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 percent of the population live more than three hours from the nearest health care facility, while even well-located centers often face shortages in staff, supplies, and infrastructure. Moreover, health care facilities in the continent, regardless of their location, are under threat from the increasing frequency and intensity of natural hazards. 

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

In response, the Global Facility for Disaster Reduction and Recovery (GFDRR) and the World Bank have been supporting eight African countries to advance resilient health systems. Provided under the auspices of the Japan-World Bank Program for Mainstreaming Disaster Risk Management in Developing Countries, a key focus of GFDRR’s 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 World Bank. 

These efforts have drawn upon the growing suite of tools and analytics on climate and DRM for health systems developed by GFDRR. Among them is the Frontline Scorecard, a rapid diagnostic policy 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, a technical team with broad expertise spanning areas such as health and building design and construction has helped the government identify and assess gaps in the country’s health system resilience. Drawing on the Frontline Scorecard, a survey was conducted in Mauritania’s Trarza region that found that, while the 19 surveyed facilities had pavements to prevent waterflows inside these facilities, construction generally did not account for the impact of flooding. Moreover, none of the surveyed facilities had a business continuity plan. 

"Focusing attention and resources in this way will undoubtedly enable the resilience of the system to be steadily strengthened.” – Dr. Sidi Zehaf, former Minister of Health, Mauritania

Such findings have informed the design and implementation of the $70 million Mauritania Health System Project, which expects to retrofit 50 health facilities by 2028, with the aim of ensuring that these can withstand flooding and are able to provide continuous access to health services. Trarza is among the nine target regions under the project. 

Drawing on the Frontline Scorecard, the team also worked closely with the government, specifically the Ministry of Health, to develop a monitoring tool to track resilience improvements to the country’s health system over a 10-year horizon. The tool has incorporated tracking of relevant improvements that may not fall squarely within the health sector including, for example, progress on strengthening electricity supply. This tool has since 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. 

While the work in Mauritania has been one of GFDRR’s most extensive engagements in resilient health in Africa, the facility’s efforts on this front are also advancing in seven other countries across the continent. For example, 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. The project aims to upgrade facilities to remain operational in times of crisis. The Frontline Scorecard has also been used to identify gaps in health systems resilience in Mali and South Africa, subsequently informing World Bank operations. These include the Advancing Resilience and Inclusive Health Systems for Everyone Project in Mali, financed by a $100 million contribution from the World Bank’s International Development Association (IDA), which aims to improve access to and use of essential health services and strengthen health emergency preparedness in targeted areas of Mali.

This story is an update of a previous version.