Accountability for COVID-19 Aid: Better Visibility Matters for the Quality of the Response

As low- and middle-income countries are hit by the health and economic effects of COVID-19, the international community is working to mobilize billions of dollars in grants, loans, and debt relief. Beyond addressing the direct health impacts of COVID-19, routine essential health services must be delivered, health workers protected, and continuity assured in health worker wages. Earlier this month, World Bank experts estimated that sub-Saharan African countries would need up to 3 percent of the continent’s GDP in additional health financing resources alone over the next 250 days. On a global scale, projections indicate trillions, not billions, will be needed to support countries as they struggle to mount an effective response amid the growing economic fallout. Building on these estimates, multilateral, bilateral, and philanthropic actors, as well as private companies and high-net worth individuals, have announced a variety of appeals, pledges, and commitments.

While country governments struggle to make up for plummeting revenues, external funders should limit the conditions placed on the assistance they provide—particularly where financing serves as critical budget support. But even as funders limit ex-ante conditions for receipt of funding, they should establish clear standards for tracking and reporting the allocation and uses of aid—and commit to making this information publicly available.

At the moment, it is difficult to get a full picture of the funding on offer, to whom it is given, and how it will be used. Aid visibility matters—to inform a coherent and coordinated package for country governments, not-for-profits, and firms mounting a crisis response; to support response oversight by civil society and other stakeholders while also sending a clear signal to markets; and to ensure future decisions are informed by data and persistent resource gaps can be quickly identified. Given the development outcomes and the money at stake, the aid community must define a feasible minimum standard while remaining agile in disbursement.

Dashboards and trackers are in place, but it’s still hard to get a full picture of funding

Looking at publicly available information, it is difficult to get a complete picture of the financing landscape and determine how appeals and pledges fit together. Here’s a snapshot of some existing trackers:

• Devex’s dashboard captures $15 trillion in COVID-19 response “initiatives,” though there is likely double-counting and it is difficult to navigate. Notably, it also includes domestic government responses in high-income countries, and focuses on capturing “funding opportunities” for potential contractors and other bidders. Details for the more than 1,000 initiatives are behind a paywall, and what’s made available doesn’t distinguish between requests and pledges, or break down pledges involving multiple funders (e.g., the Gates Foundation is linked to the entire $675 million WHO request, without specifying its contribution of $11 million). 
• Kaiser Family Foundation (KFF) compiled headline funding pledges for the health response from donor governments, multilaterals, and private funders; by KFF’s latest tally these funders have collectively “pledged or distributed an estimated $19.3 billion.” But as KFF states, the tracker excludes some funding components, including for economic stimulus or recovery efforts from the international financial institutions, which may represent a sizeable share of funding for low- and middle-income countries.
• OCHA’s Financial Tracking Service database tracks humanitarian funding; it covers funding towards the UN’s $2 billion Global Humanitarian Response Plan (GHRP) appeal and increasingly includes non-GHRP humanitarian funding.
• The Overseas Development Institute’s tracker categorizes donor responses into macroeconomic, structural/trade/private sector, and social/health support, but like KFF, does not capture pending funding appeals.

Building on these important efforts, we pulled together an illustrative “cheat sheet” of some of the key players and topline funding amounts below, with a more comprehensive version available here. (Given how rapidly the funding landscape is evolving, our cheat sheet will be outdated soon after posting.)

The direct health response mobilized across a range of multilateral, bilateral, philanthropic, and other private funders broadly focuses on accelerating detection and curbing disease transmission; scaling up COVID-19 medical supplies and equipment; and boosting laboratory capacity, surveillance, and contact tracing, among other areas. By our latest ballpark estimates, multilateral development banks have committed over $300 billion to respond to the health and economic needs of the crisis. Notably, the World Bank has already approved 78 projects focused primarily on the health response. Alongside these efforts, there has been a significant global R&D response. The Bill & Melinda Gates Foundation, Wellcome Trust, and Mastercard together donated $125 million in seed funding for a COVID-19 Therapeutics Accelerator; Wellcome also launched an $8 billion fundraising initiative aimed at the private sector, to help fund vaccines, treatments, and testing.

In several cases, it is hard to distinguish whether the pledged amounts are “new money”—this is important to better understand how governments and their development partners are balancing the direct response to COVID-19 with the provision of essential health services. As our colleagues pointed out, it is not entirely clear if the World Bank’s $160 billion package is additional to its normal pipeline. For example, 26 of the bank’s 78 COVID-19 response operations involve (at least some) redeployment of existing projects. In the case of the US response, Congress has appropriated $2.39 billion for efforts focused on low- and middle-income countries across the Coronavirus Supplemental Appropriations Act and CARES Act (this includes foreign aid plus the CDC response); to date, the Trump administration has announced $775 million in committed funding towards health, humanitarian, and economic assistance in more than 100 countries. On the other hand, while the EU’s $17 billion package is clearly reoriented from existing funds and programs, it is hard to see which existing funds and programs have been affected.

We know little about when, where, and how resources will be deployed and used

Information on when funding is disbursed, which countries or organizations receive it, and how it is used is even more important.

On the “when”: In some instances, longstanding obstacles may limit capacity to disburse funding in a timely manner, as in the case of USAID. Encouragingly, every effort is being made to get money out the door quickly given that time is of the essence. The World Bank is fast-tracking disbursements and offering retroactive financing in some cases. While there are often significant lags between commitments and disbursements, this would be more problematic given the urgency in the current crisis—and closely tracking disbursements will be important going forward.

On the “where”: While some funders, like the World Bank and the US, have provided country-level funding information, others have yet to outline how resources will be allocated to specific countries. Beyond information about country-level funding flows, understanding which partners are receiving funds will also be important. Despite consensus around the critical role of frontline implementers, some global health initiatives have struggled to direct funds to local partners. And only a tiny portion of the UN’s $2 billion GHRP is intended for implementing partners, with 95 percent meant for UN agencies themselves. Where feasible, international assistance should strengthen national health systems, rather than create parallel structures.

On the “what”: We also attempted to identify the intended use for COVID-19 resources in our “cheat sheet” but it’s hard to get a full handle in the public domain for now. For example, while global attention is rightly focused on financing procurement of critical COVID-19 supplies, (with some notable exceptions) there is little visibility in the public domain on what is being purchased by whom, and how philanthropy and other development partners could provide support to fill critical gaps.

Another key question is how resources should be used to both respond to the immediate health (and socioeconomic) fallout and help build the preparedness infrastructure needed to stop the next outbreak in its tracks. The World Bank is focusing on preparedness in its newly approved operations and also announced a new trust fund to fund some elements of preparedness over the next 15 months. The UN’s $1 billion Response and Recovery Fund includes a window to strengthen national preparedness to “recover better” over a 9-month timeframe. These are positive developments but they fall short of meeting the need for longer-term funding to close preparedness gaps in the poorest countries (in 2019, less than 1 percent of all development assistance for health went towards pandemic preparedness). A more holistic picture of COVID-19 funding can help keep sight of these and other key gaps.

Aid visibility matters to assure the speed, cohesiveness, and accountability of the response

Limited visibility into funding is not a new problem for the aid community. Notably, several years following the 2010 Haiti earthquake, it was still difficult to account for where all the money had gone. And during the 2014-2016 West Africa Ebola outbreak, it was hard to see how much and where money was being spent; recipient country governments had little visibility of the full scale of the effort.

We recognize that full tracking and accountability of health aid for COVID-19 may not be realistic in the emergency period. Even so, better information is necessary for global health institutions and their funders to smartly allocate resources, avoid duplication, draw attention to critical gaps, and ensure accountability—and, further down the line, drive towards mutual learning in the aftermath of the crisis.

Looking ahead, we see three key questions:

• What would a feasible minimum standard for tracking and reporting COVID-19 aid constitute?
• Who would lead such an effort at the global level?
• Beyond publishing data, who would collate and analyze information in a useful way for governments and civil society partners to support oversight and accountability for a comprehensive and effective pandemic response?

The onus for accountability lies with both parties to the aid relationship—the funders and their government partners—and should ideally build on existing structures. At the moment, the funders could better organize their efforts. In the next phase, should the G-20 back such an effort, with the OECD-DAC leading on tracking and reporting the allocation and uses of aid? Could the International Aid Transparency Initiative’s common reporting standard offer a start? What specific format and reporting elements would be most feasible? What incentives are needed to ensure donors’ commitment to timely and complete reporting? Do technologies and systems like e-procurement offer feasible ways to report funding flows in real time? And how could longstanding challenges, such as data coverage gaps, be addressed?  

More questions than answers for now, but we invite your ideas for strategies below.

See here for the full table, and for a full list of funding from bilateral donors for the health response, see Kaiser Family Foundation’s helpful analysis here.

Thanks to Erin Collinson and Sarah Rose for helpful comments.