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TRANSCRIPT
Document of
The World Bank
Report No: ICR00001696
IMPLEMENTATION COMPLETION AND RESULTS REPORT
(IDA-41780 TF-56629 TF-58076)
ON A
CREDIT
IN THE AMOUNT OF SDR 4.4 MILLION
(US$ 6.25 MILLION EQUIVALENT)
TO THE
REPUBLIC OF ARMENIA
FOR A
AVIAN INFLUENZA PREPAREDNESS (AIP) PROJECT
December 14, 2010
Sustainable Development Department
South Caucasus Country Department
Europe and Central Asia Region
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CURRENCY EQUIVALENTS
(Exchange Rate Effective July 31, 2010)
Currency Unit = Armenian Dram (AMD)
AMD 1.00 = US$0.0027
US$ 1.00 = AMD 370
FISCAL YEAR
January 1 – December 31
ABBREVIATIONS AND ACRONYMS
ADCCF Animal Disease Control and Compensation Fund
AHIF Animal and Human Influenza Facility
A/H1N1 Swine Influenza virus, subtype H1N1
ASF African Swine Fever
BSL Bio-Safety Level
CDCP Center for Disease Control and Prevention
CVL Central Veterinary Laboratory
EMP Environmental Management Plan
FSVSI Food Safety and Veterinary State Inspection
GOA Government of Armenia
GPAI Global Program for Avian Influenza and Human Pandemic Preparedness and Response
HPAI Highly Pathogenic Avian Influenza
HSMP Health Systems Modernization Project
H5N1 Avian Influenza A virus, subtype H5N1
IMTF Inter-Ministerial Task Force
IT Information Technology
Marz Administrative Regions of Armenia
M&E Monitoring and Evaluation
MOA Ministry of Agriculture
MOH Ministry of Health
NADSS National Animal Disease Surveillance System
OIE World Organization for Animal Health
PAD Project Appraisal Document
PDO Project Development Objectives
PPE Personal Protective Equipment
QAE Quality at Entry
QAG Quality Assurance Group
San-Epid State Hygiene and Anti-Epidemic Inspectorate
SQP Sanitary Quarantine Post
VSI Veterinary State Inspection
Vice President: Philippe Le Houerou
Country Director: Asad Alam
Sector Manager: Dina Umali-Deininger
Project Team Leader: Brian Bedard
ICR Team Leader: Brian Bedard
REPUBLIC OF ARMENIA
AVIAN INFLUENZA PREPAREDNESS (AIP) PROJECT
CONTENTS
Data Sheet
A. Basic Information
B. Key Dates
C. Ratings Summary
D. Sector and Theme Codes
E. Bank Staff
F. Results Framework Analysis
G. Ratings of Project Performance in ISRs
H. Restructuring
I. Disbursement Graph
1. Project Context, Development Objectives and Design............................................. 1
2. Key Factors Affecting Implementation and Outcomes ............................................ 1
3. Assessment of Outcomes ....................................................................................... 2
4. Assessment of Risk to Development Outcome ........................................................ 3
5. Assessment of Bank and Borrower Performance ..................................................... 3
6. Lessons Learned .................................................................................................... 3
7. Comments on Issues Raised by Borrower/Implementing Agencies/Partners ............ 3
Annex 1. Project Costs and Financing ........................................................................ 4
Annex 2. Outputs by Component ............................................................................... 5
Annex 3. Economic and Financial Analysis ................................................................ 6
Annex 4. Bank Lending and Implementation Support/Supervision Processes .............. 7
Annex 5. Beneficiary Survey Results ......................................................................... 8
Annex 6. Stakeholder Workshop Report and Results .................................................. 9
Annex 7. Summary of Borrower's ICR and/or Comments on Draft ICR .................... 10
Annex 8. Comments of Cofinanciers and Other Partners/Stakeholders ...................... 11
Annex 9. List of Supporting Documents ................................................................... 12
MAP
i
A. Basic Information
Country: Armenia Project Name: Avian Influenza
Preparedness Project
Project ID: P099832 L/C/TF Number(s): IDA-41780,TF-
56629,TF-58076
ICR Date: 02/01/2011 ICR Type: Core ICR
Lending Instrument: ERL Borrower: REPUBLIC OF
ARMENIA
Original Total
Commitment: USD 6.3M Disbursed Amount: USD 5.4M
Revised Amount: USD 5.0M
Environmental Category: B
Implementing Agencies:
Ministry of Health, HSMP-PIU
Ministry of Agriculture - ARSP-PIU
Cofinanciers and Other External Partners:
B. Key Dates
Process Date Process Original Date Revised / Actual
Date(s)
Concept Review: 03/09/2006 Effectiveness: 09/05/2006 09/05/2006
Appraisal: 03/13/2006 Restructuring(s): 09/15/2008
Approval: 06/02/2006 Mid-term Review: 03/17/2008 02/10/2008
Closing: 07/31/2009 07/31/2010
C. Ratings Summary
C.1 Performance Rating by ICR
Outcomes: Moderately Satisfactory
Risk to Development Outcome: Moderate
Bank Performance: Moderately Unsatisfactory
Borrower Performance: Moderately Satisfactory
C.2 Detailed Ratings of Bank and Borrower Performance (by ICR)
Bank Ratings Borrower Ratings
Quality at Entry: Moderately
Unsatisfactory Government: Moderately Satisfactory
Quality of Supervision: Moderately
Unsatisfactory
Implementing
Agency/Agencies: Moderately Satisfactory
Overall Bank
Performance:
Moderately
Unsatisfactory
Overall Borrower
Performance: Moderately Satisfactory
ii
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 11 11
General public administration sector 42 42
Health 27 27
Other social services 2 2
Theme Code (as % of total Bank financing)
Health system performance 17 17
Other communicable diseases 33 33
Pollution management and environmental health 17 17
Rural services and infrastructure 33 33
E. Bank Staff
Positions At ICR At Approval
Vice President: Philippe H. Le Houerou Shigeo Katsu
Country Director: Asad Alam D-M Dowsett-Coirolo
Sector Manager: Dina Umali-Deininger Juergen Voegele
Project Team Leader: Brian G. Bedard Mark R. Lundell
ICR Team Leader: Brian G. Bedard
ICR Primary Author: Gotz A. Schreiber
F. Results Framework Analysis
Project Development Objectives (from Project Appraisal Document)
The overall objective of the Project is to minimize the threat in Armenia posed to humans
by the highly pathogenic avian influenza (HPAI) and other zoonoses in domestic poultry,
iii
and to prepare for the control and response to an influenza pandemic and other infectious
disease emergencies in humans. To achieve these goals, 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 in Armenia, limiting the regional spread of HPAI, and enhancing economic
and social prospects at the national, regional, and global levels.
Revised Project Development Objectives (as approved by original approving authority)
The objective of the Project is to minimize the threat in Armenia posed by the HPAI
infection and other livestock diseases, and to prepare for the control and response to an
influenza pandemic and other zoonoses 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 :
Evidence* of improved effectiveness of participating animal and public health
services in limiting the spread of an HPAI outbreak and consequent pandemic in
Armenia.
Value
quantitative or
Qualitative)
No human case as of
February 1, 2006
No human pandemic
No human pandemic
Contain spread
and number of
cases.
No human
pandemic
No human
pandemic
Date achieved 02/01/2006 06/03/2006 07/31/2010
Comments
(incl. %
achievement)
Indicator 2 : Evidence* of widespread adoption of recommended practices for the prevention
and control of HPAI among poultry producers, distributors, and retail vendors.
Value
quantitative or
Qualitative)
No human case as of
February 1, 2006 0 new cases 0 new cases
Date achieved 02/01/2006 06/03/2006 07/31/2010
Comments
(incl. %
achievement)
Indicator 3 : Improving trend in poll of experts designed to gauge HPAI readiness in Armenia.
Value
quantitative or
Qualitative)
Moderate readiness Advanced
readiness Advanced readiness
Date achieved 02/01/2006 06/30/2006 07/30/2010
Comments
(incl. %
achievement)
No such poll or survey was ever carried out. The outcome assessment is that of
the ICR mission, reflecting the technical, institutional and human capacity
created by the project.
iv
(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 : Component I.A:
Detailed assessment of the Veterinary State Inspection of the MOA
Value
(quantitative
or Qualitative)
Partial FAO assessment 100% complete
OIE assessment and
gap analysis
completed
Date achieved 06/02/2006 06/30/2006 07/30/2010
Comments
(incl. %
achievement)
Indicator 2 : National AI strategic plan developed and adopted by government.
Value
(quantitative
or Qualitative)
MOA and MOH AI
Action Plan 100% complete Completed
Date achieved 06/02/2006 06/30/2006 07/30/2010
Comments
(incl. %
achievement)
Indicator 3 : Component I.B:
BSL-2+ attained in one reference laboratory.
Value
(quantitative
or Qualitative)
BSL-2+ not attained in
reference laboratory
BSL-2+ attained
in reference
laboratory
BSL 2 status
achieved
Date achieved 06/01/2006 06/30/2006 07/30/2010
Comments
(incl. %
achievement)
Indicator 4 : Self-assessment of the veterinary services executed.
Value
(quantitative
or Qualitative)
No self-assessment made 100% complete Completed
Date achieved 06/02/2006 06/30/2006 07/30/2010
Comments
(incl. %
achievement)
Indicator 5 : 100% monitoring of poultry breeding stock farms.
Value
(quantitative
or Qualitative)
25% monitoring 100% monitoring 40%
Date achieved 06/02/2006 06/30/2006 07/30/2010
Comments
(incl. %
achievement)
This activity was minimally implemented
v
Indicator 6 : Component I.C:
Emergency supplies procured and available at strategic locations in the field.
Value
(quantitative
or Qualitative)
Minimal
Supplies for 120
staff and 40 teams
procured and
deployed
Supplies for 120
staff and 40 teams
procured and
deployed
Date achieved 06/02/2006 06/30/2006 07/30/2010
Comments
(incl. %
achievement)
Indicator 7 : One mobile incineration units deployed and accessible by areas at risk.
Value
(quantitative
or Qualitative)
0 mobile incinerators
deployed
One mobile
incinerator
deployed
No mobile
incinerators
deployed
Date achieved 06/02/2006 06/30/2006 07/30/2010
Comments
(incl. %
achievement)
Incinerator use was found not permissible under Armenian environmental
regulations
Indicator 8 : Number of farms in which unconfined backyard poultry farming addressed and
demonstrated
Value
(quantitative
or Qualitative)
0 2000 0
Date achieved 06/02/2006 06/30/2006 06/30/2006
Comments
(incl. %
achievement)
Activity was not implemented
Indicator 9 : Compensation Fund established with clear operating modalities
Value
(quantitative
or Qualitative)
No Compensation Fund
Compensation
Fund fully
functional
No Compensation
Fund established
Date achieved 06/02/2006 06/30/2006 07/30/2010
Comments
(incl. %
achievement)
Drafting of legal and operational documents was completed, but these
instruments were not implemented nor ratified by project completion.
Indicator 10 :
Component II.A: National strategic plans for improvement of public health
surveillance and disease control systems prepared according to WHO
recommendations and approved and fully resourced for implementation.
Value
(quantitative
or Qualitative)
MOA and MOH AI
Action Plan Completed Completed
Date achieved 06/02/2006 06/30/2006 07/30/2010
Comments
(incl. %
achievement)
Indicator 11 : Component II.B: Increased surveillance and outbreak investigation capacity.
Value
(quantitative Varies by province
100% of provinces
w/ functional
100% of provinces
w/ functional
vi
or Qualitative) capacity capacity
Date achieved 06/02/2006 06/30/2006 07/30/2010
Comments
(incl. %
achievement)
Indicator 12 :
Number of public health laboratories available for routine influenza diagnosis
and typing, rehabilitated and equipped, and with appropriate biomedical waste
management systems
Value
(quantitative
or Qualitative)
2 labs
a) Genetic Center PCR
Lab-temporarily carries
out AF diagnosis
b) CDC PCR Lab # in the
stage of development
1 lab, TBD at
project launch
a) NIH PCR lab
CDC lab capable of
avian influenza
diagnosis;
NIH lab capable of
PCR diagnosis of
HPAI
Date achieved 06/02/2006 06/30/2006 07/30/2010
Comments
(incl. %
achievement)
Indicator 13 : Number of health personnel trained in influenza virus surveillance and control.
Value
(quantitative
or Qualitative)
TBD at project-launch TBD at project
launch
More than 2300
staff trained
Date achieved 06/02/2006 06/30/2006 07/30/2010
Comments
(incl. %
achievement)
Indicator 14 : Increased laboratory capacity to collect and analyze specimens per day for viral
typing, sub-typing and isolation in times of surged specimen load.
Value
(quantitative
or Qualitative)
0/day 30/day Not recorded by
labs
Date achieved 06/02/2006 06/30/2006 07/30/2010
Comments
(incl. %
achievement)
No lab records available of daily analysis loads during surge but no outbreaks
occurred during project to trigger specimen submission.
Indicator 15 : % of positive tests of specimens confirmed by reference laboratory.
Value
(quantitative
or Qualitative)
0 100%
No positive
specimens
confirmed
Date achieved 06/02/2006 06/30/2006 07/30/2010
Comments
(incl. %
achievement)
Indicator 16 : Component II.C: Strategy for procurement and access to human influenza
vaccine on the basis of well-defined criteria developed.
Value
(quantitative
or Qualitative)
1449 poultry workers ,
who are vaccinated
99,061 at risk population
New HI vaccine
for 1450 poultry
workers + at-risk
66,000 doses
procured;
no new HI vaccine
vii
population, TBD
at project launch
was developed or
used
Date achieved 06/02/2006 06/30/2006 07/30/2010
Comments
(incl. %
achievement)
No new suitable HI vaccine became available for use in humans.
Indicator 17 : Strategy to access antivirals for national use (e.g., stockpiling) developed.
Value
(quantitative
or Qualitative)
420 doses Tamiflu Stock maintained
at the same level
Stock level
maintained
Date achieved 06/02/2006 06/30/2006 07/30/2010
Comments
(incl. %
achievement)
Indicator 18 : A contingency plan for procurement of AI vaccine for humans is developed
should one become available and needed.
Value
(quantitative
or Qualitative)
Initial contacts w/
manufacturer
Procurement of
350,000 doses for
at- risk population,
TBD
No plan developed,
since no new HI
vaccine was
developed
Date achieved 06/02/2006 06/30/2006 07/30/2010
Comments
(incl. %
achievement)
No new suitable HI vaccine became available for use in humans.
Indicator 19 :
Cumulative incidence rate (CIR)
CIR = total cases
pop x yrs exposure
Value
(quantitative
or Qualitative)
0.0/million 0.0/million CIR= 0.0/million
Date achieved 06/02/2006 06/30/2006 07/30/2010
Comments
(incl. %
achievement)
Indicator 20 : % change in AI case fatality rate.
Value
(quantitative
or Qualitative)
0% fatality rate 0% fatality rate 0% fatality rate
Date achieved 06/02/2006 06/30/2006 07/30/2010
Comments
(incl. %
achievement)
Indicator 21 : Component III.A: Political and civic leadership organized around a national
strategic risk communication plan.
Value
(quantitative
or Qualitative)
AI Action Plan revised to
include a National
Strategic Risk
Communication Plan
100% complete
National AI Action
Plan was not
revised to include a
NSRCP
viii
(NSRCP) 10% complete
Date achieved 06/02/2006 06/30/2006 07/30/2010
Comments
(incl. %
achievement)
Indicator 22 : Research-based risk communication strategies and products, responding to the
needs of priority audiences, are developed.
Value
(quantitative
or Qualitative)
NSRCP and priority
audience communication
needs assessment 0%
implemented
100 % complete Not completed
Date achieved 06/02/2006 06/30/2006 07/30/2010
Comments
(incl. %
achievement)
No evidence of reports indicating such preparations under AI project but
developed under parallel USAID program.
Indicator 23 : Consistent awareness-raising and behavior change interventions made with
population at risk using appropriate communications channels.
Value
(quantitative
or Qualitative)
Knowledge, attitude and
practices studies and
design of
communications products
25% implemented
100% complete
No KAP survey
implemented;
communications
products developed
without it
Date achieved 06/02/2006 06/30/2006 07/30/2010
Comments
(incl. %
achievement)
KAP survey was carried by UNICEF and USAID in 2006. No budget available
for KAP in late 2009.
Indicator 24 :
Communications strategies and products highlighting the actions and investments
of participating ministries and the mobilization of group resources to contain the
epidemic, generating social trust and credibility.
Value
(quantitative
or Qualitative)
NSRCP 10% complete 100% complete No NSRCP
completed
Date achieved 06/02/2006 06/30/2006 07/30/2010
Comments
(incl. %
achievement)
Indicator 25 : Evidence of consistent communication and information technologies, to promote
reporting of outbreaks, fast response and an uninterrupted social dialogue.
Value
(quantitative
or Qualitative)
Secretariat Information
Center operational at 50%
of demand
100% complete Not functioning
Date achieved 06/02/2006 06/30/2006 07/30/2010
Comments
(incl. %
achievement)
Government reluctant to continue ongoing communication dialogue considering
no outbreaks and reduced risks assessment.
Indicator 26 : Evidence of consistent communication and information technologies, to promote
reporting of outbreaks, fast response and an uninterrupted social dialogue.
Value Secretariat Information 100% complete Not functioning
ix
(quantitative
or Qualitative)
Center operational at 50%
of demand
Date achieved 06/02/2006 06/30/2006 07/30/2010
Comments
(incl. %
achievement)
Indicator 27 :
Production and dissemination of informational products that educate priority
audiences about possible scenarios and mitigation and pandemic control actions
to be undertaken.
Value
(quantitative
or Qualitative)
NSRCP 10% complete 100% complete Completed
Date achieved 06/02/2006 06/30/2006 07/30/2010
Comments
(incl. %
achievement)
Indicator 28 : Methodology defined and monitoring and evaluation periodically undertaken.
Value
(quantitative
or Qualitative)
ARSP PIU and MOH PIU
with M&E capacity
Detailed surveys
completed
No surveys
undertaken
Date achieved 06/02/2006 06/30/2006 07/30/2010
Comments
(incl. %
achievement)
M&E methodology was not developed, and no M&E capacity was established
Indicator 29 : Methodology defined and monitoring and evaluation periodically undertaken.
Value
(quantitative
or Qualitative)
ARSP PIU and MOH PIU
with M&E capacity
Detailed surveys
completed
No surveys
undertaken
Date achieved 06/02/2006 06/30/2006 07/30/2010
Comments
(incl. %
achievement)
G. Ratings of Project Performance in ISRs
No. Date ISR
Archived DO IP
Actual
Disbursements
(USD millions)
1 09/22/2006 Satisfactory Satisfactory 0.00
2 11/21/2006 Satisfactory Satisfactory 0.30
3 03/26/2007 Satisfactory Satisfactory 1.13
4 04/04/2008 Satisfactory Satisfactory 3.06
5 06/26/2009 Satisfactory Satisfactory 4.04
6 03/10/2010 Satisfactory Satisfactory 4.80
x
H. Restructuring (if any)
Restructuring
Date(s)
Board
Approved
PDO Change
ISR Ratings at
Restructuring
Amount
Disbursed at
Restructuring
in USD
millions
Reason for Restructuring &
Key Changes Made DO IP
09/15/2008 S S 3.33
I. Disbursement Profile
1
1. Project Context, Development Objectives and Design
1.1 Context at Appraisal
In 2005 the highly pathogenic H5N1 avian influenza virus emerged as a global threat,
and in January 2006 the Bank’s Board approved the Global Program for Avian Influenza
and Human Pandemic Preparedness and Response (GPAI) to provide immediate
emergency assistance to countries seeking support to address this public health threat. By
January 2006 cases of highly pathogenic avian influenza (HPAI) had been reported in
Croatia, Romania, Russia, Ukraine, Greece, Turkey and Iraq. HPAI outbreaks in
neighboring Azerbaijan led to five human deaths there and the culling of some 500,000
birds in several commercial poultry farms. Situated on major migratory bird flyways and
with outbreaks reported in neighboring countries, Armenia clearly faced both a public
health and an economic risk. The veterinary and public health services systems had
limited diagnostic and surveillance capacity to address the HPAI threat. Border
inspection posts were underequipped, 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.1
At the end of October 2005 the Ministry of Agriculture (MOA) established an Inter-
Ministerial Task Force (IMTF) on Avian Influenza to coordinate nationwide measures to
combat the potential spread of HPAI in Armenia. Soon afterwards MOA collaborated
with the Ministry of Health (MOH) in drafting an Action Plan, and in January 2006 the
Government (GOA) drafted a broader National Strategy for Avian Influenza, to be
implemented by an Inter-Ministerial Committee on AI (IMCAI), to which the IMTF was
to report. To prevent transboundary incursion of the disease, GOA prohibited the import
of poultry and poultry products from countries with reported H5N1 cases. Following a
Bank-supported risk assessment,2 GOA requested Bank assistance through the GPAI to
address the risks associated with HPAI and mitigate the potential impact on animal and
public health and the economy. The project was prepared as a component of the Bank-
wide horizontal adaptable program loan instrument (APL) for avian influenza and under the
procedures for emergency investment operations (OP 8.50) in early 2006 and approved
by the Board on 2 June 2006. If became effective on 5 September 2006.
A PHRD Cofinancing Grant of US$0.8 million was provided at the same time, and an
AHI Facility Grant of US$2.0 million was added in 2007. Of the IDA Credit SDR 3.49
million (US$5.36 million equivalent) were disbursed and SDR 0.91 million cancelled; of
the PHRD Grant US$0.7 million were disbursed; and the AHI Grant was fully disbursed.
1.2 Original Project Development Objectives (PDO) and Key Indicators (as approved)
1 The Armenian poultry subsector comprises some 10 million birds, of which 45 percent are kept under
free ranging backyard conditions. The subsector generates about 7.5% of Gross Agricultural Output
and about 1.5% of the country’s GDP. Gross annual output is estimated at US$60-80 million. 2 World Bank Assessment of HPAI in Armenia, Avian Influenza Rapid Response Actions , February 2006.
2
The overall objective of the Project was to “minimize the threat posed to humans by
HPAI infection and other zoonoses in domestic poultry and prepare for the control and
response to an influenza pandemic and other infectious disease emergencies in humans.”
To achieve this, three areas were to be supported: (i) prevention, (ii) preparedness and
planning and (iii) response and containment.
The key performance indicators were:
Evidence of improved effectiveness of participating animal and public health
services in limiting the spread of an HPAI outbreak and consequent pandemic in
Armenia;
Evidence of widespread adoption of recommended practices for the prevention
and control of HPAI among poultry producers, distributors, and retail vendors;
Improving trend in poll of experts designed to gauge HPAI readiness in Armenia.
1.3 Revised PDO (as approved by original approving authority) and Key Indicators, and
reasons/justification
The PDO were amended in early 2008 to reflect the Project restructuring carried out in
response to GOA’s request after the severe outbreaks of African Swine Fever (ASF) that
struck Armenia beginning in 2007. A review carried out in November 2007 at the
request of GOA concluded that supporting ASF control actions would not compromise
the Project’s integrity or original objectives. The PDO were therefore amended to read:
“The objective of the Project is to minimize the threat in Armenia posed by the HPAI
infection and other livestock diseases, and to prepare for the control and response to an
influenza pandemic and other zoonoses or infectious disease emergencies in humans.”
The Results Framework and PDO indicators were not changed.
1.4 Main Beneficiaries,
The PDO targeted humans threatened by HPAI infection and other infectious disease
emergencies, but the PAD also refers to three other specific groups of beneficiaries: (i)
private poultry farmers receiving competitive grants to improve their on-farm biosecurity,
(ii) stakeholders (undefined) receiving information and public awareness training to
guard against HPAI; and (iii) poultry owners that would be compensated for culled
poultry. Institutional beneficiaries were the Veterinary State Inspection (VSI)3 of the
MOA, its staff and its laboratory, surveillance and inspection services, and the MOH, its
staff, its laboratory and epidemiological surveillance units, and the infectious disease
reference hospital. The works, equipment, vehicles, training, consumables and technical
assistance to be provided for the VSI and the MOH, their laboratories, their surveillance
capability, their communications and information technology, were intended to upgrade
significantly their capacity to detect any future outbreak of HPAI and to respond rapidly
and effectively to any emerging threat from the virus. This enhanced detection and
response capacity, coupled with a substantial public awareness and information campaign
and a compensation facility, was intended to ensure that poultry owners’ risk of losing
their flocks to the virus would be minimized and that any humans infected with H5N1
would receive immediate and effective treatment.
3 Since 2007 Food Safety and Veterinary State Inspection (FSVSI).
3
1.5 Original Components (as approved)
The Project had four components.
Component I: Animal Health
(i) Support was to be provided for the development of a national policy framework, a
national strategic plan and an enabling regulatory environment in accordance with OIE
standards and recommendations (on bio-security, vaccination, control of animal
movement, border controls, culling and carcass disposal, compensation, etc.) and for
updating the essential information on migratory birds.
(ii) The animal disease surveillance and diagnostic capacity of the VSI (now FSVSI) and
its reference and regional diagnostic laboratories -- to detect, report and follow up
suspected and/or confirmed cases of HPAI -- was to be strengthened through the
refurbishment of the central laboratory in Yerevan and its upgrading to biosafety level 3
(BSL-3), the modernization (works and equipment) of marz-level laboratories and border
posts, the provision of rapid test kits, laboratory consumables, sprayers, disinfectants and
vehicles, and technical training of VSI and marz-level veterinary and border post staff in
disease surveillance, outbreak management, laboratory diagnosis and analysis of
epidemiological data and risk-based AI surveillance.
(iii) Support was to be provided for the development and, if necessary, implementation of
an HPAI Outbreak Containment Plan, with clearly detailed roles of the various
institutions involved. This was to include support for virus eradication at source, i.e., for
culling of infected and likely to be infected poultry, compensating their owners, and
safely disposing of carcasses and potentially infectious materials in a biosecure manner in
special burial facilities (Bekkari pits) and/or incinerators. The Project would support the
establishment of a compensation policy and a compensation fund, and financing would
be provided for compensation in the event of mandated culling. To protect veterinary
and laboratory personnel, personal protective equipment was to be provided for them and
for staff and temporary workers involved in culling and disposal.
(iv) To improve biosecurity at the level of backyard poultry holdings, the project intended
to provide small matching grants, on a competitive basis, to poultry owners to convert
their free-range backyard poultry operations to confined small-scale enterprises, with
recipients contributing at least 25% of the conversion cost themselves.
Component II: Human Health
(i) To enable the MOH services to implement the National Strategy for AI, their
organizational and logistical capacity was to be strengthened through the provision of
training, technical assistance, protective gear, transport, and information and
communications equipment, including for the regional branches of the San-Epid network.
(ii) The national public health surveillance system was to be upgraded through the
establishment of a reference laboratory for the diagnosis of HPAI, improved laboratory
capacity at the central level and in remote regions, laboratory capacity upgrading at the
4
Republican Infectious Diseases reference hospital, rehabilitation of laboratory premises
in Syunik marz and at the Infectious Diseases hospital, and support for specimen
collection, transportation and laboratory investigations through the provision of
equipment and consumables. The health information and telecommunication systems
were to receive technical assistance and investments in IT hardware and software as well
as internet access. For improved surveillance effectiveness the Project also was to assist
with the development of updated standard reporting guidelines, registries, forms and
information material, and with case standardization, notification and feedback between
the center and the marzes, and with staff training at different levels of the health system
in clinical management, epidemiology, laboratory reporting, laboratory biosafety,
molecular diagnostic techniques and molecular epidemiology.
(iii) To strengthen health system response capacity, the project intended to support
activities to help contain and prevent the spread of HPAI through social distancing,
containment and mass prophylactic activities. This was to include expanded regular
seasonal influenza vaccination, procurement of anti-viral drugs and influenza vaccines
for high-risk population groups, provision of prophylactic and preventive equipment and
supplies for patient care in the intensive care unit of the Infectious Diseases reference
hospital and for active case detection.
Component III: Public Awareness and Implementation Support
(i) The project would provide support for the design, implementation and evaluation of an
integrated information and communications strategy to raise public the awareness with
the aim of elevating knowledge, promoting behavior-change in populations at-risk,
controlling the spread of the virus, preventing infection, fostering timely reporting and
supporting containment measures. At-risk populations were to be informed about
preparedness plans and mitigation measures across pre-pandemic and pandemic phases.
Measures called for in the Environmental Management Plan (EMP) for safe culling of
backyard poultry and disposal of carcasses would also be covered.
(ii) To ensure effective coordination of HPAI control and response activities, support was
to be provided to bolster project implementation and monitoring capacity at the existing
project implementation structures in both MOA and MOH. The Inter-Ministerial
Committee for Avian Influenza (IMCAI), supervising the work of the Inter-Ministerial
Task Force (IMTF) for Avian Influenza, would receive support to establish a Secretariat
with four staff to oversee and monitor the national awareness activities. The Secretariat
would be responsible for reviewing annual work plans and ensure coordination and
linkages across relevant agencies and international partners. In HPAI outbreak situations,
it would also be the National Disease Crisis Center (NDCC), responsible for triggering
emergency responses by MOA and MOH, monitoring the actions taken, and coordinating
public statements to the media. The two existing project implementation units in MOA
and MOH, the Agricultural Reform Support Project Implementation Unit (ARSP-PIU)
and Health Systems Modernization PIU (HSMP-PIU), were to be supported in their
fiduciary tasks of procurement and financial management. Both were to be strengthened
with additional fiduciary staff, and MOA and MOH would appoint project coordinators
5
for their respective components. Finally, support was to be provided for project
monitoring and impact evaluation. In addition to semi-annual progress reports containing
relevant data compiled by the two ministries and focusing on output indicators,
implementation status and use of project funds, specific surveys were to be carried out to
obtain data for various indicators. Annual impact evaluation reports were to ascertain the
effectiveness and impact of project interventions and to cover both quantitative and
qualitative aspects.
Component IV: Support for Critical Imports
This component was to finance, in the event of a confirmed outbreak of a human HPAI
pandemic, under Emergency Recovery Assistance procedures, critically needed imports
to support a response program to such a pandemic. The list of eligible items included
protective clothing and gear, pharmaceuticals and vaccines, medical and veterinary
supplies and equipment. Other items could have been added with the prior agreement of
the Bank in the case of a pandemic.
1.6 Revised Components
In order to respond to the devastating outbreaks of African Swine Fever (ASF) that began
in April 2007, the Animal Health component was restructured following the mid-term
review in February 2008. Laboratory staff training was expanded to include ASF
diagnosis and surveillance. Three emergency management disinfection vehicles were to
be procured, three tire washes to be constructed at the border inspection posts near the
border with Georgia, and additional disinfectants to be procured. Project financing for
the culling compensation fund was increased by US$300,000 to US$1,050,000, with
US$750,000 of this earmarked for ASF compensation (subject to several conditions).
Public awareness and communication activities were to include also ASF, and project
funds were reallocated to facilitate this.
At the same time, the original project facility to provide matching grants to backyard
poultry producers to switch from free-range to caged poultry management, which had
proven to be impractical, was cancelled and the funds were reallocated for the provision
of international TA to develop a diagnostic manual, dealing with the diagnosis, pathology
and treatment of the most prevalent livestock and poultry diseases in Armenia.
1.7 Other significant changes
Two other significant changes were made.
(i) US$2 million in additional funding from the AHIF Trust Fund became effective on 8
June 2007.
(ii) The closing date was extended by one year, from 31 July 2009 to 31 July 2010 in
order to allow for the completion of the CVL rehabilitation and modernization.
2. Key Factors Affecting Implementation and Outcomes
2.1 Project Preparation, Design and Quality at Entry
(including whether lessons of earlier operations were taken into account, risks and their
mitigations identified, and adequacy of participatory processes, as applicable)
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The project was prepared within the framework of the GPAI and under the provisions of
the Bank’s emergency policy guidelines (OP/BP 8.50). Although several other donors
readily agreed to dedicate some resources from ongoing operations to help meet the
HPAI threat, only the GPAI offered the possibility of stepping in very quickly with an
overarching assistance effort to meet the critical needs in the policy, planning, public
health, veterinary services and public awareness fields. However, with the limited funds
available, the focus had to be limited and clear, and care had to be taken to avoid
duplication or conflicts with initiatives planned or already begun by others. To ensure
this, the project design drew directly on the findings and recommendations of an HPAI
risk assessment carried out in January/February 2006 and on reports prepared by or for
WHO, FAO and USAID on Armenia’s HPAI preparedness. The multiple sources of
background information and related recommendations provided further rationale for
support of interventions to mitigate the risks associated with HPAI. Lessons were also
incorporated from several HPAI projects appraised for other countries during the
preceding months, although these were all only just entering their actual implementation
phase.
The basic project design was sound, based on the global guidelines applicable to GPAI-
supported operations and on the country-specific assessments mentioned above.
However, due to the very rapid preparation and appraisal, a number of aspects were not
fully developed or evaluated and left to be dealt with during project implementation,
notably on the Animal Health side as outlined below. It was also recognized that,
although the most effective preparedness measures would require fundamental systemic
reforms, the project was being prepared as a rapid response project and could not fully
address all the issues. The project was designed to focus on the key elements for
optimizing risk reduction on an urgent basis. Regardless, the complexity of the
interventions led to considerable implementation delays for several project activities,
significant redesign of some planned activities (e.g., BSL-2 instead of BSL-3 at the
central veterinary laboratory), and failure to implement others altogether (e.g., poultry
sector restructuring, rehabilitation/construction of Bekkari pits, provision of incinerators).
Conversely, several important activities not considered at the time of appraisal
subsequently had to be added in order to ensure that the project objectives would be
achieved (e.g., major central veterinary laboratory building rehabilitation). On the
Human Health side, in contrast, project activities were quite clearly specified; they
constituted HPAI-specific complements and refinements to the ongoing Health Systems
Modernization Project where needs and gaps were readily identifiable.
The hurried preparation also meant that not enough attention was paid at that time to
refining the Results Framework, the outcome and monitoring indicators, their baseline
values, and the instruments by which these indicators were to be obtained. Since this
weakness was not subsequently corrected during project implementation, monitoring
project progress and assessing outcomes was made rather difficult.
A QAG assessment undertaken in 2007 gave the project an overall assessment of
“moderately unsatisfactory” and rated Bank inputs and processes moderately
unsatisfactory as well. Of the eight major aspects rated, two were rated moderately
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unsatisfactory: (i) poverty, gender and social development, and (ii) policy and
institutional aspects. Fiduciary aspects were rated satisfactory, all others moderately
satisfactory.
2.2 Implementation
Implementation benefitted from the fact that both of the line ministries with a principal
stake in the project, the Ministry of Health and the Ministry of Agriculture, maintained
sustained interest in the project throughout implementation and each had an existing and
experienced PMU to manage project implementation. Counterpart funding was adequate
and provided in a timely fashion. Procurement and financial management were
satisfactory; all financial management and audit reports were provided on time and were
found satisfactory.
The rushed and in several respects incomplete preparation and appraisal process caused a
number of implementation delays and problems, mainly in the Animal Health field,
because specifics still needed to be defined and agreed to. An initially rather more
descriptive than action-oriented Project Operational Manual (POM) also contributed to
start-up delays in a number of areas because the roles, actions and responsibilities of
different agencies and institutions were not clearly defined. After the POM was revised
in 2007 with the assistance of an international consultant, implementation performance
improved considerably.
Components I, II and III were, with some notable exceptions, largely implemented,
although the project’s closing date had to be extended by one year to ensure this.
Component IV (Support for Critical Inputs) was not implemented, because no HPAI
pandemic developed; the funds were reallocated.
Four major activities envisaged in the PAD were not carried out or not completed:
(i) The plans for poultry sector restructuring to improve backyard poultry biosecurity
were dropped when, after considerable further study, it became evident that it would be
financially, socially and structurally impractical to shift 4.5 million poultry from free-
ranging backyard to confined production arrangements. The funds allocated for this were
reallocated; part of it was utilized to produce a well-designed, practical handbook and
training for practitioners on the management of the most prevalent animal diseases in
Armenia and an extensive training program on biosafety in three marzes.
(ii) The establishment of a compensation fund for poultry owners was not achieved by
project closing and the Credit funds earmarked for it were cancelled (SDR 650,000). The
preparatory work needed (drafting of legislation, statutes and operational guidelines) was
successfully completed, albeit after much delay, but the necessary legislation has not yet
been enacted. This is now expected to be accomplished after and outside the project
framework and will entail the creation of an Animal Disease Control and Compensation
Fund. Compensation to owners of pigs killed by ASF was provided out of the
Government’s own budget; the funds reallocated after the MTR within the restructured
IDA Credit for this purpose were not used and were cancelled.
8
(iii) Investments planned for environmentally acceptable disposal of animal carcasses
were not carried out. The plan to rehabilitate existing bio-thermal Bekkari burial pits had
to be abandoned when it was discovered that most, if not all, of these pits were located at
environmentally unacceptable places.4 The alternative of using mobile incinerators was
also found impractical, not only due to very high costs but due to severe legal and
regulatory restrictions on their use in Armenia which the project was unable to address.
Carcass disposal thus continues to take place through burial, which is an acceptable
procedure, but it is only sporadically monitored for safety.
(iv) No integrated national communications strategy was developed, adopted or
implemented. Communications and awareness raising efforts were carried out, but were
designed and implemented in an ad-hoc fashion.
Both the Government (GOA) and IDA displayed appropriate flexibility when it became
necessary to modify project content in response to needs not adequately identified during
appraisal (e.g., major civil works at the CVL and the Meghri border post) or arising
afterwards (inclusion of AFS response measures). The mid-term review in early 2008 led
to a project restructuring that allowed it to address other major livestock diseases, expand
the public awareness activities beyond HPAI, further strengthen the veterinary service’s
diagnostic and response capacity, expand the national animal disease surveillance and
information system, and facilitate the diagnosis and monitoring of swine flu (H1N1) in
the public health sector.
A notable aspect of project implementation was the generally effective coordination
among and across different institutions and with projects and initiatives supported by
other donors and international technical agencies such as FAO and WHO, with the Inter-
Ministerial Task Force on Avian Influenza playing a key role in this regard. This ensured
that project activities dovetailed, rather than duplicated or conflicted, with those
supported by other external donors and thereby facilitated consistency in approach and
efficiency of resource use. Particularly beneficial were the relations with FAO and WHO
projects and staff (which provided important technical expertise during implementation),
with USDA (which provided complementary veterinary TA) and with a USAID project
(which stepped in with a substantial public information and awareness effort and a
training program for rural veterinarians when the project’s own communications
component was very slow in getting started). On at least one occasion, however, the
Bank’s willingness to cooperate with other donors had a serious negative effect: many
months were lost when USAID after a long delay backed out of financing the design of
the CVL refurbishment, necessitating a lengthy new procurement process for a suitable
laboratory design company.
2.3 Monitoring and Evaluation (M&E) Design, Implementation and Utilization
4 Deep, circular holes lined with cement where animal carcasses are buried and covered. The resulting
bio-thermal action of disposal kills any pathogens. This method of carcass disposal is acceptable
practice in Armenia, and it was the intention to rehabilitate many of these pits. This approach,
however was abandoned in favor of incineration/
9
Rather inadequate attention was given to the M&E design during project appraisal.
Although the QAE review pointed out the need to remedy this deficiency and
recommended a simpler framework with more emphasis on outcomes and impacts, this
issue was not addressed during implementation. The framework set out in the PAD was
heavy on process and weak on outcome and impact indicators, included too many
indicators that were both vague and difficult to measure, and in several cases would have
required periodic surveys or studies to obtain valid findings. It included too many
indicators, and it relied heavily on reports from implementing agencies that were in fact
not prepared/submitted/collected/processed and/or on surveys (e.g., KAP surveys) that
were not carried out. The EMP requirement to develop M&E indicators for
environmental monitoring, to be submitted in annual reports, was also not complied with.
An M&E specialist was to be contracted at project onset, but the qualifications of the
initially selected candidate were considered inappropriate and no further effort was made
to find a suitable specialist. Project implementation therefore proceeded without an
M&E specialist. As a consequence very little M&E was conducted, and regular M&E
reports were not issued. The special surveys envisaged at appraisal and included in the
initial project budget were not carried out.
2.4 Safeguard and Fiduciary Compliance
Compliance with fiduciary policies was satisfactory. All audits were satisfactory.
The only Safeguard applicable for the project was Environmental Assessment (OP 4.01),
and the project was assigned Environmental Category B. The Environmental
Management Plan (EMP) approved in September 2006 emphasized three key areas: (i)
public awareness to protect the public against exposure to infectious agents, (ii)
environmentally acceptable waste disposal of carcasses, and (iii) safe management of
laboratory wastes. Public awareness has been effectively raised. A laboratory waste
management plan was developed late in the project, but is satisfactory and being adhered
to, with safe waste management by means of autoclaving. But compliance with the EMP
in developing and applying safe animal carcass disposal procedures has been
unsatisfactory. The investments envisaged to facilitate environmentally acceptable
carcass disposal were not carried out. The original plan to rehabilitate existing bio-
thermal Bekkari pits had to be abandoned when it became clear that many, if not all of
them, were located at environmentally unacceptable places. The alternative of using
mobile incinerators then considered was also found impractical, not only due to very high
costs,5 but due to severe legal and regulatory restrictions on their use. As a consequence,
carcass disposal continues to take place through burial and is rarely monitored for safety.
Pigs killed by ASF were often inadequately disposed of (e.g. dumped into rivers or left in
forests) or transported from their place of death for burial elsewhere, thereby increasing
the threat of spreading infectious materials.
5 Large-capacity (1 t/hour) incinerators are not suitable for use as mobile units. Furthermore, the
transportation of mobile units from one disposal site to the next is logistically problematic, especially
were gas is used as fuel.
10
The EMP requirement to develop M&E indicators for environmental monitoring, to be
submitted in annual reports, was also not met.
2.5 Post-completion Operation/Next Phase
The project has helped establish critically important institutional and technical capacities
in the veterinary services sector, that had received very little attention and support over
the past two decades. Their continued and effective operation is essential for both public
health and livestock sector productivity and profitability, and this will require adequate
budgetary allocations for operation and maintenance. To expand service coverage to
other key livestock diseases such as brucellosis, to complete the establishment of the
computer- and internet-based animal disease surveillance system (NADSS) and to
establish and finance an Animal Disease Control and Compensation Fund (ADCCF) will
require financial resources that GOA may find difficult to mobilize. Budgetary
sustainability is, thus, a serious concern and further external support will be desirable
over the next few years. Accordingly, discussions are ongoing to consider a new IDA
project or other donor programs that would support further strengthening of the
veterinary services.
On the policy side, the legal basis for operating an ADCCF, with mandatory animal
registration and fees, remains to be established. GOA is determined to do this in the near
future, and MOA is taking the lead on this. A new Veterinary Law providing for such a
facility has been drafted, as have the legal instrument to set up an ADCCF and the draft
charter. Enactment of these legal provisions and establishment of the ADCCF will be
critically important to ensure livestock owner compliance with animal disease reporting
and eradication requirements.
3. Assessment of Outcomes
3.1 Relevance of Objectives, Design and Implementation
Project objectives, design and implementation remain highly relevant for Armenia today.
The country’s human health services and especially its animal health services are today
far better prepared and equipped to detect and respond to outbreaks of highly infectious
diseases, including zoonoses, than they were in 2006. The devastating outbreaks of AFS
in 2007 and 2008 and the appearance of the A/H1N1 swine flu virus in 2009 indicate the
importance of having in place effective disease surveillance, diagnostic, control and
treatment capabilities. The project investments in communication and multi-sectoral
collaboration were beneficial in preparing the groundwork to rapidly respond to the
H1N1 threat and the and equipment (including vehicles), training and laboratories were
utilized in the response to the African Swine Fever outbreaks. And the high prevalence of
brucellosis among humans illustrates the close link between animal disease control and
public health and this was also address with project resources that were applicable such
as the information systems, training materials, etc.
3.2 Achievement of Project Development Objectives
The Project largely achieved its PDOs, but not fully. Surveillance, diagnostic, control
and response capacity in both the animal and human health sectors have been improved
11
considerably, not merely with regard to HPAI but also to other zoonoses and infectious
diseases, and the threat posed by HPAI and other livestock diseases has thereby been
much reduced. The National Pandemic preparedness plan for MOA/MOH was updated
and the legal framework (decree/charter) and operational manual were drafted for Animal
Disease Control and Compensation Fund. In the human health sector, where
considerable institutional and staff capacity upgrading had already been initiated under
the Health Systems Modernization Project, the project met important additional needs
relevant to the health care system’s ability to cope with potential HPAI or other
epidemics. Two public health laboratories engaged in routine influenza diagnosis and
typing were rehabilitated and equipped with appropriate biomedical waste management
systems. In the animal health sector, the project provided the essential technical capacity
(equipment and training) to detect and respond to possible outbreaks of HPAI, but also
much needed general upgrading of facilities, staff skills, policies and operating modes in
a sector long neglected. Thus, the veterinary services were equipped with vehicles for
surveillance and response measure throughout Armenia. The National Reference
Laboratory was upgraded to the BSL 2+ status and six regional veterinary laboratories
were refurbished.
Armenia did not experience any known outbreaks of HPAI, and the country’s capability
to respond to such an outbreak has therefore not been tested (except in a successful field
simulation). But its human and animal health institutions are now clearly far better
equipped and prepared than in 2006. This has been illustrated by the rapid and effective
response to the outbreak of ASF, which was contained in Tavush and Lori marzes, in
2007 and 2008.
However, two important gaps remain in the country’s capacity to minimize the threat of
zoonoses and other livestock diseases, that the project intended to fill: there is still no
acceptable, officially monitored and enforced national system for disposing safely of
highly infectious animal carcasses other than through burial, and there is still no
institutionalized arrangement to compensate livestock owners when their animals are
killed by an epizootic disease or culled on government orders.
3.3 Efficiency
The analysis undertaken at project completion related AIPP project costs to the economic
value of a stream of losses avoided in human health and the poultry industry from project
activities (see Annex 3). An outbreak with a mutated virulent virus is assumed to occur
with a probability of once every five years, and the first outbreak is assumed to occur in
2011. The project benefits are expressed as the expected value of the economic losses
avoided over the period of 2011-2025 in the “With Project” scenario over the “Without
Project” scenario.
The human health benefits estimated comprise the economic value of: (i) hospitalization
costs averted, (ii) income losses avoided from days lost due to illness, and (iii) lifetime
income losses avoided due to the reduction in fatal HPAI cases. Poultry industry benefits
were also estimated in terms of loss avoidance; they include the economic value of: (i)
poultry meat production losses avoided, and (ii) egg production losses avoided, and (iii)
the avoidance of the loss of the layers before the end of their productive lives. The
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number of human and poultry affected in an outbreak of HPAI and the death rate
estimates were difficult to estimate; nevertheless, the estimates and sensitivity analysis
provided robust results.
The base case scenario assumes that the percentage of the population affected by HPAI
infection is reduced by the project from 5% to 2% and that the mortality rate among those
affected is likewise lowered from 3% to 1.5%. For the poultry sector it assumes that the
percentage of birds affected and killed or culled is reduced from 5% to2%. The results of
the analysis show a 53% ERR, a benefit/cost ratio of 4.5 and an NPV of US$42.4 million.
Assigning only 50% of the human health benefits to the project, because of reduced
benefit assumptions and/or because of the simultaneously implemented Health Systems
Modernization Project and other HPAI-related initiatives launched in Armenia at the time,
the analysis shows a 33% ERR, a benefit/cost ratio of 1.8 and an NPV of US$16.5
million, confirming the project’s economic value added.
Project benefits are primarily driven by key assumptions regarding the gross attack rate
for the human population and for the mortality rate among those affected as well as by
the likely frequency of HPAI outbreaks. This is to be expected in a project that is
intended to prepare for a contingency for which neither timing nor severity can be
reliably predicted.
3.4 Justification of Overall Outcome Rating
The overall outcome rating is “Moderately Satisfactory”. The project was and still is
highly relevant for Armenia. Its PDOs were not fully achieved. Its efficiency was
satisfactory.
3.5 Overarching Themes, Other Outcomes and Impacts
(a) Poverty Impacts, Gender Aspects, and Social Development
The project’s poverty and gender impacts – through the avoidance of losses of livestock
and income and the payment of compensation for poultry lost to culling – are potentially
significant, but are only likely to be realized in the event of an HPAI outbreak. Backyard
poultry are an important feature of rural livelihood systems, particularly for the poorer
households, and it is primarily women who manage birds and realize income (be it
through sales or home consumption) from their small backyard flocks.
(b) Institutional Change/Strengthening
The project has left the beneficiary institutions in both the veterinary and the human
health fields, but particularly in the former, significantly strengthened and better prepared
to detect, respond to and contain future outbreaks of HPAI and other zoonoses and highly
infectious diseases. Epidemiological surveillance, disease monitoring, laboratory
diagnostics, field response capabilities and patient treatment capability have all been
upgraded through investments in human resources, facilities and equipment and through
the development of updated operating protocols and guidelines. This was evidenced
already during project implementation by the much improved capacity of the veterinary
services to organize and carry out ASF control measures and, on the human health side,
13
by the rapid development and application of a monitoring and rapid response system for
swine flu (A/H1N1) in 2009.
(c) Other Unintended Outcomes and Impacts (positive or negative)
As a result of intensive dialogue with Bank staff and consultants, TA provided and a
project-funded study tour to Germany, MOA and GOA are now determined to establish
an Animal Disease Control and Compensation Fund comparable in design, functions and
financing arrangements to those in a number of Western European countries. This would
be not merely a facility to pay compensation to poultry owners for animals killed or
culled due to HPAI, but a farmer-funded facility to finance or co-finance infectious
animal disease surveillance, prevention, control and eradication measures.
3.6 Summary of Findings of Beneficiary Survey and/or Stakeholder Workshops
Not applicable.
4. Assessment of Risk to Development Outcome
Rating: Moderate
The risk to sustaining the project outcomes is moderate, mainly because of the uncertain
prospects of adequate future budgetary support for the operation, including staff salaries,
and maintenance of the upgraded laboratory and other service facilities. The
establishment, now planned by GOA for the near future, of an Animal Disease Control
and Compensation Fund, with mandatory animal registration and mandatory annual fees,
to pay or co-pay for essential epidemiological surveillance and control measures would
greatly allay concerns over the financial sustainability of the much strengthened
veterinary services.
5. Assessment of Bank and Borrower Performance
5.1 Bank Performance
(a) Bank Performance in Ensuring Quality at Entry
Rating: Moderately unsatisfactory
The rushed appraisal left a number of important issues to be resolved or fully developed
during implementation. Several subcomponents envisaged in the PAD could not be
implemented at all because they were inadequately prepared and appraised and proved to
be unrealistic (poultry sector restructuring) or in violation of existing laws and
regulations (Bekkari pit construction, incinerators). The Results Framework and the
M&E arrangements required significant further refinement – but were subsequently
largely ignored.
A QAE assessment undertaken in 2007 gave the project an overall assessment of
“moderately unsatisfactory” and rated Bank inputs and processes “moderately
unsatisfactory” as well. The overall rating may have been overly critical; indeed, of the
eight major aspects rated, only two – (i) poverty, gender and social development, and (ii)
14
policy and institutional aspects – were rated moderately unsatisfactory. Fiduciary aspects
were rated satisfactory, all others moderately satisfactory. In its detailed response the
Region took issue with a number of QAR statements and judgments. Where it
acknowledged weaknesses and lacunae in the PAD, it pointed out that these were to be
addressed during the initial implementation phases.
(b) Quality of Supervision
Rating: Moderately unsatisfactory
The quality of Bank supervision was mixed, satisfactory on financial management,
procurement and technical issues, but very spotty on others. Notable was the failure to
follow up on the need to refine the Results Framework and M&E arrangements and,
related to this, on the project’s failure to prepare regular M&E reports. The HSMP-PIU
prepared and provided semi-annual progress reports as required under the provisions of
the Financing Agreement, but the ARSP-PIU never did, and the Bank’s task team did not
remind the PIU or demand these reports. Progress reporting therefore took place mostly
orally in face-to-face meetings or phone and video conferences, with only brief
summaries provided in supervision Aide Memoires. Progress indicators and M&E
summary reports were not attached to these Aide Memoires. Aide Memoires also tended
to be issued with considerable delays after SPN missions, thereby delaying action on
issues identified and recommendations made by the supervision missions. The project
restructuring, which included the expansion to African Swine Fever and other livestock
diseases, was initiated at the time of the mid-term review in February 2008, but it took
until December 2008 to complete the Bank-internal process of preparing the necessary
documentation to amend the Financing Agreement. The task team did not reflect the
restructuring in an update of the Results Framework and/or monitoring indicators,
although this was proposed to be done. Neither did it follow up on the EMP requirement
to develop M&E indicators for environmental monitoring, to be submitted in annual
reports.
Positive aspects of Bank supervision included the proactive approach to collaboration and
coordination with other donors and projects, even though this did on occasion cause
difficulties and delays in implementation. The task team also demonstrated a forward-
looking approach, recognizing the project as a platform for longer-term institutional
capacity building beyond merely a one-time emergency preparedness operation. The
introduction of a pilot operation on participatory disease surveillance, the support for a
computer-based animal disease surveillance system, the expansion of project activities to
AFS, to brucellosis and to swine flu all attest to this.
(c) Justification of Rating for Overall Bank Performance
Rating: Moderately Unsatisfactory
5.2 Borrower Performance
(a) Government Performance
Rating: Moderately satisfactory
15
The Government remained fully committed to the project and its objectives. Adequate
counterpart funding was provided, and when project financing for specific expenditures
was not (yet) accessible, as was the case when compensation payments were made to
owners of pigs killed by AFS, GOA readily provided its own budgetary resources
instead. However, failure to implement the steps required to establish the Compensation
Fund was a notable shortcoming.
(b) Implementing Agency or Agencies Performance
Rating: Moderately satisfactory
MOH implemented its project activities very effectively, dovetailing them with the
broader program of activities funded by the Health Sector Modernization Project (HSMP),
and its HSMP-PIU performed the requisite management and fiduciary responsibilities
very well, led by the component coordinator in the PIU. Progress reports were regularly
prepared, as were financial management and procurement reports.
Performance under the animal health component, where no prior experience with Bank
operations existed and a number of issues had not been adequately set out at the time of
appraisal, was marred by some problems. Fiduciary aspects were satisfactorily managed
by the ARSP-PIU, and the component coordinators performed well with respect to
implementation coordination. The failure to employ an M&E specialist and to produce
semi-annual progress reports was a serious shortcoming, however. The decision-making
process within the VSI (later FSVSI) was often very slow, causing considerable delays on
several project activities. The important staff training program did not begin until mid-
2008. MOA itself remained strongly committed to the project and its objectives and
provided effective leadership throughout. It did not, however, manage the process of
establishing the Compensation Fund (or Animal Disease Control and Compensation
Fund) very effectively, and so this important institution has still not been set up. Neither
the FSVSI nor MOA took a proactive role in seeking a solution to the problem of safe
animal carcass disposal when neither Bekkari pit construction nor incinerators were
found to be a viable option, especially once the massive ASF outbreaks made this a
matter of high urgency.
There proved to be little need for the Secretariat of the Inter-Ministerial Committee
established under the project. The Inter-Ministerial Committee was essentially dormant
throughout the project life, since no HPAI outbreak was registered. Inter-ministerial
coordination was effectively handled by the Inter-Ministerial Task-Force established
prior to project preparation, headed by the Deputy Minister of Agriculture and comprised
of working level representatives of the key ministries and agencies (agriculture, health,
nature protection, emergencies, police, etc). The only task actually handled by the
Secretariat was to manage the public awareness, information and communication
subcomponent of the project; this was very slow in getting off the ground, but was finally
ably organized by an international consultant working closely with a communications
specialist employed for this purpose from December 2006 until July 2009.
(c) Justification of Rating for Overall Borrower Performance
Rating: Moderately satisfactory
16
6. Lessons Learned
Ambitious multi-sector operations such as the AIPP require sufficient time to
implement. While many specific emergency response activities (e.g., procurement of
protective gear, equipment, consumables) can be carried out quickly, institutional
strengthening and capacity building take time. Although critical response mechanisms
can be put in place, a three-year timetable to implement significant institutional reform is
therefore not realistic and investments in more systemic reforms are required.
Effective coordination of activities with other donors and projects requires time and
can delay implementation. The efforts to cooperate with other donors’ HPAI and
veterinary services support operations were useful in harmonizing approaches and
achieving efficiencies in resource allocations and use. But they also entailed some cost,
especially in terms of slippages from initial work plans. Where cross-donor coordination
is envisaged, it is therefore prudent to incorporate flexibility into implementation
schedules.
Project interventions should be designed to be flexible and allow response to
unexpected but related priorities. The project gained significant recognition when it was
recognized that resources were not restricted for HPAI could be used to supported related
problems in the animal and public health sectors including response to H1N1, ASF and
endemic diseases such as brucellosis. The high quality practical training materials which
were developed under the project cover a broad spectrum of diseases and have been used
as training materials, as field manuals for veterinarians and animal health workers and for
students in the university.
A well designed and implemented M&E framework is essential for effective monitoring
of project implementation. Although the project implementation did progress reasonably
well, the absence of effective, meaningful and systematically applied M&E arrangements
made it difficult to monitor progress and to identify problems and take corrective action
in a timely manner.
Creating project-specific coordination bodies outside existing civil service structures is
not necessarily advisable. It tends to imply a transfer of responsibility from mainline
officials to staff with mere “consultant” status, create unwanted and resented parallel
lines of communication and/or decision-making, and foster an attitude of disinterest and
disengagement among those responsible for the sector or subsector.
7. Comments on Issues Raised by Borrower/Implementing Agencies/Partners (a) Borrower/implementing agencies
The Government agrees with the assessment provided in this Implementation Completion Report.
(b) Cofinanciers
n/a
17
(c) Other partners and stakeholders
(e.g. NGOs/private sector/civil society)
n/a
18
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 5.56 5.43 98
HUMAN HEALTH 2.75 4.06 148
PUBLIC AWARENESS AND
IMPLEMENTATION SUPPORT 0.91 1.02 112
CRITICAL IMPORTS 0.23 0.00 n.a.
Total Baseline Cost 9.45 10.50 111
Physical Contingencies
0.00
0.00
0.00
Price Contingencies
0.00
0.00
0.00
Total Project Costs 9.45 10.50 111
Front-end fee PPF 0.00 0.00 .00
Front-end fee IBRD 0.00 0.00 .00
Total Financing Required 9.45 10.50 111
(b) Financing
Source of Funds Type of
Cofinancing
Appraisal
Estimate (USD
millions)
Actual/Latest
Estimate (USD
millions)
Percentage of
Appraisal
Avian and Human Influenza Facility 0.00 1.96 n.a.
Borrower 2.15 2.42 113
International Development
Association (IDA), Cr. 4178 6.42 5.36 86
JAPAN: Ministry of Finance - PHRD
Grant 0.80 0.69 88
IDA Cr. 4095 (RESCAD) 0.00 0.08 n.a.
19
Annex 2. Outputs by Component
Component 1: Animal Health
A. National Policy Framework and Development of a National Strategic Plan
A1: Policy development and enabling environment
With support from the project and the OIE, the VSI/FSVSI carried out a PVS assessment
in 2007, followed by a gap analysis in 2009 and the formulation of a strategic plan in
2010. This work took much longer than planned or necessary, but it did establish a
framework for medium-term strengthening of the service that would raise its PVS rating
from 2 to 3 (“satisfactory”). The development of the legal and operational documentation
for setting up and operating a Compensation Fund was not completed during the project.
The causes included ineffective leadership and process management within MOA, some
ineffective TA early in the process, poor management of the discussion among different
departments within MOA, and failure to obtain high-level political support until very late
in the project. Only after the MTR in February 2008 and a subsequent, highly
informative study tour of key officials to Germany did this process gain momentum, and
GOA now intends to establish a more broadly mandated Animal Disease Control and
Compensation Fund in the near future. As a consequence of this failure, project funds
earmarked for compensation poultry and pig owners could not be used and were
cancelled. Compensation to pig owners whose swine were lost to AFS was paid from
GOA budget resources; the absence of clear operating instructions resulted in significant
problems and irregularities in the administration of this compensation program.
A2: Updating Essential Information on Migratory Birds
A national NGO, the Armenia Society for Protection of Birdlife (ASPB) carried out study
in eight major high-risk areas, covering three seasons, of the flight, rest and nesting
patterns of migratory birds, so as to identify locations with high risk of HPAI
transmission from wild birds to domestic poultry. The study developed a useful
framework for risk assessment. It also raised significant concerns about the waste
management at commercial poultry farms, an issue also looked into by the subsequent
poultry sector restructuring study, but there was no further follow-up on this issue.
B. Strengthening Disease Surveillance and Diagnostic Capacity
B1: Strengthening Animal Disease Surveillance and Diagnostic Capacity
The initially postulated aim of establishing a Bio-Safety Level 3 (BSL-3) central
veterinary laboratory was scaled back after further study to BSL-2, since this would
clearly satisfy the requirements of a diagnostic laboratory. This was effectively achieved,
although after much delay caused initially by the failure of USAID to carry out the
technical design work, then by the need to undertake more substantial civil works than
had been anticipated, and lastly by unusually lengthy contract negotiations. Following a
substantial modernization of the laboratory building, the necessary equipment was
installed, rapid test kits and reagents were provided, staff were trained, and operating
20
protocols were developed and are adhered to. Diagnostic capacity has therefore been
considerably improved.
The 10 marz-level veterinary stations were upgraded through the provision of heating,
water and gas supply as well as office furniture and equipment. Six of the associated
small laboratories were also upgraded, partly with support also from an EU TACIS
project, with serological facilities to allow basic field testing for HPAI and brucellosis.
However, the civil works renovations carried out by GOA with its own funds were not
well done, and the marz laboratories were therefore still not operating effectively when
the project closed. Six border posts were similarly modernized and equipped. One of
them, Meghri at the border with Iran, required substantial new construction.
A laboratory waste management plan was developed, although only in late 2009, and its
recommendations have been put into effect. SOPs for laboratory tests and operations
were finalized with TA assistance in early 2010, as an important precondition for
eventual CVL accreditation by the OIE.
40 mobile surveillance and rapid response teams were established and provided with
vehicles, protective gear and special equipment. Sprayers and disinfectant were procured
and provided for the border posts and in selected strategic locations.
Once the HPAI threat had diminished and the devastating outbreaks of AFS, which began
in April 2007, drew attention to the high risks and costs of other highly infectious animal
diseases, the project focus was broadened to include not only AFS, but also brucellosis
and other infectious diseases more generally. Specifically, three emergency management
disinfection vehicles and additional disinfectants were procured, and three tire washes
were constructed at the border inspection posts to Georgia.
As a first step in addressing the problem of widespread brucellosis among both ruminants
and humans, the project in its final phase also supported the work of an inter-agency
working group (with participation also of FAO and USDA) to develop a national
brucellosis control strategy that will merit longer-term donor support.
B2: Veterinary Services Training and AI Surveillance
A medium-term staff training plan was developed with international TA support, and a
substantial number of topical training courses and events for different target groups
(laboratory staff, VSI staff, field-level veterinarians, university faculty and students, etc.)
were organized. The program, which only really began in mid-2008 because the
formulation of the training plan was much delayed, covered laboratory practices,
epidemiological surveillance and diagnosis, field-level surveillance as well as one table-
top and one field-level real time outbreak simulation exercise in which staff of multiple
agencies participated.
Although not foreseen at appraisal, a participatory disease surveillance (PDS) system was
introduced on a pilot basis in a number of communities, by which monthly animal disease
information is provided from the village level in two marzes to the center for inclusion in
21
the central surveillance data base.
The central disease information data base (NADSS), using the TADInfo software
developed by FAO, has been put in place and is functioning, but in the absence of full
internet access in all marzes and of interactive access for all users, information from
many locations continues to be provided in hard copy to the center and only then
computerized. At the center, NADSS amalgamates the information for subsequent
manual geo-positioning and analysis. The system appears to operate well for the
monitoring of ASF and brucellosis. Although the TADInfo software was not originally
designed for the entry of poultry disease information data, IT staff of the VSI have been
able to adapt the software to accept poultry data. They have also developed the capability
to enter data in both of the two officially adopted Armenian language scripts.
These various measures significantly improved animal disease surveillance capacity from
pre-project passive surveillance to active surveillance, reporting and data analysis.
C. Outbreak Containment Plan
C1: Targeting virus eradication at the source
Procedures were developed and training was conducted for efficient and safe culling of
infected poultry and poultry in the surrounding eradication zones. These were
successfully tested and demonstrated during a field-level simulation exercise. Carcass
disposal, however, remains an issue. Neither the planned rehabilitation and construction
of bio-thermal Bekkari pits nor the acquisition of mobile incinerators were carried out;
both were blocked by the Government on the basis of environmental safety. Carcasses
are therefore buried which, although this is an acceptable method of disposal, requires
diligent monitoring and remains an important issue to be addressed.
The preparatory work needed for establishing and operating a Compensation Fund
(drafting of legislation, statutes and operational guidelines) was successfully completed,
albeit after much delay, the necessary legislation has not yet been enacted and the
Compensation Fund has not yet been established. Since this was a disbursement
condition for this subcomponent, the project funds allocated to provide compensation
were not used, but eventually cancelled. The project was amended after the MTR to
include African Swine Fever (AFS) in the compensation scheme, but GOA compensated
the owners of pigs lost to AFS from its own resources. Independent monitors employed
by the project found much to be concerned about in the actual administration of this
program, because adequate operating and verification principles and procedures had not
been developed and applied. GOA recognizes that an effective, reliable and trusted
compensation system is an essential condition for livestock owner compliance with rapid
infectious disease reporting and intends to establish an Animal Disease Control and
Compensation Fund in the near future outside the project framework.
C2: Veterinary Personnel Safety
The project provided significant quantities of personal protective equipment for all
personnel likely to be at high HPAI infection risk.
22
C3: Restructuring the Poultry Sector
The planned restructuring of the farmyard and backyard poultry sector to improve
biosecurity was not implemented once further detailed study indicated that it would be
financially, socially and structurally impractical to shift 4.5 million poultry from free-
ranging backyard to confined production arrangements. Emphasis was placed instead on
public information and awareness raising with respect to safe handling of backyard
poultry.
Instead, the effort to improve poultry sector biosafety was shifted to an awareness and
training program for animal health personnel on basic biosafety, including containment,
vaccination, culling, etc. This was successfully carried out in two marzes. The training
material developed is available for future use in the entire country. In addition,
international TA was secured to help develop a very useful manual for veterinary
practitioners on the diagnosis, pathology and treatment of the most prevalent livestock
and poultry diseases in Armenia.
Component 2: Human Health
A. Enhancing Public Health Program Planning and Coordination
The project provided essential training and equipment to key public health institutions to
enable them to perform the functions assigned to them in the national HPAI strategy and
action plan. This included 15 vehicles for the regional centers of the State Hygiene and
Anti-Epidemic Inspectorate (San-Epid), the CDCP and the Norq Infection Hospital as
well as 40 units of disinfection equipment (including 30 mobile units) along with
disinfectants for San-Epid and CDCP. Protective gear (3500 protective coveralls, 2000
safety goggles, 5500 respirator masks, 5000 pairs of gloves) was provided to health
service personnel at potentially high risk of infection. The Norq Hospital received
special equipment (7 inhalators, 1 ultrasound nebulizer) for patient care, and additional
laboratory equipment was supplied to the Scientific Center of Forensic Medical
Examination at MOH. The intended procurement of rapid HPAI test kits was rendered
unnecessary when another donor supplied 400 of them instead.
B. Strengthening of National Public Health Surveillance Systems
B1: Improvement of Laboratory Networks
The project provided critically important upgrading of diagnostic capabilities. It did this
while coordinating closely with other donors so as to optimize the efficiency of external
support and avoid duplication and waste. By 2008, three PCR-laboratories were
established with buildings renovated and the requisite equipment provided, at the CDCP,
at the San-Epid center in Syunik marz and at the Norq Infection Hospital. The project
financed the rehabilitation of the laboratory premises at the latter two locations and the
entire equipment at hospital laboratory. Other donors provided the equipment at the
CDCP and the San-Epid center in Syunik.
The project also financed the construction of four Sanitary Quarantine Posts (SQP) and
23
the substantial rehabilitation of three others: at four land crossings from Georgia and one
from Iran and at the airports in Yerevan and Gyumri. It equipped all of them with
furniture, medical and disinfection equipment as well as IT equipment for effective
monitoring. 10 vehicles and three thermal imagers to screen passengers for body
temperature were also procured. The construction program experienced significant
delays, however, mainly due to lengthy debates among different government institutions
and with one bilateral aid agency.
B2: Improvement of Health Information and Telecommunications Systems
To strengthen the health information and telecommunication system, 60 computer sets
and other office equipment (copiers, fax machines, scanners, printers, multimedia
projectors, laptops, servers, modems, digital cameras, etc.) were provided, along with
internet connection, for 14 San-Epid locations and the Norq Hospital.
B3: Training and Development of Standard Reporting Forms and Guidelines
In close cooperation with others, especially the US-American CDC, protocols, standard
forms and guidelines were developed and subsequently introduced to the relevant staff in
training events. With local and international TA, a training program on “Avian Influenza
surveillance and treatment” was developed in the first half of 2007 and initiated
immediately thereafter. International consultants also assisted with the “Development of
Armenian public health system, needs assessment plan and monitoring & evaluation
system for the Avian Influenza, HIV/AIDS and other public health threats”, which
produced a number of specific assessments and proposals on various aspects of the public
health system.6 The training program funded by the project covered mainly
epidemiology, clinical treatment of HPAI patients, and laboratory processes. About 3300
infectious diseases specialists, epidemiologists, general practitioners, pediatricians,
family doctors, nurses, laboratory staff, etc. received specific training.
C. Strengthening Health System Response Capacity
To help strengthen health system response capacity, the project provided 66,000 doses of
seasonal influenza vaccines for 2006/7, 2007/8 and 2008/9, to prevent infection among
high-risk groups, as well as a substantial stockpile (2000 boxes) of the anti-viral drug
“Tamiflu”.
Component 3: Public Awareness and Implementation Support
A. Public Awareness through Information and Communication Services
6 Inter alia: (i) Proposal to Modernize the Public Health System of Armenia, (ii) Report on legal and
regulatory framework of the Armenian health care system, including proposals for changes towards a
Public Health oriented system, (iii) Proposal for Establishing an Effective PH Laboratory Network in
Armenia with the CDCP as the National Reference Centre, (iv) Report on strengthening the National
Disease Surveillance System in Armenia, (v) Report on Elements for a Public Health Monitoring and
Evaluation System, and (vi) Curriculum for TOT on '' Avian Influenza Surveillance and treatment''.
24
The project provided support for the design, implementation and evaluation of a program
of public information and awareness raising, targeted at various population groups and
aimed at inducing behavioral change with respect to management of poultry and poultry
products. The program also sought to inform people about preparedness plans and
mitigation measures across pre-pandemic and pandemic phases. This work did not really
get off the ground until after the mid-term review in early 2008. Fortunately, a USAID
project managed a very effective public information campaign in 2006 and 2007, and
UNICEF ran a specially targeted campaign for children in 2006 and 2007.
Performance improved considerably in 2008, when an international consultant provided
effective guidance, helped develop the draft of a national “Advocacy, Communication
and Social Mobilization Strategy to Promote Bio-Security”, and organized a series of
workshops for key personnel of the State Food Safety and Veterinary Inspectorate and
the State Epidemiological Inspectorate, for marz-level veterinarians and medical officers,
and for media professionals. Through the first half of 2009, when this component was
closed, project-funded information and awareness activities were carried out covering
avian influenza, seasonal influenza, African Swine Fever and brucellosis with television
and radio spots, posters, brochures and leaflets. Much of the public information material
relating to HPAI originated with the USAID project that had filled the gap left by the
long delayed start-up of the AIPP public awareness component. The AIPP was able to
build on this foundation and then to expand it to ASF, seasonal influenza and brucellosis.
All multi-media messaging7 was reviewed by the IMCAI Secretariat to ensure that the
public received coordinated, non-confusing information. After the first round of
transmissions, the national TV channels refused further free-of-charge broadcasting,
despite the governmental directive that public-good messages are to be broadcast free of
charge. The fees demanded exceeded the possibilities of the project, and broadcasting
was therefore limited thereafter to several regional TV stations. Unfortunately, the video
clip on AFS and compensation arrangements was not aired on TV at all, and this was an
important contributing factor when the AFS compensation program experienced
problems.
In 2008, telephone hotlines were set up at FSVSI and at San-Epid, but if they ever
functioned, it was not for long, and they were not operational at the time of the ICR
mission. A KAP (Knowledge, Attitudes and Practices) survey was carried out in 2006 by
UNICEF and USAID, and its findings helped guide the design of the project’s
communications tools, but a second one planned for late 2009 or early 2010, to assess the
impact of the campaign, was not implemented because it was neither budgeted for nor
included in the project’s M&E framework.
Nevertheless, it is generally considered that the public awareness efforts made by the
project and other agencies (USAID, UNICEF and FAO) on HPAI and AFS have been
successful, as is borne out by interviews with various stakeholders in the rural areas.
7 In addition to the AIPP’s communications activities, USAID, UNICEF and FAO also generated public
information on avian influenza. All flowed through the Secretariat for review and approval before
being published.
25
B. Coordination and Implementation Support
B1: National Coordination
The project supported activities to improve coordination and collaboration among the
various public sector institutions and other domestic stakeholders. The main tool in this
regard was the establishment of a Secretariat for the Inter-Ministerial Committee for
Avian Influenza (IMCAI), which in turn was expected to oversee the work of the Inter-
Ministerial Task Force (IMTF) for Avian Influenza. This Secretariat was to review
annual work plans and ensure coordination and linkages across agencies and international
partners and to implement the national HPAI awareness activities. In HPAI outbreak
situations, it was to trigger emergency responses by MOA and MOH, monitor the actions
taken, and coordinate public statements to the media.
The Secretariat was set up, but there proved to be little need for it. Inter-ministerial
coordination was effectively handled by the IMTF headed by the Deputy Minister of
Agriculture and comprised of working-level representatives of the key ministries and
agencies (agriculture, health, nature protection, emergencies, police, etc). The IMCAI
was essentially dormant throughout the project life, since no HPAI outbreak was
registered. The need for coordination across ministries was strong during the early period
of HPAI outbreaks in neighboring countries, but with most activities subsequently falling
strictly within the realm of one ministry or the other, coordination where necessary took
place without the need for intermediaries.
The only task actually handled by the Secretariat was to manage the public awareness,
information and communication subcomponent of the project; this was very slow in
getting off the ground, but was finally ably organized by an international consultant
working closely with a communications specialist employed for this purpose from
December 2006 until July 2009.
B2: Project Implementation
To ensure effective implementation, fiduciary management and project M&E, the
existing project implementation units at both MPH and MOA were provided with
additional fiduciary staff and operating resources. Each PIU was strengthened with the
addition of a Project Coordinator for its respective project components. The fiduciary
and general facilitation and coordination functions were well managed. On the other
hand, the important position of M&E specialist at the ARSP-PIU was never filled, with
serious negative consequences for implementation monitoring and impact assessment.
B3: Monitoring and Evaluation (M&E)
Although project funding was envisaged for M&E activities, little was actually done or
achieved. The M&E framework and arrangements were neither fully developed during
appraisal, nor adequately finalized afterwards. No M&E specialist was employed, and no
meaningful M&E activities were carried out. The EMP requirement to develop M&E
indicators for environmental monitoring, to be submitted in annual reports, was not met.
Progress monitoring took place essentially through irregular and ad-hoc reporting from
26
implementing agencies, and progress monitoring by the Bank’s task team was largely
through occasional site visits, meetings and audio and video conferences. No semi-
annual project progress reports were produced, except by the HSMP-PIU for the human
health component. Specific surveys proposed in the PAD to assess progress for certain
indicators were not carried out. No impact evaluation assessments or reports were
prepared.
Component 4: Support for Critical Imports
This component was not implemented, because no HPAI pandemic arose and the
disbursement conditions therefore were not triggered. The funds (SDR 160,000) were
reallocated.
27
List of Animal Health Workshops and Trainings
Subject Date Participants
Number Target Group
Creation of a national
compensation scheme
04.04.2007 21 MoA, FSVSI, MoF, WB, FAO, poultry
farm owners/managers
AI and data management and
analysis
04.05.2007 37 FSVSI, RVDAC at Central and Marz
level, poultry farms, FAO, USDA, MoH,
Avian Influenza field simulation
exercise
04.06.2008 101 MoA, FSVSI, RVDAC, FAO, WB,
USDA, MoH, local government agencies
(police, village mayors, marz governors),
community veterinarians,
Bio-safety 23.06.2008 38 FSVSI, RVDAC, community
veterinarians
Poultry diseases, their treatment
and prevention
24.06.2008 10 Poultry farms
PDS: Decisionmakers’ workshop 14.10.2008 24 FSVSI, RVDAC, MoH, AAU
PDS: Introductory training 11-14.11.2008 16 FSVSI, RVDAC, community
veterinarians
Leadership for Strategic Health
Communication
10-12.02.2009 37 FSVSI, RVDAC, MoH
PDS: Refresher training 2-5.03.2009 13 FSVSI, RVDAC
PDS: Result Workshop 5-7.05.2009 16 FSVSI, RVDAC
“Working Together for Armenian
Health Preparedness
18-20.05.2009 33 MoA, MoH (central and marz levels), for
Marz- level veterinarians and medical
officers
“The Role of Media during Health
Crisis Situation for Selected Media
Professionals”
21-22.05.2009 18 Media
Data management and analysis
(TADInfo)
21.07.2009 21 FSVSI, RVDAC
Serological training 22-26.07.2009 9 Marz lab technicians
Parasitological, bacteriological and
autopsy training
29.06-03.07.2009 9 Marz lab technicians
Emerging infections and
biosecurity
28.07.2009 … Lab technicians
Training in brucellosis 15-17.09.2009 20 Armenian Agrarian University faculty
and students
“Livestock Sector Biosafety,
Biosecurity, Field Diagnosis and
Immediate Control Measures”
12-16.10.2009
19-23.10.2009
47 FSVSI, Community Veterinarians, Farm
veterinarians, Lab technicians, Rapid
Response Team Members, Deputy Dean
Workshop on revision and
finalization of the Strategy on
Brucellosis
27-28.07.2010 14 MoA, MoH, PIU, FAO
MoA-Ministry of Agricultural
MoH- Ministry of Health
MoF- Ministry of Finance
RVDAC- Republican Veterinary Diagnostic and Anti-epidemic Center
FSVSI- Food Safety and Veterinary State Inspection
AAU- Armenian Agrarian University
FAO- Food and Agriculture Organization
PIU- Project Implementation Unit
28
Annex 3. Economic and Financial Analysis
(including assumptions in the analysis)
A. Introduction
This analysis seeks to quantify the benefits of a scenario, a major HPAI outbreak in
Armenia, that did not (yet) materialize and for which solid empirical data are essentially
absent. It can, thus, only provide order-of-magnitude approximations. Moreover, the
project’s objective was to prepare the country for the eventuality of a major HPAI
outbreak, and with each passing year without such an outbreak the economic valuation of
the project diminishes because of discounting.
B. Project Costs
Project costs totaled US$10.5 million, comprising US$8.1 million from IDA and IDA-
administered Trust Funds and US$2.4 million equivalent from GOA. Annual
incremental recurrent O&M costs are assumed at 10% of the project investment costs,
which in turn were about 60% of total project expenditures in the human and animal
health sectors. The exchange rate used was US$1 = AMD 370. Conversion factors on
project costs were not used in this analysis.
Table 3.1: Project Costs (US$ ‘000)
2006 2007 2008 2009 2010 Total 2011-2025
(Annual)
IDA AIPP, Cr. 41780 42 1,862 988 1,352 1,112 5,355
IDA RESCAD, Cr. 40950 75 75
PHRD TF 56629 1 230 116 237 109 694
AHIF TF 58076 515 1,365 80 1,960
GOA 15 834 359 756 456 2,420
Total Project Costs 57 3,001 1,978 3,711 1,757 10,505
Recurrent incremental O&M costs 3 184 525 630 630
C. Project Benefits
The project benefits estimated are the cost of human hospitalizations averted, the income
losses avoided due to reduced rates of infection, hospitalization and deaths, and the
production losses of poultry meat and eggs averted. Other benefits, such as the much
improved capacity to detect and respond to other zoonoses and infectious diseases, or the
reduction in scale and cost of poultry culling and compensation programs due to better
surveillance and control measures are not considered. Secondary effects, such as the
prevention of abrupt and severe changes in poultry prices on farm incomes or consumer
incomes and of cross-price elasticity effects on other livestock subsectors were also
ignored.
It is assumed, for the base-case scenario, that a severe HPAI outbreak with a mutated
virulent virus would occur every five years, with the first one in 2011, after project
29
completion. The time period for the benefits stream being considered is 2011-2025. A
discount rate of 12% per annum and an exchange rate of AMD 370/US$ were used.
1. Human Health Benefits
The project’s main impact on human health is to decrease the percentage of the human
population infected by HPAI, thereby decreasing the number of hospitalizations required
and decreasing the number of deaths attributable to HPAI. The benefits are therefore
expressed in terms of loss avoidance and include:
(i) the economic value of hospitalization costs averted: AMD 42,000 for an
average stay of 7 days per hospitalized person;
(ii) the economic value of income loss avoidance from days lost due to illness:
assumes 25% of the affected population would lose 3 days of take-home income
and 50% of the hospitalized survivors would lose 30 days of income, at a daily
wage of AMD 5000;8
(iii) income loss avoidance from fatal HPAI cases: average take-home income of
AMD 105,000/month over 15 years for all HPAI deaths prevented.9
For the base case, the incidence if HPAI infection among the human population (Gross
Attack Rate) was estimated at 5%, with 10% of those affected requiring hospitalization
and 3% of those affected dying from the disease (the Without-Project scenario).10 The
With-Project scenario estimates are that only 2% of the population would be affected by
HPAI infection, with 10% of the affected being hospitalized and a death rate of only
1.5% among those affected.
2. Poultry Sector Benefits
There are close to 11 million poultry in Armenia, mostly chickens, but also some ducks,
geese, guinea fowl and turkeys. About 70% of these birds are kept by medium and small
farms and or in household backyards. It is in these two segments of the poultry that the
risk of HPAI outbreaks is highest, since biosecurity at the large commercial poultry farms
is quite good.
The project’s impact on the poultry industry is to decrease the number of poultry infected
by HPAI and, thus, the number of poultry deaths caused by HPAI. Economic project
benefits arise therefore in terms of loss avoidance. They include:
(i) the economic value of poultry meat production loss avoided: the number of
broiler poultry deaths averted at the average live chicken farmgate price of
AMD 1750 per live chicken, and assuming that 50% of the birds killed are
broilers to be used for meat;
8 The other 50% are assumed to be children and retirement-age adults.
9 The number of persons in this group is assumed to decline by 2% annually, reflecting normal mortality
rates. 10
Similar World Bank projects used, at appraisal, Gross Attack Rates as high as 30%.
30
(ii) the economic value of egg production losses avoided: an average of 150 eggs
per layer per year at a farmgate price of AMD 40 per egg, assuming that 50% of
poultry deaths are layer hens; and
(iii) the meat value of the layer hens at the end of their productive lives: assumed to
be 75% the value of a broiler.
For the present analysis, the poultry population affected by an outbreak (Gross Attack
Rate) of HPAI was estimated at 5% of the small farm and backyard poultry population --
a “low infection rate” scenario -- with a 100% mortality rate of the birds affected by
HPAI (the Without-Project scenario). In addition, an equal number of birds, in and
around the locations where HPAI outbreaks are confirmed, was assumed to be destroyed
through culling as a precautionary virus control measure.
The With-Project scenario assumes that only 2% of the small farm and household poultry
would be affected by HPAI and would die, and that an equal number would be destroyed
by the eradication program. The project can only affect the number of poultry that
become infected and that need to be culled, but it has no effect of decreasing the
mortality rate among the poultry flocks infected. As in the case of the human health
sector, the actual numbers of poultry affected by an HPAI outbreak are difficult to
estimate since there is little empirical information and a divergence of opinions within the
veterinary profession.
In the analysis, poultry production in the absence of an HPAI outbreak is assumed to
grow at a 2% annual rate.
D. Economic Rate of Return and Sensitivity Analysis
The analysis relates the project costs (Table 3.1) to the benefits from the economic value
stream of losses avoided as a result of project activities in human health and in the
poultry industry, expressed as the expected value of the economic loss avoided from an
outbreak occurrence once in three years during the period from 2011 to 2025. It is
expected that the benefits from the project expenditures on laboratories, equipment,
patient care facilities, public awareness programs and increased human capital will
continue to accrue over this entire 15-year period. The project investment costs were
incurred from 2006 to 2010.
The market prices used for poultry and poultry products are considered to be economic
prices, because the markets 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 3.2 presents the results of the economic analysis based on the above base case
assumptions and parameters for the combination of both human health and poultry sector
losses avoided. The results are quite robust, with a 53% IRR, a benefit-cost ratio of 4.5
and a NPV of US$42.4 million.
31
Table 3.2: Economic Returns and Sensitivity Analysis
Infection Rate
Humans
Mortality Rate
Humans
Infection Rate
Poultry 2006-2025
Scenario Without
project
With
project
Without
project
With
project
Without
project
With
project
NPV
(US$ mill.) IRR
C/B
ratio
1 outbreak every five years, first outbreak in 2011
1 (base case) 5.0 2.0 3.0 1.5 5.0 2.0 42.4 53 4.5
2 3.0 1.5 3.0 1.5 5.0 2.0 23.3 40 2.5
3 5.0 2.0 3.0 2.0 5.0 2.0 40.5 51 4.3
4 3.0 2.0 3.0 2.0 5.0 2.0 18.5 35 2.0
5 3.0 1.5 3.0 1.5 5.0 3.0 20.5 36 2.2
6 3.0 2.0 3.0 2.0 5.0 3.0 15.8 31 1.7
Only 50% of human health benefits attributed to the project
7 5.0 2.0 3.0 1.5 5.0 2.0 16.5 33 1.8
8 3.0 1.5 3.0 1.5 5.0 2.0 7.0 23 0.8
9 5.0 2.0 3.0 2.0 5.0 2.0 15.6 32 1.7
10 3.0 2.0 3.0 2.0 5.0 2.0 4.6 19 0.5
11 3.0 1.5 3.0 1.5 5.0 3.0 5.6 21 0.6
12 3.0 2.0 3.0 2.0 5.0 3.0 3.2 17 0.3
1 outbreak every three years, first outbreak in 2011
13 5.0 2.0 3.0 1.5 5.0 2.0 63.4 55 6.2
14 5.0 2.0 3.0 2.0 5.0 2.0 59.0 54 5.7
15 3.0 1.5 3.0 1.5 5.0 2.0 36.2 43 3.5
16 3.0 2.0 3.0 2.0 5.0 2.0 27.2 38 2.7
17 3.0 1.5 3.0 1.5 5.0 3.0 32.0 40 3.1
18 3.0 2.0 3.0 2.0 5.0 3.0 22.9 34 2.2
Only 50% of human health benefits attributed to the project
19 5.0 2.0 3.0 1.5 5.0 2.0 32.9 42 3.1
20 5.0 2.0 3.0 2.0 5.0 2.0 30.7 40 3.0
21 3.0 1.5 3.0 1.5 5.0 2.0 19.3 33 1.9
22 3.0 2.0 3.0 2.0 5.0 2.0 14.8 30 1.4
23 3.0 1.5 3.0 1.5 5.0 3.0 15.1 29 1.5
24 3.0 2.0 3.0 2.0 5.0 3.0 10.6 25 1.0
1 outbreak every seven years, first outbreak in 2011
25 5.0 2.0 3.0 2.0 5.0 3.0 28.0 42 2.7
26 3.0 1.5 3.0 1.5 5.0 2.0 16.2 33 1.6
27 3.0 2.0 3.0 2.0 5.0 3.0 9.7 25 0.9
Only 50% of human health benefits attributed to the project
28 5.0 2.0 3.0 2.0 5.0 3.0 11.1 27 1.1
29 3.0 1.5 3.0 1.5 5.0 2.0 6.3 22 0.6
30 3.0 2.0 3.0 2.0 5.0 3.0 1.9 15 0.2
The human health benefits substantially outweigh those in the poultry production sector.
The two parameters that drive the economic value of the human health benefits are (i) the
project impact on the percentage of the human population affected by HPAI infection,
32
and (ii) the project effectiveness in reducing the expected mortality rate from HPAI
infection. The effects of changes made in these parameters can be significant, as depicted
in Table 3.2. Nevertheless, even with parameters indicating relatively small
improvements in the percentage of the human population affected by HPAI and in the
number of human deaths attributable to HPAI, the returns remain robust. For example,
Scenario 4 with very low impact rates of the project on the percentage of the human
population affected and the number of human deaths still renders an IRR of 35%, a B/C
ratio of 2.0 and a NPV of US$18.5 million,.
Changes in the key parameters for the poultry industry have less impact on the overall
outcomes. This is illustrated in Scenarios 5 and 6.
The timing of likely HPAI outbreaks has a significant influence on the results of the
analysis, since benefits begin to flow at different times and/or at lesser frequency.
Estimates were therefore made also for scenarios with a new HPAI outbreak only once in
three years and only once in every seven years, with the first one occurring in 2011. As
shown in Scenarios 25 through 27, a reduced frequency of HPAI outbreaks considerably
reduces the aggregate benefit stream. By the same token, more frequent outbreaks raise
the economic value of project benefits, as Scenarios 13 through 18 illustrate.
Finally, there is the question of ascribing all human health benefits simply to the AIPP,
when there was also the important Health Systems Modernization Project under
implementation in Armenia at the time, along with a substantial public awareness
program supported by USAID. It may thus be argued that the AIPP cannot claim the
total economic value steam of losses avoided, especially in human health. Scenarios 7
through 12, 19 through 24 and 28through 30 reflect the assumption that only half of the
human health benefits are attributable to the AIPP. The returns remain quite robust,
except when the human health impact assumptions are greatly scaled down and there is a
low frequency of HPAI outbreaks.11
E. Conclusion
Project benefits are primarily driven by key assumptions regarding the gross attack rate
for the human population and for the mortality rate among those affected as well as by
the likely frequency of HPAI outbreaks. This is to be expected in a project that is
intended to prepare for a contingency for which neither timing nor severity can be
reliably predicted.
The non-robustness of the Gross Attack Rates and death rate estimates for both humans
and poultry make the economic analysis less convincing than desired. Nevertheless, the
overall benefits from the project in terms of the decrease in human suffering and deaths
11 Separate rates of returns for human health benefits and for benefits to the poultry industry are not
presented, because AIPP project activities are an integrated package which would not be undertaken
separately.
33
alone are significant and can be argued to justify this and other similar projects. The
economic returns are robust except under sensitivity analysis parameters that significantly
reduce the likely incidence of HPAI outbreaks and very severely restrict the project
benefits.
34
Annex 4. Bank Lending and Implementation Support/Supervision Processes
(a) Task Team members
Names Title Unit Responsibility/
Specialty Lending
Mark R. Lundell Lead Agricultural Economist ECSSD TTL
Frauke Jungbluth Senior Agricultural Economist ECSSD TTL
Arusyak Alaverdyan Operations Officer ECSSD Operations
Robert Bambauer Animal Health Specialist Cons. Animal health
Enis Baris Senior Health Specialist MNSHH Human health
Mario Bravo Senior Communications Officer EXTOC Communications
Amy Evans Safeguards Specialist ECSSD Safeguards
Artavazd Hakobyan Operations Analyst ECSSD Operations
Susanna Hayrapetyan Senior Health Specialist ECSH1 Human health
Arman Vatyan Senior Fin. Management Spec. ECSO3 Financial
management
Yingwei Wu Senior Procurement Specialist ECS ECA Procurement
Supervision/ICR
Frauke Jungbluth Senior Agricultural Economist ECSSD TTL
Brian G. Bedard Senior Livestock Specialist ECSSD TTL, animal health
Mario Bravo Senior Communications Officer EXTOC Communications
Amy Evans Safeguards Specialist ECSSD Safeguards
Artavazd Hakobyan Operations Officert ECSSD Operations
Susanna Hayrapetyan Senior Health Specialist ECSH1 Human health
Arman Vatyan Senior Fin. Management Spec. ECSO3 Financial
management
Yingwei Wu Senior Procurement Specialist ECS ECA Procurement
Gotz Schreiber Economist Cons. Compensation Fund
(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 23.43 83.42
FY07 0.01 0.07
Total: 23.44 83.49
Supervision/ICR
FY06 1.35 0.75
FY07 32.86 84.80
FY08 30.11 103.77
FY09 27.36 102.75
FY10 24.38 94.05
FY11 5.32 25.42
Total: 168.26 578.52
35
Annex 5. Beneficiary Survey Results
(if any)
n/a
36
Annex 6. Stakeholder Workshop Report and Results
(if any)
n/a
37
Annex 7. Summary of Borrower's ICR and/or Comments on Draft ICR
There were no significant comments from the borrower. The response from the
Government was as follows:
“I have reviewed ICR and I have no comments. It is fine from our point of view.”
Gagik Khachatryan
Agriculture Reform Support PIU
54B, Komitas ave.
Yerevan, PO 375014
Armenia
Phone: (37410) 297301, 297302, 297303
Fax: (37410) 297308
38
Annex 8. Comments of Cofinanciers and Other Partners/Stakeholders
N/A
39
Annex 9. List of Supporting Documents
1. Republic of Armenia, Avian Influenza Preparedness (AIP) Project, Project Appraisal
Document, World Bank, 1 May 2006, Report No. 35392-AM
2. Environmental Assessment and Management Plan for the Armenia Avian Influenza
Preparedness Project, Yerevan, 2006
3. Aide Memoires 2006-2010
4. Implementation Status Reports 2006-2010
5. Letters to the Government 2006-2010
6. MTR and Restructuring Documents
7. Project Operational Manual, Yerevan, August 2006
8. Armenia CJCS, “Implementation Completion Report” (Final Evaluation and
Preparation of Implementation Completion report on Behalf of the Government of
Armenia), Yerevan, July 2010
40
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