Document o f The World Bank

FOR OFFICIAL USE ONLY

Report No: T7685-AF

TECHNICAL ANNEX

FOR A PROPOSED

GRANT OF SDR 5.4 MILLION

(US$8 MILLION EQUIVALENT)

TO THE

ISLAMIC REPUBLIC OF AFGHANISTAN

FOR

AN AVIAN INFLUENZA CONTROL AND HUMAN PANDEMIC PREPAREDNESS AND RESPONSE PROJECT

UNDER THE

GLOBAL PROGRAM FOR AVIAN INFLUENZA AND HUMAN PANDEMIC PREPAREDNESS AND RESPONSE (GPAI)

December 18,2006

Agriculture and Rural Development Sector Unit (SASAR) Human Development Sector Unit (SASHD) South Asia Region

Ths document has a restricted distribution and may be used by recipients only in the performance o f their off icial duties. I t s contents may no t otherwise be disclosed without W o r l d Bank Group authorlzation

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ADB AFP AHDP AHID AHITF AI AIRP AIS APHI A P L AVA B H C BPHS

CURRENCY EQUIVALENT (Exchange Rate Effective as o f March, 2006

Currency Umt = Afghani (AFN) US$1= 50.01 AFN (As o f March, 2006)

GOVERNMENT FISCAL YEAR March 21-Mar~h 20

ABBREVIATIONS AND ACRONYMS

Asian Development Bank Acute Flaccid Paralysis Animal Health Development Program Avian and Human Influenza Disease Avian and Human Influenza Trust Fund Avian Influenza Avian Influenza Response Project. Avian Influenza Secretanat Afghanistan Public Health Institute Adaptable Program Loan Afghan Vetennary Association Basic Health Center Basic Package o f Health Services

CBAHW Community Based Animal Health Worker CDC CHC CVDRL cvo DA DAB D C A D C D DFID DVS ELISA EMRO ERLs FA0 FCAI FMA G C M U GOA GPAI GREP HLP HMIS HPAI IDA IST ILI

Community Development Councils Comprehensive Health Center Central Vet. Diagnostic and Research Lab. Chief Vetennary Officer Designated Account Da Afghanistan Bank - Central Bank Dutch C o m t t e e for Afghanistan Department o f Communicable Diseases Department For International Development Department o f Vetennary Services Enzyme-Linked Immuno-Sorbent Assay Eastern Mediterranean Regional Office Emergency Recovery Loans Food and Apculture Orgamzation Financial Committee Avian Influenza Finance Management Agent Grant and Contract Management Umt Government o f Afghanistan Global Program for Avian Influenza Global Rinderpest Eradication Program Horticulture and Livestock Project Health Management Information System Highly Pathogenic Avian Influenza International Development Association Implementation Support Team Influenza-Like I l lness

JICA Japan International Cooperation Agency MA1 Ministry o f Agnculture and Imgation MAP Multi-country Adjustable Program MEP Ministry o f Environmental Protecbon M O C Ministry o f Commerce M O I Mimstry o f Intenor M O F Mhstry o f Finance M&E Monitonng and Evaluation MOPH Ministry o f Public Health M O W A Ministry o f Women’s Af fars MRRD N A I S National Avian Influenza Secretanat NAIPPRP National AI and I Pandemc Prep. Response Plan NAMRU Naval Medical Research Unit NERC National Emergency Response C o m t t e e NEPA National Environmental Protection Agency N G O Non-governmental Organization NSP National Solidanty Program OIE PAICs Provmcial A I C o m t t e e s PACBP PASA Participating Agency Service Agreement PCR Polymerase Chain Reaction PEFA Public Expenditure Financial Accountability PFM PPD PPE Personal Protective Equipment PRT Provincial Reconstruction Team RRT-PCRReal Time Reverse Transcnptase Chain Reaction S A R South Asia Region SDU Special Disbursement Unit T C A I Technical C o m t t e e Avian Influenza UNICEF UN International Children & Education Fund UNOPS United Nations Office for Project Services USAID U S Agency for International Development USDA United States Department o f Agnculture VFU Vetennary Field Units VSD Vetennanan Service Department WHO World Health Organization Z C U Zonal Coordination Unit

Ministry o f Rural Reconstruction and Dev

World Organization for Anma l Health

Public Adrmnistration Capacity Building Project.

Planning and Policy Department - MA1

Vice President: P rah l Pate1 Country Director: Alastair McKechnie Sector Directors: Constance Bernard, Julian F Schweitzer Sector Managers: Gajanand Pathmanathan, Anabela Abreu

Task Team Leader: Norman Bentley Piccioni

FOR OFFICIAL USE ONLY Table o f Contents

A . STRATEGIC CONTEXT AND RATIONALE .......................................................... 3 Country and Sector Issues ....................................................................................... 3 Rationale for IDA involvement .............................................................................. 5

B . PROJECT DESCRIPTION .......................................................................................... 6 Project Development Objective .............................................................................. 6 Financial Instrument ............................................................................................... 6 Project Components ................................................................................................ 7

1 . 2 .

1 . 2 . 3 .

C . IMPLEMENTATION ................................................................................................... 8 1 . 2 . 3 . 4 . 5 . 6 . 7 8 .

Partnership arrangements ........................................................................................ 8 Institutional Arrangements ...................................................................................... 8

Financial Management, Disbursement and Audit Arrangements ......................... 10 Implementation Arrangements ................................................................................ 9

Procurement Arrangements: ................................................................................. 12 Monitonng and Evaluation o f OutcomesResults ................................................. 12 Sustainability, Cntical k s k s and Possible Controversial Aspects ....................... 13 Grant conditions and covenants ............................................................................ 15

D . APPRAISAL SUMMARY .......................................................................................... 15 1 . Economic and Financial Analyses ........................................................................ 15 2 . Technical ............................................................................................................... 16

4 . Social ..................................................................................................................... 16 5 Environmental ....................................................................................................... 17 6 . 7 Policy exceptions and readiness ............................................................................ 18

3 . Fiduciary ............................................................................................................... 16

Safeguard policies ................................................................................................. 17

APPENDIX 1 - Results Framework and Monitoring ..................................................... 19 APPENDIX 2 - Detailed Project Description .................................................................. 26 APPENDIX 3 - Project Implementation Plan ................................................................. 45 APPENDIX 4 - Summary o f Project Costs by Component, Category and Financing 47 APPENDIX 5 - Financial and Economic Analysis .......................................................... 48 APPENDIX 6 - Procurement Arrangements ................................................................... 54 APPENDIX 7 - Financial Management and Disbursement Arrangements .................. 65

APPENDIX 8 - Environment and Social Safeguards Framework ................................ 78 APPENDIX 9 - Monitoring and Evaluation Arrangements ........................................... 90 APPENDIX 10 - Project Organization and Implementation Arrangements ............... 93 APPENDIX 11 -Administrative Map o f Afghanistan with elevation, main roads and Regions ............................................................................................................................... 100

This document has a restricted distribution and may be used by recipients only in the performance o f their off icial duties . I t s contents may not be otherwise disclosed without Wor ld Bank authorization .

TECHNICAL ANNEX FOR NEW GPAI GRANT

Region: SOUTH ASIA Unit: Sustainable DeveloDment Unit/Human DeveloDment Unit

-

Project ID@):

Financing type

Amount:

Proposed terms:

Implementation period:

Expected effectiveness date:

Date: December 18,2006 Country Director: Alastair McKechnie Sector Directors: Constance Bernard, Julian F Schweitzer Sector Managers: Gajanand Pathmanathan, Anabela Abreu Lending instrument: ERL Financing Data:

A. New Financing B. Additional C. Existing Financing

P100935

[ ] Loan [ 3 Credit [ 3 Grant [XI Other [ 3 $8 mill ion $5 mill ion

IDA standard

Financing (restructunng)

[.I Loan [ J Credit [ 3 Grant [ ] Other [XI

[ ] Loan [ J Credit [ 3 Grant [ ] Other [ 3

2007-2010

March 1,2007

Team Leader: Norman Bentley Piccioni Sectors: Animal production (40%), Health (40%), Gen. Info.Comm. (20%) Themes: Other communicable diseases (P) Natural disaster management (P) Environmental screening category. B

Expected closing date:

Borrower:

Responsible agency:

February 28,2010

Islamic Republic o f Afghanistan Ministry o f Agnculture, Animal Husbandry and Food and

Borrower Total IBRD/IDA Trust Funds Others Total

I Ministry o f Public Health Total IDMBRD Financing (A.+B.+C., US$m.):$13 mi l l ion

- 5.0 3 .O 8.0 3.2 1.8 5.0

8.2 4.8 13.0 -

Financing Plan (US$m.) n I - . l m a I m * - 1

2007 2008 2009 Total I B R D D D A 1,76 2,947 2,240 Trust Funds 1,075 1,863 ’ 1,425

I iota1 bource I Local I roreign

2010 2011 2012 1,053

63 7 Does the project or new component require any exceptions f rom Bank policies?

A r e there any cntical nsks rated “substantial” or “high”7

0 ) N o

0 ) Y e s

uoes tne project (anaor new components, as appiicaaie) meet me Kegionai criteria for readiness for implementation?

Development obiective. T h e PDO i s to minimize the threat posed by Highly Pathogenic Avian Influenza (HPAI) to humans in Afghanistan by controlling such infections among birds,

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especially domestic poultry, and prepanng for, controlling, and responding to possible human infections, especially an influenza epidemic and related emergencies. Short descrbtion: Animal Health KfS$6.2 million). Thls component will support the national program to develop and implement HPAI prevention, containment, control, and eradication activities in the livestock sector o f Afghanistan creating an effective system for improved bird health surveillance, diagnostic analysis and disease control. Human Health (US$ 3.4 Million). Under this component the national program o f activities to prevent, detect, respond to and mitigate the impact o f human illness caused by avian or pandemic influenza wil l be supported. I t would also support ongoing programs for re- establishing public health capacity that was destroyed dunng decades o f conflict. Communication And Public Awareness KfS$1.4 million). Under the advise and technical assistance o f a Communications Task-Team (including donors, and NGOs), the component will: (i) elevate public awareness and promote behavior-change among at-nsk and vulnerable populations; (ii) provide visibility to the multisectoral response, and generate a sense o f transparency and trust; (iii) maintain high-level political engagement; and iv) foster an "enabling environment". Institutional Coordination and Proiect Management (US$ 1.4 million). This component will support the institutional coordination and management o f the Project within the Agnculture and the Public Health line ministnes, where a core support team wil l handle key functions including financial management, procurement, and monitonng and evaluation o f Project activities, as well as compliance with the agreed environmental management framework. Which safeguard policies are tnggered, if any? Environmental Assessment (OPBP 4.01)

Significant, non-standard conditions, if any, for:

A. N e w Financing B. Additional

January 4,2007 Financing:

Ref. Section C.5 C. Existing Financing:

Approval: Loadcredi t effectiveness:

Covenants applicable to project or component implementation:

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A. STRATEGIC CONTEXT AND RATIONALE

1. Country and Sector Issues

1. Avian inJuenza: Outbreaks o f highly pathogenic avian influenza (HPAI) caused by the H 5 N 1 subtype o f influenza “A” were first recognized in Hong Kong in 1997. Since late 2003, this subtype has been spreading at an alarming rate, f rom East Asia to Central Asia, and now to the Middle East, Europe, Afnca, and South Asia. In addition to i ts impact on animal health, with millions o f domestic poultry having died or been destroyed worldwide, H 5 N 1 has been causing severe human disease. Of the known 258 humans with confirmed HPAI as o f November 2006, most (1 54) have died. The rapidly expanding area in which HPAI has been discovered and the escalating number o f human infections have raised concerns worldwide over the possible evolution o f the next influenza pandemic and its disastrous consequences.’

2. Afghanistan ’s risk status: As a result o f a quarter-century o f devastating c iv i l stnfe and hal f a decade o f senous drought, Afghanistan has some o f the poorest social, economic and health indicators in the world with high susceptibility to communicable diseases. Inadequate facilities and capacities to detect, control, contain and mitigate an outbreak o f commucab le disease have made this country highly vulnerable. 26 confirmed cases o f H5N1 virus in sampled chicken in 4 provinces have been reported since testing started in March 2006. The virus - which was f i rst diagnosed in the province o f Nangahar - appeared to be spreading fast, with infection occumng in five new provinces in close succession (Kabul, Laghman, Logar, Parwan and Kapisa). However, since bird migration stopped in May, there have been no further outbreaks o f AHID in Afghmstan. Bird migration wil l normally restart by October and preparedness wil l be particularly important dunng the following six months.

3. National Preparedness Plan. In March 2006, an inter-sectoral Task Force prepares a National Avian Influenza and Influenza Pandemic Preparedness and Response Plan (ANIPPRP) formally endorsed by the Government o f Afghanistan (GOA).’ After prepanng the plan, the Government requested the World Bank assistance to finance the Plan. The ANIPPRP provides a strong basis on w h c h to detect and combat possible outbreaks, and outlines the institutional mechmsms for doing so. The plan i s candid about what capacity and resource constraints exist. The ANIPPRP was later supplemented with an Operational Plan, which formed the basis for the World Bank appraisal.

’ Avian influenza (also called avian flu or bud flu) refers to a group o f different influenza viruses that primarily affect birds. An influenza pandemc happens when a new subtype emerges that has not previously cuculated m humans. If H5N1 adapts mto a straln that i s contagious among humans, it will no longer be a bud vms but a human influenza virus. * A National Avian Influenza Comrmttee (NAIC) was established as soon as the Mimster MA1 confirmed the existence HPAI (H5N1). Membership o f NAIC mcludes MAI, Mimstry o f Public Health (MOPH), Mitllstry o f Commerce (MOC), Ministry o f Finance (MOF, and the Mimstry o f Envuonmental Protection (MEP), representatives o f concerned donors and implementing orgarmations such as FAO, USAID, USDA, EU, ADB, WB, WHO and UNICEF

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4. Recent actions taken: Under the Plan the Mimstry o f Agnculture and h g a t i o n (MAI) adopted a pol icy o f slaughtenng birds in the vicinity o f a l l proven outbreaks o f H5N1 and payment o f compensation to farmers concerned. This pol icy was initiated under the FA0 supported Avian Influenza Response Project ( A m ) and, as a result o f the 26 diagnosed cases, about thirty thousand birds were slaughtered. Since then, eight regional emergency centers have been established for handling avian influenza (AI) (Kabul, Nangahar, Kandahar, Herat, Bamayan, Balkh Kunduz and Ghazni). Intensive training has been provided to provincial vetennary directors and training courses on AI awareness have been organized for 285 vetennanans. h t i a l supplies o f equipment, protective clothing and flu detector antigen have been distributed and a surveillance program has been initiated based o n 2 percent monthly sampling o f poultry flocks in each regonal center.

5. Status ofthe Animal HeaZth Services: The Department o f Vetennary Services (DVS) i s a part o f MA1 and is headed by the Director o f Vetennary Services/Chief Vetennary Officer (CVO). The MA1 vetennary service i s poorly equipped and has no budget for addressing regulatory and public-good functions related to animal health, including trans-boundary disease control, zoonotic disease control, disease surveillance, food safety, and quality control o f vaccines and medicines. Transport and telecommunications are weak and there i s no organized disease-information system. There are insufficient graduate vetennanans for providing an effective presence in al l provinces o f the country; salanes for MA1 vetennanans are extremely l o w and sometimes delayed.

6. Status ofthe Public HeaZthcare Services: Until the end o f 2003, the performance o f the public health system was poor. Since the beginning o f 2004, there appears to have been a large increase in service delivery, about 90 percent o f i t provided by NGOs. A rudimentary disease surveillance system based on a Health Management Information System (HMIS) and reports from vertical programs such as tuberculosis and vaccine-preventable childhood diseases exists in Afghanistan. However, the quality and completeness are vanable and utilizing this system for avian and pandemic influenza surveillance would be unreliable, due to weak data accuracy. The best functioning disease surveillance system in Afghanistan i s the acute flaccid paralysis (AFP)/poliomyelitis system. I t i s supported by WHO in collaboration with the MOPH. This system has an extensive grass-roots infrastructure throughout Afghanistan, has timely reporting, i s coupled with specimen collection and rapid shipment, and has a ngorous response component. Rapid response teams that conduct case or outbreak investigations are present in each province. As needed, these teams can be supplemented by national level personnel. Some training o f personnel on these teams regarding avian influenza (including specimen collection) has been conducted, but their ability and capacity to adequately respond i s largely untested and they have l imited equipment and transport.

7 Diagnostic Capacity - Animal Health: Diagnostic capacity for animal health i s very limited but several efforts are under way with funding and technical assistance from European Commission (EC), United States Department o f Agnculture (USDA), and Japan International Cooperation Agency (JICA). FA0 initiated a trans-boundary disease-surveillance program in Afghanistan, which i s part o f broader regional efforts in Central and South Asia. The program established an enzym-linked immuno-sorbent assay (ELISA) test laboratory At the same time, the third U S naval medical research unit (NAMRU-3) has provided the MA1

4

8.

2.

9

laboratory in Kabul with real-time reverse transcnptase polymerase chain reaction (RRT- PCR) equipment to screen samples for Avian Influenza. The FA0 laboratory provides the necessary HPAI diagnostic services through the fol lowing diagnostic tests: (i) RRT-PCR for identification o f H5, (ii) ELISA for antibodies against type A, (iii) HI3 for detection o f antibodies against H 7 and H9, and (iv) AGID4 test for antibodies against H 7 and H9.

Dzagnostic Capacity - Human Health: Laboratory diagnostic capacity for human health in Afghmstan i s very limited. Under the BPHS, no lab services are offered at health posts or BHCs. CHCs and distnct hospitals offer basic hematology, unnalysis, and biochemical assays. They are able to perform gram stains for bactenology and acid fast smears for tuberculosis. However, more advanced health care facilities are unable to perform microbiologic cultures, and instead rely o n gram stains and smears. As a result, most infectious diseases diagnoses are based o n clinical impression, although serologic diagnosis through blood collection is performed for some diseases. For influenza, FA0 has established diagnostic capacity in the vetennary diagnostic laboratory o f the Ministry o f Agnculture. Arrangements are in place for this facility to test human specimens when necessary There are also arrangements to refer specimens to the Eastern Mediterranean Regional Office (EMRO) o f WHO and the collaborating laboratory o f the U.S. Naval Medical Research Urut (NAMRU) No. 3 in Cairo. NAMRU-3 i s in the process o f developing virology capacity in the Central Laboratory o f the Ministry o f Public Health, including influenza facility renovation, RT-PCR diagnostics and virus isolation.

Rationale for IDA involvement

Bank involvement i s justified by the global public good aspect o f the HPAI, one of many emerging and re-emerging transboundary zoonoses. A human flu pandemic could cause significant increases in poverty in developing countnes. To be effective, the response requires coordination across countnes and agencies at the international and regional levels and close intra-ministry coordination in each participating county. In most instances i t also requires substantial financial resources. The Bank i s wel l placed to work in this environment, in partnership with international technical agencies, other multilateral agencies and donor countnes.

10. The Bank has endorsed the FAO/OIE Global Strategy to minimize the global threat and nsk o f H P A I in domestic poultry and humans through progressive control and eradication o f HPAI, particularly that caused by H5N1 virus from terrestnal domestic poultry Furthermore the Bank, in collaboration with the EU, WHO, FAO, OIE and bilateral donors, has established a multi-donor trust fund for Avian and Human Influenza (AHITF) that pnmari ly supports country level activities in conjunction with a smaller and complementary role at the regional and global levels. National leve l activities for progressive control and eradication o f the HPAI are a fundamental building block to global eradication. The Bank has been working with national governments, FAO, OIE, WHO, EU, other partners and bi-and multilateral agencies in the preparation o f National AI Preparedness Plan and strategies.

Haemagglutination mhibition Agar gel immuno-diffusion

5

11. The HPAI control and eradication programs are complex and require a multi-disciplinary approach to integrate technical, social, economic, political and regulatory issues. The Bank i s wel l placed to draw o n its vast expenence throughout the wor ld in multi disciplinary approaches to tackle similar emergency preparedness, nsk-mitigation and other projects and programs requinng multi-disciplinary approaches. In addition, the Bank has comparative advantage in having swift access to i t s own financial resources to support emergency preparedness and response projects. The Bank is an active member o f the NAIS and has demonstrated its capability to bnng together relevant and important national and international institutions in support o f a national preparedness plan. The Bank, recognizing the importance o f the poultry sector, has included a component for semi-intensive poultry production in the recently approved Horticulture and Livestock Project (P098256, HLP).

B. PROJECT DESCRIPTION

1. Project Development Objective

12. The overall objective o f the Project i s to mimmize the threat posed by HPAI to humans in Afghanistan by controlling such infections among birds, especially domestic poultry, and prepanng for, controlling, and responding to possible human infections, especially an influenza epidemic and related emergencies. Though the objective is specific to HPAI, the interventions are expected to contribute to the control o f other zoonotic diseases and other types o f infectious diseases, in terms o f building overall response capacity

13. This objective wil l be achieved through three types o f interventions: (i) prevention; (ii) preparedness and planning; and (iii) response and containment. If these types o f interventions achieve their goals, the proposed project wil l reduce the burden o f disease in animal and the consequent economic losses. It wil l also lower the nsk o f human infection and the loss o f productivity attributable to human infections in Afghanistan. Finally, i t would limit the nsk o f H P A I in other countnes.

14. At the end o f the project i t i s expected that (i) the capacity o f the agencies involved in AI containment, control and mit igation will have significantly improved, (ii) the threat to human health in the high n s k s provinces o f Afghanistan wil l have been substantially reduced, and (iii) the general public wil l be aware and will have adopted A I related human, animal health and environmental safeguards.

2. Financial Instrument

15 The project wil l be implemented over three years for a total cost o f US$ 13 million. IDA will finance US$8 mi l l ion and the Avian and Human Influenza Trust Fund (AHITF) wil l finance US$5.0 million.

16. The IDA Grant i s proposed under the Global Program for Avian Influenza and Human Pandemic Preparedness and Response (GPAI, approved by the Board on January 12, 2006). Under the G P A I framework, a l l new IDA financing prepared wil l fol low APL procedures for

6

follow-on operations.' GPAI operations are also processed as emergency and recovery operations (ERLs) under O P B P 8.50.

17 AHITF cofinancing i s expected to be made available within six months from effectiveness of the proposed IDA Grant under the same applicable Bank policies, practices, and standards.6

3. Project Components

18. The project will finance activities under four components: (i) Ammal Health, (ii) Human Health, (iii) Communications and Public Awareness, and (iv) Institutional Coordination and Project Management.

Animal Health KJS$6.2 million)

19 Under the responsibility o f the Animal and Plant Health Department o f the Ministry of Agnculture and Imgation, this component wil l support a national program to develop and implement HPAI prevention, containment, control, and eradication activities in the livestock sector o f Afghanistan creating an effective system for improved bird health surveillance, diagnostic analysis and disease control in accordance with FAO/OIE standards.

Human Health (US$ 3.4 Mil l ion)

20. Under the direction o f the Ministry o f Public Health (MOPH), this component wil l support a national program o f activities to prevent, detect, respond to and mitigate the impact of human i l lness caused by avian or pandemic influenza. Component activities wi l l involve emergency and long-term developments to address pnonty gaps in disease surveillance, control and treatment. I t would also contribute to MOPH's ongoing program for re-establishing public health capacity that was destroyed dunng decades o f conflict.

Communication And Public Awareness WS$1.4 million)

2 1 Under the coordination o f the commumcations specialist based at the AI Secretanat, and with the advise and technical assistance o f the Communications Task-Team (including donors, and NGOs), the communications component wil l finance baseline research, design, test and implementation o f a comprehensive and integrated communications strategy, to: (i) elevate public awareness and promote behavior-change among at-nsk and vulnerable populations, to control the spread o f the virus; (ii) provide visibility to the multisectoral response, and generate a sense o f transparency and trust; (iii) maintain high-level political engagement dunng the different pandemic phases; and (iv) build upon the available communications infrastructure o f vanous ministnes and stakeholders, to foster an "enabling environment,"

The GPAI's i s available to countries demonstrating that they have (i) a national strategic plan; (ii) nahonal 5

comrmtment; (iii) an implementation strategy through concerted action among m s t r i e s , donor commumty, and c i v i l society; and (iv) a clearly defined momtoring and evaluation system. The preparation team considers that these criteria have been satisfied. In partnership with the EU, WHO, FAO, O I E and bilateral donors the W o r l d Bank has established a multi-donor

Trust Fund for Av ian and Human Influenza (AHITF) that prmri ly supports country level activities in conjunction w i th a smaller and complementary role at the regional and global levels.

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where the community at large understands the possible threat, adopts preventive behaviors, supports programmatic activities, contributes with the reporting, social monitonng and self- reliance mechanisms.

Implementation Support KJS$1.4 million)

22. This component wil l support the institutional coordination and management o f the Project. There will be no formal Project Implementation Unit, but staff within the MA1 and MOHP would be assigned to a core support team to handle key functions including financial management, procurement, and monitonng and evaluation o f Project activities, as well as compliance with the agreed environmental management framework. The central coordination o f the project wil l be in the Planning and Policy Department (PPD) o f the Ministry o f Agnculture and Imgation. Provisions under this component wil l include goods, services and operating expenditures for coordinatinglmanaging project implementation.

Physical and Pnce Contingencies (uS$655,000)

C. IMPLEMENTATION

1. Partnership arrangements

23. In March 2006 as soon as the Ministry o f Agnculture and Imgat ion confirmed the existence o f H P A I in the country, an inter-sectoral task force was established to prepare a National Avian Influenza Pandemic Preparedness and Response Plan (NAIPPRP). The task force included representatives form Ministry o f Agnculture and Imgat ion (MAI), Ministry o f Public Health (MOPH), Ministry o f Commerce (MOC), Ministry o f Finance (MOF), and National Agency for Environmental Protection (NEPA), representatives o f concerned donors and implementing organizations such as FAO, USAID, USDA, EU, ADB, WB, WHO and UNICEF The preparedness plan has now been finalized and i t provides the basis for the proposed project.

2. Institutional Arrangements

24. Institutional arrangements are already in place and organized at central and field levels. They are consistent with GPAI standards in other countnes.

Central Level

25 The main coordination entity for AI policies, strategy and action plans is the National AI Committee (NAIC) established in March 2006 under an inter-ministenal Cabinet level National Emergency Response Committee (NERC). W h i l e the purpose o f the NERC is to address country-wide coordination for any emergency, the N A I C focuses specifically on AI control and mitigation in the event o f a major outbreak. Headed by the Minster o f Agnculture, the N A I C includes MOPH, Rural Rehabilitation and Development (MRRD), Intenor (MOI), and MOC, as well as NEPA.

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26. The N A I C i s advised by a Techmcal Committee chaired by the Director o f Vetennary Services o f MA1 w h c h provides overall t e c h c a l knowledge and shares data and information on AI. The Technical Committee is composed by representative o f the t e c h c a l department o f the interested government agencies. WHO, UNICEF, FAO, U S Department o f Health and Human Services, Centers for Disease Control and Prevention (HHSKDC), several n o n - g o v e k e n t a l organizations, Wor ld Bank, European Commission, DFID and U S A I D are also participating members.

27 By the same token a Financial Committee chaired by the Deputy Minister o f Finance advises N A I C on financial and budget issues related to AI activities, including annual budget allocations, coordinates and alignment o f donor resources, and cash f low projections.

Field Level

28. Provincial AI Committees (PAICs) chaired by the Provincial Governor, coordinate and manage AI activities in the respective provinces. Members o f the PAIC include provincial representatives o f MA1 (Vetennary Services Division), Department o f Public Health, Municipality, the Police Department, the border police (where relevant), MRRD and NEPA. The technical members o f the PAIC wil l ensure that implementation o f the vanous components o f the project are in accordance with the stipulated standards, norms, rules and regulations - not only technical but also social and cultural. The implementation at f ield level wil l be the responsibility o f the provincial and distnct level public health staff and vetennary staff with assistance from the staff o f WHO, FAO, UNICEF, other multi- or bi- lateral support agencies, Vetennary Field Units (VFU), Afghan Vetennary Association (AVA) and local NGOs.

3. Implementation Arrangements

29 Overall and ultimate responsibility for project execution, successful implementation, accountability and outcomes wil l be with a newly established National Influenza Secretanat (NAIS), hosted in the General Department for Policy and Planning o f the MA1 and integrated with an Implementation Support Team (ET) financed by the project and composed o f locally and internationally recruited specialists.

30. The IST will include an overall Project Coordinator, an Animal Health Coordinator, a Human Health Coordinator, a Communications Coordinator, a Monitonng and Evaluation specialist, a GIS specialist, two Financial Management Specialists, two Procurement Specialists, and one Safeguard specialist. Most o f the IST wil l be physically located in the General Department for Policy and Planning (GDPP) o f the MAI, while the Human Health Coordinator, Procurement Specialist, and Financial Management Specialist under the Human Health component will be based in the Directorate o f Afghan Public Health Institute (APHI) o f the MOPH. In addition, the N A I S wil l include limited supported staff.

3 1. The Project Coordinator will be nationally recruited and wil l report to the NAIS through the Director General o f Livestock Services. The coordinators for each component wi l l report to the N A I S through the Project Coordinator.

9

32. Activities under the Animal Health Component will be organized and supervised by an Animal Health Coordinator, who for technical fhctions o f the project will work in collaboration with the Director o f the Animal and Plant Health Department, MAI. Under the responsibility o f the Animal Health Coordinator, the implementation o f the component wil l be contracted to an implementing partner, which is expected to be FA0 - subject to agreement on the technical and financial terms and conditions, and acceptance of the Bank standard clauses on fraud, corruption and external audit, Draft TORs for the Animal Health Coordinator have been completed. Draft TORs for the hinng o f FA0 at an estimated cost of $560,000 have been agreed at appraisal for the first year.

33. Activities under the Human Health Component wil l be organized and supervised by the Human Health Coordinator, who for technical functions o f the project wil l work in collaboration with the relevant components o f the MOPH. The activities under the component will be outsourced to implementing partners, expected to be WHO and UNICEF, subject to agreement on the t e c h c a l and financial terms and conditions, and acceptance o f the Bank standard clauses on fraud, corruption and external audit. Draft TORs for the hiring o f WHO at an estimated cost o f $260,000 and UNICEF at $310,300 have been agreed at appraisal.

34. Activities under the Commumcations and Public Awareness Component will be coordinated and supervised by a Communications Coordinator, supported by the Communications Task- Team, and a short-term international consultant. Communication activities wil l implemented mostly through a vanety o f partners and stakeholders, including the agncultural extension and health education teams o f the MA1 and MOPH, the communications infrastructure of the National Solidanty Program and Ministry o f Education, NGOs working with media and community-radio, as wel l as UNICEF, if agreement on the technical and financial terms and conditions i s reached, and subject to acceptance o f the Bank standard clauses on fraud, corruption and external audit. TORs for the hinng o f technical assistance and the implementation o f activities under the component at an estimated cost o f $350,000 have been agreed at appraisal.

4. Financial Management, Disbursement and Audit Arrangements

35 Financial Management o f the Project wil l be coordinated by two Financial Managers o f the IST, one for the MA1 and one for the MOHP. A PFM performance rating system has been recently developed for Afghanistah by the Public Expenditure and Financial Accountability (PEFA) multi-agency partnership program, which includes the World Bank, IMF, EC, and other agencies. Afghanistan’s ratings against the P F M performance indicators portray a public sector where financial resources are, by and large, being used for their intended purposes as authonzed by a budget that i s processed with transparency and has contributed to ,aggregate fiscal discipline.

36. The facilities o f the agents contracted under the Public Administration Capacity Building project (PACBP) wil l venfy the operation and help to strengthen the fiduciary measures put in place for ensunng transparency and accountability o f funds provided by the Bank and other donors. Two advisers-Financial Management and Audit-are contracted under PACBP to work with l ine ministnes to carry out these core functions. The Financial

10

Management Agent (FMA) i s responsible for helping the MOF maintain the accounts for a l l public expenditures, including IDA-financed projects and for building capacity withn the government offices for these functions. Quarterly Financial Momtonng Reports will be prepared by MA1 and MOPH accounting units. Consolidated project reports will be prepared, reviewed, and approved by the MOF, supported by the FMA.

37. A Designated Account (DA), with an init ial deposit o f US$500,000, will be opened at D a Afghanistan Bank (DAB, Central Bank) in the name o f the project o n terms and conditions satisfactory to IDA. The DA will be maintained by the MOF Withdrawal applications for replenishment wi l l be submitted monthly Financial management arrangements for the project are detailed in Appendix 7

Fund Flows

38. Fund management for the Project wi l l fol low existing procedures for IDA financed operations. As with al l public expenditure, a l l payments under the project wil l be routed through MOF. The FM Agent will assist the MOF in executing and recording project payments. In keeping with current practices for other projects in Afghanistan, the DA will be operated by the Special Disbursement Unit (SDU) in the Treasury Department o f MOF. Requests for payments from DA fimds will be made to the S D U by the relevant implementing entities. In addition to payments from DA funds, the implementing entities can also request the S D U to make direct'payments to consultants or consulting firms, and special commitments for contracts covered by letters o f credit. Such requests wil l fol low World Bank procedures. All withdrawal applications to IDA, including replemshment, reimbursement, and direct payment applications, wil l be prepared and submitted by MOF

Accounting and Reporting

39 The FM Manual developed and approved for the Horticulture and Livestock Project (P098256, H L P implemented by the MAI) wil l be applicable for this project at the MA1 level. The Financial Management Manual outlines guidelines for project activities, and establishes a project financial management system in accordance with standard Afghan government policies and procedures. This includes use o f the Chart o f Accounts developed by the FMA to record project expenditure. Project accounts wil l be consolidated centrally in MOF, through the SDU and supported by the FMA. Consolidated Project Financial Statements wi l l be prepared for al l sources and uses o f project expenditures.

Disbursement Method

40. Disbursements from the IDA grant wi l l be made in accordance with the Bank's Disbursement Guidelines for Projects (May 2006) and Disbursement Handbook for World Bank Clients. The client may request reimbursement, .direct payment, and payments under Special Commitments including full documentation (submission o f records) or against statements o f expenditures, as appropnate.

11

Retroactive Financing

41. Provision has been made to reimburse G O A for payments i t makes for project expenditures, up to U S $ 1,000,000 between 15 June 2006 and signing o f the grant.

Audit o f Proiect Funds

42. The Auditor General, supported by the Audit Agent, is responsible for auditing the accounts o f al l IDA-financed projects. Annual audited project financial statements wil l be submitted within six months o f the close o f GOA’s fiscal year.

5. Procurement Arrangements:

43. Procurement for the Project wil l be c m e d out by two procurement specialists. One procurement specialist will operate in the MAI, and wil l be in charge o f procurement related to the Atl lmal Health, Communications, and Management components. A second procurement specialist will operate in the MOPH and procure goods and services under the Human Health component.

44. Procurement will be in accordance with the World Bank’s “Guidelines: Procurement under IBRD Loans and IDA Credits” (dated M a y 2004); “Guidelines: Selection and Employment o f Consultants by World Bank Borrowers” (dated M a y 2004); and the provisions stipulated in the Development Grant Agreement. The Bank’s Standard Bidding Documents, Requests for Proposals, and Forms o f Consultant Contract wil l be used. In case o f conflict/contradiction between the Bank’s procurement procedures and any national rules and regulations, the Bank’s procurement procedures wil l take precedence. The summary o f the procurement capacity assessment o f the implementing agencies and precise arrangements are presented in Appendix 6.

6. Monitoring and Evaluation of Outcomes/Results

45 The M&E activities will be coordinated by an M&E specialist who wil l ensure data collection, and timely reporting and dissemination o f information. Details o f a proposed M&E are presented in‘ Appendix 9, which incorporates good practices form other G P A I project and lessons learned form the FAO-implemented AIRP in Afghanistan.

12

7. Sustainability, Critical Risks and Possible Controversial Aspects

Risk Decline in political wil l and :ommitment to address the threat o f HPAI for national and global interests as a national pnonty

Project implementation agencies do not have sufficient authonty and zapacity to implement the stipulated national plan on AI control and :ontainment effectively

[n view o f the inadequate health :are capacity, intervention activities may not be effective in containing and preventing the spread o f AI from birds to humans.

Inadequate or lack o f multi-sectoral participation

Provincial coordination and commitment i s inadequate and inefficient.

Lack o f independent internal audit and lack o f commitment to the financial management in general.

Controlling the spread o f the

Rating H

S

S

M

S

S

S

Mitigation Measures Continuous f low o f accurate information at the highest level (the National Emergency Response Committee, chaired by one o f the two Vice Presidents) and the Ministenal level N A I S will help to reduce the nsk o f decline in political willingness to adequately address the threat o f AI. Linkages with vmous global programs (FAO/OIE, WHO, W). Adequate safety measures in project implementation arrangements, management and M&E have been considered for the project to help reduce this nsk. The M&E system proposed for the project wil l help in this regard. Project activities are designed to target the provinces most at nsk first with an intensive public and institutional awareness raising campaign dunng PY 1. Provisions have been made for specific AI-related capacity building in the public health sector at national and provincial levels. Intensive measures have been planned for controlling AI in birds, which i s expected to reduce the threat o f AI spread to humans. The g o v e m e n t has already created a number o f national multi-sector committees that include al l relevant ministnes and departments. The project will further strengthen these institutions. Project design includes coordination un i t s in the 8 geographic zones. These wil l help to ensure the creation and functioning o f Provincial AI Committees, and early reporting wil l prompt decision making at the highest level. A ngorous and effective financial management, including auditing, has been proposed, which wil l ensure that a robust internal audit i s independent from oDerations and reDorts to the NAIS. Proiect actions wil l encourage advocacv

13

pandemic may expose the Government to cnticism concemng the curtailment o f c iv i l nghts due to the adoption o f quarantines and other related measures.

Lack o f laboratory capacity for prompt diagnosis and surveillance and lack o f sufficient medicines and antiseptics to meet the requirement o f the population and the project.

Inadequate institutions to manage the project.

Lack o f timely and reliable access to expert advice and technical support.

L o w pnonty given to public accountability and transparency in program management.

Inadequate capacity for planned surveillance, surveys and monitonng and evaluation.

Misuse o f compensation facility

Overall Risk Rating:

H

H

M

H

M

S

S

and coalition building to sensitize key groups including pol icy and law makers, and the media. The mass communication and public awareness raising campaign i s expected to build support for the project among the population at large. Project planning includes some measures to f i l l the gap and synergies with other institutions such as FAO, WHO, U S A I D and NGOs, multilateral and bilateral institutions have been sought to address this issue. The project Implementation Support Team (IST), together with existing public institutions i s expected to provide strong and receptive capacity. The project has been designed with the help o f FAO, U S A I D and in close consultation with WHO and other stakeholders. Most o f the international agencies with expenence in AI control will be implementing partners under the auspices o f the proposed project management team. A detailed financial management and procurement plan has been developed, while a strong and dynamic M&E will detect any deviation from the planned rules, regulations and standards. Adequate capacity and the development o f detailed operation manuals and guidelines have are proposed for the project. The highly technical tasks wil l be contracted to expenenced technical institutions, with ngorous monitonng and evaluation IST Project planning includes a stnct system for payng compensation that includes the communities as well as a number o f institutions in the implementation and monitonng o f procedures and payments.

14

Implementation in High-nsk Areas

46. The extent to which the project wi l l be able to assist farmers throughout the country depends on the secunty situation. Secunty remains problematic in several provinces because o f the limited extent o f government authonty Aid agencies can face threats from cnme, inter- warlord nvalnes, and opponents to the government. The secunty situation in the country is at i t s worst since the fal l o f the Taliban regime, and it i s not clear how i t wil l evolve in the next coming years. k s k is particularly hgh in the South. Preliminary operations o f the project have therefore been designed to avoid areas o f persistent nsk.

47

8.

No controversial aspects are foreseen.

Grant conditions and covenants

48. No withdrawal wil l be made for payments under the Project unless: (i) a Financial Management Manual satisfactory to the Association has been prepared and adopted for the Project; (ii) a financial management officer for the Project has been appointed withn MAI; (5) the Implementation Support Team has been constituted and staffed with an adequate number o f key professionals, and (iv) the Operations Manual has been adopted.

49 No withdrawal against the Compensation Facility wil l be made until a Compensation Procedures Manual and an Environmental Management Plan satisfactory to the Bank have been adopted by the government

50. Before effectiveness, the Minister o f Justice should prepare and submit to the Bank a legal opinion stating that the Financing Agreement has been executed and ratified in accordance with the laws o f Afghanistan. In addition, the cofinancing agreement between IDA (as administrator for the Avian and Human Influenza Trust Fund) and the government o f Afghanistan should have been executed and al l conditions precedent to i t s effectiveness or to the nght o f the government o f Afghanistan to make withdrawals under i t will have been fulfilled.

D. APPRAISAL SUMMARY

1. Economic and Financial Analyses

5 1 In terms o f savings or prevention o f losses from further outbreaks o f HPAI the returns to the proposed investment are substantial. Using conservative assumptions, the total investment o f US$12.7 million, could prevent an estimated cumulative loss o f about US$200 mi l l ion over the next 10 years. In financial terms an average o f about US$18 mi l l ion per annum o f losses prevented may be significant in i t se l f but these losses would affect the poorest and the most vulnerable households in Afghanistan.

52. The economic analysis uses the standard cost-benefit analysis method to estimate the avoided losses in with-project situation. Without project and AI outbreak would have a significant negative impact on the poultry sector and humans, using the impact parameters from WHO and FAO/OIE (See Appendix 5 for more details). The with-project scenano assumes that the negative impact o f the disease would be minimized over the course o f the project, leading to

15

reduced costs to the stakeholders and the economy as a whole. The benefits in terms of human health and the poultry sector are significant and robust, suggesting the financial and economic viability o f the project. The sensitivity analysis shows that the project benefits are robust and do not change even with significant changes in the assumptions and parameters (Appendix 5). Nevertheless, the assigned probabilities, as cntical parameters for estimating costs and benefits with and without project scenanos are estrmates and not statistically denved. Any interpretation o f the economic analyses should therefore be correspondingly cautious.

53. Some notable and highly relevant direct and indirect costs related to a possible AI outbreak have been disregarded in the analysis, in view o f the uncertainties in extent o f correlation, lack o f appropnate data and information. Fol lowing field visits to a number o f affected and highly vulnerable provinces, the preparation mission found that many traders and the nascent poultry farms have incurred significant costs and many have been indebted as a result of the minor outbreak early in 2006.

54. Alternative sources o f income are l imited and in Afghanistan any loss o f income from the poultry sector wil l have significant food insecunty repercussions. Poultry is also one of the most significant sources o f income for the landless. Therefore, the project’s aim to help control and contain the spread o f AI will benefit pnmarily the relatively poorer members o f the society

2. Technical

55 The proposed Project involves a large set o f technical issues involving capacity o f vetennary services, laboratory facilities, bio-secunty measures, epidemiological .expertise, and emergency response to avian influenza outbreaks and a possible pandemic. These technical issues are elaborated in Appendix 2 (Detailed Project Descnption).

3. Fiduciary

56. The decision to align with the government’s systems and procedures for implementing a l l components will contribute to enhancing institutional capacity While the overall fiduciary nsk associated with the Project i s rated as “High h s k ” for financial management and procurement, the proposed nsk mitigation action plans are deemed to be adequate (see Annex 6 and 7 for details). Efforts wil l be made for capacity building in project coordination that includes procurement and financial management.

4. Social

57 Although poultry i s not a major commercial or economic activity, in Afghanistan, backyard chickens are an important livelihood, income and food secunty issue for the rural poor and especially for female-headed households. Nearly 98 percent o f the poultry sector i s owned and managed by women as one o f the very few economic activities accessible to women. Therefore, interventions in the poultry sector wil l disproportionately benefit the most vulnerable section o f the society and positively contribute to addressing the gender bias in society, representing a significant positive social impact.

16

5. Environmental

58. The Project is assesszd as Category B for environmental impact. Project activities are expected to generate no or limited adverse environmental effects, since most activities are designed to support preventive measures. The Project will, generally, have positive environmental and social impacts as investments in facilities, equipment, laboratones, and training wil l improve the effectiveness and safety o f existing avian influenza handling and testing procedures. This would be reinforced by the mainstreaming o f environmental safeguards through protocols and procedures for the culling and disposal o f ammals dung AI outbreaks and decontamination o f production facilities, and laboratones. However, adverse environmental health impacts, mainly unintentional from the spread o f HPAI, could occur when an emergency operation involves containment o f outbreaks through quarantine, isolation and culling actions and when relevant mitigation measures are not in place. Most of the key potential impacts will be avoided or minimized by routinely integrating environmental and public health safety aspects dunng project implementation.

6. Safeguard policies

Safeguard Policies Triggered by the Project Yes N o Eiivironniental Assessment (OPBP 4.0 1) [XI [I Natural Habitats (OPBP 4.04) [ I [XI Pest Management (OP 4.09) [I [XI Cultural Property (OPN 1 1.03, being revised as OP 4.1 1) [XI Involuntary Resettlement (OPBP 4.12) [I [XI Indigenous Peoples (OP/BP 4.10) [ I [XI Forests (OPBP 4.36) [I [XI Safety o f Dams (OP/BP 4.37) 11 [XI Projects in Disputed Areas (OPBP 7.60) [ I [XI Projects on International Waterways (OPBP 7.50) [I [XI

[I

59 The Environmental and Social Safeguards Framework has been disclosed by the government in D a n and Pashto, as well as English through a publication and the government’s Web site. I t i s also available at the World Bank’s Infoshop. In addition, the following information on the project wi l l be posted o n the government’s Web site (u.ww.a9Ilculture.~ov.af): summanes o f quarterly Project implementation progress reports, summanes o f annual project financial statements and audit reports, and summanes o f findings from monitonng and supervision teams (after a reasonable penod allowed for internal review).

Land Mine Risk Management

60. No project activities wi l l be implemented without appropnate mine nsk management, based on the procedures defined in the Environmental and Social Safeguard Framework (Appendix 8).

17

Land Acquisition

61. There wil l be no land acquisition under the project and carcasses o f culled birds wil l only be disposed o f on public land. For backyard poultry operations, the local committee wil l witness any culling and the,local vetennanan will s ign a document stating the carcass disposal area i s public property and free o f encroachershnformal settlements. In case o f semi-commercial poultry farms, the zonal vetennanan and an off icial f rom the local administration wil l make a similar venfication.

7. Policy exceptions and readiness

62. No policy exceptions are sought.

18

APPENDIX 1 - Results Framework and Monitoring

I Outcome Indicators PDO U s e of Outcome Information

To minimize the threat posed by HPAI to humans in Afghanistan by controlling such infections among birds, especially domestic poultry, and prepanng for, controlling, and responding to possible human infections, especially an influenza epidemic and related emergencies.

. Evidence* o f widespread adoption o f recommended practices for the control and eradication o f HPAI among poultry producers, distributors, and retail vendors;

. Evidence* o f improved effectiveness o f parhcipatmg animal and human health services in responding to the risk o f an HPAI outbreak.

Results Indicators for Each Component Intermediate Results

1. Determine the effectiveness of the program in the year 1 and make corrective measures in the fol low up years.

2. Refine the design and implementation strateges o f other complementary (under preparation and ongoing) programs in the poultry, human health and waste disposal management programs o f the country. U s e o f Results Monitoring

I. Animal Health H P A I control and outbreak containment strengthened

0

0

T w o fully trained cull ing teams established per zone. 1,000,000 birds vaccinated at the time of the outbreak

Eight training o f trainers conducted m H P A I diagnosis, reporting and surveillance, and implementing training courses for vetennary NGO~; 20 active surveillance teams trained and operational in 2 zones

0

0

A national diagnostic and surveillance system established for rapid HPAI detection

l 3 ~ ~ e that a l l activities and plans are in accordance with international standards and and activities are wel l coordinated.

Based on the verified outcomes, take appropnate corrective measures.

Capacity o f poultry stakeholders developed in bio-security measures

Guidelines developed for

Evidence* o f t imely and satisfactory progress toward delivery o f Component I outputs, as compared to the onginal plan, including specific indicators as follows:

0 Vetennary and poultry sector legislation rewsedamended, and guidelines, contingency plan and training material developed.

T o venfy satisfactory progress and appropnateness o f the implementation strategies.

0 10,000 Women trained and Ensure that the program i s heading towards a desirable direction and the national p lan i s effectively implemented.

implementing community-based disease surveillance and early warning and farm bio-security measures Manuals in local languages available 0

19

safe disposal and management o f biological and solid waste

Capacity built at Provincial and Central level

Appropnate safeguard and safety measures established for

II. Human Health A national program implemented for the identification, early warning, prevention, containment, control and eradication o f HAP1 in the human health sector.

0 Provincial AI comniittees established in al l provinces with specific guidelines on membership, TOR, and system o f communications An effective and interactive M&E system established

the protection o f environment in the event o f an outbreak and from the

0

0 Environmental management plan for Indication o f lack o f adherence to safe disposal norms and requirements

111. Communication and Improved public awareness about AH1 at al l levels.

Evidence* o f t imely and satisfactory progress toward delivery o f Component I1 outputs, as compared to the onginal plan, including specific indicators as follows:

0 90 % o f health care worlkorce with “adequate” (according to protocols) case management knowledge, including: (i) general knowledge and diagnosis; (ii) use o f PPE; and (iii) treatment using antiviral medications.

80 % o f surveillance sites enabled to: (i) report possible avian influenza cases to national surveillance unit within 48 hours; (ii) submit monthly “zero reports”; and (iii) ensure adequate laboratory testing for suspected cases o f avian influenza

90 % o f provincial and distnct hospitals with more than 10 sets o f PPE and 10 courses o f antiviral medicines

’ublic Awareness Evidence* o f t imely and satisfactory progress toward delivery o f Component I11 outputs, as compared to the onginal plan, including specific indicators as follows:

a national, integrated and comprehensive communications strategy i s in place; 50 percent o f targeted population i s informed o f the A-I risk and program.

To venfy satisfactory progress and appropriateness o f the implementation strategies.

Based on the venfied outcomes, take appropnate corrective measures.

Ensure that the program i s heading towards a desirable direchon and the national plan i s effectively implemented.

20

environmental protection, solid waste management and reducing r isks o f hazard exposure.

project activities i s prepared and made part o f the project p lan o f implementation.

Operational Manuals, guidelines, norms and standards for solid waste management and disposal practices for labs, culling, and other operations are established and made part o f the project p lan o f implementation.

An effective information system established that would ensure speedy and efficient f low o f information along the chain o f command f rom the national to provincial levels and visa versa - as wel l as provide appropriate information to the public on a l l relevant aspects o f AI.

would help retrainmg s t a f f and redirecting communication campaign.

Communication training matenal and broadcasting matenal prepared and appropriate training provlded to implementing partners o n AI-control and containment in a l l provlnces

At least 6 female communication officers trained per zone who will participate in intensive communication activities, directly contacting and provrding AI-related messages and information to women

Indication o f an incoherent and inefficient informatlon system as wel l as lack o f public awareness o f the risks o f AI to human health would help the AI Secretanat and other institutions to take appropnate corrective rmSureS at an earlier stage of the ProJect.

in the households

* V i a reports from indcpcndcnt tcchnical and social audit teams that visit the ficld, review available self-reporting data, intcrvica stakcholders, and judge the results.

21

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3

APPENDIX 2 - Detailed Project Description

Introduction

The project wil l support the national program for HPAI prevention, containment, control, and eradication activities in the livestock and public health sectors. These activities reflect an assessment o f the particular nsks, conditions, constraints, needs and possibilities in the country, including a rapid assessment o f the public health and vetennary services and poultry production systems, and reviews by donor agencies and institutions involved with AI.

A. Animal Health Component

A.1. Strengthening HPAI Control and Outbreak Containment Capacity

Project support for HPAI outbreak containment actions reflects the provisions in the NAIPPRP and associated implementation guidelines and manuals. Project financing wil l be provided for activities related to the implementation o f the NAIPPRP which specifies the responsibilities and functions o f the National and Provincial Committees on AI Control, the l ine ministnes involved, and implementing partners. I t also defines the responsibilities o f the zone offices and the teams that wil l be formed and trained now and activated in any location where an outbreak i s suspected andor confirmed. For animal health, this wil l pnmari ly involve the Vetennary Services Department (VSD) o f MAI.

Targeting Virus Eradication at the Source. The overnding objective for vetennary services i s to detect and contain any outbreak o f AI and to eradicate the disease at the source o f infection. Several activities are directly linked with this objective and accordingly, the sub-component wil l provide support for: (i) early detection o f virus among the poultry population; (ii) early response in order to suppress viral activities in the identified outbreaks by means o f culling o f infected and at-nsk poultry (stamping out) through emergency response teams, (iii) compensating farmers and commercial poultry producers (at rates prescribed by the National Avian Influenza Secretanat - NAIS), (iv) disposing o f carcasses and potentially infective matenals in a bio-secure and environmentally acceptable manner, (v) enhancing bio-secunty at poultry farms and associated premises through bio-containment and bio-exclusion; (vi) controlling the movement o f birds and products that may be infected, including controls at the interface o f infectednon-infected areas and border controls, and (vii) providing nng vaccination for al l poultry within restncted and control areas after completing culling operations.

Project financing wil l provide for the technical and logistical means to Emergency Response Teams (ERTs) to contain a HPAI outbreak through location quarantining and culling o f affected animals in infected and dangerous contact places. Culling and carcass disposal wi l l be done under the supervision o f zonal vetennanans or contracted pnvate

26

vetennanans, who will be assisted by properly trained, equipped and protected staff (governmenthetennary field un i t s - VFU staff and laborers) hued for*this purpose by VSD o f the zone. Equipment and matenals will be provided for efficient and humane animal destruction as wel l as for the safe disposal o f carcasses. Carcass disposal wil l be case-specific, depending on local circumstances, but in al l cases in an authonzed and bio- environmentally safe manner. Manuals wil l be developed in local languages and culling teams will receive proper training in human safety measures, humane killing and environmentally safe disposalldestruction o f biological and solid waste matenals. Protective clothing and other gear wil l be procured and kept in ready supply at zonal offices, to be issued in case o f an outbreak to al l staff and workers involved in containmg it. Detailed records wil l be maintained o f a l l w a l s culled, so as to prowde the basis for subsequent compensation to their owners.

For backyard poultry operations, the cul l ing wil l be done in the presence and under the “social supervision” o f a small local committee that includes two trusted members o f the village community (of which preferable one wil l be a woman) as wel l as the local vetennanan. Community representatives may be the Mullah, members o f the Community Development Council (CDC), a representative o f the Women Poultry Group, or other locally recognized and trusted community members. This committee wil l venfy the number o f birds culled and their owners, so as to ensure a correct count and f i l l transparency for subsequent compensation payments. The commission members will s i g n and the poultry owners wil l countersign the list o f birds culled.

At (semi-)commercial poultry farms, the culling wil l be carned out in. the presence o f the owner or manager or o f a person designated by h imher and under the supervision o f the zonal vetennanan and one official o f the local administration. All three wil l sign the l i s t o f birds culled.

Along with the project activities the staff members o f the ERTs will undertake f i led simulation exercises in order to test the correct implementation o f the established procedures.

Vaccination: Poultry vaccination on a large scale as a preventive measure i s not foreseen at the present time. Lessons learned f rom the epizootic occurred in March-Apri l 2006 showed -that the disease, if present, i s l ikely to move slowly within the poultry population. This might be mainly due to the l ow population density o f poultry and to the fact that 98% of the poultry population i s in the rural sector (with an estimated average size of 6 animals/family), meaning that there are no big aggregation o f birds per epidemiological unit that can sustain the survival o f the virus. In addition the vetennary

, system (government and pnvate) i s not presently equipped to implement large-scale poultry vaccination campaigns7, the secunty situation in many parts o f the country not conducive to large-scale vaccination campaigns. Vaccination can however take place on a regular basis for the semi-commercial layer farms and pullet-reanng farms, which provide birds to the rural sector, as well as the birds supplied via Rural Poultry Development ProjectsPrograms. Provisions have been made in the budget to do so. In

’ The annual import o f Newcastle disease vaccine i s reported to be 2 mi l l i on doses.

27

, the face o f an outbreak and in order to prevent hr ther spread o f disease, the project wil l undertake nng vaccinations, after culling, if required. Each zone will receive adequate stock o f vaccines to carry out nng vaccinations.

Whenever vaccination is going to be implemented a vaccination monitonng scheme has to be developed in order to momtor: (i) efficacy o f vaccine; and (ii) detect incursion o f virus in vaccinated flocks. The latter is usually achieved by leaving some unvaccinated birds in vaccinated flocks. Even if such method i s culturally unacceptable in the Afghan rural setting this might be applied in the commercial and semi-commercial sector. The project wil l support active and passive sero-surveillance programs in vaccinated birds, distributed through the FA0 implemented Rural Poultry Development project (GCP/AFG/030/USA), in order to assess the level o f protection after vaccination and to monitor vaccinated birds for possible infection with HPAI. These activities wi l l i.a. be carned out with the assistance o f female (para)vetennanans/CBAHWs and poultry trainers.

After the init ial emergency phase, dunng which poultry farmers are to be financially compensated for culled birds, a restocking scheme with vaccinated birds, based on the Afghan Rural Poultry Development Model, could be established as a mechanism within the compensation facility

Activities in support of sub-component A.l (cost Table 1 in project files):

A.1.a. In order to face avian influenza emergency situations, the Project wil l support eight regonal ERTs. Each Team wil l be composed o f four vetennanans, who wil l be equipped with al l necessary matenal to carry out field investigation and culling operations. The provisional l i s t o f minimum required equipment i s as follows: rapid tests, personal protection equipment sets (PPEs), disinfectants, sprayers, motonzed mist blowers, autopsy kits, culling bags, C02 cylinders, GPS, cel l phones, maps, laboratory equipment for samples collection, storage (refngerators and freezers) and sample transportation (liquid nitrogen tanks and cool boxes).

A.1.b. Training for the ERTs. Teams wil l be provided with technical operation manuals on samples collection, storage and transportation, outbreaks investigation, methods for culling and disposal o f carcasses.

A.1.c. Field simulation exercises wil l be organized for ERTs to check if emergency procedures could be duly implemented.

A.l .d. Procurement o f vaccine for emergency and for regular vaccination programs in the commercial and semi-commercial sector. I t i s estimated that the maximum amount o f vaccine to be purchased along with project activities i s up to 6,000,000 individual doses.

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A.1.e. Establishment and. implementation o f procedures to momtor the efficacy o f the vaccine and to establish a monitonng program in commercial vaccinated flocks in order to be able to detect early incursions o f the virus.

A.1.f. The project wil l procure a number o f station wagons, pick ups, motor bicycles and truck in order to carry out timely and effectively above mentioned activities in the country

A.2 - Human Safety Assurance. The project will support the provision o f traimng to people l ikely to be in direct contact with birds that may carry AI. Ths includes vetennary and extension field staff involved in identification o f the disease, farm workers involved in culling and waste disposal, and laboratory workers involved in virus isolation and diagnosis. Resources will be allocated for extensive field training* in order to enhance the level o f awareness. Equipment (bio-safety hoods and appropnate personal protective gear and clothing) wil l also be provided and in addition, a l l vetennary staff and workers involved in emergency response teams and laboratory staff involved in HPAI diagnostic activities wil l be vaccinated against seasonal human influenza.

Activities in support of sub-component A.2:

A.2.a. Extensive training activities wil l be camed out by ERTs for field vetennanans, field staff and farm workers on r e c o p t i o n o f avian influenza and procedures o f self-protection in case o f handling suspected birds. Training will include the procedures o f activation o f the ERTs. Each ERT will carry out three training sessions per year in order to cover the relevant satellite provinces.

A.2.b. Provision o f PPEs for the ERTs, trainees, and State Vetennary Department (SVD) staff. The Project wi l l procure 10,000 (ten thousand) units composed of coveralls, boots, cover heads, masks and gloves.

A.3. Strengthening HPAI clinical and laboratory diagnosis and surveillance for rapid and effective outbreak detection and containment capacity

Strengthening Disease Surveillance Capacity. Project financing wil l provide for supporting MA1 vetennary services and VFUs nationwide through specific operating procedures for al l staff in the detection and reporting o f clinical HPAI disease. This wil l be based on the guidelines as developed by FAO/OIE and wil l include building capacity o f public and pnvate vetennary services, through provision o f training programs in active and passive epidemiological surveillance and disease reporting, in order to combat major trans-boundary animal diseases including AI. This sub-component wi l l expand the activities already initiated and build on the expenences and lessons learnt f iom the FA0 implemented AN?, which i s providing a bndging project between the AI surveillance component o f the FA0 Regional Trans-boundary Animal Diseases project and the AHIP

~~

Adaptation for the Afghan situation o f the manual: Prevention and Control o f Avian Flu in small scale poultry A guide for veterinary paraprofessionals 111 Vietnam, FAONSF-CICDADept. o f Animal Health o f Vietnam (Appendix IX).

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project. The surveillance program i s implemented at the moment in (formerly) infected and neighbonng distncts and at l ive bird markets in established nsk areas. The preliminary results o f the program are presently under evaluation but it can be anticipated that the results so far obtained did not evidence the presence o f HPAI in the study areas.

The program was structured in four main sub-components: (i) rural areas; (ii) commercial and semi-commercial sector; (iii) wetlands; and (iv) l ive birds markets. The same approach could also be used in the present project extending the activities throughout the country Project financing wil l be provided for regular epidemiologcal studies and active and passive surveillance programs in commercial and smallholder poultry. This wil l support the process o f improving disease control measures, and wil l allow for adjustments and refinements as new information becomes available. This activity wi l l also support Afghanistan’s participation in the regional HPAI network and will enable disease information shanng. Studies to support the surveillance component will be implemented by the project and include, i.a., poultry density mapping exercises to support nsk assessments and establishment o f sample sizes for epidemiological surveys. Fol lowing these studies, VFUs will be contracted to carry out surveillance work e.g. (bi- )weekly random sampling at live-bird markets, commercial and semi-commercial sectors in their service areas. Government and pnvate service providers wil l be remunerated for both passive and active surveillance activities. I t is foreseen that surveillance in rural poultry wil l be carned out by female (para)vetennanans/CBAHWs.

UDdatina Essential Information on Migratory Birds. The Government intends to assess flight and resting patterns o f migratory birds, especially waterfowl. To this end the project management wil l liaise with the National Environmental Program for Afghanistan (NEPA) to determine migratory bird species in the country In this context, project financing wil l provide for: (i) supporting activities by an ornithologist to classify migratory bird species; (ii) an active surveillance program in villages around 15 identified wetlandsg in order to carry out nsk assessments at locations where migratory fowl may come into contact with domestic poultry and humans; and (iii) surveillance activities in wild birds through observation o f the clinical status and collection o f samples from target species adopting methodologies that will not affect protection o f wildlife and safeguarding biodiversity. Active reporting wil l be stimulated via the FA0 installed C O D A N radio network, which i s to date operating in 32 provinces o f Afghanistan. The remaining two provinces, not yet covered by the system, wil l receive a C O D A N radio shortly

Strengthening Diagnostic Capacity. Project support through this sub-component wi l l be targeted pnmari ly at strengthening the capacity o f the Central Vetennary Laboratory and public and pnvate field staff, in detection, reporting, sample collection and submission, and follow-up o f reported AI cases. This wil l involve init ial training followed by active surveillance activities. Essential equipment for the central laboratory and rapid tests for regional laboratones, as well as consumables and reagents, wil l be financed. Staff training and technical assistance wil l be provided to establish rapid institutional capacity for serological tests and screening surveys, and for virology tests to

Serological surveys carried out in Dec 2005 -Jan 2006.

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confirm the existence o f the disease. Twinning arrangements with appropnate institutions and laboratones wil l be explored to facilitate sustained capacity strengthemng over the medium and longer term.

Activities in support of sub-component A.3:

A.3.a. Training and review the regulatory and 2 legslat ion framework and development o f guidelines for compensation scheme.

A.3.b. Improvement o f information system i s an essential component o f the surveillance system, which wil l be enhanced through the procurement o f different items aimed at improving the capacity o f the State Vetennary Department to rationalize information collected through surveillance system. Training wil l also be provided on the implementation o f an ad-hoc information system.

A.3.c. In order to strengthen disease surveillance capacity, training and preparation o f guidelines and manuals wil l be provided for investigating diseases in the sub-component identified (rural, commercial and semi-commercial sectors, live birds markets and wetlands).

A.3.d. Remuneration for the vetennmans involved in investigating in commercial and semi-commercial sectors, l ive birds markets and wetlands. Investigations in commercial sector and l ive birds markets are to be carned out on a regular basis while investigations on wetlands are to be carned out mainly dunng migrating seasons o f wild birds.

A.3.e. Field vetennanans involved in surveillance activities in wetlands wil l undertake a training course on sample collection and recognition o f wild birds species, which are relevant to AI epidemiology

A.3.f. Field vetennanans involved in activities in wild l i fe wil l need to be equipped with sample collection matenal and additional devices to capture wild birds.

A.3.g. The Central Vetennary Diagnostic Laboratory in Kabul wil l be provided with laboratory equipment, reagents and consumables in support o f surveillance activities. Laboratory staff involved in diagnosis wil l undertake refreshing training courses on laboratory techniques.

A. 4. Improving the capacity of poultry stakeholders to adopt appropriate measures to counter HPAI presence in Afghanistan

Community-Based Animal Disease Surveillance and Early Warning. Early warning o f suspected outbreaks o f avian influenza i s essential in curtailing spread o f the disease and minimizing economic loss. Since the rural backyard poultry sector constitutes 98 percent o f the national flock, rural poultry raisers are the focal point to address when early warning and disease reporting issues are concerned.

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However, early warning systems at village level will only be effective if measures taken follow established guidelines and procedures, and farmers are wel l and timely compensated for loss o f healthy chickens through culling. Activities as expenenced in Afghanistan, e.g. culling in distncts without confirmed cases o f avian influenza, are not conducive to disease reporting, and may senously hamper containment and control of HPAI in Afghanistan in the near future.

The rural poultry industry i s a female core and since most rural women in Afghanistan are illiterate and often out o f contact with modern communication methods such as radio or television, the method o f choice to address these women i s through personal contact by female poultry trainers or CBAHWs.

To establish early warning systems at the community level to support a robust emergency reporting and feedback system for notifiable animal diseases, the project will finance training courses in, and implementation o f participatory disease survey techniques for female animal health workers and women poultry trainers. Training courses will further include handling o f infected animals, reporting procedures and immediate local response measures. To this purpose the project will provide training courses to FAO's Women Poultry Trainers and to female BWV, who wil l act as trainer o f trainers. NGOs wil l be sub-contracted to implement program activities at village level through training o f women poultry raisers. Poultry farmers wil l receive hands-on training in detection o f clinical signs. Group leaders wi l l be focal points for reporting suspected cases in those villages where women poultry groups exist. Group leaders wil l be reimbursed for cost" incurred for reporting (telephone, travel, small service fee, etc.). Funding wil l be provided for essential bio-secunty equipment such as sprayers and protective equipment.

Improving Bio-Security in Poultry Production. Bio-secunty i s the cheapest, most effective means o f disease control available. N o disease prevention program wil l work without it. Bio-secunty i s a concept for prevention o f disease entry/escape that must be practiced by al l farmers, cooperatives, abattoirs etc. Lack o f bio-secunty measures increases the nsk o f introducing disease or infection into the production unit, market, or any commercial operation. Farm management practices and marketing systems influence the probability o f poultry being challenged (and becoming infected) with HPAI.

Smallholder households keep approximately 98 percent o f the total poultry population in Afghanistan. Typically, smallholder households own around 6 chickens per household and sel l a bird occasionally to meet cash or domestic needs. Rural poverty i s unfortunately expected to perpetuate high-nsk behavior through slaughtenng and/or selling o f infected chickens.

The main goal o f the bio-secunty sub-component is to develop clear guidelines and to train both commercial and backyard poultry owners in clinical s igns o f senous poultry diseases, to ask them to noti fy competent authonties o f occurrences o f sick and/or dead birds, and to give them information on practicing bio-secunty measures to keep their

lo On average US$5.0 per report.

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birds safe and healthy This wil l be achieved through carehl assessment and planning o f the required measures and their applicability in the Afghan context. All commercial poultry farms should develop and implement a formal bio-secunty plan as appropnate to the type o f farm. The bio-secunty plan should be documented with clear specifications o f those responsible for i t s maintenance.

Bio-secunty practices do not have to be cumbersome or expensive. However, the effectiveness o f the measures depends on compliance by farmers and farm workers, who must have a basic understanding o f the purpose o f the measures. Breaches o f bio-secunty can occur no matter how stnngently the measures are implemented. Therefore, this sub- component will assess the capacity and willingness o f people to cany out bio-secunty measures. Willingness depends on the perception o f the nsks from HPAI, the extent to which the government i s able to enforce wntten regulations, the importance o f poultry to the livelihood, the cost o f the recommended bio-secunty measures compared to prof i t from the poultry enterpnse, and the availability o f cash to make an investment in bio- secunty measures, when weighted against the many other demands on income.

Improving bio-secunty in poultry production i s an important element in any strategy to safeguard against the damaging impact o f HPAI. The project wil l support participatory socio-economic needs and impact assessments o f bio-secunty measures in the poultry sector, encompassing al l stakeholders. Links should be established with the H L P project for baseline data on bio-secunty Support wil l also be provided for an overall assessment o f the poultry industry, including birds markets, and o f the opportunities for improving bio-secunty measures to prevent spreading o f virus from infected premises and thereby reducing the nsk o f further infection. The assessments will result in tailor-made recommendations to enhance bio-secunty at poultry farms and associated premises, through bio-containment and bio-exclusion and by the provision o f safe carcass disposal facilities. Appropnate technical training matenal adapted to vanous existing categones o f poultry stakeholders wil l be developed. Particular emphasis wi l l be given to the promotion o f the Afghan Rural Poultry Development model as viable approach for bio- secunty measures. Project management wil l liaise with the HLP to provide poultry reanng training courses to HPAI affected farmers.

Activities in support of sub-component A.4:

A.4.a. Surveillance in rural areas wil l be carned out by trained women. This activity wi l l have two main components: (i) regular surveillance in nsky areas (Le. around l ive birds markets); (ii) random surveillance in the remaining areas. The two activities wi l l have different penodicity

A.4.b. Development o f pnnted matenal to be distributed to the visited villages to raise awareness on AI.

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AS. Compensation facilities

The Project has established a compensation fund for farmers in order to reimburse them from the loss o f domestic poultry due to HPAI.

A.6. Technical Assistance - International Consultants

International consultants will be recruited to provide technical expertise to national staff throughout the project.

A.7. Waste Management and Sanitation

This sub-component wil l include the preparation o f a national plan, standard guidelines and an operational manual for HPAI-related waste management, as well as equipment and supplies to support healthy and environmentally fhendly disposal o f culled animals, laboratory waste disposal and decontamination. Detailed TORS for an international consultant to prepare guidelines and operational manuals have been prepared and are available in the draft Project Operational Manual.

B. HUMAN HEALTH COMPONENT

B.l. Enhancing Public Health Program Planning and Coordination

Support for an avian influenza coordinator within the Ministry of Public Health. At present, there is no individual in MOPH responsible for coordinating activities related to A I and human health. I t is important that a senior officer be appointed since the required elements o f human avian influenza surveillance, response, and case management, including those activities that are part o f this proposal, fal l within different parts o f the MOPH. The proposed activities must .occur in a precise time frame and sequence (e.g. guidelines must be developed before training can be initiated). A Public Health Coordinator wi l l be appointed to the project coordinating unit, to be responsible for implementing this component. The PH Coordinator wil l also serve as the M O P H liaison to the National Avian Influenza Secretanat (NAIS), and wil l coordinate the NGOs, international organizations, and technical consultants who wil l be executing a number o f the project tasks through contractual arrangements with the MOPH.

Development of command and control structures within the Ministry of Public Health, and review of institutional infrastructure. The current ability o f the M O P H to manage complex emergencies, such as disease outbreaks, i s limited and fragmented. There i s no management structure for handling a complex problem like avian influenza. An outbreak o f AI will require a system for integrating surveillance information, communications, deployng response teams, pharmaceuticals management, specimen and test result tracking. I t wil l also need to l iaise with provincial and local health authonties and other parts o f govemment. Project funding wil l assess the institutional arrangements within the M O P H for command and control, and develop a unified structure, including

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staffing and equipment, to support the formation o f a command and control w t . Project hnding wil l also provide for the appointment o f a director and operating costs for the command and control unit.

Development of protocols and guidelines for disease surveillance, response, and case management. The MOPH has developed l imited guidelines for disease surveillance, including dissemination o f a case definition. Guidelines and protocols are available from many international orgamzations (WHO, CDC, the European CDC, other countnes that have expenenced human illness from avian influenza). However, these guidelines will need to be adapted to the situation in Afghanistan. Given the multiplicity o f organizations that are providing health care in the country, uniform standards for disease surveillance, reporting, investigation, and case management, are cntically needed. Training activities cannot commence until such matenals are in place. Project financing wil l provide for the technical assistance needed to: (i) rapidly develop, produce, and disseminate such protocols and guidelines; and (ii) carry out penodic reviews o f existing protocols and guidelines and necessary modifications as the human dimensions o f avian influenza evolve.

Training workshops and activities. A comprehensive training program i s needed to assure uniform implementation o f protocols and guidelines for surveillance, response, and case management o f persons with avian influenza. The project wil l support a train- the-trainer approach. Workshops wil l be conducted for up to three trainers from each o f the provinces on disease surveillance, training o f response teams, and case management. The project wi l l also support subsequent provincial and local training activities to be conducted by the trainers. The project will also provide resources for training o f personnel at the national and regional referral hospitals being established as part of the project. The project wil l provide resources for penodic refresher courses, especially as the national situation, and the state o f knowledge o f avian influenza, evolves. Such penodic retraining wil l assure that the health care system is well-prepared to handle human disease related to avian influenza.

Conduct of tabletop and field simulations. Once protocols and guidelines are in place, i t i s important to conduct exercises to assure that policy-makers and health care managers understand how to respond to avian influenza and can identify and correct any gaps or deficiencies in the system. The project wil l support technical assistance for the development o f two tabletop exercises and four field exercises, and wil l support the actual conduct o f the exercises.

B.2. Strengthening the National Public Health Surveillance System

Develop institutional capacity for avian influenza surveillance including data collection, analysis, and dissemination in the MOPH. The project wil l support the development o f a unit within the Ministry o f Public Health to coordinate surveillance activities related to avian influenza and other pnonty diseases. At present, surveillance activities within the MOPH are fragmented, and there i s no single unit with responsibility for i t s collection, analysis, and dissemination. For avian and pandemic influenza, this i s a

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cntical deficiency I t is likewise a problem for other pnonty conditions and diseases.# The project wil l support the institutionalization o f a network for the avian influenza component through the Disease Early Warning System (DEWS) currently under development, including collection o f data o n viral pneumonia and influenza-like illness (ILI), from the local to the provincial to the national level. As regional facilities are being developed as case referral centers (see below), the project will support sentinel site ILI monitonng in these same locations. The project will also support six additional geographically representative sentinel sites for ILI monitonng. Each o f the eight sentinel sites wil l be g v e n a lump s u m payment o f $12,000 annually to cover equipment, recording, reporting, specimen collection and shipment costs, and an information coordinator at each surveillance site. Under this component, the project wil l support equipment (computers, communications equipment, training) and transportation, information dissemination through monthly bulletins, a surveillance unit director and data manager, and information collection personnel at each surveillance site. Because other donor resources are available to support the surveillance unit director and data manager for the first two years of the project, project funds are allocated for them dunng the third year o f the project only.

Support to rapid response teams. Each province in Afghanistan has rapid response teams (also known as emergency response teams) that have been developed to conduct investigations and institute control measures in emergency or outbreak situations, or when unusual illness i s recognized. Each o f these teams i s multi-person. There are also national level teams which provide back-up support to the provincial teams. The technical skill o f these response teams is inconsistent, as is their training. These teams wil l need to respond i f suspected or confirmed cases o f avian influenza are recognized. They will need to conduct field investigations, complete report forms and f i le outbreak investigation reports, initiate control measures, and collect appropnate specimens for diagnostic purposes. The project wi l l offer support to these teams, including training, communications, transportation, personal protective equipment, and incentives. For the purposes o f cost estimation, i t was assumed that the surveillance infrastructure would identify 50 potential cases or clusters requinng investigation per year, and that backup support will be required from national level teams ten times per year. Support is also provided for WHO to,provide technical support to the investigations being conducted by the rapid response teams. Because funds from other sources are available to support investigations dunng the f i rst year o f the project, project funds are provided only for the second and third year.

Equip major medical referral centers. The project supports the development o f a definitive diagnostic capacity using real-time polymerase chain reaction (RT-PCR) for avian influenza in the Ministry o f Public Health Central Laboratory This capacity i s being developed by other donors, and i s therefore not covered under the project proposal. For case management purposes, four regional medical centers have been identified as referral facilities for suspected and confirmed avian influenza (see below). Two additional referral centers are being refurbished and operated by other sources. These facilities have weak laboratory diagnostic capacity Although the project cannot support

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development o f RT-PCR in each o f these sites, i t is appropnate for case-management purposes (e.g. to aid decision making on initiation o f anti-viral therapy, health care worker prophylaxis, use o f isolation) to have access to rapid diagnostic luts to identify the presence o f influenza virus (luts identify influenza A & B only). These pre-packaged kits are feasible for resource-limited laboratones. Because two o f the four designated referral centers are in Kabul, it is not necessary to provide kits to these hospitals, since specimens can be rapidly transferred to the Central Laboratory for definitive RT-PCR diagnosis. Ki ts , along with the training to use them, will be provided to the remaimng two facilities and the two facilities being established through other donors, outside o f Kabul. Sufficient capacity to perform 100 rapid tests per year will be provided to each o f these four referral sites.

B.3. Strengthening the Health Care System Response Capacity

Designation of regional health care facilities and upgrading of these facilities to serve as referral institutions for persons with suspected or confirmed avian influenza. Although it is not possible to predict where human cases might appear in Afghanistan, dung the pre-pandemic phases there wil l need to be specialized referral facilities to isolate and care for persons with suspected or confirmed disease. Dunng the pandemic phase, when there are likely to be large numbers o f ill individuals, the health care system wil l have difficulty canng for al l .severely ill patients. However, there wil l st i l l be a role for these isolation facilities. At present, Afghan health facilities are ill- prepared to care for such patients, lacking the physical infrastructure, equipment (e.g. oxygen generators, suction devices), and supplies for such isolation wards. The project wil l support facility renovations to hospitals designated by the national government to serve as referral facilities on a regional basis. This includes two hospitals in Kabul (the infectious disease hospital and the Indira Ghandi pediatnc hospital) and two in other locations in the country yet to be designated. Two additional sites are being developed by other donor sources. The project wil l also support transportation costs to transfer patients from penpheral locations to these referral facilities. Because most health care services in Afghanistan are organized by the M O P H but managed through a consortium o f NGOs, the project wil l support a contract with an NGO to renovate and operate the wards designated for care o f persons with suspected or confirmed avian influenza (isolation wards) in the four designated regional referral facilities. I t i s expected that these wards wil l be used to care for patients with other pnonty communicable diseases (especially those where isolation may be necessary) when they are not being used for patients with avian influenza.

Personal protective equipment (PPE). Health care workers who wil l be canng for persons with suspected or confirmed avian influenza should utilize protective equipment to reduce their nsk o f exposure and infection. Standards for PPE have been established by WHO. They include masks (N95 or above), gowns, gloves, boots, and for care o f severely ill patients (e.g. in isolation facilities) goggles. Since these patients may be hospitalized in virtually any health care facility, or be seen in comprehensive or basic health care centers, some amount o f PPE should be available in these settings. A

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standardized set o f PPE, if purchased in bulk, should cost about $15 U.S. per unit. The project wi l l obtain 200 sets o f PPE per referral hospital, 100 sets per regional and provincial hospital, and 25 sets per distnct hospital. A backup stdckpile o f PPE maintained by the MOPH will also be developed. The project will also budget for a 25 percent replacement rate per year. The project wil l also fund shipping and distribution costs.

Antiviral medications. As currently circulating avian influenza (H5N1) viruses are uniformly resistant to M 2 inhibitors (amantadine and nmantidine), the only currently feasible antiviral option i s the neuraminidase inhibitor oseltamivir (for both prophylaxis and treatment). The other neuraminidase inhibitor (zanamivir) i s currently not widely available. The project will support prophylactic use o f oseltamivir in limited circumstances as follows: (a) prophylaxis o f workers engaged in culling activities (b) prophylaxis o f health care workers canng for patients with confirmed avian influenza (c) dunng the pre-pandemic phase, household and other close contacts o f patients with confirmed avian influenza. The project wil l also support use o f oseltamivir for treatment. However, to be effective, the drug must be administered within 48 hours o f illness onset. Given the challenging geography o f Afghanistan, this means that the drug must be distributed and warehoused throughout the country, particularly in the facilities designated as referral centers. The project wil l support 200 treatment courses o f oseltamivir in each o f the four regional referral centers, 100 treatment courses in each province, with a 50 percent annual replacement estimate. A backup stockpile o f 1000 treatment courses with annual replemshment wil l be maintained by the MOPH. A proportion (75%) o f the medication wil l be obtained in the adult tablet formulation while the remaining 25% wil l be in the pediatnc formulation. The ration i s reversed for the pediatnc hospital in Kabul. I f additional medication i s needed, i t can be accessed through the stockpile o f WHO, or through emergency purchases o f medication. The dose and duration o f prophylaxis is one tablet per day for 10 days. The WHO recommended treatment course i s one tablet twice daily for five days. The estimated cost o f oseltamivir i s $2/tablet and $4/dose for the pediatnc formulation, although costs may be less from other WHO-certified suppliers. The project will also support shipping and distribution costs.

Seasonal influenza vaccine for health care workers and poultry culling workers. Persons at high nsk o f exposure to avian influenza virus should be vaccinated against regular (or seasonal) influenza. This will reduce the opportunity for simultaneous co- infection with human and avian viruses, a circumstance which can promote re-assortment and enhance person-to-person transmissibility Since influenza viruses naturally dnft from year-to-year, this vaccine must be given annually In Afghanistan, individuals who should receive this vaccine are poultry culling workers, health care workers with a high 'likelihood o f canng for patients with avian influenza, and persons working in laboratones where viable avian influenza virus may be present. The estimated cost o f each vaccine dose i s $10.00. The project wi l l cover costs for procurement, distribution, and administration.

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Development of case management strategies during the pandemic phase. It has been estimated that with no interventions, at the peak o f an influenza pandemic 30-40 percent o f the population o f a community may be ill at the same time, with 10 percent o f these individuals (3-4 percent o f the population) severely ill. Few communities in Afghmstan have the infrastmcture to support such a large number o f ill persons at one time. There are strategies that can reduce the amount o f overall illness, but even in the best of circumstances, in a full-blown pandemic large numbers o f individuals wil l seek and require care. I t i s therefore important to plan for these needs and develop options to handle these illnesses. In Afghmstan, given the geographic isolation o f many areas, i t is possible not al l communities will be impacted by the pandemic. Furthermore, because o f its geographic, i t i s likely that al l would not be affected at the same time. Planrung efforts should take these factors into consideration. Given the l ow level o f surge capacity o f the Afghan health care system, a case management approach which takes full advantage o f the community health worker system and emphasizes home management, should be emphasized. The project wil l support the development o f recommendations for health care management dunng the pandemic phase.

Surge capacity in the health care system during a pandemic. Afghmstan has one o f the lowest health care worker per capita ratios in the world. Exacerbating this problem i s that these workers are not evenly distributed throughout the country, being disproportionately urban. Dunng a pandemic, health care workers wil l also be ill, leaving some communities without health care services. Therefore i t i s important to develop strategies to deal with possible shortages o f health care workers dunng the pandemic phase, and to develop strategies to reinforce the health care workforce. Among the possible strategies to be employed are shifting health care workers from less affected to more affected communities, developing and credentialing a volunteer workforce, and bnnging health care workers no longer actively engaged in health care back onto temporary service (e.g. a reserve force). The project will support the development and implementation o f recommendations for health care worker surge capacity dunng the pandemic phase.

Social distancing measures. In the pre-pandemic and pandemic phases, social distancing measures can play an important role in limiting the spread o f disease and reducing overall morbidity and mortality. Community isolation and quarantine, closure o f common gathenng places (e.g. schools, sports venues, and religious institutions), business closures or worker furloughs, and travel advisones/alerts or restnctions, are among the more common social distancing measures. Social distancing plans need to be developed before they are actually needed. Because implementation and enforcement o f many o f these measures fal l outside the responsibility o f the MOPH, it wil l be necessary to draw a number o f other stakeholders into the discussion and plan development. These stakeholders include, but are not limited to, local community leaders, religious leaders, Ministnes o f Education, Sports, Transportation, Secunty, and Defense, and the business community The project wi l l support the development o f a social distancing plan. Once this plan i s developed, consideration should be given to devoting one o f the tabletop or field exercises to implementation o f social distancing measures.

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C. COMMUNICATION AND PUBLIC AWARENESS

The AHIP fd ly recognizes the importance o f a communications component in i t s quest to control and contain AI and reduce i t s n s k s both to humans and animals. This component wil l in particular address the following activities: a) elevate public awareness, control the spread in the poultry sector, and prevent the spread o f infection among humans; b) give visibi l i ty to the multisectoral response; c) secure hgh- level political support; d) promote a pro-active commuruty-dnven response; e) install a feedback and reporting mechanism, to foster two-way information flows.

UNICEF has had significant expenence in communication and has recently designed and implemented AI-related communication strategies in a number o f countnes in Asia and elsewhere. T h e AI Secretanat in collaboration with other technical agencies (FAO, WHO and NGOs) will seek the assistance o f UNICEF to prepare a communication strategy and plan o f action for AHIP Subject to agreement o f the AI Secretanat and NAIS, UNICEF will also be responsible for implementing the strategy. If agreed with the National AI Secretanat UNICEF wil l implement al l or parts o f the communications component under a contract with the former. The communications strategy and plan o f action, which wil l be prepared by UNICEF wil l include the fol lowing activities if deemed appropnate at the time o f implementation.

C.l. Extensive Communication

Training component to pnontv stakeholders: The National AI Secretanat will sub- contract and manage the design, production and delivery o f face-to-face training to a competent agency (an option could be UNICEF) to reduce the nsk o f infection in animals, and prevent the spread o f the disease. Contents for these interventions wil l adhere to FAO’s guidelines on AI communications, and FAO- WHO-UNICEF’s “pnonty behaviors to control AI.”. Support will be provided to finance the development o f appropnate communication training matenal and training to homogenous groups o f pnonty audience. Pnonty audiences groups are:

0 Religious leaders 0 Provincial Councils 0 Community development councils

Teachers/NGOs

Agncultural extension and public health staff,

Training to media managers: The National AI Secretanat wi l l sub-contract and manage a program for the delivery o f an information workshop on the AI epidemic. This wil l include the creation and maintenance o f a cleannghouse o f information and documentation on AI matenals, accessible to media reporters, for a professional and up- to-date reporting o f the epidemic.

Community-based mobilization and media suuport: The Communications Unit o f the National Solidanty Program (NSP) will enter into partnership with the National AI

40

Secretanat to reach the Commuruty Development Councils and rural populations across the country through i t s established communications infrastructure. The partnershp with NSP wil l also include assistance in the creation o f a feedback mechmsm, to bnng information from the grass-roots level, to the APSecretanat and other stakeholders. Ths mechanism can be built on NSP’s existing community reporting system.

Support to face-to-face education and the development o f audiovisual matenals, for hgh- nsk and vulnerable rural population. T h s matenal wil l focus on five core messages: prevention and control o f AI; protection o f rural livelihoods; disclosure o f compensation mechanisms; rapid-reporting; and the mobilization o f group resources.

The Component wi l l finance the production costs o f five radio core messages. The spots wil l be produced in local languages.

The Component wi l l cover the production costs o f a weekly radio program, to highlight the activities undertaken, and investments made by pnonty mimstnes, to prevent and control AI.

A request to the NSP will be made to contribute in-kind to the AI project in the delivery o f “community-based dialogues,” the five radio core messages, and the weekly presentation o f A I government activities. Similarly, the NSP will negotiate with subcontracted networks: RTA, Inter-News and Equal Access, for the dissemination of the radio messages in an intensive radio campaign.

Radio senals for sustainable awareness: The Afghan Education PrograrrBBC, wil l be subcontracted to produce a package o f edutainment senals, covenng al l audiences in the rural population, across the country

The senals wil l focus on the AI prevention and control messages in the f i rs t three months o f the project, while maintaining a presence o f the educational contents across the rest o f the first year. The package wil l include research, message design, production in two languages, broadcasting, as well as monitonng and evaluation o f the effects, in four established radio dramas, namely. Health life, People talk, Senes for Afghan children, and Village voice

Advocacy to secure high-level political suuuort: The Component wil l organize a senes o f presentations to the N A I S members, the parliament and other decision-makers, about possible epidemic scenarios; financial and social costs; and the activities o f the national response program. Identification and training o f spokespersons wil l be provided, as well

’ as a consistent plan to inform the media on a regular basis. Lastly an operational budget for communications, assigned to the National AI Secretanat, wil l be earmarked for emerging communication needs in the f i rst year o f the project. A budget to maintain basic communications operations dunng years 2 and 3 wil l be available, with the assumption that other national government programs wil l assist and finance operations, in case o f need. The main activities include:

a) Meetings and presentations to decision-makers

41

b) Selection and training o f spokespersons c) Press conferences and roundtables d) Communications budget for emerging needs

C.2. Intensive Communication

Gender sensitive communicators in the mobile response units: Under this Sub-component the Project will subcontract the professional training o f women, to act as Communication Officers in the mobile units responding to the outbreaks. They wil l receive specialized training in the preventive health aspects o f AI, preparedness plans, socio-psychological and community-based mobilization. These Communications Officers wil l be equipped with educational matenals and resources to face the immediate needs o f impacted populations, and wil l be hired for the duration o f the project (3 years).

The mobile teams wil l receive intensive training with regard to the AI (both from the animal and human health perspectives), issues o f control, safeguards, containment and i t s dangers. The main task o f these teams are to raise awareness with regard to the AI and persuade women within the households to allow necessary culling and what precautions to take if certain symptoms are observed.

D. INSTITUTIONAL COORDINATION AND PROJECT MANAGEMENT

Financing for this Component wil l cover overall institutional coordination and project management. I t wil l cover (i) N A I S expenses for i t s operations and to strengthen the National Pol icy and regulatory environment and (ii) the cost o f the Implementation Support Team operations to implement the proposed Project, including financial management, procvrement, monitonng and evaluation.

D.l. Strengthening the National Policy and Regulatory Environment. Although there are regulations and guidelines in place, compliance and enforcement are not actively practiced. Present lack o f cooperation and exchange o f information between ministnes i s also not conducive to an effective response to the containment, control and eradication o f HPAI in Afghanistan.

The project wil l support therefore activities for improving the policy, legal and regulatory framework relating to AI. This wil l extend to ensunng inter-ministenal coordination and cooperation and the national capability to implement the recommended disease detection, control, prevention, containment and eradication measures in a uniform and effective way and in accordance with OIE standards and guidelines. The Component includes support for a detailed review o f current policies and the existing legal and regulatory environment and for drafting, as may be warranted, o f legal amendments, regulations, and implementation guidelines and manuals. Further the project wil l fund related pol icy studies and dissemination workshops especially those focusing on trans-boundary animal diseases.

National Action Plan. The Director DVS has few qualified and trained staff to delegate responsibility for implementation o f an action plan. Following the f i rs t outbreak o f HPAI,

42

a National Avian Influenza and Influenza Pandemic Preparedness and Response Plan (ANIPPRP) was developed in close collaboration with the MOPH, NEPA, FAO, USDNAPHISNS and WHO. This forms the basis o f the Project.

, As part o f the NAIPPRP, a good and comprehensive draft action plan" has been prepared for the vetennary sub-sector. The Plan includes precise details (standard operating plans) for: (i) rapid detection o f suspected cases o f HPAI in domestic poultry, and (ii) rapid eradication o f HPAI by stamping out. I t further spells out the responsibilities o f the response plan task force, and regional and local .task forces, and the cntical need for operational team training. I t also specifies a communication plan. The project wil l provide support to further refimng the NAIPPRP and to develop the necessary detailed implementation guidelines and manuals outlining the steps to be taken at al l levels for a l l relevant agencies and services. Specialists wil l be contracted to assist in this work in close collaboration with the national HPAI working group and the agencies involved (MAI, FA0 and subcontracted NGOs, notably AVA) in HPAI prevention and control of animal health.

Development o f a H P A I Contingency Plan. Init ial response efforts by the MAI to the diagnosis o f avian influenza were delayed for three weeks because o f

0

0

0

lack o f personal protective equipment PPE), lack o f equipment and supplies to conduct culling, disposal and decontamination o f premises known to hold infected poultry, lack o f training for personnel to conduct surveillance, euthanasia, and disposal of culled birds, inadequate transportation and communication to support deployed teams, and lack o f immediate financial support from GOA and donor community to support teams deployed to provinces.

The Contingency Plan to be developed under the Project wil l include guidelines for the rapid mobilization o f physical and human resources to respond quickly to an outbreak. This wil l require close cooperation between the relevant ministnes and the immediate availability o f contingency funds. Project support wil l provide for developing a contingency plan with detailed procedures for supporting early reaction capabilities o f a l l parties concerned in case o f a H P A I outbreak. U s e f u l information can be found in a number o f FAO/OIE documents12 and in the Australian Vetennary Emergency Plan documents. l3

" Act ion Plan For Facmg H P A I out break, M h s t r y o f Agriculture And Irrigation, Ammal Health and Production Deportment, I s l amc State o f Afghamstan. l2 Act ion Plan For Facmg H P A I out break, M ims t ry o f Agriculture Animal Husbandry & Food, Amma1 Health and Production Deportment, I s l amc State o f Afghanistan; FAOiOIE Prepamg for Highly Pathogemc Av ian Influenza, Manual for Countries at fisk; Guiding Pnnciples for H igh l y Pathogemc Avian Influenza Surveillance and Diagnostic Networks in Asia, FA0 Expert Meeting o n Surveillance and Diagnosis o f Av ian Influenza m Asia, Bangkok 2 1-23 July 2004; and FAO's H P A I prevention and control measures in at-risk or recently mfected countries. l3 http:/ln WM .animalhealthaustralia.con~.auiaahc/index.cfm

43

In particular project actions wil l focus on: (i) training staff and testing plans, developing capabilities at the national, provincial and distnct vetennary centers, field level and laboratory services; (ii) developing mechanisms for ensunng close collaboration between government and pnvate sector services and farming cornmumties in the emergency response; (iii) developing the capacity to mobilize resources to counter the disease or any other m m a l health emergency in the most efficient way (including equipment, vaccination, personnel and finances); and (iv) establishing legal and administrative structures to deal with an emergency. The project will support contingency allowances for appropnate human resources as required.

Regulation o f the Poultry Sector. The project will support the assessment o f present policies regulating the Afghan poultry sector. When warranted appropnate policies and regulations to strengthen the poultry sector would be drafted.

D.2. Project Coordination

Financing for this sub-component will cover overall project management, including technical coordination, financial management, procurement, monitonng and evaluation and ad hoc consultancies. Institutional capacity will be strengthened for coordinating and managing the project, at central and provincial levels (national and zonal coordination units). In addition to full time employment o f personnel at central and provincial levels, project actions wil l promote linkages with existing coordination structures. Linkages wil l be specifically made with Bank-financed operations in the agnculture/livestock/health sectors to make synergies with project management, coordination, procurement and monitonng and evaluation.

44

.- a ,E C L l

e

c E E

APPENDIX 4 - Summary of Project Costs by Component, Category and Financing

Component and Expenditure Category IDA AHITF TOTAL (US$ x 000) (US$ 000)

A. Animal Health Component Consultant Services Tramng Goods Works Compensation to Farmers Operatmg Costs

Subtotal Component A:

B.Human Health Component Consultant Services Tramng Goods Works Compensation to Farmers Operating Costs

Subtotal Component B:

C.Communications and Public Awareness Consultant Services Traimng Goods Works Compensation to Farmers Operating Costs

Subtotal Component C:

D. Project Coordination Consultant Services Trainmg Goods Works Compensation to Farmers , Operatmg Costs

Subtotal Component D: Physical and Price Contmgencies

TOTAL COSTS BY FINANCIER Consultant Services Training Goods Works ComDensation to Farmers

871 851 937

21 9 2,878

1,297 468 807 26

2,598

829 178

1,007

801 12 78

128 1,019

499 8,ooo 3,798 1,510 1,822

26

79

316 308 21 3

2,400

3,316

470 170 143

9

792

300 65

365

291 5

28

46 370 156

5goJ 1,377

547 356

9 2,400

1 ,I 87 1 ,I 59 1 ,I 50

2,400

6,194 298

1,767 638 950

35

3,390

1 ,I 29 243

1,372

1,092 17

106

174 1,389

655 13.000 5,175 2,057 2,178

35 2,400

Operiting Costs 346 126 472 Physical and Price Contingencies 499 156 655

47

APPENDIX 5 - Financial and Economic Analysis

I. Background

The AI outbreaks were f i rst identified in six South-East Asian countnes in close succession. The HPAI has since spread to more than 35 countnes, which has infected 194 people out o f which 109 cases have been fatal (as o f 12 April 2006). In addition i t has caused the death o f 200 mi l l ion birds (as o f February 2006) since the outbreak. The spread o f AI in quick succession has raised significant concern over the potential emergence o f a pandemic with devastating consequences for human health and livelihoods.

A study by the European Commission indicates that the global losses from the HPAI outbreak since late 2003 may run into billions o f U S dollars. Direct economic costs are the costs associated with the loss o f poultry population, poultry products, control, mitigation and treatment o f patients as wel l as the loss o f life. Indirect costs are the effects on higher alternative substitute food products, the loss o f capital employed in the poultry sector, from the fam-gate to the fork, and so forth.

In Afghanistan, nearly 98 percent o f the poultry sector i s owned and managed by poor households under free-range, scavenging with insignificant or no purchased feeding provided and very small numbers kept around the house. The poultry i s not only a good source of nutnt ion for poor households but also a significant source o f income as wel l as a store of value, hence, an important factor in household food secunty Lack o f sufficient alternative sources o f income and nutnt ion would augment the direct costs AI to households and increase household vulnerability to food insecurity The resilience o f the poultry sector in other countnes following the HPAI outbreaks have been noted, however, this may prove rather difficult in Afghanistan for lack o f investible fund at the household levels, in particular the resource-poor rural households.

11. Methodology and Assumptions

The economic analysis for this project uses the standard with and without-project cost-benefit analysis using accepted scenanos and standards. The without-project scenano assumes that nothing wil l be done and the toll on poultry and humans will be unhindered. The WHO estimated parameters in conjunctions with local data are used to estimate the impact o f an unhindered A I outbreak. The with-project scenano estimates the costs with the proposed project, investment costs and the losses to humans and poultry, as the mission i s under no illusion to assume that the proposed interventions wil l be 100 percent effective, given the animal and human health conditions and institutional capacities in the country Finally, the net benefit i s denved by using difference between the total costs o f with and without project.

Cntical assumptions for estimating costs and benefits are based on likely guesses on probabilities o f events that are not estimated using scientific methods, simply because

48

statistics on the AI or similar diseases do not exist. Therefore, caution i s necessary when interpreting the resulting project IRR and NPV.

Population: The last census was conducted in 1979 and no accurate census has since been conducted. Therefore, population estimates by vmous national and international organizations vary greatly and range between 22 and 26 million. However, the Central Statistics Office (CSO) in 2003 undertook a review and made some estimates for settled and nomad population. The CSO has just published population estimates for 2006 at 23.6 m i l l i on with settled population estimated at 22.1 mi l l ion and the nomads (Kuchi) population estimated at 1.5 million. The current population estimates are based o n the 2003 estimates and review, which may have some credibility issues but is st i l l the best estimate available. Population growth is estimated at 1.9 percent per year. Since the last official census in 1979, population has almost doubled (the fertility rate at 6.8 percent i s one o f the highest in the world). Urban population is currently estimated at just over 21 percent o f the total, with urbanization nsing at an alarming rate.

Table 1 - Unit Cost Estimation and Assumptions

Unit Price ValueNear

Direct costs to Poultry Sector AFS Quantitytyear

breed. (local (60% o f population) 50 eggs/year; Improved (40% o f population) 1 10 eggdyear)

85% = $3.5/bird)

Poultry Replacement cost, per bird

Total Value o f Poultry/year/bird.

Costs to Humans

Costs o f hospitalization to the patient

Costs o f hospitalization to the public Sector

Loss o f wage income for 10 days hospitalization and 5 days recovery

Costs of hospitalization to 3-caregivers for 10 days

Costs in case o f death - NPV o f 20 years o f income. (adjusted for 30% unemployment,

Eggs, A combination o f improved and local 5 74

Poultry meat (Cockerel 15%=$4/bird; hen 1

15

30

3.6

150

150

AFS US$

370 7 4

3.6 0.1

373.6 7.5 -

13250 265

2250 45

4500 90

188,230 3,764.6 - .

12% discount rate)

Without-Project Scenario. Assumes that the HPAI will spread unhindered affecting both humans and the poultry sector. Using the WHO estimated parameters in case o f unhindered AI outbreak, the direct and indirect costs for both, households and the society, are estimated. The assumptions are:

49

a. in the event o f an outbreak 30 percent o f the poultry sector will be affected, and'any affected bird wil l be destroyed (either culled or die o f the disease);

b. the probability o f an outbreak i s estimated at 0.1 with a 5 percent growth rate per annum;

c. 30 percent o f unprotected human population (all population in the case of Afghanistan) are l ikely to be affected (WHO);

d. 10 percent o f the affected population will require hospitalization (WHO); e. 1.5 percent o f the cases wil l be fatal (WHO); f. Local pnces (with appropnate adjustments) are used in calculating the appropnate

unit costs; g. The unit cost estimates and the vanous assumptions are presented in Tables 1 and 2.

With-Project Scenario. Assumes that the proposed project actions will have a gradual but notable effect on the containment, protection and treatment o f a l ikely AI outbreak. The following main assumptions are made:

a. Probability o f success in the prevention o f an AI outbreak in poultry is conservatively assumed at 20 percent reaching 50 percent in the fourth year o f the project;

b. Probability o f success in rotecting humans i s assume at 10 percent gradually reaching 40 percent in the 7 project year;

c. Probability o f success in containment o f AI and treatment o f infected humans i s assumed at 20 percent reaching 40 percent in the 4th project year, both assumptions, c and d are highly conservative in view o f the dilapidated and l o w capacity o f the public health sector in Afghanistan;

d. I t i s further assumed that the government expenditure in economic terms to continue the project containment and control plans beyond the l i f e o f the project wil l amount to about US$2.1 mi l l ion over the penod o f analysis.

tR

Some notable and highly relevant direct and indirect costs related to the AI outbreak have not been included in the analysis, in view o f the uncertainties in extent o f correlation, lack o f appropnate data and information. Many traders and the nascent poultry farms have incurred significant costs and many have been heavily indebted. In addition, many traders and poultry farmers are awaiting news and instructions from relevant authonties, when to begin their activities and in what form. This situation i s further detenorating their financial situation.

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The Results

Table 2 provides the results o f the project economic analysis using a number o f conservative assumptions and parameters. The basic assumptions are relatively more conservative even, when compared with the assumptions made for similar projects in other countnes in the region and elsewhere. Despite such conservative assumptions, the project economic analysis results in an NPV o f US$21 mi l l ion and an IRR o f 37 percent, whlch are highly significant and suggests that the proposed project i s economically and financially viable.

Table 2. Economic Analysis and Assumptions on Costs and Benefits With and Without Project

. IB.1.IProbability of success in protecting humans. (%) I 40 I Probability of success in containment and I I I

NPV, @ 12%. $ 21,069 IRR= 37%

Total investment over 3 years - in US$ 000s. $ 12,740

5 1

Sensitivity Analysis

Combination of alternative Scenarios

Base Scenario, as in Table 3 Probability of AI outbreak W/O project increase to 5% with 5 YO

Costs o f Outbreak increases from 30% to both humans and poultrv to 50%.

growth ratehear.

Table 3 provides a summary o f sensitivity analysis based on a number o f assumptions as presented in the table below. Despite significant changes in the rates o f project success, probability o f AI outbreaks and the associated costs both to humans and animals, the project IRR and NPV i s st i l l highly significant. Therefore, the project i s robust and the results do not change even if the assumptions change significantly. Changing the parameters in the human health impact o f the project significantly changes the IRR and NPV

Base Scenario, as in Table 3

IRR NPV

37%

34%

86%

Table 3. Sensitivity Analysis

Success rate in prevention decrease to lo%, reaching 40%

in Year 4. IRR NPV

35 20,020

32% 18,824

76% 6 1,243

Success rate in protection, treatment and containment droD bv 50% IRR NPV

15 2,116

13% 874

47 26,146

2 1,069

19,728

63,861

Distributional Analysis

Poultry i s one o f the most important sources o f food and income as wel l as a reliable store o f value and a cushion for consumption smoothing in lean seasons. The poultry sector i s predominantly a backyard and household activity with 98 percent o f the poultry owned by households under very small scale management (about 4 birdshousehold on average) with very l i t t le or no purchased inputs. The household poultry i s entirely owned and managed by women. Usually the income from poultry finds i t s way directly to the purse rather than the wallet, with notable impact on the intra-household consumption behavior and welfare. Any support to the household poultry sector positively contributes to correcting the gender bias in Afghanistan.

Almost al l o f the rural poor raise some poultry in their backyard, which contributes to their diet and i s an important source o f income. Alternative sources o f income are, by and large, limited and any loss o f income from the poultry sector wi l l have significant food insecunty repercussions. Poultry i s also one o f the most significant sources o f income for

52

' the landless and women-headed households in rural areas. On the other hand, the project's aim to control and contain the spread o f AI, will have disproportionately benefited the relatively poorer members o f the society

53

APPENDIX 6 - Procurement Arrangements

Country Context

The Bank has gained substantial expenence and understanding o f the procurement environment in Afghanistan through its involvement in the intenm procurement arrangements put in place through EPAP as wel l as with the institutions with current responsibility for those and the subsequent arrangements, namely A R D S . As part o f the broader review o f Afghanistan’s Public Finance Management (PFM) system, the Bank camed out an assessment o f the procurement environment in the country based on the baseline and performance indicators developed by a group o f institutions led by the World Bank and O E C D D A C .

The f i rs t key issue identified through the procurement assessment was the need for ownership and a champion in the Government for reform, deepening o f capacity, ensmng integnty in the operation o f procurement systems, and promoting sound procurement among ministnes.

A new Procurement Law has been adopted in November 2005 which radically transforms the legal and regulatory framework. Whi le i t provides a very modern legal system for procurement, i t may be difficult to implement in the current context. The Procurement Policy Unit (PPU) has now been established under the M O F to ensure implementation through the creation o f secondary legislation, standard bidding documents, provision o f advice and creation o f the necessary information systems for advertising and data collection. I t further relies on the development o f an independent complaints review mecharusm to ensure enforcement. These institutional arrangements are yet to be in place.

In the absence o f adequate capacity to manage procurement activities effectively, some intenm arrangements have been put in place to improve the procurement management o f the country A central procurement facilitation service has been established under A R D S which i s supervised by the Ministry o f Economy The Bank and the Government has agreed on a program for country wide procurement reform and capacity building, leading to the transition from centralized to decentralized procurement services. The Bank funded Public Administration Capacity Building project (PACBP) i s the pnmary instrument for implementing the program to strengthen capacity o f the l ine ministnes to manage public procurement in an effective, transparent and accountable manner. However, the implementation o f the procurement capacity building strategy has not made any significant progress yet due to lack o f coordination and delays in decision making within the Government. The envisaged radical changes to the procurement management environment expected from the new Law also require the urgent implementation o f a comprehensive human resources and capacity development program. The implementation o f the procurement reform component o f the PACBP should be considered with due pnonty to ensure that fiduciary standards are further enhanced and that capacity i s developed in the Government to maintain these standards.

54

A. General

Procurement for the Avian and Human Influenza Project would be camed out in accordance with the World Bank's "Guidelines: Procurement Under IBRD Loans and IDA Credits" dated M a y 2004; and "Guidelines: Selection and Employment of Consultants by World Bank Borrowers" dated M a y 2004, and the provisions stipulated in the Legal Agreement. The vanous items under different expenditure categones are described in general below. For each contract to be financed by the Grant, the different procurement methods or consultant selection methods, the need for pre-qualification, estimated costs, pnor review requirements, and time f i -me are agreed between the Recipient and the Bank in the Procurement Plan. The Pr~curement Plan wil l be updated at least annually or as required to reflect the actual project implementation needs and improvements in institutional capacity.

Procurement of Works: Works procured under this project would include: facility renovations each contract estimated to cost around U S $ 30,000 in two hospitals in Kabul and two provincial hospitals to establish isolation wards, rehabilitation o f office space for command and control unit, excavation o f pits for manual bunal o f carcasses from slaughtered birds. Provincial Health Departments wil l be responsible for c a n y n g out t h s component. Works contracts wil l be awardedcamed out as required in accordance with paragraph 3.5 - 3.8 o f Bank's Procurement Guidelines. Provincial Health Departments with the assistance o f consultants (UN agencies) will implement the works contracts. The procurement will be camed out using the Bank's Standard Bidding Documents (SBD) for al l I C B and National SBD agreed with or satisfactory to the Bank for al l NCB. Threshold for N C B works wil l be U S D 500,000 per contract and for shopping will be 50,000 per contract.

Procurement o f Goods: Goods procured under this project would include (i) Procurement o f emergency requirements o f PPEs, vaccines, diagnostic kits and medical supplies (ii) Poultry Vaccines for emergency vaccination (iii) Vehicles (iv) motor cycles (v) bicycles (vi) Equipment and supplies for Emergency Response Teams (six packages) for Animal Health (vii) office equipment and fbrniture (viii) Office Equipment, Furniture and other Equipments '(Five lots) (ix) Procurement o f equipment for sample collection, storage and special equipment to capture birds (in two packages) (x) Communication Equipment for C C U and Surveillance Unit (in three packages) The procurement will be done using the Bank's SBD for al l I C B and National SBD agreed with or satisfactory to the Bank for al l NCB. Procurement o f the above equipment, drugs and consumables wil l be carned out following ICB, NCB, Shopping

, and Direct Contracting procedures as per the Bank's Procurement Guidelines. Most o f the UN Agencies based in Afghanistan are already involved in carryng out preliminary activities to control avian influenza. These organizations have extensive expenence in handling similar work worldwide.

The government agencies lack capacity to procure the urgently needed goods to cater to a rapid outbreak o f AI. Therefore, i t i s proposed to contract WHO and UNICEF for the procurement o f first year requirements o f drugs, vaccines, specialized test equipments

55

. and supplies and other specialized matenal in accordance with paragraph 3.9 o f Bank’s Procurement Guidelines. Threshold for N C B goods wil l be U S D 200,000 per contact and for shopping wil l be US$lOO,OOO per contract. However, package# 2 under goods wil l be procured fol lowing shopping procedures as they will be needed in an emergency situation and I C B wil l not be an appropnate procurement procedure for the above package, therefore, on exceptional basis we have agreed to fol low shopping procedure for package# 2 in the procurement plan.

Selection of Consultants: There wil l be several major consultancy contracts under the project, including:

(a) For Human Health: (i) Developing guidelines, procunng antiviral, conducting simulation exercises and pandemic planning (ii) Strengthening of Health Care System Capacity - National and three Regional Referral Centers; (b) For h m a l Health: (i) Preparation o f manuals, guidelines, training, and Epid. Survey; and

(c) Communication Component: Training, Production o f AI educational matenals Radio Broadcasts to raise awareness.

Some o f these assignments for project year one will be contracted to appropnate UN agencies following Single Source Selection Procedure. There will also be several contracts for qualified NGOs that wil l be awarded following competitive procedures. Based on the need, MOPH and MA1 will implement the second and third year plans with the support from NGOs hired to provide the needed TA as facilitating partners (FP). The project wil l also hire several nationally recruited individual consultants to support the AI secretanat. In addition, several short term consultants wil l be required to oversee the environmental and social aspects o f the project. The selection methods for consultants will include QCBS, QBS, CQS, LCS, FBS, SSS and Section V o f Guidelines for individual consultants. Short lists o f consultants for services estimated to cost less than US$50,000 equivalent per contract may be composed entirely o f national consultants in accordance with the provisions o f paragraph 2.7 o f the Consultant Guidelines.

Operating Costs: The project will finance vehicle rental charges including the cost o f fuel and charges to the divers, communication costs, costs towards maintenance o f office equipment and stationery fuel and other consumables for generators, hinng o f skilledsemi skilled persons in the event o f an outbreak.

B. Assessment of the agency’s capacity to implement procurement

The MA1 wil l be hosting the NAIS, with overall responsibility for project implementation with support form the Implementation Support Team, (IST). The IST wil l consist o f qualified national individual consultants Relevant MA1 and M O P H departments wi l l be responsible for implementing the technical components.

Ministry o f Agnculture and Imgation. Assessment o f the capacity o f the procurement staff o f MA1 to implement Bank financed projects was carned out by the Bank in

56

January 2006 and i t was found that the existing Ministry staff does not have adequate expenence for handling Bank financed projects.

To mitigate this nsk, the mimstry will be strengthened by a competent procurement specialist to carry out procurement action under the project and train the ministry procurement staff.

The procurement specialist wil l be responsible for managing procurement for: (i) the animal health component based on technical specifications provided by the Department o f Vetennary Services; and (ii) the communications component, based on t e c h c a l specifications provided by the relevant MA1 departments. The procurement specialist, if needed, wil l also get help from the procurement team already h r e d under IDA financed Horticulture and Livestock Project (HLP, P098256)

To ensure compliance with the World Bank policy and procedure, procurement documentation for complex and large value o f goods, works and consultancy contracts will be carned out with consultation o f the A R D S .

Ministry o f Public Health. The Bank made an assessment o f the capacity o f the procurement staff o f MOPH to implement part o f the procurement actions for the project in April 2006 and it was revealed that the existing personnel does not have adequate expenence for managing Bank financed projects. To mitigate the nsk, the following arrangement wil l be adopted for the Project:

a) a competent procurement specialist wil l be hired under Grant and Contract Management Unit (GCMU) o f M O P H to procure small value o f goods, works and consultancy contracts;

b) procurement o f high value and complex contracts for the f i rs t year o f the project wil l be carned out through UN agencies which wil l be contracted as consultants under the project.

Because o f the overall responsibility o f MA1 for implementing the Project, a l l procurement for the public health component wil l be carned out in collaboration with the IST based in MAI. To ensure compliance with the World Bank pol icy and procedure, procurement documentation for complex and large value o f goods, works and consultancy contracts wi l l be carned out with consultation o f the A R D S .

The overall project nsk for procurement i s high.

C. Procurement Plan

The Recipient, at appraisal, developed a procurement plan for project implementation which provides the basis for the procurement methods. This plan has been agreed between the Recipient and the Project Team on December 7,2006 and i s available at Directorate General o f Policy and Planning Ministry o f Agnculture and h g a t i o n . I t wil l also be available in the project’s database and in the Bank’s external website. The Procurement Plan wil l be updated in agreement with the Project Team annually or as

57

required to reflect the actual project implementation needs and improvements in institutional capacity

D. Frequency of Procurement Supervision

In addition to the pnor review supervision to be carned out from Bank offices, the capacity assessment o f the Implementing Agency has recommended two supervision missions per year to visit the f ield to carry out post review o f procurement actions. In addition it i s proposed to carry out post review o f procurement actions o n a sample basis

E. Procurement Audit:

In addition to the pnor review and post review supervisions to be carned out from Bank offices, an independent procurement audit wil l also take place dunng the project l i fe .

F. Details o f the Procurement Arrangements Involving International Competition

7

Review by Bank [Prior / Post) Prior

1. Goods, Works, and,Non Consulting Services

(a) List o f contract packages to be procured fol lowing ICB and direct contracting:

8

Expected Bid-Opening Date Dec 2006 HH. 1

Ref. Contract !No. I (Description)

Method Procurement o f 304,300 D C A s

AH and HH.3

emergency per para

PPEs, vaccines, procurem diagnostic k i t s and ent GL medical supplies Vehicles 590,000 ICB Trucks (1 Nos) Pick-ups (8 Nos fo r AH and 10 Nos fo r HH)

Station wagons (1 1

requirements o f 3.9 o f

]Nos) -

HH 9 I Communication I 240,000 I ICB

Prior

Prior Equipment for CCU and Surveillance Unit

Jan 2007

Feb 2007

5 p-Q

No

No

No

6

Domestic Preference jyes/no) No

Yes

Yes

9

Comments

DC to UNICEF

(b) All works contracts estimated to cost US$500,000 or more per contract, al l goods contracts estimated to cost US$200,000 or more per contract and al l direct contracting wil l be subject to pnor review by the Bank.

58

2. Consulting Services

Strengthening o f Health Care System Capacity - National and three Regional Referral Centers

(a) L i s t o f consulting assignments with short-list o f international f i rms.

Estimated Selection Review Expected Comments cost Method by Bank Proposals

(Prior , Submission Post) Date

500,000 QBS Prior Jan 2007 Performan ce based contract

Ref. No.

- HH .8

-b- (

Description of Assignment

(b) Consultancy services estimated to cost above U S $ 100,000 per contract and al l single source selection o f consultants (firms/individual) for assignments will be subject to pnor review by the Bank.

(c) Short l i s ts composed entirely o f national consultants: Short lists o f consultants for services estimated to cost less than US$ 50,000 equivalent per contract, may be composed entirely o f national consultants in accordance with the provisions o f paragraph 2.7 o f the Consultant Guidelines.

Procurement Plan

I. General

1. Project information: Country- Afghanistan Project Name: Avian and Human Influenza Project Loadcredi t No: PO1 0093 Project Implementing Agency (PIA): M O P H & M O A

2. Bank’s approval Date o f the procurement Plan [Onginal . . . ., Revision 1.. 3

3. Date o f General Procurement Notice: . . . . . e . .

4. Penod covered by this procurement plan:

59

II. Goods and Works and non-consulting services.

1. 2. 3.

1. Pnor Review Threshold: Procurement Decisions subject to Pnor Review by the Bank as stated in Appendix 1 to the Guidelines for Procurement:

Procurement Activity Prior Review Threshold Comments Works 500,000 Goods 200,000 Dlrectme Contractme All

2.

3.

Prequalification. Bidders for Nil- will be prequalified in accordance with the provisions o f paragraphs 2.9 and 2.10 o f the Guidelines. Proposed Procedures for CDD Components (as per paragraph. 3.17 of the Guidelines: Not Applicable

Reference to (if any) Project OperationaVProcurement Manual:

Any Other Special Procurement Arrangements: Provision has been made to reimburse the Government o f Afghanistan (GOA) for payments i t makes for project expenditures, up to US$ 1,000,000 between 15 June 2006 and signing o f the grant.

Procurement Packages with Methods and Time Schedule A. Goods

1 Ref. No.

HH. 1

AH.2

iH an I H . 3

Description of Assignment

Procurement o f emergency requuements o f PPEs, vaccmes, diagnostic kits and medical supplies Poultry Vaccines for emergency vaccination

Vehicles Trucks (1 Nos) Pick-ups (8 Nos for AH and 10 Nos for HH)

3 Estimated cost

304,300

150,000

590,000

4 Procur. Method

D C

c

Pre - qualific ation

No

No

No

6 Domestic Prefer.

N o

No

Yes

7 Review by Bank (Prior/ Post) Prior

Prior

Prior

8 Expected Bid Opening Date Dec 2006

Jan 2007

Jan 2007

9 Comments

D C to UNICEF

Emergency requirement for First year. International Shopping on exceptional basis

1 Ref.

6 Domestic Prefer.

No N o No

No.

7 8 Review Expected by Bank Bid (Prior/ Opening Post) Date

Post Dec 2006 Post Dec 2006 Post Dec 2006

AH.4 AH.5 AH.6

itation wagons (1 1 $os) Motorcycles (34 Nos) Bicycles (34 Nos) Equipment and supplies for Emergency Response Teams (six packages) for Ammal Health component.

AH and HH.7

AH.8

30,000 Shoppmg 2,100 Shoppmg 370,000 ShoPPmg

HH 9

Office Equipment, Furniture and other Equipments (Five

2 13 1 4 Description of I Estimated I Procur.

110,000

I Cost

Assignment

~~

lots) Procurement o f equipment for sample collection, storage and special equipment to capture birds (in two

Method

60,000 I ShoPPmg

2 Description of Assignment

Rehabilitation of office space for Command and Control Unit

3 4 5 6 7 8 9 Estimated Procur. Pre - Domestic Review Expected Comments cost Method qualific Prefer. by Bank Bid

ation (Prior/ Opening

35,000 Shopping N o N o Post Feb 2007 Post) Date

NCB

F

5 Pre - qualific ation

No No No

N o

No

No

No

I

Dec 2006

Dec 2006

I

I Pnor I Feb2007 packages) Commumcation Equipment for CCU and Surveillance Unit (in three packages)

B. Works:

Q

Comments

Emergency requlrement for First year. Internahonal Shoppmg on exceptional basis

61

III. Selection of Consultants

Selection Method Pr ior Review Thresholc 1. Competitive Methods (Firms) 100,000 2. Individual Consultants 50,000 3. Single Source (Firmshdividual) Al l

Comments

2. Short list comprising entirely of national consultants: Short l i s t o f consultants for services, estimated to cost less than $ 50,000 equivalent per contract, may compnse entirely o f national consultants in accordance with the provisions o f paragraph 2.7 of the Consultant Guidelines.

3. Consultancy Assignments with Selection Methods and Time Schedule

1.8 1.9 1 10

1 12 13 14 15

M&E Specialist $50,400 IC Prior GIS Specialist $50,400 I C Pnor International Advisor to Project $72,000 I C Prior Coordinator International Advisor to Animal Health Coordinator International Advisor to Human Health Coordinator International Advisor to Communication Manager Command and control unit director Surveillance director p

A H 6

$72,000 IC Prior

$72,000 IC Pnor

$72,000 IC Prior

80,000 IC Prior

60.000 I C Prior Prior

h

Expected Proposals Submiss.n Date

Dec 2006 Dec 2006 Dec 2006 Dec 2006 Dec 2006 Dec 2006 Dec 2006 Dec 2006 Dec 2006 Jan 2007

Jan 2007

Jan 2007

Jan 2007

Jan 2007

Jan 2007 Jan 2007 Jan 2007

Jan 2007

AH AH HH Com AH AH AH AH AH,HH

and

62

1

Ref, Description of Assignment No. 1

2 3

Estimated cost

Review by Bank (Prior/ Post)

Pnor

Expected Comp. Proposals f3ubmiss.n Date

HH Dec2006 HH

HH 6 HH.7

HH.8

AH.9

4

Select. Meth.

Developing guidelines, procumg 3 13,000 antmrals, conducting simulation exercises and pandemic planning

Strengthening of Health Care 500,000 System Capacity - National and three Regional Referral Centers

Preparation o f manuals, 560,000 guidelines, training, and Epid.

(firm)

(firm)

sss

QBS

sss

sss

IC

Pnor

Pnor

Pnor

Prior

5 16 17

Jan2007 HH

Feb 07 AH Training and survey related to needs. First month Com o f the project starting date March AH 2007 and

HH

Corn 10

AH and HH 11

Training 350,000 Production o f AI educational

Radio Broadcasts to raise awareness (Firm) Environment Specialist - Waste 90,000

Management

materials

Agreed Procedures for National Competitive Bidding

8

2omments

sss of WHO

Performa nce based contract

sss o f FA0

sss o f UNICEF

6 months over a period o f 2 years

In order to ensure economy, efficiency, transparency and broad consistency with the provisions o f Section I o f the Procurement Guidelines, the following cntena will be followed in procurement under National Competitive Bidding procedures:

Standard bidding documents approved by the World Bank will be used.

Invitations to bid will be advertised in at least one (1) widely circulated national daily newspaper and bidding documents wil l be made available to prospective bidders, at least twenty eight (28) days pnor to the deadline for the submission o f bids.

Bids will not be invited on the basis o f percentage premium or discount over the estimated cost.

Bidding documents will be made available, by mail or in person, to all who are willing to pay the required fee.

63

Foreign bidders will not be precluded from bidding.

Qualification cntena (in case pre-qualifications were not carned out) will be stated on the bidding documents, and if a registration process i s required, a foreign firm determined to be the lowest evaluated bidder will be given reasonable opportunity o f registenng, without any hindrance.

Bidders may deliver bids, at their option, either in person or by comer service or by mail.

Al l bidders will provide bid secunty as indicated in the bidding documents. A bidder’s bid secunty will apply only to a specific bid.

Bids will be opened in public in one place preferably immediately, but no later than one hour, after the deadline for submission of bids.

Evaluation o f bids will be made in stnct adherence to the cntena disclosed in the bidding documents, in a format, and within the specified penod, agreed with the Association.

Bids will not be rejected merely on the basis o f a companson with an official estimate without the pnor concurrence o f the IDA.

Split award or lottery in award o f contracts will not be carned out. When two (2) or more bidders quote the same pnce, an investigation will be made to determine any evidence o f collusion, following which: (A) if collusion i s determined, the parties involved wil l be disqualified and the award will then be made to the next lowest evaluated and qualified bidder; and (B) if no evidence o f collusion can be confirmed, then fresh bids will be invited after receiving the concurrence o f the IDA,

Contracts will be awarded to the lowest evaluated bidders within the initial penod o f bid validity so that extensions are not necessary Extension o f bid validity may be sought only under exceptional circumstances.

Extension o f bid validity will not be allowed without the pnor concurrence of the IDA (A) for the first request for extension if it i s longer than eight (8) weeks, and (B) for al l subsequent requests for extensions irrespective o f the penod.

Negotiations will not be allowed with the lowest evaluated or any other bidders.

Re-bidding will not be carned out without the IDA’S pnor concurrence; and

All contractors or suppliers will provide performance secunty as indicated in the contract documents. A contractor’s or a supplier’s performance secunty will apply to a specific contract under which it was furnished.

64

APPENDIX 7 - Financial Management and Disbursement Arrangements

Country Issues

The Bank has gained substantial expenence and understanding o f the financial management environment in Afghmstan through the large number o f projects under implementation over the past four years. The Public Administration Capacity Building Project (PACBP) i s the pnmary instrument to continue and enhance the fiduciary measures put in place dunng the past years to help ensure transparency and accountability for the funding provided by the Bank and other donors.

A PFM performance rating system using 28 high-level indicators that was developed by the Public Expenditure and Financial Accountability (PEFA) multi-agency partnershp program was applied in Afghanistan in June 2005 PEFA IS compnsed o f the World Bank, IMF, EC, and several other agencies. The system i s structured around six core dimensions o f PFM performance: i) budget credibility, ii) comprehensiveness and transparency, iii) policy-based budgeting, iv) predictability and control in budget execution, v) accounting, recording, and reporting, and vi) external scrutiny and audit. Afghanistan’s ratings against the PFM performance indicators generally portray a public sector where financial resources are, by and large, being used for their intended purposes. T h s h a s been accomplished with very high levels o f support from international firms; this assistance wil l continue to be needed over the medium term if these ratings are to be maintained. There i s also much room for improvement.

In spite o f undeniable gains made in reconstruction since the end o f 2001, the challenges facing Afghanistan remain immense; not least because o f the tenuous secunty situation in the region and continued prevalence o f a large illegal and i l l ic i t economy The pol icy framework benchmarks have not yet been fully costed so vanous pnonties are funded through the annual budgeting process. The nsing costs o f the secunty sector constitute the major constraint on attainment o f fiscal sustainability With regard to executive oversight, the national assembly wi l l play an increasingly active role. All in all, the new national strategy has created high expectations o f the executive which could prove to be quite difficult to meet.

The public sector, in spite o f considerable efforts to reform i t s core functions, remains extremely weak outside o f Kabul. The lack o f qualified staff in the c iv i l service and the absence o f qualified counterparts in the government after 30 years or war and conflicts i s a binding constraint. Delays in reforming the pay structure and grading o f c iv i l servants have severely crippled the public administration o f the country Domestic revenues lag behind expenditures by a factor o f ten to one. Large-scale corruption could emerge to undermine the government’s efforts to enhance aid flows through national accounts. Capacities to track expenditures and monitor expenditure outcomes have improved, but they need rapid and substantial strengthening if progress toward the attainment o f national development targets i s to be monitored. Currently, 75 percent o f external revenues bypass government appropnation systems.

65

The World Bank is financing a Financial Management Advisor to assist the Ministry o f Finance, an Audit Advisor to assist the Control and Audit Office, and a Procurement Advisor to assist in Procurement-related activities. Also an Internal Audit h c t i o n i s being developed within the Ministry o f Finance with World Bank financing. U S A I D and earlier the Indian Aid Assistance Program are also financing a team o f consultants and advisors to assist the D a Afghanistan Bank in local as well as foreign currency operations. The activities carned out under the existing Public Administration projects have helped the Government to ensure that appropnate fiduciary standards are maintained for public expenditures, including those supported by the Bank and the donor community.

Progress has been slower than expected in shifting from operations support provided by the three Advisors to capacity development and knowledge transfer to the c iv i l servants. Given that, i t i s expected that the Advisors wil l continue to be required for the medium term. Challenges s t i l l remain in attaining the agreed upon fiduciary standards and also to further enhance them. And to make matters more complex, the regulatory environment in Afghanistan has advanced significantly in the past three years. Unfortunately, even mastery o f basic skills in the early environment does not fully qualify the c iv i l servants to work effectively in the new emerging environment.

Risk Assessment and Mitigation

The table below identifies the key n s k s that the project may face and indicates how these nsks are to be addressed.

Risk

Inherent Risk Country Inherent hsk Project financial Management Risk

Perceived Corruption

Overall Inherent Risk Control Risk

Risk Rating

M H

H

H

Risk Mitigation Measures

Source - PFM study Minimize use o f Designated Account, maximize direct payments to consultants; a l l procurement through Procurement Advisor Government commitment, internal controls and new internal audit wil l al l help reduce the high level o f perceived corruption

Residual Risk

M S

Condition of negotiations, Board or Effect i ven ess flm)

N N

N

66

1 Weak Implementing Entity

Bulk of the implementation will be through contracts issued to UN agencies l ike UNICEF, WHO and FA0 and some existing NGOs.

2. Funds Flow

S

3. Budgeting

In MOPH adequate staffing exist in GCMU to implement the Human Health Component This wil l be in accordance with the funds flow arrangements being utilized by other projects in Afghanistan Head o f Development Budget wil l be responsible for coordinating the GDPP function for HLP with the support of FMS-IMST Will follow international standards. Project accounting procedures are being developed under the HLP and wil l be detailed in the F M Manual to be approved by the Bank

audit department wil l review project internal control systems Will be audited by CAO with support from Audit Advisor Strengthening the SDU i s a priority under the new FM Advisor contract, to provide information that will comply with agreed format of financial reports.

Newly created internal

4. Accounting Policies and Procedures

M

M

M

S

S

S

S

5 Internal Audit

6. External Audit

7 Reporting and Monitoring

Overall Control Risk

H

S

S

S

H

H

H

H

Y Disbursement

N

N

Y Disbursement

N

N

Y Negotiations

67

Detection fisk S AccountingRecordingIoversi M ght by S D U - MOF o f a l l advanceshl-16 supported by Financial Management Advisor.

Strengths and Weaknesses

N

Strengths

Significant Weaknesses Shortage o f qualified and expenenced FM staff Project internal controls and procedures need to be defined Interim reports need to include required information

The Government provides assurance to the Bank and other donors that the measures in place to ensure appropnate utilization o f funds wil l not be circumvented. The Government support for PACBP i s strength in itself to enhance financial management in Treasury operations, public procurement, internal audit in the public sector, and external audit by the Auditor General. This wil l be the second IDA-funded grant for MAI, so the Ministry has expenence in fol lowing Bank procedures. Under the Horticulture and Livestock Project (HLP) MA1 has established an Implementation Management Support Team (IMST) to oversee al l aspects o f the project. The I M S T is part o f the General Department for Policy and Planning (GDPP) and includes a Lead Facilitating Partner (LFP) involving technical and administrative specialists to train and strengthen MA1 personnel in project implementation. This team includes a financial management specialist who will be responsible for developing sound financial management procedures and training Afghan personnel responsible for financial management. In the same way, this facility wil l be available to support the HAICP

Action Responsible Completion

Appointment o f an FMO in MAI MAI Before disbursement

Financial Management Manual MAL'MOPH Before developed disbursement Un-audited intenm financial IDA/MOF/- Before report formats confirmed (DBER) negotiations

Agent Date

Weaknesses and Action Plan

The main weakness in this project, as in many others in Afghanistan, i s the ability to attract suitably qualified and expenenced counterpart staff especially for Financial Management. The additional staff to be funded by the project, together with intensive training programs included in this project, i s expected to strengthen the fiduciary arrangements.

Action Plan

68

Implementing Entity

The National Emergency Response Committee through the AI National Committee (NAIC) will serve as the oversight body. The NAIC, through the Finance Committee (FCAI) will convene at least every four months to review progress with implementation and review and approve work plans and budget. The Minister MAI, as Chairman o f NAIC, will have overall responsibility for project implementation. The relevant technical departments o f MA1 and MOPH will be responsible for implementing the &mal Health and Human Health components respectively. Their activities will be managed by a Project Coordinator who will report to the Mimster of Agnculture.

In order to ensure comprehensive management o f NAIC finances, a Financial Management Officer (FMO) i s being hired in MAI to perform key project functions and to help develop capabilities o f the MAI Finance and Administration Department (FAD). T h s responsibility wil l also include training staff at the national and provincial levels. The FMO will work closely with the financial management personnel responsible for financial management o f the Project and HLP in I M S T This staffing i s considered adequate for the project since the bulk o f the project work i s expected to be contracted out to other UN Agencies l ike WHO, UNICEF and FA0 who wil l have their own FM arrangements.

The F M O i s expected to seek guidance and technical assistance from the Financial Management Specialist o f the LFP o f HLP. The Financial Specialist IMST and his Afghan colleagues will liaise with the Financial Management Officer (FMO) when prepanng M-16 forms (payment orders). The Head o f the accounting department for Grant and Contracting Management Unit (GCMU) in M O P H wil l take responsibility for the financial management activities o f the component to be implemented by MOPH. This department is adequately staffed with FM personnel who are efficiently managing al l external grants including IDA Health Sector Project. The present capacity i s adequate to absorb FM work related to A I C project.

Budgeting

The budgets for respective components would be prepared in the responsible l ine ministry, i.e. MA1 and MOPH and included in the development budget for the line ministry These wil l however, be consolidated for the project at the AI Secretanat.

Because limited capacity exists within MA1 to manage the external budget, the FMO with support fi-om the Specialist under HLP will strengthen the financial management capacity o f MAI. The F M O wil l be responsible for ensunng that projects expenditures expended in a fiscal year are captured in the Governmental Development budget o f that fiscal year. The MA1 must get an approval from the presidential office and the parliament to be attached to B27 and PCS forms at the time o f requesting yearly allotments for contracts under development project to avoid delays when payments are processed. Similarly G C M U will be responsible for this function in MOPH.

69

Funds Flow

The standard mechanism o f f low o f funds in Afghanistan wil l be followed in this project. Project funds wil l be deposited in the Designated Account (DA) to be opened and maintained at the D a Afghanistan Bank (DaB). The DA, in keeping with current practices for other projects in Afghanistan, wil l be operated by the Special Disbursement Unit (SDU) in the Treasury Department o f M o F Requests for payments out o f the DA will be made to the S D U by the implementing entity when needed.

In addition to payments out o f DA funds, the implementing entities could also request the S D U to make direct payments from the Grant Account and Trust Fund Account to consultants, f i rms, and contractors and special commitments for goods contracts covered by letters o f credit. These payments wil l follow the World Bank procedures. All project payments are expected to be made to either international f i r m s or local f i r m s that have bank accounts in DaB, a local commercial bank, or an overseas bank. All payments will be made either through bank transfers into the account o f such f i r m s or by check. All expenditures for each component will be paid centrally f rom MA1 and MOPH respectively in accordance with the approval mechanisms documented in the FM Manual.

Retroactive Financing Retroactive financing o f up to US$l,OOO,OOO IS envisaged for government financed expenditures related to start-up activities between 15th June 2006 and when the grant i s signed. The retroactive finance can be claimed only after the grant becomes effective and al l disbursement conditions have been met.

70

FUNDS FLOW CHART

Legal requirements for authorized signature

Designated Account in DAB denominated in

c \

Direct Payments to Suppliers, etc. after approval o f W.A initiated by the project and

submitted through S D U

. /

Project transactions processed through S D U and paid in U S D or Afghanis

Payment T T Requests Payment Requests

Ministry o f Finance has authonzation to disburse funds from the Grant, specimen signatures o f authonzed signatones in M o F wil l be submitted to the Bank pnor to commencing disbursements.

Accounting

The SDU wil l maintain a proper accounting system o f al l expenditures incurred along with al l the supporting documents to enable IDA to venfy these expenditures. The Financial Management Officer and the government counterparts in MA1 and FM Staff o f GCMU in M O P H will: i) supervise preparation o f supporting documents for expenditures, ii) prepare payment orders (Form M16), iii) obtain approval for M-16s by the Minister or Deputy Minister depending on the payment amount, and iv) submit them to the Treasury Department in M o F for venfication and payment. Whilst onginal copies o f required supporting documents are attached to the Form M16, the project i s required to make and keep photocopies o f these documents for

71

their record purposes. The FM Advisor in the MoF/SDU wil l use the government's computenzed accounting system, AFMIS for reporting, generation o f relevant financial statements, and exercising controls.

Currently, al l records o f payments by MA1 are filed manually However, the Financial Management manual to be prepared for the project wil l establish a simple tracking and reporting system in the General Department for Pol icy and Planning o f MAL The FMO and the government counterpart wil l train existing MA1 staff to record project expenditures in spreadsheets for maintenance o f accurate and timely financial data. The FM manual, to be reviewed and approved by the Bank will include roles and responsibilities o f all FM staff, documentation and approval procedures for f inds transfers in each o f the subprograms, project reporting requirements, and quality assurance measures to help ensure that adequate internal controls and procedures are in place and are being followed.

The FM Manual wil l also establish project financial management in accordance with standard Afghan government policies and procedures, including use o f the government Chart o f Accounts to record project expenditures. The use o f these procedures wil l enable adequate recording and reporting o f project expenditures. Overall project accounts wil l be maintained centrally in SDU, which wil l be ultimately responsible for recording o f al l expenditures and receipts in the Government's accounting system. Reconciliation o f project expenditure records with M o F records will be carned out by the General Department for Policy and Planning together with the Financial Management Officer and assigned FM staff in G C M U for MA1 and MOPH respectively. Consolidated project accounts will be maintained centrally in M o F through the S D U in the Treasury Consolidated project financial statements wil l be prepared for al l sources and uses o f project finds.

Compensation Fund

In order to ensure efficient and transparent management o f the compensation fund, the Compensation Procedures Manual wil l include details on the following: (i) the legal basis for establishing responsibilities for Compensation Fund administration; (ii) conducting a financial needs assessment (how much wil l compensation cost); (iii) identification o f sources o f funds and likely amounts from each source and mobil izing needed financing; (iv) identification o f the payment agencies needed to get the funds to the beneficianes; (v) payments instruments to be utilized (cash, bank transfers, vouchers, etc.; (vi) designing the basis on which payment wil l be made i.e. certification; (vii) communication o f the time frame for payment; (viii) monitonng disbursements; (ix) operation and financial audits; and (x) social accountability mechanisms. Where UN agencies are involved, audit arrangements for the UN agencies wil l be described in the Manual.

There i s also need for enhanced accountability measures to reduce the risk o f fraud and abuse. Provision wil l be made in the Compensation Procedures Manual for continuous monitonng and oversight through: (i) enhanced disclosure and transparency o f project-related information - after culling, a paying l i s t o f farmers per village including the amounts to be compensated wil l be announced in public space; (ii) establishment o f a mechanism to handle complaints about misuse o f funds, especially for the Compensation Fund; and (iii) to supplement the annual audit,

72

an annual operational review wil l be camed out by external reviewers, acceptable to the Bank, the terms o f reference for the operational reviews will focus o n confirming the legitimacy o f compensation payments made from a randomly selected sample o f villages.

Responsible Agency Audit Auditors MoF, supported by Special SOE, Project Accounts and Auditor General DI sbursement Unit Designated Account

Internal Control & Internal Auditing

Date Sep 22

Project-specific procedures for requests and approval o f funds wil l be described in the FM Manual to be developed before disbursements begin including segregation of duties, documentation reviews, physical asset control, and cash handling and management. Adequate procedures, guidelines and controls on payment o f compensation will be included in the FM Manual.

The Head o f Development Budget in GDPP o f MA1 and the Financial Management Officer will be responsible for coordinating FM activities o f the project with the SDU. Assigned staff of G C M U in M O P H wil l undertake this responsibility also.

Annual Financial statements wi l l be prepared by SDU/MoF, detailing activities pertaining to the project as separate l ine items with adequate details to reflect the component and category wise details.

The project financial management systems will’ be subject to review by the newly established internal audit directorate o f the MoF, according to programs to be determined by the Director o f Internal Audit using a nsk-based approach.

External Audit

The project accounts wil l be audited by the Auditor General, with the support o f the Audit Advisor, with terms o f reference satisfactory to the Association. The audit o f the project accounts wi l l include an assessment o f the: (a) adequacy o f the accounting and internal control

’ systems; (b) ability to maintain adequate documentation for transactions; and (c) eligibility o f incurred expenditures for Association financing. The audited annual project financial statements wi l l be submitted within six months o f the close o f fiscal year. All agencies involved in implementation and holding records o f expenditures would need to retain these records as per the IDA retention pol icy The following audit reports wil l be monitored in the Audit Reports Compliance System (ARCS):

73

Financial Reporting

Financial Statements and Project Reports wil l be used for project monitonng and supervision. Based upon the FM arrangements o f this project Financial Statements and Project Reports will be prepared monthly, quarterly, and annually by the FMO (with assistance from GDPP local counterpart staff) in the MA1 and by the G C M U in the MOPH. These reports wil l be produced based on records kept on Excel spread sheets after due reconciliation to expenditure statements from S D U (as recorded in AFMIS) and bank statements from DAB.

The quarterly Project Reports wil l show: (i) sources and uses o f funds by disbursement category and project component and also expenditures consolidated based on governmental head of accounts compared with budget; (ii) physical progress; and (iii) status o f procurement activities. MA1 and MOPH will forward the relevant details to S D U D B E R with a copy to IDA within 45 days o f the end o f the quarter. The government and IDA have agreed on a pro forma format for al l Bank projects, and a final customized format will be agreed pnor to project negotiations.

The annual Project accounts to be prepared by S D U from AFMIS and after due reconciliation to the records maintained at the project, wil l form part o f the consolidated Afghanistan Government Accounts for al l development projects, which i s done centrally in the Ministry o f Finance; in particular, the Treasury Department, supported by the Financial Management Advisor.

Disbursement Arrangements

Table 1 shows the allocation o f IDA proceeds and Table 2 the expected co-financing. A single category for “goods, works, consultancy services, training, audit and operating costs” i s defined in the financing agreement to facilitate preparation o f withdrawal applications and record- keeping. Because there are specific disbursement conditions attached to the Compensation Facility, there i s a separate disbursement category for this component. Project funds wil l be disbursed over 36 months. The closing date o f the project wi l l be March 31, 2010 with a final disbursement deadline four months after the closing date.

Dunng this additional 4-month grace penod, project-related expenditures incurred pnor to the closing date are eligible for disbursement. Disbursements procedures set out in the Bank’s Disbursement Guidelines (May 2006) and “Disbursement Handbook for World Bank Clients ” (May 2006) are applicable to this project.

74

Table 1. IDA Financing by Category o f Expenditure (US$ million) Amount of the Financing

Expenditure Category Grant Allocations Percentage (1) Goods, works, consultants’ services, training and 8.0 100 % Operating ~ o s t s ’ ~ Total 8.0 -

Category

(1) Goods, works, consultants’ semces, training, audit costs and Incremental Operating Costs for the Project

(2) Compensation Facility under Part l(a)(i) o f the Project

TOTAL AMOUNT

Table 2: Estimated Co-financing (US$ million)

Amount of the Grant

Allocated (expressed in United States

Dollars)

8,000,000

0

8,000,000

Amount o f the AHITF Grant

Allocated (expressed in United States

Dollars)

Total

I

2,600,000 10,600,000

2,400,000

5,000,000

Summary Reports. Summary reports in the form o f Statements o f Expenditure wil l be used for expenditures on goods and works contracts below U S $ 100,000; consultant firm contracts below US$ 100,000; individual consultants contracts below U S $ 50,000; and al l incremental operating costs and training.

2,400,000

13,000,000

MA1 and MOPH’s controls for holding, accounting, and preparation o f Statement s o f Expenses (SOEs) have been satisfactorily assessed.

l4 Operating Costs means the Project-related incremental expenses incurred on account o f Project implementation support and management including the rental o f office space; the operation, maintenance, rental and insurance of vehicles; fuel; communications supplies and charges; advertisements; books and periodicals; office administration and maintenance costs; bank transaction charges; utility charges; domestic travel and per diem but excluding salaries o f officials and staff of the Recipient’s civil service.

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Records. Records (supporting documents) are required for a l l other expenditures (those which may not be claimed on a Summary Report in the form o f a Statement o f Expenditure.

Designated Account. A single designated account will be opened at DAB for a maximum amount o f US$ 500,000 representing 3 months o f estimated expenditures. The S D U in M O F will manage payments from and new advances/replenishments to this account. For the DA, expenditure reporting in the form o f submission o f SOEs and records must be done on a monthly basis.

Cash advances may be taken from the Designated Account, and held and managed by MA1 or MOPH. This agency’s controls, holding, accounting, and holding small cash advances have been satisfactorily assessed.

New cash advances wil l only be made when al l other pnor cash advances have been justified through submission o f SOEs to the SDU. The designated account wil l be replenished on a monthly basis.

Direct Payments. Third-party payments (direct) wil l be permitted for amounts exceeding 20 percent o f the advance in the Designated Account. All such payments require records (supporting documentation).

Preparation of Withdrawal Applications. The S D U wil l review withdrawal applications for quality and conformity to Treasury procedures, and then obtain signature. Selected M A M O P H finance staff will be registered as users o f the World Bank Web-based Client Connection system, and take an active hand in managing the f low o f disbursements.

Financial Management Covenants

M o F wil l submit audited financial statements for the project within six months o f the end o f each fiscal year. The Project’s audit report wi l l cover the financial statements, the Designated Account and SOEs, .in accordance with terms o f reference to be agreed with the Association.

0 Un-audited intenm project financial reports wil l be submitted by MA1 and M O P H separately on a quarterly basis to the World Bank and a copy to SDU-MoF within 45 days after the end o f each quarter.

0 MA1 wil l ensure that the new Financial Management Officer to be employed i s retained throughout the duration o f the project in order to ensure smooth project implementation.

Supervision Plan

Dunng project implementation, the Bank wil l supervise the project’s financial management arrangements. The team will:

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0 Review the project’s quarterly un-audited intenm financial reports as wel l as the project’s annual audited financial statements and auditor’s management letter.

0 Review the project’s financial management and disbursement arrangements (including a review o f a sample o f SOEs and movements on the Designated Account) to ensure compliance with the Bank’s mimmum requirements.

Review agency performance in managing project funds to ensure that i t i s tunely, accurate, and accountable. Particular supervision emphasis wil l be placed on asset management and supplies.

Conclusion

The FM arrangements, including the systems, processes, procedures, and staffing are adequate to support this project - subject to implementation o f the items listed in the action plan.

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APPENDIX 8 - Environment and Social Safeguards Framework

Environmental assessment: Environmental Category B

1. Environmental Aspects. The Project i s assessed as a Category B Project. Activities under the proposed Project are expected to generate n o or l imited adverse environmental effects, since most activities o f the Project are considered to support preventive measures. The Project will, generally, have positive environmental and social impacts as the project’s investments in facilities, equipment, laboratones, and training wil l improve the effectiveness and safety o f existing avian influenza handling and testing procedures. This would be reinforced by the mainstreaming o f environmental safeguards into the protocols and procedures for the culling and disposal o f animals dunng AI outbreaks, decontamination o f production facilities, and laboratones. However, adverse environmental health impacts, mainly unintentional from the spread o f HPAI, could occur when an emergency operation involves containment o f HPAI outbreaks through quarantine, isolation and stamping out actions and when relevant mitigation measures are not in place. Most o f the key potential impacts could be avoided or minimized by integrating environmental and public health safety aspects in the preparatioddesign and implementation o f the project activities.

2. Worker Safety The suggested investments in health facilities, equipment, clothes, staff training and management o f the waste wil l improve the safety and effectiveness o f Highly Pathogenic Avian Influenza (HPAI) handling and testing procedures. The PIM to be prepared pnor to the disbursement should include these provisions.

The project wil l help the Government o f the Islamic Republic o f Afghanistan in developing strategies to manage future outbreaks o f infectious and zoonotic diseases that may emerge and re-emerge. The Environmental and Social Safeguards wil l be benefited from this iri two major ways: (i) Environmental safeguards wil l be mainstreamed into protocols and procedures for the inspection and disposal o f animals dunng an outbreak in due consideration o f OLE standards, and (ii) Policies on compensation for poultry owners affected by future outbreaks wil l be developed.

Social Issues

There are no Social Safeguards tnggered by the project, which wil l have significant positive social impact by protection o f human lives through HPAI early warning, prevention and containment, improved poultry farming practices, increased public awareness o f HPAI and improved hygiene and food preparation practices and waste management. Development o f compensation policies to affected poultry owners wil l contribute to mitigate the effects of losses suffered from H P A I pandemic.

There wil l be no Land Acquisition (voluntary or involuntary) under the project, and carcasses o f culled birds wil l only be deposited on public land. For backyard poultry operations, the local

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committee witnessing the culling and the local vetennanan sign a document stating the carcass deposit area for is public property and free o f encroachers/informal settlements. In case o f semi- commercial poultry farms, the zonal vetennanan and an official f rom the local administration wil l s i g n a document stating that the carcass deposit area is public land and free of encroachers/infonnal settlements.

In Afghanistan, almost al l poultry (98 percent) is raised in family backyards rather than in large commercial poultry farms. There are an estimated 250 small artisan incubators and only one commercial hatchery that operate part time”. According to the NRVA, an average o f 86 percent o f rural households have poultry - at a rate o f 4 ammals per household (2003)16, w h c h i s a reduction o f almost 2/3 compared to the situation in 1995 (before the drought), where the average number o f birds per household were 11.6. In al l but two provinces, more than 75 percent o f rural households own poultry - the exceptions being Badghis (25 percent) and Jawzjan (57 percent). Through the RAMP project, poultry production has been promoted in 25 distncts o f Ghazni, Kunduz, Nangarhar and Parwan provinces.

The pnmary poultry production system i s the traditional backyard system where small numbers o f domestic fow l are raised for home consumption with small, mostly seasonal surpluses being soId in village markets. Women and children are the main tenders o f ammals in the rural households, and unlike the larger livestock, poultry is normally considered the property of women, who would normally control any income generated from the sale o f poultry and eggs. Hence, village-based scavenger and semi-scavenger systems are owned and operated by women, whereas semi-commercial poultry producers are exclusively men and are based in urban and semi-urban areas. l7 With the preponderance o f village-based scavenger system, women and children are thus high nsk groups in respect o f H P A I and women and poor households in general wi l l in particular suffer economically from the HPAI, since poultry i s one o f the very few income sources for women, and an important source o f supplementary foodincome particular in poor households.

While women are the main poultry owners, cultural restnctions on their mobil i ty and social interaction prevents them for being engaged in the marketing o f poultry and eggs, which is thus an entirely male domain. Live farm chickens and eggs either being sold at farm gate to collectors or sold on the local markets directly to local consumers or to collectors. Young boys may retail eggs produced by the family in rural penodic markets and pen-urban markets. The collectors/middlemen wil l sometimes buy the chickens and eggs from the rural women through barter, payng for the poultry and eggs in commercial goods particularly aimed at female customers. Collectors transport the live chickens to urban centers for sale by retailers in the urban l ive poultry markets, where different species of poultry (chickens, turkeys, ducks, geese, guinea fowl) are kept in cages, which are not cleaned or disinfected regularly Even visibly sick birds are attempted sold o f f before dyng, and in case o f culled birds, they are normally not

RAMP Draft Afghanistan Poultry Sub-sector Assessment. Chemonics International, April, 2004. l6 Chickens - as this number does not include ducks, geese, guinea fowl, turkeys, and other poultry kept by rura l and urban dwellers. (Afghanistan Livestock Survey, FAO, 2003) ” Ibid: 13

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disposed o f f until the end o f the market day Poultry market retailers may store the used poultry cages in general merchandise shops with foodstuff.

People usually prefer buyng a l ive bird and kill it themselves at home as i t i s considered healthier than buyng a slaughtered bird, since the meat i s fresh and frozen chicken can spoil before reaching the retailer due to the many interruptions in the cold storage chain.” Chicken i s a very popular food in Afghanistan, often served to guests and invanably at special occasions such weddings, engagements, funerals and religious festivals like Eid. Whi le both poultry and eggs normally are fully cooked when consumed, food handling practices in general are far from safe. Eggs are usually consumed in the momng, but boiled eggs are also sold as a snack in the bazaar and at bus stations. L ike in case o f chickens, there i s a strong preference for Afghan produced brown eggs (“national eggs”) which consumers consider healthier than white eggs (“machine eggs”, imported from Pakistan or Iran), since they have a larger yolk. Brown eggs sells for twice the pnce o f w h t e eggs, but cover only around 10 percent o f the market (ibid).

Special measures are required (a) to reach the pnmarily female poultry producers and assisting children with sufficient information, training and mobilization to prevent the spread o f Avian diseases. (b) to change household level behavior in poultry raising, improved hygiene and food preparation practices and waste management food through awareness raising and community mobilization campaigns; (c) likewise, the identification o f the disease and the culling o f birds have to involve significant community mobilization and awareness raising in view o f the preponderance o f small domestic poultry units where cultural restnctions on the mobil i ty and social interaction o f women poultry owners render outreach activities, identification and culling o f sick birds difficult and necessitates recruitment o f female field staff.

3 The following are the potential adverse effects for each o f the G P A I activities:

Animal Health Component: a) Improving HPAI Prevention and Control Planning. There are no foreseen

potential adverse effects but emphasis i s put on country preparedness. Country’s Emergency Contingency Plan to include al l institutional, financial and human resources and arrangements to deal with adverse environmental impacts from prevention and control activities.

b) Strengthening o f vetennary services. Training o f vetennary workers to include procedures for safe handling o f AI matenals and refurbishing o f reference and health clinics, include key environmental issues related to zoonotic disease containment and waste management practices.

, c) Safe culling and transport o f infected and at-nsk birds: The current pol icy in the management o f AI outbreaks i s stamping out by imposing a quarantine area, slaughter o f infected and potentially exposed birds, and decontamination o f poultry houses, sheds and contaminated areas. Improper transport o f any contaminated

AltadUNDP Consumer Survey, February 2005 quoted m UNDP Market Sector Assessments SME Development, Altai Consulting, March 2005.

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birds, bird products or waste (eggs, manure and feathers) and equipment (for example in open containers) may pose environmental and public health nsks.

d) Safe disposal o f carcasses. A practical and samtary system for disposing o f dead birds wil l help prevent the spread o f disease and protect air and water quality

Human Health Component: Refurbishing o f reference diagnostic laboratones (if any), refurbishing o f referral hospitals and health clinics and training o f staff to include key environmental issues related to zoonotic disease prevention and special waste management (laboratones, clinics and hospitals).

Public Awareness and Coordination Support Component: No environmental issues, but an important component for design and delivery o f communications tools for good hygiene, safe culling and disposal o f animal carcasses and animal waste management.

Implementation Support and Critical Imports (if applicable): No environmental issues.

The pnmary potential key nsks can be grouped into two categones:

a) Inadvertent human exposure and spread o f the virus due to: improper culling and disposal of dead birds (wild birds, sick and dead birds from backyard and commercial poultnes); lack of, or improper personal protection equipment (PPE); improper disposal of farm waste (Le. bedding, manure, washngs, etc. dunng andor after an outbreak); lab and hospital/medical, and

b) Inadvertent release o f chemicals in the environment from unsatisfactory decontamination procedures (for personnel, poultry sheds, and transport vehicles, etc.).

An Environmental Management Plan (EMP) for carcass, excreta and waste (eggs, manure and feathers) disposal facilities is attached (Attachment 1 to this appendix). However, i t i s important to note that the EMP wil l be further revised and updated with the evolving situation and conditions in the country with regard to AI. The necessary adjustments in the scope o f the EMP will be specified dunng the initial phases o f the project implementation. While the EMP i s being finalized, the project wi l l follow the init ial EMP and the operating procedures to manage and monitor potential negative impacts o f the disposal o f carcasses, excreta, litter, contaminated soils, disposal equipment in accordance with the advice o f a technical specialist to the Project Management Team. These Provisions wil l be included in the Project Implementation Manual (PIM) to be ready pnor to disbursement, and updated as necessary to reflect any changes or additions to procedures recommended in the EMP

To prevent further spreading o f H5N1 , surveillance in domestic poultry as wel l as in wild birds should be strengthened in the country as i t i s along migrating bird routes. Resources should be focused on the reduction o f close contacts between humans, domestic poultry and wildlife through better management practices and improved biosecunty practices in poultry production enterpnses, especially those that are small and 'open-air'- where domestic poultry and waterfowl are allowed to mingle with wild birds.

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Officials would also need to monitor 'wet' and wildl i fe markets, where wild and domesticated species are kept in close proximity, which are at n s k o f exposure to a wide range o f pathogens. Limiting contact with wild birds should therefore be part o f any avian influenza control strategy To protect domestic poultry, vaccination should be considered as a tool for the prevention and control o f HPAI in at nsk situations., The control o f avian influenza infection in wild bird populations at this stage, i s not feasible - from a logistical, environmental and biodiversity point o f view hdiscnminate culling o f wild migratory bird populations would be ineffective in preventing further spread o f avian influenza and their hunting would likely cause dispersion o f the birds.

The investments in laboratory facilities, equipment and staff training wil l improve effectiveness and safety o f avian influenza handling and testing procedures by meeting international standards established by OIE. If there are existing guidelines from other projects, for the handling of medical waste generated in health care facilities, such guidelines wil l be adapted. The Project wil l also support updating o f these guidelines, training o f healthcare workers to manage medical wastes according to these guidelines and, if necessary, the purchase o f equipment for the proper handling and disposal o f medical waste in participating facilities. These provisions wil l be included in the PIM.

The Project wil l 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 o f animals dunng an outbreak, in particular by adopting OIE standards; (ii) improving understanding o f the relevant practitioners o f waste management systems in health facilities; and (iii) developing policies on compensation for poultry farmers affected by future outbreaks.

As an emergency operation under OP/OD 8.50, the safeguard documents are not required to be prepared and disclosed pnor to appraisal. However, i t i s expected that the E M P for the carcass disposal facilities wil l need to be prepared and disclosed pnor to the appraisal.

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Safeguard Policies

Table 1 List o f safeguard policies

Safeguard Policies Triggered by the Project Yes No Environmental Assessment (OP/BP/GP 4.0 1) [XI [ I Natural Habitats (OP/BP 4.04) [ I [XI Pest Management (OP 4.09) [ I [XI Cultural Property (OPN 1 1.03, being rewsed as OP 4.1 1) [ I [XI Involuntary Resettlement (OP/BP 4.12) [ I [XI Indigenous Peoples (OD 4.20, being revised as OP 4.10) [ I [XI Forests (OPBP 4.36) [ I [XI Safety o f Dams (OP/BP 4.37) [ I [XI Projects in Disputed Areas (OP/BP/GP 7.60) [ I [XI Projects on International Waterways (OP/BP/GP 7.50) [XI

Strategic Communication. The Project is designed to promote awareness, consensus building, support buy-in on mitigation measures by the Afghan public and stakeholders on the Avian and Human Influenza Control and Preparedness Emergency Project in the country. This strategy is predicated on the fact that pandemic wil l be slowed down by everyday behavior change, which is in turn determined by information and beliefs, and also by sheer plain habit. One o f the lessons learned elsewhere around the wor ld from the AIDS epidemic i s that public information alone does not necessarily generate action. People’s response i s contingent o n social networks, social beliefs and how they affect behavior as well as resource availability in their community Government’s role i s to provide enabling policies for restoration o f public health infrastructure and preparedness at individual, community and national levels, developing training courses in communication methodology and techniques for apcul tura l extension and vetennary staff, health workers, NSP social organizers/facilitators information and National Onentation staff at national, local government levels as well as community based groups, such as, CDCs, CBOs, the traditional shuras and etc.

The Project i s designed to safeguard human health, in particular for extension staff, animal health workers, poultry producers and their families, by improving public awareness and information. Support wi l l be provided for information and communication activities to increase the attention and commitment o f government, pnvate sector, and c iv i l society organizations, and to raise awareness, knowledge and understanding among the general population about the n s k and potential impact o f the pandemic. I t wil l also involve conducting a rapid social and hygiene assessment to investigate household and individual health-related behaviors within ‘their complex, rational matnx of personal, organizational, and social realities. The assessment will explore opinions, attitudes, behavior, and motivations o f affected communities, leading to understanding o f health, livelihood and other social development issues relevant in designing an effective communication strategy

In Afghanistan, raising chicken i s one o f the means o f income generating activities and livelihood strategy, and many o f poor farmers and peasants l ive in close proximity with their flocks and depend on poultry production for their survival, often in remote areas. Unl ike in some other countnes, where poultry production i s largely concentrated in huge enterpnses, the

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scattered and small holdings in Afghanistan pose enormous problems for controlling any outbreak.

The fact that the virus o f Avian Influenza does not recognize national boundanes, Highly Pathogenic Avian Influenza (HPAI) strategy should address the migratory nature o f wild birds carryng the virus across the borders.

The new environmental law i s giving NEPA the mandate o f ensunng the Environmental Management in the country in general and particularly among other issues o f the transboundary environmental issues and making regulations with regard to EIA o f projects. In this case NEPA and i t s partner UNEP could be p l a y n g a vital role in making sure that relevant major environmental concerned are adhered to and capacity i s developed in the relevant implementing agencies to comply with the stipulated laws as far as possible given the conditions in the country

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APPENDIX 9 - Monitoring and Evaluation Arrangements

A. Introduction

The project wil l include two major categones o f interventions: (i) emergency or short-term interventions geared to control and prevent the spread and outbreak o f Avian Influence threat to general public in a bio-secure and environmentally fhendly manner; and (ii) interventions for the longer-term that aim to improve existing national capacity, systems, procedures and public awareness to prevent, respond effectively and rapidly to any potential A I threat, and to control the situation in the event o f an AI outbreak. In the init ial stage o f project implementation, the focus will be on emergency interventions. Therefore, the Monitonng and Evaluation Framework and Strategy should be capable to provide necessary information to policy makers, and related stakeholders, including government agencies on project inputs, outputs, outcomes and implementation performance in relation to both these two phases o f interventions. Lessons learned during the emetgency phase wil l also be a learning exercise for the government to refine and fine tune medium term interventions thgt will continue beyond the emergency phase.

B. M&E Approach

The AHIP places significant emphasis on M&E and sees it as a vehicle for ensunng that the envisaged activities fully reflect the changing environment. The monitonng and evaluation (M&E) system i s intended to provide information to the relevant stakeholders on project implementation performance, process, outputs, and outcomes.

There are a number o f cntical aspects that need to be monitored in order to achieve the objectives o f this operation. In view o f the high nsks posed by the AI threat and the emergency nature o f the project as well as lack o f pnor expenence with similar projects in the country, the M&E system will be dynamic and reflect the changing environment and conditions. The iterative and dynamic M&E approach would ensure that the changing environment and lessons learned from implementing the project wil l be reflected in the ensuing project activities. Such an arrangement will and can help emergency response team and task forces as well as implementing agencies and partners to introduce early corrective measures, which would lead the project to achieve i t s stipulated objectives in a dynamic fashion. A dynamic and continuous monitonng and evaluation system will be established to ensure that the project implementation fully reflects the changing environment and i s sufficiently flexible to alter the direction and implementation modality o f the project. Lessons learned from this project will not only feed into the design and implementation strategies o f the subsequent phases o f the project but will also contribute to improving the design and implementation o f other similar projects in the country

'

B. 1 Organization for M&E

The ultimate responsibility for national level M&E will rest w i th the National A I Secretanat (NAIS). A Project Coordinator wil l be appointed for implementing the Project and this person wil l work in team wi th the public health and animal health coordinators for technical implementation and in liaison with the Director General o f the General Department for

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Policy and Planning (GDPP) MA1 for administrative matters and monitonng and evaluation. An Implementation Management Support Team (IMST) has been established for coordinating the Horticulture and Livestock Project (HLP) and a lead Facilitating Partner (LFP) has been appointed to provide technical assistance specialists to work with Afghan coordinators in IMST The IMST i s headed by a Project Manager who - working in collaboration with the Project Director i s responsible for project implementation. Appendix 10 provides al l details o f the institutional arrangements proposed for the project.

The I M S T includes a monitonng and evaluation specialist to help develop the operations of the Monitonng and Evaluation Department within GDPP A full time senior officer will be designated as M&E specialist for THE PROJECT, working as part o f the M&E team in GDPP and in liaison with NAIS. In addition, the two implementing ministnes will designate staff at their eight zone offices to keep track of project implementation progress, inputs and outputs and to provide detailed and frequent reporting to the centre. The frequency o f reviews and progress monitonng for the NAIS, TCAI and F C A I will be determined dunng the project implementation depending on the levels o f nsk and emergency

Terms o f References for key Project staff, including the M&E specialist, highlighting the scope and institutional arrangements o f the M&E system for the proposed project will be developed as part o f the Project Operational Manual. In view o f the emergency nature o f the project and the consequent need to achieve efficiency and transparency in project procurements and financial management, the M&E specialist will play an overlapping role in monitonng some aspects o f procurement and financial management o f the project as well. The M&E specialist wil l work together with staf f responsible for overall financial management, establishing and enforcing transparent systems and procedures to register and monitor the disbursement o f financial compensation to the affected poultry farmers. In addition, he/she wil l also work in close collaboration with the relevant staff for monitonng o f the timely implementation o f the procurement plan and external and ex-post procurement and financial management audits o f the project. Some o f the most important inputs and outputs o f the project components are presented in Appendix 1. These matnces should be considered dynamic, which wil l be revised from time to bme based on the expenence and lessons learned dunng the project implementation. In addition, the M&E specialist will be responsible for organizing, contracting and implementing specific analytical work, research and field studies required to assess the project’s outcomes and impact in l ine with the Results Framework (Appendix 1). The main aspects o f the proposed M&E are outlined in the following sections.

B.2 Physical geographic monitonng

The Project M&E specialist wil l maintain a GIS based data base o f the provinces and specific geographic locations where the A I virus has been detected and preventive and control measures have been carned out. Necessary technical assistance wil l be obtained from a local I T company to develop the GIS system. The M&E Specialist will produce maps showing geographical locations where H5A1 virus have been detected, culling and animal vaccination activities have been carried out with other information and statistics such as the number o f poultry killed and vaccinated and number o f persons treated with preventive vaccines. The M&E Specialist wi l l : (i) through i t s zonal representatives, establish proper communication channels for provincial and central level departments o f the two ministnes; and (ii) help to design and improve the data collection and registration formats used by the M O P H and MAI.

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He/she will also ensure that accurate data and information are collected by animal health and, human health workers and transmit the information timely from the field to the provincial offices and provincial offices to the Secretanat.

B.3 Implementation Monitonng and Learning

The success o f the intended AI control program and the achievement o f the intended project objectives depend in part on the speed and ability with which a l l the stakeholders can respond to demands o f a changing situation and conditions. Success also depends on the diligence with which planned control and prevention measures are implemented with satisfactory adherence to the sanitary, environmental and safety requirements o f the program as elaborated in Appendix 8 and partly in Appendix 2-1.. I t i s essential to monitor the implementation o f the program not only focusing on the quantitatwe inputs and outputs but also covenng the qualitative aspects o f the implementation program. For example, if the quality o f protective clothing used by the animal heath workers i s not satisfactory or necessary safeguard procedures are not adopted in culling and disposing culled poultry, not only the intended benefits o f the program may not be fully achieved but further risk may also be generated. Safety standards and appropnate procedures specific to salient implementation aspects o f the project wil l be prepared and translated into local languages for implementation in the form o f an operation manual. Careful monitonng o f the adherence to prescribed procedures, standards and safeguards will therefore be a key part o f the monitonng and learning o f the project. The monitonng o f project inputs and outputs, both in quantitative and qualitative dimensions, will be useful for al l project stakeholders, including the emergency response team, to rectify the shortcomings on regular basis. Core aspects o f inputs and output monitonng with respect to the project components are illustrated in Appendix I.

B.4 Outcome and Impact MonitonnP and Evaluation

The outcome and impact monitonng will be guided by the Results Framework, presented in Appendix I. The framework shows the major outcome indicators as well as the potential use o f the outcome indicators during project implementation. The framework also shows the arrangements for results monitonng for each outcome indicator expressed in terms o f baseline status, cumulative target values, frequency o f reporting, means o f venfication and responsibility for M&E.

C. Implementation 'Completion Evaluation

At the end o f the project, a comprehensive evaluation o f the project outputs, outcomes and impacts wil l be carned out by the A I Secretanat. The evaluation will specifically assess whether the target set in Annex I had been achieved at the end o f the project.

IDA w i l l produce an Implementation Completion Report, which wil l focus on evaluating whether the project objectives and targets for key performance indicators have been met.

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APPENDIX 10 - Project Organization and Implementation Arrangements

A. Introduction The inst i tut ional arrangement for the Project are based on the responsibi l i t ies and capacities o f exist ing departments and organizations, us ing operational guidel ines and technical capacity specif ic to the Project. Awareness o f avian inf luenza (AI) and i t s control and containment are a preoccupation at the highest government level.

Early in 2006 the government established a Na t iona l Emergency Response Commi t tee (NERC) at V i c e President-level to address ma jo r national emergencies. However, because o f the senousness o f a potent ia l threat from av ian in f luenza it also created a specif ic National Avian In f luenza Commi t tee (NAIC) responsible for tack l ing prevent ion and cont ro l o f th is disease. The NAIC i s supported by two specialized committees (Box 1).

Box 1. Various Actors in the AI Control, Afghanistan

National Emergency Response Committee (NERC): Headed by the Vice President. This i s an inter- mnisterial level body that coordinates national level activities, policies and strateges o n a l l national emergencies. The c o m t t e e has recently begun discussing issues relating to the AI outbreak in the country All pol icy and strategy issues, in particular those that concern more than one rmnistry, can be addressed in the emergency response c o m t t e e . Since the AI concerns a number o f mnistfles, this c o m t t e e will be particularly useful in pursuing specific AI-related policies and strateges and ensunng that al l concerned rmnistries adhere to the recommendations o f the c o m t t e e . The c o m t t e e meets twice per month, which can increase in case o f emergencies. National A I Committee (NAIC): T h i s body has recently been established, just before the outbreak of AI in Afghanistan 111 March 2006. It i s headed by the Mimster o f MAI. The members o f the c o m t t e e include: Ministry o f Public Health (MOPH), Ministry o f Finance (MoF), Ministry o f Rural Rehabilitation and Development (MRRD), National Environmental Protection Agency (NEPA), Ministry o f Commerce, Ministry o f Interior and the Mimstry o f Foreign Affairs. This i s the main coordination unit for national level AI policies, plans o f action and activities. The NAIC reports to the National Emergency Response C o m t t e e and is advised by two Techmcal C o m t t e e s . Technical Committee for A I (TCAI): The T C A I i s chaired by the General Director o f the Animal and Plant Health, MAI and includes: Infection Department MOPH, NEPA, Kabu l Municipality, FAO, WHO, UNICEF, U N M , UNDP, Asian Development Bank (ADB), the Wor ld Bank, U S A I D and DFID. The T C A I has provided guidelines, technical knowledge, data and information to the public and the relevant field workers. The T C A I provides technical advice on al l aspects o f AI control and containment to the Provincial C o m t t e e on AI (PCAI). Financial Committee for A I (FCAI): The F C A I i s chaired by the Deputy Mimster o f Finance and includes a representative f rom the T C A I and bilateral and multilateral donors present 111 the country This c o m t t e e coordinates sources o f financing and disbursements in relation to AI activities. Provincial A I Committee (PAIC): The PAIC is chalred by the Governor o f the respective province and includes the fol lowing agencies at the provincial level: the Department o f Agriculture - in particular the Vetennary Services Division, Department o f Public Health, Municipality, The Police Department, T h e border police (if a bordering province), NEPA, MRRD, FAO, WHO, UNICEF and relevant NGOs. No t al l provinces have formed a provincial c o m t t e e , while efforts are underway to establish PAICs in al l provinces.

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B. Project Implementation Arrangements

Overall and ultimate responsibility for project execution, successful implementation, accountability and outcomes wil l be with under a newly established Secretanat (NAIS) hosted in the General Department for Policy and Planning (GDDP) o f the Ministry o f Agnculture and Irngation. The N A I S i s supported by a hired Implementation Support Team (IST) financed by the project and composed o f recruited specialists for the duration o f the project. The positions under the IST are currently being advertised.

The IST will include an overall Project Coordinator, an Animal Health Coordinator, a Human Health Coordinator, a Communications Coordinator, a Monitonng and Evaluation specialist, a GIS specialist, two Financial Management Specialists, two Procurement Specialists and a Safeguard specialist. Most o f the IST will be physically located in the General Department for Policy and Planning (GDPP) o f the MAI, while the Human Health Coordinator, Procurement Specialist, and Financial Management Specialist under the Human Health component wil l be based in the Directorate o f Afghan Public Health Institute (APHI) o f the MOPH.

The Project Coordinator wil l be nationally recruited and will report to the N A I S through the Director General o f Livestock Services. The coordinators for each component will report to the N A I S through the Project Coordinator.

Activities under the Animal Health Component will be organized and supervised by a Animal Health Coordinator, nationally recruited, who for technical functions o f the project will work in collaboration with the Director o f the Vetennary Department, MAI. Under the responsibility o f the Animal Health Coordinator, the implementation o f the component will be contracted to an implementing partner, which i s expected to be FA0 - subject to agreement on the technical and financial terms and conditions. Draft TORS for the Animal Health Coordinator have been completed.

Activities under the Human Health Component will be organized and supervised by the Human Health Coordinator, nationally recruited, who for technical functions o f the project w i l l work in collaboration with the Director o f the Afghan Public Health Institute, MOPH. The activities under the component will be outsourced to implementing partners, expected to be WHO and UNICEF, within framework agreements already existing with the Ministry

Activities under the Communications Component will be coordinated and supervised by a Communications Coordinator, nationally recruited, supported by a short-term international consultant. The implementation arrangements for the communication activities wil l be subcontracted to a vanety o f partners and stakeholders, including UNICEF, the agncultural extension and health education teams o f the MA1 and MOPH, the communications infrastructure o f the NSP and Ministry o f Education, as well as NGOs working wi th media and community-radio, subject to agreement on the technical and financial terms and conditions.

The IST will also be responsible for Monitonng and Evaluation, Financial Management and Procurement for the project, including reporting.

94

' At the field level, the Provincial A I Committees (PAICs) will coordinate and manage A I activities in the respective provinces. The technical members o f the PAIC will ensure that implementation o f the various components o f the project are in accordance with the stipulated standards, regulations and social and cultural norms. The Ministers MA1 and the MOPH will joint ly ensure that Provincial A I Committees are formed and counterparts from each o f the two ministnes are assigned to the NAIS.

The project wil l finance the employment o f Zonal coordination units (ZCUs) compnsing of an animal health specialist, a communication and M&E specialist and a database management specialist. Coordination, management, monitonng, data collection and tabulation, managing the f low o f information between provinces, distncts and the centre will be the responsibility o f the ZCUs. The ZCUs will also be responsible for monitonng A I related activities in their area and ensunng that agreed contracts, rules and regulations are fulfilled. I t i s proposed that init ially the project will establish ZCUs in four regions where the A I outbreak nsk i s high. The A H C in consultation with D V S will determine the pnonaes for establishing the ZCUs in the regions. I t i s necessary to appoint a qualified and expenenced contact person in every province, selected from the provincial staff o f the Department o f Animal Health, to ensure that general surveillance and awareness-raising for AI i s camed out and specified measures are taken in case o f an outbreak. Table 1 below presents the definition o f regions as has been adopted by FA0 for animal health planning since the 1990s.

Figure 1 below depicts the vanous institutions involved in coordinating A I activities at national and sub-national levels.

95

Figure 1. Institutional Arrangement Chart, COORDINATION

A. 5. Finance Committee

(Chaired by Deputy

A. 3. Technical Committee

(Chaired by Director of Animal Health-MAI) 7,

*%.

A.4. National AI Secretariat

- 0.

Response Committee

-*.* i ..*- 0.. ..u+*...'''' '

m

D. Possible Technical Service Providers at Provincial ~ Level b...9 e ; t I - U n

WHO FA0 UNICEF

Note: The shaded boxes already exist; the project supported institutions are the A I Secretariat and the Zonal Coordination Units.

96

r 1

1

n

J

8 e

3 The zonal representation o f the Department o f Communicable Diseases in MOPH will coordinate i t s activities with the project ZCUs and utilize the latter’s established capacities for AI purposes, in particular communication.

NORTH Faryab JUZJ an Sar-i-Pul Balkh Samagan

Table 1. Definition o f Regions in Afghanist EAST I WEST CENTRAL

Kabul Panvan Kapisa Logar Panj sher

Nangarhar Laghman Kunarha Nooristan

- SOUTH - WEST Kandahar Helmand Zabul Nimroz Urzgan

Herat Farah Badghis

WEST-CENTRAL Ghor Bamyan Daikundi

NORTH-E AST Bughlan

:s

Wardak SOUTH

Kundoz Takhar Badakhshan

Provincial AI Committees (PAIC) wil l provide relevant technical, managenal and coordination assistance with respect to al l A I activities in addition to providing office space. The implementing partners will report to the ZCUs and PAIC, while the technical members o f the PAIC, through the RCUs, wil l ensure that implementation o f project components are in accordance with the agreed plans for social and cultural as well as technical norms. The line rninistnes represented in the T C A I wil l also have direct contact with their provincial staff on a regular basis.

Paktya Pakika Khost Ghazi

98

n

fi 6 .* E

t .3 3

NORTHNORTH

WESTWEST

WEST CENTRALWEST CENTRAL

SOUTH WESTSOUTH WEST

CENTRALCENTRAL

EASTEAST

SOUTHSOUTH

NORTH EASTNORTH EAST

B A D G H I SB A D G H I S¯¯

H E R ATH E R AT¯G H O RG H O R

FA R A HFA R A H¯

¯ ¯N I M R O ZN I M R O Z K A N D A H A RK A N D A H A R¯

U R U Z G A NU R U Z G A N¯

PA K T I K APA K T I K A¯ ¯

PAKTIKAPAKTIKAG H A Z N IG H A Z N I

NANGARHARNANGARHAR¯KABULKABUL¯

LAGHMANLAGHMAN

B A G H L A NB A G H L A N¯

KAPISAKAPISA¯ ¯ ¯

PARWANPARWAN¯

SAMANGANSAMANGAN¯

TAKHARTAKHAR BADAKHSHANBADAKHSHAN¯KUNDUZKUNDUZ¯

¯JAWZJANJAWZJAN

FA R YA BFA R YA B¯ ¯

H I L M A N DH I L M A N D

KOWSTKOWST

Z A B U LZ A B U L¯

LOGARLOGAR

WA R D A KWA R D A K

KUNARKUNAR

B A L K HB A L K H

SARIPULSARIPUL

B A M YA NB A M YA N¯ ¯

NURISTANNURISTAN¯ ¯

MeydanMeydanShahrShahr

¯

BamyanBamyan¯ ¯ ¯ ¯ ¯CharıkarCharıkar

GardızGardızGhaznıGhaznı

¯ ¯TaloqanTaloqan¯KunduzKunduz

¯BaghlanBaghlan¯SamanganSamangan

¯¯

Mazar-eMazar-eSharıfSharıf

¯SheberghanSheberghan

¯ChaghcharanChaghcharan¯HeratHerat

¯FarahFarah

ZaranjZaranj

¯Lashkar GahLashkar Gah ¯KandaharKandahar

¯QalatQalat

¯Tarın KowtTarın Kowt

Pol-e ‘AlamPol-e ‘Alam

¯ ¯ ¯JalalabadJalalabad

¯MehtarlamMehtarlam

¯ ¯NuristanNuristan ¯ ¯AsadabadAsadabad

SharanSharan

KowstKowst

MeymanehMeymaneh

SaripulSaripul

Qal‘eh-ye NowQal‘eh-ye Now

¯ ¯¯Mahmud-e RaqıMahmud-e Raqı¸

FaisabadFaisabad

KABULKABUL¯

B A D G H I S¯¯

H E R AT¯G H O R

FA R A H¯

¯ ¯N I M R O Z K A N D A H A R¯

U R U Z G A N¯

PA K T I K A¯ ¯

PAKTIKAG H A Z N I

NANGARHAR¯KABUL¯

LAGHMAN

B A G H L A N¯

KAPISA¯ ¯ ¯

PARWAN¯

SAMANGAN¯

TAKHAR BADAKHSHAN¯KUNDUZ¯

¯JAWZJAN

FA R YA B¯ ¯

H I L M A N D

KOWST

Z A B U L¯

LOGAR

WA R D A K

KUNAR

B A L K H

SARIPUL

B A M YA N¯ ¯

NURISTAN¯ ¯

MeydanShahr

¯

Bamyan¯ ¯ ¯ ¯ ¯Charıkar

GardızGhaznı

¯ ¯Taloqan¯Kunduz

¯Baghlan¯Samangan

¯¯

Mazar-eSharıf

¯Sheberghan

¯Chaghcharan¯Herat

¯Farah

Zaranj

¯Lashkar Gah ¯Kandahar

¯Qalat

¯Tarın Kowt

Pol-e ‘Alam

¯ ¯ ¯Jalalabad

¯Mehtarlam

¯ ¯Nuristan ¯ ¯Asadabad

Sharan

Kowst

Meymaneh

Saripul

Qal‘eh-ye Now

¯ ¯¯Mahmud-e Raqı¸

Faisabad

KABUL ¯

NORTH

WEST

WEST CENTRAL

SOUTH WEST

CENTRAL

EAST

NORTH EAST

SOUTH

TURKMENISTAN

UZBEKISTAN TAJIKISTAN

TAJIKISTAN

PAKISTAN

PAKISTAN

ISLAMICREPUBLICOF IRAN

Gowd-eZereh

Helmand

Helmand

Hamun-eSaberı˛

¯ ¯¯ ¯

Harırud¯ ¯

Morghab¯¯

¯

Pamir

Pyandzh

Murghob

Khas

h¯

Farah¯

Harut

¯ ¯

Darya-y

e Qonduz

Tarnak¯

Arghandab

ToMashad

ToMary

ToChardzhev

ToDushanbe

ToKulob˘

ToDushanbe

To Shazud

ToChitral

ToMardan

To Peshawar

ToKohat

ToZhob

ToQuetta

ToQurghonteppa˘

30° N

30° N

35° N

60° E

35° N

75° E

60° E

65° E 70° E

65° E 70° E

AFGHANISTAN

0 50 100

0 50 100 Miles

150 Kilometers

IBRD 34820

MAY 2006

AFGHANISTANAVIAN AND HUMAN INFLUENZACONTROL AND PREPAREDNESS

EMERGENCY PROJECTTRANSPORT INFRASTRUCTURE AND REGIONS

PROVINCE CAPITALS

NATIONAL CAPITAL

MAIN ROADS

RAILROADS

PROVINCE BOUNDARIES

REGION BOUNDARIES

INTERNATIONAL BOUNDARIES

This map was produced by the Map Design Unit of The World Bank. The boundaries, colors, denominations and any other information shown on this map do not imply, on the part of The World Bank Group, any judgment on the legal status of any territory, or any endorsement or acceptance of such boundaries.