The UK’s humanitarian response to COVID-19

The UK’s rapid humanitarian response to the COVID-19 pandemic has saved lives and built resilience, but could have done more to ensure inclusion of some vulnerable groups

The COVID-19 pandemic created a humanitarian crisis of unprecedented scale. With humanitarian need already at historically high levels at the beginning of the pandemic, COVID-19 and the lockdown measures imposed by governments to contain it threatened the lives and livelihoods of vulnerable people around the world. In March 2020, the UN launched its first ever global humanitarian appeal to respond to the COVID-19 pandemic, and by the end of 2020 it was appealing for £7.6 billion in support for 63 countries.

As a major humanitarian donor, the UK made a significant financial contribution to the global humanitarian response, committing £218.7 million in central funds5 by February 2020. It also adapted its bilateral aid programmes to support national responses to the pandemic.

This review assesses two years of the UK’s emergency response to COVID-19, from the onset of the pandemic to February 2022, focusing on the work of the former Department for International Development (DFID) and, from September 2020, the Foreign, Commonwealth and Development Office (FCDO).6 In this report, the term “the department” refers to DFID before the merger and to FCDO thereafter. We analyse the relevance, coherence and effectiveness of the response, looking at the UK’s central humanitarian funding and its bilateral response in six countries: Bangladesh, Ethiopia, Jordan, Kenya, Nepal and Yemen. The review identifies lessons to inform UK aid responses to future large-scale health emergencies.

Relevance: How well did the UK government prioritise its humanitarian response to COVID-19?

On 11 March 2020, the World Health Organisation (WHO) declared the COVID-19 outbreak a global pandemic. Over the next two years, the pandemic precipitated the first truly global humanitarian emergency. It struck at a time when the world was already facing its highest level of humanitarian need in decades. At the beginning of 2020, at the onset of the pandemic, it was estimated that 168 million people were in need of humanitarian assistance across 53 countries. By the end of 2020, humanitarian need had risen to 243.8 million people across 75 countries, due to both the direct impacts of the pandemic and the extraordinary measures taken to control its spread.

The global humanitarian response has been unprecedented in scale and scope. As a major humanitarian donor, the UK has played a significant role. By 19 February 2020, even before the WHO announcement, the UK government had already committed £218.7 million from its central humanitarian funds to support vulnerable countries, initially through the UN, the Red Cross and other international agencies. There was also a significant reprogramming of bilateral aid, as the UK government sought to identify and support those most in need.

The COVID-19 pandemic coincided with considerable changes to the UK aid programme. In September 2020, the Department for International Development (DFID) was merged with the Foreign and Commonwealth Office (FCO) to become the Foreign, Commonwealth and Development Office (FCDO). The UK aid budget was also reduced by £0.7 billion in 202011 due to the impact of the pandemic on the UK economy, and then further reduced by £3.5 billion in 2021 due to the government’s decision to reduce the aid spending target from 0.7% to 0.5% of UK gross national income.

The purpose of this review is to assess the UK’s humanitarian response to COVID-19, from the onset of the pandemic in January 2020 to December 2021, and to identify lessons to inform future responses to COVID-19 and other global health emergencies. It is part of a series of ICAI reviews looking at the UK’s aid response to COVID-19, including a rapid review of The UK aid response to COVID-19, published in October 2021, and a December 2020 information note: UK aid spending during COVID-19: management of procurement through suppliers. It draws on ICAI’s reviews of Management of the 0.7% ODA spending target, published in November 2020, and Management of the 0.7% ODA spending target in 2020, published in May 2021. This review also complements work undertaken by the National Audit Office, including a recently published study on reductions to the UK aid budget in 2021 and a series of reports on the UK government’s response to COVID-19.

This review focuses on emergency support for populations in humanitarian need as a result of the COVID-19 pandemic. It assesses how well the UK identified and prioritised those most vulnerable to the pandemic, the effectiveness of the support provided, and how well the UK worked with other stakeholders at global and country levels. It covers the UK’s response both to the direct impacts of the pandemic on public health, and to the indirect impacts – principally, the effects of social distancing regimes, curfews and other measures taken to contain the virus on vulnerable populations, including those already dependent on humanitarian support. It looks at contributions at the global level and in six case study countries: Bangladesh, Ethiopia, Jordan, Kenya, Nepal and Yemen. It does not cover vaccine development and distribution, which was covered in the October 2021 rapid review.

Methods

The review used the combination of methods shown in Figure 1 to answer the review questions and to provide a sufficient level of triangulation to ensure robust findings.

Figure 1: Summary of methodological elements of the review

The COVID-19 pandemic has exacerbated existing humanitarian needs and contributed to rising humanitarian needs globally

Vulnerability also varied by region and context. Social and economic factors influenced the transmissibility of the virus, and there were wide gaps in national testing and treatment capacity. In countries already facing humanitarian crises, the COVID-19 pandemic compounded existing challenges. Conflicts and natural disasters continued alongside the pandemic over the course of 2020 and 2021, in many contexts posing a more acute risk to vulnerable populations than the pandemic itself. At the onset of the pandemic, the UN was clear that development partners should continue to see existing humanitarian needs as “an utmost priority”.

In this section, we assess the relevance, coherence and effectiveness of the UK’s humanitarian response to the COVID-19 pandemic between January 2020 and December 2021.

Relevance: How well did the UK government prioritise its humanitarian response to COVID-19?

The UK’s early, flexible contribution through the international humanitarian system was a sound choice

Support via the Red Cross provided health, food, livelihoods and other support to vulnerable communities in 74 countries. This included health services for 8.4 million people, community water, sanitation and hygiene (WASH) activities for 106 million people, and livelihoods support for 4.2 million people. A focus on early infection prevention and control is also likely to have reduced morbidity and mortality among vulnerable groups.

The UK’s Rapid Response Facility (RRF) provides rapid funding to pre-registered NGOs for emergency assistance during the initial phase of new crises. As part of its COVID-19 response, the RRF provided hygiene kits to 773,370 people and food and other essential livelihoods assistance to 19,315 households.

The UK’s support for Emergency Medical Teams (EMTs) enabled the deployment of health experts to Ghana, Cambodia, Zambia, Burkina Faso, Bangladesh, South Africa, Chad, Lebanon and, more recently, to Armenia, Lesotho, Namibia and Botswana. This enhanced the capacity of national health systems to respond to COVID 19, and included introducing systems for prevention, testing, diagnosis, isolation and treatment. In Bangladesh, as part of the Rohingya response in Cox’s Bazar, UK EMTs had trained health workers, helped establish data capture and analysis systems, and boosted laboratory testing capacities.

Despite this results reporting, there are no indicators or targets against which to assess the overall effectiveness of the UK response. In interviews, both FCDO staff and multilateral partners stressed the difficulties involved in setting meaningful targets in a context of such uncertainty. We therefore cannot reach a conclusion as to whether the UK contribution achieved its intended results. We can, however, confirm that the UK’s assistance made an important contribution to the global response.

UK in-country programmes limited disease transmission and provided life-saving support

In all our case study countries, the UK built infection prevention and control measures into ongoing programmes, including support for handwashing, sanitiser and PPE, as well as new operational guidelines on social distancing. These efforts helped protect frontline workers and the vulnerable communities they served.

While we were able to confirm that UK support reached the target communities, the results were impossible to quantify. Many programme-level monitoring and evaluation activities were postponed during the emergency phase. Furthermore, as COVID-19 measures have been mainstreamed into wider programmes, the effects are more difficult to disaggregate. At the time of our review, no attempt had been made by FCDO to calculate how many vulnerable people had been reached through in-country programmes as part of its COVID-19 response.

A significant part of the UK response has focused on hygiene promotion and community awareness raising aimed at reducing the spread of COVID-19. In Ethiopia, UK support through UNICEF improved access to WASH services in 22 health centres. In Bangladesh, the UK supported the installation of 50,000 handwashing points, including in Cox’s Bazar, and distributed supplies such as soap to 61,807 people. The UK also targeted vulnerable urban communities, providing hygiene facilities in slums in 18 towns and cities. In Kenya, the UK’s work with UNICEF reached 21.2 million people with messaging on COVID-19 prevention. Over 200,000 refugees in Kenya were also reached with hygiene awareness campaigns, as well as 56% of Kenya’s youth (see Box 3). In Bangladesh, UK support reached over 3 million people with awareness raising and early warning messages.

In some cases, the UK also supported direct treatment of COVID-19. In Bangladesh, the UK helped set up COVID-19 isolation and treatment centres to support refugees and host communities in Cox’s Bazar, home to the world’s largest refugee camp.65 At the national level, it supported the supply of oxygen plants to 62 hospitals and the recruitment of health professionals at 62 out of 132 health facilities. In Nepal, where the UK was supporting the refitting of two large public hospitals (Pokhara and Bhaktapur), temporary structures were handed over to the government to provide critical care to 3,000 COVID-19 patients. The UK also supported the Nepal Police Hospital to treat approximately 1,100 members of the police, their families and the wider public. Several stakeholders noted that the UK- supported oxygen generation plant at this hospital had helped to save many lives.

UK cash-based support helped vulnerable people through COVID-19 lockdowns

The UK government was quick to recognise that movement restrictions imposed to limit the spread of COVID-19 could cause extreme hardship for poor and vulnerable households. Urban informal workers were identified as especially vulnerable due to their reliance on casual, unskilled labour. A number of programmes pivoted to provide temporary financial support to the urban poor, although at a limited scale.

In Kenya, cash-based assistance provided 52,700 people in informal settlements in Nairobi and Mombasa with a basic income of 4,000 Kenyan shillings (the equivalent of £29) per month for three months. In Bangladesh, £3 million was reprogrammed from the humanitarian programme to provide financial support to 77,560 vulnerable urban households between March and May 2020. We were informed by stakeholders in both countries that this support had helped people most vulnerable to the indirect impacts of the pandemic to buy essential food, medicines and pay their rent. It had also contributed to a reduction in negative coping strategies among recipients (such as selling assets and entering into debt). Implementing partners in Nepal also highlighted the role of cash-based assistance in preventing vulnerable people from falling into spiralling debt.

UK budget reductions reduced the effectiveness of its COVID-19 response

ICAI’s October 2021 rapid review found that UK aid budget reductions had impacted the COVID-19 response by undermining the effectiveness of earlier investments and restricting the UK’s ability to respond flexibly to the ongoing pandemic. This review similarly finds that successive reductions (see paragraph 4.21 above) reduced the scale, reach and flexibility of the response. We were informed that reducing UK funding for UN-managed Country-Based Pooled Funds (CBPFs), for example, had diminished their capacity to support the COVID-19 response at a critical time. In 2019, the UK provided $319.6 million (approximately £259 million) to CBPFs, compared to $182.1 million (approximately £147.6 million) in 2020 and $171 million (approximately £138.6 million) in 2021. As CBPFs provide a mechanism for channelling funds to support local humanitarian efforts, this reduced the amount of funds available to local actors.

Across our case study countries, FCDO staff told us that they had to streamline delivery partners and make difficult choices about which humanitarian and development needs to prioritise. One country team told us that the budget reductions forced them to choose between health and humanitarian priorities, while multiple country teams told us that the budget reductions had a substantial impact on their ability to respond to COVID-19 and other humanitarian needs. External stakeholders and partners also expressed serious concerns about the impacts of UK aid reductions, reporting that this had undermined the department’s ability to provide technical inputs in areas such as social protection and health system strengthening.

At the time that the UK was reducing its aid budget, partners reported a rise in unmet humanitarian needs across our case study countries. In Kenya’s refugee camps, for example, reduced funding from the UK and other donors resulted in WFP cutting food rations for 440,000 refugees to 52% of the basic food basket (about 1,050 calories per day) from October 2021. This increased health risks and demand for nutrition services, and has led to more negative coping mechanisms being adopted by refugees, such as taking on debt and consuming low-nutrition food. We were told that aid budget reductions also had an impact on water and sanitation in refugee camps in Kenya.

Conclusions

The UK’s humanitarian response to the COVID-19 pandemic has been both relevant and impactful. It has undoubtedly helped to save lives and reduce hardship, even though the outcomes are difficult to quantify.

The UK’s early contribution of substantial unearmarked funding through the international humanitarian system was a sound choice, enabling international agencies to respond flexibly to a rapidly evolving situation. The UK response drew on past learning and evidence and was supported by substantial investment in generating new data and evidence on emerging impacts. At times, however, the volume of information being generated was too much for teams to process.

At country level, the response was generally effective at targeting vulnerable groups that were already receiving support before the pandemic, but missed some newly vulnerable groups, mostly because of the reliance on established programming channels. Consultation with affected populations was also limited, and often came too late to influence programming choices.

The pandemic did not prove to be an opportune time for driving forward global humanitarian reform commitments, such as those set out in the Grand Bargain. The UK did not channel much support through local responders (localisation), although it did continue to work closely with national and local governments. Compared to other bilateral donors, however, the UK was well placed to mount a cross- sectoral approach that incorporated both humanitarian and development finance.

The UK’s support was most effective where the department had made previous investments in building the resilience of local systems, particularly health systems, national social protection mechanisms and disaster resilience. The focus on system strengthening before and during the pandemic has, to some extent, increased resilience to future waves of COVID-19 and other future health emergencies in most partner countries. However, given the stress that national health systems have come under during COVID-19, there will need to be a major increase in the rate of investment by governments and donors if countries are to be ready for future epidemics.

The UK’s central humanitarian funding for the COVID-19 response was allocated within weeks and country-level programme adaptations were planned and rolled out within the first six months of the pandemic. Since then, further support for the COVID-19 response has become increasingly mainstreamed into FCDO’s wider humanitarian and development work. This was an appropriate choice, given emerging evidence that the effects of the pandemic in many developing countries were often less acute than other humanitarian needs.

Overall, we find that the UK’s humanitarian response to the COVID-19 pandemic was, for the most part, relevant, coherent and effective. It demonstrated the importance of investing in rapid evidence collection on the impacts of an unfolding health crisis, and the value of having the flexibility to allocate both humanitarian and development resources to meet a complex challenge. While the UK aid budget reductions and the merger came at inopportune times in the pandemic, the department nonetheless succeeded in making a contribution to saving lives and protecting livelihoods, meriting an overall green-amber score.