With COVID-19 rapidly spreading across developing countries, the impact on vulnerable people could be devastating, with high co-morbidities likely to cause particularly severe health impacts. Income losses of more than $220 billion are expected, risking pushing up to half a billion more people into extreme poverty.
Unfortunately, for many developing countries, the promise of containing the virus through lockdowns is elusive. 3 billion people in developing countries lack access to hand-washing facilities needed to upgrade hygiene. Social distancing will be impossible for the 1 billion living in cramped slum conditions. Internal migration is a vector of transmission to rural areas. Ceasing work is hardly an option for the 600 million people in extreme poverty, making extended or repeated national lockdowns impossible. Once a critical mass of community transmission is reached, governments will struggle to successfully contain the virus through lockdowns. Lockdowns are however giving governments invaluable time to plan forward.
Devising the right post-lockdown plan is arguably the most important and difficult task facing governments, and yet one that may be dangerously lost in the urgency of the first response. Gradually re-opening the country in a way that is so fundamentally re-organized to contain the spread is complicated. Perhaps the poor could go through one very painful and short lockdown, but as time passes, the despair associated with poverty and hunger will increasingly reduce policy options. With vaccines at least 18 months away, and promising drugs at least 9 months away from mass production, planning for a world where lockdowns are no longer feasible is paramount to minimizing the long-term impact of the pandemic.
The clock is ticking but there are promising, feasible and common sets of actions governments can launch in the next weeks to significantly improve their chances against COVID-19 after lockdowns end.
1. Bold replanning and expansion of fiscal space
Money is needed to expand health systems, support economic recovery, and provide immediate relief to the poor. Naturally, many countries have requested emergency loans from the IMF and the World Bank. Fast and bolder measures are needed.
Anticipating the depth of the crisis, governments can immediately re-allocate budgets more drastically, for instance by making temporary cuts to non-critical areas like tourism, culture, defense, and even digging into education budgets as they make hard but necessary trade-offs. Like in Colombia, reducing salaries of civil servants, especially for those in non-priority sectors is sensible when citizens are foregoing salaries. Solidarity taxes on the wealthy might also be necessary.
At the international level, bilateral creditors can allow debt rescheduling that would immediately free up $32.7 billion for developing countries. Donors can additionally relax conditionalities on the $150 billion of annual aid that they provide to developing countries to re-orient funds to the COVID response.
2. Creatively unlocking local health capabilities
To reduce future death counts, resource-constrained governments must use the time that lockdown have given them to creatively boost health capabilities.
To expand manpower, governments can emulate Italy’s efforts of deploying student doctors. They could multiply the medical force by enlisting and training the military, community health workers, and even pharmacists and informal village doctors who are often the first-point-of-care for the poor.
Infrastructure can be repurposed. Public spaces can host mobile hospitals, while idle schools, hotels, churches and other buildings can multiply quarantine facilities for COVID patients or serve as overflow facilities for regular patients.
To boost capabilities, more developing countries can activate local production and innovation lines. Ghana is repurposing factories to produce 3.6 million masks in a month. Nigeria, South Africa and Morocco have successfully challenged the private sector to locally manufacture mechanical ventilators. Colombia and Peru are financing dozens of local innovations to improve detection, surveillance, and leverage technology to contain future outbursts.
3. Developing post-lockdown guidelines for citizens
To speed up re-opening and make it a success, governments must urgently produce simple and clear guidelines to limit COVID’s spread while allowing a gradual resumption of economic activities. Guidelines would outline a plan for strategically re-opening parts of the country, focusing on those that are critical to the COVID response and to the economy, that generate jobs for the poor, and that carry minimal transmission risks. Such a plan would specify restrictions, distancing guidelines, and required adaptations to public spaces to further diminish transmission risks.
Guidelines would need to consider internal heterogeneities. For example, less crowded rural areas with low infection rates can be protected at the ‘borders’, allowing populations to operate freely within. In more crowded areas, social distancing may be impossible, and governments may enforce mask wearing. Guidelines would offer special protection to older citizens and those with co-morbidities, which would also shield the health system.
4. Set up effective delivery systems
More than ever, governments must make every cent count. Government must structure the appropriate command center to manage the crisis, that responds to its multi-dimensional nature. They can furthermore adopt two measures which may significantly improve delivery effectiveness.
Establish an observatory to adopt effective innovation: Solving this complex challenge requires continuous innovation, and the world has become an incubator of innovations against COVID-19. By establishing an observatory of global experiments, governments can efficiently identify, adopt and adapt effective innovations to their contexts, circumventing otherwise long and costly learning curves.
Real-time performance management systems: Data-driven decision-making is key to effective crisis management. Governments can build performance management systems on health, economic recovery and social protection efforts that provide real-time insights on the issues as well as on the effectiveness of government measures. That would enable rapid course-correction where needed, and focus resources on measures that work.
While far from being comprehensive, these areas of action can boost the resources and capabilities of governments to fight the virus, equip them with delivery systems to be effective and re-organize their societies in a way that allows the economy to restart and poverty impacts to be mitigated. While governments sprint to lock out the virus, they must simultaneously engage with the dissonant exercise of planning to live with it for the foreseeable future. However hard that is, it is perhaps the winning pragmatic strategy for developing countries.