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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)
Indicator was not monitored separately, but combined with indicators 4, 5, 6 and 7.
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)
Indicator was not monitored separately, but combined with indicators 4, 5, 6 and 7.
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)
Indicator was not monitored separately, but combined with indicators 4, 5, 6 and 7.
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)
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
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)
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
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)
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)
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)
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)
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)
Indicator was not monitored separately, but combined with indicators 15, 16 and 17.
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)
Indicator was not monitored separately, but combined with indicators 15, 16 and 17.
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)
Indicator was not monitored separately, but combined with indicators 15, 16 and 17.
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)
Indicator was not monitored separately, but combined with indicators 18, 19, 20 and 21.
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)
Indicator was not monitored separately, but combined with indicators 18, 19, 20 and 21.
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)
Indicator was not monitored separately, but combined with indicators 18, 19, 20 and 21.
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)
Indicator was not monitored separately, but combined with indicators 18, 19, 20 and 21.
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)
Indicator was not monitored separately, but combined with indicators 22, 23, 24 and 25.
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)
Indicator was not monitored separately, but combined with indicators 22, 23, 24 and 25.
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)
N/A Completed. N/A Completed.
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 22, 23, 24 and 25.
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)
N/A Completed. N/A Completed.
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 22, 23, 24 and 25.
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)
N/A Completed. N/A Completed.
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 26, 27 and 28.
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)
N/A Completed. N/A Completed.
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 26, 27 and 28.
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)
Indicator was not monitored separately, but combined with indicators 26, 27 and 28.
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 was dropped starting ISR2 and not monitored.
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)
Indicator was dropped starting ISR2 and not monitored.
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
2 10/12/2006 Satisfactory Satisfactory 0.30
3 07/25/2007 Moderately Satisfactory Satisfactory 1.01
4 05/30/2008 Satisfactory Satisfactory 1.69
5 06/26/2009 Satisfactory Satisfactory 2.34
6 04/28/2010 Satisfactory Satisfactory 2.87
7 03/18/2011 Satisfactory Satisfactory 3.46
8 08/29/2011 Satisfactory Satisfactory 3.46
9 12/27/2011 Satisfactory Satisfactory 3.66
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
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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.
2
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.
3
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,
4
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
5
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
6
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.
7
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.
8
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
9
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
10
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
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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:
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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.
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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.
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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
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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:
Rating: Moderately Satisfactory
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:
Rating: Moderately Satisfactory
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:
Rating: Satisfactory
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:
Rating: Satisfactory
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
Achievements under this component are rated Satisfactory.
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
Achievements under this component are rated Satisfactory.
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
Achievements under this component are rated Satisfactory.
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
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.
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
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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B AT K E N
TA L A S
J A L A L - A B A D
C H U I
I S S Y K - K U L
O S H
N A R Y N
BISHKEKBISHKEK
Sulyukta
Kyzyl-Kiya
Tash-Kumyr
Kara-Kul
At-Bashy
KirovKara-Balta Tokmok
Balykchi
Chaek
Cholpon-Ata
Barskaun
Kara-Say
Sary-Tash
Daraut-Korgan
Gul'cha
Toktogul
Tunuk
Tyup
Enilchek
Shyirak
Osh
Jalal-Abad
Batken
Naryn
TalasKarakol
BISHKEK
T A J I K I S T A N
UZBEKISTAN
C H I N A
K A Z A K H S T A N
Chatkal
Chu
Naryn
Aksay
Kyzyl Suu
Kurshab
Lake Issyk-Kul
ToktogulReservoir
Lake Sonkul
LakeCharyi-Kel'
To Panfilov
To UshtobeTo
Burylbaytal
To Shymkent
To Tashkent
To Bukhoro
To Murghab
To Hotan
T i a n S h a n
K u n g e y - A l a t a u M t s .
Peak Pobedy7439 m
72E 74E 76E 78E 80E
70E 72E 74E 76E
78E 80E
44N
42N42N
40N40N
KYRGYZREPUBLIC
This map was produced by the Map Design Unit of The World Bank. The boundaries, colors, denominations and any other informationshown on this map do not imply, on the part of The World BankGroup, any judgment on the legal status of any territory, or anyendorsement or acceptance of such boundaries.
0 25 50 75
0 25 50 75 Miles
100 Kilometers
IBRD 33430
SEPTEMBER 2004
KYRGYZ REPUBLICSELECTED CITIES AND TOWNS
OBLAST CAPITALS
NATIONAL CAPITAL
RIVERS
MAIN ROADS
RAILROADS
OBLAST BOUNDARIES
INTERNATIONAL BOUNDARIES
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