世界发展银行-Overconfident---How-Economic-and-Health-Fault-Lines-Left-the-Middle-East-and-North-Africa-Ill-Prepared-to-Face-COVID-19_76页_2mb

MENA Economic Update October 2021: Overconfident - How Economic and Health Fault Lines Left the Middle East and North Africa Ill-Prepared to Face COVID-19

Core Content

The MENA Economic Update October 2021 highlights the region's ill-preparedness to handle the Covid-19 pandemic, emphasizing the role of economic and health system vulnerabilities. The report argues that long-term trends in economic, demographic, and epidemiological transitions have weakened the resilience of MENA's public health systems, making them unsuitable for managing the health emergency caused by the pandemic.

Main Findings

Economic Recovery

• The World Bank forecasts that MENA's regional GDP contracted by 3.8% in 2020 and is expected to grow by 2.8% in 2021.
• The recovery is tenuous and uneven, with most economies expected to remain below their 2019 GDP per capita levels.
• The GCC is forecasted to grow by 2.6% in 2021, while other oil exporters (OEC) and oil importers (OIC) are expected to grow by 3.2% and 2.8%, respectively.
• GDP per capita in all three groups is forecasted to be below pre-pandemic levels.

Health System Preparedness

• MENA's health systems were overconfident about their ability to handle the pandemic, as evidenced by self-assessments that were more optimistic than independent assessments.
• Public health systems in middle-income countries were particularly unprepared, despite the growth of the public sector as a share of GDP.
• Low public health expenditures relative to the public sector wage bill led to high out-of-pocket spending on medical care.
• Inadequate surveillance and limited reserve capacity in health services contributed to the systemic failure to respond effectively to the pandemic.

Truncated Transitions

• Economic transitions in MENA were truncated due to slow reforms and continued reliance on public sector spending and employment, leading to underinvestment in public goods like health systems.
• Demographic transitions were also truncated, with high fertility rates creating a young population that masked underlying health issues.
• Epidemiological transitions were abnormal, with high burdens of both communicable and non-communicable diseases (NCDs), especially in middle-income countries.

Key Trends and Implications

Economic and Health Fault Lines

• Slow economic reforms and lack of market-oriented institutions have left MENA with large public sectors that crowded out investment in health.
• High fertility rates led to high dependency ratios, worsening macroeconomic imbalances and current account deficits.
• High prevalence of NCDs and communicable diseases indicates poor health outcomes compared to income-level peers.

Pandemic Response

• Health systems were overstretched by the pandemic, with insufficient staffing, quality of care issues for non-Covid patients, and limited physical resources.
• Vaccination rates are uneven, with high-income countries leading and middle- and low-income countries lagging behind.
• Fiscal constraints and lack of reliable data hindered effective health sector planning.

Data and Governance

• Data availability and transparency were poor, contributing to overconfidence in health system preparedness.
• Governance challenges and lack of leadership further weakened the region's ability to respond to the pandemic.
• Modern technologies were underutilized, limiting the ability to track and contain the virus.

Forward Look

• Public health data is crucial for effective pandemic control and health system reforms.
• Smart digitized systems can enhance health outcomes and preparedness for future health emergencies.
• Systemic improvements in data systems and institutions are needed to build resilient, effective, and equitable health care systems.

Conclusion

The Covid-19 pandemic exposed the weaknesses in MENA's public health systems, which were overconfident in their capacity to handle the crisis. The truncated economic, demographic, and epidemiological transitions have left the region ill-prepared for health emergencies, with uneven economic recovery and systemic challenges in health governance and data availability. The report emphasizes the need for reforms in data systems and institutional capacity to support long-term health system resilience and equitable development.

Key Figures and Tables

Economic Recovery

• Figure 2.1: GDP Level and per Capita Forecasts
• Figure 2.2: An Uneven Recovery
• Figure 2.3: Growth Adjustments and Positivity Rate
• Figure 2.4: Oil Prices and Futures
• Figure 2.5: Exposure to International Commodity Markets

Health System Preparedness

• Figure 3.1: Government Expenditure in Total GDP
• Figure 3.2: Changes in Government Expenditure over GDP
• Figure 3.3: Shares of Public Employment in Non-GCC MENA
• Figure 3.4: Public Health Expenditures over Public Sector Wage Bills
• Figure 3.5: Spending on Preventive Health and Health System Functions

Demographic and Epidemiological Transitions

• Figure 4.1: Fertility Rates versus GNI per Capita
• Figure 4.2: Fertility Rates in MENA Compared to Benchmarks
• Figure 4.3: Obesity in MENA and the Rest of the World
• Figure 4.4: Illusion of Healthy Populations with Age Demographics
• Figure 4.5: Burden of Communicable and Non-Communicable Diseases
• Figure 4.6: Age-Standardized Deaths from NCDs

Pandemic Impact

• Figure 5.1: Health Spending in MENA Compared to Level of Development
• Figure 5.2: Sources of Health Spending
• Figure 5.3: Skilled Health Worker Density
• Figure 5.4: Primary Health Care Facility Density

Data and Preparedness

• Figure 6.1: Reasons for Service Disruptions
• Figure 6.2: Excess Mortality P-score
• Figure 6.3: Containment and Health Index in MENA
• Figure 7.1: Data Availability Assessment for MENA

Appendices

• Appendix A1: Growth Adjustments and Positivity Rate
• Appendix A2: Impact of Commodity Price Shocks on GDP Growth
• Appendix A3: Estimates of Truncated Long-Term Transitions
• Appendix A4: State of MENA's Public Health Systems
• Data Appendix: Includes detailed tables on GDP forecasts, health indicators, and growth adjustments.

Summary of Key Data

• GDP per capita in 2021 is 1.1% higher than in April 2021 but 4.3% below 2019.
• GCC GDP is 2.5% below pre-pandemic levels.
• OEC and OIC GDP are forecasted to exceed pre-pandemic levels.
• Egypt accounts for more than half of the OIC GDP recovery.
• Vaccination rates are uneven, with high-income countries leading.
• Out-of-pocket spending is disproportionately high due to low public health investment.

References and Authors

• Authors: Roberta Gatti, Daniel Lederman, Rachel Yuting Fan, Arian Hatefi, Ha Nguyen, Anja Sautmann, Joseph Martin Sax, Christina A. Wood
• Acknowledged Contributors: Abdo Yazbeck, Johannes G. Hoogeveen, Claudio Jeremias Rojas Guzman, Rana Mohamed Amr Mohamed Nabil Lotfi, and many others in the World Bank's MENA Health Sector team.

Foreword by Ferid Belhaj

• Highlights the importance of data and institutional reforms in building resilient health systems.
• Notes that the economic performance of the region is strongly linked to pandemic control.
• Emphasizes the need for long-term reforms to address systemic weaknesses in data systems and health governance.

Conclusion

The MENA Economic Update underscores the interconnectedness of economic and health system vulnerabilities, and the urgent need for reforms in both areas to enhance resilience and equity in the region's health systems.