Chronic

PovertyReport

2023Pandemic

PovertyChronicPovertyAdvisoryNetworkAnumberofreviewershavecontributedsignificantlytoimprovingthereport,andwethankthemfor

theirconsiderableefforts.Theseinclude:GregCollins,TimConway,LuciaDacorta,SonalDesai,Toby

Green,VivianKazi,OswaldMashindano,KatiePeters,José-ManuelRoche,andKeetieRoelen.CPAN

isanetworkofresearchers,policymakersandpractitionersacross15developingcountries(Afghanistan,Bangladesh,Cambodia,Ethiopia,India,Kenya,Malawi,Nepal,Niger,Nigeria,Philippines,Rwanda,Tanzania,Uganda,Zambia,Zimbabwe)focusedontacklingchronicpovertyandgettingtozeroextremepovertyanddeprivation,andbysustainingescapesfrompovertyandpreventingimpoverishment.Itislookingtoexpandthisnetworktothe30countrieswiththelargestnumbersofpeopleinpoverty.It

hasa‘hub’,whichiscurrentlyhostedbytheInstituteofDevelopmentStudiesintheUnitedKingdom.Theauthorswouldalsolike

toexpressappreciationtoalltheCPAN

partnerswhocontributedtoBulletinsfor

theCPAN

Covid-19PovertyMonitoringInitiativewhichproducedasnearaspossiblereal-timeinformationtobeavailabletodecision-makersduringthepandemic,basedonre-interviewinglife

historyandotherrespondentsfrompre-pandemicqualitativeresearch.ThiswasanattempttoprovidelivedexperiencestocomplementthedatafromHighFrequencyPhoneSurveysandothersourcesduringthepandemic.Authors

of

this

report:?

AlfredBizoza?

AmandaLenhardt?

AndrewShepherd?

ArthurMoonga?

AsifShahan?

BipasaBanerjee?

ChanmonySean?

CourtneyHallink?

JosephSimbaya?

KateBirdOfcourse,responsibilityfor

thecontentsofthereportrestswiththeauthors,andthereportdoesnotrepresenttheviewsofIDS,theCovidCollective,orofFCDO.Copyeditedby:JamesMiddletonDesignedby:GiantArcDesignContact:?

Website:

?

Twitter:@ChronicPoverty?

Email:

chronicpoverty@ids.ac.uk?

ManjisthaBanerji?

MartaEichsteller?

MartyChenSuggestedCitation:Shepherd,A.;Diwakar,V.,et

al.(2023)ChronicPovertyReport5-PandemicPoverty,CPAN,Brighton:InstituteofDevelopmentStudies,DOI:10.19088/CC.2023.006Coverimagecredit:WallArt:Covid-19awarenessbyP.L.Tandon.ArtworkbyAravaniArtProject.CC?

MirzaHassan?

NashipaiKarinten?

RaeesaRahemin?

RoberteIsimbi?

SantanuPramanik?

SophanySanBY-NC-SA2.0.https://flic.kr/p/2nwUqBL.?CrownCopyright2023?

TheavyChom?

VidyaDiwakar?

YisakTafereFunderAcknowledgmentsAcknowledgementsThisreportwascommissionedthroughtheCovidCollectivebasedattheInstituteofDevelopmentStudies(IDS)andisfundedbytheUKForeignCommonwealthandDevelopmentOffice(FCDO).TheCollectivebringstogethertheexpertiseof,UKandSouthernbasedresearchpartnerorganisationsandoffersarapidsocialscienceresearchresponsetoinformdecision-makingonsomeofthemostpressingCovid-19relateddevelopmentchallenges.TheviewsandopinionsexpresseddonotnecessarilyreflectthoseofFCDO,theUKGovernment,oranyothercontributingorganisation.We

acknowledge

the

financialsupport

andintellectual

environment

ofthe

CovidCollective,convened

bythe

InstituteofDevelopmentStudies(IDS)and

financiallysupported

byForeign,Commonwealth

and

DevelopmentOffice’s

(FCDO)Researchand

EvidenceDivisionasa

socialscience

contribution

tothepandemic.

Thesupport

ofPeterTaylor,

DirectorofResearchatIDSisspecifically

appreciated,aswellasallthe

CovidCollectivecolleagueswho

attended

meetings

and

discussionsduring

the

pandemic.Forfurtherinformation,pleasecontactcovidcollective@ids.ac.ukContentsAcronyms2Director’s

forewordSummary35Overview9Chapter

116Introduction:

rationale

and

startingpointsChapter

249Lives

versuslivelihoods:

the

trade-offbetweenpublic

health

restrictionsandresilienceChapter

3Acomparative

lens:countrycasestudiesof

mitigation

measures

duringCovid-196798Chapter

4Theresponsivenessof

social

protectionthrough

the

Covid-19

crisisChapter

5120149Economic

impact

and

policy

responsesChapter

6Delivering

pro-pooreducation:

lessonsfrom

Covid-19Chapter

7168Equitably

responding

to

and

recoveringamid

polycrisisAnnexe194206229BibliographyEndnotesAcronymsANC

AfricanNationalCongressCBT

Cash-basedtransferCMSMEs

Cottage,micro-,smallandmediumenterprisesCPAN

ChronicPovertyAdvisoryNetworkDRC

DemocraticRepublicoftheCongoDRM

DisasterriskmanagementDRR

DisasterriskreductionEPWP

ExpandedPublicWorksProgrammeGBV

Gender-basedviolenceGDP

GrossdomesticproductHDP

HumanitariandevelopmentpeaceHIC

High-incomecountryHNO

HumanitarianNeedsOverviewKII

KeyinformantinterviewLIC

Low-incomecountryLMIC

Low-andmiddle-incomecountryMGNREGA

MahatmaGandhiNationalRuralEmploymentGuaranteeActMIC

Middle-incomecountryMILO

MonitoringImpactsonLearningOutcomesNCDM

NationalCommitteefor

DisasterManagementNGO

Non-governmentalorganisationPMI

PovertyMonitoringInitiativePSNP

ProductiveSafetyNetProgrammeSGBV

SexualandGenderbasedviolence2CPAN

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Poverty

Report

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AcronymsDirector’sforewordAstheCovid-19pandemicmatured,itbecameobviousthatthemajorpoliciespursuedintheworldinresponsetothepandemicwerenotdesignedtosuitthelargelyinformal,rural,andpooreconomieswherethebulkoftheworld’speoplearelocated.We

arenotdiscountingtheliveslostfromCovid-19,whichwasunimaginableandextremelydistressingfor

millionsofpeople.Instead,wearearguingfor

amorecontext-specificapproachtorespondingtoaglobalpandemic(oranycrisis)andabetterbalanceofmitigatingmeasureswithanynecessaryrestrictions.Fewcountriesintheglobalsouthwereabletomitigatetheeffectsofthepandemic,suchastherestrictionsonmovement,andtheeconomicandsocialactivitiesimposedinthenameofpublichealth,savinglives,andtoavoidhealthservicesbeingoverwhelmed.It

becameincreasinglyimportanttolearnthelessonsofthispandemicfromtheperspectiveofpoorandvulnerablepeoplelivingintheglobalsouth.ThisiswhatthistheChronicPovertyReport2023setsouttodo:toinvestigatethehighlynegativeeffectsoftherestrictions,andmostimportantly,thesuccessorotherwiseofthemeasurespursuedtomitigatethoseeffectsonpeopleinandnearpoverty.Theleadingmessage

isthatifrestrictionswerenecessary,

they

should

beminimised,andcomplementedbymeasurestomitigatetheirnegativeeffects.Duringthepandemic,suchmeasureswereinmostcountriescompletelyinadequatetopreventimpoverishmentanddownwardsocio-economicmobility.Thereportmakessuggestionsonwhatneedstobedoneinasimilarfuturecrisistoavoidtheeconomicandsocialreversalswehaveseensince2020,andsomestepsontheroadtorecovery.ThisfirstCPAN

reportonPandemicPovertyistheproductofalong-termpartnershipacross18countriesintheglobalsouth.12ofthosecountriesparticipatedintheChronic

Poverty

Advisory

Network’s

Covid-19Poverty

Monitoring

Initiative.Theserevisitedlife

historyrespondentsfrompre-pandemicqualitativeresearchandcaughtupwiththeirlivedexperiencesduringthepandemic.Thiswasdesignedasapeople-centredcomplementtothehigh-frequencyphonesurveyswhichwereundertakeninmanycountriesduringthepandemic.AuthorsfromsomeofthesamecountriesandothersbasedattheInstitute

of

Development

Studies,wereinvolvedinwritingthisreport.Theycarriedoutkeyinformantinterviewswithpolicymakersandimplementerstotrackandunderstandthedevelopmentofpolicyresponsesduringthepandemic,andtoanalysethepolicydiscoursesineachcountry.Theco-authorsmetmonthlyfor

sixmonthswhilethereportwasbeingwrittentoensurecoherence.3Director’sforeword/

CPAN

Chronic

Poverty

Report

2023WhileChina’sresponsetothepandemicprovidedthemainmodelonwhichtheWorldHealthOrganisation(WHO)baseditsguidancetocountries,whatwefoundinourfocuscountrieswasawidevarietyofpolicyresponses,withsomecountrieseitherrefusingtogoalongwiththerestrictionsorabandoningthemquitesoonaftertheystarted,andrelyingontheirownunderstandingoftheircontextstocraftresponseswhichworkedfor

them.Oneofthepurposesofthisreportistolegitimisethisvarietyofcontext-specificresponses,ratherthanaone-size-fits-allapproach.FollowingtheCovid-19pandemiccrisis,othercriseshavetakenprecedencewhichhasmeantthatrecoveryfromthepandemichasbeenputonthepolicyback-burneracrosstheworld.Theresultingfailuretorecoverwillhitthepoorest,leastresilientpeoplehardestastheywilltakelongertoregaintheassets,humancapital,andenterprisestheylost.Thisenvironmentof‘polycrisis’—whereonecrisisislayeredonorintersectswithanother—isalreadythesituationfacedespeciallyduringrecentdecadesinmanyoftheworld’spoorercountries,whereclimate-relateddisasters(droughts,flooding,andotherextremeweatherevents)haveoccurredatthesametimeasorinclosesequenceasconflict,andsometimeshealthcrises.Theseintersectingcriseshavesignificantconsequencesfor

theleastresilientpeople.It

willbeachallengefor

policymakers,disasterriskmanagementagencies,peace-buildinginitiativesaswellassocialprotectionsystemstorespondtomultiplecrises,ratherthanthesingularemergenciestheyarecurrentlygearedupfor.Ihopethereportanditsaccompanyingpolicynoteswillbeofusetopolicymakersandadvisersastheypreparefor

futurecrises,aswellasreflectonwhatneedstobedonenowtorecoverequitablyfromtheCovid-19pandemic.Andrew

ShepherdDirector

Chronic

Poverty

Advisory

NetworkAssociate

Institute

of

Development

StudiesUniversityofSussex,UK4CPAN

Chronic

Poverty

Report

2023

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Director’sforewordSummaryPandemic

povertyThe

worstexperiences

inthe

pandemic

wereoftenfelt

bypeopleinthebottomhalfofthe

income

distribution,who

werealreadyliving

inpoverty,who

werenear

and

vulnerable

topoverty,

orwho

hadpreviously

escapedpoverty

butlosttheir

resiliencemainly

asa

resultofthe

measures

takentocontain

the

Covid-19

virus–

particularly

inregardtojobs,markets,food

security,and

school

attendance.

Manyofthe

poorestlostaccesstothe

casuallabouropportunities

they

relied

onfor

subsistence,

whileothers

lostaccesstomarkets

orexperienced

significant

food

priceinflation.Certain

groupsexperienced

additionalhardship.orexample:migrants

faced

extremelydifficultjourneys

home,

and

discriminationandexclusionwhen

they

reached

home;

women

borea

disproportionate

shareofthe

addedcaring

responsibilities

throughlockdowns

and

experiencedheightened

exposuretodomestic

and

other

abuseand

violence;

andchildreninpoorand

rural

areasoftensuffered

significant

losesoflearningand

manywereunabletoaccessschool

meals.

The

resulting

wide-spreadfood

insecurityand

malnutritionwasoftennot

adequately

compensatedbyfood

distributionorsocialprotectionmeasures.Assetsalesandothernegativecopingresponses,includingeducationlosses,combinedwiththesmalltonon-existentimpactofmitigationorrecoverymeasuresinmanysituations,andthelayeringofthepandemiconothercovariantandidiosyncraticshocks,meanthattheeffectsoftheCovid-19pandemicwillbefeltfor

manyyears.It

islikelythatthemultipleshocksinducedbythepandemicitself–thedeathsandillnessitcaused,andbytherestrictionsoneconomicandsocialactivitywidely(ifvariably)rolledoutinresponsetothepandemic,andoverlainbyinflation,naturalhazardslike

droughts,floodsandhurricanes,andconflictandinsecurity–willplacealargenumberofpeoplenotonlyintotemporarypoverty,butintochronicpoverty,fromwhichescapewillbeextremelydifficultandexpensivefor

thenextdecadeorlonger.The

case

for

strengthened

mitigation

measuresPolicyresponsesweregenerallydominatedbytheconcerntoprotectliveswhilelivelihoodsandresilienceweresecondaryorbarelyaddressed.Whileprotectingliveswasclearlyextremelyimportant,therisksdifferedsignificantlyfor

differentpopulationsandwerenotadequatelyassessedbydecision-makersindifferentcontexts.Themeasurestakenwereoftennotproportionatetothelevelofriskactuallythere,whichwassometimessignificantlylowerfor

populationsinpoorcountriesthaninrichercountriesbecauseofmoreyouthfuldemographicstructures,andtheoutdoorcharacterofeconomicandsociallife.5Summary/

CPAN

Chronic

Poverty

Report

2023Thelives/livelihoodstrade-offisartificial,aslosingliveshasamassiveimpactonhouseholdwellbeing,andpovertyresultingfromlivelihoodlossescanfeedintoillhealthandlossoflife

(especiallyfor

infantsandchildren).Inrelativelypoorcountries,withyoungpopulationswhomightbelessseverelyaffectedbythevirus,asbecamenoticeablerelativelyearlyinthepandemic,itmadesensethatdecision-makersshouldfocusonlivelihoodsasmuchaslives.Thisreportfocusesonthetrade-offbetweenimposingrestrictionsastheleadingresponsetoapandemicandtomakingsocialandeconomicprogress.To

getabetterbalancebetweentheseobjectives,mitigatingmeasuresneedsignificantstrengthening,particularfor

butnotonlyinlow-incomecountries(LIC).Experiencesfromcountrieslike

CambodiaorBangladeshindicatethatthisbalancecanbeachieved.Keyfactorsare:fiscalspaceincludingborrowingcapacity;politicalcommitmenttoprotectthewelfareofthevulnerablecitizens;anabilitytoassessandre-assessrisksintheround;andtheabilitytoimplementmitigatingmeasures.Thesevariedsignificantly,asdidinvestmentinandratesofvaccination,whichwascapableofsignificantlyincreasingthespeedwithwhichrestrictionscouldbeliftedfrom2021onwards.MoregenerallythepandemicrevealedabigdivideopeningupbetweenLICs

andothercountriesonanumberofindicators–acrossarangeofmitigatingmeasures.Excessmortalityduringthepandemicwasrelatedtotherangeofmitigatingmeasures1inLICs

–measuresintroducedtomitigatetheeffectsofrestrictions;andsurprisinglynottothestringencyoftherestrictionsintroducedtomanagethespreadofthevirusinlow-ormiddle-incomecountries(LMIC)moregenerally.Across-countryanalysissuggeststheneedtopromotenon-standardapproachestoandinnovationinpandemicmanagementinLMICstotakeaccountofdifferentsocio-economiccontextsandvirusdynamicsandeffects.Policy

responses

to

promote

recovery

frompandemic-driven

povertyLong-term

investment

in

health

services

mustbesignificantlyincreasedandisdefinitelyneededtoputcountriesinabetterpositiontohelprecoveryandwithstandfuturepandemics.Wheresuchinvestmentshadbeenmade,suchasinNicaragua,governmentswereinabetterpositiontomanagethepandemicandmakedecisionswhichwouldminimisethesocio-economicdamagefromimposingrestrictions.National

decision-making

inthepandemicwasbestwhenjoinedupacrossseveralsectorsanddisciplines–‘whoisintheroom’makingdecisionsmakesadifference.Wherethereiscapacityatthelocal-level,manydecisionsinthemanagementofandrecoveryfromapandemicarealsobesttakenatlocallevels,aswasdiscoveredinanumberofcountriesasthepandemiccontinuedovertime.Thishelpedtominimisethedisruptionscausedbytherestrictions.Local-leveldecision-making6CPAN

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Summaryhasbeenattheforefrontofgoodpracticeinhumanitarianworkinrecentyears,andsuchlessonsneededtobeappliedtopandemicmanagementtoo.Social

protection

(especiallysocialcashtransfers)wasthemainglobalresponsetomitigatetheeffectsofrestrictions.However,manymeasureswereshortlived,anddidnotcontinuethroughthepandemic,despitethecontinuedrecoursetolockdownsandotherrestrictions.Wheretheywereofalongerdurationandbuiltonpreviousstrongsocialprotectionsystems,effectscouldbepositiveandtheservicewasappreciated.MuchstrongernationalsystemsofsocialprotectionarestillrequiredinmostLICs

andLMICs,whichcanthenbeadaptedandexpandedincrisissituationsifthisistobeaneffectivepolicyresponse.Other

economic

policies

couldalsobesignificantinpreventingimpoverishmentsuchashouseholddebt-managementmeasures,orspecialmeasuresfor

returningmigrants,for

example.However,inmostsettingsthesemeasureswereabsent,late,orweak.Manygovernmentsprovidedfinancialandtaxreductionsupporttoformalbusinesses.However,measuresdirectlytargetingtheinformaleconomieswheremostpoorandvulnerablepeopleworkwerebadlyneededbutneglected,withtheexceptionofsomemeasuressupportingsmallholderfarmingandfinancialservices.A‘NewDeal’for

theinformaleconomyisthereforeneeded,followingthepandemic.Aswomenarefrequentlyworkingininformalemploymentorself-employment,thiswouldparticularlybenefitthemandhelptocompensatefor

thevery

negativeeffectstheyexperiencedfromlockdowns,movementrestrictions,andschoolclosures.Financialserviceswerenotasresponsiveastheycouldhavebeenduringthepandemic.Mobilemoneywasextremelyusefulandcouldbemorewidelyextendedinfuture.Somefinancialinstitutionspostponedrepaymentsbutcontinuedcharginginterest,thusmakingloansmoreexpensive.TherecouldbesignificantlearningfromtheUnitedStatesofAmerica(USA)whereinterestwasfrozen.Areviewoffinancialservices,includingmicro-finance,isurgentlyneedednow,followingthepandemictoredressthedamagealreadydoneandtoavoidfuturehouseholdover-indebtednesspriortoanyemergency.Additionalregulationmayalsoberequired.Macro-economicmanagementmatters.Wherethemacro-economyhadbeenwellmanagedtherewasapossibilityofabalancedpolicyresponse,withadditionalpublicsupporttohealthservicesandsocialprotection,withoutrecoursetoheavyborrowing.Cambodia,whichrecentlybecameaMiddle-IncomeCountry(MIC)wasabletomakefurloughpayments,provideadditionalsocialprotectioncoverageanddepth,andotherpublicexpendituresbecauseofitsprudentfiscalmanagement.7Summary/

CPAN

Chronic

Poverty

Report

2023School

closures

lastedfor

alongtimeandwereimposedearlyinthepandemic.Thisresultedinamassivelossoflearningespeciallyforchildreninpoorandruralhouseholds.Thelossesarelikelytoleadtogreaterfuturepovertythanthepresentpovertycreatedbythepandemic.Therewassignificantvariationinlengthofschoolclosures.TheextremelylongclosureswidespreadinpartsofLatinAmericaandSouthAsiaarepuzzling,and,insomecases,persistedlongaftereconomicre-opening.Thispuzzleisperhapsexplainedbytheabsenceofstronglobbiesfor

schoolstudentscomparedwithenterpriseandworker-basedlobbiesandprotests.It

mayalsobeduetogovernments’concernswiththeirlegitimacyintheeyesofthepopulation,whichmaynothavebeenenhancedbyprematurere-openingofschools,despitethelearninglosseswhichwereoccurring,andincreasinglywellevidenced.Alternative

education

models

allowedparentstochoosewhethertosendchildrentoschool,orfor

localauthoritiestodecidewhenschoolsshouldcloseoropendependingoninfectionrates.Thesemodelscouldbeadoptedmorewidelyinanyfuturepandemic(dependingonvirusdynamicsandtheextenttowhichchildrenareinfectedorarecarriers)inordertominimiselearninglossesandlearningpoverty,whereinvestmentinhealthserviceswasgreater.School

feeding

programmes

canhelpwithchildren’snutritionaswellasmotivationfor

attendingschoolbutwerealsowidelylostduringthepandemic.LICs

needsignificantinvestmentinschoolfeedingprogrammes.Multiple

crises

thataffectpeopleinthebottomhalfofincomedistributionneedeffectivepolicyresponsestothepandemic.Mostnotably,thisincludespoliciesfor

energyandfoodpricerisesduringorinthewakeofthepandemic,andothercrisescausedbydrought,flooding,orconflict.Joined-upresponsesareeasierwherecrisisresponsedecisionsaretakeninacollaborativeway.Integratingpandemicorconflictmanagementintodisasterriskmanagement(DRM)andthemandatesofDRMagencieshasadvancedduringrecentyears;muchmorerapidadvancesarealsoneededinthehumanitarian-development-peacenexus,aswellassocialprotectionsystemstoreducethenegativeeffectsofpolycrisesonpoorandvulnerablepeople.8CPAN

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SummaryOverviewChapter

1Introduction:

rationale

and

startingpointsTherationalefor

thisreportisthatthereisaninformationgapfordecision-makers,especiallythoseworkingfor

peopleinandnearpoverty.Forexample,onhowpoortheyareandwhy.Thisgapexistsforexampleintermsoftheextentofpeople’spovertyandthemulti-facetedreasonsfor

it.Theremaybeacommitmentgapaswell,whereelitedecision-makersarenothighlycommittedtothewelfareofthecitizensinandnearpovertywhovotethemintooffice.Decision-makingstructuresdetermine‘whoisintheroom’makingthedecisions,andthisisveryimportantinshapingoutcomes.Broadorinclusivedecision-makingstructuresaremorelikelytoleadtothelivesofpoorandvulnerablecitizensbeingtakenintoaccountinahighlystressedenvironmentwherethereisalotofuncertaintyandinternationalpressuretoact,asintheonsetoftheCovid-19pandemic.Thereportadoptsa‘resilienceframing’.Inacrisis,thisismainlyaboutthecapacitytoabsorbtheeffectsofashockormultipleshocks(absorptivecapacity),eventhoughsomepeoplecanadapttheirlivestocope(adaptivecapacity).Duringthepandemic,few

wereinapositiontotransformtheirsituations(transformativecapacity).Resiliencewasmassivelyunderminedespeciallyfor

thepoorest.Jobandincomelossescausedbyrestrictionswerefeltmostbythepoorest,andtheirrecoverywasslowestin2021and2022.Foodinsecuritywashighacrossthebottomhalfoftheincomedistributioninmanycountries,andhighestamongthepoorestinmostcountries.Theseeffectswereworsefor

womenonaverage,andwithmenathomeandunemployed,domesticandotherviolenceandabusesofwomenincreased.Therewerefew

ifanycounter-balancingattemptstoshiftsocialnorms,inwhatcouldhavebeenatransformativemoment.Men’semploymenttypicallyrecoveredmorerapidlythanwomen’sby2021.Migrationprovidescriticalopportunitiestoescapepoverty,particularlyinternalmigration.Thereisevidencethatinternationalremittancelosseswerelessseverethancouldhavebeenexpectedoverall,andbouncedbackdespiteborderclosures,butthepooresthouseholdssufferedthegreatestremittancelossesfromallsourcesofmigration.Migrantswererarelythesubjectofmitigatingmeasures,perhapsbecausetheydonotconstituteaneffectivelobby,andtheywerelikelytorelocateagainduringorshortlyafterthepandemic.Thereisalsooftenextremelylow-qualityinformationavailabletopolicymakersaboutwhoismigrating,whereandwhy,especiallywhenitcomestointernalmigrants.Salesofassetsincreasedduringthepandemic,especiallyamongstthepooresthouseholdswhocouldleastaffordtolosethem.Progressloston9Overview/

CPAN

Chronic

Poverty

Report

2023resilienceneedsrecoveringandbuildingbeforeanyfuturepandemicorothersignificantcrisis.Therewerealsoothernegativecopingstrategieswithpotentiallylong-termeffects,aspeopleresortedtodegradingandhumiliatinglivelihoodstrategiesinsomecircumstances.Havinggoodhealthiscriticalfor

resilience.StructuralpublichealthinvestmentandexpenditureincreasesareneededespeciallybutnotonlyinLICs

–thisisaveryaclearpolicymessage.However,itisnotsoclearhowsuchincreasesininvestmentinhealthservicescanbeachievedgiventhecriticalindebtednessofagrowingnumberofcountries.Thereisasubstantialfinancinggapfor

achievingtheSustainableDevelopmentGoals(SDG)inmanycountrieswhichwillhavetobefilled.Therearecountrieswhichhavebeenmakingsuchinvestments,andtogoodeffectinthepandemic,butthisneedstobereplicatedextensively,repairinginsomecasesdecadesofunderinvestment.Theeffectsofmitigationmeasures,whetherintheeconomy,educationorhealth,werenotmuchinevidenceinthehouseholdsurveysandqualitativeresearchreviewedhere.Evenwherethereweresomemitigationmeasuresinplacethesewerenotenoughtopreventnegativecoping.Recoverymeasureswerebroadlynon-existentfor

thepeopleinandnearpoverty..Asaresult,theeffectsoftheCovid-19pandemicwillbefeltfor

manyyears.Chapter

2Lives

versuslivelihoods:

the

trade-offbetweenpublic

health

restrictionsand

resilienceInmanagingapandemic,theobjectiveofmaintainingresilientlivelihoodsneedstobebalancedwithsavinglivesandboostingresilience.Awidevariationindecision-makingstructuresandprocessesshapedthisbalance.Mitigationmeasuresneedsignificantstrengtheninginfuturepandemics(andothercrises)especiallybutnotonlyinLICs.Decision-makersneedamenuofmitigationmeasureswhichtheycanadapttocontextinafuturepandemic.Thestrengthofmitigationmeasuresthatcountriesintroduceddependedon1)

fiscalspaceandpriormacro-economicmanagement;and2)politicaleconomyor‘politicalsettlements’.Thesecananddidinafew

casesevolveinacrisis.Therewashugevariationinpublicexpendit