Across Africa, limited access to quality and affordable health care services remains one of the continent’s most persistent development challenges. In rural areas, as many as 15% of the population live more than three hours from the nearest healthcare facility, while even well-located centers often face shortages in staff, supplies and infrastructure.

The COVID-19 pandemic highlighted how compounding shocks and existing vulnerabilities in the health sector can trigger health crises and place additional pressure on already scarce resources. One study found that between 2020 and 2021, Ethiopia and Ghana saw declines in health service utilization, with Kenya seeing a 25% drop.

In response, the World Bank and the Global Facility for Disaster Reduction and Recovery (GFDRR), through the Japan-World Bank Program for Mainstreaming Disaster Risk Management in Developing Countries (Japan Program), have been supporting eight African countries since 2023 to advance resilient health systems. 

A key focus of the engagement has been to provide technical assistance and advisory support that enable World Bank teams to integrate disaster risk management (DRM) components into health systems strengthening projects financed by the Bank, including the International Development Association (IDA). 

These efforts have drawn upon the growing suite of tools and analytics on climate and disaster risk management for health systems developed by GFDRR. Among them is the Frontline Scorecard, a rapid diagnostic tool that enables decision-makers to conduct a holistic, high-level assessment of the resilience of health systems using publicly available data, information from country governments, and prior assessments from the World Bank, the World Health Organization (WHO), and other international organizations.

In Mauritania, the Frontline Scorecard was used to identify gaps in the country’s health system resilience. A questionnaire provided additional data on the retrofitting needs for health facilities. These findings have informed the implementation of the $70 million Mauritania Health System Support Project, which aims to retrofit 50 health facilities by 2028 to withstand flooding and maintain continuous access to health services. The Frontline tool has also been used in Mali and South Africa to inform World Bank operations. 

The engagement also supports countries in developing tools and analytics tailored to national contexts. For instance, a technical team worked closely with Mauritania’s Ministry of Health to develop a monitoring tool to track resilience improvements to the country’s health system over a 10-year horizon. This tool has helped lay the groundwork for the country’s first ever cross-sectoral governmental commission focused on strengthening climate and disaster resilience of the national health system.

Meanwhile, in South Sudan, a disaster and climate risk exposure assessment of the primary health care system has informed the $117 million South Sudan Health Sector Transformation Project (HSTP). The project aims to upgrade facilities to remain operational in times of crisis.

GFDRR and World Bank support for advancing resilient health in Africa are part of broader and multi-faceted engagement to strengthen the resilience of health systems across the globe.  In Cambodia, for example, analytical work has laid the groundwork for the country to potentially use multi-purpose flood shelters to fill gaps in health care service delivery during non-emergency periods.

In Belize, support has been provided toward a tool which will help the government prioritize and estimate the costs of interventions to strengthen the health sector’s resilience to shocks. The tool is informing the development of health components for the country’s first Catastrophe Deferred Drawdown Option (Cat DDO), a World Bank instrument that provides immediate liquidity in the aftermath of a disaster and supports policy actions for resilience.

These country-level analytical support help to build and expand the global knowledge base on resilient health systems.  Drawing on Japanese experience, the recent Preparing Health Systems for Shocks report highlighted the importance of linking health systems, disaster risk management, and quality infrastructure. The 2021 Frontline report, which also drew on Japanese experience and provided a comprehensive roadmap for how countries can build health system resilience, continues to shape and inform the policy dialogue on this critical topic globally.