Investing in Health to Build Human Capital, Protect Lives and Promote Economic Resilience: World Bank Support to East Asia and Pacific

• The COVID-19 crisis revealed deficiencies in national health systems, but the pandemic was also a catalyst for change.
• The World Bank is supporting post-pandemic health-sector reform and investments. The Bank’s approach will support expanding coverage, improving quality of primary healthcare, and strengthening core public health functions.
• Bank efforts are also focused on preparation for the next pandemic, and improving efficiency of healthcare delivery and expenditures.

COVID-19 was one of the greatest health and economic shocks in a century, leading to millions of deaths, pushing millions more into poverty and disrupting lives around the world. Across East Asia and the Pacific, the pandemic also brought a renewed consensus to improve healthcare delivery to people throughout the region.

Several governments, including Indonesia, Malaysia, and the Philippines, among others, have announced efforts to reform and rebuild.

“Covid was a wakeup call,” said Achim Schmillen, the World Bank’s practice leader for human development in Indonesia and Timor-Leste. “It really showed the deficiencies of health systems, but it also was a catalyst for change.”

The World Bank has been a long-standing partner in supporting East Asia and Pacific governments address health emergencies and strengthen health systems. The Bank quickly responded to COVID-19 with technical assistance, knowledge sharing and financing to help EAP countries navigate the health shock. Between April 2020 and October 2022, the Bank committed US$1.9 billion across 18 COVID-19 health response projects in the region.

Now, with populations largely vaccinated, economic activity returning, and livelihoods recovering, the Bank is providing financial support and technical expertise to help Indonesia, China, Papua New Guinea, Samoa, and other countries throughout the region build stronger and better-resourced healthcare for their citizens.

“Governments across the region have now pivoted to a recovery phase and are rebuilding around nationally defined reform plans,” said Ronald Mutasa, practice manager for health, nutrition, and population in the East Asia and Pacific region. “By investing in stronger health systems today, countries will be better prepared to build human capital and for the health crises of tomorrow.”

At the national level, the Bank is supporting the post-pandemic consensus for health-sector reform and investments. The Bank’s support generates new knowledge to inform policymakers on key reforms, technical assistance to accompany such reforms, and financing for projects.  A few select examples of countries with such partnerships include:

• Indonesia launched an ambitious health system transformation plan, committing unprecedented resources to address longstanding constraints to access and quality across the primary care, referral hospital, and public health laboratory systems.

The World Bank is supporting this with a two-pronged approach: The Indonesia Health Systems Strengthening Project is a US$4.3 billion investment, approved in December 2023, and co-financed by Asian Infrastructure Investment Bank, Asian Development Bank, and Islamic Development Bank. It is designed to increase the availability of functional equipment in public health facilities and improve the utilization of public health services across the country.

The World Bank is also supporting the Indonesia’s efforts to strengthen the supply of medical care professionals through a Universal Health Coverage Development Policy Loan. This program will unlock critical and longstanding policy constraints that have led to shortages of medical doctors and barriers to accessing medical care.

• The Health Equity and Quality Improvement Project in Cambodia is helping the country provide equitable utilization of health services, especially for the poor and vulnerable populations, and will provide immediate and effective response during crises. With a grant from the Pandemic Fund, the project will incorporate a new component to support the country to strengthen capacity for pandemic prevention, preparedness, and response. The new component, together with the ongoing support to establish a high physical containment laboratory under the Emergency COVID-19 Response Project, will help the country build a resilient health system and prepare better for future emergencies.

• Lao PDR’s Health and Nutrition Services Access Project (HANSA2) will continue to support the government’s efforts to improve equitable access, utilization, and quality of health and nutrition services in target areas, and provide immediate response during emergencies. HANSA2 also shows how the Bank can develop platforms for aligning partners, promoting coordinated financing to bolster health system resilience, and minimize financial fragmentation in the pursuit of universal health care.

• The Bank’s longstanding analytical support to Pacific Island health ministries helped build a solid foundation to inform change. The Bank is now stepping up its assistance to help governments build health systems that will build human capital, protect against future pandemics, and foster resiliency against the constant threats of climate change, natural disaster, and noncommunicable disease. The Bank’s systems-oriented support ranges from Program-for-Results lending to tackle noncommunicable diseases in Samoa to foundational investments to strengthen sub-national health services in Papua New Guinea.

At the regional level, where health engagements generate significant positive spill-over benefits between countries, the World Bank has focused on two goals.

• A first objective is to help prepare for the next pandemic through engagement on vaccine security. This process started with a regional assessment—conducted jointly by the International Bank for Reconstruction and Development (IBRD) and International Finance Corporation (IFC)—of country capacities in developing and manufacturing vaccines. This analytical piece has led to consensus among Association of Southeast Asian Nations (ASEAN) countries on the need to closely coordinate on investments and policies across the vaccine value-chain.

• A second objective has been to help countries improve efficiency of healthcare delivery and expenditures without cutting essential services. To give just one example, the Bank has developed new tools for reviewing health insurance claims, especially regarding the quality and appropriateness of hospital expenditures. The work stream invests in building mid-level bureaucrat’s capacity for data use for decision making and provides entry points to addressing broader health sector bottlenecks.

In addition to new reforms, the EAP region still must confront a mix of challenges that pre-date COVID-19. EAP is home to countries with some of the world’s highest rates of stunted growth among children, such as Timor-Leste, as well as countries that have seen significant progress, such as Indonesia, where the World Bank has made its largest cumulative investment in nutrition globally. Since 2015, the Bank and its partners have supported operations to address stunting in Cambodia, Lao PDR, Papua New Guinea, and, more recently, the Philippines.

Going forward, the Bank’s approach will support expanding coverage, improving quality of primary healthcare, and strengthening core public health functions.

The Bank is building on its longstanding partnership with the Australian government to advance universal health coverage in the region, and is deepening cooperation with other governments and key development partners to achieve results that are at scale and in line with the Evolution Roadmap for the region.

“Countries in EAP are increasingly demanding the Bank’s support along key healthcare service frontiers such as strengthening models for public-private sector interfaces, health financing reforms, digital health, scaling up the convergence of nutrition specific and sensitive interventions, rethinking and upgrading primary healthcare to tackle NCDs, mental health, and aging,” said Ronald Mutasa.