In war-torn Yemen, the World Bank's International Development Association (IDA) and the World Health Organization (WHO) worked together through the Yemen COVID-19 Response Project (YCRP) to support and strengthen the country's preparedness and response to the pandemic. The project supports early detection and screening for the virus, provides essential medicines and medical equipment to treatment centers, and builds the capacity of human resources to respond to the pandemic in Yemen. In 2020, 37 isolation units across the country were established and supplied with medicines and medical equipment to provide treatment and handle severe cases of COVID-19. Specialized Rapid Response Teams (RRTs) were trained and deployed to 84 high priority districts to detect and respond to COVID-19. Additionally, YCRP has supported the country's diagnostic capacity with six national laboratories to conduct a polymerase chain reaction (PCR) testing for suspected cases since the beginning of the response. The project also supports the local health system with Infection Prevention and Control (IPC)to prevent further spread of the virus.

Challenge

Years of conflict in Yemen have taken a massive toll on the already vulnerable health system. Only half of the country's health facilities remain open, despite lacking essential requirements---including water, fuel, and oxygen---to be fully functional. Millions of Yemenis suffer every day from the lack of healthcare services. In 2021, over 20 million people (almost 80 percent of the population) depend entirely on aid to survive and get access to essential medical services, and over 2 million children are acutely malnourished.

COVID-19 has exacerbated the situation, further limiting health access to the people in need. Since the first declared case on 10 April 2020, health authorities have reported 2,912 confirmed cases, with 699 associated deaths as of 16 March 2021. However, health partners remain concerned that underreporting is occurring in large areas of the country due to a lack of testing facilities, delays in seeking treatment, stigma, difficulty accessing treatment centers, or the perceived risks of seeking care. Moreover, it can indicate the large asymptomatic infections that are yet to be detected in the country.

Approach

Based on the Yemen National COVID-19 Preparedness and Response Plan, the partnership between the World Bank and WHO aims to fill critical gaps in technical capacities by supporting surveillance and rapid response capacities, strengthening National Laboratories, and equipping isolation units for the treatment of severe cases.

The project also emphasizes health system strengthening, particularly at the district level, and supports capacity building, infection prevention and control at health facilities, and sanitation and medical waste management.

The YCRP builds on work done by the Emergency Health and Nutrition Project (EHNP), supported by the World Bank and implemented through the WHO and UNICEF in Yemen since 2017, which has worked to strengthen the health system through support to 72 hospitals and 2,000 primary care facilities, as well as responding to the malnutrition and cholera crises in the country.

Results

Surveillance and rapid-response teams and case investigation:

The existing 333 rapid response teams (RRTs), which work within the surveillance system to detect and respond to notifiable diseases in Yemen, were enabled and strengthened to incorporate the COVID-19 response into their day-to-day disease surveillance activities. Additionally, teams specifically designed to respond to COVID-19 have also been activated in 84 priority districts.

Points of Entry:

To improve rapid detection and screening, thermal scanners and thermometers were provided for the 26 formal entry points to enhance screening capacity and reduce the chances of imported cases of COVID-19 into Yemen.

National Laboratories:

The Yemen COVID-19 Response Project (YCRP) supported the existing health system to respond to COVID-19 by improving the capacity of the central public health laboratories. The support included the procurement of additional lab equipment and supplies such as PCR thermocyclers (instruments used to amplify DNA and RNA samples by the polymerase chain reaction) and staff training. Six of eight planned national laboratories are currently functional and providing testing for COVID-19 in Sana'a, Aden, Mukalla, Taizz, Sayoun and Hodeida. The laboratory supplies delivered by the project included polymerase chain reaction (PCR) diagnostic kits (, ribonucleic acid (RNA) extraction kits, tubes and pipette tips, and nasopharyngeal swabs.

Infection Prevention and Control:

WHO has rehabilitated 19 isolation units to improve water, sanitation and hygiene (WASH) infrastructure and ensure compliance with IPC protocols. Environmental ventilation systems with high-efficiency particulate air (HEPA) filters have been installed in these isolation units. The project also trained 1,473 healthcare workers on IPC protocols based on WHO guidelines.

Case Management:

In 2020, a total of 1,134 individuals have been trained on case management in 37 isolation units supported by the project.

World Bank Group Contribution

The World Bank's International Development Association (IDA) was the first to commit to support the COVID-19 response in Yemen through the Yemen COVID-19 Response Project (YCRP), which helps Yemen mitigate the risks associated with the COVID-19 outbreak. The project financing is an IDA grant of an amount equivalent to $26.9 million, managed by WHO.

Partners

The Yemen COVID-19 Response Project (YCRP works closely with the national health authorities represented by the Ministry of Public Health and Population to ensure proper and timely coordination to implement the project's activities. In addition, WHO works closely with UNICEF in the COVID-19 response, where some activities are being implemented jointly, such as the Risk Communication, which included radio broadcasts, TV programs, public service announcements and other various forums. UNICEF supports the project by providing water supply and waste management to isolation units in southern governorates through the EHNP.

Moving Forward

The World Bank and WHO, through the YCRP, will continue their efforts to scale-up the activities implemented to respond to COVID-19 in Yemen. The COVID-19 vaccine is now being rolled out globally. The COVID-19 Vaccines Global Access (COVAX) Facility provide vaccines to Yemen for the first prioritized 20 percent of the total population. The YCRP will play a significant role in deploying vaccines by supporting deployment costs to administer the vaccine to the population. On the other hand, the project will continue supporting and improving national laboratories, strengthening surveillance capacity, conducting case management of COVID-19 cases, and ensuring environmental and social safeguards.

Beneficiaries

After years of armed conflict and economic decline, as well as other shocks such as malnutrition and cholera, the COVID-19 pandemic has pushed the exhausted people of Yemen to a breaking point. Meanwhile, COVID-19 had the potential to shatter the already fragile health care system and drain the country of its already meagre resources. The YCRP provides the country with critical resources, which helped Yemen to respond to the pandemic.