​​Yemen: Building and Preserving Human Capital During Prolonged Conflict​

Key Achievements

• ​​Between 2021 and 2023, the Yemen Emergency Human Capital Project (EHCP) has achieved the following results:​
  • Supported the delivery of health & nutrition services to more than 11 million people, of which 5.8 million are women and girls, at health facilities and through mobile teams.
  • Increased people’s access to primary health care services in over 2,200 supported facilities (78% of all functional primary health care facilities in Yemen), with 99% of facilities able to provide management of acute malnutrition and 98% of facilities supporting integrated management of childhood illnesses.
  • Provided antenatal care services to more than 590,000 women, mental health, and psychosocial support to 180,000 people, and immunization for more than 1.3 million children.
  • Improved access to water supply, sanitation, and hygiene (WASH) services by providing 530,000 people with restored access to rehabilitated water supply services
  • Provided 390,000 people with restored access to rehabilitated sanitation services (48% of them women and girls).
  • Reached the hardest-to-reach communities with quality primary health and nutrition services through a network of more than 15,000 health workers and volunteers.
  • Improved access to inpatient services across 26 governorate hospitals, 45 district hospitals, and 19 interdistrict hospitals.
  • 97% of beneficiaries were satisfied with the services delivered.

Synopsis

​​​In the face of dire challenges stemming from almost a decade of conflict in Yemen, the World Bank-supported Emergency Human Capital Project (EHCP) has worked to improve access to essential health, nutrition, and population (HNP), and water supply, sanitation, and hygiene (WASH) services nationwide, while also supporting institutional strengthening to improve national and local systems’ resilience to shocks. Between 2021 and 2023, the EHCP helped provide over 11 million people with HNP services, of whom nearly 6 million are women and girls. Over 921,000 people (of which 48 percent are women and girls) were provided with access to improved WASH services.​​

Challenge

Yemen’s health and water sectors have been devastated by almost a decade of conflict, institutional weakness, and economic volatility. As of 2023, almost 20 million people need urgent health services, 2.2 million children are suffering from acute malnutrition, and 48% of children under five years old are stunted and chronically malnourished. Only 54 percent of health facilities are fully functional, with gaps in health care personnel, financial resources, and essential equipment and supplies.

Yemen also experiences a massive water shortage along with deterioration in water quality, causing major outbreaks of water-borne disease. Over 15 million people lack access to safe water and adequate sanitation services, and only 21 percent of water and sanitation facilities are functional.

Approach

​​The overarching goal behind the World Bank's engagement in Yemen is to support the people of Yemen through preserving service delivery, human capital, and institutions in order to bolster their resilience to conflict and preparedness for recovery. Under the unique operational context of Yemen, our project support is implemented by partnering with agencies on the ground. In this case, this project is implemented by the United Nations Children’s Fund (UNICEF), the United Nations Office for Project Services (UNOPS), and the World Health Organization (WHO), in close partnership with local service delivery actors such as hospitals, primary health care facilities, district and governorate health offices, local water and sanitation corporations, national water and sanitation authority branches and autonomous utilities. These organizations were selected based on the project design and their implementation experience under previous IDA-financed projects. These organizations managed to set implementation mechanisms in place for these projects, through the existing local public system structures, and delivered results on the ground during the ongoing conflict in Yemen. The EHCP uses a multi-sectoral approach with a shock-responsive and adaptive project design, which means they can be scaled up and scaled down quickly, especially during shocks and crises, when expanding the system is paramount.) By being operationally flexible and agile, the project quickly responds to the evolution of situation on the ground and addresses emergencies, such as outbreaks, shortage in medical goods, etc. The project has helped improve access to HNP services at all levels of care (community, primary, secondary, and tertiary), as well as access to improved WASH services. The EHCP invests in strengthening health, nutrition, and WASH systems by (i) enhancing the Health Information System (HIS), (ii) improving quality of care through quality situation analysis, quality improvement plans for hospitals, and developing quality of care strategy, (iii) investing in local leadership by empowering national and subnational entities and utilizing them to help deliver essential services which helped preserve the national capacity and maintained the core functions of the health system, and (iv) establishing and sustaining community health network tasked with reaching the hardest-to-reach communities who have limited access to health services with quality primary health and nutrition services. The EHCP complements these investments by assessing people’s knowledge, attitudes, and practices on maternal and child health, malnutrition, and non-communicable diseases and implementing awareness campaigns and social behavior change activities to encourage uptake of related services. To underpin project activities and understand health system gaps, the project generates reliable data on project implementation and results from Third-Party Monitoring (TPM), triangulated with data from the implementing agencies.

Results

The EHCP has worked and continues to work to preserve Yemen’s human capital by supporting the delivery of HNP services to more than 11 million people, of which 5.8 million are women and girls, at over 2,200 supported health facilities and through outreach and mobile teams between 2021 and 2023.

Investing in WASH services has provided over 921,000 people of whom 48 percent are women and girls, with access to improved water supply and sanitation, between 2021 and 2023.

The project promoted sustainable approaches with focused investment in local/decentralized institutions by training 10,360 health care personnel.

It generated reliable data on project implementation and results from TPM, triangulated with data from the implementing agencies, to underpin project activities and understand health system gaps.

A District Health Information System II (DHIS II) was rolled out in 4,822 health facilities in all 22 governorates and the project supported building the capacity of 1,800 health district data officers.

The electronic integrated disease early warning system (EIDEWS) for disease surveillance was integrated at 2,379 sites, supporting 333 rapid response teams, and enhancing the nutrition surveillance system at 340 sites.

The project provided vaccination services to more people by identifying additional Expanded Program on Immunization (EPI) service delivery points, based on World Bank-led geo-spatial analysis.

Assessing people’s knowledge, attitudes, and practices on maternal and child health, malnutrition, and non-communicable diseases helped to design evidence-based social behavior change communication, which was implemented through World Bank-led analytical engagement and supported by Trust Funds.

World Bank Group Contribution

​​The EHCP is financed by the International Development Association (IDA) through grants of $450 million. The analytical studies conducted the World Bank (funded by the Japan Policy and Human Resources Development Fund) is informing the EHCP on strengthening the context-specific model of care to enhance essential health and nutrition service delivery and introduce task shifting to empower community health care workers to improve access and quality. ​

Partnerships

The implementing agencies (and recipients of grants) are the United Nations Children's Fund (UNICEF), the United Nations Office for Project Services (UNOPS), and World Health Organization (WHO). Activities implemented by UNICEF and WHO aim to improve access to the minimum service package at all levels of care, improve access to essential preventive and curative nutrition services, as well as sustain and strengthen the national health system preparedness and public health programs. Activities implemented by UNOPS aim to improve access to water supply and sanitation and to strengthen local systems. Partnering with competent and capable implementing agencies has proved to be critical for achieving results in a challenging and fragile environment. The project, through the implementing agencies, works closely with the national authorities represented by the Ministry of Public Health and Population, Ministry of Water and Environment, governorate and district health offices, urban water and sanitation project management units in Sana’a and Aden, local water and sanitation corporation and branches, and autonomous utilities to ensure proper and timely coordination to implement the project's activities.

Looking Ahead

​​Building on the successful results achieved thus far, the EHCP will continue to operationalize much needed support through the humanitarian-development-peace nexus, by sustaining and improving access to quality HNP and WASH services, while at the same time strengthening systems that improve Yemen’s (or Yemeni people’s) response to shocks and emergencies. This will be done through (i) scaling up the delivery of quality services to reach 19 million people; (ii) strengthening and implementing the Minimum Service Package for essential health services; (iii) strengthening the readiness, prevention, and response to disasters and outbreaks; (iv) building the capacity of healthcare workers; and (v) strengthening the HIS to produce and use quality data for decision-making. The EHCP will also continue to provide access to improved water and sanitation services to two million people. To improve sustainability and reduce reliance on fuel and water trucking, the project is investing in fuel exist strategies through financing renewable energy sources at facilities instead of relying on using fuel. It is also investing in water trucking exist strategies by connecting the facilities to the public water networks. ​