Download DOC - World bank documents

PROJECT INFORMATION DOCUMENT (PID)
APPRAISAL STAGE
Report No.: AB4889
Project Name
Region
Sector
Project ID
Borrower(s)
Implementing Agency
Environment Category
Date PID Prepared
Date of Appraisal
Authorization
Date of Board Approval
Influenza Control and Prevention Project
LATIN AMERICA AND CARIBBEAN
Health (100%)
P116965
MEXICO
Federal Secretariat of Health
Lieja No. 7, Piso 1
Col. Juárez
06696 México, D.F.
Phone: (52-55) 5553-0758
[ ] A [X ] B [ ] C [ ] FI [ ] TBD (to be determined)
July 14, 2009
June 26, 2009
September 10, 2009
1. Country and Sector Background
An influenza pandemic originated in Mexico in mid-March of this year. As the country neared the end
of the annual influenza season, officials noticed an unusual increase in patients presenting flu-like
symptoms. Genomic testing revealed that a new strain of influenza A/H1N1 (henceforth referred to as
A/H1N1) was responsible for the infections. Little is known about this new virus, but it may spread more
easily among humans than other A/H1N1 strains and have more severe health effects than the seasonal
influenza A. By mid-June, the spread of A/H1N1 around the world—there were 36,000 confirmed cases
in 76 countries—led the WHO to declare a Phase 6 Pandemic Alert. The final phase of pandemic alert,
the declaration of Phase 6 is, according to the WHO, an indication that “a global pandemic is underway”
and that “actions should shift from preparedness to response.” By the end of June, A/H1N1 had infected
more than 9,295 and caused the death of more than 119 people in Mexico.
The Government acted quickly to contain the spread of the virus and to minimize morbidity and
mortality. In accordance with the National Plan for Preparedness and Response to an Influenza Pandemic
(which was developed in view of World Health Organization guidelines), the Government heightened
epidemiological surveillance, upgraded laboratories, executed a massive communications campaign
encouraging preventive behaviors, expanded and strengthened the provision of health services, and
replenished stocks of medicines and vaccines, and prepared for an evaluation of the response effort.
Going beyond actions foreseen in the National Plan, the Government then enforced a temporary closure
of schools and businesses in an attempt to slow the rate of spread of the virus, thus soften the peak of the
epidemic and avoid overwhelming health service capacity.
In full compliance with International Health Regulations, the Government informed the public and the
World Health Organization about the epidemic, at times to the detriment of its economy and foreign
relations. Article 6 of the International Health Regulations requires all states, party to the agreement, to
notify the WHO within 24 hours of “all events which may constitute a public health emergency of
international concern within its territory in accordance with the decision instrument, as well as any health
measure implemented in response to those events.” Because reporting of such events can lead other
countries to impose travel and/or trade restrictions, complying with IHR requirements can contravene the
self-interest of the reporting country. Mexico complied despite these disincentives and some
repercussions, a decision which received international recognition and acclaim at a recent summit of
health ministers and WHO officials in Cancun.
Current macroeconomic and fiscal conditions complicate the Government’s response to the A/H1N1
epidemic. In 2009 Mexico will likely experience its sharpest economic contraction since the 1994-1995
peso crisis: the Federal Secretariat of Finance in June projected that GDP will decline 5.7 percent, a sharp
drop from the moderate growth of the past four years. The cause of this contraction is the global financial
crisis, which has occasioned a large drop in demand for Mexico’s exports. Other mechanisms by which
the financial crisis affects Mexico’s economy include lower oil prices, capital flight (and consequent
credit contraction), and a decline in remittances (with resultant reduction in consumer demand). The
economic contraction has contributed to a large projected budget deficit for 2009 (perhaps reaching 2
percent of GDP), which circumscribes the Government’s ability to direct resources toward the A/H1N1
response effort.
Reciprocally, the A/H1N1 epidemic further weakens fiscal and macroeconomic conditions. The
Government estimates that direct public expenditures on its A/H1N1 response have surpassed US$600
million, and the Federal Secretariat of Finance and the Bank expect the macroeconomic impact of the
A/H1N1 epidemic to reach 0.3-0.8 percent of GDP. The A/H1N1 epidemic will affect the overall
economy primarily through: (1) revenues lost due to reduced demand resulting from social distancing
(i.e., closing of businesses and encouraging people to stay at home), particularly in the retail sector and
(2) a severe drop in tourism revenue. In addition to constraining the Government’s ability to respond to
the epidemic, the economic downturn may create conditions that facilitate the spread of the virus. As both
the experience of the first wave of A/H1N1 and the experience of prior epidemics (such as the 1918
Spanish Flu) indicate, poverty may enable the spread of influenza and its health impact. Factors
responsible for this include the absence of basic sanitation, lack of access to health services, and reduced
access to information, among others. Because poverty is expected to increase this year as the economy
contracts, these factors may play a role in the development of the epidemic.
The A/H1N1 epidemic and the economic contraction threaten human development and specifically
health outcomes in Mexico, many of which are already incommensurate with the country’s income
level. While Mexico’s overall Human Development Index—which aggregates measures of life
expectancy, literacy, and income—is close to that of countries with similar levels of GDP per capita,
some outcomes are closer to those of countries much poorer than Mexico. Infant mortality, for example,
is 28 per 1000, above the expected level for a country with Mexico’s US$13,000 GDP per capita (PPP).
In addition, human development outcomes vary across federal entities (31 states and the Federal District):
Mexico’s overall HDI is ranked 52nd in the world; were the state of Chiapas a country, its HDI would be
ranked 107th in the world, while the state of Nuevo Leon would be ranked 43rd. Previous economic
crises in Mexico have caused increased mortality among children and the elderly, largely because both
households and the government reduce investment in health.
Characterized by low public expenditures and high levels of fragmentation, Mexico’s health system is
not ideally positioned to confront the twin challenges of the epidemic and the recession. The
Government spends 2.9 percent of GDP in the health sector, well below the regional average of 3.6
percent for LAC countries. Partly as a consequence of this, more than half of all health expenditures are
out-of-pocket, much more than in Colombia, for example, where out-of-pocket expenditures account for
about seven percent of total expenditures. Social health insurance programs and national health services
operate in parallel with decentralized state-level health service provision; this fragmentation is
problematic because it constrains effective planning and sector-wide coordination.
Epidemiologists expect a second wave of A/H1N1 to affect Mexico beginning in the fall; by then, the
virus may have mutated into a more virulent strain. Influenza flourishes during the winter months; the
virus is currently spreading through the Southern Hemisphere (where it is winter) and will likely return to
the Northern Hemisphere as the seasons change. The genetic fragility of viruses, the current incidence of
A/H1N1 (i.e., the large number of infections among humans and possible epidemics among animals), and
the co-occurrence with the seasonal influenza and other human influenza viruses (e.g. avian influenza
outbreaks among humans in East Asia) make mutation likely, and an A/H1N1 mutant could be more
contagious, more lethal and/or more resistant to treatment. This pattern would be consistent with that of
past influenza pandemics.
This risk of a new epidemic, together with the experience of the first wave, led the Government to
identify two key health policy priorities for the coming months: first, to further improve capacity to
monitor influenza; second, to further improve capacity to control it. The former requires strengthening
SINAVE and involves upgrading information systems and laboratories, including reconstructing the
national reference laboratory (the Institute for Diagnosis and Epidemiological Reference, or InDRE),
training staff, and strengthening data analysis capacity. Strengthening capacity to control epidemic waves
entails building stocks of medicines, vaccines and medical supplies, strengthening the country’s
temperature-controlled supply chain (the cold chain) for medicines and vaccines, and strengthening
intensive-care units. At a presentation at the Second Annual National Health Week on June 16, the
President announced that Mexico would vaccinate more than 10 million people against influenza
A/H1N1.
2. Objectives
The objective of the proposed project is to strengthen the capacity of the Mexican health system to
monitor the spread of influenza viruses and to control epidemic waves. The capacity to monitor the
spread of influenza viruses rests on the robustness of the National Epidemiological Surveillance System,
the improvement of which entails developing SINAVE into a secure intranet, upgrading the national
laboratory network, training staff, and strengthening data analysis. The capacity to control influenza
epidemic waves depends largely on the available stock of medicines, vaccines and medical supplies; it
also depends on the treatment capacity of intensive care units throughout the country. These two
objectives—to improve the capacity of the health system to monitor the spread of influenza viruses and to
improve its ability to control influenza epidemic waves—would form the two components of the
proposed project.
3. Rationale for Bank Involvement
On April 26, at the Bank and IMF spring meetings, the Government requested financial support to
help close the gap between the costs of controlling the first wave of influenza A/H1N1, improving
detection, expanding its response capacity and the budget resources available. In response, the Bank
and the Government reprogrammed US$25 million from the Third Basic Health Care Project to reimburse
expenditures on laboratory equipment and anti-viral medicines and requested grant funding (US$1.7
million) of the Avian and Human Influenza Facility to support state health systems in promoting
preventive behaviors. The proposed project would supplement these resources.
The rationale for Bank support is two-fold. First, Bank involvement would be productive in part
because of the Bank’s two decades of experience in supporting the development of the health sector in
Mexico. Since the preparation of the First Basic Health Care project in the late 1980s, Bank projects have
supported expanding the reach and improving the quality of health services, ensuring the financial
sustainability of social health insurance programs, expanding non-contributory health insurance coverage
of the poor, and developing of institutional capacity in the health sector. In analytic work, too, the Bank
has engaged with the health sector in Mexico; a current analytical and advisory activity assesses the
challenges of fragmentation among social health insurance programs and the national health services
system and explores potential solutions. Health sector-specific support is complemented by operations in
social protection and in education. For example, more recently, the Bank has started to collaborate with
Mexico in strengthening the conditional cash transfer program Oportunidades to, among other objectives,
increase health service utilization among the poor.
Second, the Bank has extensive experience supporting governments across the globe in preparing for
and responding to influenza epidemics, in controlling other infectious diseases, and in strengthening
national epidemiological surveillance systems. Established in 2005, the Global Program on Avian
Influenza has financed 59 projects around the world. The Bank also supported governments in
responding to the SARS epidemic and has worked extensively with governments in Latin America and
the Caribbean on controlling the spread of HIV/AIDS. Two projects in Latin America were devoted
entirely to strengthening national epidemiological surveillance systems: the Bank worked with the
governments of Brazil and Argentina to build laboratory capacity, train surveillance system personnel,
improve information systems, and evaluate the surveillance systems in their respective countries.
4. Description
Component I: Strengthening the capacity to monitor the spread of influenza viruses (US$88 million).
The proposed objective of Component I is to strengthen the capacity of the Mexican health system to
monitor influenza activity. The Project would accomplish this by improving the National Epidemiological
Surveillance System (SINAVE). Specific activities would include: the development of SINAVE into a
secure intranet, the upgrading of the national reference laboratory network, the establishment of a unit
within SINAVE devoted entirely to epidemiologic analysis, the development of research programs that
assess the relevance and deepen the understanding of collected information, and the training of personnel
at all levels of the system in the use of information technology, laboratory procedures and data analysis.
Component II: Strengthening the capacity to control epidemic waves of influenza viruses (US$390.8
million). The proposed objective of Component II is to strengthen the capacity of the Mexican health
system to control influenza epidemic waves. This would be achieved by replenishing and expanding the
health systems strategic reserve of medicines, vaccines and medical supplies, strengthening the capacity
of the country’s cold chain and expanding the treatment capacity of intensive care units in public
hospitals. In particular, the Government plans to expand the stock of vaccines such that it will be able to
vaccinate more than 10 million Mexicans during this fall and winter.
5. Financing
Source:
Borrower
International Bank for Reconstruction and Development
Total
(US$m.)
72.8
480.0
552.8
6. Implementation
Project activities would be coordinated and implemented using organizational structures and staff of
the Federal Secretariat of Health. Relevant organizational structures operate exclusively under the
oversight of the Under-Secretariat for Prevention and Promotion in Health. Within the Under-secretariat,
the National Center for Epidemiological Surveillance and Disease Control (CENAVECE), the National
Center for Child and Adolescent Health (CENSIA) and the Directorate of Operations would have lead
roles, and within CENAVECE, the Adjunct Directorate for Epidemiology (DGAE), the Adjunct
Directorate for Preventive Programs (DGAPP). On fiduciary matters, all units and in particular the
Directorate of Operations would be supported by Nacional Financiera (NAFIN), a public fiduciary agent
with ample experience in supporting the implementation of Bank-financed projects.
The Adjunct Directorate for Epidemiology would serve as the Project Coordination Unit (PCU) and
lead the implementation of component I. Under the supervision of its Adjunct Director serving as the
head of the PCU, the DGAE would ensure that all legal requirements are met, coordinate the preparation
of operational and procurement plans, ensure the seamless cooperation with federal entities under
cooperation agreements, facilitate Project supervision, assess regularly implementation progress, respond
to Project-related external inquiries, and implement component I. On all technical and strategic matters,
the DGAE would seek guidance from a twelve-member advisory committee to be established not later
than 2 months after effectiveness and comprising Directors of other General Directorates and Centers
within the Federal Secretariat of Health as well as the Chairman of the National Commission on Social
Protection in Health and Directors of the National Institute for Public Health and the National
Autonomous University.
In close collaboration with DGAE, the Adjunct Directorate for Preventive Programs (DGAPP) and the
National Center for Child and Adolescent Health (CENSIA) would jointly implement Component II of
the Project. DGAPP would be responsible for carrying out activities to replenish and maintain the
strategic reserve of influenza vaccines, medicines and medical supplies as well as to provide intensive
care units of public hospital with additional equipment. DGAPP and CENSIA would be responsible for
carrying out activities to strengthen the country’s cold chain.
7. Sustainability
Project results are considered sustainable for four main reasons. Proposed Project activities constitute
core elements of the Government’s National Epidemiological Surveillance System Plan 2007-2012, and
its National Health Sector Plan 2007-2012. Key Project Outcomes are reinforced by related Bank
operations and complemented by Government efforts – supported by various development partners - to
improve animal disease prevention and control. Proposed activities enjoy support by a wide range of
sector stakeholder as they serve not only to monitor the spread of A/H1N1 and mitigate the effects of
future waves but also to strengthen Mexico’s health systems. Finally, proposed Project activities, Bank
efforts to strengthen additional pillars of influenza epidemic preparedness, and the national plans of which
these efforts form a part, all support objectives of Mexico’s National Development Plan 2007-2012.
The Project would accelerate the implementation of influenza epidemic preparedness activities outlined
in the Government’s National Epidemiological Surveillance System Plan 2007-2012 and in its
National Health Sector Program 2007-2012, focusing on improving epidemiological surveillance and
building stocks of medicines and vaccines. Conceived at the outset of the current administration, the
Government’s five-year plans for SINAVE and for the health sector emphasize the need for strengthening
preparedness for disease epidemics. The Project would support all of the seven action areas identified in
the SINAVE plan; it would also support five of the ten strategies outlined in the Health Sector Program.
The elements of the Health Sector Program most directly supported by the Project include: “strengthen
the prevention of acute respiratory diseases in childhood,” “reduce the incidence of preventable diseases
through vaccination,” “mitigate the effects of epidemiological emergencies,” “consolidate a unified
system of statistical and epidemiological information for public health decision-making,” and “improve
infrastructure essential to the prevention and control of diseases,” among others. The Project would
ensure that critical activities would be implemented in time to prepare for a possible second wave of
influenza A/H1N1 and help that the SINAVE Plan and the National Health Sector Program would be
successfully completed by 2012 (the last year of the administration and also the close of the loan).
Health service response capacity and other pillars of influenza epidemic preparedness (that is, those
pillars not directly supported by the project) are reinforced by related Bank operations; Project
activities would not be executed in a vacuum, but rather as part of a comprehensive plan to strengthen
the capacity of the Mexican health system to respond to the A/H1N1 challenge. The Bank’s loan
supporting the Third Basic Health Care Project helps the government achieve the objective of
strengthening health service capacity, expanding access to and raising the quality of health services for 22
million (mostly poor) Mexicans. In addition, the Bank’s new loan (under preparation) to support
Mexico’s social protection system in health will assist the Government’s effort to ensure universal access
to quality health services, especially during the economic crisis. A grant approved by the Avian and
Human Influenza Facility with the grant agreement shortly to be signed will reinforce the prevention
pillar of preparedness by strengthening the communication campaigns of federal entities . The grant
would ensure the successful production and dissemination of messages on influenza-related behavior
change, providing for the communication of those messages to public and in particular to hard-to-reach
groups such as indigenous populations. Together, these related activities would enhance the potential
impact of the project.
In addition to these measures directed toward improving human health (that is, the Project activities
themselves and supporting activities financed through related operations), the Government is working
with other partners to strengthen the prevention and animal health pillars of A/H1N1 control.
Mexico’s Federal Secretariat of Agriculture and National Agency for Hygiene and Food Quality work
together to monitor animal health, collecting and analyzing samples from farms, butchers, packaging
centers, and markets. The National Commission Against Public Health Risks investigates and acts on
laboratory results. These entities work together with international organizations under a multi-sector plan
for animal disease surveillance. The Food and Agriculture Organization (FAO) of the United Nations has
been closely supporting the Secretariat of Agriculture and the National Commission Against Public
Health Risks in the surveillance of influenza among birds and swine in Mexico since the onset of the
epidemic. The Organization for Animal Health is also working with the Government to strengthen
influenza surveillance and control programs in accordance to international experiences and standards.
Proposed Project activities would serve not only to monitor the spread of A/H1N1 and mitigate the
effects of a potential second wave of A/H1N1 influenza but also to strengthen Mexico’s health system.
Neither epidemiologic surveillance nor epidemic response capacities are disease-specific; the investments
supported in the proposed project would enable Mexico to better control other infectious diseases. Nor
are the benefits limited to infectious disease: in allowing the Government to obtain real-time information
on the country’s epidemiologic profile, improving surveillance systems would provide critical knowledge
for addressing infant and maternal mortality, chronic illness, and numerous other health challenges.
The Project activities, the Bank efforts to strengthen other pillars of influenza epidemic preparedness,
and the national plans of which these efforts form a part, all support objectives of Mexico’s National
Development Plan (NDP) 2007-2012. One of the five central axes of the NDP is “equality of
opportunities,” in which one of eight action areas is health. Among the goals articulated in the health
chapter are: “to strengthen programs of protection against public health risks,” “integrate disease
prevention activities across sectors,” “to ensure the availability of human resources, equipment,
infrastructure and technology sufficient to meet the health needs of the population,” “promote health
research,” and “to guarantee effective protection against epidemiologic threats.” Project activities would
advance all of these objectives. In particular, the upgrading of information technology systems within
SINAVE would support “integrat[ion] of disease prevention activities across sectors,” in that these
systems would gather data from and disseminate data to government officials outside the health sector.
The training of personnel, building of infrastructure, establishment of a central unit for epidemiological
analysis, strengthening of SINAVE, and building of stocks of medicines and vaccines would all support
the NDP health objectives.
8.
Lessons Learned from Related Bank Operations
One lesson that has emerged from projects addressing Avian Influenza is that a clear, well-designed
national strategy for preparedness and response to influenza is essential, as is ensuring that all
relevant actors understand the strategy. While many countries had an influenza strategy document, many
of them were underdeveloped or unfamiliar to key officials. The project design assimilates this lesson by
ensuring that project activities correspond, where possible, to actions laid out in Mexico’s National Plan
for Preparedness and Response to an Influenza Pandemic. This plan, developed as it was with the
participation of representatives from numerous government agencies and with guidance from WHO, is
already familiar to most relevant actors and is more complete than that of any other LAC country except
Chile. The Project would reinforce these strengths, facilitating further dissemination, use, and
improvement of the plan. It would also enhance the flexibility built in to the plan, the importance of
which was highlighted at a recent summit of health ministers and WHO officials in Cancun.
From past projects focused on strengthening epidemiologic surveillance, we have learned that
ensuring the cooperation and compliance of sub-national actors is complicated and difficult.
Epidemiologic surveillance projects in Brazil and Argentina, for example, struggled to ensure timely
execution of procurement and other activities at the state and district levels. Given the public health
emergency, the design of this project incorporates this lesson by centralizing the execution of activities to
the extent possible.. As described in detail in the “Implementation” section, the central office of the
Federal Secretariat of Health will execute all project activities. As for complementary activities (outside
the scope of the project) that do require action at various levels of government, the Federal Secretariat of
Health would sign coordination agreements with each state. Moreover, the Project would improve
coordination capacity by streamlining information-flow processes, upgrading communication technology,
and training personnel at all levels.
The experience of related projects also emphasizes the importance of planning evaluation efforts ahead
of time. Without prior planning, ICRs caution, it is impossible to obtain the detailed information
necessary for assessing response to a disease epidemic. Even such basic data as sequencing of
Government response activities, direct expenditure on epidemic response, and organization of
implementation among various agencies can be difficult to recover after the fact. The present project
responds to this lesson by supporting the Government’s effort to contract and coordinate evaluation
activities well in advance, during project preparation. The Government will arrange for several separate
evaluations: one of its response to the first wave of A/H1N1 influenza, a second of the epidemiologic
surveillance system in general, and a third of its response to a second wave of A/H1N1 (should it occur).
9. Safeguard Policies (including public consultation)
Safeguard Policies Triggered by the Project
Environmental Assessment (OP/BP 4.01)
Natural Habitats (OP/BP 4.04)
Pest Management (OP 4.09)
Physical Cultural Resources (OP/BP 4.11)
Involuntary Resettlement (OP/BP 4.12)
Indigenous Peoples (OP/BP 4.10)
Forests (OP/BP 4.36)
Safety of Dams (OP/BP 4.37)
Projects in Disputed Areas (OP/BP 7.60)*
Projects on International Waterways (OP/BP 7.50)
*
Yes
[X]
[]
[]
[]
[]
[X ]
[]
[]
[]
[]
No
[ ]
[X]
[X]
[X]
[X]
[ ]
[X]
[X]
[X]
[X]
By supporting the proposed project, the Bank does not intend to prejudice the final determination of the parties' claims on the
disputed areas
Environment
The proposed Project has potentially adverse environmental impacts that suggest its classification
as category B; accordingly it would trigger the Bank’s environmental safeguard policy (OP 4.01).
The proposed upgrading of the national laboratory network will include the construction and equipping of
the national reference laboratory, the refurbishing of state laboratories and increases in bio-security levels
requiring enhanced capacities to handle bio-hazardous materials and waste. The proposed replenishment
and maintenance of the strategic reserve would require ensuring the adequate disposal of bio-medical
waste, i.e. expired medicines, vaccines as well as medical waste resulting from vaccination efforts in
health facilities. Federal legislation provides appropriate guidance on bio-medical waste management;
however, implementation is weak and needs to be improved.
The Project would use assessment instruments and other measures to avoid or mitigate any adverse
environmental impacts. The Government conducted a comprehensive environmental impact assessment
in preparation for the construction of the national reference laboratory. It assessed not only site-specific
impacts but also those of bio-hazardous material the laboratory will handle. The assessment is being
reviewed to verify compliance with Bank safeguard policies. An Environmental Management Framework
taking into account eventual refurbishing measures and risk factors associated with increased bio-security
capacities would be incorporated in the Operational Manual to provide guidance to states as they upgrade
laboratories. Building on efforts carried out in support of the Third Basic Health Care project, the
Government would continue reinforcing the appropriate disposal of medicines and vaccines through
capacity building measures, for example, ongoing initiatives such as the Program for the Collection and
Final Disposal of Expired Medicines carried out by federal entities with the support of the Federal
Commission for the Protection Against Sanitary Risks.
Social
The proposed Project is expected to have a positive social impact and, specifically, to improve the
Government’s capacity to protect the poorest populations from avoidable morbidity and mortality from
A/H1N1 influenza, including the indigenous population. The experience of prior epidemics (such as the
1918 Spanish Flu) and the first wave of A/H1N1 in Mexico indicate that poverty may enable the spread of
influenza A. Factors responsible for this include, among others, the absence of basic sanitation, lack of
access to health services, and reduced access to information. The proposed Project would address this
challenge by strengthening SINAVE to better target interventions and strengthening the health system’s
capacity to respond to emergencies.
Focusing on capacity building, the proposed Project activities would benefit the Mexican population as
a whole rather than any particular social group, yet, the indigenous peoples social safeguard policy
(OP/BP 4.10) would be triggered and an Indigenous Peoples Plan (IPP) prepared during supervision
(as provided for by OP/BP8.00) to ensure that Indigenous People are enabled to benefit from the
Project in an culturally appropriate manner. Preliminary analyses suggest that the IPP, in accordance
with consultations on a draft that are scheduled for September 2009, would include the following key
elements and would specify required budget allocations and roles and responsibilities of the different
units and divisions in the Federal Secretariat of Health and federal entities in carrying out the action plan.
The action plan would be prepared to be submitted for Bank approval not later than December 31, 2009.
(1) The Center for the Development of Indigenous Communities would participate as a member of the
National Commission for Epidemiological Surveillance providing guidance in the design of culturally
appropriate activities and policies. (2) Strengthening of elements of the SINAVE would include the
disaggregation of data by gender and ethnicity to facilitate the design of policies and activities for these
population groups. (3) Federal entities would develop and implement disease prevention and health
promotion strategies that are culturally appropriate for indigenous and would be disseminated, among
other platforms, by Oportunidades health promoters. (4) In line with general vaccination policies, the
preparation of a national influenza A/H1N1 vaccination plans would give specific attention to indigenous
communities. (5) Strengthening and expanding the country’s cold chain would give priority to
disadvantaged federal entities and administrative health units (jurisdicciones) with particular attention to
federal entities with a high percentage of indigenous peoples among their population.
The Project would not require any resettlements and therefore would not trigger the Bank’s
involuntary resettlement safeguard policy (OP/BP 4.12). The financing of constructions would be
limited to the national reference laboratory, which will be constructed on the site of a recently demolished
hospital. The land is property of the government. A site visit confirmed that there are no resettlement
concerns.
10. List of Factual Technical Documents
- DGE, 2006. Plan Nacional de Preparación y Respuesta ante una Pandemia de Influenza.
- Federal Secretariat of Health, Boletines de Prensa -Secretaría de Salud, México. Available at:
http://portal.salud.gob.mx/contenidos/sala_prensa/sala_prensa_prensa/sala_prensa_boletines.html
[Accessed June 26, 2009].
- Federal Secretariat of Health, 2007. Caminando a la excelencia - Evaluación 2007.
- Federal Secretariat of Health, 2009. Defunciones: Descripción Preliminar.
- Federal Secretariat of Health, 2007a. Programa de Acción Especifico 2007-2012 - Sistema Nacional de
Vigilancia Epidemiologica.
- Federal Secretariat of Health, 2007b. Programa Sectorial de Salud 2007-2012 - Por un México
sano:construyendo alianzas para una mejor salud.
- Federal Secretariat of Health, 2009. Se exhorta a la población a tomar medidas para evitar contagio de
influenza estacional (Comunicado de Prensa No. 126).
- Federal Secretariat of Health, 2005. Sistema de Protección Social en Salud. Elementos conceptuales,
financieros y operativos.
- Federal Secretariat of Health. 2009. Draft Environment Impact Assessment
- Federal Secretariat of Health. 2009. Draft Indigenous People Plan
- Kuri-Morales, P., 2008. Influenza Pandemica: Posibles Escenarios en Mexico. CENAVECE.
- Presidencia, 2009. DECRETO por el que se ordenan diversas acciones en materia de salubridad
general, para prevenir, controlar y combatir
la existencia y transmisión del virus de influenza estacional epidémica.
- World Bank, 2008, Country Partnership Strategy, Washington D.C., The World Bank - (Report No.
42864-MX).
- World Bank, 2004. Disease Surveillance and Control Project (VIGISUS I) - Washington D.C. - The
World Bank - (Implementation Completion Report: Report No. 29779).
- World Bank, 2009c. Influenza Prevention and Control Project – Washington, D.C. - Draft Emergency
Project Paper. The World Bank.
- World Bank, 2008. Mexico Health: Towards greater equality and efficiency through functional
integration - Concept Note . The World Bank.
- World Bank, 2009a. Mexico: Economic Impact of A H1N1 Flu—Issues and Uncertainty.
- World Bank, 2009b. Support to Oportunidades Project - Washington D.C. - The World Bank - (Project
Appraisal Document; Report No. 46821-MX).
- World Bank, 2001. Third Basic Health Care Project (PROCEDES) - Washington D.C. - The World
Bank - (Project Appraisal Document; Report No. 22186-ME).
11. Contact point
Contact: Christoph Kurowski
Title: Sector Leader
Tel: 5782+4263 / 52-55-5482-4263
Fax: 52-55-5482-4222
Email: [email protected]
Location: Mexico City, Mexico (IBRD)
12. For more information contact:
The InfoShop
The World Bank
1818 H Street, NW
Washington, D.C. 20433
Telephone: (202) 458-4500
Fax: (202) 522-1500
Email: [email protected]
Web: http://www.worldbank.org/infoshop