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PROJECT INFORMATION DOCUMENT (PID)
APPRAISAL STAGE
Project Name
Region
Sector
Project ID
Borrower(s)
Report No.: AB4022
AVIAN INFLUENZA CONTROL AND HUMAN INFLUENZA
EMERGENCY PREPARDNESS AND CONTROL
LATIN AMERICA AND CARIBBEAN
Agricultural extension and research (70%);Health (30%)
P111667
GOVERNMENT OF THE REPUBLIC OF HAITI
Republic of Haiti
Haiti
Ministry of Economy and Finance
Palais des Ministeres
Haiti
Fax: 509-222-4222
Implementing Agency
Ministry of Agriculture, Natural Resources and Rural
Development
Haiti
Environment Category
Date PID Prepared
Date of Appraisal
Authorization
Date of Board Approval
[ ] A [X] B [ ] C [ ] FI [ ] TBD (to be determined)
July 14, 2008
June 5, 2008
July 14, 2008
1. Country and Sector Background
Country context
The population of Haiti is estimated at about 9.5 million, with an annual growth rate of 1.6%.
Haiti is the poorest country in the Western Hemisphere, and one of the most disadvantaged in the
world, with 78% of the population living below the poverty line (US $2/day)1. With an infant
mortality rate of 75 per 1000 births, 47% illiteracy, and the highest incidence of HIV/AIDS
outside Sub-Saharan Africa, Haiti ranks 146th of 177 countries in the United Nations 2007
Human Development Index.
There are approximately 5 million poultry in Haiti of which only 20% is owned by commercial
enterprises that serve the larger urban populations in the major cities (Port au Prince, Cap
Haitian, Gonaive, Les Cayes and Jacmel). The remaining 80% is owned by subsistence farmers
for family consumption and sale on local markets. The Ministry of Agriculture, Natural
Resources and Rural Development’s (MARNDR) Directorate of Animal Health (Direction de la
Santé Animale – DSE), that includes the National Veterinary Laboratory at Tamarinier (LNVT),
has limited prevention, surveillance and response capacity due to the dearth of facilities. It also
suffers from a shortage of veterinarians.
1
EIU (Economist Intelligence Unit): Country Profile 2007
The H5H2 virus was detected in December 2007 in the Dominican Republic that shares the
Hispaniola island territory with Haiti2. A ban on poultry products is in effect, but has had little
impact on the flow of imports, as the border is extremely porous. It has been reported that the
virus may have been entered Haiti through cocks that are transported from corner of the island to
another to cater to the needs of cock fight organizers and fans. Cock fighting is not an illicit
activity and is extremely popular on both sides of the island.
Relevant sector-specific needs and priorities
Existing GoH programs for animal health fall short of the immediate needs for emergency,
preparedness and control of avian influenza, not only in terms of quarantine, laboratory facilities
and epidemiologic surveillance, but also in terms of communications. The project would permit
the needed expansion of the ongoing capacity building program financed under the Avian and
Human Influenza Facility (AHIF) (see para11 below), and improve the required communications
and emergency activities that are not yet covered.
Concerning human health, expenditures in Haiti are among the lowest Latin America, and the
sector is characterized by insufficient health workers, essential drugs, and equipment. Most
hospitals have insufficient isolation rooms and equipment for patients with severe respiratory
diseases. The constraints in the health sector are mirrored in the National Center for Laboratory
and Epidemiology (NCLE), which lacks sufficient human and financial resources and
operational facilities.
Avian influenza response
The global response to the threat of AHI in humans and domestic poultry, under the umbrella of
Global Program for Avian Influenza (GPAI) of which Haiti is party, is guided by strategies
developed by the World Health Organization (WHO), the Food and Agriculture Organization
(FAO), and the World Organization for Animal Health (OIE). The program consists of four key
strategies: (i) progressively controlling and eradicating the virus’ spread among animals, thus
lowering the animal-origin virus load in the environment and reducing the risk of human
infection; (ii) preventing and limiting the virus among humans, thereby reducing the opportunity
for human transmissibility; (iii) helping affected populations cope in the event of a pandemic;
and (iv) minimizing AHI’s social and economic impact. AHI prevention and control involves
multiple actors in the fields of health, agriculture, natural disaster response, finance and
planning, and thus requires a multi-sectoral approach. It is also recognized that individual
countries are central to a coordinated and effective global response. Country strategies should be
developed in accordance with country-specific needs and circumstances, and the strategies
should be owned by the individual governments facing the threat of AHI.
Under the GPAI, the GoH prepared an integrated National Avian Influenza Control and
Pandemic Preparedness Plan (the National Plan) covering the period 2006-2010. This National
The Dominican Republic has a population slightly higher than Haiti’s (9.5 millions vs. 8.5 million) but its land
territory is almost twice that of Haiti (29,000 km2 vs. 50,000 km2), i.e., its average population density is half what it
is in Haiti.
2
Plan is fully consistent with, and draws heavily upon, the global strategies developed by
FAO/OIE and WHO-PAHO, and provides the basis for the program that the World Bank and
other donors can support. This National Plan calls for the following lines of action: (i)
development of a disease free avian management system; (ii) disease surveillance and response
during outbreaks; (iii) laboratory analysis and curative care; (iv) health education and community
action; and (v) strengthening of institutional and legal frameworks.
The regional dimensions
Like all contagious disease, avian influenza crosses borders easily. A case in point is between
the Dominican Republic and Haiti since they share the Hispaniola island space. The border
between the two countries is particularly porous and there is very little in term of sanitary
controls at national borders. At this juncture there is a high probability that the H5N2 avian
influenza virus discovered in the Dominican Republic in December 2007 would already have
crossed the border to Haiti, even though its presence is yet to be confirmed officially in the latter.
One additional factor that may explain why the virus is likely to have crossed over the Haiti is
that it is propagated by fight cocks that move from one corner of the island to the other rapidly
and unchecked. The regional aspects of avian influenza need to be emphasized. The virus will
not be eradicated on the island of Hispaniola in the absence of control and mitigation measures
taken at binational level and close coordination between the two countries. Although the
proposed project does not address binational issues, it would be implemented in close
coordination with the FAO Technical Cooperation Project (TCP) (see para12 below) that will
focus on the entire island. Coordination between Dominican and Haitian technicians already
exists. An example is a workshop organized in April 2008 by the World Bank in the Dominican
Republic on the theme of avian influenza that include the participation of a Haiti delegation in
video conference.
2. Objectives
The proposed project development objective (PDO) is to support the GoH National Plan, which
aims to minimize the threat posed to humans by highly-pathogenic avian influenza (HPAI)
infection and other zoonoses and to prepare for, control, and respond to influenza pandemics and
other infectious disease emergencies in humans. The key indicator will be the percentage of
communal sections (655 in the entire country) that remain free of confirmed AHI infection.
Intermediary indicators will be measured to assess progress in the achievement of this overall
indicator, two of them being respectively (I) the time taken to report avian influenza outbreaks at
the local level in a representative sample of communal sections; and (ii) the number of backyard
poultry farmers currently applying at least three prescriptions to protect their poultry and/or family from
AI
3. Rationale for Bank Involvement
A key justification for World Bank involvement is the global public goods aspect of controlling
AHI, one of many emerging and re-emerging zoonoses. There is also a national public goods
perspective for countries to strengthen their veterinary services, disease surveillance, and human
health system as planned in this operation. The social and economic impacts of the threat of AHI
are extensive. AHI control programs require a multi-disciplinary approach to integrate the
technical, social, economic, political, policy, and regulatory issues that must be addressed in a
coordinated response. The technical assistance provided by the World Bank has been important
in similar global or regional emergency situations such as SARS, and post-disaster
reconstruction. The World Bank has a comparative advantage in providing integrator skills and
multi-sect oral perspectives and in addressing the institutional dimensions of the response to such
emergencies. This is especially the case in Haiti where the Bank has traditionally been agile in
responding to emergencies and has often assumed a leadership role in donor coordination on that
front. In collaboration with the donor community, the Bank has developed a substantial disaster
mitigation and management and post-conflict portfolio, and recently has responded swiftly to the
food crisis that has affected the country. On the avian influenza front, the Bank has spearheaded
support to GoH and assumed the lead donor coordination role as part of the preparation of the
AHIF program.
4. Description
IDA financing under the proposed project would support the implementation of the GoH’s
National Plan as a complement to the AHIF program currently underway and other possible
donor support. Project components have been designed to mirror the strategies and actions
identified in the National Plan. Projects components and financing would be as follows:
Table 1: Summary Project Costs
Component / Sub-Component
1. Animal Health
1.1 Pilot community activities
1.2 Emergency actions
1.3 Capacity building for prevention and response
2. Public health
3. Communication
4. Administration
5. Un-allocated
TOTAL
Costs (US$)
760,000
300,000
150,000
310,000
212,500
379,000
130,000
75,500
1,557,000
 Component 1: Animal health (US$ 760,000)
Component 1 would support investigation, surveillance, prevention, and preparedness for any
Avian Influenza (AI) outbreak. Activities to reduce the risk of AI infection in peasant and
commercial poultry production, as well as commercial fight cock activities would be supported,
as are those to increase the capacity for laboratory diagnosis and early detection and response
(including improving the national information system) at the field level.
Specifically, Component 1 would (i) provide the required knowledge on the status of AI in Haiti;
(ii) strengthen facilities for early detection and mitigation of the potential impacts of AI,
predominantly quarantine facilities; and (iii) test sanitary measures in the context of peasant
poultry production. Component 1 would have national coverage and be implemented in two
years through three sub-components: (i) Sub-component 1.1: Pilot community actions through
Groupements Santé Bêtes (GSBs); (ii) Sub-component 1.2: Emergency actions; (iii) SubComponent 1.3: Institutional capacity building (MARNDR).
 Component 2: Human health (US$ 212,500)
Component 2 would support AHI prevention and mitigation activities at the national level,
through capacity building and epidemiologic surveillance in the human health sector, and
through the establishment of a mechanism for responding in the event of an outbreak. It would
involve implementing the WHO/PAHO-recommended strategic measures for preparedness
regarding potential avian influenza outbreaks, and avoid or diminish transmission to humans if it
were to occur. Activities include capacity building of health staff to improve the surveillance
system and integration of routine surveillance systems and data. Simulations to assess the state
of implementation and effectiveness of public health measures would also be covered as well as
information campaigns to increase the general level of knowledge of public health staff and the
population at large. The component would aim at strengthening the capacity of MSPP staff to
undertake preventive and mitigation measures, effectively enabling them to be on proactive
surveillance mode and adequate readiness state in case of an avian influenza outbreak. This
would be achieved through appropriate training sessions and workshops.
 Component 3: Communications (US$ 379,000)
The objectives of Component 3 are to: (i) raise public awareness on the topic of AHI with a
focus on vulnerable groups; (ii) secure political and civil society support; and (iii) prepare
institutions for increased demand for advice, products and services, in the animal and human
health sectors in case of an avian influenza outbreak. It would seek to promote behavioral
change to control the spread of the virus, prevent infection, strengthen surveillance, adopt biosafety procedures and reporting mechanisms, and highlight the required investments in
infrastructure and institutional reforms. It would select and train spokespersons to provide
timely and accurate information, channel incentives and compensation mechanisms, and promote
a coordinated and coherent multisectoral response if and when the AF virus would appear. The
component would seek synergies with established and credible rural community programs run by
NGOs and other groups.
 Component 4: Project administration (US$ 130,000)3
This component would cover the administration of grant activities including procurement and
disbursement services provided by the fiduciary agency. It will also cover the audit of the
project costs.
5. Financing
Source:
BORROWER/RECIPIENT
IDA Grant
Total
3
($m.)
0
1.56
1.56
Monitoring and Evaluation activities are not included here. They would be built into Components 1, 2 and 3
individually.
6. Implementation
MARNDR would have overall project oversight and would be vested with coordination of
project implementation. This ministry would also be directly responsible for implementation of
Component 1 (animal health). MSPP would be responsible for implementing Component 2
(human health). Component 3 (communications) would be implemented collaboratively by the
MARNDR, MSPP, the Ministry of Information and Culture (MIC), and mass organizations (i.e.,
youth, women, and trade unions).
7. Sustainability
Strong political support and leadership, an adequate flow of financial resources and the
continuous ownership by the various stakeholders would be critical to project sustainability.
Government has demonstrated a very strong commitment to H5N2 control and preparedness.
The establishment of the National Commission for Avian and Human Influenza is testimony of
the GoH strong support for a national multi-sectoral response. Ownership by all stakeholders
would be ensured by: (i) strengthening of programs to maintain public awareness of the threat of
H5N2 and other rapidly spreading infectious diseases; and (ii) sustained surveillance and
prevention and control activities, particularly in high-risk regions.
8. Lessons Learned from Past Operations in the Country/Sector
Lessons of the Avian and Human Pathogenic Influenzas World Bank Operational Response
portfolio includes a number of operations in other regions (in South East Asia and Europe) that
have been taken into account in designing this operation. Recent experiences of avian flu
projects in the LCR region were also taken into account in designing monitoring and evaluation
of this project.
Donor strategy and programs
The proposed project follows and complements the on-going AHI Prevention and Control
Program financed under the Global AHI Facility (grant of $1.0 million signed in March 2008).
This program was developed in close liaison with international and bilateral institutions that are
active on the AHI front and/or broader disease prevention and control in Haiti, as well as the
Dominican Republic and the entire Caribbean region. Close coordination has been maintained
with these institutions throughout preparation of the proposed project; it would continue to be
maintained during implementation. These institutions and their respective programs are as
described below.

FAO is administering the regional AHI program (TCP/RLA/3103) for the Caribbean
and has approved a bi-national Technical Cooperation Program (TCP) for AHI
covering the entire Hispaniola Island ($1.0 million of which $500,000 is allocated for
Haiti). The FAO Investment Center (Cooperative Program with the Bank) fielded a
special mission in April 2007 in support of the development of the program funded by
the Global AHI facility. It also contributed to the preparation of the current project.





The Inter-American Institute of Cooperation for Agriculture (IICA) is providing
technical assistance to MARNDR as part of the APHIS/USDA-funded classic swine
pest eradication program.
WHO-PAHO is providing support to the Ministry of Public Health and Population
(MSPP) which involves in particular cooperation with the sanitary protection services
so that samples can be sent to the Center for Control of Infectious Diseases (CCID)
which is the international reference for AHI diagnosis.
USAID provided financial support in the amount of $100,000 to the GoH to get the
AHI program off the ground in 2006-2007.
The French cooperation is providing technical assistance, and related training, for
epidemiologic surveillance, including assistance to establish the required information
system; Haitian laboratory facilities will be included in Ciardi’s regional network.
The Cuban cooperation has a team of veterinarians supporting MARNDR, and is
providing training in Cuba for Haitian veterinarians.
9. Safeguard Policies (including public consultation)
The project is not expected to have any large-scale, significant and/or irreversible impacts as its
activities focus largely on public sector capacity building and ensuring readiness for preventing
or reducing possible large infections of poultry. This will be achieved by strengthening
emergency preparedness and response to outbreaks of H5N2 in both back-yard poultry and
industrial poultry units. The project design incorporates other beneficial measures such as
improved bio-security in farms and live markets, and control of poultry movement within and
across countries (particularly at the bi-national level with the Dominican Republic. The project
activities aim at improving the effectiveness and safety over the existing AHI practices and will
have positive environmental impacts. Among the Bank's safeguards policies, only the policy on
Environmental Assessment is triggered. The project design incorporates the necessary
mitigation measures for the potential adverse impacts associated with the activities involved in
responding to AI outbreaks. A draft Environmental Management Plan (EMP) has been prepared
and will be finalized during project implementation. The EMP will be disclosed in Haiti and
Washington D.C. (InfoShop) after consultation with various Government agencies, the
commercial poultry associations, mass organizations, and NGOs. The Financing Agreement will
reflect implementation of the EMP.
10. List of Factual Technical Documents
1. Enhancing control of highly pathogenic avian influenza in developing countries through
compensation: issues and good practice. ARD, The World Bank. 2006. 85 pages.
2. Dominican Republic, South-south cooperation in action: responding to avian influenza. En
Breve number 124. May 2008.
11. Contact point
Indira J. Ekanayake, TTL
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