DUBAI (Reuters) - Countries in the Middle East and North Africa are struggling to recover from the coronavirus crisis as underfunded public health systems exacerbated economic woes, the World Bank said on Thursday. The cumulative cost of the COVID-19 pandemic, estimated as gross domestic product losses, will amount to nearly $200 billion in the region by the end of this year, the bank said in a report. Thirteen of its 16 countries will have lower standards of living this year than pre-COVID, with overall gross domestic product (GDP) per capita forecast to grow by 1.1% this year after a 5.4% decline in 2020. “Long-term socio-economic trends and underfunded public health systems left the MENA region ill-prepared to respond to the pandemic, contributing to a tenuous and uneven recovery as the region struggles to emerge from COVID-19,” the lender said. In the decade preceding the crisis and following the 2011 Arab Spring, the region failed to embark on deep reforms aimed at switching to a market-based economic model, which led to an expansion of the public sector. “In the process, MENA suffered from fiscal myopia: as public sector wage bills rose, public expenditures in health ended up being atypically low for MENA’s level of development,” the World Bank said. Most countries in the region had higher-than-average increases in government expenditure shares of GDP between 2009 and 2019 when compared to peers starting at the same level of income per capita. “In the social contract prevailing in the region, many countries overused public employment to maintain social peace and consensus,” said the bank. “For all MENA countries with available data, the ratios of government health expenditure to public wage expenditure are below those of other countries with similar income.” Going forward, the World Bank forecasts an uneven recovery due partly to different vaccination rates, with richer countries far ahead. Also, while a rebound in oil prices is boosting economic activity in the Gulf, it is weighing on the region’s oil-importing economies. “Health and economics has come to be intrinsically connected ... what ends up being fundamental is how to manage a pandemic,” Roberta Gatti, chief economist for MENA at the World Bank told Reuters. “A better investment in data collection, data sharing, and data publication can really go a long way and even be a cheap thing to do to help the surveillance in the region.” Reporting by Davide Barbuscia; editing by Philippa Fletcher