Document of The World Bank FOR OFFICIAL USE ONLY EMERGENCY PROJECT PAPER ON A PROPOSED CREDIT

Transcription

1 Document of The World Bank FOR OFFICIAL USE ONLY Report No UG EMERGENCY PROJECT PAPER ON A PROPOSED CREDIT IN THE AMOUNT OF SDR 6.20 MILLION (US$10 MILLION EQUIVALENT) TO THE REPUBLIC OF UGANDA FOR THE AVIAN AND HUMAN INFLUENZA PREPAREDNESS AND RESPONSE PROJECT UNDER THE GLOBAL PROGRAM FOR AVIAN INFLUENZA CONTROL AND HUMAN PANDEMIC PREPAREDNESS AND RESPONSE MAY 28, 2008 Agriculture and Rural Development Sustainable Development Department Eastern Africa Country Cluster 1 Africa Region This document has a restricted distribution and may be used by recipients only in the performance of their official duties. Its contents may not otherwise be disclosed without World Bank authorization.

2 ABBREVIATIONS AND ACRONYMS CURRENCY EQUIVALENTS (Exchange Rate Effective April 30, 2008) Currency Unit = Uganda Shilling US$ 1 = USh 1,705 SDR 1 = US$ FISCAL YEAR July 1 June 30 AHI Avian and Human Influenza AHIP Avian and Human Influenza Preparedness and Response Project AI Avian Influenza AHITF Avian and Human Influenza Trust Fund APL Adaptable Program Loan AU-IBAR African Union / Inter-African Bureau for Animal Resources BL Bio-security Level BSL-3 Bio-Safety Level CAO Chief Administrative Officer CAS Country Assistance Strategy CBPP Contagious Bovine Pleuropneumonia CBSS Community-Based Surveillance System CDC Centre for Disease Control CFP Communication Focal Point CHS/CH Commissioner for Health Services/Community Health Department CWG Communication Working Group DANIDA Danish International Development Agency DAR Directorate of Animal Resources DDHS District Department of Health Services DDMC District Disaster Management Committee DFID Department for International Development DHO District Health Officer DLH&E Department of Livestock Health and Entomology DMT Disaster Management Team DOs Development Objectives DPs Development Partners DVO District Veterinary Officer EAC Eastern African Community EC/EU European Commission/European Union ESD Epidemiology and Surveillance Division ERC Emergency Recovery Credit FAO Food and Agriculture Organization FAQs Frequently Asked Questions FVM Faculty of Veterinary Medicine, Makerere University, Kampala MUK Makerere University GOU Government of Uganda

3 GPAI HPAI IBAR IDA IDSR ICS ICRC IEC IGAD ILRI INAP KAP LCs LIRI LPAI MAAIF M&E MFPED MOH MOLG MOU MTTI MUWR NAADS NARO ND NDA NGO NIC NIMES NLPIP NPA NPSC NTF/AI NVS OIE OPM PACE PEAP PCR P&P PPPH PARC PAU PCT PDS PHS Global Program for Avian Influenza Control and Human Pandemic Preparedness and Response Highly Pathogenic Avian Influenza Inter-African Bureau of Animal Resources International Development Association Integrated Disease Surveillance & Response Incident Command System International Committee of Red Cross and Red Crescent Information Education Communication Intergovernmental Authority on Development International Livestock Research Institute Integrated National Action Plan. Knowledge Attitude Practice Local Councils Livestock Research Institute Low Pathogenic Avian Influenza Ministry of Agriculture, Animal Industry and Fisheries Monitoring and Evaluation Ministry of Finance, Planning and Economic Development Ministry of Health Ministry of Local Government Memorandum of Understanding Ministry of Tourism, Trade and Industry Makerere University Walter Reed National Agricultural Advisory Services National Agricultural Research Organization Newcastle Disease National Drug Authority Non Governmental Organization National Influenza Centre National Implementation, Monitoring and Evaluation System National Livestock Productivity Improvement Project National Plan of Action National Project Steering Committee National Task Force on Avian Influenza National Veterinary Services World Organization for Animal Health Office of the Prime Minister Pan African Control of Epizootics Poverty Eradication Action Plan Polymerase Chain Reaction Prevention and Preparedness Public Private Partnership for Health Pan African Rinderpest Campaign Poultry Association of Uganda Project Coordination Team Participatory Disease Surveillance Public Health Service

4 PPE Personal Protective Equipment PPP Public Private Partnership PPR Peste des Petites Ruminants PS Permanent Secretary PIM Project Implementation Manual PVS Performance, Vision and Strategy (OIE evaluation system) Q&As Questions and Answers R&R Response and Recovery RCC Response Command Center RP Rinderpest RRT Rapid Response Team RT-PCR Real Time Polymerase Chain Reaction SOP Standard Operating Procedures TAD Transboundary Animal Disease TOT Training of Trainers TWG Technical Working Group UK United Kingdom UN United Nations UNICEF United Nations Children s Fund UPHOLD Uganda Program for Human and Holistic Development URA Uganda Revenue Authority USAID United States Agency for International Development USDA United States Department of Agriculture USD United States Dollars UShs Ugandan Shillings UVRI Uganda Virus Research Institute UWA Uganda Wildlife Authority UWEC Uganda Wildlife Education Centre VPH Veterinary Public Health WAHIS World Animal Health Information System WB World Bank WHO World Health Organization Vice President: Obiageli K. Ezekwesili Country Director: John M. McIntire Sector Manager: Karen M. Brooks Task Team Leader: Wilson. O. Odwongo

5 FOR OFFICIAL USE ONLY REPUBLIC OF UGANDA AVIAN AND HUMAN INFLUENZA PREPAREDNESS AND RESPONSE PROJECT TABLE OF CONTENTS A. Introduction... 1 B. Emergency Challenge: Country Context and Rationale for Proposed Bank Emergency Project... 2 Country Context... 2 Rationale for Bank Involvement... 3 C. Bank Response and Strategy: The Project... 4 Brief description of Bank s strategy of emergency support... 4 Project Development Objectives... 4 Summary of Project Components... 5 Eligibility for Processing under OP/BP Consistency with Country Assistance Strategy (CAS)... 9 Expected Outcomes... 9 Monitoring and Evaluation of Outcomes/Results D. Appraisal of Project Activities, Benefits and Risks Economic and Financial Analysis Technical Institutional Fiduciary Social Environmental Safeguard Policies Policy Exceptions and Readiness E. Implementation Arrangements and Financing Plan Institutional and Implementation Arrangements Project Costs and Financing Plan Financial Management and Disbursement Arrangements Procurement Arrangements Bank Supervision F. Project Risks and Mitigating Measures G. Terms and Conditions for Project Financing ANNEXES Annex 1: Detailed Description of Project Components Annex 2: Results Framework and Monitoring Annex 3: Summary of Project Costs Annex 4: Financial Management And Disbursement Arrangements... 40

6 Annex 5: Procurement Arrangements Annex 6: Implementation and Monitoring Arrangements Annex 7: Project Preparation and Appraisal Team Members Annex 8: Environmental and Social Safeguards Framework Annex 9: Economic and Financial Analysis Annex 10: Documents in Project Files Annex 11: Statement of Loans and Credits Annex 12: Country at a Glance Annex 13: Map... 79

7 Republic of Uganda Avian and Human Influenza Preparedness and Response Project Africa Region Emergency Project Paper Data Sheet Date: May 28, 2008 Country Director: John Murray McIntire Sector Manager/Director: Karen M. Brooks / Inger Andersen Lending instrument: Emergency Recovery Credit i Team Leader: Wilson Onyang Odwongo Sectors: Agriculture, Livestock & Health Themes: Avian & Human Influenza Environmental Category: B Type of Operation: New Operation [ X ] Additional Financing [ ] Existing Financing (restructuring) [ ] Financing type: Loan [ ] Credit [ X ] IDA Grant [ ] Other [ ] Project ID(s): P Total Amount: US$10 million Proposed terms: Standard IDA Credit Expected implementation period: Four years Expected effectiveness date: August 1, 2008 Expected closing date: June 30, 2012 Borrower: Republic of Uganda Responsible agencies: 1.Office of the Prime Minister, P.O. Box 341, Kampala, Uganda - Focal Point Officer Apollo Kazungu; Tel ; <comdor@opm.go.ug> 2. Ministry of Agriculture, Animal Industry and Fisheries - Focal Point Officer, Chris Rutebarika; Tel , <crutebarika@yahoo.com> 3. Ministry of Health Focal Point Officer- Winyi Kaboyo; Tel , <winyi.kaboyo@health.go.ug>. Development Objective: The overall development objective is to substantially reduce the threat posed to the poultry industry and humans in Uganda by HPAI infection and other zoonoses and to prepare for, control, and respond effectively to future AHI pandemics and other infectious disease emergencies in livestock and humans. To achieve this, support will be provided in three main areas: (i) preparedness and prevention, (ii) outbreak response and recovery, and (iii) coordination, monitoring and evaluation. Short Description: The proposed AHIP has four components: (i) animal health; (ii) human health; (iii) communication; and (iv) coordination, monitoring and evaluation. Animal Health: The component will support: (i) overall institutional strengthening for animal disease prevention and control; (ii) national AHI prevention and control strategies over the short- and medium-term; (iii) strengthening the capacity of the National Veterinary Service (NVS) to cope with HPAI epidemic and new emerging infectious diseases; and (iv) increased monitoring and surveillance of migratory and resident birds. Human Health: This component will support: (i) building the health system capacity to detect AI early, respond and contain the infection at source; (ii) adapting guidelines and training materials (including infection control guidelines); and (iii) training, activating and strengthening of national and district Rapid Response Teams (RRTs), establishing isolation units, upgrading laboratories and pre-positioning Personal Protective Equipment (PPEs),

8 supplies and medicines. Communication: The component will, inter alia provide funds to: (i) fill strategic information gaps; (ii) enhance the communication skills of key policy makers and spokespersons through training; (iii) establish communications centers within the coordination/operation centers at central and district levels, (iv) mount media campaigns on AHI (v) train farmers and households with back yard poultry, local government officials, and religious and cultural leaders on the risks of AI; and (vi) develop an M&E system. Coordination, M&E: This component will support implementation costs associated with project planning, coordination, management, as well as overall monitoring and evaluation (M&E) at the national and district levels. The support will be provided to the OPM, MAAIF, and MOH for the operational costs of the National Project Steering Committee (NPSC), NTF/AI, Technical Working Groups (TWGs), Project Coordination Team (PCT), and the RRTs. Financing Plan (US$m.) Source Local Foreign Total Borrower Total IBRD/IDA Avian & Human Influenza Trust Fund EC funded AU-IBAR SPINAP* USAID* Total *Parallel financing Estimated disbursements (Bank FY/US$m cumulative) FY 09 FY 10 FY 11 FY 12 FY 13 FY 14 Total IBRD/IDA Trust Funds Does the emergency operation require any exceptions from Bank policies? Have these been approved by Bank management? Are there any critical risks rated substantial or high? Yes [] No [X] Yes [ ] No [ ] Yes [ X ] No [] What safeguard policies are triggered, if any? Environmental Assessment OP 4.01 Significant, non-standard conditions, if any: The AHITF Grant Agreement has been executed and delivered, and all conditions precedent to its effectiveness, or to the right of the Recipient to make withdrawals under it (other than the effectiveness of the Financing Agreement), have been fulfilled. ii

9 A. INTRODUCTION 1. This Project Paper seeks the approval of the Executive Directors to provide a credit in an amount of US$10.0 million equivalent to the Republic of Uganda for the proposed Avian and Human Influenza Preparedness and Response Project (AHIP). 2. With the continuing reports of outbreaks and spread of Highly Pathogenic Avian Influenza (HPAI) in Asia, Africa, Europe and Middle Eastern Countries, Uganda is among those countries in Sub-Saharan Africa at risk of HPAI epidemic outbreak. The four key factors which put Uganda at high risk include: (a) (b) (c) (d) The reported outbreak in 2007 of HPAI in Juba, Southern Sudan, which is close to Uganda s northern border and with whom there is considerable formal and informal cross-border trade; The high prevalence of backyard and/or free-range poultry rearing in the majority of rural Ugandan households; The legal or illegal movement of poultry and/or poultry products as well as the unregulated trading in poultry in most rural and urban markets; and The location of the major routes for the wild migratory birds within the borders of the country and the presence of large masses of water which facilitate close interaction between wild birds and domestic poultry. 3. The proposed credit would help finance the costs associated with substantially reducing the threat posed to the poultry industry and humans in Uganda by the HPAI infection and other zoonoses, and to prepare for, control, and respond effectively to future AHI pandemics and other infectious disease emergencies in livestock and humans. The proposed financing will help respond to the situation by supporting the Government of Uganda (GOU) in three main areas: (i) preparedness and prevention, (ii) outbreak response and recovery, and (iii) project coordination and monitoring and evaluation. The main outcomes will result in strengthening the capacities of the Ministry of Agriculture, Animal Industry and Fisheries (MAAIF) and the Ministry of Health (MOH) in the following areas: coordination system for animal health surveillance and emergency disease control; strengthening the national veterinary services (NVS); strengthening coordination between health services line ministries for early detection and rapid response to emerging and reemerging zoonotic diseases; and consolidating health facilities for prevention, containment and control of AHI and similar epidemic outbreaks. 4. Partnership arrangements: The total cost of a comprehensive AHI program in Uganda is estimated in the Integrated National Action Plan (INAP or the Plan )) for Preparedness and Response to Avian and Human Influenza (February, 2008) at US$14.6 million over five years. The Bank proposes to finance the INAP with US$12 million (IDA credit of US$10 million and a grant of US$2 million from the AHI Trust Fund), whilst grants 1

10 from other Development Partners (DPs EC/EU and USAID) for INAP implementation are estimated at US$1.26 million. Furthermore, the preparation of the INAP at an estimated cost of about US$1.4 million (which includes the cost of training, sensitization, production of AHI posters, and supply of laboratory reagents and kits for AI preparedness and prevention up to end December, 2007), was undertaken with the support of several DPs and NGOs CDC, Care International, DANIDA, DFID, EC/EU, FAO, HPF (Sweden), WHO, UNICEF, USAID, and the Bank. B. EMERGENCY CHALLENGE: COUNTRY CONTEXT AND RATIONALE FOR PROPOSED BANK EMERGENCY PROJECT COUNTRY CONTEXT 5. Whilst AHI has not attracted wide spread media coverage in recent months, it continues to stir serious human health concerns world wide because of the potential threat it poses if it mutates in ways that would allow sustained human to human transmission. While the strain of the AHI virus (known as H5N1) has been identified as the pathogen for the HPAI responsible for the large scale epidemic outbreaks and deaths in wild and domestic birds, no cases have yet been reported of it being transmitted from human to human. Nearly all reports of over 230 human deaths reported to date from H5N1 infections, have been caused through animal to human transmission. While an AHI outbreak has not yet occurred in Uganda, there is no doubt that the negative socio-economic impact of an outbreak would be enormous and devastating. For instance in Asia, where the epidemic has persisted since the first outbreaks in 2003, over 200 million domestic poultry have either died or been destroyed and over 300 people have contracted the infection of which at least 190 have died as a result of infections from H5N1 strain. Economic losses to the Asian poultry sector alone are already estimated at over US$10 billion with unprecedented adverse social and economic impact. In Nigeria, between February 2006 and October 2007, there were 920 suspected cases of HPAI of which 265 were confirmed positive. A total of 1.3 million birds were depopulated and about US$4.5 million was paid out to farmers in compensation over the same period. There has been one confirmed case of human fatality in Nigeria due to HPAI. Egypt has recorded 37 human cases with 15 fatalities and Djibouti one human fatality. 6. Since October 2005, the GOU has been actively working on prevention, preparedness and response to the AHI threat. A comprehensive and multi-sectoral National Task Force on Avian Influenza (NTF/AI), co-chaired by MAAIF and MOH was established to develop a national strategy against the threat. The NTF/AI prepared the National Plan of Action (NPA) for Preparedness and Response to Avian Influenza in Uganda ( ), which was endorsed by the Cabinet in April In April 2007, GOU requested the Bank to coordinate a Joint Rapid Assessment of its action plan to bring it in line with international technical standards of the World Health Organization (WHO), Food and Agriculture Organization (FAO) and the World Organization for Animal Health (OIE), and also assist it in mobilizing resources necessary for implementing AHI activities in Uganda from DPs. The Rapid Assessment was carried out in June/July 2007 by a team of experts from WHO, OIE and FAO, working in collaboration 2

11 with the NTF/AI, and coordinated by the Bank. The Rapid Assessment exercise resulted in the production of INAP with a budget proposal of US$14.6 million for implementation of AHI activities in Uganda over the next five year period. The INAP was endorsed as the main working document for AHI activities in Uganda by GOU, following a national workshop in February In addition to the above process, GOU is actively involved in regional and subregional coordination and preparedness activities through the East African Community (EAC), Intergovernmental Authority on Development (IGAD), African Union-Inter-African Bureau of Animal Resources (AU-IBAR), FAO, and WHO. 9. The above processes undertaken by the GOU are consistent with key principles identified in the Bank s Global Program for Avian Influenza Control and Human Pandemic Preparedness and Response (GPAI), which are listed below: Avian influenza control is multi-sectoral in nature; The risk of human pandemic is real; The livelihoods of the rural poor are particularly threatened; Individual countries are central to any coordinated response; An appropriate balance between short and long term actions need to be made; and Global and regional aspects of the response need to be addressed and coordinated. 10. Uganda has, therefore, taken the necessary steps and preparations that make the Bank s support to its AHI activities very appropriate at this stage. RATIONALE FOR BANK INVOLVEMENT 11. The rationale for the Bank to support an AHI project in Uganda includes the following: The global public goods aspect of controlling HPAI, in order to strengthen Uganda s response capacity as part of coordinated international and regional initiatives to minimize the risk posed by spreading of any outbreak to neighboring countries and other parts of the world. This requires the need to strengthen Uganda s veterinary services, disease surveillance, and human health systems, as planned in this operation. HPAI control programs require a multi-disciplinary approach to integrate technical, social, economic, political, policy, and regulatory issues in addressing a complex problem. In Uganda, therefore, the Bank can be helpful in bringing together the relevant ministries, government agencies and DPs, and in facilitating high level political coordination. 3

12 The Bank s main comparative advantage vis-à-vis its partner agencies WHO, FAO and OIE is its ability to provide significant funds to countries at risk, as a lender of last resort. In Uganda, the Bank has already been requested by Government to leverage additional resources from other bilateral and international agencies. The grant resources being provided by DPs are not adequate for the basic needs of the veterinary services and facilities required for AHI. Thus, there is a strong case for the provision of resources from the World Bank s GPAI. The Bank is also well placed to draw on its knowledge base concerning evidence and lessons already learned in various regions during emergency preparedness and response programs. The Bank can also contribute towards understanding and addressing the social and economic impact of such emergency operations. The proposed project is fully consistent with the Bank s GPAI (which is an APL of emergency operations) and draws heavily on the global strategies developed by FAO, OIE and WHO. C. BANK RESPONSE AND STRATEGY: THE PROJECT BRIEF DESCRIPTION OF BANK S STRATEGY OF EMERGENCY SUPPORT 12. Initially, a review of the existing agriculture and health sector portfolio was undertaken to assess if funds were available for AHI activities through reallocation or restructuring. The review determined that sufficient funds were not available for this emergency operation. In addition, the proposed AHIP was not included in the Country Assistance Strategy (CAS), Therefore, at the request of GOU, the Bank agreed to process AHIP as an Emergency Recovery Credit (ERC) under the Bank s policy for emergency operations (OP/BP 8.00). 13. The AHIP will be co-financed by: (i) an IDA credit under the GPAI Adaptable Program Loan (APL), approved by the Executive Directors on January 12, 2006; and (ii) grant funds from the Avian and Human Influenza Trust Fund (AHITF)1, which is being administered by the Bank. The AHIP will support the government s INAP over a four year period. As indicated earlier, the project aims at building and consolidating all GOU and DP initiatives related to HPAI in order to avoid any duplication and make the best use of scarce resources. In addition to the resources from the Bank, EC and USAID will also provide grant resources, under parallel financing arrangements for the INAP/AHI activities. PROJECT DEVELOPMENT OBJECTIVES 14. The overall development objective is to substantially reduce the threat posed to the poultry industry and humans in Uganda by HPAI infection and other zoonoses and to prepare for, control, and respond effectively to future AHI pandemics and other infectious disease emergencies in livestock and humans. To achieve this, support will be provided in three 1 Contributors to the AHITF include the EC, DFID, Russia, Australia, China, South Korea, Iceland, Slovenia and Estonia. 4

13 main areas: (i) preparedness and prevention, (ii) outbreak response and recovery, and (iii) coordination, monitoring and evaluation. SUMMARY OF PROJECT COMPONENTS 15. The proposed AHIP has four components: (i) animal health; (ii) human health; (iii) communication; and (iv) coordination, monitoring and evaluation. A summary of the project components and activities is given below and more details are provided in Annex 1. Component 1: Animal Health (US$5.66 million) 16. This component will be the primary focus of the project as HPAI outbreaks must be addressed at source. The component aims at overall institutional strengthening for animal disease prevention and control, with emphasis on the emerging zoonoses including Transboundary Animal Diseases (TADs). It will also support national prevention and control strategies proposed to cover the country s needs over the short- and medium-term, based on detailed assessments of the avian influenza epidemiological status, the capacity of the National Veterinary Service (NVS) to cope with HPAI epidemic and the vulnerability of the poultry industry to new emerging infectious diseases. The component will provide funds for increased monitoring and surveillance of migratory and resident birds. Part I: Preparedness and Prevention (P&P) Subcomponent 1: Strengthening Capacity for Animal Health Surveillance, Monitoring and Emergency Disease Control 17. The project will use the existing institutional framework for surveillance, monitoring and emergency disease control. The project will support: (i) MAAIF to strengthen its epidemiological unit: (ii) MAAIF to put in place a system in all the districts to detect the appearance of HPAI in migratory birds and domestic animals; (iii) strengthening the surveillance capacity of MAAIF, HPAI Rapid Response Teams (RRTs), and Uganda Wildlife Authority (UWA) through training, provision of PPEs and procurement of necessary equipment and supplies for control of HPAI and other emerging diseases. Subcomponent 2: Strengthening of National Veterinary Services (NVS) 18. This subcomponent will support activities to strengthen NVS to enhance animal disease surveillance, diagnosis and control. The support will cover the following: (i) upgrading knowledge and skills through training, equipping laboratories, provision of transport; (ii) development and distribution of Standard Operating Procedures (SOPs) for reporting between MAAIF and other line ministries; (iii) dissemination of the OIE developed Performance Vision Strategy document; (iv) Sero-prevalence surveys to establish baseline data on the epidemiology of re-emerging diseases; (v) review of curricula of the Faculty of Veterinary Medicine, Makerere University (FVM-MUK) and Para-Veterinary schools to cater for HPAI and other TADs; and (vi) strengthening of the regulatory framework. 5

14 Subcomponent 3: Improved Veterinary Technical Competence for emerging disease prevention, early detection and rapid response 19. The project will build capacity in risk analysis, through training and research in various areas of specialisation (risk analysis, infectious disease epidemiology, wildlife surveillance). Simulation exercises for HPAI and other infectious diseases will also be undertaken. Subcomponent 4: A Balanced Veterinary Epidemio-surveillance programme capable of early detection of emerging infectious diseases and other TADs 20. The project will support: (i) passive, active and targeted surveillance, (ii) improving animal health information flow among relevant agencies; (iii) early detection and timely reporting and follow-up of suspected or positive cases; (iv) public and Community-Based Surveillance System (CBSS) by establishing a community-based early warning system; (v) routine serological surveys and epidemio-surveillance; and (vi) upgrading of the laboratories earmarked to carry out diagnostics for HPAI including upgrading of the MAAIF National Diagnostics and Epidemiology laboratory to Bio-Safety Level 3 (BSL-3). Animal disease surveillance will be strengthened through provision of the necessary infrastructure, equipment, supplies and transport capacity. Subcomponent 5: Evidence-Based Veterinary Rapid Response Capacity for Emerging Infectious Diseases Preparedness, Detection and Control 21. To enhance the capacity for effective rapid response, the project will: (i) establish an Incident Command System (ICS) for animal HPAI outbreak response; (ii) develop national policies and SOPs for HPAI rapid response and control; (iii) procure rapid response supplies and equipment for all levels of NVS, including PPEs, disinfection units and culling equipment; (iv) improve commercial farm and backyard poultry production bio-security; (v) strengthen NVS quarantine capacity; and (vi) support preparation of compensation policy and guidelines. Subcomponent 6: Coordination, monitoring and evaluation 22. MAAIF will be responsible for coordination, monitoring and evaluation of animal health activities planned under the project. The OPM will be responsible for the overall M&E activities. The project will provide funds to all the implementing ministries responsible for their own coordination, monitoring and evaluation. Part II: Response and Recovery (R&R) 23. In case of an outbreak, there will be additional costs to cater for immediate response, over and above the expenses related to P&P activities. However, the exact amount cannot be known for the time being because neither the timing nor the extent of an eventual outbreak (or outbreaks) can be anticipated. This subcomponent will provide support for immediate reaction to the outbreak; implementation of sanitary measures; quarantine and movement control; strengthening of surveillance; initiation of recovery activities (compensation), 6

15 improvement of bio-security; strengthening of public awareness; and re-enforcement of active surveillance (e.g. border check posts). Component 2: Human Health (US$2.06 million) 24. The AHIP will strengthen the human health strategy for the preparedness and response to Avian Influenza (AI) in Uganda by helping to build the health system capacity to detect early, respond and contain the infection at source. The project will provide funds for adapting guidelines and training materials (including infection control guidelines), conducting training, activating and strengthening of national and district RRTs, establishing isolation units, upgrading laboratories and pre-positioning PPEs, supplies and medicines. Part I: Preparedness and Prevention (P&P) Subcomponent 1: Strengthening of Surveillance of humans for influenza 25. Surveillance activities for human influenza will be strengthened in all aspects and the number of sentinel sites expanded from the present three sites to at least eight sites. The project will provide funds to strengthen MOH s existing field disease investigation system and expand sentinel surveillance to cover at least the regional hospitals and community based surveillance in selected high risk districts Subcomponent 2: Strengthening the Capacity of the Uganda National Health Research Organization 26. This will include: (i) strengthening of the capacity of UNHRO for developing policies to ensure effective coordination and to harmonise research in new and emerging infectious diseases including avian influenza (ii) upgrading the National Influenza Centre (NIC) laboratory at the Uganda Virus Research Institute (UVRI) to BSL3, including provision of laboratory diagnostic equipment and reagents; and (iii) training of staff for quality control in AI diagnostics, field specimen collection, and testing for influenza viruses. Subcomponent 3: Consolidation of preparedness for AHI Prevention, Containment and Control 27. This sub-component will support: (i) development of infection control procedures and educational programs for the most vulnerable and at risk communities and health workers and (ii) establishment of isolation facilities and procurement of infection control materials and PPEs for at least six regional hospitals. Subcomponent 4: Improving Food safety and Environmental Hygiene 28. The project will support activities and assessments aimed at improvement of environmental, occupational and food safety of poultry and poultry products in poultry markets and along major highway food vending points. Subcomponent 5: Health Services and Systems Prepared to handle suspected cases. 29. Based on the lessons learnt from the Ebola outbreak, the implementation of this subcomponent is aimed at increase the surge capacity and flexible deployment of both human 7

16 and infrastructure resources. This will be achieved mainly by training of health workers in case management and rapid response, development and conducting of simulation exercises and the development of a contingency plan of human resource management in case of an outbreak. Subcomponent 6: Preparation for Effective Case Management. 30. The ultimate aim of any outbreak management strategy is to ensure proper treatment of all cases detected. The project will: (i) provide limited stock of pharmaceuticals for emergencies (Tamiflu and other antibiotics) while adequate budgetary provision should be made for additional supplies when the situation warrants; (ii) support preparation of guidelines and SOPs; and (iii) procurement of necessary accessories and medical supplies (including vaccines). Part II: Response and Recovery (R&R) Subcomponent 1: Response to Outbreak of pandemic influenza of avian origin 31. The Project will help create and sustain a system that can rapidly contain the infection as this is one of the key elements which will drastically reduce human to human transmission, suffering and death. Support will be provided for activating RRTs to undertake active case investigations, intensify collaboration with the veterinary services in the areas of disease surveillance, provision of PPEs, prophylaxis to investigating teams and treatment of human cases to control the spread of the epidemic. In the pandemic phase support will be provided for exceptional measures like quarantine and restricting movement of people, closure of schools and markets. Component 3: Communication (US$1.83 million) Part I: Preparedness and Prevention (P&P) 32. The main challenges faced in fighting AI relate to lack of motivation due to low risk perception and a general lack of knowledge of AI among the general public and a wide range of stakeholders, especially the small-scale back-yard poultry farmers. To address these constraints, the Project will provide funds to: (i) brief policy makers on AI through development and presentation of policy papers; (ii) enhance the communication skills of key policy makers and spokespersons through training; (iii) establish a Communications center within the coordination/operation centers at central and district levels, designate Communication Focal Points (CFPs) within them, and equip the CFPs with dedicated communication facilities, ready supply of posters, and standard protocols for reporting any outbreaks; (iv) mount media campaigns using Information, Education and Communication (IEC) materials specially developed, and establish a national AHI web-site; (v) train farmers and households with back yard poultry, local government officials, and religious and cultural leaders on the risks of AI; (vi) build strategic partnerships with the media through briefings and simulation exercises; and (vii) develop an M&E system.. Part II: Response and Recovery (R&R) 33. The R&R strategy should be launched within the first 24 hours of any report of an outbreak. To facilitate this, the project will support: (i) establishment of SOPs for the 8

17 outbreak communication strategy; (ii) dissemination of IEC materials for outbreaks; (iii) activation of media plan for outbreaks; (iv) Strengthened communication to the public at the outbreak foci or ground zero ;(v) plan for officially communicating the end of the emergency phase; and (vi) the evaluation of the impact of the communication effort. Component 4: Coordination, Monitoring & Evaluation (US$0.45 million) 34. Coordination: This component will support implementation costs associated with project planning, coordination, management, as well as overall monitoring and evaluation (M&E) at the national and district levels. This will cover support for these functions for the OPM, MAAIF, and MOH. This support covers the operational costs for the National Project Steering Committee (NPSC), NTF/AI, Technical Working Groups (TWGs), Project Coordination Team (PCT), and the RRTs. 35. Monitoring and Evaluation: The OPM has in place a National Implementation, Monitoring and Evaluation System (NIMES). The project will support the development of, and integration of an M&E system for AHIP activities into the NIMES. The project will also support the M&E aspects of AHIP activities at MAAIF and MOH. ELIGIBILITY FOR PROCESSING UNDER OP/BP The proposed Uganda AHIP is being processed under the GPAI framework, which was endorsed by the Bank s Executive Directors. The GPAI framework recognizes the need to minimize the threat posed to humans by HPAI infection and the need to prepare for, control, and respond to influenza pandemics and other infectious disease emergencies in humans. The GPAI identifies three areas to be considered for Bank support: (i) prevention, (ii) preparedness and planning, and (iii) response and containment. These areas are fully consistent with the following objectives of OP/BP 8.00: (i) assisting with the crucial initial stages of building capacity for longer-term disaster management and risk reduction; and (ii) supporting measures to mitigate or avert the potential effects of imminent emergencies, or future emergencies, or crises in countries at high risk. CONSISTENCY WITH COUNTRY ASSISTANCE STRATEGY (CAS) 37. The AHIP is consistent with the Uganda Joint Assistance Strategy (UJAS) discussed by the Board on December 14, 2005 Report No UG, which was aligned with Uganda s development objectives as articulated in the 2004 Poverty Eradication Action Plan (PEAP). The AHIP will provide support mainly for strengthening livestock services, improving health services provision and build management and technical capacity within MAAIF, MOH and OPM. These interventions will support Pillars 2, 3 and 5 of the PEAP. EXPECTED OUTCOMES 38. The results framework and the performance indicators adopted for the AHIP are consistent with the indicators included in the PEAP and UJAS. At the end of the project the expected outcomes are: (i) the capacity of the government ministries/agencies involved in HPAI containment, control and mitigation will be improved; (ii) the threat to human health in the high risk areas of Uganda will be reduced; and (iii) the general public will be better 9

18 informed and will have adopted AHI related human health, animal health and environmental safeguards. The results framework and the list of indicators are provided in Annex 2. MONITORING AND EVALUATION OF OUTCOMES/RESULTS 39. The M&E unit in the OPM will, with assistance from MAAIF and MOH, continuously and systematically monitor project implementation activities, outputs and outcomes. The key indicators to be monitored include: extent of animal surveillance and laboratory testing; training of veterinary and health officers; readiness for outbreak containment; enactment of containment plans (as and when necessary); changes to legislation; fully developed human surveillance systems and equipped laboratories; training of health workers; weekly/monthly disease reporting; preparation of communication material and communication strategy. Further details are provided in Annex An M&E specialist from OPM s Coordination and Monitoring department will be assigned to work with the PCT for the entire project period. He/she would be responsible for preparing the M&E program at the beginning of the project, in consultation with his/her counterparts in MAAIF and MOH, and for training central and district staff on how to record and report data, and for producing regular reports for the NPSC and the World Bank. He/she would work closely with the PCT in preparing quarterly progress reports. 41. In addition, the PCT will select, using agreed procurement guidelines, consultants for carrying out independent impact evaluation of the project at mid-term and end of the project. D. APPRAISAL OF PROJECT ACTIVITIES, BENEFITS AND RISKS ECONOMIC AND FINANCIAL ANALYSIS 42. There are several major difficulties in estimating the economic impact of AI in Uganda, most of which would also be valid for other countries. First, scenarios for gross attack rates (GARs) of AI in the case of a pandemic, based mostly on past events, are only approximate. There is a lack of scientific knowledge on the primary factors affecting the spread of the HPAI in humans and the probability of its occurrence. Second, there is no data to assist in predicting the probability of any of the scenarios for which a possible impact of HPAI can be estimated. 43. Nevertheless, based on reasonable assumptions, the economic and financial analysis, the details of which are provided in Annex 9, provides considerable justification for this project. The internal rates of return estimated for this project are summarized in the following Table. GAR Scenario Outbreak in year 2 Outbreak in year 4 I % 7% II % 13% III % 34% 10

19 44. The results show that for minimal Gross Attack Rates (GARs), and depending on when the outbreak occurs during the project cycle, the IRRs are sufficiently high to justify the investment in AHI preparedness and prevention. TECHNICAL 45. The technical proposals for both the animal health and human health related AI activities of the AHIP are based on a phased and multi-disciplinary approach. These proposals were formulated on the basis of a sound epidemiological approach to control and contain HPAI outbreaks, and are tailored to the prevailing conditions in Uganda. The technical proposals will address the weaknesses in, inter alia, the following areas: inadequate surveillance and diagnostic capacity of the NVS to respond rapidly to an HPAI outbreak; inadequate laboratory facilities, insufficient funds for operating costs, and lack of staff expertise; inadequate capacity to implement bio-security measures; scarce scientific expertise in epidemiological and epizoological areas linked to disease control programs; inadequate surveillance of migratory birds, which have been a source for the transmission of the H5N1 virus to domestic poultry; and, weak coordination among the public agencies, and weak linkages with the private sector. INSTITUTIONAL 46. The INAP proposed the setting up of a separate Project Coordination Unit (PCU). Taking into account the Paris Declaration, and the need to strengthen the capacities of the implementing ministries and agencies, the AHIP will use the existing government structures to implement all aspects of the project. Given the multi-sectoral nature of the project and the need to have high level political engagement, the AHIP design envisages using a multisectoral Project Coordination Team, led by the OPM. There are no major weaknesses in the Financial Management arrangements of the three implementing institutions to note under this section. FIDUCIARY 47. Financial Management: With increasing reliance on the country systems and shifting the focus from creating a parallel system to using the existing Public Financial Management (PFM) system, the AHIP will be implemented within the financial structures of the implementing ministries. The animal heath component will be implemented by the MAAIF, while the human health component will be implemented by MOH and the overall coordination function will be implemented by OPM. To facilitate smooth implementation, each implementing agency will have access to project funds through its own designated (special) account. The communication component will be implemented jointly by MAAIF and MOH with support from OPM, but the funding for this component will be placed in the account of MOH. MAAIF, MOH and OPM will follow GOU s existing financial management system. 48. The Public Expenditure and Financial Accountability (PEFA) Report of November 2005 (issued in July 2006) and Country Financial Accountability Assessment (CFAA) 11

20 carried out by IDA in 2004 shows that the Government of Uganda has made substantial progress in improving its Public Financial Management Systems since the last CFAA undertaken in The fiduciary risks associated with poor budget formulation and budget preparation processes have been reduced. In terms of appropriate legislation and regulatory frameworks, significant progress has been made to ensure that the risk associated with the lack of clear rules and regulations has been reduced. Also, more useful information is provided in the Report and Opinion of the Auditor General to Parliament on the Public Accounts of the Republic of Uganda, which are up to date. However, risks remain in terms of: (i) Quality and timeliness of in-year budget reports since budget reports only include information on budget releases and not actual expenditures; (ii) Stock and monitoring of expenditure payment arrears; (iii) Effectiveness of internal audit; (iv) Oversight of aggregate fiscal risk from other public sector entities; (v) Effectiveness of measures for taxpayer registration and tax assessment; (vi) Legislative scrutiny of external audit reports; (vii) Effectiveness of payroll controls; and, (viii) Effectiveness in collection of tax payments. Government of Uganda (GOU) has prepared a Financial Management Accountability Program (FINMAP) to address the weaknesses in its Public Financial Management system. The FINMAP is supported by a number of development partners, including the World Bank, that form the Public Financial Management Donor Group. 49. The project s financial management transactions will be managed within the existing set-up in the three institutions of which the overall accounting officer is the Permanent Secretary (PS). All the three institutions accounting departments are adequately staffed with a Principal Accountant as head, senior accountants, accountants, and several accounts assistants. The Principal Accountants report to the Under Secretaries, who in turn report to the Permanent Secretaries. The three institutions have accounting policies and procedures that will be used for the project. These are documented in the government s Treasury Accounting Instructions, 2003, issued under the Public Finance and Accountability Act These procedures, however, fall short on project requirements on external auditing and financial reporting, which will be documented in the Financing Agreement. The ministries are computerized on Integrated Financial Management Information Systems (IFMIS). However the IFMIS has not yet been configured to be utilized by projects, which implies that AHIP accounting will be done using other accounting software or excel spreadsheets. The institutions have internal audit units comprised of the head of internal audit and two internal auditors seconded from the Ministry of Finance, Planning and Economic Development (MFPED), who will include the project activities in their work plan. The project s financial statements will be audited in accordance with statutory requirements, and suitable Terms of Reference will be developed. 50. Actions outlined in the Financial Management Action Plan will be undertaken by the three ministries to strengthen the financial management system. The formats of the Interim Financial Reports (IFR) were agreed with IDA at the time of the negotiations. 51. In order to ensure that the project is effectively implemented, the three ministries will ensure that appropriate staffing arrangements are maintained throughout the life of the project. 12

21 52. The conclusion of the assessment is that the financial management arrangements for the project have an overall residual risk rating of moderate (Annex 4), which satisfies the Bank s minimum requirements under OP/BP These arrangements are adequate to provide, with reasonable assurance, accurate and timely information on the status of the project, as required by IDA. With the implementation of the action plan, the financial management arrangements will be strengthened. 53. Procurement: Procurement for the proposed project would be carried out in accordance with: (i) the World Bank s Guidelines: Procurement under IBRD Loans and IDA Credits dated May 2004, revised October 2006; (ii) Guidelines: Selection and Employment of Consultants by World Bank Borrowers dated May 2004, revised October 2006; (iii) the Simplified Procurement Plan as permitted by the new OP 8.00; and (iv) the provisions stipulated in the Financing Agreement. The details of the procurement arrangements are set out in Annex 5, whilst the procurement requirements by expenditure categories are summarized in Table 2 of Annex 3. SOCIAL 54. The main social concern is the maintenance of livelihoods for poultry producers, especially backyard producers, in the event of future outbreaks of HPAI. There are two main ways in which GOU can assist small producers. The first is through the establishment of a compensation program that operates in a transparent and agreed way. GOU and producers need to reach agreement on the amount of compensation payable for each bird culled. Discussion is needed between GOU and the industry to draw up compensation payment mechanisms. The second important thing is for all stakeholders to develop and promote risk awareness messages that will avoid the creation of panic so that people do not refuse to buy poultry just because of an outbreak in some parts of the country. Some progress has been made on this front, but more needs to be done, especially with regard to news media. The project will have significant positive social impact by protecting human lives through HPAI early warning, prevention and containment, improved poultry farming practices, increased public awareness of HPAI, and improved hygiene and food preparation practices and waste management. ENVIRONMENTAL 55. The project is assessed as a Category B project, based on the type of interventions proposed under the project and the nature and magnitude of potential environmental impacts. The project is likely to have limited adverse environmental impacts as the interventions are largely on public sector capacity building and improved readiness for dealing with outbreaks of AI in domestic poultry. These prevention-focused activities are expected to have positive environmental impacts because project investments in facilities, equipment, laboratories and training will improve the effectiveness and safety of existing AI handling and testing procedures by meeting international standards established by OIE. This would be reinforced by the mainstreaming of environmental safeguards into the protocols and procedures for culling and disposal of animals in the event of an AI outbreak, decontamination of production facilities and laboratory biosafety. However, adverse environmental health impacts, mainly inadvertent spread of HPAI, could occur when an emergency operation 13

22 involves containment of HPAI outbreaks through quarantine, isolation and stamping out actions, and when relevant mitigation measures are not in place. Therefore, precautions have been taken under the project to avoid or minimize such impacts by integrating environmental and public health safety aspects in the preparation, design, and implementation of the project. The potential adverse environmental impacts identified above will be mitigated by integrating environmental and public safety aspects in all stages of the project. The Government is preparing Guidelines for safe culling, transport and safe disposal of carcasses, which will be supported under the project. The project will provide training to all relevant staff for implementation of the Guidelines as well as infrastructure needed in the event of an outbreak. SAFEGUARD POLICIES 56. Environmental Assessment is the only safeguard policy triggered under this project, considering the scope of activities financed under the project. There are no Social Safeguards triggered by the project because there will be no land acquisition, voluntary or involuntary. Therefore, there would be no displacement of people. The Environmental Management Plan (EMP), that outlines the measures proposed to address all potential adverse environmental and social impacts, will be prepared and will serve as a guide to ensure that the project will not result in any potential indirect and or long-term impacts (see Annex 8 for details). The preparation of the Guidelines will involve an evaluation of suitable alternatives for safe culling, transport and particularly for safe disposal of carcasses. The project will finance the implementation of the selected alternatives, according to the EMP. In the case of the AI Component of MOH, a Health Care Waste Management Plan already exists and will form the basis of environmental management for avian influenza activities as well (no separate EMP will therefore be prepared for the Human Health component). Most of these activities related to the safeguards will be undertaken in consultation with the National Environmental Management Authority (NEMA). POLICY EXCEPTIONS AND READINESS 57. No policy exceptions are required. The project meets the regional implementation readiness requirements. The INAP has been endorsed for implementation by the GOU. The project NPSC and NTF/AI are in place, and GOU has established the PCT. A simplified Procurement Plan for the first six months and the implementation program for the first year (year 1) have already been prepared. The draft Project Implementation Plan (PIP) is under preparation, and a draft Compensation Policy has been prepared and awaits Cabinet approval. The National Communication Strategy for Avian Influenza and Human Pandemic Influenza has also been prepared and approved by GOU. E. IMPLEMENTATION ARRANGEMENTS AND FINANCING PLAN INSTITUTIONAL AND IMPLEMENTATION ARRANGEMENTS 58. Implementation of the Plan: The GOU has designated MAAIF and MOH to implement its national Plan (INAP), with appropriate coordination from the Office of the 14

23 Prime Minister (OPM) and support from the other ministries/agencies. A National Project Steering Committee (NPSC) comprising 22 Ministers, Permanent Secretaries, and representatives of relevant GOU agencies and the private sector, and headed by the Minister for General Duties in the OPM, has been designated as the apex coordinating body. It will meet quarterly. Below the NPSC, a multi-sectoral National Task Force on Avian Influenza (NTF/AI) has been established with representation from a wide range of public and private sector agencies to provide advice on technical matters to the NPSC. The implementation of the GOU Plan is being facilitated through the AHIP. 59. Implementation of the Project: The IDA is supporting the AHIP under the framework of the Global Program for the Avian Influenza and Human Pandemic Preparedness and Response (GPAI). The AHIP, an emergency project, is designed to provide assistance for AI within the overall framework of the GOU national Plan. The project will be implemented over a four year period through existing government structures. A Project Coordination Team (PCT) has been established to implement and coordinate the project activities, including the technical components, communication, financial management, procurement, safeguards, monitoring and reporting. 60. Project Coordination Team: The PCT will consist of seven members three Focal Point Officers (FPOs) from the OPM representing the Departments of Disaster Management and Refugees (DDMR/OPM), Information and National Guidance, and Coordination and Monitoring, one FPO each from MAAIF and MOH responsible for the technical components, and one nominee each from MAAIF and MOH responsible for the Communication aspects/component. The PCT will work closely together to achieve project objectives. The FPO representing the DDMR/OPM will act as the Project Coordinator (PC), with responsibility for overall project coordination. The other PCT members from MAAIF and MOH will have the responsibility to coordinate implementation of the project s technical and communication components. Given the importance of the Communication component, it will be implemented jointly by MAAIF and MOH, with support from OPM, as required. On project matters, the PCT members will send their work plans, budgets and progress reports to the PC through their heads of departments. The PC will consolidate the annual work plans, budgets, and progress reports for the NPSC and IDA for approval, guidance, and information. The DDMR/OPM will serve as the secretariat to the NPSC. On administrative, coordination, procurement, financial management, communications, safeguards and internal M&E matters, the PCT will be supported by the relevant sections/units from within OPM, MAAIF, and MOH, and/or other relevant GOU ministries. The project will provide support for coordination, monitoring and evaluation, and implementation. Annex 6 provides details about project implementation and monitoring arrangements. PROJECT COSTS AND FINANCING PLAN 61. As indicated earlier, the GOU s INAP has been budgeted at US$14.6 million. However, based on commitments thus far, DPs are expected to finance about US$13.26 million of the GOU s Plan as shown below: 15

24 US$ Million AHIP proposed IDA Credit Proposed grant financing from World Bank AHITF Facility 2.00 AU-IBAR SPINAP (Supported by EC/EU) 0.80 Financing from USAID 0.46 Total financing available for INAP The AHIP project cost of US$10 million would be financed by an IDA credit under the GPAI Adaptable Program Loan window, whilst the AHITF is largely expected to finance technical assistance and training under the INAP. The financing by IDA and AHITF will be at 100%. The GOU may claim a small amount of expenditures (estimated at US$ 100,000) under the IDA credit as retroactive financing. Furthermore, the project aims at building and consolidating all GOU and DPs initiatives related to INAP and HPAI in order to avoid any duplication and make the best use of resources. The funds from the EC/EU and USAID programs supporting the INAP would be available to GOU under parallel financing arrangements. FINANCIAL MANAGEMENT AND DISBURSEMENT ARRANGEMENTS 63. The three implementing institutions have established effective financial management and accounting systems. These will facilitate the introduction of report based disbursements where cash flow forecasts based on work plans are submitted for a period of six months, along with IFRs, for each quarterly period. The IFRs will also be submitted for disbursement on a quarterly basis. In order to continue using report based method, IDA will expect the project to: (a) sustain satisfactory financial management rating during project supervision; (b) submit IFRs consistent with the agreed form and content within 45 days of the end of each reporting period, and (c) submit a Project Audit Report by the due date. The details are provided in Annex 4. PROCUREMENT ARRANGEMENTS 64. As in the case of financial management, the procurement of consulting services, goods, motor vehicles, equipment and civil works relating to the AHIP activities will be undertaken by the Procurement units of the implementing ministries OPM, MAAIF, and MOH. Some of the emergency procurements will be handled through the UNDP-IAPSO. The detailed procurement arrangements are given in Annex 5. BANK SUPERVISION 65. The supervision, monitoring and evaluation of AHIP will require an experienced multi-sectoral task team. The project will require three implementation review missions in the first year and at least two missions during each of the following three years. It is estimated that, on average, the supervision effort will require an input of about 25 staff weeks per year. For the mid-term review of the project, additional budgetary resources of about 10 staff weeks would be required to field a mission covering all aspects of the project. 16

25 F. PROJECT RISKS AND MITIGATING MEASURES 66. Critical Risks: A summary of critical risks for the Project and the likely mitigation measures is provided below: Risk Rating Mitigation Measure From Outputs to Objective Lack of coordination among project implementing agencies and insufficient agency authority, leadership and capacity to take a leading role in avian influenza prevention and control. Intervention activities are not effective in containing the spread of avian influenza from birds to the human population.. Insufficient commitment at local levels despite strong central commitment. Risks that the disease might re-occur through porous borders. Financial resources not accessible in a timely manner; weak procurement management. H S M S S AHIP will facilitate coordination and linkages across relevant agencies and development partners with project support through NPSC, NTF/AI and TWGs. It will also support the coordination functions of the PCT. The proposed project activities will strengthen the response capacity in the event of AHI outbreak over the short and medium term. They will also put in place strategies for prevention and control of the epidemic. Implementation linkages between national and district/local levels will be strengthened and project s activities focus on building capacity at local levels. Quarantine measures will be strictly enforced and movements of birds across borders will be closely monitored. Quarantine stations will also be strengthened. Procurement and financial management arrangements will be handled by the experienced staff of the relevant ministries; training will be provided to enhance capacity. Overall Risk Rating: S Risk Rating: H (High Risk), S (Substantial Risk), M (Modest Risk), N (Negligible or Low Risk) 67. Possible Controversial Aspects: The project will support the implementation of necessary actions to prevent, control and respond to possible influenza pandemic. Some of the typical and necessary "social distancing measures" (such as quarantines, bans on mass gatherings and travel restrictions) may be socially and politically controversial. Culling for outbreak control among poultry is also likely to be controversial. Intensive and continuous dialogue is needed among different stakeholders. This will be supplemented by a well designed communication strategy. A high degree of political commitment is needed for managing any controversies with respect to preventing and controlling influenza pandemic. 68. There are no controversial aspects in the Financial Management arrangements of the three implementing institutions to note under this section. As noted in Annex 4, the mitigation measures proposed for the financial management arrangements are expected to reduce the critical risks considered as substantial to moderate. 17

26 G. TERMS AND CONDITIONS FOR PROJECT FINANCING 69. Terms: The Emergency Recovery Credit would be on standard IDA terms, with a maturity of 40 years, including a grace period of ten years. 70. Legal Covenants: Financial covenants are the standard ones as stated in the Financing Agreement Schedule 2, Section II (B) on Financial Management, Financial Reports and Audits and Section 4.09 of the General Conditions. 71. Effectiveness Conditions: The conditions for project effectiveness are: (i) the receipt of the Legal Opinion from GOU s Attorney General; (ii) the AHITF Grant Agreement has been executed and delivered, and all conditions precedent to its effectiveness, or to the right of the Recipient to make withdrawals under it (other than the effectiveness of the Financing Agreement), have been fulfilled; and, (iii) the Recipient has prepared and adopted a Project Implementation Plan (PIP), in form and substance acceptable to the Association. 72. Disbursement Condition: There is an urgent need for GOU to finalize and approve the compensation policy and operational guidelines that would provide the basis on which compensation would be paid, including eligibility of commercial as well as backyard poultry producers. A sample of guidelines on compensation for AI has been provided to the Government s NTF/AI for consideration. These guidelines can be modified as deemed appropriate in the context of the country environment. Finalization and approval of the compensation policy and guidelines will be a condition for IDA to disburse any part of the credit for compensation in the event that government will request withdrawal for such purpose. 18

27 REPUBLIC OF UGANDA ANNEX 1 AVIAN AND HUMAN INFLUENZA PREPAREDNESS AND RESPONSE PROJECT Annex 1: Detailed Description of Project Components Component 1: Animal Health (US$5.66 million) 1. This component will be the primary focus of the project as HPAI outbreaks must be addressed at source; within the animal sector as the threat to human health will persist as long as the problem persists in livestock and poultry flocks. Preparedness for HPAI, and the capacity to prevent its introduction, depends directly on the policies, infrastructure, capacities and systems in place for animal disease surveillance and control. Strong institutional structures for the prevention and control of emerging diseases minimize the risk of HPAI introduction, and ensure appropriate responses in the unfortunate case of introduction. Therefore, this component aims at overall institutional strengthening for animal disease prevention and control, with emphasis on the emerging zoonoses including Transboundary Animal Diseases (TADs). The project will therefore support national prevention and control strategies proposed to cover the country s needs over the short, medium and long term, based on detailed assessments of the avian influenza epidemiological status, the capacity of NVS to cope with HPAI epidemic and the vulnerability of the poultry industry to new emerging infectious diseases. It is, therefore, important that the primary focus of attention in the prevention of the introduction and perpetuation of the virus in the country is initiated from the animal health perspective to ensure that any introduction of the HPAI virus in poultry is quickly detected and contained within the outbreak areas. 2. Uganda Wildlife Authority (UWA) officials will perform increased monitoring and surveillance in sites recognized as a principal landing sites for migratory bird populations in Uganda. The project will provide funds for hiring of boats for surveillance for migratory and resident. Part I: Preparedness and Prevention Subcomponent 1: Strengthening Capacity for Animal Health Surveillance, Monitoring and Emergency Disease Control 3. The project will use the existing institutional framework for surveillance, monitoring and emergency disease control. The project will support the MAAIF to strengthen its epidemiological unit to improve data management and flow within MAAIF and other institutions. MAAIF will put in place a sufficiently sensitive system in all the districts in order to detect the appearance of HPAI in migratory birds and domestic animals. To prevent entry of HPAI virus into the country, the capacity of HPAI rapid response teams will be strengthened through training and provision of PPEs. District Rapid Response teams will be supported to undertake disease surveillance and monitoring. Systems for rapid investigation and response to rumors by MAAIF teams will be strengthened through procurement of equipment and supplies. UWA s surveillance capacity will be strengthened through 19

28 procurement of bird capture equipment and hiring of surveillance boats. SOPs for rapid response and control of emerging diseases in other species will be developed, printed and disseminated. Specific targeted research will be carried out for HPAI and other emerging diseases. Subcomponent 2: Strengthening of National Veterinary Services (NVS) 4. As part of the control strategy for HPAI and other emerging diseases, this subcomponent will support activities to strengthen NVS, including the private sector operating under its authority, to enhance animal disease surveillance, diagnosis and disease control. This activity will enable the NVS to respond adequately not only to HPAI but also to other trans-boundary animal diseases. 5. Based on the recently concluded evaluation of NVS and related services, support will be provided to strengthen NVS to make it compliant with OIE standards. Emphasis will be in upgrading knowledge and skills of the staff of veterinary services through training and providing the necessary infrastructure for provision of services including equipped laboratories, transport capacity. For HPAI preparedness and control, the current short fall in human resources will be met by hiring personnel on a contractual basis. 6. Standard Operating Procedures (SOPs) for reporting between MAAIF and other line ministries will be developed, pre-tested, printed and distributed. 7. Funds will be provided for dissemination of the Performance Vision Strategy Document that was developed by the OIE after the evaluation of the NVS. Public private partnership will be enhanced by involving the private sector in participatory planning and monitoring. 8. Sero-prevalence surveys will be undertaken to establish baseline data on the epidemiology of re-emerging diseases. The curricula of the Faculty of Veterinary Medicine, Makerere University (FVM-MUK) and Para-Veterinary schools will be reviewed to include HPAI and other TADs. The FVM-MUK will be facilitated to undertake field exercises for HPAI and other TADs surveillance. 9. The project will support strengthening of the regulatory framework to address key policy issues to ensure that the recommended disease control, prevention and eradication measures are implemented in a uniform and effective way and in accordance with OIE standards and guidelines. In addition, support will be provided to review the existing regulations and policies and policy studies that focus on trans-boundary animal diseases. Subcomponent 3: Improved Veterinary Technical Competence for emerging disease prevention, early detection and rapid response 10. Successful prevention of and an appropriate response to emerging diseases depends on the human capacity of NVS. Risk analysis is an increasingly important tool for disease preparedness and prevention. The project will build capacity in risk analysis, design of effective disease control programmes and understanding of infectious disease epidemiology as the main areas of focus to enhance national capacity for preparedness and response for 20

29 HPAI and other TADs. This will be achieved through training and research in various areas of specialisation (risk analysis, infectious disease epidemiology, wildlife surveillance). Simulation exercises for HPAI and other infectious diseases will be undertaken. The project will not only focus on AI but also on other diseases. 11. Personnel from all districts will be trained and sensitized on HPAI recognition and the need for timely and accurate reporting of all suspected outbreaks. Subcomponent 4: A Balanced Veterinary Epidemio-surveillance programme capable of early detection of emerging infectious diseases and other TADs 12. Rapid response to, and successful control and eradication of emerging infectious diseases depends directly on early detection. The capacity for early detection is a product of an effective, balanced integrated animal health surveillance system that is directly linked to rapid response plans for disease emergencies. An effective surveillance system is sensitive, specific, representative, timely, simple, flexible and acceptable to stakeholders. To achieve this, a system must be balanced to include passive and active elements that produce disease intelligence about all livestock and wildlife systems, in a way that brings the animal health priorities of producers to the national decision making level and allows disease prevention and control programs to meet the multi-faceted needs of all consumers of surveillance information. The objective is to strengthen Uganda s veterinary surveillance system by helping the NVS improve its surveillance program by adding active surveillance elements, a Monitoring and Evaluation System (ME), and ensuring an integrated internationally compliant animal health database. 13. The activity will support: (a) passive, active and targeted surveillance, supported by sound epidemiological principles, (b) improving animal health information flow among relevant agencies; (c) early detection and timely reporting and follow-up of suspected or positive cases; (d) public and community-based surveillance system by establishing a community-based early warning system, utilizing existing human health infrastructures at the village level, and (e) routine serological surveys and epidemio-surveillance. 14. An active HPAI surveillance program will be implemented in all high risk areas, live bird markets and at the border areas. Epidemiological mapping of high risk areas will be undertaken in collaboration with MOH. Epidemiological mapping protocols will be developed and discussed with other stakeholders. 15. Animal disease surveillance will be strengthened through provision of the necessary infrastructure, equipment, supplies and transport capacity. 16. The activity will support the upgrading of the laboratories earmarked to carry out diagnostics for HPAI. The MAAIF National Diagnostics and Epidemiology laboratory will be upgraded to contain a Bio-Safety Level 3 (BSL-3) facility and will be expected to carry out HPAI confirmatory diagnosis at molecular level using Polymerase Chain Reaction (PCR) and Real Time PCR (RT PCR) after screening samples using Rapid Antigen Detection kits. Surveillance will be carried out by antibody detection tests. The MAAIF laboratory as a national referral laboratory will collaborate and coordinate with regional and international 21

30 reference laboratories for quality assurance. Capacity at the Central Diagnostic Laboratory will be strengthened through training and provision of laboratory equipment and supplies. 17. The laboratory network will be strengthened to ensure proper coordination of diagnostic activities in the country. The district laboratories will be provided with rapid detection kits to enable them screen samples for routine surveillance and rapid response. Subcomponent 5: Evidence-Based Veterinary Rapid Response Capacity for Emerging Infectious Diseases Preparedness, Detection and control 18. Effective rapid response to infectious disease emergencies depends directly on early detection. The aim of this output is to undertake the following: a. Establish an Incident Command System (ICS) for animal HPAI outbreak response. The NVS will establish an ICS for disease control, and ensure that the necessary equipment and supplies are available at the field level. b. Develop national policies and SOPs for HPAI rapid response and control, including culling, compensation, livestock insurance, movement control, bio-security, vaccination, quarantine. Indicators of completion are Minimum of 7 SOPs for HPAI rapid response and control activities; a vaccine(s) to be used in case of vaccination program identified, and a supplier(s) identified who can have stock available at the district or lower level within 3 weeks of an outbreak report. Provisions for procuring of vaccines and for carrying out vaccination campaigns have been included in the proposal. Vaccine procurement through subscribing to vaccine banks will guarantee availability of vaccines if and when needed. c. Procure rapid response supplies and equipment for all levels of NVS, including PPEs, disinfection units and culling equipment (burdizzos for all field staff for smaller numbers of animals, asphyxiation systems at district level for larger culls. Rapid response equipment and supplies will be procured and stored at the central level. These will be made available within 24 hours to the affected districts. Indicators of completion are sufficient stocks of PPE, disinfection units, burdizzos and asphyxiation systems available in every district. d. Improve commercial farm and backyard poultry production bio-security. This component will support; improved public hygiene in poultry slaughter facilities, poultry product outlets and live-bird markets; bio security protocols for commercial farms and backyards poultry production systems; devising rural poultry sector restructuring strategies to promote poultry housing systems; and training of people likely to be in contact with live virus. e. Strengthen NVS quarantine capacity. This subcomponent supports the following activities; development of SOPs, training and procurement of limited equipment and infrastructure (quarantine facilities) to achieve reliable internal movement control and border quarantine. f. Preparation of compensation Policy and Guidelines. The national AHI preparedness strategy recognizes that a comprehensive compensation policy and guidelines are prerequisites of effective control of AHI outbreaks. Consequently a policy and guidelines 22

31 have been developed and a compensation fund will be established to handle a possible outbreak of HPAI in the country. The policy consequently focuses on four key issues: Subcomponent 6: Coordination, monitoring and evaluation 19. MAAIF will be responsible for coordination, monitoring and evaluation of Animal Health component activities planned under the project. The OPM will be responsible for the overall M&E activities. The project will provide funds to all the implementing ministries responsible for their own coordination, monitoring and evaluation. Part II: Response and Recovery 20. In case of an outbreak, there will be additional costs to cater for immediate response, over and above the expenses related to P&P activities. However, the exact amount cannot be known for the time being because neither the timing nor the extent of an eventual outbreak (or outbreaks) can be anticipated. For this reason, a provision of funds has been earmarked to activities related to the R&R stage to ensure that funds are available in the programme and in the government budget to make immediate interventions in the affected districts and regions in the eventuality of an outbreak. 21. Cost estimates are based on an outbreak scenario which has been described at length in the Animal Health Sector Background paper. It is related to two outbreaks in Mbale district and one outbreak in a commercial farm with 10,000 poultry in the same district. Additional costs will be incurred in terms of need for strengthening the immediate reaction, increasing sanitary measures and improving bio-security. In the event of an outbreak, of HPAI and government wishes to apply part of the credit for compensation, up to US$120,000 of the credit may be used for that purpose. The purpose of the proposed scenario is to make a calculation of the R&R budget based on assumptions that are as realistic as possible, e.g. distance and time needed for interventions (for transport and per diem costs). Compensation cost has been calculated based on the poultry density population of Mbale district. The scenario also provides simple basic data and information that will serve as a multiplier factor in case of a real outbreak. 22. This subcomponent will provide support for immediate reaction to the outbreak; implementation of sanitary measures; quarantine and movement control; strengthening of surveillance; initiation of recovery activities (compensation), improvement of bio-security; strengthening of public awareness; and re-enforcement of active surveillance (e.g. border check posts). Component 2: Human Health (US$2.06 million) 23. The AHIP will strengthen the Human Health strategy for the preparedness and response to Avian Influenza in Uganda by helping to build the Health System Capacity to detect early, respond and contain the infection at source in case of a highly pathogenic avian influenza. In case of a human influenza pandemic, the MOH will build on existing surveillance and response mechanisms established together with partners such as WHO, CDC and others. The process will include adapting guidelines and training materials, conducting training, activating and strengthening of national and district Rapid Response Teams (RRTs), establishing isolation units and pre-positioning personal protective materials 23

32 and medicines. In order to confirm a working diagnosis early, the National Influenza Center (NIC) laboratory will be remodeled and equipped to Biosafety Level 3 (BSL3) and laboratory staff trained. Spread of infection in the community will be detected and contained through health education, community based surveillance and confinement of cases. Infection control guidelines will therefore be among the key activities to be implemented. Part I: Preparedness and Prevention Subcomponent 1: Strengthening of Surveillance of Humans for Influenza 24. Surveillance activities for human influenza will be strengthened in all aspects and the number of sentinel sites expanded from the present three sites to at least eight sites. The MOH has in place the Integrated Disease Surveillance & Response (IDSR) which is a weekly reporting system for priority diseases including human influenza of avian origin. The aim of this subcomponent is to strengthen the existing field disease investigation system and expand sentinel surveillance to cover at least the regional hospitals and community based surveillance in selected high risk districts. The project will ensure that surveillance tools reach the desired end users. This will be achieved through training, ensuring data collection and reporting. The broad functions and activities under this subcomponent are presented below: Function Remarks 1. Case detection & reporting Case definition, Reporting forms for human and animal health events 2. Sentinel surveillance Select districts in high risk areas to capture data on human & animal health events 3. In-service Training Training at national level to strengthen technical capacity and at district level to strengthen AI surveillance activities 4. Epidemiological mapping Mapping of high risk areas for AI 5.Strengthening national and district rapid response teams Purchase of vehicles, equipment and logistics for easy and rapid access to high risk areas and outbreak areas. 6. Investigation of outbreak threats Threats identified from increased threshold from sentinel surveillance data 7. Provide regular feedback Outbreak investigations & surveillance reports 8. Respond to private sector information Work with poultry farmers, media, etc to respond to information on sick and dead confined and/or backyard chickens. 9. Community Based Disease Surveillance Develop reporting forms, train members of the DHT,DVO and Village Health Teams to report suspected sickness and deaths from severe acute respiratory infections and influenza like illnesses 24

33 Subcomponent 2: Strengthening Capacity of Uganda National Health Research Organization (UNHRO) 25. The project will support UNHRO to ensure effective coordination of stakeholders and development of harmonized policies and strategies for active surveillance and laboratory investigations at national and regional levels. It will also build capacity for integrated research and management of new emerging infections e.g. avian influenza, Ebola, Marburg, monkey pox and others. The project will also support UNHRO to coordinate the establishment of the Centre for Infectious Diseases ecology and upgrading of the National Influenza Centre (NIC) laboratory at UVRI to BSL 3 and provision of laboratory diagnostic equipment and reagents. Training of staff and quality control in AI diagnostics, field specimen collection, and testing for influenza viruses including HPAI will also be supported Subcomponent 3: Consolidation of Preparedness for AHI Prevention, Containment and Control 26. Infection control procedures and educational programmes will be developed for the most vulnerable and at risk communities and health workers while at the same time isolation facilities and infection control materials and PPEs will be set up at least at six regional hospitals from where they can be easily accessible to health centres within their catchment areas. Subcomponent 4: Improving Food Safety and Environmental Hygiene 27. In view of a potential risk of an outbreak of Avian Influenza from occupational and environmental exposure to infected poultry and poultry products, the project will support a number of activities and assessments aimed at improving on the level of preparedness and prevention of Avian Influenza in the food industry. The main focus will be on improvement of the environmental, occupational and food safety of poultry and poultry products in the country. The main activities will be carried out in poultry markets in a sample of towns and along major highway food vending points where chickens are slaughtered, roasted and openly sold to the traveling public. These places can be potential sources of unsafe poultry and poultry products and an ideal medium for the rapid spread in case of an avian influenza epidemic. Subcomponent 5: Health Services and Systems Prepared to Handle Suspected Cases 28. The experiences with Ebola Haemorrhagic fever outbreaks in northern and western Uganda shows that the health systems need to be ready for a surge in case of an outbreak. The implementation of this subcomponent will increase the surge capacity and flexible deployment of both human and infrastructure resources. This will be achieved mainly by training of health workers in case management and rapid response, development and conducting of simulation exercises and the development of a contingency plan of human resource management in case of an outbreak. In due course the private health practitioner sector will be included as part of the MOH /Public Private Partnership for Health (PPPH). 25

34 Subcomponent 6: Preparation for Effective Case Management 29. The ultimate aim of any outbreak management strategy is to ensure proper treatment of all cases detected. In addition to the treatment, the project will ensure availability of a limited stock of pharmaceuticals for emergencies (Tamiflu and other antibiotics) while adequate budgetary provision should be made for additional supplies when the situation warrants. Guidelines, SOPs and other accessories and medical supplies used in treatment will also be provided. These drugs and supplies including vaccines (once they become available); will be positioned in a location that makes them easily available to those in need. The project will also provide operational expenses such as those related to mobilization of health teams, allowances and technical assistance. Part II: Response and Recovery Subcomponent 1: Response to Outbreak of Pandemic Influenza of Avian Origin 30. Previous outbreaks of pandemic influenza have shown how rapidly it can spread and the mortality it can bring upon a community. The Project will help create and sustain a system that can rapidly contain the infection as this is one of the key elements which will drastically reduce human to human transmission, suffering and death. Rapid response teams will be activated immediately to undertake active case investigations, detection and provide situation analysis reports. There will be need to intensify collaboration with the veterinary services in the areas of disease surveillance, provision of PPEs, prophylaxis to investigating teams and treatment of human cases to control the spread of the epidemic. In the pandemic phase exceptional measures like quarantine and restricting movement of people, closure of schools, markets etc will be taken by the central government in consultation with WHO. In the recovery phase the project will support restocking of equipment and drugs used by RRT, health facilities and the laboratories. Component 3: Communication (US$1.83 million) Part I: Preparedness and Prevention 31. The main challenges faced in fighting avian influenza relate to lack of motivation due to low risk perception and a general lack of knowledge of avian influenza among the general public and a wide range of stakeholders, especially the small-scale back-yard poultry farmers. To address these constraints, the Project will identify lines of communication, social beliefs, practices and perceptions and habits of stakeholders by improving public awareness and information aimed at fostering positive behavior change. 32. The communication interventions as elaborated in the Communication Strategy of the Project aims at achieving the following objectives: (i) To increase the number of policy makers and community leaders who are aware of AI and actively advocate for AI prevention, preparedness and control. (ii) To increase the number of at risk people who are aware of the signs and symptoms of AI in animals, and the bio- security measures needed to prevent infection; and to 26

35 increase the number of people who promptly report sick and dead birds that might be suspected as cases of HPAI. (iii)to increase the numbers of people who are aware of the signs and symptoms of AHI in humans and also know the proper action to take in case of suspected human infection such as seek prompt treatment at a health centre. (iv) To increase the number of relevant front line workers (veterinarians, para-veterinarians, extension workers, teachers, health workers, border officials and key religious and community leaders including local council members, and district media representative, particularly the FM radio stations) who have a comprehensive understanding of AHI prevention and who can actively train others to take appropriate protective measures. Subcomponent 1: Achieve Advocacy with Key Policy Makers at the National and District Levels 33. This will be done to ensure the support of key local and national policy makers to AI prevention and control efforts. The project will support the development of policy papers on the evolution of AHI globally and in Africa, on the latest information on the science of the outbreaks in birds and on the threat to human beings as well as on the likely damage to the national economy and to family finances and food security. Briefing to policy makers with video support will also be undertaken to help achieve the expected result. Subcomponent 2: To Enhance the Communication Skills of Key Policy Makers and Spokespersons 34. Strengthening the communication capacity and media dealing skills of senior policy makers and spokespersons through small-group trainings, would be an asset in any outbreak situation. The spokespersons and policy makers need to apply the principles of Outbreak communications and maintain trust and transparency in order to secure the trust and compliance of the public especially so during an outbreak. Media training for senior spokespersons will be conducted to enable them to deal more effectively with the media which play a very important role in the control of any outbreak. Subcomponent 3: Establishment of a Communications Center within the Coordination/Operation Center at Central and District Levels 35. Communication Focal Points (CFPs) for AI will be located at the central and district AI Coordination/operation centers. The project will equip the CFPs with dedicated communication facilities, e.g. hotlines and computers with internet connectivity. The CFPs will also be provided with a ready supply of posters and handouts on the basic information on AI for poultry and human health, as well as standard protocols for reporting any outbreaks. The project will ensure availability of the SOPs for the communication chain of command, for urgent passage of information, both up to the central command centre and down to the sub-district and LC levels. 27

36 Subcomponent 5: Development, Production and Evaluation of Relevant Communications Messages and Materials. 36. The public at all levels will need to be kept informed, of the situation in the country, the potential risk from neighbouring countries, and the risk during an actual outbreak. This will involve mounting media campaigns using IEC materials specially developed, pre-tested and prepared to inform people about the risks to their poultry and the associated risk to human health. At the same time a national AHI web-site will be developed for posting and updating information on AHI. Subcomponent 6: Inform and Mobilize a Critical Mass of Communication and Social Mobilization Teams at National and Sub-national Levels 37. The project will inform and mobilize farmers and households with back yard poultry and support their efforts to build partnerships with the district and sub district officials, technical people, religious and cultural leaders and the media. To bring them on board, the project will undertake training at various levels, and this will require development of training modules and training of trainers to ensure quality training. Subcomponent 6: Build Strategic Partnership with the Media 38. The project will support building of strong partnership with the key national and district level media since any local outbreak of AI has the potential of becoming international news. This will be done through regular meetings with news editors and senior journalists and also by including journalists in simulations and table top exercises which reveal the complex nature of outbreaks. A well-informed set of journalists would be able to report responsibly and with a greater understanding of the subject. Subcomponent 7: Develop a Monitoring and Evaluation (M&E) matrix 39. To study the effectiveness of the communications activity and to make mid-course corrections as necessary, the project will support the development and application of an M&E matrix. This would be developed under the supervision of the AHI Communication TWG with the help of a consultant, who will develop the matrix and start the evaluation in the second year. The consultant will also train two M&E staff from MAAIF and MOH. These staff will join the evaluation process from the start, and will continue it further in collaboration with other technical staff in the two ministries. Part II: Response and Recovery 40. The outbreak response strategy should be launched within the first 24 hours of any report of an outbreak and by 48 hours to have the full response in position. However, to ensure this state of readiness, the following outputs are essential to be developed for a six month response strategy, and must be finalized in the next 6 months, as a priority. 41. SOPs for the outbreak communication strategy established. Activities planned include: Chain of command for movement of information from the field (outbreak site) to the central AHI command established; 28

37 Procedure for chain of clearance for all Talking points and press releases established and published; List of authorized spokespersons, including the specific role of the Ministry Communication officers, at centre and districts designated; Key spokespersons provided training in Outbreak Communications and in media skills and dealings. 42. IEC materials for outbreaks in poultry and in humans readied and disseminated particularly to borders and districts at risk. Activities planned include: Prevention and containment messages developed, pre-tested and produced: Posters/ material on quarantine and movement control to be widely disseminated at pre-designated sites Information about compensation policy to be clearly communicated to the community to encourage compliance with culling measures. Experts/Spokespersons to appear on Television and radio explaining the actual situation, without over reassuring the public and maintaining transparency in all measures being taken. In case of infection in a human, ready posters and IEC materials to be intensively disseminated in the affected area. Inform the public through press releases/media talk shows about the dangers to their health and the steps to self protection. In case self- isolation is necessary, the measures would have to be explained in messages from high level political leadership. Specific posters/ material on quarantine outbreak in humans. 43. Media plan for outbreaks is activated. 44. Schedule of regular media briefings established and media informed. Principles of Outbreak communications applied. Activate media surveillance to obtain feedback on rumors and public perceptions and concerns about AI. Ensure the next communication messages address these concerns. Press releases and Fact Sheets drafted and disseminated. Web site regularly updated with latest information. Prepare Key talking points for and regular briefings of the spokespersons on the outbreak situation and the response measures. Professional photographers and videographers will be commissioned to document the situation. 45. Strengthened communication to the public at the outbreak foci or ground zero. 46. Ground level, frontline workers for social mobilization activated. Community mobilization teams activated. Rapid training in correct practices provided to farmers in affected areas. 47. Plan for officially reaching the end of the emergency phase clearly demarcated and restocking/recovery measures clearly communicated to the media and the public. 48. Evaluate the impact of the communication effort and make necessary revision in the strategy for future use. 29

38 Component 4: Coordination, Monitoring & Evaluation (US$0.45 million) 49. This component will support implementation costs associated with project planning, coordination, management, as well as overall monitoring and evaluation (M&E). The Project will therefore support strengthening the effectiveness and quality of project management and operations at the national and local levels of government for overall project coordination and supervision. The project will be implemented at the grassroots level. Therefore, the OPM, as leader of Government Business, will provide overall policy coordination and project M&E at national level, while MAAIF and MOH will coordinate, monitor and evaluate the district offices and health units on the technical aspects of the project to ensure effective implementation, reporting and backstopping. Subcomponent 1: Coordination at National Level 50. This function will be undertaken by the Project Coordination Team (PCT) which will be led by the Project Coordinator/Focal Point Officer in the Disaster Management Department of OPM. The later office will also serve as the secretariat of the National Project Steering Committee (NPSC). The main goals of coordination are three fold: To ensure that the various sectors (human and animal health and the communication sectors) work effectively and efficiently in developing and implementing prevention, preparedness and response policies and strategies for AHI; To facilitate the exchange of and access to all information necessary for the development, adjustment, and implementation of strategies by all actors/players at all levels. To increase the synergies derived from sharing resources, information and experiences. 51. The project will strengthen and support strong inter-linkages among the various sectors of intervention (animal health, human health and communication) to avoid overlaps in the implementation of the different components of the AHIP. The coordination mechanisms will be both multi-ministerial and multi-sectoral partnerships of the NPSC, NTF/AI and TWGs and the wider stakeholders involving DPs and international and local NGOs. The project will also support the inclusion of private human and animal health practitioners and farmers groups and facilitate their participation in the prevention, preparedness and response to AHI and the promotion of public private partnership (PPP) projects on AHI to private companies and investors through PPP fora. Subcomponent 2: Coordination at District Level 52. The project will strengthen coordination between the NTF/AI and district Rapid Response Teams (RRTs) which will play a key role in the preparedness and response to AHI outbreaks. On the coordination point of view, district RRTs will be set up in all 80 districts and district operational plans developed based on the strategies set at central level. The project will support districts to have reliable ways of communicating regularly with the central, counties, sub-counties levels, and with each other. 30

39 Subcomponent 3: Expanded Coordination and Collaboration across Borders 53. The government through the NPSC and PCT in OPM, the NTF/AI and TWGs will maintain its active participation in regional, sub-regional and key international meetings on AHI. The government will therefore increase its involvement in the region and sub-regional prevention and preparedness activities and proactively expand, strengthen its collaboration with all neighboring countries and partners involved in the import-exports of poultry and poultry products. Subcomponent 4: Regular Coordination with DPs 54. It is important to strengthen coordination with DPs to ensure buy-in and additional mobilization of resources for the INAP. To this end the project will ensure that the DPs are regularly kept abreast of project implementation progress. Subcomponent 5: Monitoring and Evaluation 55. Overall M&E by OPM at national level: The OPM has in place a National Implementation, Monitoring and Evaluation System (NIMES). An effective and comprehensive system of monitoring and evaluation for the AHIP activities at all levels and for all sectors needs to be developed and integrated into the NIMES. The data for this system will be provided to the OPM by MAAIF and MOH who are responsible for technical monitoring aspects at both the national and district levels. This would help the NSC to accurately measure progress and achievements, and identify gaps and obstacles so that timely corrective actions can be taken. 31

40 ANNEX 2 REPUBLIC OF UGANDA AVIAN AND HUMAN INFLUENZA PREPAREDNESS AND RESPONSE PROJECT Annex 2: Results Framework and Monitoring PDO Outcome Indicators Base line The overall development objective is to substantially reduce the threat posed to the poultry industry and humans in Uganda by HPAI infection and other zoonoses and to prepare for, control, and respond effectively to future AHI pandemics and other infectious disease emergencies in livestock and humans. Increased % of annual suspected HPAI cases in poultry reported and fully investigated (both laboratory and field) in ten high-risk districts Proportion of veterinary facilities with capacity to diagnose HPAI in at-risk districts 0 0 Data Collection and Reporting YR1 YR2 YR3 YR4 Frequency and Reports Annual 20% 40% 60% 80% Annual Data Collection Instruments Progress Reports Progress Reports Responsibility for Data Collection National Task Force, Committee on HPAI Directorate of Animal Resources (DAR) Percentage of districts with sufficient stocks of PPE, disinfection units, burdizzos and asphyxiation systems Annual Progress Reports MAAIF/Director of Animal Resources Percentage of commercial poultry farms, poultry slaughter facilities, and live bird markets practicing acceptable bio-security standards 0 10% 25% 45% 60% Annual Progress Reports MAAIF/Director of Animal Resources Percentage of veterinary facilities meeting OIE standards for diagnostic laboratories Annual Progress Reports MAAIF/Director of Animal Resources Intermediate Outcomes Component 1: Animal Health Sub-components Strengthened capacity for animal disease surveillance, monitoring and Emergency Disease Control Number of districts reporting promptly on veterinary services Monthly Progress Reports Directorate of Animal Resources 32

41 Strengthened National Veterinary Services Number of districts with adequate GPS equipment and transport facilities for HPAI control Annual Progress Reports MAAIF Directorate of Animal Resources The curricula at MUK/FVM and Para-Veterinary Schools reviewed 0 25% 100 % Annual Consultancy Report MAAIF/UVB Improved Veterinary Technical Competence for Emerging Disease Prevention, Early Detection and Rapid Response Number of sero-prevalence surveys of HPAI and re-emerging zoonotic diseases Annual Survey reports MAAIF/Epidemiology Unit A Balanced Veterinary Epidemiosurveillance Program capable of early detection of emerging infectious diseases and other Transboundary Animal Diseases Full diagnostic competence at MAAIF veterinary laboratory for HPAI differential diagnosis to H5. No Parti al Yes Yes Yes Annual Progress Report Director of Animal Resources 5 high risk districts with active community based surveillance system Annual Survey MAAIF/Diagnostics & Epidemiology Centre Percentage of commercial poultry farms and breeders registered Bi-annual Survey/ Reports MAAIF/DAR Evidence-Based Veterinary Rapid Response Capacity for Emerging Infectious Disease Preparedness, Detection and Control An incident command system established within the NVS for the management of logistics at all levels, and the distribution from national to local level (No. of districts linked each year cumulative) No Yes (10) Yes (20) Yes (30) Yes (40) Annual MAAIF/NTF on HPAI A Balanced Veterinary Epidemiosurveillance Program capable of early detection of emerging infectious diseases and other Transboundary Animal Diseases Number of updated HPAI protocols, SOPs and case definitions printed and distributed 0 20% 60% 80% 100% Annual Progress Reports Project Focal Point Officer/MAAIF Evidence-Based Veterinary Rapid Response Capacity for Emerging Infectious Disease Preparedness, Detection and Control Number of veterinary policies (e.g. compensation) adopted by the Cabinet and legislations passed by parliament Number of Quarantine centers and check points renovated and operationalized 0 1 (on com pens atio n) Annual Progress Reports Project Focal Point Officer/MAAIF Project Focal Point Officer/MAAIF 33

42 Component 2 Human Health Improved public health planning and coordination on AHI Percentage of districts with preparedness and response plans for HPAI Bi-annual Progress Report MOH Improved public health surveillance systems Availability of ILI reports and feedback to districts and regional referral hospitals. Strengthened HPAI prevention and preparedness capabilities Percentage of districts reporting data on influenza-like illness (ILI) using the weekly IDSR system. Number of epidemiological mapping exercises of AI risk factors undertaken in high risk districts. Proportion of districts and regional referral hospitals with bulletins /IDSR feedback reports Bi-annual Annual Bi-annual Survey and Reports Reports Survey MOH and DHO MOH MOH Percentage of districts with trained District Rapid Response Teams Bi-annual Progress Report MOH Component 3: Communication Increased awareness and participation in HPAI infection control and prevention Percentage of population reporting awareness of AHI activities being planned and implemented in the high risk districts 0 25% 45% 55% 65% Bi-Annual Progress Reports/ Surveys MOH & MAAIF Note: GOU intends to complete a baseline survey within about six months of project effectiveness, largely to complete an inventory of the existing equipment in the laboratories, both at the central and district level. This will allow project performance to be monitored and assessed on an objective basis. 34

43 ANNEX 3 REPUBLIC OF UGANDA AVIAN AND HUMAN INFLUENZA PREPAREDNESS AND RESPONSE PROJECT Table 1: Project Cost by Component SUMMARY OF ESTIMATED PROJECT COSTS Annex 3: Summary of Project Costs (In US$ million equivalent) Project Cost by Component Local Foreign Total % of total Animal Health % Human Health % Communication % Coordination, % M&E Total Project Costs % Figures may not add up due to rounding Table 2: Project Cost by Category Category (1) Animal Health: (Works, goods and equipments, consultants services, Training and Workshop, and Operating Costs for Part A of the Project) Amount of the Financing Allocated (expressed in SDR million equivalent) Amount of the Financing Allocated (expressed in US$ million equivalent) Percentage of Expenditures to be Financed (inclusive of Taxes) 3, , % (2) Human Health and Communication: (Works, goods and equipments, consultants services, Training and Workshops, and Operating Costs for 35

44 Parts B and C of the Project) (a) Human Health 1, , % (b) Communication 1, , % (3) Goods and equipments, consultants services, Training and Workshops, and Operating Costs for Part D of the Project % TOTAL AMOUNT 6, ,

45 Table 3: Detailed Project Costs Amount in US$ 000 Project Components 2008/ / / /12 Total Component 1: Animal Health Part 1: Preparedness and Prevention Strengthening capacity for animal health surveillance, monitoring and ,126.0 emergency disease control Strengthening of National Veterinary Services (NVS) Improved veterinary technical competence for emerging disease prevention, early detection, and rapid response A balanced veterinary epidemio-surveillance program ,226.5 Evidence based veterinary rapid response capacity for emerging ,165.5 infectious diseases Part 2: Response and Recovery Strengthening HPAI Control Programs & Outbreak containment Part 3: Coordination, Monitoring and Evaluation Coordination, Monitoring and Evaluation Sub-total 2, , ,657.2 Component 2: Human Health Part 1: Preparedness and Prevention Strengthening of surveillance of humans for influenza Strengthening the Capacity of Uganda National Health Research Organization Consolidation of preparedness for AHI prevention, containment and control Improving safety and environmental hygiene Preparation of health services and systems to handle suspected cases Part 2: Response and Recovery Response to outbreak of Pandemic Influenza of Avian origin Preparation for Effective case management Part 3: Coordination, Monitoring and Evaluation Coordination, monitoring and evaluation

46 Amount in US$ 000 Project Components 2008/ / / /12 Total Subtotal ,066.8 Component 3: Communication Part 1: Preparedness and Prevention Achieve advocacy with key policy makers at National and District levels To enhance communication skills of key policy makers and spokepersons Establishment of a communication centre within the coordination/operation centre at the central and district levels Development of communication messages and materials for electronic and print media Inform and mobilize a critical mass of communication and social mobilization teams at the national, district and lower levels Build strategic partnership with media Part 2: Response and Recovery SOPs for outbreak, communication strategy established IEC materials for outbreaks in poultry and in humans ready and disseminated Media plan for outbreaks Activation of strategies to strengthen communication to the public at ground zero in the affected districts Plan to end the emergency phase demarcated and restocking/recovery measures communicated to the public Part 3: Coordination, M&E Evaluate and assess the impact of the communication effort Office operational costs Subtotal ,

47 Amount in US$ 000 Project Components 2008/ / / /12 Total Component 4: Coordination, Monitoring and Evaluation Project coordination (inter-sectoral, DPs, TWGs, & NPSC meetings) Office equipment and vehicles Support for Public Private Partnership forum on AHI activities Study on the role of private sector in service delivery for AHI activities Participate in sub-regional, regional and key global AHI meetings Monitoring of the implementation of the project Office operational costs Sub-total GRAND TOTAL 3, , , , ,000 39

48 ANNEX 4 REPUBLIC OF UGANDA AVIAN AND HUMAN INFLUENZA PREPAREDNESS AND RESPONSE PROJECT Annex 4: Financial Management And Disbursement Arrangements Introduction 1. This report is a record of the results of the assessment of the proposed financial management arrangements for Avian and Human Influenza Preparedness and Control Project (AHIP) implemented by the Ministry of Health (MOH) and Ministry of Agriculture, Animal Industry and Fisheries (MAAIF) and overseen by the Office of the Prime Minister (OPM). The objective of the assessment is to determine: (a) whether the three implementing entities have adequate financial management arrangements to ensure AHIP funds will be used for purposes intended in an efficient and economical way; (b) AHIP financial reports will be prepared in an accurate, reliable and timely manner; and (c) the project s assets will be safeguarded. The financial management (FM) assessment was carried out in accordance with the Financial Management Practices Manual issued by the Financial Management Sector Board on November 3, Country Issues 2. The Public Expenditure and Financial Accountability (PEFA) Report of November 2005 (issued in July 2006) and Country Financial Accountability Assessment (CFAA) carried out by IDA in 2004 shows that Government of Uganda has made substantial progress in improving its Public Financial Management Systems since the last CFAA undertaken in The fiduciary risks associated with poor budget formulation and budget preparation processes have been reduced. In terms of appropriate legislation and regulatory frameworks, significant progress has been made to ensure that the risk associated with the lack of clear rules and regulations has been reduced. Also more useful information is provided in the Report and Opinion of the Auditor General to Parliament on the Public Accounts of the Republic of Uganda. However risks remain in terms of: (i) Quality and timeliness of in-year budget reports since budget reports only include information on budget releases and not actual expenditures; (ii) Stock and monitoring of expenditure payment arrears; (iii) Effectiveness of internal audit; (iv) Oversight of aggregate fiscal risk from other public sector entities; (v) Effectiveness of measures for taxpayer registration and tax assessment; (vi) Legislative scrutiny of external audit reports; (vii) Effectiveness of payroll controls; and, (viii) Effectiveness in collection of tax payments. Government of Uganda (GOU) has prepared a Financial Management Accountability Program (FINMAP) to address the weaknesses in its Public Financial Management system. The FINMAP is supported by a number of development partners, including the World Bank, that form the Public Financial Management Donor Group. 40

49 Risk Assessment and Mitigation 3. The objectives of the project s financial management system are: to ensure that funds are used only for their intended purposes in an efficient and economical way; to ensure that funds are properly managed and flow smoothly, adequately, regularly and predictably in order to meet the objectives of the project; to enable the preparation of accurate and timely financial reports; to enable project management to monitor the efficient implementation of the project; and to safeguard the project assets and resources. 4. Furthermore, the following are necessary features of a strong financial management system: an adequate number and mix of skilled and experienced staff; the internal control system should ensure the conduct of an orderly and efficient payment and procurement process, and proper recording and safeguarding of assets and resources; the accounting system should support the project s requests for funding and meet its reporting obligations to fund providers including Government of Uganda, IDA, other donors, and local communities; the system should be capable of providing financial data to measure performance when linked to the output of the project; and an independent, qualified auditor should be appointed to review the Project s financial statements and internal controls. 5. The table below identifies the key risks that the project management may face in achieving these objectives and provides a basis for determining how management should address these risks. Risk Risk Rating Risk Mitigating Measures Incorporated into Project Design Inherent Risk Country Level M 2005 PEFA report identified weaknesses in government PFM systems and they are being mitigated under a government PFM reform program called FINMAP. Condition of Negotiations, Effectiveness (Y/N?) 41

50 Risk Risk Rating Risk Mitigating Measures Incorporated into Project Design Entity Level L Legal and institutional frameworks for the three institutions are adequate and performance in core aspects of accounting, financial reporting and auditing is satisfactory. There is a sound framework for legislative oversight. Project Level S It is a complex project implemented by three ministries working with districts, private companies and investors, at regional, sub regional and international coordination levels. However this will be mitigated by satisfactory financial management systems in the MOH, MAAIF and OPM that will ensure funds are spent for purposes intended and accounted for. Control Risk Budgeting L Accounting L Accounting systems are satisfactory in all the three ministries. Staffing is satisfactory and there are accounting policies and procedures in place being adhered too. The IFMIS is used as the computerized accounting system for the three ministries but is not configured to be used for projects. As such, AHIP accounts will be d ll i l d Condition of Negotiations, Effectiveness (Y/N?) 42

51 Risk Internal Control Risk Rating S Risk Mitigating Measures Incorporated into Project Design The three ministries have qualified and experienced internal auditors who have included the project within their work plan to ensure the internal audit unit carries out its role within the project. Accounting policies and procedures are satisfactory. Condition of Negotiations, Effectiveness (Y/N?) Funds Flow L Financial M Reporting However, in the Auditor General s report of 30 June 2006, OPM and MAAIF audited accounts were qualified on an except for basis and MOH had a disclaimer audit opinion. In all the three ministries, issues of lack of accountability were raised in the report hence making the risk of their internal control system substantial. In order to mitigate this risk, the funds for this project have been ring fenced within these ministries and their use will be closely monitored by the Accounting Officer, Internal Audit Unit, Auditor General s Office and the Bank to ensure they are used for purposes intended. There is a likelihood of challenges being Yes- condition faced by the implementing institutions like of negotiation ministries, districts, private companies in regard to and investors, regional, sub regional and OPM, MOH, international organizations in financial MAAIF reporting. This will be mitigated by constant producing and continuous training and monitoring by formats of IFRs. the accountants in the three ministries during project implementation. The three ministries have produced formats of Interim Financial Reports (IFRs) that will be used for AHIP. These formats were agreed with the Bank at the negotiations. Auditing L Audits for the project will be done by the Auditor General using International Standards on Auditing. Overall Risk Rating S H High S Substantial M Modest L Low 43

52 6. The overall residual risk is expected to be moderate upon the mitigation of identified risks in the risk assessment and mitigation table above. 7. The action plan below indicates the actions to be taken for the project to strengthen its financial management system and the dates that they are due to be completed by. Action Date Due Responsibility 1. Production of formats of interim financial reports (IFRs) that will be used for AHIP and agreeing them with IDA. Before negotiations OPM. MOH and MAAIF /IDA 2. The Auditor General s audit report in the three ministries identified accountability issues which, implies that all these implementing institutions will have to improve on their internal control systems to ensure that the project s funds are used for purposes intended. In order to mitigate this risk, the funds for this project have been ring fenced within these ministries and their use will be closely monitored by the Accounting Officer, Internal Audit Unit, Auditor General s Office and the Bank to ensure they are used for purposes intended. To be done during Project implementation. OPM. MOH, MAAIF, Auditor General s Office and IDA Strengths and Weaknesses of the Financial Management System 8. The project financial management is strengthened by the following salient features:- The accounting personnel within the three ministries are adequately qualified and experienced. The project being under the ministries will use the Treasury Accounting Instructions 2003, issued under the Public Finance & Accountability Act 2003 as its accounting policies and procedures. Budgeting arrangements are adequate; External and internal auditing arrangements are adequate; Funds flow arrangements are adequate; and The IFMIS is used as the computerized accounting system for the three ministries but is not configured to be used for projects. As such, AHIP accounts will be prepared manually using excel spread sheets or other accounting packages. The three ministries have adequate financial reporting requirements. They have developed formats for IFRs that have been agreed with the Bank. 9. The project financial management is weakened by the following salient features:- The Auditor General s audit report for 30 th June 2006 for the three ministries identified accountability issues which, implies that all these implementing institutions will have to improve on their internal control systems to ensure that the project s funds are used for purposes intended. In order to mitigate this risk, the funds for this 44

53 project have been ring fenced within these ministries and their use will be closely monitored by the Accounting Officer, Internal Audit Unit, Auditor General s Office and the Bank to ensure they are used for purposes intended. Institutional and Implementation Arrangements 10. No Project Coordination Unit (PCU) is envisaged but there will be a multi-sectoral, sustainable, robust coordination system at central level. A multi sectoral Project Coordination Team (PCT) will be set up. The PCT will be chaired by the office of the Prime Minister (OPM), which is responsible for disaster management and will serve as the secretariat to the Project Steering Committee. The project will largely be implemented by the Ministry of Agriculture, Animal Industry and Fisheries (MAAIF- Animal health component) and ministry of health (MOH-Human health component). The communication and M&E components will be coordinated by the PCT and implemented by the relevant ministries for areas pertinent to their responsibilities, with OPM maintaining the consolidated project data. 11. During project execution the ministries shall individually coordinate project implementation and manage: (a) procurement, including purchases of goods, works, and consulting services; (b) project monitoring, reporting and evaluation; (c) contractual relationships with IDA and other co-financiers; and (d) financial management and record keeping, accounts and disbursements. 12. The three ministries will also constitute the operational link to the IDA and Government of Uganda on matters related to the implementation of the project. 13. The Permanent Secretaries (PSs), of the three ministries, will be the Accounting Officers for the project, assuming the overall responsibility for accounting for the project funds. 14. The project will have a number of implementing units that include ministries, districts, private companies and investors, regional, sub regional and international coordination organizations. Memorandums of Understanding (MoUs) will be entered between the ministries and these implementing institutions. The MoUs should include the following in order to ensure the implementing institutions have adequate financial arrangements acceptable to the Bank. (a) They should have a designated qualified and experienced accountant to budget, account and prepare financial reports in regards to the use of AHIP funds or alternatively submit their accountabilities to the three ministries. (b) They should open a designated AHIP bank account for the funds sent from the ministries. (c) They should have satisfactory accounting policies and procedures in place. (d) They should provide quarterly unaudited interim financial reports (IFRs) to the ministries in regard to the utilization of AHIP funds. These reports should be 45

54 submitted within thirty (30) days after the end of the quarter in order for the ministries to consolidate AHIP IFRs to be submitted to Bank within forty five (45) days after the end of the quarter. (e) They should provide access to both internal and external auditors and the Bank to information in relation to the utilization of AHIP funds. Budgeting Arrangements 15. In all the three implementing institutions, Government planning and budgeting procedures which are documented in the government s Treasury Accounting Instructions, 2003 are followed. These arrangements have been found to be adequate. There is a planning unit that is responsible for budgeting in the ministry. There is also a budget officer responsible for budgeting. All other departments are involved in the budgeting process. The capacity of the accounting staff to fulfill budgeting needs of the project is adequate. Accounting Arrangements 16. Books of Accounts and List of Accounting Codes: All the three implementing institutions will maintain similar books of accounts to those for other IDA funded projects. The books of accounts to be maintained specifically for AHIP should thus be set up and should include: a Cash Book, ledgers, journal vouchers, fixed asset register and a contracts register. A list of accounts codes (Chart of Accounts) for the project should be drawn upon finalization of the accounting computerization process. This should match with the classification of expenditures and sources and application of funds indicated in the Financing Agreement. The Chart of accounts should be developed in a way that allows project costs to be directly related to specific work activities and outputs of the project. 17. Staffing Arrangements: All the three implementing institutions are adequately staffed with qualified and experienced accounting staff. The project s accounts will be prepared by a designated staff in each of these institutions who will report to the Principal Accountant who reports to the Under Secretary and ultimately to the Permanent Secretary. The designated accountant will be assisted by an accounts assistant. Otherwise the OPM has 1 Principal Accountant, 2 Senior Accountants, 3 Accountants while MOH has 1 Principal Accountant, 1 Senior Accountant, 3 Accountants and 5 accounts assistants and MAAIF has 1 Principal Accountant, 1 Senior Accountant, 4 Accountants and a number of senior accounts assistants as well as accounts assistants. 18. In order to ensure that the project is effectively implemented, the three implementing institutions will ensure that appropriate staffing arrangements are maintained throughout the life of the project. 19. Information System: All the three implementing institutions are connected to the Integrated Financial Management System but it has no project module and will not be used to account for the project s funds. However, OPM will prepare the accounts for the project manually using excel spreadsheets, MOH will use its Sun Accounting software and MAAIF will use its Navision Accounting software. The accounting staff in MOH and MAAIF are conversant in preparing the accounts using their accounting software. The risk of OPM using 46

55 excel spreadsheets to prepare accounts is minimal given that few accounting transactions are expected to be processed by OPM. Internal Control & Internal Auditing 20. Internal Controls and Financial Management Manual: The existing Financial Management Manual (FMM) in the three implementing institutions is the Government s Treasury Accounting Instructions 2003 issued under the Public Finance and Accountability Act These procedures, however, fall short on project requirements on external auditing and financial reporting which will be documented in the Financing Agreement. 21. The FMM describes the accounting system i.e. major transaction cycles of the project; funds flow processes; the accounting records, supporting documents, computer files and specific accounts in the financial statements involved in the processing of transactions; the list of accounting codes used to group transactions (chart of accounts); the accounting processes from the initiation of a transaction to its inclusion in the financial statements; authorization procedures for transactions; the financial reporting process used to prepare the financial statements, including significant accounting estimates and disclosures; financial and accounting policies for the Project; budgeting procedures; financial forecasting procedures; procurement and contract administration monitoring procedures; procedures undertaken for the replenishment of the Special Account; and auditing arrangements. 22. In the Auditor General s report of 30 June 2006, OPM and MAAIF audited accounts were qualified on an except for basis and MOH had a disclaimer audit opinion. In all the three ministries, issues of lack of accountability were raised in the report hence making the risk of their internal control system substantial. In order to mitigate this risk, the funds for this project have been ring fenced within these ministries and their use will be closely monitored by the Accounting Officer, Internal Audit Unit, Auditor General s Office and the Bank to ensure they are used for purposes intended. 23. Internal Audit: All the three implementing institutions have qualified and experienced internal auditors. OPM and MOH have 2 internal auditors i.e. a Senior Internal Auditor and an Internal Auditor while MAAIF has 3 internal auditors i.e. a Senior Internal Auditor and 2 Internal Auditors. The Senior Internal Auditor in all the three implementing institutions reports to the Accounting Officer who is the Permanent Secretary although reforms are underway to ensure internal audit reports to an Audit Committee. The internal audit unit issues out reports on a quarterly basis based on their review of the internal control system of the ministry and the management at the ministry takes action on the report. The commissioner Internal Audit in the MFPED also receives copies of the audit reports for monitoring purposes. The qualification and experience of the staff in the unit is adequate and their quality assurance is monitored by the Ministry of Finance, Planning and Economic Development (MFPED) under the Commissioner Internal Audit. In this regard, the internal audit arrangements at the three implementing institutions are adequate. 47

56 Funds Flow Arrangements Bank Accounts 24. The following bank accounts will be maintained by each of the three implementing institutions for the purposes of implementing the project: Designated Account: Denominated in US dollars, disbursements from the IDA will be deposited on this account. Project Account: This will be denominated in local currency. Transfers from the Designated Account (for payment of transactions in local currency) will be deposited on this account in accordance with project objectives. 25. These bank accounts shall be opened at Bank of Uganda in accordance with the Financing Agreement. 26. The signatories for the project will be in accordance with the Treasury Accounting Instructions/ Public Finance and Accountability Act, Payments will be approved and signed by The Accounting Officer (Permanent Secretary) as the principal signatory and the person designated by the Accountant General who in this case is the Principal Accountant. Flow of Funds 27. The three implementing institutions will be using the report-based disbursement method. Funds flow arrangements for the project (through the two bank accounts above) will be as follows: The ministries will prepare a six monthly cash flow forecast for AHIP based on the work plan and submit the Withdrawal Application to the Bank after the effectiveness of the project. Subsequent withdrawal applications should be submitted quarterly with IFRs within 45 days after the end of the quarter. The quarterly periods follow the calendar year quarters hence IFRs should be prepared as of end of March, June, September and December. IDA will make an advance disbursement from the proceeds of the funding based on the cash flow forecast by depositing into a Borrower-operated Designated Account held at Bank of Uganda denominated in US Dollars. Funds can be transferred from AHIP designated account to the project Account denominated in Uganda Shillings to make payments in the local currency. The project expenditure can be paid from either the designated account or the project account. These will include transfers to other implementing units under an MoU such as ministries, research institutions, NGOs and international organizations, private sector agencies, local government/district entities and community facilitation teams who will have to account for the funds before receiving the next transfer. 48

57 FIGURE 1: AHIP FUNDS FLOW CHART (For each of the implementing institutions) IDA Designated Account (USD) in BOU Project Account (UGX) in BOU Transactions paid in either USD or UGX including transfers under an MoU to implementing units e.g. NGOs and international organizations, private sector agencies, investors, etc government/district entities and community facilitation teams Disbursement Arrangements 28. The three implementing institutions have established effective financial management and accounting systems, which will facilitate the introduction of report based disbursement where cash flow forecasts based on work plans are submitted for a period of six months every quarterly period along with IFRs. The IFRs will be submitted for disbursement on a quarterly basis. In order to continue using report based method, we will expect the project to, (a) sustain satisfactory financial management rating during project supervision; (b) submit IFRs consistent with the agreed form and content within 45 days of the end of each reporting period, and (c) submit a Project Audit Report by the due date. Another acceptable method of withdrawing funds from IDA is the direct payment method, involving direct payments from the Credit/Grant to a third party for works, goods and services upon the Borrower s request. Payments may also be made to Bank of Uganda for expenditures against IDA special commitments covering Bank of Uganda s Letter of Credit. IDA s Disbursement Letter will stipulate a minimum application value for direct payment and special commitment procedures. 29. The three implementing institutions will be expected to submit within six months after effectiveness a six months cash flow forecast based on their work plan using the report based method of disbursement to IDA for disbursement. IDA will then deposit funds into the Designated Account and these funds will be used by the Borrower to finance the project. 30. Upon effectiveness, the three implementing institutions will be required to submit an IFR with the six month cash flow forecast to IDA in order to make a deposit to the 49

58 designated (Special) Account. Replenishment of funds from IDA to the Special Account will be made upon receipt of the quarterly IFRs which will contain the 6 monthly cash flow forecast for the subsequent period. If ineligible expenditures are found to have been made from the Designated Account, the Borrower will be obligated to refund the same. If the Designated Account remains inactive for more than six months, the Borrower may be requested to refund to IDA amounts advanced to the Designated Account. 31. IDA will have the right, as reflected in the Financing Agreement, to suspend disbursement of the Funds if reporting requirements are not complied with. Financial Reporting Arrangements 32. Formats of the various periodic financial monitoring reports to be generated from the financial management system will be developed. There will be clear linkages between the information in these reports and the Chart of Accounts. The financial reports will be designed to provide quality and timely information to the project management, implementing agencies, and various stakeholders monitoring the project s performance. 33. The following quarterly IFRs will be produced by the three ministries; A statement of Sources and Uses of Funds for the reported quarter and cumulative period (from project inception) reconciled to opening and closing bank balances; and A statement of uses of funds (expenditure) by project activity/component comparing actual expenditure against the budget, with explanations for significant variances for both the quarter and cumulative period. 34. The three implementing institutions have prepared the formats for the IFRs which were agreed with the Bank during the negotiations. 35. In addition to the above IFRs, the three implementing institutions will also have to submit to the Bank the following information in order to support report-based disbursement: Designated Account (DA) Activity Statement. DA Bank Statements. Summary Statement of DA Expenditures for Contracts subject to Prior Review. Summary Statement of DA Expenditures for contracts not subject to Prior Review. 36. The financial statements should be prepared in accordance with International Public Sector Accounting Standards (which inter alia includes the application of the cash basis of recognition of transactions). The IDA Financing Agreement will require the submission of audited financial statements to the Bank within six months after the financial year end. 37. These Financial Statements will comprise of: (i) A Statement of Sources and Uses of Funds / Cash Receipts and Payments which recognizes all cash receipts, cash payments and cash balances controlled by the entity; and separately identifies payments by third parties on behalf of the entity. 50

59 (ii) (iii) (iv) A Statement of Affairs/ Balance Sheet as at the end of the financial year showing all the assets and liabilities of the project. The Accounting Policies Adopted and Explanatory Notes. The explanatory notes should be presented in a systematic manner with items on the Statement of Cash Receipts and Payments being cross referenced to any related information in the notes. Examples of this information include a summary of fixed assets by category of assets, and a summary of SOE Withdrawal Schedule, listing individual withdrawal applications; and A Management Assertion that Bank funds have been expended in accordance with the intended purposes as specified in the relevant World Bank legal agreement. 38. Indicative formats of these statements will be developed in accordance with IDA requirements and agreed with the Country Financial Management Specialist. External Auditing Arrangements 39. The Auditor General is primarily responsible for the auditing of all government projects. Usually, the audit may be subcontracted to a firm of private auditors, with the final report being issued by the Auditor General, based on the tests carried out by the subcontracted firm. The private firms to be sub-contracted should be among those that are acceptable to the Bank, following a review of audit firms in Uganda. In case the audit is subcontracted to a firm of private auditors, IDA funding may be used to pay the cost of the audit. The audits are done in accordance with International Standards on Auditing. 40. The three implementing institutions will each submit an audit report to the Bank within six months after the end of each financial year for the project components they handle. 41. The arrangements for the external audit of the financial statements of the project should be communicated to IDA through agreed terms of reference. Appropriate terms of reference for the external auditor should be developed by the three ministries and agreed with the Country Financial Management Specialist. A format of the ToR will be shared by the Bank with The three ministries in order to complete the ToR. 42. In the Auditor General s report of 30 June 2006, OPM and MAAIF audited accounts were qualified on an except for basis and MOH had a disclaimer audit opinion. In all the three ministries, issues of lack of accountability were raised in the report hence making the risk of their internal control system substantial. In order to mitigate this risk, the issues raised by the Auditor General should be addressed and internal control systems strengthened. In addition, the other mitigation measure to be adopted will be ring fencing the project s funds within these ministries and ensuring their use will be closely monitored by the Accounting Officer, Internal Audit Unit, Auditor General s Office and the Bank to ensure they are used for purposes intended. 43. GOU does not have a policy that allows public disclosure of audit findings but Article 41 (1) of the Constitution of Uganda allows the public to access this information. The Access 51

60 to Information Bill, No. 7 of 2004 has been drafted to complement the clause in the constitution and is currently with Parliament. The media under the Press and Journalist Act also has access to information such as audit findings. In addition, the public is allowed to attend the Public Accounts Committee of Parliament when it is addressing audit issues. 44. The audit reports that will be required to be submitted by the three implementing institutions and the due dates for submission are: Audit Report Due Date 1) AHIP audited project Financial Submitted within six months after the end of Statements submitted by each implementing each financial year i.e. by 31 st December institutions (OPM, MOH and MAAIF). given that the accounts will be prepared for the year ended 30 th June. Supervision plan 45. A supervision mission will be conducted at least twice every year based on the risk assessment of the project. The mission s objectives will include that of ensuring that strong financial management systems are maintained for the project throughout its life. Reviews will be carried out regularly to ensure that expenditures incurred by the project remain eligible for IDA funding. The Implementation Status Report (ISR) will include a financial management rating for the components. This will be produced by the World Bank Country Financial Management Specialist after an appropriate review. Conclusion of the assessment 46. A description of the three implementing institutions financial management arrangements above assesses the financial management risk as substantial, but based on the improvements envisaged under the financial management plan (detailed above), the residual risk is considered as moderate. Thus, the project satisfies the Bank s minimum requirements under OP/BP10.02, that with the planned improvements, the financial management system will be adequate to provide, with reasonable assurance, accurate and timely accounts/information on the status of the project, as required by the Bank. 52

61 REPUBLIC OF UGANDA ANNEX 5 AVIAN AND HUMAN INFLUENZA PREPAREDNESS AND RESPONSE PROJECT A. General Annex 5: Procurement Arrangements 1. Procurement for the proposed project would be carried out in accordance with (i) the World Bank s Guidelines: Procurement under IBRD Loans and IDA Credits dated May 2004, revised October 2006; (ii) Guidelines: Selection and Employment of Consultants by World Bank Borrowers dated May 2004, revised October 2006, (iii) the Simplified Procurement Plan as permitted by the new OP 8.00, and (iv) the provisions stipulated in the Financing Agreement and Legal Agreement or any other method accepted by the Bank. For each contract to be financed by the Avian and Human Influenza Preparedness and Response Project (AHIP), the different procurement and consultant selection methods, estimated costs, prior review requirements, and time frame are agreed between the Recipient and the Bank project team in the Procurement Plan. The Procurement Plan will be updated at least annually or as required to reflect the actual project implementation needs and improvements in institutional capacity. 2. Procurement of Goods: Goods procured under this project would include; resettlement items, vehicles, motorcycle, bicycles, office equipment and accessories, stationery, furniture as well as vehicle and motor-cycle tyres. The procurement will be done using Bank s SBD for all ICB and National SBD satisfactory to the Bank. Framework Contracts for common small value supplies will be procured annually so as to enable the implementing agency to place orders for urgently needed supplies at short notice, at a competitive price. 3. Procurement of non-consulting services: Procurement of non-consulting services will be done using the Bank s sample SBD for non-consulting services for all ICB and NCB agreed with or satisfactory to the Bank and for shopping, the PPDA solicitation template will be used. 4. Standard Bidding Documents (SBDs) for Works and Goods: The use of World Bank Standard Bidding documents (SBDs) is mandatory for all ICB/LIB procurement of works and goods. All contracts following National Competitive Bidding, and other lower procurement procedures (shopping, and selective tender for smaller works contracts) will follow the national public procurement law (PPDA 2003 Act and its Regulations). These procedures have been reviewed by the Bank and found to be acceptable, except for the following provisions which will not be applicable under this project. (i) Negotiations with the best evaluated bidder is inappropriate, except for consulting services contracts, and for contracts procured through direct contracting; (ii) the merit point system for bid evaluation shall not be applied for goods and works contracts. (iii) Any Direct Contracting, or Single 53

62 Source Selection, should be used on exceptional basis with adequate justification and with the Bank s prior approval. 5. Procedure for Shopping: For clarity and removal of doubt, the following procedures will be followed for shopping. Request for quotations shall be from as many suppliers or contractors as practicable, but from at least three. The request for and quotations shall be in writing and the quotations shall be submitted and opened at the same time. The request for quotations shall contain all required specifications (and drawings, if needed, in case of works); standards etc. to enable the supplier or contractor provide a complete quotation. Invited bidders shall be required to acknowledge receipt of the RFQ and copies of this acknowledgement shall be kept on the respective procurement files. Each supplier or contractor from whom a quotation is requested shall be informed of the place, time and method of submission of quotations and whether any elements, apart from the charges for the goods or services themselves, such as transportation and insurance charges, customs duties and taxes, are to be included in the quotations or not. Each supplier or contractor may only give one price quotation and may not change this quotation, once the quotations are submitted and opened. No negotiations shall take place with respect to a quotation submitted by the supplier or contractor. 6. Selection of Consultants: Consultancy services will be required as indicated in the procurement plan. For all contracts to be awarded following QCBS, LCS and FBS, the Bank s Standard Request for Proposals will be used. 7. Training and Workshops: These will be carried out on the basis of approved programs on a yearly basis. The programs will identify the general framework of training and similar activities for the year, including the nature and objectives of training, conferences, workshops, institutions where training/ workshops would be conducted (selection of institutions and justification thereof), cost estimates and contents of the course, the number of participants, cost estimates, and the translation of the knowledge gained in the actual implementation of project components. 8. Incremental Operating Costs: This will cover project implementation-related expenditures such as in-country travel and per-diem, office supplies, office rentals, utilities, vehicle and equipment maintenance, communication costs, etc. They will be procured using the implementing agency s administrative procedures reviewed and found acceptable to the Association. 9. Procurement through IAPSO: Procurement of specialized equipment required for this emergency project (e.g. PDAs, GSI mappers and 4WD vehicles for specimen collection and rapid response) will be undertaken through the UN IAPSO as indicated in the procurement plan. 10. Assessment of the Agencies Capacity to Implement Procurement: The Project will be implemented by the Ministry of Agriculture, Animal Industry and Fisheries (MAAIF) and Ministry of Health (MOH) and coordinated by the Office of the Prime Minister (OPM). The OPM will have the overall responsibility to: (a) assure steady progress of the procurement in accordance with an implementation schedule reviewed and approved by the 54

63 World Bank; and (b) ensure satisfactory implementation of procurement activities included in all contracts. A capacity assessment was carried out by Ms. Grace Nakuya M. Munanura, Procurement Specialist, Uganda Country Office, of the Ministry of Agriculture, Animal Industry and Fisheries on April 25, 2008 and for the Ministry of Health on April 29, 2008, and completed on May 06, B. MAAIF 11. MAAIF has a Procurement and Disposal Unit (PDU), which has 3 Procurement staff a Principal Procurement Officer (PPO) and 2 Procurement Officers (PO). The Officers are all conversant with procurement using the Country System. Although none of the staff in the PDU have received any training in World Bank Procurement procedures, the PPO worked as a Procurement Officer on an IDA funded project Primary Education and Teacher Development Project in the Ministry of Education from The PDU reports to the Permanent Secretary. 12. MAAIF has a fully functional Contracts Committee) in accordance with the Procurement Act. The Committee has been fully involved in the review and approval of Procurement Documents (Bidding Documents, Evaluation Reports and Contracts award) and therefore has experience in the review of these documents using the PPDA Act. 13. Although the Ministry has 6 projects funded by ADB, the projects have Implementation units which prepare their own documentation, which are then forwarded to the PDU for presentation to the Contracts Committee. The PDU workload therefore consists of the Government of Uganda funded procurements only. 14. The Ministry maintains an acceptable Procurement Records management system. The storage space and equipment available is fully occupied. The Bidding documents (using PPDA SBD s) viewed were well prepared with clear evaluation criteria and detailed technical specifications. 15. The Evaluation reports reviewed indicated that the evaluations were not well conducted there was an instance of using criteria not specified in the solicitation documents and another of elimination of qualified bidders for not presenting documents that they had in fact presented this points to a case of negligence by the PDU or Contracts Committee in failing to review the evaluation reports thoroughly, or possible collusion to eliminate some bidders, or insufficient internal controls to note such errors. A member of the PDU should participate in all Evaluation processes and guide the evaluation teams to ensure correct evaluation 16. A procurement plan based on the Country System templates was in place. The plan however doesn t adequately cover the key stages of the procurement process and the duration and would therefore not be a good tool for planning purposes. 17. Considering the volume of Procurement to be conducted under the Project and the capacity of the agency, the overall risk for procurement of MAAIF to the Project is Average. 55

64 C. MOH 18. MOH has a Procurement and Disposal Unit (PDU) which has 4 Procurement staff a Principal Procurement Officer (PPO also Head of Procurement Unit (HPDU)), a Senior Procurement Officer (SPO), and 2 Procurement Officers (PO). The Officers are all conversant with the use of the Country Systems. 19. The HPDU has not received training in IDA funded procurement procedures but has experience including working on 2 IDA funded projects. He also previously worked in the Supply Chain in the WFP. The SPO has had training in Goods, works and Consultancies under IDA funded projects as a Procurement Officer on an IDA funded project. The rest of the staff in the PDU have not received any training in World Bank Procurement procedures training but are proficient in the use of the country systems. 20. MOH has a fully functional Contracts Committee consisting of 5 members in accordance with the Procurement Act. The Committee has been fully involved in the review and approval of Procurement Documents (Bidding Documents, Evaluation Reports and Contracts award) and therefore has experience in the exercising oversight over the procurement process. 21. The Ministry maintains an acceptable Procurement Records management system each procurement is kept in a well marked procurement file with most of the records on file. Payment records should also be included in the file. The Bidding documents (using PPDA SBD s) viewed were well prepared with clear evaluation criteria and detailed technical specifications. The Evaluation reports were also of acceptable quality. 22. A procurement plan based on the Country System templates was in place. The plan however doesn t adequately cover the key stages of the procurement process and the duration and would therefore not be a tool for planning and monitoring purposes. 23. The Ministry, however, needs to address the following challenges: (i) lack of storage space - the storage space and equipment available is fully occupied, (ii) recruitment of storekeeper to ensure deliveries are recorded when made and to keep track of the distribution of the goods/equipment, and (iii) Use of the Goods Received Note on receipt of goods. 24. Considering the volume of Procurement to be conducted under the Project and the capacity of the agency, the overall risk for procurement of MOH to the Project is Average. D. OPM 25. A Procurement Capacity Assessment of the OPM was conducted in July 2007 by Howard Centenary, Procurement Specialist, Uganda Country Office. 26. The OPM has a PDU headed by a Principal Procurement Officer, who is supported by a Procurement Officer. Both officers have very limited experience in IDA procurement; they however have some experience in the use of the Country system under which most of their procurements are handled. 56

65 27. It was established that: (i) the solicitation documents are well prepared, (ii) the bidding process well managed, (iii) The Bid evaluation reports were of fair quality, (iv) the Ministry Contracts Committee reviews all the key stages of the procurement process and wards contracts, and (v) the PDU has a good records keeping system. 28. In light of (i) the very limited experience of the Procurement Officers under the project, and (ii) the limited procurement to be done under the project, the risk to procurement management by the OPM is Average. E. OVERALL PROJECT RISK ASSESSMENT 29. In light of: (i) the experience of the HDPU of MAAIF and MOH; (ii) the limited procurement to be done under the project; and (iii) that there are no reports of political interference in all the ministries, the risk to procurement management for this project is Average. F. ACTIONS TO MITIGATE OVERALL RISK 30. Considering the multi-agency nature of the project, the Project Coordinator in liaison with IDA, shall organize a project launch upon effectiveness of the project. In addition to confirming readiness for implementation, the launch shall be used to; (i) explain the responsibilities and roles of each of the entities, (ii) to update all PDU, CC members and user departments of the applicable procedures and (iii) to review key elements of the Project Implementation Manual. G. PROCUREMENT THRESHOLDS Expenditure Category Contract Value Threshold (US$) 1. Works 1.2 Above US$ 500, Below US$ 500, Below US$ 100, Goods 1.8 Above US$ 200, Below US$ 200, Below US$ 30,000 Procurement Method ICB NCB Shopping / selective bidding ICB NCB Shopping Review Prior Post Post Prior Post Post 57

66 Expenditure Category 3. Consulting Services Training and Contract Value Threshold (US$) 1.13 With firms above US$ 100, With individuals above US$ 50, With Firms below US$ 100, With Individuals below US$ 50,000 Procurement Method QCBS/LCS Individual Qualifications/Other Individual Review Prior Prior Post Post 4. Non Consulting Services 5. All Types of contracts 1.20 Above US$ 100, Below US$ 100, Below US$ 30, All Contracts ICB NCB Shopping Sole source / Direct Contracting and TORs Prior Post Post Prior H. PROCUREMENT PLAN 31. The Recipient, at appraisal, developed the procurement plan below for the first 6 months of project implementation. This plan covers goods, works and services to be procured for project implementation and the procurement methods to be used. The Procurement Plan will be updated in agreement with the Bank annually or as required to reflect the actual project implementation needs and improvements in institutional capacity. I. FREQUENCY OF PROCUREMENT SUPERVISION 32. In addition to the prior review supervision to be carried out from Bank offices, the Bank will carry out supervision missions at least three times a year to conduct post review of contracts which are not subject to prior review requirements. The procurement post-reviews should cover at least 20% of contracts subject to post-review. 58

67 Component 1: MAAIF Ref. Contract ( Description) Estimated Procurement Domestic Expected Bid Comments No Cost ($) Method preference Opening Date (a) GOODS 1 Procure capture and sampling equipment 2 Procurement of Services for : Lot 1: Printing and Distribution of SOPs Standard Operating Procedures(Rapid Response) Lot 2: Printing and dissemination of SOPs ( Sample collection) Lot 3: Print and distribute the revised surveillance protocols, SOPs 3 Procurement of : Lot 1: 3 Station Wagons, Lot 2: 2 No. Double Cabin pickups at national level for RRTs Lot 3: 10 No. Double Cabin pickups for high risk districts DRRTs Lot 4: 50 No. Motorcycles for district veterinarian in high risk areas District Rapid response teams (DRRTs) 4 Develop, pretest and update SOPs ( Reporting for MOH & 15,000 Shopping Yes 65,000 NCB Prequalification (Yes/No) No Yes No Review by bank (Prior/Post) Post Post 15 th Sept th Sept ,000 ICB No No Prior 23 rd October ,000 Shopping Yes No Post 14 th Sept 2008 MAAIF) 5 Procure GPS sets for DRRTs 4000 Shopping Yes No Post 15 th Sept,

68 6 Print and distribute the national policies for HPAI contract (for technocrats, private sector and policy makers) 7 Procurement of: Lot 1: Personal Protective Equipment (PPEs), Lot 2: Burdizzos, Lot 3: Asphyxiation system, Lot 4: PM Kits, Lot 5: disinfectants 38,500 NCB Yes No Post 20 th Sept ,000 ICB Yes No Prior 16 th October 2008 Component 2: MOH Ref. No. Contract (Description) A) GOODS 1. Procure 38 PDAs for data collection + B6 2. Procure 3 GIS/Health mapper equipment for national level field activities 3. Procure three 4WD Vehicles for field activities, specimen collection and rapid response (3@40,000) and one vehicle/ambulance for case management and referral 4. Procure Lab Reagents and supplies Estimated Cost ($ mill) excludes local taxes Procurem ent Method 50,000 Direct Contractin g 10,000 Direct Contractin g 160,000 Direct Contractin g Prequalificat ion (yes/no) Domest ic Prefere nce (yes/no) Review by Bank (Prior / Post) Expected Bid- Opening Date Com ment s NO NO Post Supply by IAPSO NO NO Post 05/09/08 Supply by IAPSO NO NO. Prior 05/09/08 Supply by IAPSO 20,000 Shopping NO NO Post 17/09/08 60

69 Ref. No. Contract (Description) 5. Procure office supplies (equipment, stationery) for Operational and logistical support to the Desk Office and NFT/AHI 6. Printing Guidelines & SOPs for food safety and poultry processing, infection control SOPs for Health Units and influenza treatment protocols 7. Printing of Training Manuals handouts reference material media related, SOPs for outbreak communications and media kits 8. Procurement of : Lot 1: Two 4WD Vehicles for MOH & MAAIF for outbreak communication activities, Lot 2: 20 Motorcycles for Health Educators in 10 Hard to reach and risky districts Lot 3: two fully equipped multimedia vans for MAAIF to facilitate mobilization with video and road shows Estimated Cost ($ mill) excludes local taxes Procurem ent Method Prequalificat ion (yes/no) Domest ic Prefere nce (yes/no) Review by Bank (Prior / Post) Expected Bid- Opening Date 10,000 Shopping NO NO Post 02/09/08 16,000 Shopping NO NO Post ,000 NCB NO NO NO 19/09/08 240,000 ICB NO NO Prior 30/09/08 9. Printing of IEC Materials 85,000 NCB NO NO Post 25/11/ Procurement of : Lot 1: 12 Computers, Lot 2: 12 Fax Machines, Lot 3: 1 No. Photocopiers, Lot 4: 3 Printers Lot 5: 2 Scanners 60,000 NCB NO NO Post 23/09/08 Com ment s 61

70 Ref. No. Contract (Description) B) WORKS 1. Construction/remodeling of isolation units 3 regional Referral hospitals 2. Upgrading of NIC Laboratory at UVRI to a BSL3 facility Estimated Cost ($ mill) excludes local taxes Procurem ent Method Prequalificat ion (yes/no) Domest ic Prefere nce (yes/no) Review by Bank (Prior / Post) Expected Bid- Opening Date 150,000 NCB NO NO Post ,000 Shopping NO NO Post Com ment s CONSULTANCY ASSIGNMENTS WITH SELECTION METHODS AND TIME SCHEDULE Ref. No. Description of Assignment Estimated Selection Method Cost (US$ mill) Review by Bank (Prior / Post) Expected Proposals Submission Date 1. Undertake KAP study in 10 selected 90,000 Individual Prior 04/09/08 districts 2. Dissemination of the study findings 5,000 Individual Post 25/11/08 Comm ents 3. Technical assistance of a media specialist to facilitate skills development of Key spokespersons and policy makers 12,000 Individual Post 06/11/08 62

71 ANNEX 6 REPUBLIC OF UGANDA AVIAN & HUMAN INFLUENZA PREPAREDNESS AND RESPONSE PROJECT Annex 6: Implementation and Monitoring Arrangements Overall Project Organization and Management 1. General Considerations: In considering the institutional arrangements for this multisectoral project, due regard has been paid to the lessons learned over the past several years. Experience shows that the following aspects need to be considered, and fulfilled as much as possible, for multi-sectoral projects to be successfully implemented: (i) high level of support at the political and policy level; (ii) a sizeable level of autonomy for the sectoral ministries; (iii) stakeholder participation; (iv) sustainable funding mechanism; and, (v) coordinated implementation of projects and programs. Further, consistent with the agreements reached under the Paris Declaration (March 2005), a stand-alone project coordination unit will not be set-up. Instead, the project will be implemented under regular government structures, through the key technical ministries/agencies - MAAIF, MOH, and the OPM. Apart from providing strong linkage at the political level, the OPM is directly responsible for disaster management. 2. Project Organization: At the apex, the project will have a National Project Steering Committee (NPSC), comprising Ministers and Permanent Secretaries of the implementation ministries and a number of other relevant ministries/agencies. The NPSC will report to the Cabinet though the OPM. Below the NPSC, the project will have a National Task Force on Avian Influenza (NTF/AI), comprising senior technical officials nominated by the Permanent Secretaries and Heads of relevant GOU ministries and agencies. Both the NPSC (previously referred to as the NSC) and the NTF/AI are already in place. They were set up in 2006 at the time when the NTF/AI was asked to prepare the National Plan of Action for Preparedness and Response to Avian Influenza in Uganda. At the implementation level, the project will have a Project Coordination Team (PCT) comprising senior and experienced officials from the OPM, MAAIF, and MOH. The organization chart for the project is shown in Appendix 1, whilst details relating to the above bodies are discussed below. The AHI focal point officer in the Department of Disaster Management, OPM, would serve as the Project Coordinator for the project. Institutional Arrangements 3. National Project Steering Committee (NPSC): The NPSC is chaired by the Minister for General Duties in the OPM, and comprises the Ministers and Permanent Secretaries of the following ministries/agencies: (i) OPM; (ii) MAAIF; (iii) MOH; (iv) Ministry of Foreign Affairs; (v) Ministry of Internal Affairs; (vi) Ministry of Local Government (MOLG); (vii) Ministry of Tourism, Trade and Industries (MTTI); (viii) Ministry of Finance, Planning and Economic Development (MFPED); (ix) Deputy Secretary of the Treasury, MFPED; (x) Representatives of Uganda Revenue Authority (URA), FAO, WHO, Chairperson of the 63

72 Poultry Association of Uganda; and (xi) the Director of Information, OPM. The NPSC will be convened by the Chair on a quarterly basis. The Department of Disaster Management, in the OPM will serve as secretariat to the NPSC, whilst the Project Coordinator will serve as the Secretary to the NPSC. 4. The NPSC will be responsible for the following: To provide policy direction and strategic planning, including approval of the project s annual work plans and budgets; To ensure accountability from all sectors participating in the project; To provide an enabling environment and allocation of necessary resources for effective implementation of the AHI INAP and the project; To provide high level political support; To provide linkages with other relevant sectors, institutions, and stakeholders; and, To mobilize resources for the implementation of INAP from development partners, government, and other stakeholders. 5. National Task Force on Avian Influenza: To provide technical advice to the NPSC for sound policy making, the government has set up a National Task Force on Avian Influenza (NTF/AI). The key responsibilities of the NTF/AI are to: provide technical backup to the NPSC; plan the technical preparedness and response actions (surveillance, prevention, containment, health system s response and communication) for AHI; and, to monitor and evaluate performance as required by the NPSC. The NTF/AI is co-chaired by the MOH Commissioner for Health Services and the MAAIF Commissioner for Livestock Health and Entomology, and includes members from OPM, MAAIF, MOH, Uganda Virus Research Institute (UVRI), Livestock Research Institute (LIRI), Uganda Wildlife Authority (UWA), Uganda Wildlife Education Center (UWEC), MOLG, MTTI, FAO, UNICEF, WHO, NGOs such as Nature Uganda and Uganda Media for Health, International Committee of the Red Cross and Red Crescent (ICRC), and the Poultry Association of Uganda (representing the private sector). GOU also invites DPs such as DFID, EC/EU, Japan Embassy, USAID, and the World Bank, to meetings of the NTF/AI. 6. Technical Working Groups (TWGs): Six TWGs, reporting to the NTF/AI, have also been set up. These TWGs work on further development and implementation of key strategies in the following areas: (i) Surveillance; (ii) Public Awareness and Advocacy; (iii) Food Hygiene and Safety, Containment, Culling, Compensation, and Vaccination for poultry; (iv) Drugs and Supplies; (v) Case Management of human cases; and (vi) Resource Mobilization. All the relevant ministries/agencies are well represented in the TWGs. In particular, MAAIF and MOH have already established close collaboration, and have conducted joint awareness and sensitization activities, and joint surveillance. 7. Project Coordination Team (PCT): As indicated earlier, the project design embraces the use of existing country systems and structures. The three ministries responsible for project implementation OPM, MAAIF, and MOH have each nominated senior and experienced technical staff from amongst their ranks as the Focal Point Officers for the project, who will serve on the PCT. These focal point officers would be responsible for the day-to-day coordination and management of implementation matters relating to their respective ministry 64

73 or department, to ensure that they are implemented effectively and in accordance with approved work plans and budgets. The PCT officers will carry out their tasks in close collaboration with the implementation staff, both at the national level and in the field. Within their relevant ministries, the focal point officers would continue to report on project progress through their departmental structures. Three departments from OPM will be represented on the PCT. These are Department of Disaster Management and Refugees, Department of Information, and the Department for Coordination and Monitoring and Evaluation. MAAIF and MOH have each nominated one Focal Point Officer. In addition to the above five members of the PCT, two other nominees (one each from MAAIF and MOH) representing the key Communication aspects of the project, will complete the PCT. Whilst the team is expected to work closely on a collegial basis, to achieve project objectives and for practical reasons, the focal point officer from the Department of Disaster Management (OPM) would serve as the Project Coordinator. To facilitate its work, including for reporting purposes, the PCT would be able to co-opt other colleagues involved in project implementation (e.g. financial management, procurement, M&E). The MAAIF and MOH focal point officers would be responsible for compiling their sector s progress report on project activities on a quarterly basis, and sharing it with the Project Coordinator. The Project Coordinator will consolidate the progress reports from the three ministries for presentation to the NPSC. Animal Health Component 8. The Animal Health Component of the Project will be implemented in the Department of Livestock Health and Entomology (DLH&E) under the overall supervision of the Permanent Secretary of the MAAIF, who is the Accounting Officer of the ministry. The Focal Point Officer in DLH&E will oversee the day-to-day running of the project, under the guidance of the Commissioner, Livestock Health and Entomology, who is the Co-chairperson of the NTF/AI. The Commissioner reports directly to the Director of Animal Resources, who in turn reports to the Permanent Secretary (PS) MAAIF. The project will utilize the existing civil service structure under the Directorate of Animal Resources. 9. Activities associated with wild birds will be undertaken by UWA. The latter has an existing Memorandum of Understanding with MAAIF for purposes of wildlife disease surveillance and reporting. 10. At the district level, district veterinary staff headed by the District Veterinary Officer (DVO) will be responsible for the implementation and coordination of project activities in all the districts under the technical supervision of the Commissioner, Livestock Health and Entomology. 11. Private veterinarians will supplement the activities of the district veterinary staff and participate in project activities under the coordination of the Uganda Veterinary Association and professional supervision of the Uganda Veterinary Board. 65

74 Human Health Component 12. The Human Health Component of the Project will be implemented in the Ministry of Health under the overall supervision of the Permanent Secretary of the Ministry, who is also the Accounting Officer. The project will utilize the existing civil service structure under the Directorate of Clinical and Community Health and will be operationalized in the Department of Community Health. The Focal Point Officer of MOH, who will be responsible for day to day implementation and coordination of the human health component, will report to the Commissioner for Health Services (CHS/CH). 13. At the district level, District Health Officers (DHOs) and Medical Superintendents will be responsible for the implementation and coordination of project activities in all districts and hospitals, respectively, under the technical supervision of the CHS/CH. 14. Responsibility for Preparation of Annual Work Plans: The relevant government departments will be responsible for the preparation of annual work plans and budgets as well as quarterly and annual project management reports. The OPM will be responsible for consolidating the annual work plans and budgets for submission to the NPSC and the World Bank. 15. Compensation Arrangements: With respect to all cash transfers or other forms of compensation, an adequate operational review will be in place to confirm the validity and legitimacy of the said transfers. In addition, the external auditors will provide an opinion on the soundness of accounting, reporting, and internal controls in respect of cash compensation activities. 16. Project Implementation Plan: A Project Implementation Plan (PIP) is to be prepared prior to effectiveness to facilitate the management and implementation of the project. 66

75 UGANDA AHIP - APPENDIX TO ANNEX 6 Project Coordination Framework Rt. Hon. Prime Minister National Project Steering Committee OPM, MAAIF, MOH, MTTI, URA, MOIA, MOLG, Uganda Poultry Association National Task Force on Avian & Human Influenza (Provides technical advice to NPSC Project Coordination Team: OPM [Disaster Management & Refugees, Coordination & Monitoring, and Directorate of Information]; MAAIF & MOH 67

76 Annex 7 REPUBLIC OF UGANDA AVIAN & HUMAN INFLUENZA PREPAREDNESS AND RESPONSE PROJECT Annex 7: Project Preparation and Appraisal Team Members TIME TABLE FOR PROJECT PREPARATION Milestone Available Date Appraisal April 22 May 9, 2008 Negotiations May 19 20, 2008 VP s Approval May 27, 2008 Board Approval (indicative) June 12, 2008 Expected Date of Effectiveness August 1, 2008 Credit Closing June 30, 2012 It is proposed that this project be processed using streamlined procedures. IDA TASK TEAM Name Title Unit Wilson Onyang Odwongo Rural Development Specialist / AFTAR Task Team Leader Madhur Gautam Lead Economist AFTAR Mohammed Taqi Sharif Consultant AFTAR Edith Mwenda Senior Counsel LEGAF Francois Le Gall Lead Livestock Specialist AFTAR Luis Schwarz Sr. Finance Officer LOAFC Peter Okwero Sr. Health Specialist AFTH1 Mary Bitekerezo Sr. Social Dev. Specialist AFTCS Jane Kibbassa Environmental Specialist AFTEN Grace Munanura Procurement Specialist AFTPR Patrick Umah Tete Senior FM Specialist AFTFM Veronica Schreiber Health Specialist AFTAR Yves Jantzem Operations Analyst AFTAR Harriet Kiwanuka Team Assistant AFMUG Meseret Kebede Program Assistant AFTAR Patrice Sade Team Assistant AFTAR 68

77 ANNEX 8 REPUBLIC OF UGANDA AVIAN AND HUMAN INFLUENZA PREPAREDNESS AND RESPONSE PROJECT Annex 8: Environmental and Social Safeguards Framework Environmental assessment: Environmental Category B 1. The project falls under the Bank s Global Program for Avian Influenza Control and Human Pandemic Preparedness and Response (GPAI). Most of the activities under the proposed project are not expected to generate any adverse environmental effect, since a large part of the project is geared to supporting prevention activities. The project will, overall, have positive environmental and social impacts. Since the Project supports investments for the disposal of carcasses and laboratory wastes, an Environmental and Social Safeguards Assessment Framework (ESSAF) and an Environmental Management Plan (EMP) for carcass disposal facilities will be necessary. The ESSAF would provide guidance on the approach to be taken during implementation for the selection and design of proposed investments and planning of mitigation measures, including consultation and disclosure requirements. The EMP will address the clean up of animal wastes of infected and culled poultry. The scope of this EMP will be specified during the initial period of project implementation. The EMP will include guidelines for carcass disposal facilities; it will summarize the potential negative impacts of disposals, as well as provide measures for mitigating and monitoring those impacts. 2. While the EMP is being prepared, the project will follow interim guidelines and operating procedures to manage and monitor potential negative impacts of carcass disposal. Precautions have been taken under the project to avoid or minimize such impacts by integrating environmental and public health safety aspects in the preparation, design, and implementation of the project. However, adverse environmental health impacts, mainly inadvertent spread of HPAI, could occur when an emergency operation involves containment of HPAI outbreaks through quarantine, isolation and stamping out actions and when relevant mitigation measures are not in place. The potential adverse environmental impacts identified above will be mitigated by integrating environmental and public safety aspects in all stages of the project. The Government is preparing Guidelines for safe culling, transport and safe disposal of carcasses, which will be supported under the project. These interim guidelines and procedures will be formulated by a technical expert to the PCT. These provisions will be included in the PIP/PIM, to be finalized prior to disbursement. The PIP/PIM will be updated as necessary to reflect any modifications or additions to the procedures that are recommended in the EMP. 3. The proposed investments in laboratory facilities, equipment and staff training will improve the effectiveness and safety of avian influenza handling and testing procedures by meeting international standards established by OIE. In the case of the AI Component of 69

78 MOH, a Health Care Waste Management Plan already exists, and this will form the basis of environmental management for avian influenza activities as well (no separate EMP will therefore be prepared for the Human Health component). The Project will also support updating of these guidelines, training of healthcare workers to manage medical wastes according to these guidelines and, if necessary, the purchase of equipment for the proper handling and disposal of medical waste in participating facilities. These provisions will be included in the PIP/PIM. 4. The Project will assist the government in developing a strategy for managing future emerging and re-emerging zoonotic and infectious disease outbreaks. Such a strategy would improve environmental and social safeguards in three areas: (i) mainstreaming environmental safeguards into protocols and procedures for the stamping out and disposal of animals during an outbreak, in particular by adopting OIE standards; (ii) improving bio-medical waste management systems in health facilities and laboratories; and (iii) developing policies on compensation for poultry farmers affected by future outbreaks. 5. As an emergency operation under OP/BP 8.00, the safeguard documents are not required to be prepared and disclosed prior to appraisal. However, it is expected that the medical waste management plan and the EMP for the carcass disposal facilities will need to be prepared and disclosed within six months of project effectiveness. 6. Safeguard Policies: The only policy which applies to the AHIP is Environmental Assessment, as shown in the table below. Table: List of safeguard policies Safeguard Policies Triggered by the Project Yes No Environmental Assessment (OP/BP/GP 4.01) [x] [ ] Natural Habitats (OP/BP 4.04) [ ] [x] Pest Management (OP 4.09) [ ] [x] Cultural Property (OPN 11.03, being revised as OP 4.11) [ ] [x] Involuntary Resettlement (OP/BP 4.12) [ ] [x] Indigenous Peoples (OD 4.20, being revised as OP 4.10) [ ] [x] Forests (OP/BP 4.36) [ ] [x] Safety of Dams (OP/BP 4.37) [ ] [x] Projects in Disputed Areas (OP/BP/GP 7.60) [ ] [x] Projects on International Waterways (OP/BP/GP 7.50) [ ] [x] 70

79 ANNEX 9 REPUBLIC OF UGANDA AVIAN AND HUMAN INFLUENZA PREPAREDNESS AND RESPONSE PROJECT Annex 9: Economic and Financial Analysis A. Introduction 1. This annex presents the results of economic analyses of the proposed Uganda AHIP. The analyses examine economic impacts of AI in terms of costs incurred without the AHIP and economic impacts of AI in terms of benefits and costs accruing with the AHIP. B. Background 2. Outbreaks of the H5N1 strain of AI in birds have now been registered in more than 60 countries in Asia, Europe, Africa and the Middle East, spreading from what was initially (in late 2003) an East Asian phenomenon. This has been accompanied by an increase in human cases from less than 100 deaths in the period 2003 to over 230 deaths by the end of Moreover, the virus has been extremely deadly on those infected with an estimated death rate of 57% of all human cases detected since Globally the primary concern, in terms of economic impacts of AI, relates to the possibility of a future human pandemic through human-to-human transmission of the H5N1 virus. To date, transmissions have been bird-to-bird with some cases of bird-to-human transmissions. The main economic impact has been on poultry and related sectors, particularly in South East Asia. 4. Empirical evidence on the economic impacts of AI points to two important conclusions. First, the overall impact on national GDP and GDP growth is rather small (most countries affected in Asia continued to grow approximately at the same pace). The reason for this is that the poultry sector accounts, on average, for only a very small share of GDP (normally in the range of slightly below 1% to a little over 2% of GDP) and even a large drop in sector output (e.g. 20% in Vietnam) would result in a small overall effect. Second, evidence seems to suggest that the impact of AI can actually be quite significant for certain segments of the population and for specific regions in a country. For example, despite less than 1% of the national poultry population being affected with AI, commercial poultry producers in the capital of LAO PDR lost as much as 40% of their layer flock due to deaths and culling. 5. The probability of a future human pandemic is difficult to assess, as would be the nature and severity of the disease in the event of a future outbreak. Most infections and death scenarios have been established through simulation models based on pre-defined probability distributions for key variables based on historical date. Data has been drawn from Spanish flu ( ), the Asian flu of 1957 and the Hong Kong Flu of Some of the 71

80 economic models also used inputs and data available from the SARs outbreak in Asia. In an attempt to illustrate the order of the magnitude of a possible human pandemic, the World Bank Prospects Group estimated a decline in World GDP in the range of 0.7% and 4.8% of GDP. Moreover the impact would be greater in developing countries (between 0.6% and 5.3% of GDP) because of greater population density, poverty and lower quality of health care services. Countries most open to trade and in particular large net exporters of services, would be most hit by a human pandemic, because of the movement of people in and out of the country. C. Economic Impacts of AI without AHIP 6. The status, performance and dynamics of the poultry sector in Uganda between 2003 and 2007 are summarized in Tables 1 and 2 below. The total bird population (chickens, ducks and turkeys) was 36.8 in 2007; with the bulk of the population being made up of backyard poultry. Average annual growth in the bird population in the last 5 years has been about 2.2%. The meat production and bird population ratio was 1.2 (in terms of number of kilograms) in The egg production and bird population ratio was 10 (in terms of eggs) in There are several major difficulties in estimating the economic impact of AI in Uganda, most of which would also be valid for other countries. First, scenarios for gross attack rates (GARs) of AI in the case of a pandemic, based mostly on past events, are only approximate. There is a lack of scientific knowledge on the primary factors affecting the spread of influenza and scenarios are based on a small number of past observations for which data is of differing quality and is also quite heterogeneous. Second, there is no data to assist in predicting the probability of any of the scenarios for which a possible impact of AI can be estimated. Table 1: Poultry Sector in Uganda Table 1: Poultry Sector in Uganda Poultry Population (million birds) Poultry Sector Chickens Backyard Commercial Total Growth (%)

81 Table 2: Estimates of Ratios of Meat and Egg Production Relative of Bird Populations in Uganda Item Total bird population (million birds) Total meat production (million kg) Total egg production (million) Meat production/bird (kg) Egg production/bird population (egg) A fair degree of sophistication can be adopted in estimating the economic impact on AI by, example, differentiating between age groups, for likelihood of a medical visit, hospitalization or death (allowing for better use of data from past pandemics since there is differential impact across age groups). However, given the limitations of data in Uganda and the uncertainty surrounding any estimates for the present economic analysis, only three possible Gross Attack Rate (GAR) scenarios were considered. More sophisticated and higher attack rates, including on human population could be considered, but not done so here for lack of reliable data. By nature, these estimates are difficult to estimate and hence arbitrary. Besides, the lower bound benefits estimated from even these limited and minimal scenarios are sufficiently large to justify the current levels of investment. These are described below and a summary of the scenarios and their assumptions are reported in Table 3. Table 3: Possible GAR Scenarios Considered for Economic Impact Table 4: Possible GAR Scenarios Considered for Economic Impact Population I II III Poultry Humans Scenario (i) is the case of countries such as Cambodia or Lao PDR where less than one percent of the poultry population has been infected by AI. Scenarios (ii) and (iii) are still very modest impacts in comparison to these experienced by some counties such as Indonesia and Thailand, where poultry GARs were about 10% together with a small number of the human population being infected by the disease (essentially bird-to-human transmission). Clearly, higher poultry GARs and any human GARs would produce significantly greater impacts. 10. Thus, focusing only on the poultry sector, the economic impact considered is the value of production lost, which depends of the GAR and assumptions concerning selling prices and average meat and egg production per bird. Additional impacts due to a reduction in selling prices due to consumer fears about the disease could also be considered, in which case the benefits would be further increased. Because of lack of information on elasticities and sector details, the impact on other protein producing sectors, as consumers shift demand away from 73

82 poultry products, can not been taken into consideration. The impact on trade from any restrictions imposed, in the event of AI outbreaks, is also not been taken into consideration, as Uganda is not a net exporter of poultry products. 11. The main assumptions for estimating the economic impact of AI on the poultry sector are: (i) the impact is on the initial bird population and there is 2.2.% annual growth rate; (ii) two possible AI shock scenarios are considered - one assumed to occur in the second year of the four year project, and the second in the fourth year of the project (clearly, the benefits are estimated to be even higher were it to occur in the first year itself); (iii) the impact is assessed over a 15 year horizon from year 1 of project implementation; (iv) there is an average of 1.2kg of meat per bird and 10 eggs a year per bird at a price of UShs. 7,000 per kg of meat and UShs. 150 per egg, and (v) prices used are the market prices in Based on these assumptions and the presumed shock, the internal rate of return (IRR) is estimated, using the project investments spread out over the 4 year period as given in the cost tables. The IRRs calculated under the different scenarios are presented in table 4. Table 4: Estimated Internal Rates of Returns to AHIP Investment in Uganda GAR Scenario Outbreak in year 2 Outbreak in year 4 I % 7% II % 13% III % 34% 14. The results show that the project impact will be considerable under reasonable assumptions of GARs on poultry alone. Only if the GARs are extremely low and are delayed in the lifespan of the project are the returns likely to be lower. In the event that the GARs are anywhere close to those experienced in South-East Asia, the returns would be extremely high. In addition, if there is any transmission to the human population, the economic benefits would be higher still. 74

83 ANNEX 10 REPUBLIC OF UGANDA AVIAN AND HUMAN INFLUENZA PREPAREDNESS AND RESPONSE PROJECT Annex 10: Documents in Project Files a. The Republic of Uganda: National Plan of Action for Preparedness and Response to Avian Influenza in Uganda, April 7, b. The Republic of Uganda: Progress Report on Avian Influenza Preparedness and Response, October March c. The Republic of Uganda: Integrated National Action Plan (INAP) for Preparedness and Response to Avian and Human Influenza, February d. The Republic of Uganda: Technical Annex for the Proposed IDA Credit for the Proposed Avian and Human Influenza Project, April 2008 e. The World Bank: Financial Management Assessment Report on the Project Implementing Agencies f. The World Bank: Procurement Assessment Report on the Project Implementing Agencies 75

84 REPUBLIC OF UGANDA AVIAN AND HUMAN INFLUENZA PREPAREDNESS AND RESPONSE PROJECT Annex 11: Statement of Loans and Credits UGANDA: Avian and Human Influenza Preparedness and Response Project Original Amount in US$ Millions Difference between expected and actual disbursements Project ID FY Purpose IBRD IDA SF GEF Cancel. Undisb. Orig. Frm. Rev d P UG-PRSC 7 (FY08) P UG-Local Govt Mgt Svc Del Pjt (FY08) P UG-Kampala Inst & Infrast Dev Prj (FY08) P UG - Power Sector Dev. Project (FY07) P UG-Pub Serv Perform Enhance (FY06) P UG-Millennium Science Init (FY06) P UG-Priv Sec Competitiveness P UG-Road Dev APL 3 (FY05) P UG-Natl Re Dev TAL (FY04) P UG-PAMSU SIL (FY03) P UG-N Uganda Soc Action Fund (FY03) P UG-Energy for Rural Transform (FY02) P UG-Road Dev Phase 2 APL (FY02) P UG-Priv & Utility Sec Reform (FY01) P Regional Trade Fac. - Uganda P UG-Nat Agr Advisory Srvcs SIL (FY01) P UG-EMCBP SIL 2 (FY01) P UG-Agr Rsrch & Training SIL 2 (FY99) P UG-Roads Dev APL (FY99) Total: , UGANDA STATEMENT OF IFC s Held and Disbursed Portfolio In Millions of US Dollars Committed Disbursed IFC IFC FY Approval Company Loan Equity Quasi Partic. Loan Equity Quasi Partic AEF Agro Mgmt AEF Clovergem AEF Gomba AEF White Nile DFCU Tilda Rice UMU Total portfolio:

85 REPUBLIC OF UGANDA AVIAN AND HUMAN INFLUENZA PREPAREDNESS AND RESPONSE PROJECT Annex 12: Country at a Glance 2/20/08 Sub- Key Development Indicators Saharan Low Uganda Africa income (2006) Age distribution, 2006 Male Female Population, mid-year (millions) ,403 Surface area (thousand sq. km) ,265 29,215 Population growth (%) Urban population (% of total population) GNI (Atlas method, US$ billions) ,562 GNI per capita (Atlas method, US$) GNI per capita (PPP, international $) 1,490 2,032 2,698 GDP growth (%) GDP per capita growth (%) percent (most recent estimate, ) Poverty headcount ratio at $1 a day (PPP, %) Poverty headcount ratio at $2 a day (PPP, %) Life expectancy at birth (years) Infant mortality (per 1,000 live births) Child malnutrition (% of children under 5) Adult literacy, male (% of ages 15 and older) Adult literacy, female (% of ages 15 and older) Gross primary enrollment, male (% of age group) Gross primary enrollment, female (% of age group) Access to an improved water source (% of population) Access to improved sanitation facilities (% of population) Under-5 mortality rate (per 1,000) Uganda Sub-Saharan Africa Net Aid Flows a (US$ millions) Net ODA and official aid ,198 Top 3 donors (in 2005): United States Netherlands Denmark Aid (% of GNI) Aid per capita (US$) Long-Term Economic Trends Consumer prices (annual % change) GDP implicit deflator (annual % change) Growth of GDP and GDP per capita (%) GDP GDP per capita Exchange rate (annual average, local per US$) , ,825.1 Terms of trade index (2000 = 100) (average annual growth %) Population, mid-year (millions) GDP (US$ millions).. 4,304 5,929 9, (% of GDP) Agriculture Industry Manufacturing Services Household final consumption expenditure General gov't final consumption expenditure Gross capital formation Exports of goods and services Imports of goods and services Gross savings Note: Figures in italics are for years other than those specified data are preliminary... indicates data are not available. a. Aid data are for Development Economics, Development Data Group (DECDG). 77

86 Uganda Balance of Payments and Trade (US$ millions) Total merchandise exports (fob) Total merchandise imports (cif) 954 1,991 Net trade in goods and services ,486 Current account balance as a % of GDP Workers' remittances and compensation of employees (receipts) Reserves, including gold 719 1,408 Governance indicators, 2000 and 2006 Voice and accountability Political stability Regulatory quality Rule of law Control of corruption Central Government Finance 2006 Country's percentile rank (0-100) 2000 higher values imply better ratings (% of GDP) Current revenue (including grants) Source: Kaufmann-Kraay-Mastruzzi, World Bank Tax revenue Current expenditure Technology and Infrastructure Overall surplus/deficit Paved roads (% of total) Highest marginal tax rate (%) Fixed line and mobile phone Individual subscribers (per 1,000 people).... Corporate High technology exports (% of manufactured exports) External Debt and Resource Flows Environment (US$ millions) Total debt outstanding and disbursed 3,604 4,315 Agricultural land (% of land area).... Total debt service Forest area (% of land area).... Debt relief (HIPC, MDRI) 1,282 1,705 Nationally protected areas (% of land area).... Total debt (% of GDP) Freshwater resources per capita (cu. meters).. 1,353 Total debt service (% of exports) Freshwater withdrawal (% of internal resources) Foreign direct investment (net inflows) CO2 emissions per capita (mt) Portfolio equity (net inflows) 0 0 GDP per unit of energy use (2000 PPP $ per kg of oil equivalent).... Composition of total external debt, 2006 Energy use per capita (kg of oil equivalent).... Private, Short-term, 10 IBRD, 0 0 Other multi- Bilateral, 233 lateral, 832 World Bank Group portfolio (US$ millions) IMF, 155 IDA, 3,085 IBRD Total debt outstanding and disbursed 0 0 Disbursements 0 0 Principal repayments 0 0 Interest payments 0 0 US$ millions IDA Total debt outstanding and disbursed 2,098 3,085 Disbursements Private Sector Development Total debt service Time required to start a business (days) 28 IFC (fiscal year) Cost to start a business (% of GNI per capita) 96.0 Total disbursed and outstanding portfolio Time required to register property (days) 227 of which IFC own account Disbursements for IFC own account 0 10 Ranked as a major constraint to business Portfolio sales, prepayments and (% of managers surveyed who agreed) repayments for IFC own account 6 0 Electricity Tax rates MIGA Gross exposure Stock market capitalization (% of GDP) New guarantees 0 43 Bank capital to asset ratio (%) Note: Figures in italics are for years other than those specified data are preliminary. 2/20/08.. indicates data are not available. indicates observation is not applicable. Development Economics, Development Data Group (DECDG). 78

87 ANNEX 13 REPUBLIC OF UGANDA AVIAN AND HUMAN INFLUENZA PREPAREDNESS AND RESPONSE PROJECT Annex 13: Map 79