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1、ContentsAcknowledgmentsviAbbreviations viiiCountry Codes xRegional Classification Used in this ReportxiExecutive Summary xiiPART I: The Economic Outlook and Long-term Challenges 1COVID-19 Pandemic and the Economic Outlook 3Global Context 3Europe and Central Asia: Recent Developments and Outlook 8Lon
2、g-Term Challenges and Policies30Annex 1.1. Data and Forecast Conventions35References 36COVID-19 and Human Capital41Investment in Human Capital: A Centerpiece of Post-Pandemic Recovery 41The State of Human Capital in Europe and Central Asia on the Eve of the Pandemic42Impact of the COVID-19 Pandemic
3、on Health and Education Outcomes in Europe andCentral Asia65Improving Investments in Human Capital 74Conclusion 90Annex 2.1. Estimation of Quality-Adjusted Years of Higher Education95Annex 2.2. Estimates of the Effect of Adult Health Risk Factors on Productivity102References 105II: Selected Country
4、Pages 117Albania119Armenia 121Azerbaijan 123Belarus125Bosnia and Herzegovina127Bulgaria129Croatia131Georgia133Kazakhstan135Kosovo137Kyrgyz Republic139Moldova141Montenegro143North Macedonia145Poland147Romania149Russian Federation151Serbia153Tajikistan 155Turkey 157Ukraine159Uzbekistan161 IIIExecutive
5、 SummaryThe CO VID-19 pandemic has sunk the global economy into the deepest recession in eight decades. In the emerging and developing countries of Europe and Central Asia, GDP is expected to contract 4.4 percent in 2020. This update summarizes recent developments and presents the outlook for the re
6、gion. It also focuses on human capital, an area that requires serious attention given the severe impact of the pandemic on health and education.Regional output collapsed in the first half of 2020, as growing domestic outbreaks and pandemic-related restrictions caused domestic demand to plummet, exac
7、erbated supply disruptions, and halted manufacturing and services activity. The sharp decline in remittance inflows -which account for about 10 percent of GDP in the region excluding the Russian Federation and Turkey contributed to the slide in retail sales. The economies hardest hit were those with
8、 strong trade or value chain linkages to the Euro area or Russia and those heavily dependent on tourism or energy and metals exports. Economies that were slower to implement measures to stem the spread of the virus suffered more widespread outbreaks, higher death rates, and steeper declines in activ
9、ity than economies that did so more rapidly; as restrictions to contain the pandemic had to be more stringent. At the end of the year; using the $3.20 a day poverty line, estimates suggest an additional 2.2 million people may slip into poverty in the emerging and developing countries of the region.
10、At the $5.50 a day poverty line, customarily used in upper-middle-income countries, this figure can be as high as 6 million.Growth is projected to recover in 2021, but the pace of recovery is highly uncertain and depends on the duration of the pandemic, the availability and distribution of a vaccine
11、, and the degree of improvement in trade and investment. The recovery could be weaker than expected if the pandemic worsens, necessitating prolonged restrictive measures and/or escalating geopolitical tensions. XIIOnce the health and economic crises caused by the CO VID-19 pandemic are brought under
12、 control, policy efforts in the region will need to address the steep fall in productivity growth over the past decade and focus on structural reforms that are essential to reignite long-term growth prospects. Strengthening governance and improving institutional quality could yield growth dividends
13、and attract investment. Structural bottlenecks, including limited exposure to international competition and low innovation rates, continue to weigh on the business environment. Boosting investment in human capital and climate resilience will be crucial to raise living standards and foster inclusive
14、and sustainable growth. Addressing these headwinds to long-run growth will require a well-targetedbox 2.7 Integrating noncommunicable disease prevention andtreatment at the primary care level in TurkeyTurkey scaled up a successful pilot of its family medicine model for primary care in 2010. Under th
15、e model, primary care services are delivered at Family Medicine Centers (FMCs) by family medicine practitioners and support staff. As of December 31, 2018, Turkey had 26,252 FMCs, each covering about 3,000 people on average. Family medicine physicians and other clinical staff operate under performan
16、ce-based contracts with a negative incentive, in which up to 20 percent of the provider payment is withheld if performance targets for maternal and child health, including vaccinations, are not met.In addition to the FMCs, community health centers deliver community and public health services, includ
17、ing environmental, reproductive, child, and adolescent health services; communicable disease management and control; and cancer screening. Healthy Living Centers were introduced to complement and strengthen the FMC model. They conduct follow-up activities with patients referred bySource: Sumer, Shea
18、r, and Yener 2019.FMCs and carry out population screening programs to identify and stratify the population for specific diseases (especially noncommunicable diseases NCDs) so that the system can be proactive and plan for NCD management.The FMC model has made significant progress. The new challenge i
19、s to improve coverage of NCD prevention, screening, diagnosis, and curative services. On the financing side, performance-based contracts at the primary care level include maternal and child health indicators, but NCD prevention is not yet linked to the contracts. Improving the horizontal and vertica
20、l coordination of care is essential. In particular, the family medicine system needs to increasingly function as a gatekeeper for secondary- and tertiary-level care, the e-health system needs to include disease management pla廿orms” that integrate patient information between the three levels of care,
21、 and practitioners need to use standard clinical pathways to deal with NCDs.deaths in a cross-section of 26 high-income countries (Comas-Herrera and others 2020), highlighting the inadequacy of such structures (at least in their current format) for an environment in which infectious diseases outbrea
22、ks are more common than they once were. Independent living arrangements for the elderly as well as health care provision that does not require in-person contact, such as telemedicine, may become more important.Any policy initiative will have to deal with the fact that, in many countries in Europe an
23、d Central Asia, family members are the sole providers of long-term care services. In many countries, hospitals substitute for unavailable formal longterm care facilities. The use of hospital beds for residential instead of acute care results in excessive medicalization of older people and puts unsus
24、tainable financial pressure on the health system (Bussolo, Koettl, and Sinnott 2015).Closing gaps in child, maternal, and mens healthChild stunting rates are high in Tajikistan, Turkmenistan, and the Kyrgyz Republic; levels in Armenia and Kazakhstan are also worrisome. In the Western Balkans notably
25、 Kosovo, the Republic of North Macedonia, and Serbia - and Moldova, child stunting primarily affects the most disadvantaged groups. Equity gaps are also evident in other maternal and child health outcomes, such as immunization and access to a doctor during delivery. These gaps may have grown during
26、the pandemic, as a result of disruption of health services, as discussed in the previous section. Policymakers will therefore have to renew their efforts in this area.Childrens health, nutrition, and education needs during the preschool years (ages three to five) are generally well incorporated into
27、 government policies. But the need for nurturing, stimulation, and early learning between birth and age three is often a policy blind spot. Routine preventive health care includes vaccinations and growth monitoring, but many countries lack clearly articulated, intersectoral policies to support disad
28、vantaged parents in stimulating and nurturing their children. Rolling out early childhood intervention at scale faces many challenges, including lack of clarity over how to implement multisectoral interventions for which no single ministry or entity is responsible (Black and others 2017).Early child
29、hood programs that foster the capacity of parents and caregivers to provide adequate nurturing, stimulation, and learning to children from birth to age three have tremendous potential to improve childrens cognitive and socio- emotional skills. A meta-analysis of such parenting programs finds that th
30、ey increased scores on short-term measures of psychosocial development, motor development, and cognitive development. Long-term gains varied by intervention and context (Britto and others 2017). Two studies conducted in Jamaica find that stimulation of stunted children during their early years led t
31、o long-term gains in cognition, educational achievement, employment, and adult earnings, as well as to reductions in violent behavior 20 years after the program ended (Walker and others 2011; Gertler and others 2014). Nutrition interventions at an early age have been estimated to have a benefit-cost
32、 ratio of 15:1 and a rate of return of 17 percent (Galasso and others 2016). Early childhood parenting and stimulation programs appear to have the greatest impact on the most disadvantaged children, including children who are among the poorest and children who are stunted or have lower developmental
33、 outcomes. And programs appear to be more effective in younger children.For successful integration of these interventions into health services, one policy option is well-child checkups. These checkups should include a holistic range of developmental services, including vaccinations; monitoring and c
34、ounseling on nutrition; and evaluation of developmental milestones for motor, cognitive, linguistic, and socioemotional development. Well-child visits should support parents and caregivers in developing responsive zzserve and return relationships with their children, one of the most fundamental driv
35、ers of childrens ability to thrive (Center on the Developing Child at Harvard University 2020).12 High-quality well-child checkups give health care providers many opportunities to identify children with developmental delays and disabilities, which can facilitate earlier referrals to assessments, sup
36、port, and treatment.Another critical gap that needs to be closed is between men and womens health. Women have better health outcomes than men in all countries in the region. The gap is particularly large in the former Soviet republics. In the Russian12./zServe and return relationships are relationsh
37、ips between children and adults that are responsive and attentive relationships that include much back-and-forth interaction. An example is a situation in which a child gestures or cries and the adult responds with eye contact, words, or a hug.Federation, for instance, the probability of a 15-year-o
38、ld reaching 60 is 72 percent for a boy and 89 percent for a girl, a difference of 17 percentage points. The same difference is found between boys and girls in Ukraine; in Belarus, Georgia, and Moldova, the gap is about 14 percentage points. This gender gap is not unique to the Europe and Central Asi
39、a region it was recently documented in the United States in the context of/zdeaths of despair/7 many of which are caused by alcoholism and drugs (Case and Deaton 2020).The fact that the adult mortality rate is considerably higher for men than for women may go beyond health: There is evidence that a
40、decrease in life expectancy can change the educational choices of young cohorts, eventually leading to a decrease in years of schooling (Oster, Shoulson, and Dorsey 2013; Evans, Garth- waite, and Moore 2016). Although the gender gap in mortality narrowed in the last decade, it remains very large. Po
41、licies to reduce it will have to be multidimensional, as its drivers can be social and economic (Scutchfield and Keck 2017).ConclusionHuman capital is fundamental for economic development: No society can progress if the education and health of its people are poor. Educated and healthy citizens are m
42、ore productive, helping their countries flourish; differences in human capital explain much of the differences in income levels across countries and over time.COVID-19 has hit human capital directly. School closures have deprived children and young adults from meaningful learning, and the disease ha
43、s killed or sickened millions of people. Recovery from the pandemic will require strong investment in human capital.Governments have an important role to play in promoting this investment, as individuals and families may underinvest in human capital, because they may not be able to obtain the necess
44、ary financing or because they underestimate the returns to investing, which are not evident in the short run and may arise only at the aggregate social level.Measurement of human capital is fundamental for any investment to be effective; having a pre-pandemic benchmark as a reference is important be
45、cause it can identify where investments are most needed. In 2018, the World Bank launched the Human Capital Index (HCI), an index designed to highlight how improvements in current health and education outcomes shape the productivity of the next generation of workers. This report presents a more comp
46、lete picture of the pre-pandemic human capital in countries in Europe and Central Asia by providing data on and analysis of additional dimensions that are relevant for the region.The analysis of education builds on the same components as the global HCI, which considers only basic education, by inclu
47、ding a measure of quality-adjusted years of higher education. The analysis of health extends the global HCI component, which uses child stunting and the adult survival rate as proxies for health status, by adding three adult health risk factors: obesity, smoking, and heavy drinking.Several findings
48、emerge from this analysis. Good indicators of basic education are correlated with good indicators of higher education, suggesting the continued importance of improving fundamentals. The correlation is not perfect, however: in some cases, relatively poor outcomes in basic education can be compensated
49、 for by better outcomes in higher education, particularly when attainment and quality in postsecondary education are good.Data also reveal that the gender gap in basic education, even if small, is in favor of girls. Women outperform men in higher education in most countries. Womens representation in STEM fields of study is considerably lower than that of men, however.