Delivery Plan in a Crisis
The COVID-19 pandemic has not yet reached its global peak. As Ministers, you’re in the thick of managing a full-blown crisis – and it may feel like you don’t have time or space to think ahead. But even during the acute phase of a crisis, planning for delivery is essential. Even when the COVID-19 pandemic is over, almost every government will have to manage the socio-economic consequences of this crisis for some years. With that horizon, the need for a plan becomes even more clear.
So how should a Minister, strapped for time and in the midst of chaos, approach delivery planning in a way that makes sense for the current moment? Here are five pieces of advice for the person you appoint to do the job:
1. Start with outcomes: Every good delivery plan begins with a simple question: “What are you trying to achieve?” Crisis management is no exception. You can start with the immediate goals that matter most: lowering infection rates, lowering hospitalization rates, lowering fatality rates for those infected, and protecting economic activity as best you can in the midst of that. Knowing these ultimate goals can help you to set intermediate goals – on testing, contact tracing, improving your system’s capacity to handle COVID-19 cases, ensuring continuity of other essential services, providing economic relief, and more. These intermediate goals should determine the specific actions you prioritize. And over time, immediate goals can evolve to include medium- and long-term ones, as you look toward recovery and rebuilding.
2. Get the data right: Some of the outcomes you’ll want to track will be available; with some management, your health system should be able to report on beds, ICU capacity, and ventilators available, for example. Other measures will be entirely new: how many COVID-19 tests are administered each day, and to which types of patients and where? How strong is compliance with social distancing? What has been the uptake of new economic relief benefits? How many schools are distributing meals to families through alternative means? If ever there was a time to accept no excuses for lack of data, this is it. Insist that every metric you care about be reported to you daily.
3. Empower your leaders: If you don’t know how – and through whom – each part of your plan will be delivered, the plan is not yet complete. Start by appointing a single accountable leader who reports to you for each goal in your plan. Each leader needs to be able to articulate three things to you: 1) the measurable target they’re responsible for; 2) the delivery chain, from them to others in government out to the front line of service delivery, through which they will do their work; and 3) the key actions (each with a deadline) that they will take for at least the next 30 days.
4. Hold them accountable – consistently and relentlessly: You likely already have crisis management routines set up (and if you don’t, this is a good excuse). Make sure they are used to hold each designated leader accountable for delivering on their targets on a weekly (if not daily) basis. You’ll know you’re succeeding when you’re looking at the same data each time (the same charts, graphs, maps, and so on), when the focus of your conversation is about what it will take to move these numbers, when the biggest problems are prioritized and actions agreed to address them (and these are followed up in the next meeting), and – most importantly – when you see evidence of actual progress. Over time, as the situation evolves, these routines can give you feedback that helps you update both the plan and the process for reviewing progress.
5. Communicate (more than you think you have to): Now more than ever, the public you serve needs to know what’s happening and what you’re doing to manage the crisis. They will forgive you if you occasionally get things wrong and admit your mistakes; what they won’t forgive is hearing from you too late or not at all. Think about the data and evidence of progress you’ll have if you do the four things above. How should you share it publicly? How can the information be used both to help your people confront reality and give them a rational basis for hope in the future? What do you hope to report daily and weekly, and in what format? Answer these questions plainly and use them to strengthen the quantity and quality of your communication.
This brief was prepared for the Harvard Ministerial Leadership Program by Nick Rodriguez, Delivery Associates.
7 - The Role of the Finance Minister in the COVID-19 Crisis
The impact of the COVID-19 pandemic on economies around the world will be severe. The economic consequences in developing countries will be even more harsh. This situation is truly a Finance Minister’s worst nightmare. There are no good options and yet the Finance Minister is pivotal in leading their country through this time of extreme crisis. The following are some pointers for consideration:
1. Flatten the Curve: Curtailing the spread of the virus is the immediate priority. Many countries around the world have instituted extended “lockdowns,” travel bans and other restrictions on social and economic activity. While these measures are generally considered necessary to “flatten the curve,” the resulting economic disruption is projected to put the global economy into deep and prolonged recession. The World Bank is projecting that most of sub-Sahara Africa will experience recession for the first time in 25 years. A Finance Minister has to look to the immediate need to re-allocate and mobilize budget to pay for the public health response and the likely heavy burden of health care for the infected. Additionally, to cushion the impoverishing socio-economic consequences, expanding access to social-security networks, such as unemployment insurance, feeding programs, state pensions and conditional cash transfers, may be necessary. Few countries can afford large-scale fiscal stimulus and will have to rely on external budgetary support, compounding the fact that many African countries are already heavily indebted. Some may be tempted to print money, but this will likely exacerbate inflation and currency devaluation, already a problem for many.
2. Finding Fiscal Space: Some countries include contingency funding in their annual budgets, most developing countries do not and are fiscally weak at the best of times. The shock of COVID-19 will cause precipitous declines in tax revenue, trade, tourism and foreign remittances further tightening fiscal space. Even countries with limited fiscal space and currently low levels of COVID-19 infection have implemented lockdowns. While the public health emergency is the paramount concern, the Finance Minister needs to ensure their government leaders are aware of the economic consequences of the public health measures they are implementing. Lockdowns and social distancing in most developing countries may be harder to implement and less effective than elsewhere, making the economic tradeoffs questionable.
3. No Good Choices: The Finance Minister’s first option is reallocating existing budget, reducing the budget of Ministries not essential to fighting the pandemic and cut all non-essential spending (including potentially retrenching some government workers) to fund health care and other costs related to containing the COVID-19 pandemic. This may require some legislative flexibility in some countries. Besides budget reallocation, adjusting disbursement procedures, while maintaining expenditure accountability, is important. The magnitude of the COVID-19 problem is enormous. The scale of policies that is to be carried out is also very large. Implementing policies such as providing social assistance to the community at large and the business sector, especially small-scale companies, is not easy. Finance Ministers must realize that implementing these policies do not happen in a vacuum; rather they must consider the existing political conditions and the constraints that institutions face. If political factors are not considered, there is a risk that actions will fail or not have political support.
4. No Flying Blind: Most countries were blindsided by the scale and intensity of the COVID-19 pandemic and have been scrambling to respond. The Finance Minister cannot fly blind. The Minister must know what fiscal options are available, have a robust evidence-based plan, and make decisions based on evolving scenarios such as the rate and level at which the curve can be flattened. In the United States and some countries in Europe, very high levels of COVID-19 infection are already prevalent to the point of flattening the curve meaning the burden on their health system and the economy will be prolonged. The Finance Minister should adjust the fiscal response in line with the evolving trajectory of the pandemic in their country.
5. Global Cooperation: The global financial consequences of the COVID-19 pandemic will be profound. Emerging economies have seen the largest capital outflows since the Global Financial Crisis of 2008. Financial markets will freeze and risk premiums will skyrocket. Beyond available domestic resources, most developing countries will need to look to the International Monetary Fund and World Bank for budget relief, as well countries like China and the U.S. for debt forgiveness. Unfortunately, the present global financial safety-net to deal with these imminent problems is dangerously inadequate. Central Banks and Finance Ministers must collaborate closely to protect the global economy against the impact of COVID-19. There have been calls for a globally coordinated response to the economic plight of developing countries. Some options could include expanding the use of existing credit facilities like the IMF’s Rapid Finance Instrument, quantitative easing enabling Central Banks to purchase emerging market bonds, and measures to recirculate the flight-to-safety-money flowing to the U.S. None of these measures would be without cost, fiscally and politically, most notably deepening developing countries’ dependence on external powers. The Finance Minister needs to have clear vision in opting for external budgetary support.
This brief was prepared by the Harvard Ministerial Leadership Program in collaboration with Muhamad Chatib Basri, former Minister of Finance, Indonesia, and Sufian Ahmed, former Minister of Finance and Economic Development, Ethiopia.
Interview with Chatib Basri, Former Minister of Finance, Indonesia
8 - How to Conduct Rapid Budget Execution in a Crisis
Ministers of Finance are frequently confronted with changing circumstances during a fiscal year that can disrupt even the best prepared spending plans. Some of these changed circumstances require no more than regular adjustments to plans, while others are chronic and have a significant effect on public finances. These extraordinary shocks can pose a threat to fiscal stability and public service delivery. The COVID-19 pandemic not only demands dramatically increased public expenditure on the public health measures needed to curb the outbreak and care for the infected, but also major disruption in the level of economic activity and demands for fiscal intervention to mitigate the economic damage.
As governments get to grips with the impact of the COVID-19 pandemic in their countries, Finance Ministers could consider the following pointers for the budgetary response:
1. Streamline Coordination Between the Finance and Health Ministries: As part of the overall crisis response by a government, coordination between the health and finance ministries will reduce the turnaround time for costing various activities, monitoring of expenditure, and adapting to a fast-changing situation. To achieve seamless decision-making and rapid deployment of resources, a team of officials from the finance ministry could relocate to the offices of the health ministry, as was the case in Liberia during the Ebola crisis.
2. Activate Contingency Reserve Funds Where They Exist: Several countries include a contingency reserve as part of their fiscal framework to cover unforeseen and unavoidable expenditure, such as natural and person-made disasters. If a contingency fund does not exist, more extensive reallocation of the budget may be needed. The fiscal space can also be raised by establishing a trust fund.
3. Budget Reallocation Will Be Required: Legislation in most countries allows for the shifting of funds between programs and ministries, as well as the appropriation of an adjustments or supplementary budget. To fund the Ebola response in 2014, for example, the Liberian government increased the budget allocation for health workers, equipment and medication by 60 percent. Overall budget expenditure increased by 24 percent in the respective financial year. Although these types of adjustments to the budget will affect fiscal sustainability over the medium-term, they may be necessary to save lives.
4. Establish a Trust Fund: Establishing a trust fund can serve the purpose of pooling resources from development partners, the private sector, philanthropic foundations and individuals, such as the Solidarity Fund established in South Africa. Through this Fund, individuals and organizations will be able to support the response to COVID-19 through secure, tax-deductible donations.
5. Deviate from Normal Procurement Procedures: Deviation can take the form of single-source procurement with known and trusted suppliers. The purpose will be to expedite the process, while at the same time retain the necessary safeguards. Where single-source procurement is used, careful attention needs to be given to monitoring the price of goods and services to ensure value for money and maintaining an audit trail of all expenditures and the receipt and distribution of supplies.
6. Optimal Management of Cash: In an emergency, such as the COVID-19 health crisis, resources need to get to frontline agencies and workers on time and in the correct amounts. Improved coordination between the finance and health ministries will assist in this effort, and will require the revenue authority, central and commercial banks to be kept in the loop.
This brief was prepared by the Harvard Ministerial Leadership Program in collaboration with Neil Cole, Executive Secretary, Collaborative African Budget Reform Initiative
Interview with Cristina Duarte, Former Minister of Finance, Planning, and Public Administration, Cabo Verde
9 - Preventing Collapse of the Public Health System
In a national public health emergency such as the COVID-19 pandemic, Health Ministers have the dual responsibility of putting every effort and all available resources into stemming the pandemic and ensuring care for those seriously afflicted by the virus, while at the same time ensuring that regular health services are not so severely disrupted that people not sick with COVID-19 can also access care. Babies will continue to be born, children still need to be immunized, the lives of people affected by malaria, HIV/AIDS and tuberculosis depend on their access to health services. Hypertension, diabetes and other non-communicable diseases (NCDs) will not go away. National lockdowns and stay at home orders may help avoid an initial tidal wave of affected patients overwhelming health services, but evidence suggests there will be subsequent ‘waves’. If projections for the spread of the virus are accurate, it is possible health services will be significantly over-burdened for some considerable time. In countries where the public health system is routinely over-burdened, the added COVID-19 patient load could risk collapse of the system. The following are some considerations for avoiding collapse while also ensuring that all people who need care are able to get it:
1. Testing and Isolation: Knowing the rate of COVID-19 infection and prevalence across the population is essential for directing an effective response. It is particularly important to anticipating the likely demand for COVID-related care on the national public health system. The Minister needs to muster all possible resources to ensure testing is as widespread as possible. Another reason for identifying who is carrying the virus is to prevent those people from infecting others. This is particularly challenging where overcrowding is a way of life. Some countries, (Ethiopia, Mozambique, and South Africa, among others) have set up infirmary-like temporary hospitals or re-purposed community halls and other facilities as isolation and triage units. Isolating TB patients, for example, is a longstanding practice. Besides containing the spread of infection, the additional advantage of setting up triage-style isolation units is the alleviation of burden on hospitals and other core health facilities. The challenge government has to consider is how to compel infected people to isolate in such units and stay the approximately 14 days until they are no longer infectious. Some countries have used harsh tactics. The Minister must weigh the likely political repercussions of utilizing what some may consider an authoritarian approach against the urgency of the crisis.
2. Protecting Health Providers: Besides testing, the second most important part of the pandemic response is protecting health workers. This means providing facemasks, face shields and protective clothing for those providers known to be interacting with infected patients at testing sites, emergency rooms, hospital wards and intensive care units. But it can also be assumed that many people showing up for care at other health facilities could be carrying the virus. To avoid large-scale COVID-19 infection among health providers and risk collapse of the system, providing the necessary knowledge and basic protective equipment to all health providers must be a very high priority. The challenge is global shortages of this equipment. It will be necessary to fast-track procurement procedures and to partner with the private sector and civil society to secure necessary supplies. Ministers could also consider reaching out to the WHO and other international partners for assistance procuring these supplies.
3. Community Health Workers: Most developing countries have community health worker (CHW) programs providing varying degrees of outreach at household-level. In some countries, CHWs are paid by the government, but employed through non-governmental organizations. Whatever the situation in your country, it is time to ramp up your CHW program. CHWs could play an indispensable part in community education about COVID-19 and how to prevent infection. They could enable acceptability of testing, help alleviate fear of seeking care for the virus, allay the possibilities of stigma, and identify families whose health and household-food security has been put in jeopardy by the increased poverty, food shortages and other hardships resulting from the pandemic.
4. Prioritizing Core Services: Tertiary health care facilities will carry the bulk of the COVID-19 care burden. To ensure continuity of core services, Ministers should consider strengthening the capacity of regional and district-level health centers and clinics. This means avoiding having the best skilled health providers redeployed from secondary and primary care facilities. The distribution of professional health care capacity across the health system is a crucial consideration. It is equally as important to ensure that secondary and primary facilities are not starved of resources as these are diverted to COVID-care. Boosting the COVID-19 screening capacity of secondary and primary facilities could also help lessen the load on tertiary facilities. This should however not be at the cost of maintaining essential routine services such as prenatal and child health clinics, childhood immunizations, HIV/AIDS and malaria care, treatment for hypertension, diabetes and other NCDs.
5. Harnessing the Non-Government Sector: In the early years of response to the HIV/AIDS pandemic, governments relied heavily on the non-government sector to provide-related services alongside mainstream public health care services. The private health care sector has grown substantially in most countries over recent years. The rapidity and scale of the current pandemic demands that government harness health care capability wherever it may be available. Ministers need to be innovative in boosting health care capacity through partnerships that in normal times might not be comfortable for government.
6. Shoring-Up the Supply Chain: Global health sector supply chains have been overwhelmed by the demand for supplies essential to the COVID-19 response. While securing these supplies in the quantities needed will likely be a challenge, it is equally important to ensure that supply of other essential health commodities, most notably drugs for the treatment of chronic disease such as HIV/AIDS and TB, are not disrupted. The Minister should have a senior leadership team assigned to identify and track early indicators of supply disruption and develop an action plan to remedy the problem. As with other areas, this too may require thinking ‘outside the box’ and working with partners in ways not contemplated before.
Interview with Bernice Dahn, Former Minister of Health, Liberia
10 - Avoiding Economic Collapse as a Result of the COVID Pandemic
Framing the Problem: The COVID-19 pandemic has upended the global economy, tipping the world into what is predicted to be a deep recession. Countries that were already on the edge economically before the crisis, and with weak fiscal systems will likely experience the most dire consequences. In most developing countries, the effectiveness of virus-containment measures, like social distancing, is limited by high-density populations in urban slums and informal housing. If contagion of COVID-19 were to unfold in Africa in a similar way to Europe and North America, fragile health systems would be quickly overwhelmed. Regardless of how widespread the contagion, the economic impacts will endure long after the pandemic is passed.
Economic Impact of COVID-19: The World Bank projects that sub-Saharan Africa will experience a continent-wide recession for the first time in 25 years. Economically marginal populations will immediately experience food insecurity and other deprivations if they cannot work. Depending on how long the restrictions are in place, other segments of the population will also suffer adverse economic consequences from lost wages, and possibly long-term loss of employment. Revenues and remittances are drastically reduced, and consumer demand has nosedived as people have been required to stay home and most businesses have been shuttered. Even after restrictions are lifted, consumers’ disposable income will be severely diminished, and the number of newly poor with little or no disposable income will greatly increase. These conditions could lead to the following outcomes:
- Steep drop in economic growth from average 3.2% to -2.6%;
- Up to 29 million pushed into poverty;
- 9 million jobs lost;
- 17% of households affected by COVID-19;
- No fiscal space, falling tax revenues;
- Decline in commodity prices, not only oil;
- Long-term decline in travel, tourism, remittances with negative impact on foreign exchange earnings and inflationary pressures.
The Finance Minister’s Dilemma: Finance Ministers have the difficult dilemma of mustering all possible reserves to tackle the pandemic and alleviate the worst economic effects, while avoiding ‘crashing the economy.’ One calculation Ministers have to make is how long to maintain strict lockdowns in order to effectively curb the pandemic without irreparably damaging the economy. A rush to lift restrictions too soon could have adverse health consequences. At the same time, the longer the economy is shutdown the deeper the economic dislocation. These should be ‘whole government’ decisions informed by a clear short- and medium-term strategy based on reliable data. The extraordinary size of the necessary short-term fiscal response will defy fiscal orthodoxy inevitably weakening fiscal positions, adding to the debt burden and fueling inflationary pressures. Expanded money supply and currency devaluation is an almost unavoidable consequence, but governments should avoid printing money because that would exacerbate inflationary risks. The emergency fiscal response could create severe fiscal constraints and budgetary imbalances for years to come. This is a risk that Ministers should weigh against the depth of the current crisis.
Considering these dynamics, Finance Ministers and their cabinet colleagues should keep the following in mind while mapping a strategy for avoiding economic collapse:
1. First priority is containing the pandemic. The most urgent immediate necessity is mobilizing the money needed to pay for pandemic-related prevention and treatment. The first resort is reallocating existing government budgets, and marshalling all available internal fiscal reserves. Governments will need to slash most non-essential spending, however, they should not halt public capital development projects already in progress. Besides the long-term value of these projects, that kind of public investment has a major ripple effect throughout the economy. Most developing countries will need to access short-term emergency financial support from bi-lateral and multi-lateral external sources. Priority should be in negotiating for grants over adding debt through loans (no matter how favorable the terms).
2. The second priority is ameliorating the economic effects of restrictive health measures. ‘Flattening’ the economic distress curve, is equally as important as flattening the trajectory of the pandemic. Government will need to dig deep to establish (if such programs do not already exist), bolster and expand social protection programs. The upside is money invested in this way goes into general circulation in the economy helping boost economic activity.
3. A central part of the Government’s strategy should include partnering with the private sector in ways that might seem extraordinary, such as:
- Risk-sharing between government and the banking sector to extend credit forbearance for individual and institutional creditors;
- Increase no-cost financing for small and medium size enterprises;
- Relax terms and regulations on finance for informal traders and non-commercial farmers.
Government also should engage with the corporate and commercial sector to preserve jobs, even while their workers are confined to their homes. Tax relief is the most obvious available incentive, but government should tap the private sector’s spirit of ‘national commitment’ by making these enterprises a co-equal part of the national economic revival strategy and attach their ‘brands’ to the effort. Government in turn, through their Central Banks should expand lending, as well as ease terms and restrictions on private sector borrowing.
4. Stimulating consumer demand is critical to keep the economy afloat and shore up small business. One way to do this is by providing every household with a one-time ‘COVID-cash payment.’ Countries that have the fiscal latitude could consider instituting a universal minimum household income. A variety of other economic relief measures have been floated including deferral of tax payments and temporarily suspending value added taxes, wage subsidies, water and electricity bill payments.
5. Consideration also needs to be given to medium-term measures to deal with the budgetary and fiscal imbalances resulting from short-term emergency measures to avoid protracted recession. With government reserves severely depleted and uncertain medium-term economic prospects, an important priority should be seeking debt relief from bi-lateral and international creditors.
Mitigate the Risk: The sound management of this dramatic increase in state funding is also imperative. If emergency fiscal expenditure is not targeted to areas that evidence shows can produce the most health and economic benefit, or if this funding is misdirected through inappropriate procurement and contracting, ‘leakages’ or price gauging, the consequences could be dire for the health response, the prospects for economic revival and possibly the political fate of the government. Populations around the world are in stress and on edge. Political restiveness is already increasing in many countries, developing into violent protests in some. If mismanagement of the fiscal response does not derail economic revival, rampant inflation certainly could. The bottom-line is careful control of the rate of increase in the money supply and effective use of fiscal stimulus and emergency funding (domestic and international). This is not ‘free’ money. Eventually all the world’s economies will need to find their balance again. How quickly your country is able to rebalance its economy depends on prudent decision-making and judicious management now and in the months ahead.
This brief was prepared by the Harvard Ministerial Leadership Program in collaboration with Cristina Duarte, former Minister of Finance, Planning and Public Administration, Cabo Verde.
Interview with Sufian Ahmed, Former Minister of Finance and Economic Development, Ethiopia
11 - Leading Through Collaboration
Collaboration across government is generally an effective way of optimizing effort and resources at the best of times. In the face of a national crisis, a ‘whole government’ collaborative approach is essential. The global COVID-19 pandemic is foremost a public health emergency, but it also has immediate and profound consequences for education, social safety-nets and the economic well-being of the population. The disruptive consequences of the pandemic will reverberate in most countries for a long time after it is contained. The Health Minister may be in the driver’s seat as government grapples with the initial public health response, but government needs a comprehensive strategy to address immediate goals such as continuing education and alleviating economic hardship, as well as a vision for how the country will rebuild when this crisis passes. Every Minister should determine how their ministry contributes to a whole government strategy.
Although the immediate crisis may initially generate a spirit of collaboration across government, it may be short lived. Collaboration across government is not easy because bureaucracy is organized in silos designed to perpetuate the status quo. Working across these silos, requires farsighted leadership and deliberate effort across ministries. The following are some considerations:
1. Define the Goal: Collaborative initiatives should be organized around a clear goal (or set of goals). This enables shared buy-in and development of a delivery plan with clear lines of operational responsibility and measurable progress indicators. The goal may initially be articulated by the President or Prime Minister as part of their vision for the nation’s way out of the crisis. Operationalizing the vision is the function and responsibility of the collective government. This is a moment when Ministers can demonstrate their true leadership by stepping up to help optimize the benefits of cross-government collaboration. Strong, consistent ministerial leadership is pivotal to the success of any collaborative undertaking, but it is not a popularity contest. Don’t try to outshine other Ministers or poach on their responsibilities.
2. Organizing to Collaborate: Effective and sustained collaboration requires deliberate organization and careful cultivation. Collaboration can be bi-lateral (between two ministries), multilateral or whole government. Government effort can sometimes be strengthened by including the private sector and civil society organizations in a broad coalition. The broader the scope of the collaboration, the trickier the organization. The stakeholders in the collaborating coalition should collectively decide on the appropriate organizational structure. Sometimes it is necessary for the Head of State to initially convene the collaborative coalition to get collective buy-in, but it is better from an operational perspective that the ongoing leadership fall to the collaborating Ministers. Ideally, these Ministers should collectively decide who among them is the most appropriate operational convener (lead ministry) of the coalition and agree on the organizational structure. Remembering that the ultimate objective is operationalizing the goal of the collaborative undertaking, a tiered organizational structure delineating lines of accountability down to the point of delivery is usually required.
3. Rigorous Planning is the Key to Success: The more granular and rigorous the planning the better the chances of success. Although the detailed planning process may be assigned to technocrats, agreement on the action plan needs to be inclusive of all stakeholders. Budgeting is a critical part of the planning process. Budget sharing between ministries is often the toughest challenge to cross-government collaboration. In the wake of the COVID-19 pandemic, it is likely that governments will be even more severely resource restricted. Making the best of what you’ve got will be essential. Routines are an additional success factor. The plan should clearly outline routines for meetings and reporting, as well as lines of responsibility and accountability. Problem solving and dispute resolution procedures should also be built into the plan. Equally important is ensuring that the plan is informed by the available data and establishes reliable data systems to inform progress monitoring. It is beneficial to remember that course correction may be a feature of the process.
4. Create Mutual Accountability Among Coalition Partners: Having a detailed plan provides a good starting point, but it needs to be complemented with implementation practices/rules that hold all parties accountable for delivering the results. In coordinating a multifunctional group of stakeholders, the routines of execution, monitoring, problemsolving, and reporting need to permeate across all ministries and agencies, from the top to the bottom. A good delivery program has an implementation framework that requires actors to:
Set clear cross-governmental key performance indicators (KPIs)
Establish a cross-governmental implementation structure
Rigorously collaborate on monitoring and problem solving
Validate and publish results
These actions will drive the coalition to not just collaborate, but to also be collectively accountable for the outcomes of the delivery.
5. Communicate with the Public: People in nations around the world are scared and enduring varying degrees of distress. Obviously poorer people will be worst affected. It is in moments like this that people look to government to show them the way out of their trauma. People expect government to have a coherent vision and a plan showing the way forward. Although the Head of State is usually the chief government spokesperson, all Ministers are cheerleaders who must communicate effectively being sure to demonstrate empathy with the distress people are enduring. Beyond empathy, people want government to be transparent and accountable. This can best be achieved through open, inclusive and regular public communication. Failure to win the confidence of the people as you navigate through this crisis could have political consequences.
6. It is No Longer Business as Usual: Regardless of varying rates of COVID-19 prevalence across the world, it will never be business as it once was. The world has shifted in fundamental ways: trade, travel, consumption, technology, and protectionism to name a few. In order to adapt to the new normal, governments will need to change their usual ways of operating too. Pooling effort and resources through collaboration would seem to be an obvious choice in a new era of global constraint. Although Ministers should concentrate on helping lead the ministerial coalition, effective and sustainable collaboration requires fundamental institutional change. Delegating or outsourcing this responsibility would be a mistake. Changing the traditional bureaucratic culture of government ministries is key to successful inter-ministry collaboration, more efficient government and best use of resources. Ministers will need to dig deep to lead and motivate a profound change in government culture.
This brief was prepared by the Harvard Ministerial Leadership Program in collaboration with Idris Jala, Former Minister in the Office of the Prime Minister & CEO, PEMANDU, Malaysia.
Interview with Idris Jala, Former Minister in the Office of the Prime Minister & CEO of PEMANDU, Malaysia
12 - Tackling the Impoverishing Impact of the COVID-19 Pandemic
The economic disruption resulting from the COVID-19 pandemic is expected to reverse two decades of poverty reduction. The World Bank projects that for the first time since 1998 poverty rates worldwide will rise. Approximately 9% of the world’s population (one billion people) could be tipped into destitution. Populations in sub-Saharan Africa will be most severely affected. How severely countries are affected will depend on sound management of the emergency fiscal response and the economic recovery, as well as imaginative and well targeted social assistance initiatives to off-set the worst effects, such as food insecurity, among economically marginal populations.
This will not be a short-term challenge. A longer-term poverty alleviation strategy requires effective cross-government collaboration, as well as strong inter-sectoral partnerships including the corporate sector and civil society.
The following are some considerations for Ministers:
1. Cross-government Collaboration: Although the spirit of cooperation across government and with other sectors might be high during the initial phase of the COVID-19 crisis, this could evaporate quite fast as the immediate health emergency recedes. The economic crisis will endure much longer. Most developing countries had extraordinarily high unemployment before the pandemic. Joblessness will likely greatly increase as enterprises of various kinds fail or struggle to survive in the post-COVID era. In addition, previously economically marginal populations could be tipped into poverty through loss of daily earnings and disruption of the informal economy. Dramatic increases in food insecurity will likely be one result, another is the possibility of increased political restiveness already manifest in a number of countries. Hungry, scared and distressed people expect their government to help them. Strong cross-government and inter-sectoral collaboration is essential to an effective government response informed by a comprehensive, publicly communicated, plan with short and medium-term targets and clear timelines. To be effective cross-government collaboration requires strong ministerial leadership and careful organizational planning.
2. Expanding the Social Safety Net: Most developing countries have limited fiscal reserves with which to expand existing social assistance programs or set up new ones. It is important to ensure limited fiscal resources are targeted for those with the greatest need and delivered in the most seamless, ‘corruption-proof’ way possible. Existing social assistance programs usually target and have well established access to the poorest households, but they are not geared for large-scale job loss and income shocks. Evidence shows community health workers (CHWs) can be most effective at identifying vulnerable households and families experiencing food shortages, health problems and other adverse circumstances. CHWs are a feature of most public health systems already. Ramping up CHW programs to spearhead community-level COVID-testing and to assume a broad range of social and economic welfare monitoring in addition to their existing health promotion functions should be the bedrock of an emergency poverty alleviation strategy. (Ethiopia’s Health Development Army is a good example. And in South Africa, some 30,000 CHWs are leading the continent’s largest COVID-testing program.)
The following are social assistance interventions for consideration:
- Unconditional Cash Transfers: Many countries have made one-time cash transfers to citizens with the goal of ameliorating the most immediate economic hardships like food insecurity. Such payments are generally considered the quickest way of getting cash into the hands of those who need it to survive. Although many countries now can use electronic networks for fund transfers, most cannot. An alternative disbursement mechanism will need to be considered. For most developing countries such programs are not affordable without infusions of external emergency funding assistance. If such programs are considered, defining eligibility, identifying the most needy beneficiaries and disbursing money with urgency would be key to ensuring the most value.
- Conditional Cash Transfers: Such programs are widely used to incentivize social behaviors like ensuring children are registered for education and receive routine immunizations, as well as routine clinic visits for maternal and child health. Most times the incentive is in the form of a cash payment to the mother. Food vouchers and food parcels are also common incentives. This approach could be one way of encouraging testing for COVID-19. These programs are designed to benefit the most needy and because the management and disbursement infrastructure already exists, could be the foundation for expansion.
- Food Support: Food insecurity will likely be the most wide-spread hardship arising from the economic disruption. Loss of income for the majority of people without savings and those who live by their daily earnings has meant a huge uptick in need for food support, overwhelming existing food banks and feeding programs even in the U.S. and other developed countries. Food vouchers for eligible beneficiaries is one approach. School-based feeding programs are a common feature in many countries, but with pupils out of school, different arrangements are needed. This is an area where the support of civil society and the corporate sectors in food supply and distribution could be useful. Churches, clinics and schools are all accessible service centers. Well-designed feeding programs tap the local agricultural sector, particularly small growers. Although the initial need will be ensuring the supply to meet the demand, long-term food security among the most vulnerable requires a more comprehensive strategy including household food production. This is an area where CHWs can be of particular value.
- Unemployment Benefits: Such programs only benefit those in formal employment and are assumed to be a temporary income stop-gap while the beneficiary finds alternative employment. Unemployment insurance programs are usually funded through tax on individual income, but many are employed informally or on a contract-basis and may not be eligible for unemployment benefits. Additionally, the prospective scale of ‘formal’ unemployment in the current crisis could far exceed available funds.
- Wage Subsidies/Job Retention: Some countries with the fiscal means have entered into partnerships with major corporate employers to subsidize the wages of employees for a short period in exchange for guarantees of job retention. The upside of these arrangements is that employees can slot back into their jobs once the economy opens up again. The downside is governments have limited authority to enforce corporate sector guarantees and if economies do not quickly rebound, retrenchments could escalate after regular economic activity resumes. Additional limitations are that many employees work for informal or ‘unregistered’ businesses. Others work on informal contracts and even greater numbers are self-employed.
- Other Economic Relief Measures: Countries have introduced a variety of other economic relief measures such as temporary suspension of value added taxes, extension of tax deadlines, fuel and electricity bill subsidies. Another important consideration is suspension of school fees to ensure that all students return to school once they re-open.
3. Consider the Limitations: The reason governments need a clear social assistance plan is that large numbers of people are newly vulnerable to impoverishment and malnutrition. Failure to respond could have unfortunate political repercussions. Social assistance programs can provide temporary relief, but most people want to be self-sufficient. Helping beneficiaries graduate off assistance should be a key goal. Additionally, the plan needs to identify the most affordable way to target those most in need over an extended period. A reliable infrastructure for targeting and disbursing social assistance to the most needy is essential. Such infrastructure might already exist in non-state agencies in your country. This time requires not only ‘whole government’ effort and capacity, but also partnerships across sectors that may be somewhat out of the norm.
This brief was prepared by the Harvard Ministerial Leadership Program in collaboration with Cesar Purisima, Former Secretary of Finance, the Philippines
Interview with Cesar Purisima, Former Secretary of Finance, the Philippines
13 - Addressing the Disproportionate Impact of the COVID-19 Pandemic on Women
Crises often exacerbate existing gender inequalities so it is not surprising that women are being uniquely impacted by the COVID-19 pandemic from both a health and economic perspective. Forty percent of women in formal employment work in low-skill, low-wage positions and of those that are in wage employment, 40% do not have access to social protection such as health insurance or unemployment benefits. These jobs will be most affected by retrenchment and employment attrition resulting from COVID-19 related restrictions on economic activity. Women are also the mainstay of the informal economy which has been severely disrupted. Because women most often use their income to support their children, the loss of this income could impact household food security and child health. Women are also the primary caregivers, caring for younger children and elderly (sometimes ailing) relatives, and bear greater burden for domestic work. This burden is greatly increased with children out of school and disruption of regular health care for the unwell elderly. Furthermore, women make up 70% of the health and social sector workforce and are significantly involved on the frontline providing testing and care during the pandemic. The worldwide shortage of personal protective equipment for health workers puts these women at elevated risk of infection. Frustrations with stay-at-home orders intended to curb the spread of the COVID-19 virus, combined with the stresses of income loss and fear for the future among men, put women at increased risk of intimate partner violence and other forms of domestic violence. These same circumstances, exacerbated by disruptions in reproductive health and family planning services, could result in a major uptick in unplanned pregnancies. Furthermore, safe pregnancy and childbirth benefit significantly from access to skilled health personnel and adequate facilities.
The question is what can government do? The primary consideration is that gender equity and the plight of women should be central to all policy considerations generally, and most particularly in all elements of government response to the COVID-19 crisis. The following are some more specific considerations for policymakers:
1. Include Women in Decision Making: Inclusion of women at all levels of decision making plays a critical role in ensuring that women’s voices are heard and that policies take their considerations into account. This is of particular importance in times of crisis when decisions with limited, changing evidence, need to be made fast, often by male-dominated governing bodies. Women’s equality in society will only be achieved by equality in their participation at all levels of governing. In the immediate term, reaching out to women’s organizations to leverage their input and their ability to disseminate information to women should be a priority to inform decision making and to implement effective messaging.
2. Offset Economic Impact: Given that women are more likely to be out of work, less likely to have social protection like health insurance and unemployment benefits, less likely to have access to savings, and more likely to have added burden of care and domestic responsibilities, they should be priority beneficiaries of any emergency assistance programs. Compensatory payments for informal workers and health insurance benefits for caregivers are two examples of specific policies that could help counter the disproportionate economic burden women are facing.
While both men and women are likely to suffer loss of jobs and income, women traditionally are at a disadvantage relative to men in competing for mainstream employment. There’s not much government can do in the short-term to change deep-seated attitudes, but as government gears up to tackle the larger unemployment problem through skills training, career development and entrepreneurship opportunities, gender equity should be key. Similarly, women are the backbone of the informal economy in most developing countries, but historically women are significantly disadvantaged by rules and regulations governing access to loan financing for expanding their enterprises. Government certainly has a role in outlawing discriminatory lending practices. Furthermore, to get the informal sector back on its feet, government should partner with banks and other financial institutions to underwrite loans to small and medium enterprises, and ensure equitable access to funds.
Although women generally earn less than men, they are most often the sole or primary household providers. With loss of income, already economically marginal households will be tipped into destitution. Social assistance programs to address the needs of the poorest households such as food and conditional cash transfer programs should ensure women are at the center of such programs. The domestic burden is often a limitation on women’s opportunity to engage in work outside the home. Childcare and elder care are two primary needs. Government could partner with civil society organizations to subsidize expansion of such services, and also provide tax incentives to employers for providing onsite child care facilities for their female workers.
3. Provide Extra Support for Victims of Domestic Violence: Given evidence of increased domestic violence, it is important to ensure that any existing services for victims of domestic abuse such as hotlines and shelters are considered “essential services.” This will allow them to stay open during the pandemic and provide support for women in need to minimize the consequences of gender-based trauma. In the current crisis, law enforcement and other emergency services are redirected to fighting the pandemic. One result of this is women are not able to access needed care, or report assault, meaning the real increase in domestic abuse unleashed by the COVID-19 crisis may never be clear.
A related concern is that out-of-school adolescent girls are at heightened risk. Some may not return to school due to pregnancy. Others may not return to school because they are required to care for the household while their mothers look for work, or because school fees are no longer affordable. Preventing backsliding on gender equity goals in education should be of paramount concern. Suspending school fees when schools open again, would at least remove one barrier to ensuring girls students continue their education in school.
4. Ensure Continuity of Health Services: Prioritizing procurement of personal protective equipment for all health workers is critical to preventing collapse of the health system. Diversion of health resources to fight the pandemic has meant disruption of regular health services. Government should:
- Ensure continuation of essential medical services, particularly as they relate to maternal health services regarding childbirth, mother-to-child transmission of HIV/AIDS, and access to contraception and family planning services;
- Leverage distance learning systems and women’s organizations to provide health education where possible;
- Upskill community health workers who are mostly women to increase their capacity to task shift and devolve more health care to the community-level to minimize referrals to hospitals where unnecessary.
5. Use this Crisis as an Opportunity to Rebalance Gender Equity: While governments are in the grips of the greatest public health crisis of the past 100 years, gender equity may not seem like a priority. But women are at heightened vulnerability now mainly because of historic failure to adequately address these issues. Every crisis presents an opportunity for change. An era of economic hardship and greatly diminished resources will likely intensify inequity of all kinds, but most notably for women. Governments should be concerned because women are the foundation of all countries’ human development and a major part of the economy. Institute gender balanced roles at every level of government. Consider including in public health messaging, nudges towards more balanced gender roles. Consider reaching out to women’s organizations to leverage their input, expertise, and connections to strengthen response efforts. This crisis presents opportunities for shifts towards a more gender equal society at all levels. In the medium-term, failure to rebalance human development priorities once the immediate crisis has abated will undermine prospects of economic recovery. Visionary leadership would ensure these considerations are at the heart of government strategy.
Interview with Dr. Senait Fisseha, Director of Global Programs, Susan Thompson Buffett Foundation; Professor of Obstetrics & Gynecology
14 - Focusing on the Horizon While Combatting the Pandemic
In these unprecedented circumstances, it is inevitable and right that ministers focus intensively on managing the crisis. Previous briefs in this series have given advice on how to do that. This brief assumes you will do all that but then urges you to give a small amount of (high quality) attention to three other things.
1. The Priorities: You had priorities before the crisis. They were important to you and the people of your country. After the crisis they will be important to you and the people again. Pick the most important two or three of these priorities and set up a small team in the ministry to drive them forward as best they can – progress may need to be slowed but aim to maintain some momentum. Ask this team to update you with a brief note (2 pages max) every two weeks and to tell you what is going well, what is going less well and what they are doing about the problems. They might finish with a question or two for you. Respond promptly – all this should take you no more than 30 minutes a week – it will be a valuable investment of a small amount of your precious time.
2. The Future: The crisis may dominate for months, perhaps longer, but there will, eventually, be a future beyond it. Can you find the resource to task a small number of talented people to start planning the future now? In 1940, just a year after Britain found itself at war, when London was being bombed almost every night, when France had been over-run by the Nazis, and when Hitler was planning an invasion of Britain, a small number of senior officials from the Ministry of Education requisitioned a few rooms in a hotel outside London and set about their task – to design a school system for after the war. The war lasted another five years but the design they drew up provided the foundation for legislation in the last year of the war and the system after it. Can you do something similar? If you had to build your system again from nothing, how would you build it better? See this as moment is an opportunity. Time for you per week? Often none; may be an hour’s reflection once a month.
3. The Lessons: The usual way governments go about learning the lessons from a crisis is to set up a Commission of Inquiry afterwards to examine what happened, how it was handled and what the lessons can be learnt. Often the reports produced are excellent – but often too the inquiry proceeds slowly and by the time it reports the world has moved on and the lessons don’t get learnt. Can you find a way to learn the lessons as you go? At the end of each week and again at the end of each month ask yourself and your team: What have we learnt this week/this month? What mistakes have we made and what can we learn from them? What have others in other countries done that worked /didn’t work and what can we learn from them? Apply these lessons immediately if that makes sense. In any case, write them down in a page or two, weekly and monthly, and you’ll find by the end of the crisis you have the first draft of a handbook on how to manage a crisis. Time for you per week? No more than 45 minutes.
I make that between 1 and 2 hours a week. If you can be disciplined enough to find that time as the crisis swirls around you, I think you’ll find it turns out to be an outstanding investment.
This brief was prepared for the Harvard Ministerial Leadership Program by Sir Michael Barber, Managing Partner, Delivery Associates; former Head of Prime Minister’s Delivery Unit, UK.
Interview with Kesetebirhan Admasu, Former Minister of Health, Ethiopia; CEO, Big Win Philanthropy
15 - Scenario Planning for Effective Crisis Management
The global order as it existed before January 2020 has been upended by the advent of the COVID-19 pandemic, affecting every country in fundamental ways. How well various countries cope with the immediate public health crisis, as well as their recovery, will depend in large part on how successful governments are in mapping a clear strategy to get the country through the crisis and consolidating support across sectors.
The pandemic has underscored the importance of government in marshalling resources and mounting an effective response in a national crisis. How can governments manage the unpredictability of the present crisis, plan for a post-pandemic recovery, and institutionalize processes to ensure they are better prepared for the next catastrophe?
Why scenario planning now? An effective crisis response requires a whole government effort. The COVID-19 pandemic is at its’ core a public health crisis, but the ramifications will affect every sector. Scenario planning enables government to set a ‘North Star’ — a clear end goal and direction around which all sectors coalesce — with evidence-based options to inform government action as circumstances evolve. The many variables affecting the course of the COVID-19 pandemic make scenario planning an essential tool for managing the immediate public health crisis, as well as mapping the way forward. These variables include the rate and scale of COVID-19 infection; hospitalizations and mortality rates; the duration of the pandemic, as well treatment and vaccine prospects; economic and political consequences of restrictive prevention measures; the depth and duration of the post-COVID-19 economic recession; and prospects for international emergency financial support, debt relief, and long-term recovery assistance. By understanding where you are, the links between variables, the likelihood of various scenarios, and potential ways to face them, government sectors can align and clarify the way forward with tangible solutions.
How to do scenario planning? There are five key steps:
1. Who is at the table matters: Scenario planning is an opportunity to depoliticize the response and consolidate cohesion across government and non-government sectors by ensuring that all sectors have a ‘seat at the table’. Just as important is ensuring the best available experts are brought into the process to ensure planning is based on reliable evidence and data on the evolving impact of the pandemic. Including a mix of perspectives will help ensure a more inclusive approach. The objective is to collectively define the targets and desired outcomes, such as minimizing COVID-related mortality, protecting vulnerable populations, shoring-up food security, maintaining some form of continuing education, as well as mapping strategic choices and actions to steer the country through the crisis. Given how much of the current situation remains unclear and difficult to predict, this process needs to be regularly refreshed as new evidence emerges.
2. Define a scope: Consider a matrix that includes both timeframes and sectors. The timeframes might include the emergency phase (flattening the curve), the stabilization phase (after the emergency phase but before a vaccine is available), and the long-term recovery phase (when things revert to a ‘new normal’). The sectors are the main areas where the crisis has impact: for example, health systems, education and other human development sector systems, macro and microeconomic environment, and politics.
3. Build scenarios by defining indicators and trigger points: Defining scenarios is a strategic exercise using available data as the starting point for projecting a number of possible future outcomes. Reliable data is essential for effective political decision making. Start by creating a baseline using key outcome indicators such as COVID-19 prevalence and infection rates, economic growth rates, fiscal space, etc. Then identify the critical assumptions and variables that drive these outcomes, including policy actions that could be triggered to allay worst outcomes. Based on this information, develop no more than the four or five most likely scenarios from best to worst. Define indicators with the best available data and agree on trigger points to activate the policy-actions associated with a particular scenario. Trigger points might include indicators on public health (cases, deaths) or macroeconomic indicators, and should allow you to act fast before damage is irreversible.
4. Check for consistency and biases: Scenario planning works best when a stress test is conducted. There are two areas to pay attention to. First, check for consistency in the way variables affect each other. For example, does the tradeoff between severity of restrictive prevention measures and economic output really exist? Second, minimize potential biases in the plan. Was the best information about the future used (and not only the historical data)? Were broad simplifications (such as linear forecasting) avoided? Were the scenarios conservatively defined? Were dissenting opinions heard during the process? Have scenarios been updated to reflect fast evolving circumstances?
5. Define interventions and action plans: It is recommended to have a few prioritized interventions, define protocols and processes, allocate roles and responsibilities, and draft action plans that are ready to be implemented as soon as a trigger point for a scenario is reached. Consider customizing the interventions when defining your plans. For example, a larger informal sector might make a lockdown very difficult as urban density and housing overcrowding may have consequences for the rate of disease transmission. When defining interventions, include both the risks to mitigate and the opportunities to take advantage of. Opportunities could include digitization in the provision of public services or creating a leaner and more efficient public administration.
Illustrative example of Scenario Planning
What to do with it? Developing the plan is just the beginning. The plan is a tool that is used to drive the response and make decisions under uncertainty. Once the plan is agreed, routines for monitoring progress should be set up. Monitoring the unfolding of the pandemic and the effectiveness of the interventions will provide you with feedback loops to understand what is working well and what refinements may be needed. Course correction and problem solving are a normal part of the process. It is recommended that the plan is informative rather than normative and that it is flexible and in constant iteration.
Scenario planning can provide clarity, direction, and alignment. Used well, it can help government leaders depoliticize the response and consolidate national solidarity in navigating the COVID-19 crisis, drive implementation, take advantage of potential opportunities, and be more resilient and better prepared for future challenges.
This brief was prepared by the Harvard Ministerial Leadership Program in collaboration with Juan Riesco and Nick Rodriguez, Delivery Associates.
Interview with Jamie Cooper, Chair & President, Big Win Philanthropy
16 - Alleviating the Impact of COVID-19 on Young People
Major disruptions to everyday life due to COVID-19 have become the norm for the majority of the world. Drastic measures taken to slow the spread of the disease have forced the majority of schools and non-essential businesses to close worldwide. In sub-Saharan Africa, where the median age is 19 and people under-25 make up approximately 60% of the population, the impact of these measures has both immediate and long-term repercussions on the youth population.
The majority of jobs held by people under-35 are in the informal sector or in small and medium sized businesses in the formal sector. Social protection programs are often not geared to supporting people in these types of employment, especially if they are young and have not been paying into the system for long (if at all). Access to health care for non-COVID-19 related services may also pose a major issue for young people, particularly those in need of family planning services or antiretroviral treatments for HIV/AIDS patients. School-aged youth could face challenges with remote learning, especially those living in poverty without access to internet, television or radio where many education systems have been forced to shift their curriculum. The United Nations estimates that half a billion children lost access to education as a result of lack of access to remote learning.
Longer-term, COVID-19 poses a major detriment to human capital development with lasting implications for Africa and other developing economies. The potential of long-term recession and large-scale unemployment could force millions into poverty and have a major impact on employment prospects, which is particularly troubling given the existing high levels of youth unemployment in Africa. Health issues specifically impacting young people and below standard educational outcomes could be an additional setback. Many school-aged youth could either be further behind in their studies or discouraged from returning at all when schools reopen. The reasons for this could range from the need to seek employment to support family or disruptions to home life, unplanned pregnancies in young women, and/or frustration and discouragement with their own learning progress. There could potentially be an uptick in both the number of pregnancies and HIV infections following the pandemic and thus disruption to routine services as health system resources are diverted and budgets depleted to respond to the pandemic can have lasting impacts for the health of young people.
What actions should government take to mitigate the impact on its youth population?
1. Improve Access to Social Protection Programs: Most working young people in Africa are employed through the informal sector and do not have access to traditional social protection programs. Improving the reach of social protection programs to include agriculture and informal sector workers can alleviate the financial strain being felt on the working youth population. Productive inclusion mechanisms, like targeted, incentivized cash transfers is one example.
2. Create Opportunities for Education and Training: With schools closed and most pupils expected to continue their education remotely (if at all), the risk for young people to either fall behind in their studies or drop out completely is increased. Establishing an appropriate and accessible distance learning platform for each respective country context and coordinating with teachers and parents is vital to continuing students’ education from home. Lowering barriers for students to return to the classroom once the pandemic has subsided, such as suspending enrollment fees and changing policies that prevent pregnant girls from returning to school, should be at the forefront of Education and Youth Ministers’ minds. Furthermore, developing skills training programs and a robust TVET system for young people who drop out of school can provide them with better chances of employment in entering the workforce.
3. Maintain Continuity of Health Services: The immediate demand of responding to COVID-19 has diverted much of each country’s health system resources. This is unavoidable, but should not be at the detriment of maintaining routine health services for young people. Upskilling and expanding capacity of Community Health Workers to provide childhood immunizations, HIV/AIDS prevention and treatment, as well as reproductive health and family planning services targeted to young people could alleviate pressure on the health system and provide longer-term socio-economic benefits.
4. Protect the Welfare of Children, Girls and Young Women: Social distancing could have a significant impact on behavioral and social development of children and young people as they are forced to remain separated from friends and classmates. Stay-at-home measures can potentially exacerbate problems at home, with children and young women being more susceptible to abuse or sexual assault. General despondency about their future prospects could lead to increased substance abuse among young people. Access to youth support centers and emergency services (such as assault hotlines) could be useful interventions. It is important to ensure that such programs are considered essential services so they can continue to operate during the lockdown.
5. Include Young People in Decision-making: Youth groups and organizations can provide valuable feedback on how young people are affected by the pandemic, as well as their immediate needs and expectations of the government. Youth groups and their representatives should be included in consultations about the COVID-related response. Their inclusion is politically strategic given their overwhelming demographic majority and ability to message and mobilize through social media.
Interview with Hon. Margaret Kobia, Cabinet Secretary for Public Service and Gender, former CS for Youth, Kenya
17 - Avoiding Backsliding in Key Health Indicators
Mrs. AO, a known hypertensive was feeling unwell. Her blood pressure had gone up to 220/110 mmHg and she went to her local clinic. She was referred to a tertiary facility in her home state. However, she was not treated because the doctors were reluctant to receive patients due to the COVID-19 situation. She was again referred to another tertiary hospital in another state. Interstate movement restrictions to control the epidemic were in place, but given this was an emergency, her son decided to make the trip. Enroute, they encountered the enforcers of the movement restrictions and despite all pleas, had to pay the fine as a penalty for violation of the movement restriction order. Sadly, the fine paid was meant to cover cost of care and they had to return. Now she is back home, with poorly controlled blood pressure, and resigned to her fate.
This is a real-world example of policies and interventions in a health crisis resulting in unintended consequences and worsening other health outcomes.
Over the past decades, building on the momentum of MDGs and now the SDGs, the world has made significant progress in improving key health outcomes and saving lives. World-wide 760 million children have been immunized saving over 13 million lives and resources have been mobilized to combat some of the world’s deadliest diseases in lower- and middle-income countries. Increased financing, better governance, and the right inputs/outputs have contributed to this positive trajectory.
The COVID-19 pandemic has brought about major disruptions to life and livelihoods, directly and indirectly impacting health and the economy. The impact has been multifaceted.
- The COVID-19 pandemic has significantly affected all economies. Sub-Saharan Africa is set to experience its first recession in 25 years, as growth is projected to decline from 2.4% in 2019 to between -2.1% to -5.1% in 2020. No country is exempt. The OECD estimates that for each month of containment, there will be a 2-percentage point reduction in annual GDP growth reduction. In sub-Saharan Africa, decline in global demand for commodities is worsening the economic situation. An estimated 29 million people could be tipped into poverty. Increased levels of poverty and food insecurity will have adverse health consequences.
- COVID-19 is directly impacting mortality and morbidity. So far, some 5 million people worldwide have been infected with the virus, with over 300,000 fatalities. Testing capacity in many countries remains inadequate suggesting that the real level of infection could be far higher. Although so far disproportionately affecting higher income countries, low income countries are beginning to experience an increase in incidence of cases, and many developing countries lack adequate resources and systems to mount effective responses. Health systems are stretched beyond their capacity as countries struggle to cope with the pandemic.
- COVID-19 indirectly impacts mortality and morbidity from other causes. People with chronic health conditions like hypertension, diabetes, and HIV/AIDS may experience difficulty accessing care due to the burden on health systems from COVID-related care. There could also be upticks in maternal mortality as pregnant women delay accessing needed care, emergency services are unavailable, or more women choose to deliver at home. Similarly, progress in early childhood survival rates and child health may be impacted by lack of access to basic care and reductions in childhood immunizations. As health systems all over the world prioritize COVID-19 responses, a decline in access to other services is notable. This decline could result in an additional 6.3 million cases and 1.4 million deaths from TB by 2025 (causing a 5 to 8 year set back), as well as up to 10%, 20% and 36% increases in 5-year mortality from HIV/TB/Malaria respectively from high burden countries. These reductions in services stem from reduced demand (from fear of being infected) and reduced access due to diversion of health personnel and resources to dealing with COVID-19 prevention and treatment, as well as reduced services because health workers may lack protective equipment and other essential medical supplies.
What could Ministers do?
In this (and in fact any) crisis, the imperative is that leaders simultaneously address the crisis at hand while ensuring continuation of essential basic health services and take measures to strengthen the system to better deal with future crises. However, the economic impact of COVID-19 means that leaders would have to do this with fewer financial resources and a less favorable economic outlook, as well as significant stress on health workers and health systems.
1. Ensure Access to Essential Health Services: While responding to the epidemic and ensuring all aspects of the response are maintained to prevent a resurgence, countries should ensure that priority services are not interrupted. This is a delicate balance and country contexts vary. Leaders face a dilemma, but should ensure that their populations (especially children and expectant mothers) are kept healthy, well-nourished, and can access life-saving maternal, newborn, and child health services including routine vaccinations. Basic measures could include: 1) ensuring health workers at all levels have the necessary protective equipment; 2) shoring up primary health care (PHC) in frontline facilities; and 3) enhancing the capacity of community health workers to manage a broader range of conditions. Equally as important is ensuring continued supply of necessary drugs and other commodities to frontline healthcare facilities. The crisis has demonstrated an opportunity to integrate technological approaches to sustaining and increasing access to essential health services.
2. Rebuild with Priority on Resilience: In the medium term, leaders should ensure they use this opportunity to prioritize resilient health systems, building on the foundation of strong PHC, community health workers and community engagement, as well as strengthening public health surveillance systems. This will require a significant increase in investment in emergency preparedness ensuring that it supports and not undermine regular service delivery. A resilient health system is one which protects human life and produces good health outcomes for all during a crisis and in its aftermath, while routinely delivering care and positive outcomes. This dual role, known as the “resilience dividend” enables such health systems to stay responsive to changes and shocks with minimal disruption to core functions.
3. Collaborate across borders: Diseases spread further and faster today than any time in history. Information (and misinformation) travels even faster. Combating future epidemics will require better regional and global coordination and solidarity. Although global supply chains and trade between countries have enhanced interdependence, fear and the scarcity of essential supplies and resources during the COVID-19 crisis has led to a rise of political nationalism and other barriers to collaboration. Leaders should balance their primary obligations to their citizens, with their obligations to the global community. COVID-19 demonstrates shared vulnerability across countries, making regional and global cooperation an essential part of disease prevention. COVID-19 will not be the last global pandemic and countries should converge around a global emergency preparedness plan. Health Ministers have a critical role in leading such an initiative.
This brief was prepared by the Harvard Ministerial Leadership Program in collaboration with Dr. Kelechi Ohiri, CEO of the Health Strategy and Delivery Foundation and former Senior Special Advisor to the Minister of State for Health, Nigeria.
Interview with Awa Marie Coll-Seck, Former Minister of Health & Social Affairs, Senegal
18 - Avoiding Backsliding in Education
The COVID-19 pandemic has disrupted education worldwide. Many countries have suspended schooling as part of their preventative restrictions and shifted to remote learning using the internet, radio and television. The United Nations estimates that as many as a half billion school age children worldwide have lost access to education because they lack remote access. Moreover, education systems traditionally rely on face-to-face teaching. Despite all the efforts to sustain education during the current crisis, even students with access to distance learning platforms have found it difficult to continue their education without the structure and discipline of the classroom or have found it of lower quality. Under these conditions, millions of students’ learning could be severely setback and some frustrated with their progress may choose not to return to school when they re-open. Additionally, the severe economic impact of the pandemic has caused many people to lose their income, so it is possible that some students will not be able to return to school for economic reasons. The poorest sectors of the population are inevitably the worst affected by these circumstances, further setting back progress toward greater equity in countries around the world. Below are some considerations for Ministers as they work to address these problems:
1. Re-open schools as soon as possible: Obviously re-opening schools as soon as feasible is high priority for governments, but that decision must be informed by reliable data on the trajectory of the pandemic in each country. Schools could become hot spots for the spread of the COVID-19 virus if they are opened prematurely and if the necessary protective measures are not well planned and implemented. The timing of the opening and the comprehensiveness of the protective plan is critical because if outbreaks do manifest in schools, parents will withdraw their children and teachers will refuse to return. Re-establishing face-to-face contact between students and teachers is vital to sustaining education. However, in order to establish a high degree of protection from coronavirus infection for students and teachers, governments should rethink how schools are traditionally organized. These measures should include strict social distancing rules. For example, schools could consider reorganizing into smaller groups of students working in class for fewer hours a day but in longer working days, possibly including weekends, in order to accommodate more groups. It may also be necessary to include an increased amount of student-led, home-based learning supported by a combination of printed learning materials, as well as online, radio and television programming. Such routines may be challenging for both students and teachers, as well as parents. Involving teachers and their unions, as well as parents in planning these changes is important to prospects for successful implementation. Just as essential is ensuring the necessary WASH facilities are readily available together with protective equipment (facemasks for students and teachers, as well as face shields and protective clothing) and use strictly enforced. Rigorous school sanitizing procedures and daily temperature checks for all who enter the school should also be part of the plan. Because responsibility for implementation is devolved to school leaders, breakdowns in this system are to be expected. Such measures will likely be easier to implement in better-resourced schools while less well-resourced schools with poorer students may be at greater risk from COVID-19 infection and enhanced educational disadvantage.
2. Prioritize the needs of teachers and parents: The suspension of schooling has undoubtedly been a significant inconvenience for students, but the major burden falls on teachers and parents. Like everyone else, teachers and parents share the fear and distress of the current situation, and yet they are the frontline of a successful education system. Empathy and support from government leaders is crucial to their cooperation with efforts to re-open and re-organize schooling, but equally important is continuing support to teachers in developing new lesson plans and supporting materials, as well as to enable parents to support their child’s learning at home. There are additional economic considerations which could complicate school re-opening plans. Teachers could assert that they are ‘essential workers’ taking on additional risk and demand incentive pay. Most developing countries under current circumstances would be hard pressed to afford such demands, but there are various possible international sources of funding. Parents experiencing various extremes of economic impact may no longer be able to afford school fees and other related costs such as uniforms and transport, or they may require their child (particularly adolescent girls) to stay at home to assume household duties. Consideration needs to be given to these possible barriers to students returning to school.
3. Assess the learning deficit: Take advantage of the first days students are back at school to assess how much learning occurred during the shutdown, and to measure for possible educational deficits. This could be useful in establishing which remote learning platforms may have been more effective in maintaining student engagement and learning, as well as developing approaches to making up for loss of learning. It is important that students who are identified as in need of ‘catch-up’ learning are not stigmatized. Catch-up strategies that integrate elements of remedial learning into the regular curriculum would be preferable, as well as the priority of teachers in class to students who are educationally disadvantaged. Additional tuition for lagging students after school hours, on weekends or holidays is also possible, but has the disadvantage of singling out such students, as well as the need for teachers to commit additional time and associated costs.
4. Incentivize education: Countries worldwide, and particularly in sub-Saharan Africa, have made tremendous progress over the past decade in advancing universal equitable education, but the lasting economic effects of the current crisis could undermine that progress. Conditional cash transfers usually targeting low-income families have long been used to incentivize enrollment of their children at school. Introducing or expanding such programs (perhaps as a temporary measure) might be considered in countries where there is a notable drop-off in school registration. Alternatively, well-designed informational campaigns on the economic returns of education can be effective and much cheaper than conditional cash transfers. For instance, in Latin America about 20% of students and their families underestimate college economic returns, and up to 30% underestimate returns on basic education. In the case of Peru, the implementation of informational campaigns has reduced school dropouts by 19% with only a marginal cost of less than US$0.05 per student. Peru has also shown that combining conditional cash transfers with informational campaigns has an even more positive effect. School feeding programs are another significant incentive for regular school attendance. Many children from poorer households depend on that food for their daily sustenance. Maintaining and possibly expanding such programs at a time when many more families could be experiencing food insecurity could be helpful.
5. Include education in economic recovery plans: Most countries are already prioritizing their economic recovery even while they continue to deal with the worst effects the COVID-19 pandemic. Economic recovery plans include various stimulus measures to shore-up and help re-start the economy. The effects of this deep crisis are not limited to any one sector and an effective strategy for recovery has to be a collaborative, whole-government plan. Human development is the cross-cutting foundation of such a strategy and education is the heart of human development. Ensuring education is a central part of the recovery strategy would be essential. The educational chapter could be used to finance an emergency plan that includes the following elements:
- Extra hour payments for teachers that will teach more groups and during out-of-school hours, weekends and vacations, and/or temporarily hire college students or retired teachers in good health, or community workers to support teachers with the extra work. Mexico, for example, has been very successful utilizing college students, retired teachers and physicians in early childhood education;
- The design, implementation and data analysis of the diagnostic assessments;
- Conditional cash transfers and/or informational campaigns on the returns of education; and
- Investment in the expansion and development of digital networks nationwide to support essential public services like education and health. Increased access and application of digital technology could also have broader benefits for the economic recovery of families and countries.
This brief was prepared by the Harvard Ministerial Leadership Program in collaboration with Aurelio Nuño Mayer, former Minister of Public Education, Mexico.
Interview with Dzingai Mutumbuka, Former Minister of Education, Zimbabwe
19 - Ensuring Food Security
Millions of people world-wide have lost their jobs and income because of the economic disruption of the COVID-19 pandemic. For some this may be a temporary problem, but for the vast majority of people who live on the economic margins this situation is a catastrophe with potentially long-term consequences. The World Bank has estimated as many as 49 million could be tipped into extreme poverty. As much of the progress in poverty reduction over the past two decades is reversed, a breakdown in food security could be one of the lasting legacies. The U.N. World Food Program (WFP) projects a 20% increase (10 million) in children suffering from malnutrition worldwide. Hunger generally and particularly its lasting impact on children, has substantial political and economic implications for government leaders. In sub-Saharan Africa the WFP reported that in 2018 some 239 million people were undernourished. The economic fallout from the COVID-19 pandemic could greatly magnify the effects on persistent food insecurity resulting from other problems like declining levels of agricultural production, extreme weather events, regional conflicts and severe locust plagues in East Africa.
As government leaders struggle to balance efforts to combat the pandemic with the need to avoid collapsing the economy, the following are some considerations:
1. Make Food Security a Core Part of the Whole-Government Response: The need to shore up food security should be a central part of the emergency response to the COVID-19 pandemic. Food banks and emergency feeding programs provide a critical need for those most at risk of hunger. Such programs are most often run by non-government organizations. This may mean government stepping outside its comfort zone to partner with civil society in substantially expanding the reach of such programs. As crucial as these initial measures could be, levels of increased long-term food insecurity will likely track the pace of the post-pandemic economic recovery. Predictions for the global economic recovery are dire. The World Bank estimates sub-Saharan Africa will experience its first recession in 25 years. The implication is governments’ recovery plans should include a whole-government, multi-sectoral strategy including a multi-pronged approach to shoring up food security and building a more dependable food supply system. Initial measures could include:
- Ease restrictions that inhibit economic activity as soon as pandemic-related data indicate it is appropriate. People need income to buy food. But a lot of people will not get their jobs back and many may not be able to easily revive their livelihood. Lockdown rules may also have impeded food supply chains and limited agricultural production.
- Expand social assistance programs for the jobless and most needy. In many countries women have primary responsibility for feeding and caring for others in the household. Ensuring affirmative measures to address the added burden on women is key. Many children rely on school feeding programs as their principal source of sustenance. School closures have disrupted these programs. Setting up alternative channels for feeding children at risk of under-nutrition is critical.
- Boost the informal sector. Most people in developing countries work outside the formal mainstream economy mostly in markets, small stores and street vendors, or are self-employed. Many governments have taken extraordinary fiscal measures to shore-up mainstream enterprise, but the same consideration needs to be given to the multitude of individual entrepreneurs (mostly women) who are the backbone of the informal sector including easing regulations restricting small traders and increasing access to loan finance.
- Provide emergency support to small-scale food producers. Weeks without opportunity to market their products could mean many small producers may lack the money needed to buy inputs such seeds and fertilizer, as well as feed for livestock possibly curtailing future production. Temporary assistance to small farmers either through subsidies, loan finance or direct provision of essential inputs for the next growing season could be helpful. An important part of this support could also be facilitating access for small-scale producers to markets, as well as transport for their produce. Household subsistence food production (a hallmark of most traditional communities) has been in decline as urbanization has increased. Subsistence food production could be promoted, encouraged and supported with inputs like seeds, fertilizers and agri-advice in rural communities, as well as cities by making spaces for community gardens. This is an old-fashioned idea that in current circumstances has new relevance.
2. Invest in a More Secure Food Supply: Most developing countries have inherently fragile food systems. African countries for example import about 40 million tons of grain annually. This level of dependence is costly and unreliable. Strengthening the national food supply system is a longer-term endeavor, but initial steps could include some of the following:
- Build a cross-sectoral coalition: Government’s strategy to ensure security of the national food supply should engage all components of the sector, including commercial and small-scale producers, farming cooperatives and peasant farmers in a broad coalition with shared purpose and goals. Securing the national food supply also requires cross-government collaboration. Among other considerations finance, water, transport and labor are all essential inputs. An important part of such cross-sectoral collaboration is shared technical resources and other kinds of support to promote agricultural production generally, and help small scale farmers achieve higher yields and produce more marketable crops.
- Establish a National Essential Food Reserve: In years of surplus yield, governments should resist the temptation to export essential grains and other foodstuffs, rather stockpiling such supplies in anticipation of the next major disruption to the national food supply.
- Incentivize Agriculture: Agriculture is often undervalued as a cornerstone for national economic development and yet it is perhaps the most strategic sector for human development and a potential driver of economic growth. Elevating agriculture to the core of the post-COVID economic recovery strategy could have long-term benefits. Providing greater incentive to small producers to scale-up, as well as increase yields of more marketable foods, and equitable market access is one measure. A key part of scaling up and improving productive capacity is access to finance. Short-term subsidies, government-backed loan financing or micro-credit programs for farmers with minimal collateral should be part of the plan. As important is encouraging new farmers, particularly young people. As most developing countries struggle with large-scale youth unemployment making land, technical support, finance and other inputs available to incubate a generation of agri-startups could be part of the strategy.
- Digital Technology Can Help: Innovations in digital technology have the potential to create employment in agriculture for young people, promote economic activity and enhance food security. Mobile phones are the most accessible digital platform and are already being used to provide SMS technical advice, information for farmers about how to access markets and extension services, as well as weather updates. For example, Ethiopia’s ’80-20’ hotline, providing farmers advisory services, has about 4 million users. It is notably a free service delivered in local languages. In Kenya and Nigeria, farmers can text Hello Tractor to rent a tractor. Mobile money is increasingly available for ease of payment. More sophisticated technologies improving agricultural productivity and profitability include temperature and moisture sensors, GPS technology and precision agriculture.
In responding to the current crisis, it is important that Ministers consider the basic weaknesses in national systems complicating a comprehensive government response to people’s urgent needs. Adequate food is the most basic of human needs. Initiating measures now to shore up national food security could help ensure a better response when the next crisis threatens the food supply.
Interview with the Hon. Oumer Hussien Oba, Minister of Agriculture, Ethiopia
20 - Mitigating the Impact of Job Loss
The economic impact of the COVID-19 pandemic is being felt by countries and households worldwide. Initial measures to contain the spread of the virus, including total lockdowns in some countries and various forms of stay-at-home restrictions in others, have disrupted normal economic activity. Formal sector employers have suspended operations, and many jobs may be lost as these businesses struggle to survive. In most developing countries, the informal sector is the backbone of the economy and there too severe disruption has caused widespread loss of income and imperiled many small enterprises. Most developing countries already have large numbers of unemployed. These setbacks will add significantly to existing unemployment and complicate future job creation prospects. The challenge for government is to mitigate the impoverishing impact of loss of income, while developing a strategy for longer-term job incubation. The following are some considerations:
1. When to re-open the economy? The primary concern for Ministers is balancing public health measures with socio-economic priorities. Decisions about how best to achieve that balance needs to be informed by reliable data on the evolution of the pandemic in each country. Reliable data depends in turn on sufficient testing for COVID-19 to establish a reasonable estimate of the prevalence of the virus and measures needed to contain its’ further spread. Most countries have struggled to establish testing programs of sufficient scale to pre-empt spread of the virus and decisions are being driven by public pressure to re-open the economy. There is a strong sense across countries that suspension of economic activity is more harmful to public health and well being than the virus. As countries adjust to the fact that COVID-19 is not dissipating anytime soon, most have chosen to re-open their economies while preparing to respond to concentrated local outbreaks, so called ‘hot spots’. African countries in particular have for two decades successfully managed the impact of the continuing HIV/AIDS pandemic. Lessons from that experience can be instructive now.
2. Alleviating loss of income: Many countries took initial steps to off-set loss of income through one-time payments to people, or building on existing social assistance programs like feeding programs and conditional cash transfers. Fiscal constraints will limit countries’ ability to sustain these programs at scale for too long. Rebuilding the economy to pre-COVID-19 levels will likely take some significant time too. Ministers could consider public works programs. Such programs will indeed require further government investment, but could generate large scale income opportunities, as well as public benefit from the projects tackled. Some countries (notably Kenya and Rwanda) have national youth service programs which could provide a model for expansion. Potential opportunities include:
- School Assistance Programs: Graduate students can be trained as teaching aides to support teachers and school leaders. Such a program could be particularly useful as teachers work to make up for the loss of learning due to school suspension in many countries. Teachers are at particular risk of COVID-19 infection given their daily interaction with students and fear of infection may deter some teachers from returning to work or result in increased absenteeism. A corps of appropriately trained school aides could help supplement schools’ professional teaching capacity.
- Expanded Community Health Worker Programs: Most public health systems are struggling to manage the burden of COVID-19 care while continuing to provide regular health services. Community health workers (CHWs) can play a significant role in alleviating pressure on health facilities. Most developing countries have CHW programs. The skills-level and capacity of these workers varies widely. Expanding and upskilling the existing corps of CHWs to be able to diagnose and treat common illnesses could help strengthen the foundations of the public health system while also creating employment opportunities. For countries that cannot afford to sustain scaled-up CHW programs, adding cohorts of temporary community-level health workers or health aides could be a relatively low-cost way to create jobs and supplement the efforts of core CHW programs during this time of particular stress on the public health system.
- Public Infrastructure Projects: Public works programs can be useful for the maintenance and construction of public infrastructure from street repair and cleaning to building classrooms or clinics, laying sidewalks, improving roads and bridges in rural areas. Historically, governments have used public works programs after major economic setbacks to help put money in people’s pockets and boost economic activity.
- Agriculture Work Programs: The pandemic has underscored the need in most countries to shore up the national food supply. Agriculture could be boosted by additional labor as part of national public works effort. Agricultural production is labor intensive and exposure to farming could encourage some young people in particular to make a longer-term commitment to the sector.
3. Incubating Jobs: Knowing that many people will face unemployment and a loss of income even after the pandemic has subsided, government should ramp-up efforts to incubate jobs and encourage entrepreneurship, especially for women and young people who are disproportionately impacted. Some ideas include:
- Enabling entrepreneurship and job creation: Government can facilitate job creation by providing prospective employers tax and other incentives like rent free facilities for their business. Prioritizing small and medium enterprises (SMEs) for a share of government contracts is another way to enable these businesses to scale up and increase their number of employees. Relaxing government regulations that restrict informal sector activity, as well as the growth of SMEs is another consideration.
- Easing Access to Finance: Generally, limits on access to credit and loan finance is a primary impediment to the growth of entrepreneurship. Women in particular face added regulatory hurdles and discrimination in many countries. Government can be helpful in several ways including for example backing micro- lending programs, easing regulations on access to loan finance, providing government guaranteed credit facilities for start-up enterprises, as well as scaling up those that flourish. Often government finance for small enterprises is very limited. If significant job creation is the goal, government needs to assume more risk by extending promising enterprises sufficient money to grow their employment capacity.
- Skills training: In many countries school-leavers and university graduates do not have employable skills. This was a critical problem before the disruption of the COVID-19 pandemic, but now is even more urgent. One requirement is adjusting school curricula to be more in line with the rapidly evolving nature of the national economy and economic activity globally. Another is rethinking the old concept of technical and vocational training (TVET) to ensure that people already out of school have ongoing opportunity to acquire and upgrade their skills to make them more employable. Technological skills for example could be fundamental.
Interview with Rosine Sori-Coulibaly, Former Minister of Economy, Finance, and Development, Burkina Faso