PROJECT INFORMATION DOCUMENT (PID) CONCEPT STAGE Report No.: AB2262 Project Name

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1 Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized PROJECT INFORMATION DOCUMENT (PID) CONCEPT STAGE Report No.: AB2262 Project Name Avian Influenza Control Project Region SOUTH ASIA Sector Health (50%); General agriculture, fishing and forestry sector (50%) Project ID P Borrower(s) GOVERNMENT OF NEPAL Implementing Agency Ministry of Health and Population; Ministry of Agriculture and Cooperatives Kingdom of Nepal Environment Category [ ] A [X] B [ ] C [ ] FI [ ] TBD (to be determined) Date PID Prepared March 28, 2006 Estimated Date of June 5, 2006 Appraisal Authorization Estimated Date of VPU September 5, 2006 Approval 1. Key development issues and rationale for Bank involvement Introduction: Outbreaks of highly pathogenic avian influenza (HPAI) the H5N1 strain -- began in late 2003 and have spread at an alarming rate from East Asia to Central Asia, and now to Europe, Africa, and India. Millions of domestic poultry have died or been destroyed worldwide. Of the known 190 human cases that have contracted HPAI, most have been fatal. The expanding area in which HPAI has been discovered and the increasing frequency of new cases has raised concerns worldwide over the possible emergence of a pandemic and its disastrous consequences. 1 His Majesty s Government of Nepal (HMGN) has developed a plan to ensure that its people and livestock are adequately protected against future outbreaks within its borders and formally requested World Bank assistance for the financing and implementation of the plan. Nepal s risk status: Nepal is a mountainous country of 24 million people landlocked between India and China. The country is not currently affected by avian influenza. However, the country is at high risk, with the disease already recorded in Tibet to the north and in India to the south. The lack of effective border controls with China and India on animal and human population flow increases the potential for transmission of infection to Nepal. In addition, Nepal is on two routes for migratory birds, which are known to be potential carriers of the disease. The ability to detect possible outbreaks is severely handicapped due to access problems related to Nepal s rugged terrain and widespread security problems. 1 Avian influenza refers to a large group of different influenza viruses that primarily affect birds. An influenza pandemic happens when a new subtype emerges that has not previously circulated in humans. If H5N1 adapts into a strain that is contagious among humans, it will no longer be a bird virus but a human influenza virus.

2 Poultry sector and veterinary services: It is estimated that there are 22 million chickens and 408,000 ducks in Nepal. The poultry industry employs roughly 400,000 people, and provides livelihood to millions of households. Poultry farming takes place within two systems: 45 percent of (hybrid) birds are found in a few large commercial farms located in peri-urban areas. The remainder is backyard units of indigenous fowl and ducks in roughly half of the rural households across Nepal. While most of the commercial farms have good bio-security arrangements in place, poultry meat marketing is traditional and unorganized, i.e. sold, transported, and butchered in the open air, with no disposal mechanism for waste material. The Ministry of Agriculture and Cooperatives (MoAC) has a well-knit veterinary infrastructure with 76 veterinary hospitals, 999 livestock service centres,178 veterinary officers, 10,000 para-veterinary staff and 10,000 village animal health workers. There is considerable experience in the control of Rinderpest, Newcastle, Foot and Mouth Disease and other diseases. However, there is no experience with culling and disposal of chicken and related compensation to farmers. Bio-security protocols, ring-fencing and foreign border quarantine are under implementation, and there is now a ban on imports of poultry from India as a result of the recent outbreaks of avian influenza in that country. MoAC is already suffering from capacity constraints for the testing of suspicious birds (1300 have been tested thus far). Checking of trans-border movements of animals is a daunting task because of remoteness of the borders from the capital, the lack of sufficient numbers of check-posts, and traditional free movement of animals and people between India and Nepal (there are no visa requirements for travel between these two countries). Human health: An integrated public health service delivery system is reasonably well established in Nepal under a central ministry, and includes five regional health directorates, regional and zonal hospitals and district level structures. All 75 districts have district health offices, and district hospitals with an outreach network of 3,219 sub health posts and 698 village health posts. With respect to a possible human infection, this system will be required to: (a) detect and characterize human influenza virus outbreaks promptly through the an outbreak surveillance system which would be packaged within the existing system for disease control and epidemic management; (b) be prepared to diagnose and treat large numbers of people with influenza and its complications; (c) implement a communication strategy to inform the public on the progress of avian influenza occurrence in Nepal, risks and threats, methods of self-protection against infection, sources of treatment in a timely and realistic manner, and; (d) ensure intersectoral and inter-governmental coordination in preparing for, and responding to, the threat of avian influenza and its possible spill-over to the human population. National Preparedness Plan: The Ministry of Agriculture and Cooperatives (MoAC) and the Ministry of Health and Population (MoHP) are aware of the potential risk of HPAI. HMGN has set up an inter-sectoral task force under the chairmanship of the Director-General of Health Services (DGHS) to coordinate Nepal s response to Avian Influenza and its potential for human infections. The task-force has prepared a National Avian Influenza and Influenza Pandemic Preparedness and Response Plan (NAIIPPRP) with assistance from the World Health Organization (WHO) and the Food and Agriculture Organization (FAO). The Plan provides a strong basis on which to detect and combat possible outbreaks, and outlines the institutional mechanisms for doing so. A model for compartmentalization and zoning, in the case of an outbreak, has been developed. The Plan is also candid about what capacity and resource constraints exist. A major shortcoming of the Plan is that a compensation policy for farmers has

3 not yet been framed. Other areas of the plan that would need further work include: more detailed proposals for laboratory capacity strengthening (both on the human side and on the veterinary side), more precise cost estimates for the activities proposed, clearer implementation mechanisms, and M&E arrangements. The Plan includes a budget for $15 million, and this is the basis on which World Bank support has been sought. Rationale for World Bank involvement: First, the growing pandemic risk, and the need for a coordinated international response provides a global public goods argument for World Bank involvement. Second, with its experience elsewhere, the Bank is well placed to field multisectoral teams to tackle the technical, social, economic, and regulatory dimensions of the problem on a country-by-country basis. Third, while agencies such as WHO and FAO have the technical expertise to assist their respective constituencies in the Government, i.e., MoHP and MoAC, the Bank has a comparative advantage in dealing with the Ministry of Finance and the National Planning Commission, in view of its macro policy dialogue; this is critical in any intersectoral activity such as preparedness for and response to avian influenza. Fourth, despite donor interest from many sides, Nepal s NAIIPPRP is currently unfunded, and our discussions with other development partners indicate that a considerable financing gap is likely to remain unless the Bank steps in. There are a few commitments from other donors, and more are under discussion and expected to materialize, but these fall short of requested amount. Finally, the Bank has now in place an Adaptable Program Loan (APL) which can rapidly support countryspecific preparedness using guidelines for accelerated project processing. 2. Proposed objective(s) The project s goals and components would be aligned with the recently approved Global Program for Avian Influenza Control and Human Pandemic Preparedness and Response, which provides $500 million of funding in the form of a horizontal Adaptable Program Lending (APL). The overall objectives of the Project are to minimize the threat in Nepal posed to humans by HPAI infection and other zoonotic diseases by controlling such infections among domestic poultry and to prepare for, control, and respond to an influenza epidemic and other related infectious disease emergencies in humans. These objectives will be achieved in three ways: (i) prevention; (ii) preparedness and planning; and (iii) response and containment. If these goals are achieved, the proposed Project will reduce the burden of disease, the consequent economic losses, the risk of human infection and the loss of productivity attributable to human infections in Nepal and limit the spread to other countries as well. 3. Preliminary description Three components are proposed, in line with similar projects prepared recently: (i) animal health; (ii) human health; and (iii) public awareness and coordination support. (a) Animal Health: This component will support national prevention and control strategies to cover Nepal s needs in the short, medium, and long term. It will support activities for: (i) enhancing avian flu prevention and preparedness activities; (ii) strengthening of veterinary services, disease surveillance, diagnostic capacity and applied research; (iii) strengthening avian

4 flu control programs and outbreak containment plans, and improving bio-security in poultry production and trade. This component will also provide resources for a Compensation Fund to compensate poultry owners for the loss of assets caused by mandatory culling of their birds, if this becomes required. The component would be implemented by the Department of Livestock (DoLS) in MoAC and, where appropriate, through its non-governmental implementing partners. (b) Human Health: This component aims to prevent a human influenza epidemic caused by HPAI, and in case this cannot be prevented, reduce its impact, through: (i) year-round surveillance; (ii) effective and accurate methods of diagnosis and treatment; (iii) social distance interventions; (iv) vaccines; (v) anti-viral drugs; and (vi) strengthened medical and pubic health services, including adequate laboratory capacity-building. It will support activities for training health workers in the public and private sector on diagnosing and treating potential cases of HPAI, and counseling patients and their families. It would help improve public health program planning and coordinating, strengthen the national public health surveillance system and enhance the health system capacity to deal with the threat of HPAI in a prompt and effective manner. This component would be implemented in close coordination with and as a part of the Nepal Health Sector Program, which is a sector-wide operation, envisaging concerted donor harmonization, specific sector reforms and results-based programming though the financing of the component through the APL would be in addition to the Bank s contribution to the sectorwide operation. The component would be implemented by the Department of Health Services (DoHS) in MoHP and, where appropriate, through its non-governmental implementing partners. (c) Public Awareness and Coordination Support: This component is designed to promote national awareness on the disease and improved coordination of the national preparedness plan. Information and communication activities to increase the attention and commitment of Government, the private sector and civil society organizations and raise awareness, knowledge, and understanding among the general population about the risk and potential impact of a pandemic, methods of self-protection against infection, sources of treatment. Communication efforts would also be targeted to poultry farmers on ways of recognizing the signs and symptoms of bird flu, safe methods of disposing of infected birds and steps to protect themselves and their families. This component will also support costs associated with project management and coordination and monitoring and evaluation. This component will be jointly implemented by MoAC and MoHP, in consultation and coordination with the Ministry of Information and Communications. 4. Potential risks and mitigation

5 Risk Rating Mitigation Measures From Outputs to Objective Intervention activities are not effective in containing the spread of avian influenza from birds to the human population. From Inputs to Outputs S Activities to strengthen response capacity in priority areas in the short and medium term and to lay the foundation for a more broadly based strategy, including: (i) comprehensive awareness and communication campaigns; (ii) choosing well designed, cost-effective interventions; (iii) interventions phased allowing for modifications and redesign as needed; (iv) good M&E to flag emerging issues, and to address them effectively Project implementing agencies lack sufficient authority and capacity to take leading role in avian influenza prevention and control. Inadequacy or lack of multisectoral participation HMGN is not able to react quickly to outbreaks S M S Vigorous advocacy efforts would be launched during the preparatory phase to raise the necessary awareness, and commitment among the senior leaders and policy-makers in the government, so that sufficient authority is vested in the appropriate quarters to enable an effective and prompt implementation. Capacity-building efforts will also be part of project design. Assigning a specific agency to ensure coordination and linkages across stakeholders. Creating a multi-agency working group as the counterpart team to work with IDA and other donors in project design to play a role during project implementation as well. Procurement plan, training plan, M&E system, and critical staffing must be in place at negotiations. 4. Safeguard policies that might apply Only OP 4.01 (Environmental Assessment) will likely apply. Since the Project intends to support investments for the disposal of carcasses and laboratory wastes, an Environmental Management Plan (EMP) for carcass disposal facilities will be necessary. The EMP will also cover 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. 5. Tentative financing Source: ($m.) BORROWER/RECIPIENT 2 OTHER COFINANCIERS Tbd INTERNATIONAL DEVELOPMENT ASSOCIATION 15 Total Contact points Contact: Daniel Sellen Title: Sr Agricultural Economist Tel: , extension 153 Fax: Dsellen@worldbank.org

6 Contact: Sundararajan Gopalan Title: Sr PHN Economist Tel:

PROJECT INFORMATION DOCUMENT (PID) CONCEPT STAGE Report No.: AB2282 Project Name

Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized PROJECT INFORMATION DOCUMENT (PID) CONCEPT STAGE Report No.: AB2282 Project Name Avian