The analysis of the efficiency of the international assistance provided during the COVID-19 crisis considers the extent to which partners were successful in managing resources well, including whether response efforts were timely, sufficiently adaptable and cost-effective. It identifies challenges related to staff management and corruption risks.
Strategic Joint Evaluation of the Collective International Development and Humanitarian Assistance Response to the COVID‑19 Pandemic
Abstract
A huge number of needs rose quickly during the early stages of the COVID-19 crisis, making efficient use of resources and rapid disbursement of funding critical. Flexibility was also needed, especially early on as specific needs were often not well understood, and priorities changed quickly.
This chapter examines crisis support through the lens of efficiency, building on the preceding interconnected analyses of relevance, coherence and effectiveness. It considers the extent to which international assistance was timely, sufficiently flexible and adaptive, and cost-effective. It explores some of the challenges related to timeliness and flexibility, including risks related to staff and partners, and corruption.
COVID-related international assistance was remarkably quick, both in adapting to the crisis and in rolling out new support, though at times this came at a high cost for staff and partners. Many actors quickly allowed programme adjustments and flexibility, such as relaxing procurement process requirements and reducing reporting requests. Key factors that supported a rapid response were working through existing funding relationships; the overall response would certainly have been quicker had there been greater preparedness and readiness. Greater preparedness (and a faster global response overall) would have also reduced costs. Moving quickly called for less focused targeting, which could have trade-offs in terms of meeting the needs of different parts of the population.
While the overall speed of the COVID-19 vaccine roll-out in low- and middle-income countries was too slow – especially in comparison to higher income countries – international assistance played a significant, positive role in enabling the rapid set-up of ACT-A and COVAX and contributed to reducing the delays faced by many countries. Flexibility and adaptability were also high. The approach to flexibility, adaptability and timeliness changed over the course of the pandemic: Over time, the response slowed, while efficiency in delivery increased. Nearly all agencies reported that there was a return to “business as usual”, and that few of the positive new ways of working were maintained after the crisis.
One of the most frequent observations of international assistance during the crisis was the speed at which co-operation unfolded. Both development and humanitarian actors worked to adapt to the changing needs as the pandemic evolved.
In the early stages, to address immediate needs as quickly as possible, providers and multilateral institutions worked through existing mechanisms and partnerships. At country level this involved close co‑ordination with national partners to find practical solutions to move resources quickly, as was seen in Kenya (see Box 6.1) and Bangladesh (Box 6.2).
Compared to “business as usual”, the COVID-19 response was exceptionally fast – both in terms of disbursing new funds and allowing for adjustments to ongoing work – but came at a cost in terms of staff well-being. For example, the European Commission moved agreements through conceptualisation, approval and disbursements at never-before-seen speeds (ADE, 2022[1]). The European Bank for Reconstruction and Development (EBRD) was an early mover (Box 6.3), and the African Development Bank’s (AfDB) Crisis Response Facility (CRF) used a new operating schedule which sped up the approval process for operations.
While it is difficult to judge whether this resulted in support that was “fast enough” to meet needs, findings from multiple evaluations show that international development and humanitarian assistance can be deployed quickly at scale when there is sufficient political will to do so. A political mandate to operate in “crisis mode” and the use of existing partnerships were critical factors in creating the basis for moving quicky. Embedding crisis response measures in existing projects enabled a crisis response that was both efficient, and coherent with strategic goals (DEval, 2024[2]). Sticking to existing programme sectors, focus areas, geographical locations and communities enhanced timeliness as well as relevance by drawing on established networks and knowledge of the local context (War Child, 2020[3]; Save the Children, 2021[4]; British Red Cross, 2022[5]; Sida, 2021[6]; EBA, 2022[7]; OECD/AfDB, 2025[8]; FAO, 2022[9]).
High-level political commitment played a critical role in the speed of decision making, resource mobilisation, disbursement and logistical arrangements to meet urgent needs. Political leadership and prioritisation had a signalling effect across all layers of institutions and governments, which, in turn, expedited internal processes. Spain showed a good example of this through its “Universal Access Plan: Solidarity in Vaccination”, which drove forward its strategy for ensuring universal and equitable access to the COVID-19 vaccines (Government of Spain, 2024[10]). Special emergency funds (which already existed in some UN institutions, including the WHO) were useful instruments to deploy resources quickly as they did not have to be set up as the crisis emerged (UNDS, 2021, p. ix[11]).
Pre-existing mechanisms were re-purposed to increase the efficiency and effectiveness of crisis responses. For example, the Polynesian Health Corridors (PHC) programme, which predated the crisis, was leveraged to manage New Zealand’s contribution to the vaccine rollout in six Polynesian countries and Fiji. The programme capitalised on the robust collaboration between the Global Health team at the Ministry of Health and the Health team within the Pacific and Development Group in in the Ministry of Foreign Affairs and Trade (MFAT), which also predated the crisis. Finally, since New Zealand’s development co-operation is delivered via a Cabinet mandate, all New Zealand government agencies operated under a shared strategy and guiding principles when engaging with the Pacific.
New and innovative financing mechanisms were established in response to the pandemic, for example, the Solidarity Response Fund (SRF) developed by the World Health Organization (WHO), the UN Foundation and the Swiss Philanthropy Foundation. The SRF operated from March 2020 until the end of 2021, raising nearly USD 257 million. It was designed to mobilise private funding on a global scale to stay ahead of the threat and to provide a nimble, responsive way to direct resources where they were needed most. It relied on the contributions of individuals, corporations, corporate and philanthropic foundations, and non-governmental organisations (NGOs) to provide direct support for WHO and its partners in addressing the pandemic (UNF/WHO, 2021[12]). The SRF filled an immediate funding gap at the onset of the crisis, when UN agencies otherwise experienced an absence of flexible funds. It moved from inception to fund allocation within just three weeks, enabling rapid action ahead of the global pandemic declaration. The first disbursement occurred just weeks after the fund's launch, enabling WHO and the United Nations Children’s Fund (UNICEF) to respond immediately to urgent needs (UNF/WHO, 2021[12]; MOPAN, 2022[13]). The COVID-19 Rural Poor Stimulus Facility (another multi-donor initiative) was established to improve the resilience of rural livelihoods within the pandemic context by ensuring timely access to inputs, markets, information and liquidity (IFAD, 2020[14]).
International development partners, notably the World Bank and the International Monetary Fund (IMF), provided substantial financial support to enhance Kenya's health infrastructure and socio-economic resilience during the COVID-19 pandemic.
The IMF's disbursement of approximately USD 739 million under the Rapid Credit Facility enabled Kenya to address the urgent fiscal needs arising from the pandemic. Concurrently, the World Bank's Kenya COVID-19 Health Emergency Response Project supported the provision of medical supplies, capacity building for health workers, and the establishment of quarantine and isolation centres. This financial assistance was crucial in ensuring that Kenya could respond rapidly and effectively to its fiscal and health challenges during the pandemic.
Source: OECD (2025[8]), “The Development and Humanitarian Response to the COVID-19 Pandemic in Kenya (2020-2022)”, https://doi.org/10.1787/21d3dca0-en.
The Government of Bangladesh recognised the budgetary constraints faced by development partners early in the pandemic and that mobilising additional resources might take longer than anticipated. Consequently, government officials engaged in dialogue with donors to secure a diverse mix of development assistance through various channels, prioritising the swift mobilisation of resources. This approach evolved as the immediate health emergency subsided, transitioning towards a preference for budget support over grant-based financing in the later stages of the pandemic.
Donors responded positively, with the French Development Agency (AFD) using an adaptive management approach to ensure a relevant response to the country’s new and emerging needs, expanding its support beyond infrastructure investments and corporate social responsibility to include health. In November 2020, the Government of Bangladesh urgently sought AFD's financial support for vaccine procurement and later redirected financing from vaccine procurement to the implementation of its Bangladesh Preparedness Response Plan and health system strengthening.
In 2020, the AFD partnered with World Bank to co-finance a social transfer modernisation programme in Bangladesh, which was then restructured to focus on beneficiary targeting; digital payments and data management, to address poverty which had been exacerbated by the COVID-19 pandemic. In 2021, they also initiated a policy-based loan.
Source: OECD (2025[15]), “The Development and Humanitarian Response to the COVID-19 Pandemic in Bangladesh (2020-2022)”, https://doi.org/10.1787/c3e42f6f-en.
The European Bank for Reconstruction and Development (EBRD) was the first international financial institution (IFI) to approve a comprehensive series of response and recovery measures in its Solidarity Package, unveiled on 13 March 2020.
The EBRD quickly rolled out investments and disbursements to clients and countries suffering from the economic shock of the crisis, committing all activity in 2020-2021, worth EUR 21 billion, to help priority regions counter the economic impact of the pandemic. It adapted and scaled up existing instruments and developed new initiatives to provide financing along with rapid advisory and policy support to help businesses and governments combat the economic and societal implications of the virus.
Source: EBRD (2022[16]), “Our response to the Covid-19 pandemic”, https://www.ebrd.com/home/what-we-do/focus-areas/our-response-to-the-covid-19-pandemic.html.
International humanitarian and development assistance was adapted flexibly to the crisis context, including by reducing reporting requirements, allowing for no-cost extensions, and other programmatic changes to adjust to local conditions. Unfortunately, most institutions reported that improvements to flexibility and streamlining of systems made in the crisis context were not maintained. Interviewees described a rapid return to “business as usual” as soon as the emergency period had ended.
The Large Ocean / Small Island Developing States (SIDS) case study (European Commision, 2025[17]) found that flexible and adaptive programming supported responsiveness to changing needs in SIDS during the pandemic. Providers adjusted the objectives, scope and methods of evaluations and assessments. Procedures were simplified, allowing for more flexible and responsive management at the country-office level. Funds were repurposed and reallocated from less flexible projects to those that could respond more quickly to evolving needs (European Commision, 2025[17]).
Bilateral donors and philanthropic organisations showcased high levels of agility, particularly in the early stages of the pandemic. Their smaller scale and operational independence allowed them to fill critical gaps quickly, although this was not always sustained as the pandemic’s demands increased. EU Member States implemented a range of adaptive strategies, with varying degrees of operational impacts during the pandemic period. Providers commonly simplified key internal processes, which facilitated faster decision making and resource reallocation. Streamlining bureaucratic processes also enabled quicker response strategies. An observed reduction in risk aversion across several providers was likely to have been a factor in enabling such internal adjustments and in reorienting existing development and humanitarian portfolios to address emerging needs.
Programmatic flexibility was demonstrated by donors in Georgia, who exhibited adaptability as they contributed to the government’s efforts to recalibrate Georgia’s healthcare infrastructure by investing in hospitals and the public health system. This was a priority due to challenges in testing, treating and admitting COVID-19 patients to hospital, without putting them at additional risk. Beyond the provision of financial and in-kind assistance to address the immediate public health emergency, donors also provided technical assistance through forecasting the health impacts of the pandemic; improving vaccine readiness at central, regional, municipal and district levels; and providing research and communication support to improve vaccine delivery and uptake (OECD, 2025[18]).
The multilateral system also demonstrated high levels of flexibility and responsiveness. The Pan American Health Organisation’s (PAHO’s) response took exceptional measures to repurpose resources, organisational structures and key processes to enable it to respond to the pandemic, especially given its weak financial situation at the onset of the crisis. PAHO simplified and expedited some administrative and financial processes, as well as developing new ones, balancing flexibility with control mechanisms to ensure accountability (PAHO, 2023[19]). Gavi made important decisions to reduce the transaction costs associated with the application, approval and reporting procedures for its grant provision (European Health Group, 2022[20]). COVAX’s flexibility, including matching grants and loan buydown facilities, underscored the importance of risk-sharing mechanisms in accelerating funding availability. Philanthropic foundations demonstrated agility by filling critical gaps early in the pandemic, leveraging their ability to take risks and experiment with innovative approaches (OECD, 2020[21]).
The International Labor Organisation’s (ILO’s) response to COVID-19 highlighted the organisation’s swift recognition of the need for budget flexibility and its implementation of innovative and proactive measures to enable a nimble response across all levels, including adjusting regular budget allocations and development co‑operation funds (ILO, 2022[22]). There was a strong will to preserve pre-existing programmes, as people already being assisted through existing humanitarian actions were likely to be among those most affected by the pandemic. The Global Humanitarian Response Plan (GHRP) emphasised that funding for existing humanitarian responses should take precedence over new responses. Indeed, a significant proportion of the pandemic response comprised adaptations to pre-existing programmes (IAHE, 2022[23]).
Pre-existing frameworks, such as the Central Emergency Response Fund (CERF), along with pooled funding mechanisms provided immediate and flexible financing, enabling rapid responses to urgent needs. Several organisations and agencies, including the African Development Bank (AfDB), Asian Development Bank (ADB) and Gavi, developed specialised emergency response funds, instruments, and modalities designed to support adaptive, quick and flexible funds. CERF funding was rapidly available with USD 15 million allocated on 1 March 2020 (before the formal pandemic declaration) to help global efforts to contain the virus, followed by a further USD 80 million later that month. CERF streamlined application and reporting practices to facilitate rapid adjustments, and its disbursement model allowed recipients to deploy resources without waiting for full donor disbursements found (Schwensen and Schiebel Smed, 2023[24]), (Johnson and Kennedy-Chouane, 2021[25]).
Flexible funding practices were also employed by philanthropic organisations – particularly among those that already regularly provided core funding support. The Hewlett Foundation’s practice of allocating 70-80% of its grants as flexible support enabled grantees to respond effectively to pandemic challenges (OECD, 2021[26]). The W.K. Kellogg Foundation simplified its reporting requirements, enabling non-profit organisations to focus on urgent pandemic responses while maintaining accountability.
While there were many positives in how the development and humanitarian assistance adapted to the crisis, it was not without its challenges. Information gaps, a lack of needs analyses, access to populations and limitations to travel meant that agencies were making decisions rapidly, in an environment where there was a very high level of uncertainty. Providers often worked with a “no-regrets” approach, making decisions based on the belief that waiting for more data to become available would potentially increase suffering and risk to life (ALNAP, 2024[27]). This worked well for speed, despite possible risks around targeting.
Furthermore, the rapid mobilisation needed for pandemic responses often led to inefficiencies in distribution and allocation, impacting disbursement rates. For example, the timeliness of interventions was affected by national lockdowns, travel and supply chain constraints, and restricted access to beneficiaries. Evolving and often incomplete information surrounding COVID-19 made it challenging to fully grasp its ramifications and to set objectives. In one case, a provider’s long approval processes and strict procurement and granting procedures were a barrier to both timelier assistance and to relevance, as by the time requested support was received, it was no longer a priority. Rather than allowing for adjustments, the funding had to be returning.
As the pandemic progressed, the focus shifted towards sustaining adaptability in response to the dynamic and multi-sectoral challenges posed by the crisis. While initial responses were swift, limitations in flexibility and adaptability became evident as more complex needs emerged. For example, Gavi’s risk and programmatic flexibilities were launched early, ensuring the rapid reallocation of resources. However, the delayed rollout of its monitoring, reporting and sustainability framework illustrated how procedural bottlenecks could hinder adaptability when addressing long-term challenges. This trend was not unique to Gavi, as many organisations struggled to balance the urgency of immediate responses with the need for sustained and adaptive interventions. In some cases, assistance patterns failed to align with critical moments in the pandemic. For example, the delays in the delivery of Gavi-funded personal protective equipment (PPE) to several countries, including Pakistan, reflected broader logistical and procedural bottlenecks. Supplies arrived in August and November 2020, months after peak demand during the early pandemic waves (European Health Group, 2022[20]).
While many interventions were timely, significant challenges emerged in addressing the scale and complexity of the crisis. Issues such as supply chain disruptions, uneven co‑ordination among stakeholders, and the insufficient localisation of aid were all areas for improvement. Bureaucratic delays, such as prolonged approval processes for reprogramming requests, often hampered the timeliness of funding.
Other factors affecting flexibility and timeliness included:
Administrative inefficiencies in partner organisations – including implementing organisations that were receiving funding.
Delayed development of adaptable frameworks: The implementation of new adaptive funding mechanisms often lagged behind immediate needs.
Fragmented governance structures: Disparate governance and decision-making structures across agencies undermined co‑ordinated adaptability. For example, the uneven collaboration among regional development banks highlighted the challenges of aligning funding priorities across diverse institutional mandates. This fragmentation created delays and inefficiencies in reallocating resources to critical areas.
Capacity constraints in recipient countries: In many cases, the ability to adapt funding was hindered by limited institutional and operational capacity in recipient contexts. For example, challenges in financial absorption and reallocation processes in countries such as Niger delayed the effective use of reprogrammed funds, despite their availability.
Managing duty of care and risks to staff well-being while striving for timeliness
The evaluation finds that the timely delivery of the crisis response came at a high cost in terms of human resources and staff well-being, including the mental health of staff in implementing and funding agencies, as well as local and government partners. Staff were asked to do much more across the board in response to the crisis, and many demonstrated exceptional dedication, while reporting heavy impacts on well-being.
Organisations faced the dual challenge of meeting duty of care obligations for staff, domestically and internationally, and continuing to deliver programmes and international assistance in response to existing and emerging needs. For example, a USAID study described how staff had to deal with both “the effects of the pandemic on their personal lives and the increased pace and overall intensity of work”, concluding that staff needed surge capacity and mental health and psychosocial support (USAID, 2024[28]). Interviewees and internal after-action reviews provide numerous examples of exceptionally challenging circumstances including long separations from young children and other vulnerable family members, due to re-patriation or health restrictions.
Decisions by countries to evacuate development staff from many international postings, where in some cases strict travel restrictions prevented repatriation, hampered the ability of bilateral providers to deliver coherent responses with implementing partners and other development agencies (ICAI, 2021[29]; EBA, 2022[30]; Sida, 2021[31]; Ministry of Foreign Affairs of Finland, 2022[32]). Staff departures resulted in increased pressures on the remaining in-country staff. It also led to delays in decision making, hindered engagement with stakeholders in-country and increased reliance on virtual communication methods. Effective communication and co‑ordination were challenging without staff on the ground. In contrast, international staff in Cabo Verde, Cambodia and Georgia who remained in post throughout 2020-2021 reported that their communication and co‑ordination with both other international partners and country partners intensified (becoming more frequent and less formal, for instance communicating via Signal or WhatsApp rather than through regular in-person meetings), which in turn supported both speed and relevance.
As was the case for many countries, Czechia’s Ministry of Foreign Affairs (MFA) took measures to ensure the safety and health of its staff, providing employees with protective equipment and adjusting working conditions. Moreover, the MFA also focused on the mental health of its employees by offering them psychological counselling (OECD/European Observatory on Health Systems and Policies, 2023[33]). Sweden established a Corona Team with oversight of human resources and a duty of care for its staff.
Finland’s evaluation of its COVID-19 response found that, even though their initial response to the pandemic effectively prioritised safety and operational continuity, it fell short in fully safeguarding staff well-being over time. An internal survey conducted in March 2021 showed personnel well-being to be declining (from an average of 3.51 to 3.41 out of a possible score of five), with staff experiencing boredom, monotony and concerns about eroding collegiality, especially due to remote working and the move to a new premises. Despite this, staff continued to push forward with notably the MFA’s Employment Satisfaction Barometer during the same period showing an increase in overall satisfaction (rising from 3.74 to 3.81) particularly in management resilience (Ministry of Foreign Affairs of Finland, 2022[32]). This highlighted the need for improved crisis-level preparedness at headquarter (HQ) level, flexible redeployment strategies, continued monitoring of well-being and the retention of pandemic driven innovations and reforms.
An internal survey of International Monetary Fund (IMF) staff (Figure 6.1) revealed significant strains on employee well-being and work life balance due to the workload pressures and changes in the working environment, with the majority of respondents reporting extraordinary levels of stress and disruption in their personal lives. Fewer than half of respondents felt that IMF’s reallocation of staff to the departments in greatest need was handled effectively and only 43% of respondents felt that the organisation had meaningfully adjusted relevant human resource (HR) policies and practices to mitigate excessive work-life pressures, highlighting a critical gap for the IMF (IEO/IMF, 2023[34]). Though comparable data are not available, based on interviews and other evaluations, these experiences appear to be typical of staff experiences across most international development agencies and organisations.
A process evaluation of the early crisis responses of Switzerland, Canada and Sweden in Bolivia, identifies useful elements related to staff management, including the interplay between country teams and headquarters, and the importance of open lines of communication with both international and local staff (Box 6.4).
Key drivers of successful crisis management were enabling flexible and context-specific decision making – especially by using local or country-based staff. Another important practice was revisiting expatriation (including for families) and staffing decisions promptly to avoid unnecessary separations and unsustainable workloads. Duty of care that integrated both mental health and material support with realistic workload adjustments that went beyond offering flexible remote work and included actively reducing excessive demands, were most effective in ensuring effective delivery during the crisis.
A process evaluation of three provider agencies (Swiss Agency for Development and Cooperation [SDC]; Global Affairs Canada [GAC]; and the Swedish International Development Cooperation Agency [Sida]) in Bolivia highlighted both commonalities and important differences in the initiatives undertaken to manage human resources and support staff well-being during the crisis. The evaluation found the three embassies “combined a strong headquarter focus on repatriation issues with an active and efficient engagement in the reprogramming process, even within the first months of the pandemic” (Schwensen et al., 2021[35]).
During the first weeks and months of the pandemic outbreak, agency headquarters and ministries of foreign affairs tended to manage staff repatriation using a “one size fits all” approach, with few exceptions. For example, both the Swiss and Swedish embassies faced delays and disputes due to rigid ministry instructions that did not adequately consider the different circumstances faced by local and expatriate employees. At times, these tensions revealed the inadequacy of existing decision-making structures to face a crisis of this scale, resulting in potential gaps in equitable duty of care provision that embassy management was tasked to fill.
Ultimately, however, the Swiss, Swedish and Canadian embassies in Bolivia were all found to be highly flexible and responsive in their reprogramming processes. They identified practical solutions to managing the heavy workloads arising from both repatriation and reprogramming tasks and introduced different initiatives to increase staff well-being. Local staff were noted as being appreciative of the clear decisions and communication from management, finding, for example, that maintaining regular routines and new spaces for virtual dialogue useful.
Regular staff surveys conducted by headquarters, the appointment of designated focal points, and virtual social and creative initiatives were also named as effective in providing a supportive work environment during the crisis. These efforts helped surface frustrations early so issues could be addressed and communication lines strengthened.
Source: Schwensen et al. (2021[35]), Process evaluation of three donor agencies’ responses to the COVID-19 pandemic in Bolivia during the period March–December 2020, https://www.sida.se/en/about-sida/publications/process-evaluation-of-three-donor-agencies-responses-to-the-covid-19-pandemic-in-bolivia-during-the-period-march-december-2020.
Note: Excludes the response “not applicable”.
Source: IMF (2023[36]), The IMF’s Emergency Response to the COVID‑19 Pandemic, https://ieo.imf.org/en/Evaluations/Completed/2023-0313-imfs-emergency-response-to-the-covid-19-pandemic.
Managing corruption risks
The pandemic created widespread increases in corruption risk. By mid-2020, the International Monetary Fund, World Bank and Transparency International issued stark warnings about the emergent corruption risks of the pandemic (USAID, 2023[37]). Concern revolved around two drivers of corruption risk: a dramatic increase in public sector spending to respond to the pandemic and its socio-economic impacts; and the suspension or reduced capacity of various corruption detection, reporting and enforcement mechanisms due to lockdowns, other measures and the emergency context in general. The use of emergency procurement creates opportunities for the misuse of funds (IDEV, 2022[38]).
An evaluation of pandemic-related corruption risks noted that USAID health assistance was closely controlled to avoid risks of diversion or corruption, but that this often involved the creation of parallel systems and reduced efficiency and sustainability, notably having no or negative effects on long term systems capacity USAID (USAID, 2023[37]).
It was possible to deliver anti-corruption related assistance during the crisis in ways that were effective both in supporting host country government systems and reducing corruption risks. For example, USAID health workers in Malawi, embedded within district health offices, identified financial risks created by government personnel shortages. As a result, USAID financed the hiring of auditors to work with the district councils in administering local health clinics. This suggests that such approaches to addressing corruption risks in health activities during emergencies are possible, even if not widespread.
A study by AfDB IDEV in Kenya found that there were 72 reports on the misuse of COVID-19-related funds reported since the outbreak of the pandemic. While the Government of Kenya established a fully operational multi-agency body to monitor COVID-19 expenditures, it has not acted against the public officials implicated in the misuse of the COVID-19 funds at the time of the evaluation. For example, the government’s investigation revealed irregular expenditures totalling USD 78 million in the Kenya Medical Supplies Authority (KEMPSA) for which no action has been taken. Similarly, a special audit of COVID-19 funds, required by the loan agreement, has not yet been approved.
The evaluation examined the extent to which the development co-operation and humanitarian assistance were cost effective. Although it was not possible to do a full cost-effectiveness assessment given the scope of the evaluation and the lack of necessary data, it finds that value for money informed decisions about what to support and how, both in terms of general strategies that tended to be principled and made on the basis of limited information – such as pooling funding to the United Nations or providing core funding to key international non-governmental organisations (INGOs) – and the smaller scale programmatic decisions taken later in 2020 and 2021, when more information was available.
Principled support to the multilateral system enabled efficiency while maintaining oversight of the use of funds. Assistance through multilaterals increased to USD 148 billion in 2020, USD 162 billion in 2021 and USD 153 billion in 2022. This reflected the increase of donor contributions to multilaterals as part of their response to the COVID-19 crisis. The IMF, the European Bank for Reconstruction and Development (EBRD) and Gavi saw significant funding increases. The unprecedented scale and speed of funding during the pandemic often outpaced monitoring and evaluation systems, limiting information on the efficacy of efforts to ensure that donor spending was both efficient and impactful (European Health Group, 2022[20]).
Development partners showed a commitment to using resources responsibly and cost-effectively, with some evidence showing that cost-effectiveness improved over time as interventions were adapted to the pandemic context. For example, the World Food Programme’s (WFP) cash support programmes in Peru, a country severely impacted by the COVID-19 pandemic, showed increased cost effectiveness from 2020-2022. Investing in strengthening staff capacity in policy advocacy and specialised technical assistance enabled effective engagement with national government institutions and the private sector. This resulted in large-scale benefits such as the mobilisation of important domestic resources in key priority areas (WFP, 2022[39]). All countries struggled to procure high-quality medical equipment in the face of shortages and supply chain disruptions.
PPE was considered key in preventing COVID-19 transmission and protecting healthcare workers. However, the cost-effectiveness of assistance for PPE, such as masks and gloves, was quite mixed. In Bangladesh and Kenya, the COVID-19 response was bolstered by the rapid local production of PPE, which fostered self-reliance and sustainability in cost effective ways as well as building local capacity for future crises (OECD, 2025[15]; OECD/AfDB, 2025[8]). Interviewees in Cambodia, Cabo Verde and Bangladesh reported that donors including China, Japan and Korea provided helpful deliveries of PPE and other equipment, which was possible due to their domestic manufacturing capacities or supplies.
In some cases, in the face of the health emergency, a practical approach to quickly get supplies to where they were needed was prioritised without specific considerations of value-for-money. Based on interviews and findings from evaluations, this seems to have particularly been the case for bilateral providers who prioritised highly visible and in-kind support, but less so for specialised UN agencies. Medical supplies and PPE were procured and delivered in expensive ways (e.g. shipped from provider countries to partner countries). National and local partners with relatively small budgets were at a disadvantage in procuring supplies (ALNAP, 2020[40]; Brubaker, Day and Huvé, 2021[41]). Furthermore, tying aid (i.e. using a provider’s own companies or sources) undermined its cost-effectiveness in some contexts and reflected a prioritisation of political visibility over meeting needs.
Attention to cost effectiveness was demonstrated in some cases as donors targeted support to respond to immediate needs while also building long-term health infrastructure. Many of the facilities and systems that were donated and established for COVID-19 were later adapted to other health challenges, maximising value and resilience over time. For example, the integration of triage systems and guidelines into the healthcare framework, which allowed for the repurposing of facilities to handle non-pandemic health issues, such as Dengue, thus ensuring continued value beyond the initial crisis. Moreover, triage systems, healthcare guidelines and other infrastructure developed during the pandemic have since been integrated into healthcare systems, addressing broader health needs beyond the pandemic. In some cases, the use of digital tools also provided a cost-effective means for efficient implementation. For example, digital systems for vaccine registration and tracking increased efficiency and data accuracy, optimising resource allocation.
Economic analyses regarding the cost-effectiveness of global vaccination efforts during the pandemic are thus far mixed. Early research described the efforts to vaccinate the world as the highest return public investment ever made (Agarwal and Gopinath, 2021[42]), with health, domestic and global economic benefits that vastly exceeded the costs (ALNAP, 2020[40]; Castillo, 2021[43]). However, the efficiency of global allocations was undermined and other research questions the efficiency of pursuing mass COVID-19 vaccinations in low- and middle-income countries given the disease burden and the opportunity costs of resource diversion in achieving this (Bell et al., 2023[44]). In Kenya, the total economic cost of procurement and delivery of COVID-19 vaccines, per person vaccinated with two doses, was estimated to be between USD 29.70 to USD 24.68 for 30% and 100% population coverage respectively, which alone accounts for one-third of the current total annual health expenditure per capita (Orangi et al., 2022[45]; WHO, 2025[46])
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