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Implementation Completion Report (ICR) Review - Avian Influenza Control And Human Pandemic Preparedness And Response Project For Nigeria


  
1. Project Data:   
ICR Review Date Posted:
09/04/2012   
Country:
Nigeria
PROJ ID:
P100122
Appraisal
Actual
Project Name:
Avian Influenza Control And Human Pandemic Preparedness And Response Project For Nigeria
Project Costs(US $M)
 62.20  49.90
L/C Number:
C4160
Loan/Credit (US $M)
 50.00  48.00
Sector Board:
Agriculture and Rural Development
Cofinancing (US $M)
   
Cofinanciers:
Board Approval Date
  03/29/2006
 
 
Closing Date
06/30/2009 05/31/2011
Sector(s):
General public administration sector (30%), Agricultural extension and research (24%), Health (24%), Animal production (13%), Other social services (9%)
Theme(s):
Rural services and infrastructure (29% - P) Other communicable diseases (29% - P) Health system performance (14% - S) Participation and civic engagement (14% - S) Other social protection and risk management (14% - S)
         
Prepared by: Reviewed by: ICR Review Coordinator: Group:
Robert Mark Lacey
Judyth L. Twigg Soniya Carvalho IEGPS1

2. Project Objectives and Components:

a. Objectives:
The project fell under the Global Program for Avian Influenza and Human Pandemic Preparedness and Response (GPAI). On page 12 of the Technical Annex to the Financing Proposal (which was the equivalent of a Project Appraisal Document), the project development objectives (PDOs) were stated to be as follows: “to support the efforts of FGN [Federal Government of Nigeria] to minimize the threat posed by H5N1 [a sub-type of the influenza A virus, which can cause illness in humans and in a variety of animal species] to humans and the poultry industry, and prepare the necessary control measures to respond to a possible influenza pandemic. The Project will also assist in preventing further spread of the HPAI [Highly Pathogenic Avian Influenza] to other parts of Nigeria not yet infected by the virus.

The statement of objectives in the Financing Agreement (page 4) is as follows: “to minimize the threat posed to the poultry industry and humans by HPAI infection and other zoonoses [infectious diseases that can be transmitted between animals and humans] and to prepare for, control, and respond to influenza pandemics and other infectious disease emergencies in humans.”
This Review uses the statement in the Financing Agreement because it goes beyond avian influenza to include other zoonoses and infectious disease emergencies.

b. Were the project objectives/key associated outcome targets revised during implementation?
No

c. Components:
There were four components:
A. Animal Health (US$29.20 million at appraisal, US$26.78 million at closure). This had seven sub-components: 1. Strengthening HPAI control and outbreak containment plans to eliminate the virus at the source. The subcomponent improved bio-safety by providing veterinary workers and poultry stakeholders at risk with equipment and with bio-security training for preventing and controlling HPAI outbreaks. 2. Strengthening disease surveillance, diagnostic capacity, and applied research to bring veterinary services up to World Organization for Animal Health standards. The subcomponent strengthened veterinary services, animal disease surveillance, and epidemiological analysis. It also upgraded diagnostic capacity to conduct polymerase chain reaction (PCR, a diagnostic technique) and serological testing by upgrading facilities at the National Veterinary Research Institute to Bio-security Laboratory Level 3 (BSL3) and upgrading five laboratories at veterinary teaching hospitals to Bio-security Laboratory Level 2 (BSL2). 3. Strengthening veterinary quarantine services to enforce quarantine regulations and improve inspection procedures by improving information transfer and training quarantine inspectors. 4. Strengthening applied veterinary research to conduct research and field studies on the epidemiology and disease dynamics of HPAI. 5. Enhancing legal and regulatory frameworks for trans-boundary disease prevention and preparedness capacity, by rapidly assessing national veterinary services, updating the National Emergency Contingency Plan for HPAI, and building human capacity. 6. Improving bio-security in poultry production and trade to facilitate a longer-term strategy for preventing and managing HPAI and other zoonoses through improved hygiene at live bird markets and bio-security regulations for commercial poultry farms. 7. Compensation and economic recovery through: (i) establishing a national compensation policy and national compensation fund; (ii) providing support to economically vulnerable groups; and (iii) providing alternative livelihoods for affected stakeholders based on demand-driven proposals.
B. Human Health (US$18.25 million at appraisal, US$18.17 million at closure). This had three sub-components: 1. Enhancing public health program planning, delivery, and coordination, including response coordination and management at the federal, state, and local government authority (LGA) levels; adapting and establishing appropriate public health legislation; addressing gaps in communication; and strengthening the capacity for effective preparation and supervision of implementation of the response plans. 2. Strengthening national public health surveillance systems to: (i) assess and strengthen the current Integrated Disease Surveillance and Response system to include HPAI; (ii) increase case detection through serological, epidemiological, and community-based surveillance; (iii) strengthen diagnostic capacities by establishing and upgrading laboratories; (iv) provide technical assistance to states and LGAs; and (v) support capacity building, participation in scientific meetings, and hospital mortality studies. 3. Strengthening health system response capacity by: (i) improving clinical care capacity through the procurement and distribution of drugs, vaccines, and other supplies; (ii) conducting seasonal influenza vaccinations; (iii) improving the provision of medical services; and (iv) developing guidelines on phased social distancing measures.
C. Social Mobilization and Strategic Communication (US$4.08 million at appraisal, US$4.00 million at closure). This component promoted public awareness, participation, and coordination in executing the emergency contingency plans outlined under the national influenza plan.
D. Implementation Support and Monitoring and Evaluation (US$6.89 million at appraisal, US$0.95 million at closure), for support to project management.
There were no changes to the components during implementation. There were some reallocations. By late 2009, since HPAI outbreaks had declined significantly, and demand for the large balance of US$ 6.3 million in compensation funds was consequently limited, the sum of US$ 4.8 million was reallocated to further improve bio-security measures, quarantine services, and surveillance, including construction of 11 additional model live bird markets (a good practice drawn from the Bank’s HPAI project in Vietnam). The remaining US$ 1.5 million was kept for compensation in the event of new HPAI outbreaks.

d. Comments on Project Cost, Financing, Borrower Contribution, and Dates
Project cost
Total project cost, at US$49.90 million, was 20% lower than the US$62.20 million at appraisal (which includes US$3.78 million in physical and price contingencies). The animal health component cost US$2.5 million (11%) less than foreseen, while the human health and communications components came out close to original estimates. Project management costs were substantially less than anticipated. Most of the savings in the project management component were, according to the ICR (footnote, page 21), “mainstreamed into the animal health and human health components.”
Financing
The project was entirely financed by the IDA Credit of US$50 million (US$48 million of which was disbursed) and the Borrower contribution of US$1.9 million.
Borrower contribution
The Borrower contribution was made entirely from reallocations from two ongoing IDA-supported projects, the Second National Fadama Development Project (FADAMA II, US$100 million, approved 2002) implemented by the Federal Ministry of Agriculture and Rural Development, and the Second Health System Development Project (HSDP II, US$127 million, approved 2003), implemented by the Federal Ministry of Health. To kick-start the implementation of the project under review (an emergency operation) before disbursements became available at effectiveness, initial allocations totalling US$12.2 million were made, US$7.2 million from FADAMA II and US$5.0 million from HSDP II. Of these, US$1.9 million were spent before the project became effective (US$0.7 million from FADAMA II and US$1.2 million from HSDP II).
Dates
In order to respond rapidly to the Government’s urgent request, the project was prepared under the Bank’s emergency guidelines (OP/BP 8.50). The concept note was reviewed in February, 2006; approval was in March, 2006; and the project became effective in June, 2006.
Following the mid-term review in May 2008, the project’s closing date was extended by 18 months from June 30 2009, to December 31, 2010. This was to enable a number of activities to be completed, in particular the setting up of medical and veterinary laboratories and piloting of four model live bird markets. However, these activities were still not completed by the new closing date, and in December 2010, a further five month extension was granted until May 31, 2011.


3. Relevance of Objectives & Design:

a. Relevance of Objectives:
Substantial

  • In early 2006, just before project preparation began, outbreaks of highly pathogenic avian influenza (HPAI) in poultry, caused by the H5N1 virus, were first reported in three Northern States of Nigeria. 300 outbreaks among poultry birds occurred between January 2006 and August 2008, and just over 750,000 birds were infected. The source of the virus was unknown, but it could have arrived in Nigeria through illegal poultry imports or through bird migration in the large wetland habitats in the North. This outbreak of HPIA, the first in Africa, posed a serious threat to Nigeria and other West and Central African countries, especially given the large cross-border trade in domestic poultry, both legal and illegal.
  • Nigeria’s capacity to prepare for, prevent, diagnose, and control HPAI outbreaks in poultry and humans was weak, especially its veterinary and health service delivery, disease surveillance, and diagnostics capabilities. The public sector managed a substantial share of animal health services, but those services had suffered as public budgets declined. It was, therefore, mainly private veterinarians, characterized by variable levels of qualification and service quality, who supplied and distributed veterinary drugs, vaccines, equipment, and livestock feed, in addition to providing routine clinical checks and preventive care for livestock.
  • In the human health sector, the referral system was weak and undeveloped, with few links between the primary and secondary sub-sectors. Inadequate financial resources for the health sector (US$ 2–3 per capita) caused drugs and medical supplies to become scarce and facilities to deteriorate. Diagnostics and surveillance faced several challenges, including incomplete and delayed reporting, poor logistical and communications support, and a lack of case definition and management protocols at surveillance sites.
  • The project’s objectives were, therefore, substantially relevant to the Government’s urgent need to control the outbreak and to improve its disease surveillance system. They were also consistent with Nigeria’s 2010-2013 Country Partnership Strategy (CPS) with the Bank Group, current at closure. The project supported CPS Pillar II (Improved Environment and Services for Non-oil Growth) by improving the delivery of veterinary services to prevent and control HPAI in the poultry industry, an important source of agricultural growth. It also supported Pillar I (Improved Service Delivery for Human Development) by strengthening the Federal Ministry of Health’s capacity to prevent and manage communicable diseases. The CPS specifically mentions (page 71) the project as an example of the Country Team’s ability to respond swiftly and flexibly to an emergency.

b. Relevance of Design:
Substantial.

  • Although the project objectives were generally lucid, there were, as noted in Section 2a above, some differences in scope between the statements in the PAD and in the Financing Agreement.
  • Project design was based on the Global Program for Avian Influenza and Human Pandemic Preparedness and Response template. However, the Results Framework in the Technical Annex (Appendix 10, pages 102-105) was adapted to take account of conditions in Nigeria.
  • The Results Framework presents a clear and logical causal chain between the activities financed by the project, the outputs these activities would produce and the outcomes which would measure the attainment of the objectives. For instance, with regard to animal health (component 1), the activities were expected to produce outputs such as a policy and legal framework meeting World Organization for Animal Health standards; reduced time for reporting suspected infections; a higher proportion of veterinary staff trained in awareness raising, monitoring, sampling, safety and test procedures; and a higher percentage of veterinary facilities meeting World Organization for Animal Health standards for diagnostic laboratories. These, reinforced by the social mobilization and strategic communications strategies supported by component 3, were intended to lead to strengthened animal disease control and awareness, more effective prevention policies and systems, improved disease information systems, availability of essential, modernized equipment in diagnostic laboratories, and augmented bio-security measures. If, despite reinforced prevention, there were to be evidence of animal infection, project outputs were expected to enable enhanced identification of, and response to, such infections, and their control and geographic containment.
  • Two exogenous factors that could affect outcome were partially taken into account. The possibility of lack of cooperation or whole-hearted participation by institutions operating in other sectors, or by other external and internal stakeholders, was to be addressed through inter-agency working groups and through established fora for coordinating the activities of external partners. The prospect of renewed infection originating in neighboring countries was indentified in the Technical Annex -- it is stated on page 3 that “laboratory diagnostic networking should include laboratories in neighboring countries and the West African sub-region.” However, the Results Framework contains no proposed activities of this sort to counter this threat.


  • 4. Achievement of Objectives (Efficacy) :

    The degree of achievement of the project development objectives -- to minimize the threat posed to the poultry industry and humans by HPAI infection and other zoonoses and to prepare for, control, and respond to influenza pandemics and other infectious disease emergencies in humans -- is discussed below under the headings of the three sub-objectives. 1. Minimize the threat posed to the poultry industry by HPAI infection and other zoonoses. Substantial
    Outputs
    • Six laboratories (the laboratories at the National Veterinary Research Institute and at five veterinary teaching hospitals) were renovated and equipped with capacity to diagnose HPAI. Only one such laboratory was so equipped before the project. In accordance with the target, all six are now able to diagnose HPAI using Real Time Reverse Transcription Polymerase Chain Reaction (RT-PCR) on poultry samples.
    • 6,709 veterinary staff (baseline 3,475, target 4,604) were trained in awareness raising, monitoring, investigating, sampling, safety and test procedures. 10% of trainees were in the public sector and 90% in the private sector. About 80% were in rural areas.
    • The project established a transparent compensation mechanism by registering all commercial and semi-commercial poultry farmers and disclosing the identity of the recipients.
    • The National Animal Disease Information and Surveillance network was set up, which collects information from 774 local government authorities (LGAs) and has placed global positioning system terminals in 400 high-risk LGAs.
    • Five veterinary teaching hospitals had been upgraded to bio-security level 2 (BSL2) by the end of May, 2011. Installation of a modular BSL3 laboratory at the National Veterinary Research Institute was incomplete at project closure, but the ICR states (Annex 2, page 22) that the equipment had arrived in Nigeria and was expected to be installed soon.
    • By September 2009, 44 (baseline 36, target 44) veterinary policy guidelines and pieces of legislation, which met World Organization for Animal Health standards, had been approved.
    • Bio-security was strengthened by establishing 14 model live bird markets in high-risk states, and training was provided to more than 8,000 commercial and semi-commercial poultry farmers.
    • Periodic reports on animal health were being submitted by 80% of all veterinary clinics and 100% of farms in at-risk areas. The baseline figures were 73% of clinics and 14.5% of farms. The target for clinics was achieved, and that for farms (70%) exceeded.
    • All 36 states and the FCT had adopted HPAI preparedness and response plans by January, 2007. 4,500 health workers and poultry farmers (baseline zero, target 4,500) in at-risk regions have adopted preventive measures.
    • 26 epidemiological surveys (baseline zero, target 30), including mortality, serology, and morbidity were undertaken in 25 States and the Federal Capital Territory (FCT). The ICR Data Sheet (page vi) says that this was below target because of the priority given to the 25 States where outbreaks had occurred. In addition, one nation-wide HPAI active disease survey was conducted in March 2007, and two targeted disease surveillance studies were performed at live bird markets in the at-risk areas.
    Outcomes
    • Due to a significant extent to project-supported interventions, Nigeria successfully contained 270 outbreaks of HPAI in poultry birds between June, 2006 and August, 2008.
    • The response time (from detection to diagnosis and containment) was reduced from 7–12 days in December 2007 to 24–48 hours in July 2008. The ICR states (page 11) that this was largely because the five veterinary laboratories in high-risk regions became, thanks to the project, capable of conducting seven HPAI tests recommended by the World Organization for Animal Health, thereby meeting their target. The National Veterinary Research Institute is capable of carrying out 13 of such tests.
    2. Minimize the threat posed to humans by HPAI infection and other zoonoses. Substantial.
    Outputs
    • All eight targeted public health facilities (one prior to the project) have been given capacity to diagnose and treat HPAI in humans, including carrying out RT-PCR on human samples. The laboratories are attached to respiratory intensive care units.
    • Antiviral drugs (100,000 doses of oseltamivir, baseline zero, no target) were made available, with supplies renewed when necessary, at targeted hospitals and other health facilities.
    • The project supported the development of a national communications strategy and formation of Public Enlightenment Committees in all 36 states and the FCT. Communications materials on H5N1 and H1N1 appeared in 24 languages or dialects. In all languages, 180 radio jingles were produced, 121 public awareness campaigns carried out, and 67 TV and 151 radio documentaries aired. Twenty-four fully fitted communications vans were procured and distributed to state communications desks.
    • Project-supported awareness increasing activities were implemented by the Federal Ministry of Information and Communication. The ICR reports (page 12) that the Ministry “developed a number of creative communications materials (such as mouse pads, aprons, and shopping bags) and disseminated messages effectively (for example, through Internet cafes, among passengers on commercial airlines, and at the model live bird markets).”
    Outcomes
    • Key health facilities in all 36 States and the FCT retain sufficient stocks of anti-viral drugs for avian influenza treatment. The percentage of health facilities that have not been out of stock of such drugs for at least a week rose from zero prior to the project to 100% from August 2007 onwards (the target was 100% from April, 2008).
    • The eight targeted health facilities have demonstrated their ability to diagnose and treat HPAI in humans in accordance with WHO standards, and to perform other virological diagnoses. The National Influenza Reference Laboratory scored 100 percent proficiency in WHO’s Global Influenza Surveillance Network quality assurance tests.
    • The ICR (page 12) estimates that the project increased general avian influenza awareness from 46 percent at baseline to to about 72 percent at project closure through a variety of communications activities. Five Knowledge, Attitude and Practice (KAP) surveys were carried out during implementation. The final KAP survey gathered information related to avian influenza from 4,000 respondents in 12 States in April 2011. It indicated a high degree of awareness and knowledge. 87% of respondents had heard of avian influenza, 80 percent had heard that birds were infected with avian influenza in Nigeria, and 94% were aware that avian influenza affected both birds and humans. Overall awareness of avian influenza symptoms in birds was 85%. 71% of respondents thought that control of avian influenza should not be left to the Government alone, and 82% considered that they themselves had a role to play. 71% realized that transporting birds and humans in the same vehicle would increase the risk of avian influenza exposure. 91% cited radio as their prime source of information, followed by television (86%) and the printed media (84%). 72% cited live bird and other markets (where public awareness efforts were intensive) as sources of information.
    • However, while the KAP results indicate a high level of general awareness, the gains must be consolidated – as the ICR (page 35) acknowledges: “Behavioral change should continue to be promoted through a follow-on project or sustained campaign over several years. The behavioral change achieved since 2006 must become strong enough to stand the test of time.”
    3. Prepare for, control, and respond to influenza pandemics and other infectious disease emergencies in humans. Substantial.
    Outputs
    • 18 national and local agencies (baseline zero, target 13) regularly report on, and monitor, avian influenza in Nigeria.
    • 2,436 public health workers (baseline zero, target 2,500) were trained in safety, surveillance and diagnostic methods for HPAI.
    • An inter-ministerial and inter-institutional mechanism for coordinating responses to HPAI had been established by February, 2006.
    • The eight targeted public health facilities (baseline zero, target eight) were provided with diagnostic equipment and materials in accordance with World Health Organization (WHO) standards by the end of November, 2010.
    Outcomes
    • There was only one confirmed human case of Avian Influenza in Nigeria (in February, 2007). No cases, human or animal, have been recorded since August, 2008.
    • It is reasonable to deduce that the project activities related to this and the other sub-objective played a major role in enabling the Nigerian Authorities effectively to contain not only avian influenza, but also swine influenza (H1N1). During an outbreak of the latter in 2009, Nigeria had eleven laboratory confirmed cases (and two confirmed deaths), considerably lower than many other African countries with much smaller populations.

    5. Efficiency:

    Efficiency is rated substantial.
  • At appraisal, project benefits were calculated (Technical Annex, pages 31-32) on the basis of estimates of losses prevented by the avoidance of a pandemic as well as reduced poultry industry losses. Although not all the containment of HPAI can be attributed to the project, the fact that its key outputs and objectives were substantially attained make it reasonable to assume that it played a significant role in the containment of the outbreak and of subsequent control, prevention and preparedness. Estimates by the Poultry Association of Nigeria indicated that losses from foregone poultry sales and uncompensated mortality totaled about 15.2 billion naira (roughly US$100 million equivalent) during the year ending February 28, 2007. Had the outbreak not been contained, this figure represents a likely minimum of the annual losses that would have been incurred in the poultry industry alone. The project costs (US$50 million) were thus half the value of the avoided losses. It is also probable that failure to contain, control and prevent HPAI outbreaks of at least the scale of those which actually occurred would have caused considerably greater losses, including those of human life. As it was, the poultry industry regained pre-HPAI (2005) levels of production and sales in 2010.
  • According to the ICR (page 12), investments in culled bird compensation, retraining farmers, and restocking poultry yielded an economic rate of return (ERR) of 18 percent. Investments in live bird markets yielded an ERR of 17 percent.
  • There are other indications of efficient use of project resources. Project management costs were substantially less than anticipated, and the savings were mainstreamed into the animal health and human health components. Although the project's closing date was extended for a little under two years, much of this was for the completion of activities beyond the scope anticipated at appraisal, including the establishment of four additional model live bird markets. Project activities were well coordinated with other international agencies operating in the field, and Ministries collaborated effectively at a technical level with a number of international agencies.
  • There were also some inefficiencies. Key activities, such as surveillance, compensation payments, and communications, were not delegated effectively at the State and local government authority levels. There were procurement-related delays throughout implementation (although, other than delays, no issues were reported and there were no cases of misprocurement). The Animal Health component suffered from high staff turnover. Coordination was moderately hindered by the Federal Ministry of Health’s preference for housing its project team in a different location from that of the Federal Ministry of Agriculture and Rural Development and Ministry of Information and Communications teams.

    a. If available, enter the Economic Rate of Return (ERR)/Financial Rate of Return at appraisal and the re-estimated value at evaluation:


  • Rate Available?
    Point Value
    Coverage/Scope*
    Appraisal:
    No
    %
    %
    ICR estimate:
    No
    %
    %

    * Refers to percent of total project cost for which ERR/FRR was calculated

    6. Outcome:

    The project’s key objectives of containing the 2006 HPAI outbreak and minimizing the immediate threat were achieved before the closing date was extended in May, 2008. The remaining activities concerned control and prevention, and preparedness and planning, which were continued until their completion. All three goals – response and containment, control and prevention, and preparedness and planning – were substantially achieved. Surveillance and diagnostic systems, institutional mechanisms, and facilities for human and animal health were improved, along with bio-security in registered commercial farms and live bird markets. The animal quarantine system was strengthened. Overall, it is highly probable that Nigeria is better prepared to respond to, prevent, and control HPAI and other zoonotic diseases. Relevance of project objectives and design is assessed as substantial, as is efficiency. Overall outcome is rated satisfactory.

    a. Outcome Rating: Satisfactory

    7. Rationale for Risk to Development Outcome Rating:

    Institutional. Because project implementation was mainstreamed through three line Ministries at the Federal, State, and local levels, and capacities in those institutions were enhanced through training, equipment, and transportation, there is a reasonable probability that the mechanisms developed through the project for preventing and controlling HPAI and other trans-boundary diseases will remain in place. The network of public health laboratories established under the new National Disease Control Center (NCDC) is an important achievement that should reduce risks to development outcomes. However, there is a moderate risk that standards will not be sustained, because regular monitoring of staff performance and retraining are needed to do so (while the ICR mentions this as a concern, it presents no evidence to suggest that such monitoring and retraining are not occurring). Financial. Institutional Budget lines have been, or are being, created at the Federal, State, and local levels to continue funding for control, prevention and preparedness for HPAI and other zoonotic diseases. The National Council on Health passed a resolution in May 2011 to sustain project structures at the State level. Each State is expected to provide funds to the desk offices to enable their operations to continue. The Federal Ministry of Health is expected to provide the budget to operate and maintain the structures and infrastructure created or strengthened under the project at the Federal level. Nevertheless, as time passes without an outbreak or threat of an outbreak, there is a moderate risk that budgeted resources may be diverted elsewhere.
    Private sector. The Fowl Sellers Associations have undertaken to maintain the 14 model live bird markets established through the project. The associations benefited significantly from the markets’ improved bio-security and food safety measures, which increased sales and economic returns. While no follow-on IDA projects are in the pipeline to fund zoonotic disease control and prevention in Nigeria, the proposed IDA-supported Fadama III Project plans to further the replication of model live bird markets by grouping together and training backyard poultry farmers. For enhancing bio-security on commercial and semi-commercial farms, IDA-supported projects in the agricultural sector are expected to provide continued support to keep risks to project outcomes in the low to moderate range.

    a. Risk to Development Outcome Rating: Moderate

    8. Assessment of Bank Performance:

    a. Quality at entry:

    • Project preparation incorporated key lessons derived from HPAI projects implemented in Vietnam and Kyrgyzstan and from the response to the HIV/AIDS epidemic. These included the need to: (i) ensure high-level political commitment and leadership; (ii) adopt a comprehensive, multisectoral approach; (iii) ensure buy-in from key stakeholders at all levels (particularly in the poultry market chain); (iv) ensure communication and outreach to facilitate preparedness among stakeholders; (v) develop a robust M&E system that can be relied upon when scaling up a response to national level; and (vi) develop strong fiduciary arrangements for financial management and procurement.
    • Given the emergency nature of the operation, funding was used (in the form of Borrower contribution) from ongoing IDA-supported projects in related areas (FADAMA II and HSDP II) to kick-start expenditures on project activities prior to effectiveness. The procurement capacity installed in these two projects was also used to meet urgent needs.
    • The response to the Government’s urgent request was appropriately rapid. The elapsed time from the Concept Review in February 2006, to effectiveness in June of the same year, was just over four months.
    • The need for an Apex Coordinator to synchronize the activities of the different agencies involved in the three project components was foreseen (a Chief Veterinary Officer was appointed), as were appropriate arrangements for harmonization of the contributions of the different external partners operating in the field.
    • Critical risks were identified and appropriate mitigation measures outlined (Technical Annex, pages 106-107). The overall risk rating was substantial, which was also the assessment of most of the individual risks. Three risks were rated as high – lack of continuing government commitment to addressing HPAI as a national priority, lack of laboratory capacity for prompt diagnosis, and rivalry between professionals in public institutions. This last was mitigated by mainstreaming project activity into existing institutional structures rather than establishing new ones.
    • Although the preparation team could not be expected to establish baseline data values in such a short period, the M&E system design, based on the Global Program for Avian Influenza and Human Pandemic Preparedness and Response model, could have been more complete and better structured (see Section 10 below).

    Quality-at-Entry Rating: Satisfactory

    b. Quality of supervision:

  • Project supervision was fairly intensive, with eleven formal missions in the five-and-a-half years between effectiveness and closure. In addition, the Task Team Leader and much of the task team was based in the Country Office in Abuja, and provided day-to-day support for implementation throughout the life of the project. The team was adequately staffed, with every mission including both human and animal health experts.
  • The team responded proactively to difficulties that had arisen during the first year of implementation. By March 2007, progress had slowed because key activities, such as surveillance, compensation payments, and communications, were not delegated effectively at the State and local government authority levels. The M&E system was not measuring progress adequately, and coordination among the three project components was insufficient. Steps taken during the mid-term review, in May 2008, to address these issues included reallocation of funds among expenditure categories to decentralize activities further, including the piloting of participatory disease surveillance at the community level, and the mainstreaming of project activities into State government institutions. The supervision team strengthened the M&E system and identified baseline values for most indicators. Ten new indicators were added to the results framework to monitor new activities. Following the mid-term review, implementation accelerated at the State and local government authority levels.
  • Also at the mid-term review, the decision was taken to pilot four model live bird markets (a good practice from the Bank-supported HPAI project in Vietnam), and the number of model markets was subsequently expanded to 14. All were fully functional by project closure.
  • The team demonstrated flexibility in the face of changing circumstances. For instance, when HPAI outbreaks declined significantly, resources were reallocated from compensation to other activities (see Section 2c above).
  • Project activities were well coordinated with other international agencies operating in the field, including UNICEF, WHO, the World Organization for Animal Health, the International Organization for Migration, and USAID.

  • Quality of Supervision Rating: Satisfactory

    Overall Bank Performance Rating: Satisfactory

    9. Assessment of Borrower Performance:

    a. Government Performance:

  • The Government maintained a high level of ownership in, and commitment to, the project. The risk, assessed as high, that HPAI containment, control and prevention would diminish as a national priority, did not materialize. The Government rapidly established inter-ministerial coordination bodies, one at policy level – the National Inter-ministerial Steering Committee on Avian Influenza (NISCAI) -- and the other at implementation level – the National Technical Committee on Avian Influenza (NTCAI). The first meeting of NISCAI was chaired by the President of Nigeria. There was some delay, however, in appointing the overall technical coordinator for the project in NTCAI, which was done only after the Mid-term Review.
  • The Government processed the credit rapidly and complied with its obligation to contribute US$1.5 million to the poultry farmers’ compensation fund.

  • Government Performance Rating: Satisfactory

    b. Implementing Agency Performance:

  • The implementing agencies were the three directly concerned Federal Ministries – Agriculture and Rural Development (FMARD), Health (FMOH), and Information and Communications (FMOIC)
  • The Ministries collaborated effectively at a technical level with a number of international agencies. FMARD worked closely with FAO, the World Organization for Animal Health, the International Food Policy Research Institute, and the International Livestock Research Institute (ILRI) in surveillance and various studies. FMOH collaborated effectively with the United States Centers for Disease Control and Prevention and the World Health Organization in promoting disease surveillance, strengthening diagnostic capacity, undertaking epidemiological surveys, and studies. Likewise, FMOIC coordinated communications activities and Knowledge, Attitude, and Practice surveys with several agencies.
  • The three Ministries facilitated decentralized implementation through technical training at the State, local government authority, and community levels, including training in detection and surveillance, diagnostics, and communications outreach.
  • Although only one human case of HPAI was confirmed in Nigeria, FMOH used the project as an opportunity to strengthen its capacity in surveillance, diagnostics, and case management of all communicable diseases.
  • There were procurement-related delays throughout implementation. Although some improvement took place over time as the Human Health Component benefited from a high level of support for removing bottlenecks in FMOH’s procurement procedures, the Animal Health Component remained problematic throughout and suffered from "staff turnover and the absence of a procurement officer for about five months in mid-2010” (ICR, page 9). Financial management had some initial shortcomings, but had improved by the later stages of implementation (see Section 11 below).
  • FMOH’s preference for housing its project team in a different location from that of the FMARD and FMOIC teams was a moderate hindrance to coordination.

  • Implementing Agency Performance Rating: Moderately Satisfactory

    Overall Borrower Performance Rating: Moderately Satisfactory

    10. M&E Design, Implementation, & Utilization:

    a. M&E Design:
    The M&E system designed in the Technical Annex (pages 30-31 and Annex 10, Table 9) was based on the Global Program for Avian Influenza and Human Pandemic Preparedness and Response template. It was thorough -- all outcome and intermediate outcome indicators (12 of which were added during implementation) had targets, and all but two of the original intermediate outcome indicators had baselines. There were, however some shortcomings. There were only three outcome indicators and too many (35) intermediate outcome indicators. The outcome indicators did not measure all dimensions of the PDOs. Some of the intermediate indicators (for instance, evidence of upgraded bio-security in live bird markets, and a reduction in reporting and response time) would have been more appropriately included among PDO outcome indicators. M&E activities were to be the responsibility of already existing structures at the Federal Ministries of Agriculture and Rural Development, and of Health, that had been built up under the ongoing FADAMA II and Second Health System Development Projects respectively. These activities would be carried out by the regular staff of these agencies (with
    technical assistance where necessary) or by specialized institutions contracted for the purpose.

    b. M&E Implementation:

    • The ICR reports (page 8) that the shortcomings in M&E system design were rectified during implementation. Baseline and target values were established for most indicators. Progress towards each objective was measured, and most indicators used were relevant.
    • In its initial stages M&E implementation was limited to collecting data and reporting quantitative information. According to the ICR (page 8), the system improved over time through close collaboration among the agencies responsible for each of the three components. Original and additional indicators were updated regularly, and more qualitative assessments were also made. At the Mid-term Review, ten new indicators were added to assess more accurately institutional capacities in decentralized surveillance and bio-security enhancement.
    • The level of awareness and degree of response among various stakeholders was measured by five Knowledge, Attitude and Practice (KAP) surveys undertaken during implementation by the project in collaboration with international agencies active in other HPAI projects. These ensured feedback from various target groups. Groups surveyed included the general public, poultry producers, intermediaries, transporters, traders, retailers, veterinary staff, and public health workers.

    a. M&E Utilization:
    The information collected by the project’s M&E teams and through the KAP surveys was used for quarterly project reports and shared regularly with IDA’s supervision missions. M&E data and analyses were used to inform project implementation, though there is no indication in the ICR that they also informed policy making.

    M&E Quality Rating: Substantial

    11. Other Issues:

    a. Safeguards:
    Environment. The project was classified as Category “B,” and OP 4.01 (Environment) was triggered, mainly in relation to medical and veterinary waste management. The ICR (page 8) reports that Medical Waste Management and Environmental Management Plans (the latter covering veterinary waste management) were finalized in January and February 2007 respectively, and were adopted by the Federal Government. Veterinary waste management included carcass disposal at culling sites and waste disposal at live bird markets. Medical waste management focused on clinics and hospitals. The plans were revised and updated after the experience gained during the HPAI outbreaks in 2006 and 2007 had been converted into usable data. Implementation plans and standard operation procedures were prepared thereafter, periodically revised in the light of ongoing experience with containing outbreaks, and finalized by July 2010. Livestock development officers and health workers received training on the preparation and implementation of the plans. Social. Although social safeguards were not triggered (Technical Annex, page 97), the ICR (page 6) reports that the HPAI outbreaks, which peaked in the first quarter of 2007, killed more than two million poultry birds – about 754,000 were infected and more than 1.26 million were culled. About 3,000 poultry farms and farmers were affected and received in compensation 631 million naira, equivalent to approximately US$2.03 million, of which US$1.5 million came from the Government’s own resources. The ICR states (page 15) that the compensation process was transparent. On page 18, it further states that “to facilitate accountability and transparency in the use of compensation funds, all commercial and semi-commercial poultry farmers were registered with FMARD [the Federal Ministry of Agriculture and Rural Development] and trained in promoting bio-security at the farm level. For backyard poultry owners, communities formed ad hoc committees to supervise culling and determine compensation. Compensation was disclosed on the project website as well as in the communities. Nigeria adopted the modified stamping out policy, which included the payment of compensation and encouraged poultry owners to report suspicious cases promptly. The compensation regime considered both the age and stage of production of each bird and is one of the best practices for controlling HPAI outbreaks.”

    The ICR states (page 8) that “the project complied fully with environmental and social safeguard management plans.”

    b. Fiduciary Compliance:
    With regard to financial management and auditing, the ICR states (page 8) that over time, project accounting and reporting improved at both FMARD and FMOH. The hiring of an oversight financial consultant helped improve coordination between the two ministries. Both FMARD and FMOH had adequate fund flow arrangements and no overdue external audit reports.” There is no clear statement of compliance with Bank fiduciary policies, and no indication as to whether or not external project audits were qualified.
    Concerning procurement, the ICR reports (page 9) that delays were experienced throughout implementation, particularly in procuring civil works and equipment for the 14 veterinary and public health laboratories. Some of the delays were due to complexity, but they were mostly stemming from weak procurement capacity in the implementing agencies, especially those concerned with animal health. Other than delays, no issues were reported, and there were no cases of misprocurement.

    c. Unintended Impacts (positive or negative):
    None reported.

    d. Other:



    12. Ratings:

    ICR
    IEG Review
    Reason for Disagreement/Comments
    Outcome:
    Satisfactory
    Satisfactory
     
    Risk to Development Outcome:
    Moderate
    Moderate
     
    Bank Performance:
    Satisfactory
    Satisfactory
     
    Borrower Performance:
    Satisfactory
    Moderately Satisfactory
    Procurement weaknesses persisted throughout implementation. There were coordination issues between FMOH, FMARD, and FMOIC, and financial management problems in the initial stages. 
    Quality of ICR:
     
    Satisfactory
     
    NOTES:
    - When insufficient information is provided by the Bank for IEG to arrive at a clear rating, IEG will downgrade the relevant ratings as warranted beginning July 1, 2006.
    - The "Reason for Disagreement/Comments" column could cross-reference other sections of the ICR Review, as appropriate.

    13. Lessons:
    Most of the lessons in the ICR, while useful, are specific to the project. IEG has drawn the following lessons of more general applicability from the experience of preparing and implementing this operation:
    • Preparation of operations based on a template (here, that of the Global Program for Avian Influenza and Human Pandemic Preparedness and Response)should ensure that the template is adequately adapted to take account of country realities. In this case, care was taken to do this, particularly with regard to securing stakeholder buy-in and implementation arrangements.
    • For an emergency operation, the use (with the agreement of the Borrower) of both financial and technical resources from other ongoing Bank-supported operations in related fields and sectors can help to provide a “jump start” and get activities in motion before effectiveness. Here, this was done by reallocations (only a part of which needed to be used) from the Second FADAMA Project in rural development and the Second Health System Development Project. Procurement and M&E arrangements from these two operations were also used.
    • Transparency and effectiveness of compensation schemes can be assisted by full disclosure of the identity of the recipients, encouraging reporting of outbreaks, and some self-policing by communities of distribution of compensation among smaller beneficiaries.
    • Containment, control and prevention of epidemics can benefit substantially from heightened public awareness. Awareness creation is likely to be enhanced if campaigns are conducted in a professional manner by institutions with the requisite experience, country knowledge and technical expertise. Here, the fact that the public awareness component was implemented by specialists within the Federal Ministry of Information and Communication was, according to the ICR (page 12), an important reason for the campaign’s success.
    • Application of proven good practices elsewhere can be a positive contribution to a project's success and sustainability. In this case, the adoption of the concept of model live bird markets, which had worked well in Vietnam, and its adaption to Nigerian conditions assisted the country’s efforts to address zoonotic disease epidemics.

    14. Assessment Recommended?

    Yes
    Why?
    An assessment would serve as an input as a comparative study of the lessons to be learned from the Bank's response to the Avian Influenza threat. Nigeria's case is of particular interest since, unlike many other countries, it actually suffered from an outbreak and used the compensation fund for its intended purposes.

    15. Comments on Quality of ICR:

    The ICR is thorough and clearly written. The discussion of outcomes is evidence-based. More detail on the avian influenza-related activities supported by other external partners would have been useful, particularly in helping to clarify the project’s relative contribution to the containment of the 2006-2007 outbreaks. The discussion of financial management and auditing should have been more detailed, especially for a governance-challenged country, and there is no statement as to whether or not auditors’ opinions were qualified.

    a. Quality of ICR Rating: Satisfactory

    (ICRR-Rev6INV-Jun-2011)
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