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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