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1、MENA ECONOMIC UPDATE OCTOBER 2021Overconfident:How Economic and Health Fault LinesLeft the Middle East and North AfricaIll-Prepared to Face COVID-19每日免每日免费获费获取取报告报告1、每日微信群内分享7+最新重磅报告；2、每日分享当日华华尔尔街日街日报报、金融时报；3、每周分享经济经济学人学人4、行研报告均为公开版，权利归原作者所有，起点财经仅分发做内部学习。扫一扫二维码关注公号回复：研究报告加入“起点财经”微信群。WORLD BANK MIDDL
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7、k as follows:Gatti,Roberta;Lederman,Daniel;Fan,Rachel Yuting;Hatefi,Arian;Nguyen,Ha;Sautmann,Anja;Sax,Joseph Martin;Wood,Christina A.2021.“Overconfident:How Economic and Health Fault Lines Left the MiddleEast and North Africa Ill-Prepared to Face COVID-19”Middle East and North Africa Economic Update
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13、reet NW,Washington,DC 20433,USA;e-mail:pubrightsworldbank.org.ISBN(electronic):978-1-4648-1798-4DOI:10.1596/978-1-4648-1798-4Photo credits in this publication.Further permission required for reuse.Cover photo credit:MJGraphics/SOVERCONFIDENT:HOW ECONOMIC AND HEALTH FAULT LINES LEFT THE MIDDLE EAST A
14、ND NORTH AFRICA ILL-PREPARED TO FACE COVID-19ContentsAcknowledgements.ivAbbreviations.vForeword.viChapter 1.Introduction and Overview of Findings.1Chapter 2.A Tenuous and Uneven Economic Recovery in an Ongoing Pandemic.3Impact of Public Health Surveillance.5Impact of Rising Commodity Prices.6Chapter
15、 3.MENAs Truncated Economic Transitions and Their Implications for Economic Growth.9Chapter 4.MENAs Truncated Demographic and Epidemiological Transitions.13MENAs Truncated Demographic Transition.13MENAs Truncated Epidemiological Transition.15Chapter 5.Overconfident:The State of MENAs Public Health S
16、ystems on the Eve of the Pandemic.20Inadequate Financing Hinders Health System Resources.20Financial,Human,and Physical Resource Limitations Challenge Health Systems.23MENAs Public Health System Preparedness versus Self Assessments.24Health Systems Governance Has a Way to Go.27Chapter 6.Covid-19 in
17、MENA:A Stress Test.29Covid-19 in MENA:A Stress Test on Resilience in a Data Deprived Environment.30Chapter 7.Forward Look:What Empirical Evidence Says about the Uses and Misuses of Public Health Data.38References.46Appendix.54Appendix A1.Growth Adjustments and Covid-19 Test Positivity Rates.54Append
18、ix A2.Impact of Commodity Price Shocks on GDP Growth.54Appendix A3.Estimates of Truncated Long-Term Transitions prior to the Covid-19 Shock in MENA.55Appendix A4.The State of MENAs Public Health Systems on the Eve of Covid-19.56Data Appendix.60iCONTENTSMIDDLE EAST AND NORTH AFRICA REGION ECONOMIC UP
19、DATE OCTOBER 2021List of FiguresChapter 2.A Tenuous and Uneven Economic Recovery in an Ongoing PandemicFigure 2.1.GDP Level and per Capita Forecasts.4Figure 2.2.An Uneven Recovery.4Figure 2.3.Growth Adjustments and Positivity Rate.4Figure 2.4.Oil Prices and Futures.6Figure 2.5.Exposure to Internatio
20、nal Commodity Markets.7Chapter 3.MENAs Truncated Economic Transitions and Their Implications for Economic GrowthFigure 3.1.Government Expenditure in Total GDP in 2009 and 2019.9Figure 3.2.Changes in Government Expenditure over GDP,2019 minus 2009 Relative to Benchmarks byLevels of Development.10Figu
21、re 3.3.Shares of Public Employment in Non-GCC MENA Relative to Benchmarks by Levels ofDevelopment.10Figure 3.4.Public Health Expenditures over Public Sector Wage Bills versus GDP per Capita,2018.11Figure 3.5.Spending on Preventive Health and Health System Functions.11Chapter 4.MENAs Truncated Demogr
22、aphic and Epidemiological TransitionsFigure 4.1.Fertility Rates versus Gross National Income per Capita.13Figure 4.2.Fertility Rates in MENA Compared to Benchmarks by Levels of Development.14Figure 4.3.Obesity in MENA and the Rest of the World.16Figure 4.4.The Illusion of Healthy Populations when Ag
23、e Demographics Differ across Countries.16Figure 4.5.Burden of Communicable and Non-Communicable Diseases.18Figure 4.6.Age-Standardized Deaths from Non-Communicable Diseases per 100,000 Population in MENARelative to Income-Level Benchmarks.18Chapter 5.Overconfident:The State of MENAs Public Health Sy
24、stems on the Eve of the PandemicFigure 5.1.Health Spending in MENA Compared to Level of Development.21Figure 5.2.Sources of Health Spending as a Share of Total Health Spending.22Figure 5.3.Skilled Health Worker Density.22Figure 5.4.Primary Health Care Facility Density.24Chapter 6.Covid-19 in MENA:A
25、Stress TestFigure 6.1.Reasons for Service Disruptions.31Figure 6.2.Excess Mortality P-score.33Figure 6.3.Containment and Health Index in MENA-Intensity of Covid-19 Containment Policies over Time.34Chapter 7.Forward Look:What Empirical Evidence Says about the Uses and Misuses of Public Health DataFig
26、ure 7.1.Data Availability Assessment for MENA.39iiCONTENTSOVERCONFIDENT:HOW ECONOMIC AND HEALTH FAULT LINES LEFT THE MIDDLE EAST AND NORTH AFRICA ILL-PREPARED TO FACE COVID-19List of TablesChapter 5.Overconfident:The State of MENAs Public Health Systems on the Eve of the PandemicTable 5.1.Overconfid
27、ent MENA:Public Health System Preparedness versus Self-Assessments.26Table 5.2.Correlates of Testing per Capita.27Chapter 6.Covid-19 in MENA:A Stress TestTable 6.1.Reported Covid-19 Indicators as of September 13,2021.32Table 6.2.Seroprevalence Studies in the Region Compared with the Official Confirm
28、ed Prevalence.33Table 6.3.Ratio between Excess Mortality and the Reported Covid Deaths.34Table 6.4.Vaccination Progress by World Region as of August 9,2021.36Chapter 7.Forward Look:What Empirical Evidence Says about the Uses and Misuses of Public Health DataTable 7.1.The Many Roles of Data in Modern
29、 Health Care Systems.40Appendix.54Table A1.1.Changes in GDP per Capita Forecasts and Covid-19 Test Positivity Rate.54Table A2.1.Impact of Commodity Price Shocks.55Table A4.1.Variables Included in Each Thematic Pillar.58Data Appendix.60Appendix Table B1.World Banks Growth,Current Account and Fiscal A
30、ccount Forecasts.60Appendix Table B2.Growth Forecast Adjustments by the World Bank.61Appendix Table B3.Selected Health Indicators in MENA and the Rest of the World by Income Groups circa 2019 62List of BoxesChapter 7.Forward Look:What Empirical Evidence Says about the Uses and Misuses of Public Heal
31、th DataBox 7.1.The Spread of Information,the Publics Response to Policy Measures,and the Role of Trust in aCrisis.42iiiCONTENTSMIDDLE EAST AND NORTH AFRICA REGION ECONOMIC UPDATE OCTOBER 2021AcknowledgementsThe MENA Economic Update is a product of the Office of the Chief Economist for the Middle Eas
32、t and North Africa Region(MNACE)of the World Bank.The report was written by Roberta Gatti(Regional Chief Economist),Daniel Lederman(Deputy Chief Economist),Rachel Yuting Fan(Team Lead),Arian Hatefi,Ha Nguyen,Anja Sautmann,Joseph Martin Sax,and Christina A.Wood.We are indebted to Abdo Yazbeck for his
33、 ideas and advice that shaped the report,particularly concerning the role ofeconomic,demographic and epidemiological transitions.Inputs from Johannes G.Hoogeveen and Minh Cong Nguyenare much appreciated.Claudio Jeremias Rojas Guzman and Rana Mohamed Amr Mohamed Nabil Lotfi provided invaluable resear
34、ch assistance.Helpful comments were provided by Ferid Belhaj(Regional Vice President),Stefan G.Koeberle,Jesko S.Hentschel,NadirMohammed,Fatima Zehra Shah,Ismail Radwan,Tania Meyer,Nancy Lozano Gracia,Anush Bezhanyan,Jens Kromann,Paul Welton,Laura De Castro Zoratto,Sara B.Alnashar,Majid Kazemi,Ashwaq
35、 Natiq Maseeh,Anastasia Janzer-Araji,Saadia Refaqat,Wael Mansour,Wissam Harake,Luan Zhao,Jaime de Pinies,Dalia Al Kadi,Amr Elshalakani,Paul MorenoLopez,and Javier Diaz Cassou.We gratefully acknowledge the World Banks MENA Health Sector team for its overall support,guidance,and comments,namely Rekha
36、Menon(Practice Manager),Mansour Faisal H Alrumayyan,Sherin Varkey,Sameh El-Saharty,Son NamNguyen,Denizhan Duran,Fatima El Kadiri El Yamani,Iryna Postolovska,Fernando Xavier Montenegro Torres,TakahiroHasumi,Christopher H.Herbst,Jorge A.Coarasa,and Ronald Eduardo Gomez Suarez.Susan Pleming provided ti
37、mely advice on messaging during the final stages in the production of this report.We thank James L.Rowe Jr for editing the manuscript.Help from the Translation and Printing&Multimedia Unit ofthe World Banks Global Corporate Solutions is acknowledged.Stellar administrative support was provided by Swa
38、tiRaychaudhuri.ivACKNOWLEDGEMENTSOVERCONFIDENT:HOW ECONOMIC AND HEALTH FAULT LINES LEFT THE MIDDLE EAST AND NORTH AFRICA ILL-PREPARED TO FACE COVID-19AbbreviationsAIDSAMRAcquired Immunodeficiency SyndromeAntimicrobial ResistanceBotswana HIV Response Information ManagementSystemLICsLow Income Countri
39、esMCMMCV1MENAMERSMICsMPONACMedical CountermeasuresMeasles-Containing-Vaccine First-DoseMiddle East and North AfricaMiddle Eastern Respiratory SyndromeMiddle Income CountriesMacro and Poverty OutlookNorth AmericaNon-Communicable DiseaseOil-Exporting CountriesOrganization for Economic Cooperation andD
40、evelopmentBHRIMSCDCCenters for Disease Control and PreventionCOVID-19 Coronavirus Disease 2019DOEDOIEAPECAEMROFAOFEDeveloping Oil ExportersDeveloping Oil ImportersEast Asia and PacificEurope and Central AsiaEastern Mediterranean Regional OfficeFood and Agriculture OrganizationFixed EffectsNCDOECOECD
41、OLSOrdinary Least SquaresGAVIGCCGDPGHEGHOGHSGHSIGNIGlobal Alliance for Vaccines and ImmunizationGulf Cooperation CouncilGross Domestic ProductGlobal Health ExpenditureGlobal Health ObservatoryGlobal Health SecurityGlobal Health Security IndexGross National IncomeOOPSOPECPCAPHCPMIOut-of-Pocket Spendi
42、ngOrganization of the Petroleum Exporting CountriesPrinciple Components AnalysisPrimary Health CarePurchasing Managers IndexPersonal Protective EquipmentPurchasing Power ParityPPEPPPRMNCH Reproductive,Maternal,Newborn and Child HealthHCAIHICsHIVHealthcare Associated InfectionsHigh Income CountriesHu
43、man Immunodeficiency VirusIntensive Care UnitSARSDISPARSSASouth AsiaService Delivery IndicatorsState Parties Self-Assessment Annual Reporting ToolSub-Saharan AfricaICUIDID4DIHRIMFJEEIdentity DocumentUAEUHCUnited Arab EmiratesUniversal Health CoverageUnited Nations International Childrens EmergencyFu
44、ndUnited States Agency for International DevelopmentWorld Bank IndicatorsWorld Health OrganizationIdentification for DevelopmentInternational Health RegulationsInternational Monetary FundJoint External EvaluationLatin America and the CaribbeanLesbian,Gay,Bisexual,Transgender,Queer,IntersexUNICEFUSAI
45、DWDIWHOLACLGBTQIvABBREVIATIONSMIDDLE EAST AND NORTH AFRICA REGION ECONOMIC UPDATE OCTOBER 2021ForewordWith the emergence of Covid-19 in 2020,public health systems across MENA were overwhelmed by the pandemic,whichcame on top of the need to care for patients with non-Covid diseases.Although there is
46、a lot about the Covid-19 outbreakin MENA and elsewhere that we do not understand,it is clear that a health systems capacity to absorb a sudden increasein patients due to an unexpected health shock remains a key dimension of public health preparedness.Simply put,running out of oxygen tanks,hospital b
47、eds,and even doctors and nurses during a health emergency are all symptomsof a lack of resilience.While MENA was not unique in having faced a dreadful pandemic that exhausted available public health resources,MENA was unique compared to the rest of the world in how it ended up ill-prepared to absorb
48、 the shock of Covid-19.Theauthors of this report argue that three long-term trends left MENAs public health systems with low capacity to handleemergencies.In the past decade,slow reforms toward market-oriented economic systems and transparent institutionsleft a legacy of large public sectors that ef
49、fectively crowded out investments in social services such as public health.Meanwhile,epidemiological trends left MENA with uncharacteristically high burdens of both non-communicable andcommunicable diseases compared to their income peers.And rising or atypically high fertility rates yielded a youngp
50、opulation that made it seem as though MENAs citizens overall enjoyed good health while,in fact,the region had acomparatively high number of young people in poor health.As in other regions,MENAs pandemic response challenges reflected not only the unpreparedness of its health systemsto deal with Covid