document of the world bank report no: icr1767 ... · document of the world bank report no: icr1767...

Document of

The World Bank

Report No: ICR1767

IMPLEMENTATION COMPLETION AND RESULTS REPORT

(IDA-H2030 TF-56157 TF-91994 TF-91995)

ON A

GRANT

IN THE AMOUNT OF SDR 2.8 MILLION

(US$ 4.0 MILLION EQUIVALENT)

TO THE

KYRGYZ REPUBLIC

FOR A

AVIAN INFLUENZA CONTROL AND HUMAN PANDEMIC PREPAREDNESS AND

RESPONSE PROJECT

June 27, 2012

Sustainable Development Department

Central Asia Country Unit

Europe and Central Asia Region

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CURRENCY EQUIVALENTS

(Exchange Rate Effective December 31, 2011)

Currency Unit = Kyrgyz Som (KGS)

1.00 = US$0.02151

US$ 1.00 = KGS 46.4847

FISCAL YEAR: January 01 – December 31

ABBREVIATIONS AND ACRONYMS

AI Avian Influenza IHR International Health Regulations

ADB Asian Development Bank ILI Influenza-like illness

AHIF Avian and Human Influenza

Facility

KAP Knowledge, Attitude and Practices

Assessment

APL Adaptable Program Loan LVPRI Livestock, Veterinary and Pasture

Research Institute

ASEAN Association of Southeast

Asian Nations

MAP Multi-country APL

ASSP Agricultural Services

Support Project

MAWRPI Ministry of Agriculture, Water

Resources and Processing Industry

CC Component Coordinator MES Ministry of Emergency Situations

CDC US Centers for Disease

Control and Prevention

MOH Ministry of Health

DIVA Differentiation of infected

from vaccinated animals

M&E Monitoring and Evaluation

EC European Commission NADIS National Animal Disease Information

System

ERA Emergency Recovery

Assistance

NAPA National advance purchase agreements

ERL Emergency Recovery Loan NGO Non Governmental Organization

EU European Union NSC National Steering Committee

EWS Early Warning System NVL National Virology Laboratory

FMD Food and Mouth Disease OFFLU OIE/FAO Avian Flu Network

FMR Financial Monitoring Report OIE World Organization for Animal Health

GDP Gross Domestic Product PCR Polymerase Chain Reaction

GPAI Global Program for Avian

Influenza and Human

Pandemic Preparedness and

Response

PMR Project Management Report

HPAI Highly pathogenic avian

influenza

POM Project Operational Manual

H5N1 Influenza A virus PP Procurement Plan

H1N1 Subtype of influenza A virus RAS Rural Advisory Services

IATA International Air Transport

Agency

RCVD Republican Center for veterinary

Diagnostics

IDA International Development

Association

REAAC Republican Emergency Antiepidemic

and Antiepizootic Commission

IFAD International Fund for

Agricultural Development

RMIS Republican Medical Information

System

SAEPF State Agency for

Environmental Protection

and Forestry

TOT Training of Trainers

SARS Severe Acute Respiratory

Syndrome

UNDP United Nations Development Program

SES Sanitary Epidemiological

Station

VS Veterinary Services

SOE Statement of Expenditures WHO World Health Organization

SVD State Veterinary Department WP Work Program

TCP Technical Cooperation

Program

WTO World Trade Organization

TF Trust Fund

Vice President: Philippe Le Houerou

Country Director: Saroj Kumar Jha

Sector Manager: Dina Umali-Deininger

Project Team Leader: Brian Bedard

ICR Team Leader: Sandra Broka

Kyrgyz Republic

Avian Influenza Control and Human Pandemic Preparedness and Response Project

CONTENTS

Data Sheet

A. Basic Information .................................................................................................... i

B. Key Dates .................................................................................................................... i C. Ratings Summary ........................................................................................................ i

D. Sector and Theme Codes ........................................................................................... ii E. Bank Staff .................................................................................................................. iii

F. Results Framework Analysis .................................................................................... iii G. Ratings of Project Performance in ISRs ................................................................... xi

H. Restructuring (if any) ................................................................................................ xi I. Disbursement Profile ................................................................................................. xii

1. Project Context, Development Objectives and Design ....................................................................... 1

2. Key Factors Affecting Implementation and Outcomes ....................................................................... 5 3. Assessment of Outcomes ................................................................................................................... 10

4. Assessment of Risk to Development Outcome ................................................................................. 19 5. Assessment of Bank and Borrower Performance (relating to design, implementation and outcome

issues) ........................................................................................................................................................ 20 6. Lessons Learned. ............................................................................................................................... 22

7. Comments on Issues Raised by Borrower/Implementing Agencies/Partners ................................... 23 Annex 1. Project Costs and Financing................................................................................................ 24 Annex 2. Outputs by Component ....................................................................................................... 25

Annex 3. Economic and Financial Analysis ....................................................................................... 43 Annex 4. Bank Lending and Implementation Support/Supervision Processes .................................. 50

Annex 5. Beneficiary Survey Results ................................................................................................. 52 Annex 6. Stakeholder Workshop Report and Results (if any) ........................................................... 55 Annex 7. Summary of Borrower’s ICR and/or Comments on Draft ICR .......................................... 56 Annex 8. Comments of Cofinanciers and Other Partners/Stakeholders ............................................. 64 Annex 9. List of Supporting Documents ............................................................................................ 66

ANNEX 10. Map IBRD 33430 ............................................................................................................... 67

i

A. Basic Information

Country: Kyrgyz Republic Project Name:

Avian Influenza Control &

Human Pandemic

Preparedness & Response

Project

Project ID: P099453 L/C/TF Number(s): IDA-H2030,TF-56157,TF-

91994,TF-91995

ICR Date: 06/26/2012 ICR Type: Core ICR

Lending Instrument: ERL Borrower: KYRGYZ REPUBLIC

Original Total

Commitment: USD 4.00M Disbursed Amount: USD 3.76M

Revised Amount: USD 3.43M

Environmental Category: B

Implementing Agencies:

Ministry of Health (MOH)

Ministry of Agriculture, Water Resources and Processing Industry (MAWRPI)

Cofinanciers and Other External Partners: Government of Japan - PHRD European Commission – Avian and Human Influenza Facility

Multi-Donor Trust Fund - Avian and Human Influenza Facility

B. Key Dates

Process Date Process Original Date Revised / Actual

Date(s)

Concept Review: 12/19/2005 Effectiveness: 07/10/2006 07/10/2006

Appraisal: 11/30/2005 Restructuring(s): 05/09/2010

11/23/2010

Approval: 02/09/2006 Mid-term Review: 07/15/2008 01/15/2008

Closing: 12/30/2010 12/31/2011

C. Ratings Summary

C.1 Performance Rating by ICR

Outcomes: Satisfactory

Risk to Development Outcome: Moderate

Bank Performance: Moderately Satisfactory

Borrower Performance: Satisfactory

ii

C.2 Detailed Ratings of Bank and Borrower Performance (by ICR)

Bank Ratings Borrower Ratings

Quality at Entry: Satisfactory Government: Moderately Satisfactory

Quality of Supervision: Moderately Satisfactory Implementing

Agency/Agencies: Satisfactory

Overall Bank

Performance: Moderately Satisfactory

Overall Borrower

Performance: Satisfactory

C.3 Quality at Entry and Implementation Performance Indicators

Implementation

Performance Indicators

QAG Assessments (if

any) Rating

Potential Problem Project at

any time (Yes/No): No Quality at Entry (QEA): None

Problem Project at any time

(Yes/No): No

Quality of Supervision

(QSA): None

DO rating before

Closing/Inactive status: Satisfactory

D. Sector and Theme Codes

Original Actual

Sector Code (as % of total Bank financing)

Agricultural extension and research 18 18

Animal production 13 13

General public administration sector 38 38

Health 23 23

Other social services 8 8

Theme Code (as % of total Bank financing)

Health system performance 14 14

Other communicable diseases 29 39

Participation and civic engagement 14 14

Rural services and infrastructure 29 19

Social safety nets 14 14

iii

E. Bank Staff

Positions At ICR At Approval

Vice President: Philippe H. Le Houerou Shigeo Katsu

Country Director: Saroj Kumar Jha Dennis N. de Tray

Sector Manager: Dina Umali-Deininger Juergen Voegele

Project Team Leader: Brian G. Bedard Gotz A. Schreiber

ICR Team Leader: Sandra Broka

ICR Primary Author: Sandra Broka

Caroline Plante

Nedim Jaganjac

Amy Evans

F. Results Framework Analysis

Project Development Objective (from Project Appraisal Document):

The overall objective of the Project is to minimize the threat in the Kyrgyz Republic posed to humans

and to the poultry industry by Highly Pathogenic Avian Influenza (HPAI) infection and to prepare for,

control, and respond to an influenza pandemic. To achieve this, three areas will be supported: (i)

prevention, (ii) preparedness and planning, and (iii) response and containment. Achieving these goals

will contribute to diminishing the burden of disease and loss of productivity, limiting the regional spread

of HPAI, and enhancing economic and social prospects at the national, regional, and global levels.

Revised Project Development Objective (as approved by original approving authority):

The overall objective of the project is to minimize the threat in the Kyrgyz Republic posed by the Highly

Pathogenic Avian Influenza (HPAI) infection as well as other poultry and livestock diseases and to

prepare for the control and response to animal influenza pandemic and other zoonotic or infectious

disease emergencies in humans.

(a) PDO Indicator(s)

Indicator Baseline Value

Original Target

Values (from

approval

documents)

Formally

Revised Target

Values

Actual Value

Achieved at

Completion or Target

Years

Indicator 1 : National integrated preparedness, control and response plans prepared and accepted by WHO,

OIE and FAO.

Value

quantitative or

Qualitative)

N/A

National

preparedness, control

and response plans

conform to

Target values for

this PDO-level

indicator were

not formally

Preparedness, control

and response plans

conform to intl.

requirements.

iv

requirements of

WHO, OIE and FAO.

revised. Operational plans

further developed at

local level and tested

through simulation

exercises. Control

strategies prepared for

4 additional priority

diseases.

Date achieved 12/31/2005 12/31/2010 12/31/2011 02/10/2012

Comments

(incl. %

achievement)

Achieved. Although no HPAI case was detected in the country, documentation and interviews

showed that a clear vision of early detection and response mechanisms had been established

through the set of activities conducted during project implementation.

Indicator 2 : Contained and diminishing pattern of HPAI in poultry.

Value

quantitative or

Qualitative)

N/A

Government capacity

for surveillance,

monitoring and

containment of HPAI

infection of animal

improved.

Target values for

this PDO-level

indicator were

not formally

revised.

Government capacity

for surveillance,

monitoring &

containment of HPAI

infection of animals

improved. VS capacity

to conduct passive &

active surveillance to

monitor HPAI and be

prepared to implement

containment & and

eradication measures

established.

Date achieved 12/31/2005 12/31/2010 12/31/2011 02/10/2012

Comments

(incl. %

achievement)

Achieved. The high level of preparedness achieved should ensure proper reaction to an AI

outbreak. Project extension included other diseases and led to successful design of brucellosis

control, further implemented through AISP project in a pilot oblast.

(b) Intermediate Outcome Indicator(s)

Indicator Baseline Value

Original Target

Values (from

approval

documents)

Formally

Revised Target

Values

Actual Value

Achieved at

Completion or Target

Years

Indicator 1 : National AI Strategy developed and adopted by government.

Value

(quantitative

or Qualitative)

N/A

Government capacity

for containment and

control of HPAI

outbreak improved.

N/A

Government capacity

for containment and

control of HPAI

outbreak improved.

VS capacity to control

HPAI possible due to

appropriate planning,

monitoring, preparing

and diagnostic

capacities.

Date achieved 12/31/2005 12/31/2010 12/31/2011 02/10/2012

v

Comments

(incl. %

achievement)

Indicators 1 and 2 were combined for monitoring purposes.

Achieved. The HPAI preparedness and control strategy was widely shared among stakeholders

and awareness raised through trainings and communication activities.

Indicator 2 : Outbreak Containment Plan conforms with the guidelines of FAO/OIE and GPAI.

Value

(quantitative

or Qualitative)

N/A

Government capacity

for containment and

control of HPAI

outbreak improved.

N/A

Government capacity

for containment and

control of HPAI

outbreak improved.

Existence of outbreak

containment plans in

line with international

best practices.

Date achieved 12/31/2005 12/31/2010 12/31/2011 02/10/2012

Comments

(incl. %

achievement)

Indicators 1 and 2 were combined for monitoring purposes.

Achieved. HPAI emergency plans were developed, further adapted to fit local operational

needs and tested through simulation exercises.

Indicator 3 : Assessment of the Veterinary Services completed.

Value

(quantitative

or Qualitative)

N/A Assessment

completed. N/A

Assessment completed.

Performance of VS

evaluated, gap

analysis, strategic plan

and legislation

missions completed.

Strategic plan for

reform ratified by

Government.

Date achieved 12/31/2005 12/31/2010 12/31/2011 02/10/2012

Comments

(incl. %

achievement)

Indicator monitored sporadically, not in every ISR.

Achieved. The country underwent all key steps of the OIE PVS-Pathway (framework

developed by the World Organization for Animal Health to support the strengthening of VS).

Indicator 4 : Laboratory equipment and materials are procured, distributed and installed.

Value

(quantitative

or Qualitative)

N/A

High level of

awareness of HPAI

within the country.

N/A

LVPRI and RCVD

facilities upgraded to

BSL level 2 and

equipped with modern

diagnostic devices and

staff trained for

appropriate use; two

regional Vet Labs also

renovated and

equipped.

Date achieved 12/31/2005 12/30/2010 12/31/2011 02/10/2012

Comments

(incl. %

achievement)

Indicator was not monitored separately, but combined with indicators 4, 5, 6 and 7.

Achieved. The main central veterinary diagnostic establishments are equipped and staffed with

competent people. Successful blind tests confirmed the competency acquired.

Indicator 5 : Staff is trained in surveillance and diagnostic methods.

Value

(quantitative

or Qualitative)

N/A Sufficient core staff

trained. N/A

100% State veterinary

staff trained as well as

key private

vi

practitioners, poultry

producers and

stakeholders.

Date achieved 12/31/2005 12/31/2010 12/31/2011 02/10/2012

Comments

(incl. %

achievement)


Achieved. Trainings in all provinces were delivered in close cooperation with the STOP-AI

program and reached VS, local administration and poultry farm staff.

Indicator 6 : Reporting and reaction time for suspected cases of AI is reduced to the minimally acceptable

levels.

Value

(quantitative

or Qualitative)

N/A Reporting time

acceptably rapid. N/A

Awareness of reporting

requirements and

response mechanisms.

Date achieved 12/31/2005 12/31/2010 12/31/2011 02/10/2012

Comments

(incl. %

achievement)


Achieved. Awareness of all relevant groups on HPAI, capacity to diagnose HPAI and

existence of emergency plans should allow VS to react in a timely manner.

Indicator 7 : 75% average monitoring coverage in at risk areas.

Value

(quantitative

or Qualitative)

N/A

75% average

monitoring coverage

for poultry flocks in

at-risk areas.

N/A

100% of risk areas

regularly monitored for

HPAI.

Date achieved 12/31/2005 12/31/2010 12/31/2011 02/10/2012

Comments

(incl. %

achievement)


Achieved. The VS conducts regular monitoring in at-risk flocks (3,915 blood serum, 600

pathological materials, 9,000 other tests on AI and other poultry diseases done).

Indicator 8 : Data collection and reporting including outbreak reporting, annual prevalence data.

Value

(quantitative

or Qualitative)

N/A N/A N/A Indicator was not

monitored.

Date achieved 12/31/2005 12/31/2010 12/31/2011 02/10/2012

Comments

(incl. %

achievement)

The indicator was not monitored during the project

Indicator introduced during May 2010 restructuring.

Indicator 9 : Emergency supplies procured and available at strategic locations in the field.

Value

(quantitative

or Qualitative)

N/A Emergency supplies

in place. N/A

Emergency supplies

made available in

strategic locations

(SVD, LVPRI and

RCVD).

Date achieved 12/31/2005 12/31/2010 12/31/2011 02/10/2012

Comments

(incl. %

achievement)

Indicator was not monitored separately, but combined with indicators 9, 10 and 11.

Indicator 10 : If appropriate, ring vaccination around infected areas completed.

Value

(quantitative

or Qualitative)

N/A Done if applicable. N/A Not applicable (no

HPAI outbreaks).

Date achieved 12/31/2005 12/31/2010 12/31/2011 02/10/2012

vii

Comments

(incl. %

achievement)

Indicator was not measured, as ring vaccinations were not required due to no AI outbreak.

Indicator 11 : Culling, disposal and disinfection activities completed as needed.

Value

(quantitative

or Qualitative)


HPAI outbreaks).

Date achieved 12/31/2005 12/31/2010 12/31/2011 02/10/2012

Comments

(incl. %

achievement)

Indicator was not measured, as culling, disposal and disinfection activities were not required to

be performed.

Indicator 12 : Compensation provided to poultry owners rapidly and in a monitorable way.

Value

(quantitative

or Qualitative)


HPAI outbreaks).

Date achieved 12/31/2005 12/31/2010 12/31/2011 02/10/2012

Comments

(incl. %

achievement)

Indicator not monitored.

Partially achieved. No compensations were provided as there were no outbreaks.

Compensation mechanisms were tested in the pilot brucellosis control program. The legal

basis for compensation was drafted.

Indicator 13 : Increased number of animals vaccinated.

Value

(quantitative

or Qualitative)


monitored.

Date achieved 12/31/2005 12/31/2010 12/31/2011 02/10/2012

Comments

(incl. %

achievement)

Indicator was not monitored.

Introduced during May 2010 restructuring.

Indicator 14 : Increased number of private veterinarians delivering vaccinations on a fee basis.

Value

(quantitative

or Qualitative)


monitored.

Date achieved 12/31/2005 12/31/2010 12/31/2011 02/10/2012

Comments

(incl. %

achievement)

Indicator was not monitored.

Introduced during May 2010 restructuring.

Indicator 15 : Inter-institutional/multi-sectoral coordination arrangements: legal, regulatory and institutional,

in place.

Value

(quantitative

or Qualitative)

N/A

National multi-

sectoral coordination

body established for

control of pandemic.

N/A

National multi-sectoral

coordination body

established for control

of pandemic.

Date achieved 12/31/2005 12/31/2010 12/31/2011 02/10/2012

Comments

(incl. %

achievement)


Achieved. Merger of the HIV National CCM with other outbreak control Committee proved

impractical. A separate Committee was established and works effectively.

Indicator 16 : Command and control structure for program finance/management defined and in place.

Value N/A Command and control Command and control

viii

(quantitative

or Qualitative)

structure for program

defined and adopted.

structure for program

defined and adopted.

Date achieved 12/31/2005 12/31/2010 12/31/2011 02/10/2012

Comments

(incl. %

achievement)


Achieved. Command and control committee management and financing mechanisms were

established early in the project. However, plans and mechanisms need to be updated.

Indicator 17 : Health laws, regulations and other legal provisions revised and/or promulgated.

Value

(quantitative

or Qualitative)

N/A

Compliance with IHR

achieved but

legislation was not

changed.

N/A

Compliance with IHR

achieved but

legislation was not

changed.

Date achieved 12/31/2005 12/31/2010 12/31/2011 02/10/2012

Comments

(incl. %

achievement)


Partially Achieved. Although Kyrgyz complied with IHR regulatory framework, legislation

was not formally changed to allow full compliance with IHR.

Indicator 18 : National health surveillance for influenza virus developed at national level.

Value

(quantitative

or Qualitative)

In place

National surveillance

for influenza existed

even before the

project but was

enhanced during the

project.

N/A

National surveillance

for influenza existed

even before the project

but was enhanced

during the project.

Date achieved 12/31/2005 12/31/2010 12/31/2011 02/10/2012

Comments

(incl. %

achievement)


Achieved. Some influenza surveillance existed at the national level before the project but

needed enhancement. The project activities contributed to surveillance improvement.

Indicator 19 : Number of at risk regions in the country that have implemented a system for influenza virus

surveillance and control.

Value

(quantitative

or Qualitative)

In place In place. N/A Enhanced.

Date achieved 12/31/2005 12/31/2010 12/31/2011 02/10/2012

Comments

(incl. %

achievement)


Achieved. The project activities contributed to surveillance and control improvements.

Indicator 20 : Number of health personnel trained in influenza virus surveillance and control.

Value

(quantitative

or Qualitative)

N/A

Practically 99% of

SES field

epidemiologists

trained.

N/A

Practically 99% of SES

field epidemiologists

were trained.

Date achieved 12/31/2005 12/31/2010 12/31/2011 02/10/2012

Comments

(incl. %

achievement)


Achieved. Numerous trainings and internal processes were adopted to ensure capacity in

influenza surveillance.

Indicator 21 : Percentage of national and local agencies submitting regular weekly and monthly reports on

the influenza pandemic.

Value

(quantitative In place. Enhanced. N/A Enhanced.

ix

or Qualitative)

Date achieved 12/31/2005 12/31/2010 12/31/2011 02/10/2012

Comments

(incl. %

achievement)


Achieved. Country reported on weekly/monthly influenza statistics. Delays in the reporting

process were reduced by using IT, but further improvements are required.

Indicator 22 : 'Social distancing measures', such as quarantine, bans on mass gatherings, and travel

restrictions, developed and backed up by communication strategy.

Value

(quantitative

or Qualitative)

N/A In place. N/A In place.

Date achieved 12/31/2005 12/31/2010 12/31/2011 02/10/2012

Comments

(incl. %

achievement)


Achieved. It is important to highlight that, following WHO recommendations, travel

restrictions were not imposed.

Indicator 23 : Strategy to access pandemic vaccines developed.

Value

(quantitative

or Qualitative)

N/A Completed. N/A Completed.

Date achieved 12/31/2005 12/31/2010 12/31/2011 02/10/2012

Comments

(incl. %

achievement)


Achieved. Sufficient quantities of quality vaccines were timely obtained.

Indicator 24 : Strategy to access anti-virals for national use (e.g., stockpiling) developed.

Value

(quantitative

or Qualitative)


Date achieved 12/31/2005 12/31/2010 12/31/2011 02/10/2012

Comments

(incl. %

achievement)


Achieved. Sufficient quantity of anti-virals was stockpiled.

Indicator 25 : Contingency plans for maintenance of essential services within the health and outside the

health system developed.

Value

(quantitative

or Qualitative)


Date achieved 12/31/2005 12/31/2010 12/31/2011 02/10/2012

Comments

(incl. %

achievement)


Achieved. Plans were developed early in the project.

Indicator 26 : National communication strategy for pandemic influenza established and materials and

messages prepared.

Value

(quantitative

or Qualitative)


Date achieved 12/31/2005 12/31/2010 12/31/2011 02/10/2012

Comments

(incl. %

achievement)


Achieved. Effective communication strategy was implemented resulting in compliance with

required measures and behavior change to prevent spreading of pandemic influenza.

x

Indicator 27 : Public information campaign launched in at-risk areas.

Value

(quantitative

or Qualitative)


Date achieved 12/31/2005 12/31/2010 12/31/2011 02/10/2012

Comments

(incl. %

achievement)


Achieved. National level campaign was successfully completed.

Indicator 28 : Evidence of high level of awareness by target groups following dissemination of messages.

Value

(quantitative

or Qualitative)

N/A Completed. N/A

A KAP survey in 2010

showed that 88% of

respondents were

aware of the message.

Date achieved 12/31/2005 12/31/2010 12/31/2011 02/10/2012

Comments

(incl. %

achievement)


Achieved.

Indicator 29 : Program reports, financial monitoring, procurement and disbursement reports, audits,

management and financial reports prepared and submitted periodically.

Value

(quantitative

or Qualitative)

N/A N/A N/A N/A

Date achieved 12/31/2005 12/31/2010 12/31/2011 02/10/2012

Comments

(incl. %

achievement)

Indicator was dropped starting ISR2 and not monitored.

Indicator 30 : Baseline developed for monitoring and evaluating Project impact six months after Grant

effectiveness.

Value

(quantitative

or Qualitative)

N/A N/A N/A N/A

Date achieved 12/31/2005 12/31/2010 12/31/2011 02/10/2012

Comments

(incl. %

achievement)


Indicator 31 : Methodology defined and monitoring and evaluation periodically undertaken.

Value

(quantitative

or Qualitative)

N/A N/A N/A N/A

Date achieved 12/31/2005 12/31/2010 12/31/2011 02/10/2012

Comments

(incl. %

achievement)


xi

G. Ratings of Project Performance in ISRs

No. Date ISR

Archived DO IP

Actual Disbursements

(USD millions)

1 07/11/2006 Satisfactory Satisfactory 0.00


3 07/25/2007 Moderately Satisfactory Satisfactory 1.01







H. Restructuring (if any)

Restructuring

Date(s)

Board

Approved PDO

Change

[check box]

ISR Ratings at

Restructuring

Amount

Disbursed at

Restructuring

in US$m

Reason for Restructuring &

Key Changes Made

DO IP

05/09/2010

Y

S

S

2.87

Although the project had

contributed to a reduced risk for

AI, there were other pressing

animal and human health concerns

that could be integrated with the

on-going AI activities, and minor

adjustments in the capacity

building interventions under the

project would also allow

addressing these serious problems.

The PDO was revised to include, in

addition to AI, “other poultry and

livestock diseases”, and to respond

to “other zoonotic infectious

disease emergencies in humans”.

Reference to “other zoonoses” was

introduced in Components 1, 2, 3

and 5, and three new intermediate

results indicators were added.

Extension of the project’s closing

date from 12/31/2010 until

12/31/2011 to allow for completion

xii

11/23/2010

N

S

S

3.131 of the project activities, which

were delayed by a protracted

process to complete the earlier

project restructuring compounded

by some disruption of project

activities due to civil unrest in

2010.

If PDO and/or Key Outcome Targets were formally revised (approved by the original approving body) enter ratings below:

Outcome Ratings

Against Original PDO Targets Satisfactory

Against Formally Revised PDO Targets Satisfactory

Overall (weighted) rating Satisfactory

I. Disbursement Profile

1

1. Project Context, Development Objectives and Design

1.1 Context at Appraisal:

1. In 2005 the highly pathogenic avian influenza (HPAI) H5N1 virus emerged as a global

threat. On January 12, 2006 the Bank's Board endorsed the Global Program for Avian Influenza

Control and Human Pandemic Preparedness and Response (GPAI) as a horizontal adaptable program to

provide up to US$500 million of immediate emergency assistance to countries seeking support to

address this threat to public health and economies of all countries. This was one of the Bank’s

contributions to a broad international response, which was launched at the ministerial conference in

Beijing, China, in January 2006 with pledges of US$1.9 billion from 35 donors. Throughout 2006, the

virus was spreading rapidly, and by the end of the year, 55 countries in Asia, Europe, Africa and the

Middle East had reported HPAI cases in poultry or wild birds, including Azerbaijan, Croatia, Greece,

Kazakhstan, Romania, Russia, Turkey and Ukraine in the ECA region.

2. HPAI outbreaks had been confirmed in the countries neighboring the Kyrgyz Republic.

Situated on major migratory bird flyways and with outbreaks reported in neighboring countries (in

particular, China, Kazakhstan and Russia), the Kyrgyz Republic clearly faced both public health and

economic risks. The public health and especially veterinary services systems had limited diagnostic and

surveillance capacity to address the HPAI threat, and public awareness capacity was weak. Biosecurity

at the commercial poultry farms was reasonably good, but the large free-ranging segment of the poultry

population lacked biosecurity and was vulnerable to HPAI infection (more than 80% of Kyrgyz

households have some poultry).

3. Government’s commitment to dealing with AI was high. A joint Bank/WHO/CDC appraisal

mission in December 2005 addressed the readiness of the Kyrgyz Republic to proceed with a program of

support under GPAI and concluded that the Kyrgyz Republic meets the eligibility criteria for “countries

at risk” in GPAI category (iii)1. The government’s commitment was provided in the form of a formal

request for the project (received on November 28, 2005), and a draft national plan on response to an

avian influenza pandemic, which was prepared by the Government prior to the appraisal mission.

4. The project required a multi-pronged approach. The relatively poor status of the national

human and veterinary health-care systems, outdated equipment and lack of test kits at the laboratories,

limited scale of disease surveillance and control, lack of tradition for communication strategies, and the

overall unpreparedness for disease emergency situations were placing the country at high risk. The

project, therefore, required resolution of a whole set of issues concurrently, to strengthen the country’s

ability to respond to HPAI crisis. The responsibility for the project implementation was shared between

the Ministry of Health (MOH) and the Ministry of Agriculture, Water Resources and Processing

Industry (MAWRPI).

5. Rationale for the Bank involvement. HPAI control programs require a multi-disciplinary

approach to integrate technical, social, economic, political, policy and regulatory issues in addressing a

complex problem, and the World Bank served as an integrator in successfully addressing this problem.

In addition, with its experience to assisting many countries under the GPAI umbrella, the Bank was able

1 Country Eligibility Criteria under GPAI category (iii) states: “Countries at risk, with no outbreaks or at an early stage of an

outbreak, will need to demonstrate governmental commitment to addressing the situation and have in place an appropriate

plan for early detection and rapid response, including implementation and monitoring arrangements that the international

agencies and donor community, including the Bank, could support.

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to share valuable lessons learned from other countries that faced similar threats. The Bank also helped to

mobilize funds under its other projects, as well as co-financing from other donors towards achieving the

project objectives. Thus, in addition to the IDA grant of US$4 million, the Government of Japan

supported the program with a PHRD Grant in the amount of US$1 million, and the grants totaling

US$1.15 million were provided from the AHIF (including US$0.352 million from the multi-donor

window and US$0.798 million from the EU window).

6. In addition, two IDA-financed projects: the Agricultural Support Services Project (ASSP) and

Agricultural Investment and Services Project (AISP) were deployed in support of furthering the AI

project goals. Following a restructuring, US$1.13 million were allocated under ASSP to rehabilitate

buildings of four veterinary laboratories and to procure urgently needed equipment for them, as well as

to construct a number of Bekkari holes for safe carcass disposal. AISP allocated US$1.6 million, which

were supported by financing from an EU Trust Fund in the amount of EUR6.7 million, from IFAD in

the amount of US$1.6 million, and from SDC – US$0.2 million. The funding is being used for the

following purposes: legal framework development (e.g., the veterinary law), further support to the SVD

on the national disease control strategy development, staff training and equipment upgrades and a

twinning program with the Swiss Federal Veterinary Office, training and start-up grants for private

veterinary service development, and animal vaccination program

1.2 Original Project Development Objectives (PDO) and Key Indicators:

7. The program development objective of the GPAI is “to minimize the threat posed to humans by

highly-pathogenic avian influenza (HPAI) infection and other zoonoses and to prepare for, control, and

respond to influenza pandemics and other infectious disease emergencies in humans.” This project also

contributed towards achievement of this umbrella PDO.

8. This PDO was adapted to the conditions in country, thus the Project Development Objective

was to minimize the threat posed to humans and to the poultry industry by HPAI infection and to

prepare for, control, and respond to influenza pandemics. To achieve this, three areas were to be

supported: (i) prevention, (ii) preparedness and planning, and (iii) response and containment. Achieving

these goals was to contribute to diminishing the burden of disease and loss of productivity, limiting the

regional spread of HPAI, and enhancing economic and social prospects at the national, regional, and

global levels.

9. The key project outcome indicators were:

Evidence of improved effectiveness of participating animal and public health services in responding to

the risk of an HPAI outbreak and/or pandemic:

(i) National integrated preparedness, control and response plans prepared and accepted by

WHO, OIE and FAO.

(ii) Contained and diminishing pattern of HPAI infection in poultry.

1.3 Revised PDO and Key Indicators, and reasons/justification:

10. The original PDO has been revised as follows: The overall objective of the project is to minimize

the threat in the Kyrgyz Republic posed by HPAI infection as well as other poultry and livestock

diseases and to prepare for the control and response to an influenza pandemic and other zoonotic or

infectious disease emergencies in humans.

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11. ISR5 (June 2009) provides the rationale for revision: “…in consultations with the Deputy Prime

Minister’s Office and Ministry of Health, the project team was urged to consider the possibility of

providing support for other pressing animal and human health concerns that could be integrated with the

ongoing Avian Influenza (AI) including brucellosis, anthrax, rabies, TB, echinococcosis and others. The

government wanted to use the funds allocated under the compensation funds to address such other

issues, especially, since there was no AI outbreak and the threat had diminished. The project team

reviewed this proposal and agreed that the project inputs should be considered in the broader context of

animal disease control and especially as it relates to zoonotic diseases. It was agreed the restructuring of

the project would be required to allow addressing these broader concerns but without compromising the

basic integrity of the AI related project objectives.” On the Bank’s side it was agreed that minor

adjustments in the capacity building interventions under the project including technical assistance

related to epidemiology, support for the national animal disease surveillance system, and public

awareness would similarly address these serious problems. It would allow for continuing to develop

capacity to prevent AI in the short term, while working towards establishment of a more sustainable

system for eradicating zoonoses in the longer term.

12. Although the revised PDO went beyond the GPAI original objectives, the restructured PDO

provided an opportunity for better addressing the human/animal/environmental interface and, therefore,

offered a more comprehensive approach to strengthen control of HPAI and other zoonoses including

animal specific diseases. In addition, this approach in fact piloted the comprehensive “one Health”

approach which was adopted by all stakeholders.

13. The key project outcome indicators were not revised. The expanded PDO was accommodated by

adding three new intermediate results indicators (for Components 1.B and 1.C).

1.4 Main Beneficiaries (original and revised):

14. Although the PAD does not make a specific reference to the Main Beneficiaries of the project,

the PDO implies that the entire human population and poultry industry of the country would benefit

from the increased preparedness of the country and the reduced risk and impact of a pandemic. In

particular it was important for rural households, 80% of which have some poultry, much of which is

managed with the help of children. The bulk of backyard poultry production is consumed within the

household and represents an important component of the diet, and some of it is sold. Market sales are

done by women, thus backyard poultry assets and income are essentially women’s assets and income.

15. With the expansion of the PDO and addition of other zoonotic diseases, the project beneficiaries,

in addition to the human population and poultry industry also included the livestock sector of the

country. In addition, as originally intended, a range of institutions have benefitted from the project

activities, including the MOH, MAWRPI, Republican Central Veterinary Laboratory, State Veterinary

Department, Sanitary-Epidemiological Service, health care providers.

1.5 Original Components (as approved):

16. The project had 5 components: (i) Animal Health; (ii) Human Health; (iii) Public Awareness

and Information; (iv) Implementation Support and Monitoring and Evaluation; and (v) Emergency

Imports.

17. Component 1: Animal Health. This component aimed to support national prevention and

control strategies to cover the country’s needs in the short, medium or long term, by supporting activities

for: (i) enhancing HPAI prevention and preparedness capability, (ii) strengthening of veterinary services,

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disease surveillance, diagnostic capacity and applied research, and (iii) strengthening HPAI control

programs and outbreak containment plans, and improving bio-security in poultry production and trade.

This component aimed also to provide resources for a Compensation Fund to compensate poultry

owners for the loss of assets caused by mandatory destruction (culling) of their poultry.

18. Component 2: Human Health. This component targeted the reduction of the impact of a

pandemic influenza virus through: (i) year-round surveillance; (ii) effective and accurate methods of

diagnosis; (iii) social distance interventions; (iv) vaccines (once they become available); (v) anti-viral

drugs; and (vi) strengthened medical services. It aimed to support activities for: (i) enhancing public

health program planning and coordination, (ii) strengthening of the national public health surveillance

system, and (iii) strengthening health system response capacity.

19. Component 3: Public Awareness and Information. This component was designed to promote

awareness and improved coordination of the execution of the national action plan for avian influenza

control. It included information and communication activities to increase the attention and commitment

of government, the private sector and civil society organizations and raise awareness, knowledge and

understanding among the general population about the risk and potential impact of a pandemic. It aimed

also to support the Republican Emergency Antiepidemic and Antiepizootic Commission in its roles of

triggering emergency responses by the Ministry of Agriculture, Water Resources and Processing

Industry and the Ministry of Health, monitoring the actions taken by them, coordinating public

statements to the media, and executing project evaluation activities.

20. Component 4: Implementation Support and Monitoring and Evaluation. This component

aimed to support costs associated with project management and coordination and monitoring and

evaluation.

21. Component 5: Emergency Imports. In case of a declared influenza pandemic, this component

was to finance emergency imports identified as necessary under a well-defined preparedness and

response program to be prepared as part of project implementation. These imports are likely to include:

(i) pharmaceuticals and vaccines, (ii) medical and veterinary supplies and equipment, (iii)

communication equipment, supplies and information campaigns, (iv) food and water containers, and (v)

protective gear and clothing.

1.6 Revised Components:

22. During the restructuring of May 9, 2010, the components were slightly revised and now read as

follows (the changes are in italic and underlined):

23. Component 1: Animal Health supported national prevention and control strategies to cover the

country’s needs in the short, medium or long term. Activities supported for: (i) enhancing prevention of

HPAI and other zoonoses, and preparedness capability, (ii) strengthening of veterinary services, disease

surveillance, diagnostic capacity and applied research, and (iii) strengthening HPAI and other zoonoses

control programs and outbreak containment plans, and improving bio-security in poultry production and

trade. It provided resources for a Compensation Fund to compensate owners of poultry and other

domestic animals for the loss of assets caused by mandatory culling.

24. Component 2: Human Health targeted the reduction of the impact of the virus of a pandemic

influenza and other zoonoses through: (i) year-round surveillance; (ii) effective and accurate methods of

diagnosis; (iii) social distance interventions; (iv) vaccines; (v) anti-viral drugs; and (vi) strengthened

medical services. It supported activities for: (i) enhancing public health program planning and

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coordination, (ii) strengthening of the national public health surveillance system, and (iii) strengthening

health system response capacity.

25. Component 3: Public Awareness and Information was designed to promote awareness and

improved coordination of the execution of the national action plan for control of Avian Influenza and

other zonoses. Information and communication activities to increase the attention and commitment of

government, the private sector and civil society organizations and raise awareness, knowledge and

understanding among the general population about the risk and potential impact of a pandemic. It

supported the Country Multi-Sectoral Coordination Committee on Socially Significant and Dangerous

Diseases in its roles of triggering emergency responses by the MAWRPI and MOH, monitoring the

actions taken by them, coordinating public statements to the media, and executing project evaluation

activities.

26. Component 4: Implementation Support and Monitoring and Evaluation. The component

description remained unchanged.

27. Component 5: Emergency Imports. In case of a declared pandemic of influenza or any other

zoonoses, this component will finance emergency imports identified as necessary under a well-defined

preparedness and response program to be prepared as part of project implementation. These imports are

likely to include: (i) pharmaceuticals and vaccines, (ii) medical and veterinary supplies and equipment,

(iii) communication equipment, supplies and information campaigns, and (iv) protective gear and

clothing.

1.7 Other significant changes:

28. Closing Date extension: The Closing Date was extended once, from December 30, 2010 to

December 31, 2011 in order to allow the remaining activities to be completed.

29. Re-allocation of funds: followed the government’s request expressed at the projects mid-term to

include other zoonoses in the project, which would allow for more efficient use of the project funds in

the absence of an AI outbreak. The project achievements as of that date, in particular, in legal and

institutional framework development, institutional capacity building and awareness raising mechanism

development allowed for serving a bigger purpose – such as addressing the other priority zoonoses –

with little adjustments required. This approach was fully supported by the Bank’s team, in particular

given the importance of livestock (sheep and cattle) for rural livelihoods. A reallocation of the Grant

proceeds was carried out to accommodate the expansion of scope of the project, in order to address other

prevailing veterinary emergency issues in the country while maintaining the original focus on avian

influenza preparedness. Some funds from the categories “Eligible imported goods and commodities “,

“Compensation Fund”, “Unallocated” and “Operating costs” were redirected to increase the “Civil

Works” (from SDR 56,000 to SDR 100,000) and “Goods” (from SDR 804,000 to SDR 1,630,000)

Categories.

2. Key Factors Affecting Implementation and Outcomes

2.1 Project Preparation, Design, and Quality at Entry:

30. The project supported the implementation of two national-level policy documents: the

National Poverty Reduction Strategy (NPRS) and the Bank’s Country Assistance Strategy (CAS)

approved by the Bank’s Board in May 2003. The NPRS emphasized the importance of placing greater

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attention on public health and combating communicable diseases and on public awareness campaigns

concerning key health issues. One of the 16 specific key poverty indicators for monitoring progress

towards the NPRS goal was a reduction in mortality from infectious diseases. The CAS noted the critical

need for effective provision of health care services and for continued efforts to promote agricultural

development as a key driver of growth and poverty alleviation. The project was to support both of these

objectives: by improving the country’s capacity to deal with the threat of serious communicable disease

for humans, and by putting in place institutional capability to prevent massive loss of poultry due to

avian influenza or at least minimize its impact on the agricultural economy and the rural poor in

particular.

31. The Project’s design followed the GPAI framework, which indicated that an appropriate

balance between short and long-term actions needed to be taken. This guidance was appropriate for the

project, as the project had to address a complex issue with a diversified set of measures. The immediate

objective in the short-term was to reduce the risk to humans by preventing further spread of HPAI and

enhancing detection, containment and treatment. The long-term strategy was to minimize the global

threat and risk of HPAI in humans and domestic poultry, through progressive control and eradication of

HPAI.

32. The Project was prepared and processed as an emergency investment operation using

procedures under OP8.50 – Emergency Recovery Loan. The preparation of the project was thus very

fast. The Concept Note meeting of December 19, 2005 was also used as the Decision meeting, and

issued the authorization to Negotiate. The Negotiations took place less than a month later, on January

11, 2006. The project was approved by the Bank’s Board of Directors on February 9, 2006 and became

effective on July 10, 2006 (effectiveness delay resulted from in-country processing). The project was the

second to be processed under the GPAI (which meant that there was more sharing of knowledge during

the implementation than learning from other operations during the preparation), and the last to be

approved by the Board (all subsequent AI projects were approved by RVPs in accordance with

horizontal APL procedures).

33. In a context of an emergency, the lack of data and information resulted in the project being

partly built on assumptions. Although outcomes were eventually attained, the Project was ambitious in

a context of weak institutions and infrastructures as developing strong policies, legal framework, and

human capacity building are lengthy processes, thus required an extension of the closing date, albeit

only for one year. This project was also the first ever of this scale involving the Veterinary Services in

the country, thus little knowledge was available at the project outset. Although Veterinary Services

made a great leap forward during the project, the project duration and budget were too limited to allow

for development of a sustainable veterinary services system. It was fortunate that another World Bank-

financed project (AISP) was launched in 2008 and strongly linked with this project’s development

objectives to ensure continuity and/or complementarities of activities. It should also be noted that some

indicators, in particular those built on an assumption of an AI outbreak, later appeared not to be relevant.

34. Eligibility for EMP deferral. As an emergency operation, the project was eligible for a delay in

completion and disclosure of the Environmental Management Plan (EMP) to after appraisal. The RVP

agreed that completion of the EMP could be delayed, and would be disbursement condition components

1 and 2 (animal health and human health) of the project. The EMP was completed and disclosed prior to

Effectiveness.

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2.2 Implementation:

35. Expansion of the PDO scope to include other zoonoses and increase the efficiency of the use

of project funds. The country did not experience an AI outbreak. Therefore, the mid-term review of the

project activities established that although the improved preparedness with Project support has

contributed to a reduced risk for Avian Influenza in the Kyrgyz Republic, there were other pressing

animal and human health concerns that could be integrated with the ongoing avian influenza activities,

including brucellosis, anthrax, rabies, tuberculosis, echinococcosis and others. In addition, the

government was interested in the efficient use of the project funds, in particular, the allocations for

compensation funds and the emergency supplies, in the absence of an AI outbreak. Technically, the

expansion of the PDO scope did not require major changes. Minor adjustments in the capacity building

interventions under the project including technical assistance related to epidemiology, support for the

national animal disease surveillance system, and public awareness helped to address these serious

problems while continuing to develop capacity to prevent Avian Influenza in the short terms, and

leading to a more sustainable and systematic way for eradicating zoonoses in the future. This project, in

fact, piloted a comprehensive “one Health” approach.

36. Focus of the project activities on AI remained highly relevant throughout the project

implementation period (and continues to be today, as the Kyrgyz Republic continues to consider itself

a high risk country, in particular due to its proximity to countries with occurrences of AI outbreaks). The

changes in the project involved a revision to the Project’s Development Objectives and project

components to allow the project to encompass some of these pressing issues, yet to preserve the integrity

of the original Project design related to Avian Influenza. The initial Development Objectives and project

components continued to be relevant and fully in line with the main objective of the Global Program for

Avian Influenza Control and Human Pandemic Preparedness and Response (GPAI), even though the

international attention to the risk of a pandemic influenza originating from H5N started diminishing

during 2008. Expanding the scope of the Project Development Objectives, however, allowed the Project

to have a wider impact on animal health issues and to incorporate other disease priorities while

maintaining the original project design.

37. Implementation proceeded swiftly, although the Project started with some delay (5 months

after approval), due to a late ratification of the Project documents. The emergency aspects were dealt

with as a priority such as provision of equipments and consumables for SVD and SES, including

laboratory, and protective gear and sampling kits for SAEPF, and were subsequently followed by mid-

to long term actions (strategic plan, legislation development, diseases diagnostic and control programs,

among others). At the project mid-term it was determined that the progress had been satisfactory. It was

also decided that the project should be restructured based on the urgent need voiced by the Government

to address other zoonotic disease risks of concern which were posing a risk to people and animals. The

second restructuring in the second half of 2010 allowed for completion of the project activities which

were disrupted and delayed due to a civil unrest, which took place in the country in Spring and Summer

of 2010.

38. The Government was highly engaged all throughout the Project implementation: both

MAWRPI and MOH early appointed Component Coordinators with responsibility for project activities

under their respective ministries. Effective coordination between MAWRPI and MoH was established,

with good cooperation experience between the Sanitary and Epidemiological Surveillance Service and

Veterinary Service. Inter-agency coordination was especially good during the functioning of an AI

project inter-agency secretariat (2006-2008). After 2008, coordination between MAWRPI and MoH was

maintained to develop infectious disease communications materials.

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39. The Project was managed in close cooperation with other partners, in particular the OIE, the

European Union and the USAID funded STOP AI program and Bank-financed AISP project. The EU

Food Security Program provided assistance for the institutional review and reform of the SVD’s regional

structures, together with the OIE, which provided a number of recommendations to strengthen VS in

line with international standards. The STOP AI program provided many trainings supported by both the

Project and AISP. The AISP supported twinning programs with parallel financing from the SDC and

further work on the legislation. The initial “one health” work started under the AI project and the AISP

served as a model for other countries during the follow-on Central Asia One Health Project. FAO

activities were also monitored to avoid duplication and ensure consistency of activities. WHO recruited

an international expert to help with in-country project implementation and facilitate incorporation of the

fast changing global guidance to measures to treat and control HPAI and pandemic influenza.

40. Disbursement of the Compensation Fund allocation experienced delays due to absence of

AI in the country. The Project was designed to primarily address an emergency situation as the country

was at a very high risk of HPAI occurrence, and unprepared for the prevention and control of the

disease, therefore, provision of resources for a Compensation Fund under the Component 1 (Animal

Health), and Component 5 (Emergency Import) aimed at responding to exceptional situations. It was

indeed impossible to predict to which extent the disease would affect the country, and the allocation for

such expenses was fully justified. As in other AI projects, Kyrgyzstan allocated funds for compensation,

but did not need to use them due the absence of AI in the country (a positive development). They instead

piloted a compensation scheme in the frame of the brucellosis control program implemented after

project restructuring. However, towards the end of the project the counterparts ran out of time to

reallocate and disburse all funds prior to project closing. The remaining portion of the IDA grant

(US$240,000) was returned to the World Bank.

2.3 Monitoring and Evaluation (M&E) Design, Implementation and Utilization:

41. Design. The original results framework was very long and complex, and was set up in the PAD

and ISRs. While there were only two outcome indicators, 31 intermediary results indicators were

initially established in the PAD. After the first supervision mission, the intermediary results indicators

were revised to drop three (related to project management) and combine most of the remaining original

28 indicators into eight in the ISR. In addition, the indicators were slightly modified during the project

implementation on several instances. During the restructuring of May 2010, three new indicators were

introduced under Component 1, to capture the broadened PDO, which also covered other zoonoses, in

addition to AI. Overall, the M&E system and the list of key indicators (original and revised) covered the

PDO adequately both in quantitative and qualitative terms. However, while these changing indicators

were consistently moving towards the achievement of the PDO (and consistent with other HPAI

projects), the changes to the indicators were not formally recorded through a restructuring process

(except for the three indicators pertaining to other zoonoses, which were introduced during the May

2010 restructuring).

42. Implementation and Utilization. Monitoring of the indicators was spotty, and not done

correctly and systematically. For instance, the three indicators introduced during the May 2010

restructuring were not tracked at all. The APIU monitoring specialist found the monitoring indicators to

be vague and unclear, thus the PIU was not sure what and how to monitor and measure. Two issues need

to mentioned: (i) the fact that the data for M&E were collected by the component coordinators from the

MOH and Min Ag (SVD) and other involved parties, which may have made the coordination efforts of

M&E even more difficult; (ii) in retrospect, the combining of the indicators starting from ISR 2 may

have lead to more uncertainty on the APIU side as to what and how to monitor. It may have been easier

to track the large number of more specific indicators designed at the preparation stage. However, it

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should also be mentioned that given the extremely short preparation time of the project, the team may

have felt that not all indicators are relevant, thus the revision done in ISR2 was, to some extent,

warranted.

2.4 Safeguard and Fiduciary Compliance:

43. Overall safeguards compliance in the project was satisfactory. The EMP identified the

moderate adverse environmental effects of the Animal and Human Health Components. For the Animal

component, the EMP addressed zoonotic disease containment and waste management as they pertain to

disposal of special waste, emissions and materials at laboratories, and training for veterinary services

workers to include procedures for safe handling of AI materials, safe culling of infected and at-risk

poultry and disposal of carcasses. For the Human Health component, the EMP focused on equipment,

refurbishing and training for reference and regional diagnostic laboratories to include key environmental

issues in zoonotic disease containment and waste management. The EMP provided mitigation plans and

monitoring plans to ensure appropriate attention to environmental issues, and tracking progress or

problems in their management.

44. The project activities were carried out in accordance with the EMP. No AI outbreaks were

detected in the country during the implementation period. Preparatory activities to deal with an outbreak

have been carried out. These include construction of 27 Bekkari holes for disposal of carcasses, training

for government and private vets in proper disposal procedures, study and monitoring of migratory

waterfowl, upgrading of facilities for biological agents, and provision of equipment (vehicles, PPEs,

laboratory equipment) that would be used in case of an outbreak. In addition, the Republican Center for

Veterinary Diagnostics (RCVD) and laboratories in Osh city and Kochkorka village were fully re-

equipped and staff trained to enhance their ability to cope with an AI outbreak. For human health

interventions, the National Virology Laboratory (NVL) has been renovated, PPEs provided for public

health outlets, and training delivered on republican, regional and rayon levels throughout the republic.

45. As part of the 2010 restructuring, the SVD made specific requests for support to upgrade the

existing vaccine storage facilities adjacent to the SVD headquarters to provide sufficient cold storage

capacity for the national vaccination program. The project team agreed with this proposal and requested

detailed cost estimates for these additional civil works. Although the storage would provide for HPAI

vaccine if deemed necessary, it was recognized that this facility would be used primarily for other

animal vaccines such as anthrax, rabies, brucellosis and, as such, could only be accommodated through a

restructured project. Minor environmental disturbances were expected to occur during upgrading of the

vaccine storage facilities in Bishkek. The original ISDS was updated to reflect this new activity. The

project’s Environmental Management Plan (EMP) was also updated to include the Annex on the

monitoring and mitigation measures for minor renovation works. Both the revised ISDS and EMP were

disclosed in Infoshop; the updated EMP was also disclosed in country.

46. Financial Management. Financial Management arrangements of the project, including

budgeting and planning, internal controls, accounting and reporting, funds flow, staffing and external

audit were assessed as satisfactory throughout the project life. The project was in compliance with

financial covenants of the Financing Agreement, including timely submission of the Interim Unaudited

Financial Reports (IFRs) and annual audited financial statements. Final audit report is expected on time,

i. e. by June 30, 2012.

47. Procurement. The procurement performance under the project was mixed, with majority of

contracts awarded according to the agreed procurement schedule and provisions, while a few packages

suffered slight delays due to low capacity of the implementing agency at the beginning of the project. As

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recommended by the World Bank, the implementing agency hired the qualified local procurement

specialists with experience in international/national procurement. This action strengthened the

implementing agency's procurement capacity and significantly improved the procurement performance

of the project. The format of the Procurement Plan used for the project was very good and all necessary

information easily found (planned vs. actual dates and amounts, name of contractors etc.). Several

Bank’s supervision missions reported that the procurement processing under the project and filing

system were found to be adequate and the missions did not note any major issues. According to the

Bank requirements, the contracts that were not subject to the Bank prior review had to be subject to ex-

post review on a sample basis. By the project completion, four procurement ex-post reviews were

conducted for the project. The recommendations provided by the previous ex-post review missions were

properly implemented before the next ex-post review mission. Lack of adequate physical inspection

under the project may be considered as lesson learned. The project was included in the Kyrgyzstan

Country Portfolio Fiduciary Review; and as a part of this exercise, the goods delivered under the

following three contracts were inspected by a qualified specialists during the period of end September

and early October 2008. No major procurement issues were identified. The review mission rated the

procurement performance for the project as satisfactory.

2.5 Post-completion Operation/Next Phase:

48. This project was processed under OP 8.50 as an emergency operation and as such at the design

stage there was no specific consideration to achieve sustainability. However, by broadening the PDO to

include other zoonoses and animal diseases, the project introduced sustainability aspect in this operation

and ensured that activities will continue to address global pandemic threat as well as countries ability to

detect, contain and treat infections in humans and animals. The initial “one health” work started under

the projects and the AISP served as a model for other countries during the follow-on Central Asia One

Health Project, which continued to create sustainable environment to control zoonoses and animal health

diseases and also enhance detection, treatment and containment of zoonoses in humans. In addition, the

sustainability of the project activities will be further strengthened though a new AISP II currently under

preparation with funding from IFAD, which will have activities contributing towards sustainability of

the project activities.

3. Assessment of Outcomes

33..11 Relevance of Objectives, Design and Implementation:

49. Project objectives, design, and implementation remain highly relevant to Kyrgyzstan

today. Although the country did not experience an AI outbreak, they remain highly relevant to

Kyrgyzstan’s neighbors and the rest of the world. HPAI is still present endemically in some countries, in

particular in South and South East Asia and the pandemic threat remains. The risk of pandemic and

other zoonoses that originate in livestock or wildlife and can affect humans is growing globally and

especially in developing countries. Another influenza pandemic that will be more severe than the one in

2009-2010 is expected to occur one day. Capacity to detect HPAI rapidly was the first and foremost

justified objective of this project. Still other endemic zoonotic diseases of public health or economic

importance, such as brucellosis, anthrax, rabies, TB, echinococcosis and others continue to burden many

poor people in Kyrgyzstan. The revision of the PDO to include other zoonotic diseases was therefore

relevant, and easily built on activities conducted on HPAI.

50. In coherence with GPAI guidelines, the Project was also aiming at ensuring reasonable impacts

through the development of institutional and technical capacity, improved governance and

communication. Although the project was prepared as an emergency project, it has been recognized that

11

many of the systemic reforms anticipated under the GPAI would require more long term commitments

to ensure sustainability. To this end the project worked closely with the EU and the OIE to develop

legal reforms and prepare the groundwork for more long term interventions under parallel and

anticipated follow-on projects. As an example, the integration of the project objectives and continuation

of activities to strengthen veterinary services through the AISP which was approved in April 2008 and

running up to June 2013, are key ensure sustainability of the initial project impacts. The initial “one

health” work started under the AI project and the AISP served as a model for other countries during the

follow-on Central Asia One Health Project.

51. In addition, the successful restructuring introduced further sustainability of this operation

and ensured that activities would continue to address the global pandemic threat as well as the country’s

ability to detect, contain and treat infections in humans and animals. In this way the Bank-financed

project, in cooperation with the USAID and EU projects, provided the groundwork for building a more

comprehensive and systemic approach for the control of zoonoses and supported through the parallel

and followed-on AISP, the Central Asia One Health Project and a new AISP II currently under

preparation with funding from IFAD and which has activities continuing on this basis.

33..22 Achievement of Project Development Objectives:

52. The main elements of the original PDO were to: (i) minimize the threat in the Kyrgyz Republic

posed to humans and to the poultry industry by Highly Pathogenic Avian Influenza (HPAI) infection

and (ii) to prepare for, control, and respond to an influenza pandemic. The main elements of the revised

PDO were to: (i) minimize the threat in the Kyrgyz Republic posed by the Highly Pathogenic Avian

Influenza (HPAI) infection as well as other poultry and livestock diseases and (ii) to prepare for the

control and response to an influenza pandemic and other zoonotic or infectious disease emergencies in

humans.

53. The primary Project outputs were: (i) support to the veterinary sector, (ii) support to the human

health sector, and (iii) strategic communication. The first restructuring that was endorsed in May 2010

did not change significantly those primary outputs. Only minor adjustments of activities such as capacity

building interventions and upgrading of cold storage facilities for Veterinary Services were added to

address the broader scope of the Project targeting zoonotic diseases in general.

54. After restructuring (paragraph 53), the PDO was broadened from solely the HPAI threat, to

include minimizing the threats, control and response to other zoonoses. To accommodate the broadened

PDO, both the indicators and activities under Components 1 and 3 were modified, while Component 2

remained largely the same. The ICR considers the achievement of PDO in two stages: before

restructuring and after restructuring. As to the PDO itself, both the original and revised PDO had two

parts. However, the discussion on outcomes below reflects on all component activities together, as they

all contributed towards achieving of both parts of the PDO.

55. The causal linkages between outputs /outcomes to the original PDO can be summarized as

follows:

12

56. The causal linkages between outputs /outcomes to the revised PDO can be summarized as

follows:

57. Overall, significant outcomes have been achieved under the project, towards achievement of

the revised PDO: (i) groundwork was set for development of control strategies of six major diseases:

brucellosis, anthrax, rabies, tuberculosis, FMD, echinococcosis and PPR, enabling the work to be

continued under AISP; (ii) as a result of equipment, procedure and staff upgrades under the project, the

Republican Central Veterinary Laboratory (RCVL) achieved 100% success in diagnosing HPAI samples

through a blind test organized by an OIE/FAO Reference laboratory, and continues to act as a national

reference laboratory for animal health and coordinates the work for avian influenza and other diseases.

The Central Virology Laboratory in SES received refurbishment, equipment, procedure and staff

training upgrades to enhance testing and isolation of virus. The development of local regulations for

transportation of specimens allowed to achieve 100% accuracy in the samples sent by the Kyrgyz

laboratory, which allowed the Kyrgyz laboratory to achieve accreditation from WHO for virus detection;

(iii) SVD was reorganized in line with the national veterinary strategy assisted by the project, and the

completed OIE assessment ascertained an improved capacity for containment and control of HPAI

outbreaks in poultry; (iv) a successful sheep brucellosis control program was piloted for further scale-up

under AISP: brucellosis-related abortions were reported to have been reduced by 75% in sheep in the

project area, and a following the pilot, a total of nine million of sheep have already been vaccinated; and

(v) the comprehensive public awareness and communication campaign (training, methodical information

in 80,00 copies, 423 public media broadcasts) resulted in increased awareness of population of the

Original outputs (i) Veterinary sector

support for HPAI

control

(ii) Human health

sector support focused

on pandemic

influenza.

(iii) Strategic

communication.

Intermediate PDO Outcomes (i) Field and laboratory

detection and response

capacity for HPAI in birds.

(ii) Detection of HPAI in

humans and response capacity

of health services

(iii) Awareness of all sectors of

the society (State services,

producers, small holders and

consumers).

Original PDO

elements (i) HPAI threat to

human and the poultry

industry minimized.

(ii) Readiness for

potential human

pandemic.

Intermediate PDO Outcomes

(i) Surveillance and control

strategies, including field

surveillance, and lab

diagnostic developed for 6

major diseases.

(ii) Detection, containment and

treatment

(iii) Awareness and behavior

change

Original PDO

elements (i) HPAI threat to

humans and poultry

and livestock diseases

minimized.

(ii) Preparedness for

potential human

pandemic and other

zoonotic or infectious

disease emergencies.

Revised outputs (i) Veterinary sector

support for poultry

and livestock diseases

control

(ii) Human health

sector support for

pandemic and other

infectious diseases.

(iii) Strategic

communication.

13

diseases transmitted from animals to humans – 88% of respondents in a Knowledge, Attitudes and

Practices (KAP) survey confirmed that they are aware of the AI and other zoonotic disease risks.

Component 1: Animal Health

58. Output:

Before restructuring: The RCVL (Republican Central Veterinary Laboratory) and LVPRI (Livestock,

Veterinary and Pasture Research Institute) underwent important renovation works and were equipped

with modern devices, including ELISA and PCR, allowing for achieving of BSL level 2; all

veterinarians were trained to detect and react in the face of HPAI suspicion including through field

simulation exercises; active surveillance on wild and domestic birds in strategic areas was done

annually, including two in-depth studies; contingency plans for HPAI were upgraded and adapted to

regions; office equipments and protective clothing were provided where needed, at central and field

levels; some 27 Bekkari holes (to dispose of dead animals) were renovated or constructed; Veterinary

Services were evaluated through the OIE PVS Pathway (performance of Veterinary Services) and

received support to develop a modern legal framework.

59. After restructuring: the project contributed to development of strategies for the control of 6

major diseases and provided additional training to VS including laboratory staff; the national animal

information system database was further developed to include brucellosis control; the veterinary vaccine

warehouse was renovated with cold storage capacity; compensation mechanisms were tested in pilot

regions for brucellosis control by compensating owners of livestock infected with brucellosis in 8 pilot

rayons in two oblasts.

60. Outcomes:

Before restructuring: Through the assistance from the project in the form of capacity building, technical

assistance, key equipment and refurbishment of premises, the VS were enabled to conduct reliable HPAI

diagnosis, through appropriate field detection, sampling, shipping and laboratory diagnosis; VS

identified their level of compliance with international standards, developed a 5 year strategic plan, and

drafted new legal basis; as ascertained by OIE assessment, the VS were ready to react in a coordinated

manner and promptly to an HPAI outbreak, while ensuring safety of people in contact with the materials

at risk; the effectiveness of wild bird and domestic birds surveillance was improved through regular

surveys and sampling for laboratory diagnosis, and provided assurance about absence of disease; poultry

farms introduced stringent biosecurity measures through the communications plan and training of

veterinarians and staff, and construction of Bekkari holes.

61. After restructuring: initial steps of brucellosis control of were implemented successfully in the

pilot regions, with the abortions from brucellosis reduced by 75%; efficacy of vaccines and drugs was

increased through better storage conditions (the refurbished cold storage); groundwork was provided for

the further development of the six other zoonoses control programs under AISP; laboratory diagnostic

capacity was further improved by access to ELISA technique, in particular for rabies and brucellosis

diagnosis; national disease information system was developed, and piloted for brucellosis control

program (in particular, the compensation fund and the vaccinations).

Component 2: Human Health

62. No significant differences were observed in the achievement of both Outputs and Outcomes

before and after the restructuring of May 2010.

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63. Output:

Ministry of Health and its affiliated institutions established outbreak command and control mechanism

for HPAI and other zoonoses; Hospital for infectious diseases established three isolation rooms, but then

changed policy from isolation to intensive care treatment following new global policy recommendations;

hospital staff were trained in treatment guidelines; virology laboratory received equipment and training

and became accredited by WHO for virus detection; priority target groups were vaccinated annually

with varied coverage levels, but it is estimated that high coverage was reached at most priority target

groups; sufficient quantity of drugs were obtained and stored at central level for case of outbreak and

pandemic.

64. Outcomes:

Public health program planning and coordination was enhanced by setting up the National Epidemic

Committee, with clear lines or responsibilities and well equipped to manage outbreaks; capacity in the

human health sector was improved, which can be used during HPAI and other zoonoses outbreaks:

better laboratory equipment and staff skills for virus detection, surveillance, containment and control,

including compliance with IHR; appropriate equipment purchased for isolation rooms/intensive care for

enhanced treatment at intensive care with modern technology; these achievements also provide feedback

to animal sector through strengthened coordination and command mechanism at a central level that is

now able to take the lead in containment and crisis management in case of pandemic among humans. It

also set the groundwork for the close coordination between the animal and human health sectors, which

was further carried forward under the Central Asia One Health project.

Component 3: Public Awareness and Information

65. Output:

Before restructuring: This component provided MoH, MAWRPI, REAAC, RAS and APIU with

technical assistance, training and goods for support of awareness and public relations on HPAI through

development of a communications strategy, production and dissemination of targeted AI information

materials, training courses on informational methodologies and effective coordination and collaboration

between stakeholders2. An express poll of public awareness of AI risk, which was carried out in October

2006, revealed a high general awareness of AI risks, but little understanding of disease transmission and

prevention measures. These findings were used to design the communications messages. Different

messages were targeted for specific audiences, e.g., public health workers, veterinarians, farmers,

traders, school children. For instance, the communications strategy included leaflets for farmers on AI

prepared by the Rural Advisory Services (RAS), an extension service. Overall: (i) a modular training

program for government ministry and agency officials, journalists, etc., was developed and implemented

through workshops on HPAI surveillance, control and monitoring; as well as crisis communication and

relations with mass media (the latter with 750 participants). Materials on external communication were

disseminated in the workshops, including: methodical guidelines, booklets, leaflets on AI prevention

(more than 80,000 copies distributed). In all, 423 information broadcasts were carried out.

66. After restructuring: A mid-term impact evaluation of the communications strategy was carried

out as a Knowledge, Attitudes and Practices (KAP) assessment. Based on the KAP survey, the

communications plan was revised and further developed with inputs from the Turkey AI counterpart

project team, providing a good example of “South-South” learning and sharing of experience.

2 An express poll of public awareness of AI risk was carried out in October 2006, with the objectives to i) provide policy

makers and major institutions involved in preventing and combating AI with a general picture on public awareness of the

phenomena; ii) define which sources of information are most trusted and effective; and iii) identify which channels of

information could be used for transferring information in pre-pandemic and pandemic times.

15

Implementation of the communications plan for the priority animal diseases, which was designed under

the project is continuing under AISP.

67. Outcomes:

Before restructuring: The outputs from the communications component were a key element in the

improved public and professional preparedness achieved under the project for AI. For example, findings

from the 2006 rapid KAP survey helped to shape the content and identification of target audiences for

subsequent interventions under the project regarding design of public communications messages,

training materials for public health and veterinary workers and media outreach. A well working

communication methodology was implemented, which after the restructuring was replicated for

awareness outreach for the other priority zoonoses.

68. After restructuring: Professional and public awareness and response capacity was greatly

improved for the six other priority diseases that were addressed by the project after restructuring (same

communications channels/methods were used for the other diseases learning from the very positive AI

communication experience). Comprehensive coverage of zoonotic diseases-related issues was achieved

through setting up of an inter-agency working group with a mandate of covering the broader range of

zoonotic diseases than solely AI. Effectiveness of the communications strategy was improved by its

tailoring to address the most important animal diseases in different parts of the country, for example, to

focus on anthrax in Osh oblast.

Achievement of the Final (post-restructuring) PDO

69. HPAI did not occur in the country, but the threat of this and other six priority zoonoses has been

diminished by overall better preparedness and response capacity: good planning and coordination, better

and earlier diagnosis capability, and much-improved public awareness raised through a country-wide

communication campaign. Overall, the project interventions have, without any doubt, helped to achieve

the PDO and key outcomes.

33..33 Efficiency:

70. The economic analysis relates the project costs to the project benefits which are characterized as

the economic value of the stream of losses avoided in human health and the poultry industry from

project activities. The benefits are expressed as the expected value of the economic loss avoided from

one outbreak occurrence in a period of 15 years (2008-2022) for With-Project and Without Project

scenarios.

71. Human health benefits expressed in terms of loss avoidance include: (i) the economic value of

hospitalization costs averted, (ii) the economic value of income loss avoidance from days lost due to

illness, and (iii) lifetime income loss avoidance from fatal HPAI cases. Poultry industry benefits are also

expressed in terms of loss avoidance and include: (i) the economic value of poultry meat production

loss avoided, (ii) the economic value of egg production loss avoidance plus the avoidance of the loss of

the economic value of the layer at the end of her productive life, and (iii) the costs of government

eradication and poultry replacement programs. The number of human and poultry affected in an

outbreak of HPAI (Gross Attack Rates) and death rate estimates were difficult to estimate and it is

difficult to get practitioners to provide estimates as they do not have good statistical data and

information to base their estimates on. Nevertheless, the estimates and sensitivity analysis provided

robust results.

16

72. The base case scenario results are robust with a 34% ERR, Benefit-Cost ratio of 2.9 and a NPV

of US$8.4 million. The ERR is robust even under sensitivity analysis parameters that severely restrict

the benefit streams. Also, allowing only 75% of the benefits to be claimed by the Project because of the

other AI and AI related projects in Kyrgyzstan, the results remain robust with a 26% ERR, Benefit-Cost

ratio of 2.2 and a NPV of US$4.7 million. The economic analysis results confirm that the project was

worth undertaking from an economic standpoint and a good investment for the people of Kyrgyzstan.

The Parameters used in the analysis, especially the estimates of Gross Attack Rates and death rates for

both human health and poultry, are very conservative leading to lower, but still highly satisfactory rates

of returns to the project. Furthermore, there is no question as to the overall benefits from HPAI projects

of this kind in terms of the decrease in human suffering and deaths which alone could be said to justify

such projects.

73. In the terms of the amendment to the PDO, which introduced the coverage of livestock diseases

under the project, it is difficult to describe the results in quantitative terms, in particular because the

work on brucellosis vaccinations, etc., was done under AISP. However, qualitatively, the project set the

foundations and systems in place, to enable to AISP to move forward with the works. In particular: (i)

the laboratory equipment and staff skill upgrade facilitated lab-related work on other zoonoses, not just

AI; (ii) the compensation fund mechanism set under the project was allowed to identify a mechanism to

pay to farmers participating in the pilot brucellosis program; and (iii) the public awareness mechanism

set up for the AI project facilitated outreach on other zoonoses.

33..44 Justification of Overall Outcome Rating:

Rating: Satisfactory.

74. The project followed a template under GPAI guidance and PAD for Bank projects in a number of

countries to address the threat of HPAI. The project was relevant: for the Kyrgyz Republic, given the

significant HPAI threat, yet the limited capacity of the country to respond to and control the threat.

When the HPAI outbreak did not occur, flexibility was shown by restructuring the project to broaden the

project’s focus on six other zoonoses. This, objectives and design maintained their relevance throughout

the project. As concluded in Section 3.2, the project successfully achieved its revised PDO: including

setting the groundwork for development of control strategies of six major diseases, enabling the work to

be continued under AISP; strengthening the zoonotic disease testing, detection and control capacity in

the country through equipment, procedure and staff upgrades under the project, to allow two key

laboratories for human and animal health to achieve international recognition; a successful livestock

brucellosis control program was piloted for further scale-up under AISP, significantly (up to 75%)

reducing brucellosis-related abortions; and the comprehensive public awareness and communication

campaign (training, methodical information in 80,00 copies, 423 public media broadcasts) resulted in

increased awareness of population of the diseases transmitted from animals to humans – 88% of

respondents in a KAP survey confirmed that they are aware of the AI and other zoonotic disease risks.

75. The project was efficient, as the economic analysis above shows. However, the comparison of

the economic analysis in the PAD and in the ICR is difficult, since the PAD one is based on an

assumption of an HPAI outbreak, whereas in the reality there was no outbreak of HPAI in the Kyrgyz

Republic. Thus, the number of human and poultry affected in an outbreak of HPAI and death rate

estimates were difficult to estimate, and practitioners find it difficult to provide estimates as they do not

have good statistical data and information on which to base their estimates. Nevertheless, the estimates

and sensitivity analysis provided robust results, and the project was considered to make economically

justified investments. In addition, consideration of qualitative benefits leads to the conclusion that the

project’s investments were justified and that it will have long-term economic benefits.

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33..55 Overarching Themes, Other Outcomes and Impacts:

(a) Poverty Impacts, Gender Aspects, and Social Development

76. Poverty-related impacts of the project. Despite the reduction in poverty in recent years,

poverty in the Kyrgyz Republic remains prevalent, particularly in rural areas where up to 60% of

households live in poverty, including 19% in extreme poverty. As the crisis was rising in the

neighboring countries, unmanaged communication increased fear among rural households and resulted

in spontaneous killing and destruction of poultry in many instances, depriving those households of

valuable source of food proteins. It was the coordinated communication efforts provided under the

project and confidence gained in State services that helped the situation return to normality and stop the

loss of backyard poultry. In addition, by including other animal diseases such as brucellosis into the

project design, PDO relevance for poverty alleviation became even stronger as those diseases are mostly

affecting small farmers and affecting women more than men.

(b) Institutional Change/Strengthening:

77. The Government’s engagement during the project was strong, although the frequent changes

in the Ministers and the Chief Veterinary Officer (five CVOs were in the office during the project

implementation) resulted in the need to “sell” the message of the project repeatedly. Nevertheless, it was

successfully done by the project team on both sides, as the Government’s commitment at the project

closing was very strong. The request for a Veterinary Services evaluation, which was followed by an in-

depth gap analysis and strategic plan under the OIE auspices, as well as support missions to legislation

modernization testify of the government’s willingness to tackle deficiencies in the animal health sector.

The Project team supported this approach and worked in close cooperation with the OIE and the EU.

These steps were critical to set up the basis for longer term reforms that the currently on-going AISP

project continues to support. This was necessary not only to sustain achievements of the project but also

to lay the foundations for well organized, equipped, and competent Veterinary Services.

78. The Government of Kyrgyz Republic was also the initiator of the expansion of the PDO

scope to address other diseases, primarily brucellosis and has continued to be strongly supportive of the

One Health approach aiming at addressing health issues at the animal/human/environment interface,

taking the lead in the region in promoting this approach and further developing programs, now through

AISP and building on the Central Asian Regional One Health project (March – Sept 2011) studies.

(c) Other Unintended Outcomes and Impacts:

79. Development of a Strategic Plan for strengthening the Veterinary Services towards

achieving international standards. The ultimate goal was to ensure the VS’s capacity to detect,

prevent, control and eradicate diseases, including zoonotic ones. The process of prioritizing animal

diseases prompted SVD to request OIE/PVS engagement, which led to the strategic plan being

developed with EU support. This work and other efforts started under the AI project are being further

supported through the Bank-financed Agricultural Investment and Services Project (AISP), representing

useful transition of resources and capacities from one project to another

80. A number of positive and unexpected impacts on the veterinary services have been observed.

Increased prestige, profile and motivation of the Veterinary Services was a very positive (and

unplanned) outcome, reflecting the benefit of dedicated resources and attention (this was the first

externally financed project that targeted the veterinary sector). Student enrollment in the veterinary

18

faculty from Naryn oblast (the pilot oblast for brucellosis control), where the veterinary profession was

previously disregarded, increased to the level that they make between 25% and 30% of new veterinary

students. Also in Naryn oblast, the number of private veterinarians increased by 150% (from 60 to

150) since the beginning of the AIHP project, reflecting the benefit of better availability of veterinary

supplies and better defined working relationships between private and public vets.

81. Addressing other zoonoses will have a positive impact on trade in Kyrgyz meat products.

Some of Kyrgyz Republic’s large neighbours have formed a Customs Union, which the country also

plans to join. Improving the zoonoses situation in the country will provide an opportunity for the Kyrgyz

producers to meet the increasing quality requirements and to supply meat products to the other members

of the Customs Union and beyond.

82. Another important aspect to note is that none of the Central Asian countries have legislation

enabling them to comply with international health regulations, especially for sending virus for typization

to reference laboratories outside former Soviet Union. However, despite this legislation, Kyrgyz

managed to establish working relations with several reference laboratories outside the country and send

specimens for confirmation and typization. The legal framework is trying to catch up with these

developments. The existing legislation is still under revision, but it is unlikely that it will be changed

without sustained efforts.

3.6 Summary of Findings of Beneficiary Surveys:

83. Two beneficiary surveys were carried out during the project implementation, a baseline survey in

2006, and a survey in 2010 to assess the public awareness on HPAI among the country’s population.

The objectives of the baseline 2006 rapid survey were to (i) provide policy makers and major

institutions involved in preventing and combating AI with a general picture on public awareness of the

phenomena; (ii) define which sources of information are most trusted and effective; and (iii) identify

which channels of information could be used for transferring information in pre pandemic and pandemic

times. The questionnaire topics were awareness about AI; specific knowledge; sources or information;

level of trust of the sources of information; and what sources of information were considered most

effective. The key findings were as follow: (a) a majority (+90%) of the population was aware of AI, but

detailed knowledge about AI and modes of transmission were lacking; (b) majority of people (87% of

adults) would report sick birds and possible cases of AI to veterinarians, health workers and sanitary &

epidemiological services, trust of which was rather high; (c) universally across the country, clusters and

across the sampling categories, people get most information on zoonotic diseases from mass media as

the most reliable and quickest source of information, including television was acknowledged as the most

popular source, with radio is the second most important; and (iv) gender may have had an effect on

which channels of information are more effective. For instance, people who get information from RAS

workers are more likely to be men, while people who get information from NGO’s are more likely to be

women.

84. The second public awareness survey ("Control of Avian Influenza and pandemic preparedness

and as well as public awareness of outbreaks of other zoonotic diseases in the Kyrgyz Republic”) was

carried out in 2010 with some 1,200 subjects throughout all 7 provinces of Kyrgyzstan. The survey

assessed the level of awareness about zoonotic diseases, social, cultural habits and hygiene associated

with animal care, public awareness about safety precautions and response to the pandemic, as well as

identification of the most effective channels of information dissemination. The following key findings of

the 2010 survey were noteworthy: (a) farmers and traders are well aware about main zoonotic diseases,

as 88% of respondents knew that animals can be a source of zoonotic diseases, among them 86% of

women farmers; (b) people knew that there was a risk of human infection with zoonotic diseases -

19

67.4% respondents were sure that there was a high risk of infection of human with zoonotic diseases; (c)

sellers of livestock and poultry products followed the hygiene rules, and understood that meat of a sick

animal could cause zoonotic diseases - 44% of sellers noted that they wash hands several times a day,

including 28% washed hands after serving of the each customer; (d) the level of preparedness of the

population for zoonotic diseases was rather low, mostly due to the lack of awareness about the

symptoms of the disease and the main actions need to be taken and required to undertake in cases of

zoonotic diseases (respondents awareness of the symptoms varied between 56% and 86%, depending on

the disease); and (e) the main channels through which farmers and traders receive information on

zoonotic diseases, was television (32%), followed by neighbors (18%) and relatives (16%).

4. Assessment of Risk to Development Outcome

Rating: Moderate

85. Risks to development outcomes vary across all components. Overall, the risk is assessed as

moderate mostly due to the consideration of political volatility in the country, which may lead to

instability in the institutional arrangements, attrition of skills, as well as wavering government and

budgetary support to the project outcomes. At this time, the risks are low – as described, the institutional

set-up has been finalized and is functioning well, and the government is very supportive of the project’s

causes and outcomes. However, in the longer term, the uncertainty increases. One mitigating factor is

the continuation of the project activities under AISP, and, in the future under an IFAD-financed project3,

with a focus on the priority zoonoses, which may further help to improve the sustainability of the

systems set up under the project, thus mitigating the political instability risks.

86. In terms of Animal Health component outcome, the risk is moderate: the instability of the State

Veterinary Services institutions (5 Chief Veterinary Officer appointed during the Project implementation

period, and regular change of staff whose capabilities not always matched the job requirements) and

uncertainty about reform decisions, may undermine the longer term impact of Project activities.

However, this risk is mitigated by the fact that AISP (April 2008- June 2013) has been developed in

close coordination with the Project team and will ensure a continuity of activities and build upon

achievements to further strengthen the Veterinary Services. The same team is also supporting the

development of the IFAD-financed project referred to in the previous paragraph.

87. In terms of Human Health component outcome, the risk is also moderate. While the systems

have been set up under the project and are functioning well, further maintenance needs to be ensured, to

ensure that the efficient operation of systems is ensured. For example, pandemic plans should be

updated on regular basis.

88. For the Public Awareness and Information Component, the risk to development outcomes is

moderate, mostly due to the uncertainly related to the need for recurrent cost support for continuation of

these activities. Effectiveness of the efforts was measured in a baseline 2006 express survey "Public

awareness on AI" and compared to a 2010 survey on AI awareness and other zoonotic diseases. The

results from the 2010 survey showed that 88% of respondents were aware of avian influenza and other

3 An IFAD-financed project in the total amount of US$20 million is currently under preparation, with an expected start date

of April, 2013. The project, for the purposes of this ICR, will focus on furthering work on two animal-health-related aspects:

(i) designing the specific arrangements for the implementation of the six national priority disease strategies, and (ii)

strengthening the private veterinary services in the Kyrgyz Republic. It will also further build the linkages between the

pasture committees and animal health services, in particular to ensure appropriate vaccinations of the animals.

20

zoonotic diseases risks. At the same time, these efforts need to be kept up. For instance, the 2009-10

pandemic was very mild and had negative effect for awareness, so media efforts should be maintained.

5. Assessment of Bank and Borrower Performance (relating to design, implementation and

outcome issues)

5.1 Bank

(a) Bank Performance in Ensuring Quality at Entry:

Rating: Satisfactory

89. The Bank’s team built a solid case during the project preparation (although partly relying on

assumptions) to allow for quick preparation and approval of the project by the Bank’s Board. To ensure

the full scope of the necessary expertise, the preparation mission of December 2005 was multi-sector

agency mission, comprising the World Bank, World Health Organization (WHO) and the US Center for

Disease Control (CDC). The Project Concept Note review meeting took place on December 19, 2005,

with Appraisal in December 2005, Negotiations on January 11, 2006, and Board presentation on

February 9, 2006. The successful collaboration between the ECSSD and ECCHD should also be noted –

the project had two Task Team Leaders, one from each sector, however, the team was able to deliver on

a very tight schedule.

90. The project was relevant: situated on major migratory bird flyways and with outbreaks reported

in neighboring countries (in particular, China, Kazakhstan and Russia), the Kyrgyz Republic clearly

faced both a public health and an economic risk. At the same time, the public health and especially

veterinary services systems had limited diagnostic and surveillance capacity to address the HPAI threat,

and public awareness capacity was weak.

(b) Quality of Supervision:

Rating: Moderately Satisfactory

91. Overall, the project activities were implemented well, in full and on time, and achieved

sustainable results. During the project implementation period, implementation support missions took

place at regular intervals, about two times a year. At the same time, post-mission Aide Memoires and

Management Letters were not sent in a timely manner, and the ISRs were not submitted regularly. Based

on the terms of reference and statement of mission objectives, specialists from both Sustainable

Development (SD) and Human Development (HD) Departments were present on missions.

92. In addition, weaknesses were identified in the project’s M&E system implementation, as a

number of indicators were not tracked/reported on throughout the project implementation period, and,

for instance, the indicators introduced during the May 2010 were not reflected in the project’s internal

reporting system, not tracked.

(c) Justification of Rating for Overall Bank Performance:


21

93. The rating reflects Satisfactory rating for the Quality at Entry and Moderately Satisfactory for the

Quality of Supervision.

5.2 Borrower Performance

(a) Government Performance:


94. The government was committed during the project preparation and implementation, and,

in particular during the second half of the project, considered the project to be highly beneficial to the

country. The proposed rating is slightly downgraded due to the frequent changes of the top key staff in

the government and veterinary services, which created the need to re-establish the right footing for the

project implementation several times. These frequent changes in the top officials also caused some delay

in the creation of a Secretariat at the Republican Emergency Antiepidemic and Antiepizootic

Commission (REAAC). However, once established the Secretariat was recognized to be pro-active in

the implementation of the communications strategy. A subsequent decision of the government to transfer

the Secretariat under the umbrella of the MAWRPI resulted in a lower authority and activity and

ultimately its disbandment. However, the expansion of the project focus to deal with endemic priority

zoonotic diseases and the overall awareness created around disease prevention and control, nurtured a

growing interest. This was confirmed by a request sent by the Vice Prime Minister to the World Bank on

October 2011 to pursue financing of activities in the domain of zoonotic diseases, the importance of

which has been underlined through this project and the regional ECA-One Health project. An additional

identified issue is the weaknesses in the M&E systems, which were functioning under both ministries.

(b) Implementing Agency or Agencies Performance:


95. The PIU showed effectiveness and responsiveness during the entire project implementation

period. This was emphasized several times in different Aide-Memoires. Staff was recruited according to

the specific identified needs, which allowed for adaptation to institutional changes and addition of

activities of AISP. The project was implemented smoothly, and achieved its objectives. Procurement and

financial management for the project were performed well. Together with the Component Coordinators

(CC) appointed in the MOH and MAWRPI and other players, the APIU ensured a good level of

coordination and monitoring of activities of all components of the project.

96. One identified weakness has been the M&E system for the project. An M&E specialist for

both AISP and AI projects was hired by the APIU late 2008. Unfortunately, the monitoring indicators

were found to be vague and unclear to the APIU staff, who did not know what and how to monitor and

measure. As a result, the PIU staff mostly focused on preparation of quarterly reports for the Ministry of

Finance and for the parliament, which contained the results of the “physical” activities carried out under

the project: what was procured, what training were done, how many people participated, etc.

Information to the Bank was provided mostly during the missions and at ad hoc requests.

(c) Justification of Rating for Overall Borrower Performance:


22

97. The rating is based on the Moderately Satisfactory rating for Government Performance and the

Satisfactory rating for the performance of the Implementing Agencies.

6. Lessons Learned.

98. A global template and coordination with specialized agencies can enable rapid, good

project design. The GPAI was in place and was used as the basis for the preparation of this project. The

existence of a sound, global plan ensures that an effective project can be formulated rapidly. WHO and

CDC gave technical assurance for project implementation by working together with the World Bank’s

implementing partners and agencies. This lesson would be applicable to a wide range of projects, not

just those in the health sector.

99. Putting project activities in longer-term perspective may help improve the project’s

sustainability. While the initial aim of the project was to address a possible emergency situation and

ensure Avian Influenza preparedness and response capacity in the country, the restructuring allowed for

a broader and more comprehensive approach to addressing important animal and human health threats.

This longer-term vision opened the opportunities for progressive improvements and establishment of

sustainable systems, as well as starting the dialogue with other donors and programs on the support to

this project’s objectives (it was evidenced by the additional operations and financing that IDA, EU,

IFAD and SDC contributed to further the goals of this project). In addition, broadening of the PDO

beyond HPAI paved the way to addressing zoonoses in more comprehensive way and contributed to

development of integrated control of animal diseases and zoonoses which later resulted in “one health

approach” and a Regional One Health Project in Central Asia.

100. In the context of weak governance and institutions, where the capacity building may take a

longer and concerted effort, it is important to have step-by-step approach, to ensure higher

effectiveness and chances of sustainability of achievements. The project started off by building the

legal framework and institutional capacity for addressing possible Avian Influenza emergencies.

However, minor subsequent adjustments then allowed the project to easily initiate work on other priority

zoonoses, which allowed for a complex approach to addressing major animal and human health threats.

Further work, building on the achievements of this project, is implemented by AISP, with animal

vaccinations and other more practical applications of the AI project results.

101. Timely assessment, to the extent possible, of the occurrence of a possible health threat

emergency will allow for more effective utilization of the project funds. Under this project, the

decision to expand the PDO was taken 18 months before the project closing. Although it may have

become clear earlier in the project implementation that the compensation fund allocation would not be

used to a full extent, the decision to reallocate the funds for other activities was not made until it was too

close to the project closing date. Due to the shortage of time before the project closing, it was not

possible to reallocate and disburse the funds prior to project closing. This portion of the IDA grant

(US$240,000) was returned to the World Bank. On a more general scale, if the future projects involving

compensation funds focused on establishing the compensation fund (legal, administrative, financing

options, piloting, and related communications) rather than financing compensations per se, it would

allow avoiding such situations altogether.

102. In addition to the long-term investments supported by the project, it is necessary to ensure

financing for additional operating costs in the future (for laboratory consumables, vaccines, drugs,

etc.) to guarantee operation of the equipment and systems. In absence of an operational budget the

sustainability of the financed equipment is significantly diminished. It is necessary to agree on a budget

allocation from the government for these purposes, or find an alternative source of financing.

23

103. The number of indicators should be manageable, clear and measurable. A large number of

indicators was an issue with many AI projects given the complexity of issues these projects were

covering and the speed with which these projects were prepared. This project had original 31 indicators,

which were then combined and/or dropped to streamline the M&E system. However, this lead to a lot of

confusion on the PIU side, as well as deficiencies in the M&E system and poor monitoring of results on

the Bank’s side. Therefore, it is suggested to design a sound M&E system, to avoid the need for

(sometimes several) revisions of the indicators, causing possible confusion.

7. Comments on Issues Raised by Borrower/Implementing Agencies/Partners

(a) Borrower/implementing agencies:

104. Comments were received from the Ministry of Agriculture and Melioration (MOAM), which

also consolidated the comments provided by the State Veterinary Department, Kyrgyz Scientific

Research Veterinary Institute, Republican Center of Veterinary Diagnostics, and Department of Disease

Prevention and Expertise. Overall, the comments were supportive of the ICR conclusions, and no

significant issues were raised. The MOAM comments stressed that: (i) the general preparedness and

response to control avian influenza, animal diseases and zoonotics were strengthened as a result of the

project by setting up effective response measures at the national and local levels including all key parties

responsible for agriculture, public health etc.; (ii) the logistic, training and human capacity of the state

institutions and laboratories involved into the project implementation was also strengthened; (ii) the

awareness of danger and threat caused by the avian influenza and other animal diseases among

population, state and private organizations was significantly increased; and (iv) an effective and reliable

compensation system was piloted. The comments also noted as a very important project result the

integration of avian influenza and other priority animal disease, including zoonotic disease, control. The

project’s impact on animal health resulted in reducing the level of human virus diseases that allows for

increasing cost effectiveness and minimizing the real threat to both animal and human health. More

detailed comments and the Borrower’s ICR are attached in Annex 7.

(b) Cofinanciers:

105. Comments were received from the Delegation of the European Union to the Kyrgyz Republic.

The comments were addressed in the text of the ICR and in the separate communication sent to the EU

Delegation. See Annex 8 for details.

(c) Other partners and stakeholders (e.g. NGOs/private sector/civil society):

Not Applicable.

24

ANNEXES

Annex 1. Project Costs and Financing

(a) Project Cost by Component (in USD Million equivalent)

Components Appraisal Estimate

(USD millions)

Actual/Latest

Estimate (USD

millions)

Percentage of

Appraisal

Animal Health 2.88 2.41 83.7

Human Health 2.30 2.61 113.5

Public Awareness and Information 0.44 0.24 54.5

Implementation Support and

Monitoring & Evaluation 0.38 0.34 89.5

Total Baseline Cost 6.00 5.60 93.3

Physical Contingencies

0.10

0.00

0.00

Price Contingencies

0.30

0.00

0.00

Total Project Costs 6.40 5.60 100.0

Front-end fee PPF 0.00 0.00 0.00

Front-end fee IBRD 0.00 0.00 0.00

Total Financing Required 6.404 5.60

5 87.5

(b) Financing

Source of Funds

Appraisal

Estimate

(USD millions)

Actual/Latest

Estimate

(USD millions)

Percentage of

Appraisal

Borrower 0.30 0.08 27

IDA Grant 4.00 3.74 94

JAPAN: Ministry of Finance - PHRD

Grants 1.00 0.72 72

AHI Facility Grants (EC and 9 other

donors) 0.10 1.06 1,060

Total 5.46 5.6

6 103.7

4 This amount includes ASSP co-financing to the project in the amount of US$ 1 million. However, after this project was

approved, the financial management for the two projects was carried out separately. Therefore, the Actual represents only the

direct co-financing of the Borrower, PHRD grant and the AHI Facility grants. US$1.13 million under the ASSP, were used to

rehabilitate buildings of four veterinary laboratories and to procure urgently needed equipment for them, as well as to

construct a number of Bekkari holes for safe carcass disposal. 5 Does not include the US$1.13 million spent under ASSP.

6 Does not include the estimated allocation of US$1 million under ASSP.

25

Annex 2. Outputs by Component

Component 1: Animal Health

Achievements under this component are rated Satisfactory.

The Animal Health 5 subcomponents were: (A) enhancing HPAI prevention and preparedness

capability, (B) strengthening disease surveillance, diagnostic capacity and applied research, (C)

strengthening HPAI control and outbreak containment capacity, (D) improving bio-security in poultry

production and (E) compensation fund.

Details of output per sub-component are provided below:

A) Enhancing HPAI prevention and preparedness capability

A1- Strengthening the National Policy and Regulatory Environment

Comprehensive National Action Plan for Avian Influenza was updated and adapted at regional level to

include operational components. The plans are available at the lowest administrative level.

The Project supported and endorsed the Government’s request to the World Animal Health Organization

(OIE) to conduct an independent evaluation of VS using the Performance of Veterinary Services (PVS)

Tool; the project collaborated with the EU’s Food Security Program (EUFSP) to use the PVS report as

the basis for developing a 5-year strategic plan and related investments to improve VS quality according

to OIE international standards. Certain key elements of the strategic plan were further supported by the

Project and helped inform the preparation of the AISP which now includes important components

related to VS upgrading.

Missions were conducted to support the development of a new Veterinary Law, in order to modernize

the legal framework in accordance with international standards and engaged reforms, such as the

privatization of veterinary practice, and compensation principles. Various versions of the law were

developed that were not found fully adequate. Longer term support will be needed to help the VS come

up with a sound primary legislation. Secondary pieces of legislation (6) were also developed that will be

ready for adoption once the Veterinary Law will have been approved.

A legal framework was developed with the support of international and local experts; as the enforcement

of compensation principles is linked to the overall Veterinary Law which still needs further work before

being presented for adoption, compensation legal basis is still pending. However, Government endorsed

a pilot compensation program to work out the implementation arrangements and determine any

shortcomings prior to final ratification and scaling up country-wide.

A2 – Updating essential information on Migratory Birds

The strategic situation of Kyrgyz Republic for migratory birds claimed for enhanced knowledge and

surveillance. Two studies were conducted, at the start and at the end of the Project. They focused on

wild bird resting sites, species, census, and risks to the poultry holdings. No suspicion of HPAI was

found in wild birds. Strengthened surveillance including sampling for laboratory diagnosis was held in

poultry flocks in areas of higher risk of contact and infection. All tests came out negative.

26

The State Agency on Environment and Forestry awareness was strengthened, in particular its rangers

which are best placed to detect any unusual wild bird mortality.

(B) Strengthening disease surveillance, diagnostic capacity and applied research

B1 – Strengthening veterinary and related services

As mentioned above, the Project worked closely with the EU Team to identify the major gaps in VS and

develop a strategic plan to strengthen these services. Specific activities were conducted in a coordinated

way with the concurrent AISP project to ensure complementary actions. This included provision of

training and technical assistance in the field of disease surveillance, control strategies, data management,

awareness raising ; as well as necessary equipments (IT, protective equipments, adapted vehicles such as

refrigerated vehicles for vaccine transportation, laboratory diagnostic equipments) and key

infrastructures (laboratory renovation works, and after restructuring, storage facilities of the SVD

headquarters to provide sufficient cold storage capacity for the national vaccination programs).

A training plan for SVD staff was developed, and all relevant field and headquarters staff, from public

and private sectors, received in-depth training on HPAI, including communication guidance. Those

trainings were done in close partnership with other programs such as USAID funded STOP AI. The

Project also supported participation in FAO trainings on epidemiology.

Epidemiological studies and recommendations for surveillance programs and provision of essential

hardware at the SVD were financed as part of the national disease information system. IT specialists

designed the system and its various modules and staff was trained for its use. After restructuring, the

scope of the system was broadened beyond HPAI surveillance to include other zoonotic and

transboundary diseases. The system was tested along with the implementation of the pilot brucellosis

control program in 2 regions.

B2 – Strengthening diagnostic capacity

Important repair works were done in the Republican Centre for Veterinary Diagnostics (RCVD) which

was raised to a BSL level 2 and was equipped with ELISA and Polymerase Chain Reaction (PCR)

devices; other 2 regional laboratories in Osh and Kochkor had facilities renovated and essential

equipment, consumables and reagents procured for AI basic diagnosis. Staff received in-country

training, with Project as well as FAO support and for some lead specialists in foreign Reference

laboratories (RCVD 100% success in diagnosing HPAI samples through a blind test organized by an

OIE/FAO Reference Laboratory proved its acquired capacity to diagnose Avian Influenza in a reliable

manner). This laboratory continues to act as a national reference laboratory for animal health and

coordinates the work of other VS regional laboratories for Avian Influenza and other diseases. As

expected, infrastructure and equipment upgrading were great value not only for HPAI diagnosis, but also

for all other major diseases. The expansion of the scope of activities after the Project restructuring and

the ongoing supported activities through the AISP readily benefited from these investments: diagnostic

capacities for rabies, foot and mouth disease, Brucellosis, echinococcosis, anthrax and PPR have been

evaluated and will be further supported through AISP.

B3 – Community-based animal disease surveillance and early warning

The Project coordinated with the STOP AI program re train-the-trainers activities and field trainings, as

well as AISP to deliver trainings to private practitioners. It included additional materials related to other

diseases of concern for which the project had been restructured.

B4 - Strengthening Applied Veterinary Research Capacity

27

The Livestock, Veterinary and Pasture Research Institute (LVPRI) underwent important repairing

works, and some essential equipment, consumables and reagents were provided. This Institute is now

capable to develop applied research activities. Training of staff was supported through both the Project

and the AISP, in-country and in foreign Reference laboratory to perform advanced diagnostic tests.

(C) Strengthening HPAI control and outbreak containment capacity

C1 – Targeting virus eradication at the source

In addition to the development of HPAI emergency plan, field and table-top simulation exercises were

conducted involving all keys actors (State and private veterinarians, central and local key

administrations, as well as poultry plant employees), allowing to test the plan and learn lessons from

those exercises. After restructuring, Project resources were mobilized to help control brucellosis in

addition to HPAI and supported the national disease control program. Rapid effects were observed in the

pilot area where brucellosis related abortions were reported to have been reduced by 75% in sheep.

These excellent results will help further justify the scaling up of the control program.

C2 – Human safety: training for field staff, farm and lab workers

Training and provision of protective equipments (for labs and field staff) aimed at preventing

contamination of people in the event of HPAI outbreaks in birds. Training materials and communication

tools also included basic principles of personal hygiene, food preparation and preventative measures that

would help to prevent infection from some of the other diseases of concern such as anthrax and

brucellosis.

(D) Improving bio-security in poultry production

Trainings addressed biosecurity and biosafety together with the communication strategy. As outlined

above, this was done in cooperation with the STOP AI program. Poultry farms were targeted in the

communication plan and veterinarians, as well as poultry farm employees were involved in trainings.

Bio-security in commercial farms has been increased and all staff sensitized about risks. Smallholders’

awareness was also raised and few suspicions were reported to the VS, which eventually proved not to

be HPAI.

Disposal facilities were constructed (27 Bekkari holes) with the primary aim to collect carcasses of birds

in the event of an outbreak, as planned in the procedures. Still, it was acknowledged that burying or

burning carcasses on the spot would be more suitable than transporting them with the risk of spreading

the virus. Regardless of their use in an HPAI event, those Bekkari holes have a public sanitary role and

now serve for the disposal of other dead animals, preventing stray animals from scavenging carcasses.

(E) Compensation fund

In the absence of HPAI cases, compensation mechanism was piloted by compensating owners of

livestock infected with brucellosis in 8 rayons of Chui and Osh Oblasts.

Component 2: Human Health


The 3 sub-components of Human Health were: (A) enhancing public health program planning and

coordination, (B) strengthening of the public health surveillance, system, and (C) strengthening health

system response capacity.

28

Details of output per sub-component are provided below:

(A) Enhancing Public Health Program Planning and Coordination

Establishment of outbreak/pandemic national coordination body was initially done through attempts to

establish a National Coordination Committee, composition and functions of which changed several

times in the attempt to strengthen its functions and include multisectoral approach and response to

manage pandemic situation. The existing Country Coordination Mechanism for HIV/AIDS was merged

with the National Epidemic Committee but this merger did not function well in practice as it was too

big. Finally, two separate Committees were established with clear mandates and functions. The National

Epidemic Committee, with clear lines of responsibilities and well equipped to manage outbreaks, was

established.

National Pandemic Preparedness Plan was prepared in 2005 and regular revisions have been done on

regular basis since.

(B) Strengthening of National Public Health Surveillance Systems

B1 – Improvement of health information and telecommunications systems

System of surveillance of influenza-like illnesses is inherited from soviet style network of reporting,

with epidemiologists based in regional and central sanitary epidemiological units. The existing

surveillance system, which is based on wide spread network of epidemiological stations, despite some

delays in reporting, provides relatively good information on increased number of ILIs and its

geographical spread.

The Kyrgyz Republic developed its own software based on CDC recommendation to upgrade reporting

system and gain crucial time and accuracy. Project contributed by providing hardware to enable

installation and operationalization of the software which is among the first ones of such kind in Central

Asia. Although it was envisaged that this system will be upgraded, in addition to providing hardware for

health information system, lack of clear definition of how and what needs to be done to improve the

software prevented concrete action to upgrade the existing procedures and software. It should be noted

that such situation is not unusual as expertise in this field is not readily available, and has only been

developed in recent years following intense efforts piloted in several countries in the region.

Opportunities to improve this reporting would be: in further strengthening of the existing health

information system, and introduction of this module into health information system at all levels of care.

B2 - Improvement of laboratory networks

The Central Virology Laboratory in SES was partly renovated and equipment and training were

provided under the project to enhance testing and isolation of virus. Close collaboration was established

with the Center for Disease Control and Prevention in Atlanta Georgia, WHO and other bilateral

organizations in Europe. These efforts resulted in accreditation of this laboratory by WHO. During

pandemic of 2009-10, specimens were sent to reference laboratories for confirmation and typization.

Kyrgyz Republic is the only country in Central Asia that managed to ensure transport of virus to WHO

reference laboratory despite unfavorable legislation.

The main focus for compliance with IHR was on approving the procedures for reporting and for sending

specimens to one of WHO reference laboratories for testing. Although all countries in the region have

signed IHR, several NIS countries still have legislation – mostly related to defense - that bans transport

of any contagious specimens to WHO reference laboratory for typization and confirmation. However,

29

despite this legislation and honoring IHR obligations in global fight against pandemic flu specimens

were sent for testing to accredited reference laboratories. WHO-funded Global Shipment Program and

support from CDC were used to transport the virus. Several staff were trained and certified in IATA

procedures with support of Stop-AI project funded by USAID. Development of local regulations and

guidelines for transport of specimens is essential to achieve a high level of accuracy in testing as poor

transport and storage of specimens can damage biological material resulting in high number of false

negative results. So far all tests were 100% accurate and therefore the Kyrgyz laboratory gained

accreditation from WHO.

B3 – Training

Training in surveillance and containment included activities aimed at enhancing the theoretical and

practical knowledge and skills of sanitary and epidemiological staff. At an early stage of the project,

several joint human and animal teams for outbreak containment exercises were conducted. Only later

WHO and OCHRA recommended to separate table-top and field exercises for human and animal

outbreaks following the logic that up to Level 3 of epidemic it is really animal disease and only at Level

4 and higher this becomes human health outbreak with little or no efforts needed from veterinary side.

Although the Kyrgyz Republic has inherited strong network of sanitary and epidemiological system,

inadequate funding and lack of modernization of those services is preventing full utilization of such

network and timely detection and better control of outbreaks. Attempts of SES team to enhance

surveillance and reporting especially using modern technology and information system should be further

strengthened and supported.

(C) Strengthening Health System Response Capacity

C1 - Social distancing measures

Activates related to social distancing measures were mostly addressed under the Communications

component and under Development of the National Pandemic Preparedness Plan activity. Health

education and health promotion were among the key activates that improved compliance with social

distancing measures and significantly advanced the general awareness of population for protection

against flu.

C2 - Vaccination for priority target groups

Priority target groups for vaccination with seasonal flu were identified already at the beginning of the

project. Priority target groups for vaccination followed WHO guidelines and recommendations. The

main reason for vaccination with seasonal flu was to prevent genetic re-assortment of avian and seasonal

flu in the same person which could result in development of strain that is transmissible human to human.

The annual vaccination coverage varied but it is estimated that high coverage was reached at most

priority target groups, with only exception of small farmers and poultry workers in remote areas.

C3 - Drug therapy

Some 1500 doses of Tamiflu were purchased under the project and stockpiled in the main hospital for

infectious diseases. During the H1N1virus pandemic, the stock was depleted. Tamiflu became widely

available in pharmacies throughout the country and strategic reserve of this drug is no longer stockpiled.

C4 – Medical services

As per WHO recommendations, three isolation rooms were rehabilitated and adopted in the Clinic for

Infectious Disease in Bishkek. However, since AI patients, as well as other severe pandemic flu cases

need intensive care instead of isolation rooms, practical use of these isolation rooms is limited. All

equipment was, therefore, transferred to intensive care. At the same time, much attention was paid to

strengthen intra-hospital infection control for the isolation rooms rather than for intensive care facilities.

30

Despite the fact that project followed guidelines from WHO, in practice these guidelines proved

unusable and example of transferring equipment from isolation rooms to intensive care presents a good

example of adaptation to what is practical.

It should also be mentioned that the country participated in a GDLN session organized by the World

Bank that focused on clinical preparedness case treatment. Further several seminars were organized to

enhance clinical skills of infectious disease specialists and specialists of intensive care for treatment of

AI patients.

Component 3: Public Awareness and Information Component


The Component had two sub-components: (a) capacity building; and (b) information and

communication services.

(A) Capacity Building

There were no specific separate capacity building activities, capacity was built as part of the

development of communication systems and materials. This component was designed to promote

awareness and improved coordination of the execution of the contingency plans and the National AI

strategy. Support was provided for information and communication activities to increase the attention

and commitment of government, private sector, and civil society organizations, and to raise awareness,

knowledge and understanding among the general population about the risk and potential impact of the

pandemic. Main activities included: a) development of a detailed Communication Action Plan; b)

preparation and deployment of basic pre-pandemic communication materials; c) development and

testing of messages and materials to be used in the event of a pandemic or emerging infectious disease

outbreak; d) training of veterinary staff and health workers in implementing their responsibilities under

the Communication Action Plan; e) measures to support effective coordination and collaboration among

stakeholders; and f) in the event of a pandemic, funding for the immediate implementation of relevant

parts of the Communication Action Plan.

(B) Information and Communication Services

B1 – Communication preparedness

A Communication Strategy was developed in 2006 with the help of an international consultant,

approved by the World Bank and adopted for implementation. Rapid research was conducted on “Public

Awareness of AI”. A modular training program was developed and implemented through workshops on

HPAI surveillance, control and monitoring; for journalists on AI awareness; and for journalists and

opinion leaders from relevant ministries and agencies on crisis communication and relations with mass

media (the latter with 750 participants). Materials on external communication were disseminated in the

workshops, including: methodical guidelines, booklets, leaflets on AI prevention (more than 80,000

copies distributed). In all, 423 information broadcasts were carried out including 80 TV spots, 43

publications by information agencies, 262 radio broadcasts and 98 newspaper articles.

Two Open Days for the Kyrgyz mass media journalists were held in the State Veterinary Department

and State Agency on Environmental Protection and Forestry, covering the activities carried out in these

agencies to control and prevent AI and pandemic.

31

The Communication Strategy on AI and other zoonotic diseases was revised and refined in May 2009

with the help of a Turkish communications specialist. In 2010, three types of booklets and billboards,

and five types of posters on zoonotic diseases, personal hygiene and quarantine regulations were

prepared in Russian and Kyrgyz.

Other outputs included:

- Films and spots translated and broadcast on National TV.

- Research on population’s awareness of the diseases transmitted from animals to human. The results

revealed that 88% of respondents are aware of AI and other zoonotic diseases risks. The outcomes of

research were used for information and educational campaign on zoonotic diseases in 2011.

- Two dozen publications were issued (“Agrovesti”, “MSN”, “Vecherny Bishkek”, “Bazar Tamyry”

newspapers) and internet resources were dedicated to AI issues.

From the beginning of the project the overall level of awareness and community preparedness for avian

influenza increased with risk reduced. With restructuring, the project became engaged with other disease

priorities. Communication activities developed under the AI project continue to be implemented by the

APIU under the AISP.

B2 – Collaboration with stakeholders

The major stakeholders include various ministries/departments (Economy and Finance, Agriculture,

Health, Education, Transport and Communications, Veterinary Services, laboratories), NGOs, civil

society, veterinarians and farmer involvement at the grass root level). In 2006, an inter-agency

Secretariat on coordination, monitoring and evaluation of the National HPAI Response Plan was

established under the Republican Emergency Anti-epidemic and Anti-epizootic Commission. Because

of the Project restructuring, in early 2009 the coordination Secretariat was disbanded7. From that point

on, coordination efforts for AI and other zoonotic diseases were managed by MAWRPI, primarily

through a working group comprising SVD and MoH.

Through the work of the Secretariat up to 2010, analysis of health and veterinary legislation was

provided with respect to prevention of especially dangerous infections including AI, and amendments

were introduced into a number of normative documents. A plan for interaction between the public,

private, international structures and civil society was prepared to ensure preparedness and operative

response in case of occurrence and spread of AI.

7 When after the project restructuring the project started focusing on other zoonoses, the Government made a decision to

disband the Secretariat, which was focusing solely on AI. An inter-agency working group was set up to continue the work on

AI and other zoonoses, but with much less authority and visibility. In general, the focus then shifted more to AISP, which

concentrated on brucellosis, anthrax and other zoonoses.

45 thousand copies of the posters and 120 thousand copies of booklets were

transferred to SVD and DSSES for dissemination to farmers and health care

facilities.

32

B3 – Developing pilot models for Community-based Rapid Communications

Instead of developing pilot models, the project implemented a community-based rapid communication

approach through the delivery of the various information materials. The information campaign had a

very broad coverage, it reached every village, majority of schools and other large-scale organizations.

Component 4: Implementation Support and Monitoring and Evaluation Component


Overall coordination of the project activities and project management was effectively implemented by

the Agricultural Projects Implementation Unit (APIU) under MAWRPI, which was responsible for

coordinating of project activities, technical assistance and training, as well as the fiduciary tasks of

procurement and financial management. Component Coordinators, responsible for coordinating project

implementation and providing inter-agency cooperation, were appointed in both MOH and MAWRPI.

The APIU facilitated smooth implementation of the project, fully adhering to the procedures and

requirements for World Bank-financed projects. These arrangements were functioning satisfactorily.

The only identified weakness, as mentioned above in paragraph 92, was the M&E of the project.

The inter-ministerial REAAC was reactivated at the outset of the project to provide policy guidance,

coordination and oversight at the national level and to oversee the implementation of the project.

However, subsequently it was disbanded by the government and its responsibilities were rolled into the

Public Health Sector Coordination Committee under the Deputy Prime Minister’s Office. This was

consistent with the intended project approach.

Component 5: Emergency Imports Component

Achievements under this component are rated: Not-rated.

Since no influenza pandemic was declared, the emergency imports component was not implemented.

However, it was appropriate to include emergency imports as a part of the project, since it was not

known at the time whether an avian flu pandemic would break out or not.

33

TABULATED INDICATORS AND TARGETS/OBJECTIVES FOR COMPONENTS 1 TO 3

OUTCOME INDICATORS

Outcome Indicators

Baseline

Targets (Project-end)

Original

Indicators (from

PAD)

Revised

Indicators

Other Changes/

Revisions

Plan (from ISRs

No 1 and 2)

Revised

Actual

(ICR mission)

COMPONENT 1

Sub-component 1.A

1. National

integrated

preparedness,

control and

response plan

prepared and

accepted by

WHO, OIE, and

FAO

From ISR2:

National

integrated

preparedness,

control and

response plans,

acceptable to

WHO, OIE, and

FAO, adopted

and implemented

as needed

From ISR 2:

Draft strategy

and plan under

preparation

From ISR 1:

National

preparedness,

control and

response plans

conform to

requirements of

WHO, OIE and

FAO

From ISR 2:

National

preparedness,

control and

response plans

conform to

requirements of

WHO, OIE and

FAO and are

implemented as

required

From ISR 3:

National

integrated

preparedness,

control and

response plans

acceptable to

WHO, OIE and

FAO and

demonstrated in

joint simulation

exercises

Achieved. Preparedness,

control and

response plans

conform to intl.

requirements.

Operational plans

further developed

at local level and

tested through

simulation

exercises.

Control strategies

prepared for 4

additional

priority diseases.

34

2. Contained and

diminished

pattern of HPAI

infection in

poultry

From ISR 2:

Contained and

diminished

pattern of HPAI

infection in

poultry, and

transmission of

HPAI to humans

effectively

controlled

From ISR 2:

No outbreaks

reported, but

national capacity

to detect

outbreaks

extremely limited

From ISR 1:

Government

capacity for

surveillance,

monitoring and

containment of

HPAI infection

of animal

improved

From ISR 2:

Effective

capacity for

surveillance,

monitoring and

containment of

HPAI infection

of animals and

humans

established and

outbreaks

effectively

contained

Achieved. Government

capacity for

surveillance,

monitoring &

containment of

HPAI infection

of animals

improved. VS

capacity to

conduct passive

& active

surveillance to

monitor HPAI

and be prepared

to implement

containment &

and eradication

measures

established.

INTERMEDIATE OUTCOME INDICATORS

Indicators

Baseline

Targets (Project-end)

Original

Indicators (from

PAD and ISR

No 1)

Revised

Indicators

Other Changes/

Revisions

Plan (from ISRs

No 1 and 2)

Revised

Actual

(ISR and ICR

mission)

COMPONENT 1

Sub-component 1.A

1. National AI

Strategy

developed and

adopted by

government

Starting ISR2,

indicators 1 and

2 combined:

1. Animal health

and strategy

framework:

From ISR 2:

No strategy or

outbreak

containment

plans in place;

capacity self-

From ISR 2:

Capacity for

containment and

control of HPAI

outbreaks in

poultry

From ISR 3:

Capacity for

containment and

control of HPAI

outbreaks in

poultry improved

Achieved,

Government

capacity for

containment and

control of HPAI

outbreak

35

National AI

Strategy and

Outbreak

Containment

Plan developed

and adopted,

conforming with

the guidelines of

FAO/OIE and

GPAI

assessment of

veterinary

services not yet

done

improved.

according to new

OIE rating

assessment

improved.

VS capacity to

control HPAI

possible due to

appropriate

planning,

monitoring,

preparing and

diagnostic

capacities.

2. Outbreak

Containment

Plan conforms

with the

guidelines of

FAO/OIE and

GPAI

Achieved.

Government

capacity for

containment and

control of HPAI

outbreak

improved.

Existence of

outbreak

containment

plans in line with

international best

practices.

3. Assessment of

the Veterinary

Services

completed

From ISR 1:

N/A

From ISR 1:

Assessment

completed

From ISR 9:

Completion of

strategic plan

Achieved.

From ISR 9:

Assessment

completed and

strategic plan for

reform ratified by

Government.

ICR Mission:

Assessment

completed.

Performance of

VS evaluated,

36

gap analysis,

strategic plan and

legislation

missions

completed.

Strategic plan for

reform ratified by

Government.

Sub-component 1.B

4. Laboratory

equipment and

materials are

procured,

distributed and

installed

Starting ISR 2

indicators 4, 5, 6

and 7 seem to be

combined:

2. Animal

disease

surveillance and

diagnostic

capacities:

Adequate field

surveillance and

laboratory

capacity in place

From ISR 2:

Field

surveillance

capacity

minimal;

laboratory

migratory birds

survey completed

From ISR 2:

Laboratory

capacity

conforms to at

least Bio-Safety

Level 2 and staff

are trained to

carry out

virology

analysis; field

surveillance

capacity is fully

adequate

From ISR 1:

Reporting time

acceptably rapid

From ISR 3:

Laboratory

capacity

conforms to at

least Bio-Safety

Level 2 with

PCR installed

and staff trained;

field surveillance

capacity is fully

adequate

Achieved.

LVPRI and

RCVD facilities

upgraded to BSL

level 2 and

equipped with

modern

diagnostic

devices and staff

trained for

appropriate use;

two regional Vet

Labs also

renovated and

equipped.

5. Staff is trained

in surveillance

and diagnostic

methods

Achieved.

100% State

veterinary staff

trained as well as

key private

practitioners,

poultry producers

and stakeholders.

6. Reporting and

reaction time for

suspected cases

of AI is reduced

Achieved.

Awareness of

reporting

requirements and

37

to the minimally

acceptable levels

response

mechanisms.

7. 75% of

average

monitoring

coverage in at-

risk areas

Achieved.

100% of risk

areas regularly

monitored for

HPAI.

From May 2010

Restructuring:

8.(old) / 3. (new)

Data collection

and reporting

including

outbreak

reporting, annual

prevalence data

Indicator was not

monitored.

Sub-component 1.C

9. Emergency

supplies procured

and available at

strategic

locations in the

field

Starting ISR 2,

indicators 9, 10

and 11

combined:

4. Animal

outbreak

response

capacity:

emergency

veterinary

supplies

available at

strategic

locations;

culling, disposal,

disinfection and

ring vaccinations

done as needed

From ISR 2:

No equipment or

supplies

available; no

outbreak

response plan,

procedures or

training

From ISR 2:

Equipment and

supplies in place;

outbreak

response actions

effectively

implemented as

needed

Achieved.

Emergency

supplies made

available in

strategic

locations (SVD,

LVPRI and

RCVD).

10. If

appropriate, ring

vaccination

around infected

areas completed

Not applicable

(no HPAI

outbreaks).

11. Culling,

disposal and

disinfection

activities

Not applicable

(no HPAI

outbreaks).

38

completed as

needed

12.

Compensation

provided to

poultry owners

rapidly and in a

monitorable way

Starting ISR 2:

5. Compensation:

adequate

compensation

provided to

poultry owners,

rapidly, and in a

transparent and

monitorable

manner

From ISR 2:

No compensation

policy or plan is

in place

From ISR 2:

Compensation

mechanism in

place and applied

as warranted

Not applicable

(no HPAI

outbreaks).

From May 2010

Restructuring:

13. / 6. Increased

number of

animals

vaccinated

Indicator was not

monitored.

From May 2010

Restructuring:

14./ 7. Increased

number of

private

veterinarians

delivering

vaccination on a

fee basis

Indicator was not

monitored.

COMPONENT 2

Sub-component 2.A

15. Inter-

institutional

/multi-sectoral

coordination

arrangements in

place

Starting ISR 2

indicators 15, 16

and 17 seems to

be combined:

8. Public health

inter-institutional

From ISR 2:

Coordination

arrangements

being developed

From ISR 2:

System in place

and fully

functioning

Achieved.

National multi-

sectoral

coordination

body established

for control of

39

coordination:

legal, regulatory

and institutional

arrangements in

place

pandemic.

16. Command

and control

structure for

program finance

/ management

defined and in

place

Achieved.

Command and

control structure

for program

defined and

adopted.

17. Health laws,

regulations and

other legal

provisions

revised and/or

promulgated

Partially

Achieved.

Compliance with

IHR achieved but

legislation was

not changed.

Sub-component 2.B

18. National

health

surveillance for

influenza virus

developed at

national level

Starting ISR 2

indicators 18, 19,

20 and 21 seem

to be combined:

9. Public health

surveillance:

National HPAI

surveillance

system

functioning

From ISR 2:

No plans in

existence; health

personnel not

sufficiently

trained in

surveillance; no

systematic

reporting

From ISR 2:

Surveillance

systems in place

and functioning

Achieved.

National

surveillance for

influenza existed

even before the

project but was

enhanced during

the project.

19. Number of at

risk regions in

the country that

have

implemented a

system for

influenza virus

surveillance and

control

Achieved.

Enhanced.

20. Number of

health personnel

trained in

influenza virus

Achieved.

Practically 99%

of SES field

epidemiologists

40

surveillance and

control

were trained.

21. % of national

and local

agencies

submitting

regular weekly

and monthly

reports on the

influenza

pandemic

Achieved.

Enhanced.

Sub-component 2.C

22. “Social

distancing

measures”, such

as quarantine,

bans on mass

gatherings, and

travel

restrictions,

developed and

backed up by

communications

strategy

Starting ISR 2

indicators 22, 23,

24 and 25 seem

to be combined:

10. Public health

response

capacity: Access

to vaccines and

anti-virals

assured; capacity

to implement

social distancing

measures in

place

From ISR 2:

Not in place

From ISR 2:

Response

capacity fully

adequate to deal

with major

outbreaks

Achieved.

Enhanced.

23. Strategy to

access pandemic

vaccines

developed

Achieved.

Strategy

completed.

24. Strategy to

access anti-virals

for national use

(e.g., stockpiling)

developed

Achieved.

Completed.

25. Contingency

plans for

maintenance of

Achieved.

Completed.

41

essential services

within the health

and outside the

health system

developed

Additional Indicators

From ISR 8:

Health personnel

receiving training

From ISR 8:

0 (none)

From ISR 8:

2,012

From ISR 8:

Health facilities

constructed,

renovated, and/or

equipped

From ISR 8:

0 (none)

From ISR 8:

7

COMPONENT 3

26. National

communication

strategy for

pandemic

influenza

established and

materials and

messages

prepared

Starting ISR 2,

indicators 26, 27

and 28 seem to

be combined:

11. Public

Information:

National

communication

for HPAI

pandemic

established;

materials and

messages

prepared; public

information

campaign

launched in at-

risk areas

From ISR 2:

General public

poorly informed’

no

communications

strategy in place.

From ISR 2:

Strategy adopted;

program

implemented;

majority of

population

adequately

informed and

aware

From ISR 3:

Strategy adopted,

sustainable

program

implemented for

on-going public

health awareness

including AI;

majority of

population

adequately

informed and

aware.

Achieved.

Completed.

27. Public

information

campaign

launched in at-

risk areas

Achieved.

Completed.

28. Evidence of

high level of

awareness by

target groups

following

dissemination of

Achieved.

A KAP survey in

2010 showed that

88% of

respondents were

aware of the

42

messages message.

COMPONENT 4

Sub-component 4.A

29. Program

reports, financial

monitoring,

procurement and

disbursement

reports, audits,

management and

financial reports

prepared and

submitted

periodically.

Starting ISR 2:

Deleted

From ISR 1:

N/A

From ISR 1:

Reports received

Indicator was

dropped and not

monitored.

Sub-component 4.B

30. Baseline

developed for

monitoring and

evaluating

project impact

six months after

grant

effectiveness

Starting ISR 2:

Deleted

From ISR 1:

N/A

From ISR 1:

Baseline

established

Indicator was

dropped and not

monitored.

31. Methodology

defined and

monitoring and

evaluation

periodically

undertaken

Starting ISR 2:

Deleted

From ISR 1:

N/A

From ISR 1:

M&E carried our

regularly

Indicator was

dropped and not

monitored.

43

Annex 3. Economic and Financial Analysis

The Kyrgyz Republic did not experience a recorded outbreak of avian influenza, although a number of

poultry died in October in Sokuluk raion near Bishkek but it was never confirmed as the H5N1 virus

(World Bank Project Appraisal Document Report No. 34623-KG). However, the seasonal migration of

birds contributes to the transmission of new strains to different geographical regions. The Kyrgyz

Republic is located at the cross-roads of migration routes of many migratory birds including water fowl

from Southeast Asia to the Urals and from the Caspian basin and Western Siberia. Thus the chance of a

future outbreak of a strain of the H5N1 virus in Kyrgyzstan is a real possibility.

Several Avian Influenza (AI) and related human health projects were initiated in Kyrgyzstan as a result

of confirmed H5N1 strain of Highly Pathogenic Avian Influenza (HPAI) outbreaks in the Asian region

and as part of the global program (GPAI) of AI control and preparedness. The World Bank assisted

Avian Influenza Control and Human Pandemic Preparedness and Response Project was the major AI

project which built on many of the achievements from other AI projects in Kyrgyzstan and from the

region (USAID STOP AI program, FAO, OIE, and WHO programs including UNICEF). The World

Bank assisted project was instrumental in the consolidation and strengthening of the overall country’s

preparedness to diagnose, control and contain possible future widespread AI outbreaks in the country.

This Annex outlines and identifies the benefits and costs of the World Bank assisted Avian Influenza

Control and Human Pandemic Preparedness and Response Project and includes an economic analysis

that relates the project costs to the anticipated benefits identified for (i) human health project activities

and (ii) for animal (poultry) project activities in terms of economic value loss avoidance. An economic

analysis of the project was carried out at project preparation (Annex 9 of the PAD). The economic

analysis estimated cost-benefit ratios ranging from 3.7 to 9.1 under various assumptions concerning the

percentage of protection forthcoming from project activities in terms of the number of human lives that

would be saved.

Project Costs:

Total project costs, as of the quarter ending 31/03/2012, were USD 6,756,121. Funding sources included

the ADA Grant, the Government of the Kyrgyz Republic and smaller amounts other donor agencies. For

the analysis, costs for each of the project years (2006 to 2012) are in terms of 2011 constant USD – the

Kyrgyzstan Consumer Price Index (CPI) was used to change 2006 to 2012 current project costs to 2011

constant USD costs. The Kyrgyz Government incremental recurrent costs beyond 2009 were set at USD

500,000 per year for incremental salaries, materials, and O&M costs associated with continuing the

functioning of the labs and programs set in place by the project (see Table 1). The exchange rate used in

the analysis was one USD = 48.6 KGS1

1 Conversion factors on project costs were not used in the analysis. All costs are net of taxes and import duties.

44

Table 1. Yearly Project Costs (000’ USD)

___________________________________________________________________________

2006 2007 2008 2009 2010 2011 2012 2013

+

Project Costs 1/ 159.3 2,042.4 1,029.4 1,397.8 1,241.2 378.6 147.5

Recurrent Costs 2/ 500 500

CPI 3/ 105.6 116.3 144.8 154.7 167.1 175

1/ Yearly current project expenditures as given by Kyrgyzstan Project APIU.

2/ Estimate of Kyrgyzstan Government yearly recurrent costs after project completion.

3/ Consumer price Index 2005 = 100 from World Bank statistics. 2011 is an estimate.

Project Benefits:

1. Human Health Project Benefits

The impact on human health from the project decreases the percentage of human population infected by

HPAI thereby decreasing the number of hospitalizations and decreasing the number of deaths attributed

to HPAI. Benefits are thus expressed in terms of loss avoidance that include: (i) the economic value of

hospitalization costs averted (number hospitalized x the cost of hospital stay), (ii) the economic value of

income loss avoidance from illness associated with contact with HPAI, and (iii) income loss avoidance

from fatal HPAI cases.2

The affected human population (Gross Attack Rate) for an outbreak of HPAI was estimated at 3% of the

population (2011 population at 5,477,600 with a 1.4% growth rate) with 10% of the affected population

being hospitalized and a 3% death rate for those affected (the Without Project scenario).3 The With-

Project scenario estimates were that 2% of the population would be affected by HPAI with 10% of the

affected population being hospitalized with a lower 1.5% death rate of those affected.4 It is important to

note that AI projects decrease the consequences but do not totally eradicate the problems of HPAI.

These particular estimates are difficult to estimate and it is difficult to get practitioners to provide

estimates as they still do not have good statistical data and information to base their estimates on and

there is a divergence of opinion within the medical profession regarding these numbers. Historic patterns

of the severity and incidence of influenza outbreaks are also changing with the change in world-wide

travel patterns making estimation of such numbers even more difficult.

The Gross Attack Rate used in this analysis is considerably lower than the 30% used in the project PAD

economic analysis. For the current analysis, it was felt that 30% was very high given the current

2 Hospitalization costs set at USD 250 for a 7 day stay (based on Falkingham, J., et al. 2009. Trends in out-of Pocket

payments for health care in Kyrgyzstan, 2001-2007. Health Policy and Planning). The number of days lost due to illness

assumes 25% of the affected population would lose 2 days income each while each hospitalized survivor would lose 40 days

income at an average daily wage of USD 8.45/day. Income loss avoidance from fatal HPAI cases is calculated as the

average remaining life time earnings expressed as the present value of annual take-home income of USD 183/month over 15

years discounted at 12%. 3 A review of similar World Bank projects used Gross Attack Rates as high as 30%.

4 Estimates based on information given in the project PAD plus a consensus from Health Specialists and those who know

the with and without project capabilities of the country if they had to deal with an HPAI outbreak. Information from

neighboring Asian countries that have had an HPAI attack was also used.

45

experience on the subject. Also, the current analysis uses very conservative estimates for the base

parameters such as the Gross Attack Rate to show that even with very conservative parameters, the

project gives an acceptable rate of return.

For the economic analysis, the economic value of human health losses avoided are calculated given that

an outbreak would occur in any one of the years over a 15 year period from 2008 – 2022 based on the

above Gross Attack Rate and other parameters and represents the base analysis calculation. The Gross

Attack Rates and other parameters estimated above may be seen as what may happen in a moderate

outbreak of HPAI in the country.

There is one major unquantifiable project benefit that needs mentioning. The programs put in place in

reaction to the HPAI outbreaks by the Kyrgyz Government and donor agencies, especially the

communications and awareness programs as well as the training and capacity building, has strengthened

the country’s preparedness to not only prevent and contain future HPAI outbreaks, but to also be better

prepared for other human health disease outbreaks. That is, the present health system has more

experience, information, and a means to cope with the other diseases because of AI projects.

2. Poultry Sector Project Benefits

There were about 4.7 million poultry in Kyrgyzstan in 2010. Over 90% of poultry are chickens with a

small number of ducks, geese and turkeys. In 2010, poultry production was about 4.4 thousand tonnes

while domestic egg production was 373 million eggs. Poultry are produced by State farms, some

modern enterprise farms and by medium sized and small farm households. Kyrgyzstan does not export

poultry meat or eggs. About 95% of poultry meat consumption is imported and between 12% to 15% of

egg consumption is imported. The poultry sector essentially operates in a free market with no quotas or

subsidies, or price restrictions on products or inputs.

The impact on the poultry industry from the project interventions (with-project) is to decrease the

number of poultry infected by HPAI thereby decreasing the number of poultry deaths attributed to HPAI

relative to a without project scenario. Future benefits are thus in terms of loss avoidance in the economic

analysis and include: (i) the economic value of poultry meat production loss avoidance (average value of

the live chicken farm gate price x number of broiler poultry deaths averted), and (ii) the economic value

of egg production loss avoidance plus the value of a layer bird at the end of her productive life. 5

The avoidance of the costs of an eradication and poultry replacement program are also included as a

future benefit. While it remains to be seen if Kyrgyzstan would have an eradication program paying the

farmer for all poultry destroyed in the event of an outbreak, many countries have opted for these types of

programs. For the analysis, the market price of a broiler was used for the compensation to farmers for

both layers and broilers plus 50% of the broiler price was added to account for eradication program

costs.

Other possible benefits from the project are (i) an avoidance of economic losses to farmers from a price

decrease of both eggs and broiler meat during the HPAI attack,6 (ii) an avoidance of a decrease in GDP

5 Poultry live weight price set at USD 5.34 (USD 2.67/kg x 2 kg/bird). Available statistics indicates 30% of all chickens are

broilers and 70% are layers. The economic value of egg production loss avoidance = an average of 122 eggs/layer per year x

farm gate egg price of USD 0.06/egg x layer chicken deaths avoided plus the value of a layer hen at the end of productive

life for meat (set at 50% the value of a broiler x the number of layer chicken deaths avoided). Data and information from the

Kyrgyzstan National Statistical Committee and from the Ministry of Agriculture, and World Bank country data.

6 It is unclear if this should be taken into account as a producer loss in this instance is a consumer gain and offsetting in terms

46

reflecting a general average lower income/person in the country, (iii) the avoidance of an increase in

foreign exchange requirements for imports of poultry meat and eggs (and possibly other substitute food

products) during the crisis period, and (iv) the avoidance of economic losses to consumers because of

price changes in the other animal sub-sectors of the economy (cross-price elasticity effects). These were

not brought into the analysis because of data and time limit constraints and the assumption that these

effects would most likely be small. 7

For example, the effect on GDP and foreign exchange requirements

are likely to be small in the case of Kyrgyzstan. There are no readily available statistics on the

contribution to GDP by the poultry industry but the poultry industry makes up a very small part of

Agriculture and Forestry GDP, thus the decrease in poultry numbers due to an HPAI outbreak, unless

close to 100% mortality of the national flock, would be minimal.8

For the Without Project scenario, the infected poultry population given an outbreak (Gross Attack Rate)

of HPAI was set at 5% of the poultry population9 with a 100% mortality rate of those birds affected by

HPAI. Because there has been no HPAI outbreak in Kyrgyzstan to date, no information is available to

base The Gross Attack Rate on. It is based on a consensus from Veterinary Specialists and those who

know the without project capabilities of the country if they had to deal with an HPAI outbreak.

Information from neighboring Asian countries that have had an HPAI attack was also used.

The With-Project scenario estimates were that 2% of the poultry population would be affected by HPAI

and die either from HPAI or be destroyed by the eradication program because again there is a 100%

mortality rate of those poultry affected. The project can affect the number of poultry deemed to be

infected because of the preparedness of the country and the ability to stop the disease spreading but the

project has no effect of decreasing the mortality rate in a flock once a bird is infected.10

As in the case

of the health sector, these particular estimates of the actual number of poultry affected by an HPAI

outbreak are difficult to estimate as practitioners rarely have solid statistical data and information to base

these numbers on and there is a divergence of opinion within the Veterinary profession.

For the analysis, the economic value of poultry losses avoided are calculated given that an outbreak

would occur in any one year over a 15 year period from 2008 – 2022 based on the above Gross Attack

Rate and other parameters and represents the base analysis calculation. The Gross Attack Rates and

other parameters estimated above may be characterized as what may happen in a medium (5%)

of loses and gains to society. Also, as statistics show, much of the broiler meat ends up in storage to be sold when prices are

higher. Studies on the subject have found it difficult to calculate gains and losses in this situation (see Yalcin, Cengiz. 2006.

Market impacts of HPAI outbreaks: a rapid appraisal process in Turkey, FAO, Rome). 7 The economic loss to tourism has not been included in the analysis on the basis that little available information and data

exist for the analysis and that tourism is not a large contributor to the Kyrgyz economy. 8 The decrease in GDP in Vietnam from an outbreak of HPAI, where the poultry industry is a much larger contributor to

GDP, was estimated at 0.1% for poultry meat production and 0.07% for egg production. Source: Vietnam Avian and Human

Influenza Control and Preparedness Project, World Bank PAD, 2007 Report No. T7686-VN, Appendix 8. 9 It was suggested that a rate between 5% and 15% would be the most appropriate for Krygyzstan. Each county will have its

individual Gross Attack Rates that may differ widely from another country because of geographical and environmental

conditions and the type of H5N1 strain. 10

The OIE states “...the high pathogenicity avian influenza (HPAI) viruses, can kill up to 90-100% of a poultry flock.

Epidemics of high pathogenicity avian influenza can spread rapidly, devastate the poultry industry and result in severe trade

restrictions.” from: High Pathogenicity Avian Influenza, 8 January, 2009, The Centre for Food Security and Public Health,

College of Veterinary Medicine, and Institute for International cooperation in Animal Biologics, Iowa State University,

Ames, Iowa.

See: http://www.cfsph.iastate.edu/Factsheets/pdfs/highly_pathogenic_avian_influenza.pdf

http://www.cfsph.iastate.edu/Factsheets/pdfs/highly_pathogenic_avian_influenza.pdf

47

outbreak of HPAI in the poultry industry in Kyrgyzstan. In the analysis, poultry production is assumed

to grow at a 2% annual rate from 2010 onwards.

Economic Rate of Return and Sensitivity Analysis:

The analysis relates the yearly project costs in 2011 constant US$ (Table 1) to the benefits from the

economic value stream of losses avoided in human health and the poultry industry from project activities

- the benefits are expressed as the expected value of the economic loss avoided from one outbreak

occurrence in a period of 15 years (2008-2022). It is expected that these benefits would be forthcoming

at these estimated levels in any given year over the 15 year period if there was an HPAI attack because

of the continued government expenditure (recurring costs) on the laboratories and equipment, awareness

programs and the maintaining of human capital to carry out control and preparedness activities. While

there were project costs in 2006 to 2012, possible benefits from the project were assumed to start in mid-

2008 - some of the project benefits would have been available given that an attack occurred in 2008 as

some of the control and preparedness program was in place. However, since the project was not

complete, an assumption was made that only 10% of the project was effectively in place in 2008, 20% in

2009, 50% in 2010, 75% in 2011 and that there was full effectiveness from 2013 onward.

The market prices used for poultry and poultry products are considered to be economic prices as the

markets, for the most part, operate freely with no production quota system and no subsidies for poultry

or poultry inputs. Wages and other market prices used in the analysis are also assumed to be economic

prices.

Table 2 first presents the results of the economic analysis based on the above base case assumptions and

parameters for the combination of both health and poultry losses avoided. The results are robust with a

34% ERR, Benefit-Cost ratio of 2.9 and a NPV of US$8.4 million. The results are driven by the human

health benefits – the economic value of human health loss avoidance is on the order of 20 times that of

the economic value of the loss avoidance from the poultry sector. Taking this into consideration, a

sensitivity analysis concerning the poultry sector was not undertaken as even large changes in all poultry

parameters will have an insignificant effect on the overall rate of return.

The two parameters that drive the economic value of the human health benefits are (i) the percentage

human population affected by HPAI (Gross Attack Rate), and (ii) the expected number of deaths as a

percentage of total human population. Since the base case returns are robust, changes are made to the

above two mentioned parameters that decrease the economic value stream of losses avoided in human

health. The results indicate that the returns are still robust for Scenarios 1 through 3. For example,

Scenario 3 in Table 2 estimates an ERR of 22%, B/C ratio of 1.9 and a NPV of USD 12.3 million given

a very low rate of the percentage human population affected and low number of deaths. The switching

value (where the project NPV is equal to zero at which beyond this point the project becomes unviable

and not a good investment for the country) is given in Scenario 4.

Table 2. Economic Returns and Sensitivity Analysis

___________________________________________________________________________

Human Pop.

Affected by

HPAI 1/

___________

% Mortality

of those

Affected

__________

Returns

_______________________ WOP WP WOP WP ERR

(%)

B/C

Ratio

NPV

(USD Mil)

___________________________________________________________________________

48

Base Case Analysis 3% 2% 3% 1.5% 34% 2.9 8.4 Scenario 1 3% 2.5% 3% 1.5% 30% 2.5 6.4 Scenario 2 3% 2% 3% 2.0% 29% 2.5 6.2 Scenario 3 3% 2.5% 3% 2.0% 23% 2.0 3.6 Scenario 4 3% 2.75% 3% 2.5% 12% 1.0 0.0 Scenario 5 (Base x 0.75) 2/ 3% 2% 3% 1.5% 26% 2.2 4.7

___________________________________________________________________________

1/ WOP = Without Project scenario and WP = With-Project scenario.

2/ Scenario 5 calculates the returns allowing the Project to claim only 75% of the total economic value

stream of losses avoided in human health and in the poultry industry under the Base Case scenario.

There is the question of multiple HPAI and HPAI related projects operating in Kyrgyzstan and thus one

could say that the Project cannot claim the total economic value steam of losses avoided in human health

and in the poultry industry. Although, as indicated in the lead paragraph, the project was built on the

achievements from other projects from within and without the country, it was nevertheless instrumental

in the consolidation and strengthening of the country’s preparedness to prevent and contain future HPAI

outbreaks. It could further be said that without the World Bank assisted project, all or most of the

previous project work may not have been used to as great an effect and should thus be treated as sunk

costs. An alternative is to allow the Project to only claim a proportion of the benefits. The returns

presented in Table 2 Scenarios 1 to 4 lay claim to 100% of the total economic value stream of losses

avoided in human health and in the poultry industry. Scenario 5 calculates the returns allowing the

Project to claim only 75% of the total economic value stream of losses avoided in human health and in

the poultry industry under the base case scenario (Scenario 5 in Table 2). The returns are still highly

robust in Scenario 5 with an ERR of 26%, B/C ratio of 2.2 and a NPV of USD 4.7 million.

Increasing the With-Project human population Gross Attack Rate from the base rate of 3% to 15% while

maintaining the Without Project human population Gross Attack Rate at the base rate of 2% gives an

ERR of 137%, B/C ratio of 20.2 and a NPV of USD 97.5 million. This serious outbreak scenario was

possible and could have happened in a Without Project situation.

Concluding Comments

The economic rate of return of 34% to the Project is robust even under sensitivity analysis parameters

that severely restricted the benefit stream and confirms that the project was worth undertaking from an

economic point of view and a good investment for the people of Kyrgyzstan. The Parameters used in the

analysis, especially the estimates of Gross Attack Rates and death rates for both human health and

poultry, are very conservative leading to lower, but still highly satisfactory rates of returns to the project.

There is no question as to the overall benefits from HPAI projects of this kind in terms of the decrease in

human suffering and deaths which alone can be said to justify such projects.

The results of the current economic analysis of the project concur with the results of economic analysis

done in the PAD at appraisal. Both economic analyses indicate a satisfactory project rate of return.

While the NPV from the PAD were considerably higher than those derived in the current analysis, the

difference can be attributed to (i) different methodologies (although both included similar costs and

benefits), and (ii) the use of significantly lower Gross Attack Rates in the current analysis.

49

Attached below is the Table summarizing the Economic Analysis results.

Economic Analysis of Avian Influenza Control and Human Pandemic Preparedness and Response Project - Kyrgyz Republic

In 2011 USD 2006 2007 2008 3/ 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Value of Income Loss Avoidance (Human Health) 5,013,352 10,138,740 25,678,597 38,939,450 52,646,136 53,383,182 54,130,547 54,888,374 55,656,811 56,436,007 57,226,111 58,027,276 58,839,658 59,663,414 60,498,701

Value of Income Loss Avoidance (Poultry) 228,601 434,586 1,178,872 1,803,674 2,452,997 2,502,057 2,552,098 2,603,140 2,655,203 2,708,307 2,762,473 2,817,722 2,874,077 2,931,558 2,990,189

Total Value of Income Loss Avoidance (Yearly) 5,241,953 10,573,326 26,857,469 40,743,124 55,099,133 55,885,239 56,682,644 57,491,514 58,312,014 59,144,314 59,988,584 60,844,999 61,713,735 62,594,972 63,488,891

Annual Expected Value of Economic Loss Avoidance 1/ 349,464 704,888 1,790,498 2,716,208 3,673,276 3,725,683 3,778,843 3,832,768 3,887,468 3,942,954 3,999,239 4,056,333 4,114,249 4,172,998 4,232,593

Costs (in 2011 constant USD) 2/

Project Investment Costs (IDA) 519,295 2,042,394 1,029,385 1,397,775 1,241,191 378,561 147,520

Government Recurrent Costs 0 0 0 0 0 500,000 500,000 500,000 500,000 500,000 500,000 500,000 500,000 500,000 500,000 500,000 500,000

Total Costs 519,295 2,042,394 1,029,385 1,397,775 1,241,191 878,561 647,520 500,000 500,000 500,000 500,000 500,000 500,000 500,000 500,000 500,000 500,000

Net Expected Value of Economic Loss Avoidance -519,295 -2,042,394 -679,921 -692,887 549,307 1,837,648 3,025,755 3,225,683 3,278,843 3,332,768 3,387,468 3,442,954 3,499,239 3,556,333 3,614,249 3,672,998 3,732,593

Economic Rate of Return (ERR) 34%

Net Present Value (NPV) 8,343,761

Present Value of Total Benefits 18,536,071

Present Value of Total Costs 6,433,081

Benefit-Cost Ratio 2.9

1/ Expresses the expected value of economic loss avoided from one outbreak occurrence in the 2008-2022 period.

2/ In 2011 constant USD (2006-2008 adjusted by CPI)

3/ Benefits from project assumed to start in mid-2008 with 10% effectivness and with 20% ,50%, and 75% effectivness in 2009, 2010 and 2011 respectively with full effectiveness in 2012.

50

Annex 4. Bank Lending and Implementation Support/Supervision Processes

(a) Task Team members

Names Title Unit

Lending

Gotz Schreiber Task Team Leader,

Lead Economist ECSSD

Betty Hanan Task Team Leader,

Senior Operations Officer ECSHD

Talaibek Torokulovich Koshmatov Operations Officer (Bishkek) ECSSD

Patricio Marquez Lead Health Specialist ECSHD

Asel Sargaldakova Health Specialist (Bishkek) ECSHD

Anarkan Akerova Counsel LEGEC

Bekzod Shamsiev Agricultural Economist ECSSD

Naushad Khan Lead Procurement Specialist ECSPS

Nurbek Kurmanaliev Procurement Specialist ECSPS

John Otieno Ogallo Senior Financial Management

Specialist ECSPS

Siew Chai Ting Lead Financial Management Specialist ECSPS

Nicholay Chistyakov Senior Finance Officer LOAG1

Lynette Alemar Senior Program Assistant ECSSD

Valencia Copeland Program Assistant ECSSD

Gyulaiym Kolakova Team Assistant ECCKG

Daniyar Aitimbetov Team Assistant ECCKG

Yulia Balybina Team Assistant ECCKG

Ludmila Mosina Epidemiologist CDC

Gerald RockenSchaub Disaster Preparedness and Response

Expert WHO EURO

Guenael Rodier Communicable Diseases Expert WHO EURO

Rob de Rooij Veterinary Specialist, Consultant ECSSD

Supervision/ICR

Lynette Alemar Senior Program Assistant ECSSD

Alexander Balakov Procurement Specialist ECSO2

Brian G. Bedard Task Team Leader,

Senior Livestock Specialist ECSS1

Natalia Cherevatova Operations Analyst SEGOM

Valencia Copeland Program Assistant ECSSD

Amy Evans Safeguards Specialist, Consultant ECSS1

Peter Goodman Senior Agricultural Specialist ECSS1

Peyvand Khaleghian Country Sector Coordinator ECSH1

Hannah M. Koilpillai Senior Finance Officer CTRFC

Talaibek Torokulovich Koshmatov Senior Rural Development Specialist ECSS1

Nurbek Kurmanaliev Procurement Specialist ECSO2

Martin Henry Lenihan Social Development Spec. ECSS4

51

Kenneth K. Mwenda Senior Counsel LEGEM

John Otieno Ogallo Senior Financial Management

Specialist ECSO3

Asel Sargaldakova Health Specialist ECSH1

Gotz A. Schreiber Lead Economist, Consultant ECSSD

Solongo Zulbaatar Legal, E T Consultant LEGEM

Rob Coenraad de Rooij Veterinary Specialist, Consultant ECSSD

Alexander Balakov Senior Procurement Specialist ECSO2

Aliya Kim Financial Management Analyst ECSO3

(b) Staff Time and Cost

Stage of Project Cycle

Staff Time and Cost (Bank Budget Only)

No. of staff weeks USD Thousands (including

travel and consultant costs)

Lending

FY06 159.61

Total:

159.61

Supervision/ICR

FY06 58.67

FY07 91.86

FY08 92.74

FY09 111.67

FY10 48.37

FY11 64.40

FY12 82.31

Total: 550.02

52

Annex 5. Beneficiary Survey Results

Two beneficiary surveys were carried out during the project implementation, a baseline survey in 2006,

and a survey in 2010 to assess the public awareness on HPAI among the country’s population.

Objectives and Findings of the 2006 Rapid Survey

The objectives of the baseline 2006 rapid survey were to i) provide policy makers and major

institutions involved in preventing and combating AI with a general picture on public awareness of

the phenomena; ii) define which sources of information are most trusted and effective; and iii)

identify which channels of information could be used for transferring information in pre pandemic

and pandemic times. The questionnaire topics were awareness about AI; specific knowledge; sources

or information; level of trust of the sources of information; and what sources of information were

considered most effective.

The key findings were as follow:

General Awareness

- A majority (+90%) of the population were aware of AI

- The major source of information was TV, not official sources

- Detailed knowledge about AI and modes of transmission were lacking

- Adults in general were aware of major methods of AI prevention, but many children were not

- Most of the interviewees understood the seriousness of AI for the economy and the health of the

nation.

Attitude to Information about Avian Influenza

- Majority of people (87% of adults) would report sick birds and possible cases of AI to veterinarians,

health workers and sanitary & epidemiological services.

- The general level of the trustworthiness of AI information was very high.

- People tended to doubt the transparency and efficiency of the Government, and trust medical bodies

more than others as providers of open and timely information on veterinary diseases.

- Some people (12%) thought that there have been AI cases in poultry in Kyrgyzstan although they

were not formally reported.

Sources of Information

- Universally across the country, clusters and across the sampling categories, people got most

information on zoonotic diseases from mass media as the most reliable and quickest source of

information.

- Television was acknowledged as the most popular source, with radio as the second most important.

- Newspapers were deemed not sufficiently fast, reliable or far reaching source of information,

especially in remote areas.

- There were regional differences in the way people got their information.

- The internet did not have a wide reach as a channel of information.

- Gender may have had an effect on which channels of information were more effective. For instance,

people who got information from RAS workers were more likely to be men, while people who got

information from NGO’s were more likely to be women. Women preferred to listen to oblast radio

more than men.

53

Objectives and Findings of the 2010 Survey

A second public awareness survey ("Control of Avian Influenza and pandemic preparedness and as well

as public awareness of outbreaks of other zoonotic diseases in the Kyrgyz Republic”) was carried out in

2010 with some 1,200 subjects throughout all 7 provinces of Kyrgyzstan. The survey assessed the level

of awareness about zoonotic diseases, social, cultural habits and hygiene associated with animal care,

public awareness about safety precautions and response to the pandemic, as well as identification of the

most effective channels of information dissemination. Research tools were translated into Kyrgyz and

Russian and included 2 types of questionnaires, one for farmers and their families, and one for sellers of

poultry and livestock products. The main topics included:

Demographic and socio-economic information (age, sex, education, nationality and financial

status of respondents);

Awareness about zoonotic diseases and risks;

Awareness about bird flu and risks;

Socio-cultural habits and biosafety;

Preparedness for a pandemic of zoonotic diseases and avian influenza;

Information distribution channels.

The following key findings of the 2010 survey were noteworthy:

Farmers and traders were well aware about main zoonotic diseases, including avian influenza,

information details of which first came to the respondents 2-3 years ago.

- 88% of respondents, farmers knew that animals could be a source of zoonotic diseases, among them

86% of women farmers

- farmers were mostly aware of such diseases as murrain, followed by brucellosis, anthrax, bird flu,

rabies and echinococcosis.

11% of households reported that their families had experienced cases of infection of zoonotic

diseases, of which 80% of brucellosis.

People knew that there is risk of human infection with zoonotic diseases, understood the danger of

zoonotic diseases, and believed that those involved in caring for livestock and poultry, especially

children, were in the risk group.

- Respondents believed that it is dangerous to eat the meat of the sick animals.

- 67.4% respondents were sure that there was a high risk of infection of human with zoonotic diseases.

Care and maintenance of livestock and poultry involved all members of the farmer's family,

including children.

- 90% of farmers always washed hands with soap after contact with animals.

Sellers of livestock and poultry products followed the hygiene rules, and understood that meat of a

sick animal could cause zoonotic diseases.

- 44% of sellers noted that they washed hands several times a day, but fewer (28%) washed hands

after serving of the each customer, although 85% of sellers had free access to water in the store or

market.

54

Low level of preparedness of the population was due to lack of awareness about the symptoms of the

disease and the main actions that need to be taken and required to be undertaken in cases of zoonotic

diseases.

- 67% of respondents did not know the signs of avian influenza disease, 70% of anthrax, 57% -

brucellosis, 56% - with rabies, 64% echinococcosis, and 86% - murrain.

- 97% of farmers vaccinated animals, those farmers who did not vaccinate, associated it with a lack of

access to vaccines, or no confidence in the method of vaccination.

The main channel, through which farmers and traders received information on zoonotic diseases,

was television (32%), followed by neighbors (18%) and relatives (16%).

- The most reliable and prompt information channel was National Television.

- Respondents were more likely to trust professionals (veterinarians and doctors) for information on

zoonotic diseases.

55

Annex 6. Stakeholder Workshop Report and Results (if any)

Not Applicable

56

Annex 7. Summary of Borrower’s ICR and/or Comments on Draft

ICR

58

Avian Influenza Control and Human Pandemic Preparedness and Response Project

General Comments

of the Ministry of Agriculture and Melioration of the Kyrgyz Republic to

IMPLEMENTATION COMPLETION AND RESULT REPORT

The Implementing Authority – the Ministry of Agriculture and Melioration agrees with the overall

content and conclusions of the ICR. The project has helped to improve the mechanisms to respond to an

outbreak of Avian Influenza. The fortunate fact that no such outbreaks have occurred in the project

period means these mechanisms have not been put to the test. Yet the inputs provided have been applied

to improve the preparedness for zoonotic diseases in general and the awareness about them. We

measured that our rural population have a better understanding of the importance of avian influenza and

controlling it.

The expansion of the scope of the project to include some other important animal diseases is considered

an important change made in the project design. This flexibility has been good, as it allowed us to make

improvements in controlling existing diseases. These are complex diseases, sometimes involving

multiple species and they have a deep effect on livestock owners. It is therefore important that this

essential project activity was a platform for beginning to formulate a strategy for controlling these

diseases, using current insights.

The public veterinary services system, especially the disease surveillance system has benefitted of this

assistance, and has participated in some innovations. An important institutional innovation is the

acknowledgement of the role of private veterinarians in public-goods services. They were the main

actors in the pilot vaccination campaign against brucellosis and other important project events.

Within the project it has been implemented a successful pilot project on compensating farmers whose

brucellosis-positive animals had to be slaughtered. The mechanisms used in this pilot were transparent,

quick and well monitored in databases at rayon level and the central level. Unfortunately because of

limited time and lack of an adequate legislation of veterinary the pilot project has not been growing into

the governmental program. However, the mechanisms developed for compensation as well as the

preliminary pilot activity would help further to use this lesson in effective way in case of creating the

compensation fund specified by the law.

On the whole we accept the observation that a number of the IO indicators have been “not monitored”

At the same time, it is good to note that efforts were made, and many were successful, to define and

collect management and progress data to measure intermediate results. An example, concerning the

Project Development Objective intermediate output “Local surveillance and control system”, is the

organization of the campaign of sheep and goat brucellosis control vaccination with official involvement

of private veterinarians. The standard contractual arrangements and centralized system for reporting and

coverage statistics were developed through this project, and these have been later extended countrywide.

It should be noted that monitoring of three project indicators included after the project restructuring in

May 2010 took place in parallel with other project AISP implemented by APIU. On the one hand this

combination has been fruitful and important as separate project activities have complemented each

other, rather than competed with each other. On another hand this does mean that the effects of

vaccination, for instance, can be associated with more than one project. The project-internal monitoring

59

team has therefore been careful not to ascribe some of the progress achieved in this field to the present

project activities.

The main lesson the APIU has drawn of the project now completed and of its evaluation is that the

indicators in the logframe are to be measured more strictly.

As a conclusion it should be noted in whole that owing to implementing the Avian Influenza Control

and Human Pandemic Preparedness and Response Project it has been increased the general preparedness

and response to control avian influenza, animal diseases and zoonotics by arranging the effective

response measures at the national and local levels including all key parties responsible for agriculture,

public health etc.; it has been strengthened the logistic, training and human capacity of the state

institutions and laboratories involved into the project implementation; it has been significantly increased

the awareness of danger and threat caused by the avian influenza and other animal diseases among

population, state and private organizations; it has been developed on pilot basis the effective and reliable

conditions for compensation that is the most important element, which provides cooperation with

farmers/producers.

The most important factor of the project result is an integration of controlling avian influenza and other

priority animal diseases including zoonotic diseases. The project impact on animal health resulted in

reducing the level of human virus diseases that allows increasing cost effectiveness and minimizing real

threat to both animal and human health.

Annexes:

1. Translation of the Letter from the State Veterinary Department.

2. Translation of the Letter from the Kyrgyz Scientific Research Veterinary Institute.

3. Translation of the Letter from the Republican Center of Veterinary Diagnostics.

4. Translation of the Letter from the Department of Disease Prevention and Expertise.

60

#1274, June12, 2012

Attn.: M.A. Tairov, Agricultural Project Implementation Unit under the Ministry of Agriculture

and Melioration of the Kyrgyz Republic

Dear Mr. Tairov,

State Veterinary Department has no comments and remarks regarding the reviewed Completion Report

on Avian Influenza Control and Human Pandemic Preparedness and Response Project (AICHPPRP)

prepared by the World Bank.

Sincerely,

M. Sydygaliev

(Signature)

Deputy of SVD General Director

61

#01-103, June13, 2012

Attn.: M.A. Tairov, Agricultural Project Implementation Unit under the Ministry of

Agriculture and Melioration of the Kyrgyz Republic

RE.: Completion Report

Dear Mr. Tairov,

Kyrgyz Scientific Research Veterinary Institute named after A. Duisheev has no comments and remarks

regarding the reviewed Completion Report on Avian Influenza Control and Human Pandemic

Preparedness and Response Project (AICHPPRP) prepared by the World Bank.

Sincerely,

K.A. Abdykerimov

(Signature)

KSRVI Director,

Doctor of Veterinary Science

62

#216, June12, 2012

Attn.: M.A. Tairov, Agricultural Project Implementation Unit under the Ministry of Agriculture

and Melioration of the Kyrgyz Republic

Dear Mr. Tairov,

Republican Center of Veterinary Diagnostics has reviewed the Completion Report on Avian Influenza

Control and Human Pandemic Preparedness and Response and informs that the Project has influenced

on human health by reducing the number of infected people.

In general the Project activities were implemented well in full with sustainable results.

Republican Center of Veterinary Diagnostics expresses its gratitude for the support and hopes to

continue working with the World Bank.

M. S. Toroev (Signature)

RCVD Director

63

#05-2-743, June12, 2012

Attn.: M.A. Tairov, Agricultural Project Implementation Unit under the Ministry of

Agriculture and Melioration of the Kyrgyz Republic

Dear Mr. Tairov,

Department of Disease Prevention and Expertise has no comments and remarks regarding the reviewed

Completion Report on Avian Influenza Control and Human Pandemic Preparedness and Response

Project (AICHPPRP) prepared by the World Bank.

Sincerely,

S.T. Abdikarimov

(Signature)

DSSES General Director

64

Annex 8. Comments of Cofinanciers and Other Partners/Stakeholders

66

Annex 9. List of Supporting Documents

World Bank Documents

1. Project Appraisal Document, January 2006

2. Financing Agreement (Avian Influenza Control and Human Pandemic Preparedness and

Response Project) between Kyrgyz Republic and International Development Association, Grant

Number H203 KG, April 27, 2006

3. Kyrgyz Republic Avian Influenza Control and Human Pandemic Preparedness and Response

Project – Mid-term Review and Project Restructuring Missions Aide Memoire – September 29 –

October 9, 2008 and January 19 – February 25, 2009

4. Aide Memoires of implementation support missions during 2006 – 2011.

5. Implementation Status and Results (ISR) Reports, 2006 – 2011

6. Restructuring Paper on a Proposed Project Restructuring of the Avian Influenza Control and

Human Pandemic Preparedness and Response Project, IDA Grant Number H203 KG to the

Kyrgyz Republic, May 9, 2010

7. Restructuring Paper on a Proposed Project Restructuring of the Avian Influenza Control and

Human Pandemic Preparedness and Response Project, IDA Grant Number H203 KG to the

Kyrgyz Republic, November 23, 2010

8. Kyrgyz Republic - Japanese Grant for Co-financing of Avian Influenza Control and Human

Pandemic Preparedness and Response Project (Grant Number TF056157), Letter Agreement

dated March 15, 2006

9. Kyrgyz Republic -Avian and Human Influenza (AHl) Facility Grant for the Avian Influenza

Control and Human Pandemic Preparedness and Response Project (Grant No. TF091994 and

Grant No. TF091995), Letter Agreement, dated July 11, 2008.

Government and Other Documents

10. Kyrgyz Republic, National Action Plan for AI Response, January 2006

11. Avian Influenza: A Choice Between Disease Eradication and Large-scale Vaccination, Technical

Note, February 2006

12. Borrower’s Completion Report

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OBLAST CAPITALS

NATIONAL CAPITAL

RIVERS

MAIN ROADS

RAILROADS

OBLAST BOUNDARIES

INTERNATIONAL BOUNDARIES