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Implementation Completion Report (ICR) Review - Avian And Human Influenza Control And Preparedness Project


  
1. Project Data:   
ICR Review Date Posted:
09/10/2013   
Country:
Laos
PROJ ID:
P100081
Appraisal
Actual
Project Name:
Avian And Human Influenza Control And Preparedness Project
Project Costs(US $M)
 13.56  10.4
L/C Number:
CH243
Loan/Credit (US $M)
 4.0  3.9
Sector Board:
Health, Nutrition and Population
Cofinancing (US $M)
 9.56  6.4
Cofinanciers:
Japan, Multi-donor Avian and Human Influenza Trust Fund Facilitiy
Board Approval Date
  06/29/2006
 
 
Closing Date
09/30/2010 06/30/2012
Sector(s):
General public administration sector (35%), Health (29%), Agricultural extension and research (20%), Animal production (12%), Other social services (4%)
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:
Judith Hahn Gaubatz
Denise A. Vaillancourt Christopher D. Gerrard IEGPS2

2. Project Objectives and Components:

a. Objectives:


    According to the Grant Financing Agreement (page 6) and the Project Appraisal Document/Technical Annex (page 4), the project objectives were as follows:
      • To contribute to the Government's National Plan which aims to minimize the threat posed to humans and the poultry sectors by highly pathogenic avian influenza (HPAI) infection and other zoonoses; and
      • To prepare for, control, and respond to influenza pandemics and other infectious disease emergencies in humans.

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

c. Components:
The Project's five components were aligned with the five parts of the Government's National Avian Influenza Control and Pandemic Preparedness Plan (2006-2010).

1. Animal Health (Appraisal: US$5.35 million; Actual: US$5.55 million): This component aimed to control avian influenza infection in poultry, in accordance with technical guidance from international agencies. Activities included: capacity building for diagnosis and early detection, training of village veterinary workers, and funds for a compensation mechanism for farmers due to destroyed poultry.

2. Human Health - Surveillance and Response (Appraisal: US$1.1 million; Actual: US$0.41 million): This component aimed to improve surveillance of human influenza outbreaks and establish mechanisms for response. Activities included capacity building to improve the surveillance system and to assess the effectiveness of public health measures.

3. Human Health - Curative Services (Appraisal: US$2.54 million; Actual: US$1.73 million): This component aimed to strengthen the public health system's response in the event of an outbreak. Activities included: development of pandemic preparedness plans, construction/renovation of two laboratories, and improvements in laboratory quality control.

4. Information, Education and Communication (Appraisal: US$1.87 million; Actual: US$0.05 million): This component aimed to support the development and dissemination of a national awareness campaign on avian influenza. Activities included: translation of communications into local languages, and conducting of knowledge, attitudes, and practices (KAP) surveys.

5. Program Coordination and Regulatory Framework (Appraisal: US$2.69 million; Actual: US$2.66 million): This component aimed to support coordination of multisectoral activities. Activities included: a review of existing regulations, programmatic research, and operational support for the National Emerging Infectious Diseases Coordinating Office.

d. Comments on Project Cost, Financing, Borrower Contribution, and Dates

Project cost

    • The appraised project cost was US$13.56 million.
    • The actual project cost was US$10.4 million, lower than appraised due to the absence of significant influenza outbreaks.
    • Actual costs of some project components varied significantly from the appraised costs. This was in part due to the unpredictable nature of the outbreaks (or lack thereof), and in part due to the Bank's intentional role as "financier of last resort" for the National Plan (see below). According to the ICR (page 9, Table 1), USAID and the Asian Development Bank allocated US$1.4 million for Component 2 -related activities; AFD and Institute Pasteur allocated US$4.6 million for Component 3 - related activities;and UNICEF and Academy for Education Development allocated US$2.9 million for Component 4 - related activities.

Financing
    • The project was financed by the World Bank and other donors, including through a multi-donor Avian and Human Influenza Facility (AHIF). The Bank financing of US$4.0 million came in the form of an IDA grant for emergency response lending, under the Bank's Global Program for Avian Influenza umbrella program.
    • Co-financing from other donors included a Japanese Policy and Human Resource Development (PHRD) grant for US$2.0 million and two co-financing grants from the AHIF, one for US$2.0 million and the other for US$2.4 million.
    • As the Bank intentionally took on the role of "financier of last resort", this led to some delays in disbursement of Bank funds, as well as frequent re-allocations by category. This was in part due to the Borrower's decision to utilize time-bound funds from other donors first, leaving the Bank project funds to disburse last. The ICR notes (page 13) that although this arrangement was "a complicating factor in terms of disbursements," it was ultimately of benefit to the country due to its flexibility.

Borrower contribution
    • There was no planned borrower contribution.

Dates
    • November 2008: The financing agreement was revised to adjust financing percentages between IDA and the AHIF.
    • July 2009: The project closing date was extended to allow completion of project activities.
    • June 2011: Several project indicators were revised to better capture project outcomes, and the project closing date was extended a second time to June 2012, to allow completion of civil works projects.


3. Relevance of Objectives & Design:

a. Relevance of Objectives:
Substantial. The project objectives were substantially relevant given the emergence of avian influenza as a global threat. By the end of 2006, 55 countries had reported avian influenza cases in poultry, including all the countries neighboring Lao PDR. The potential economic costs to the country due to the negative impacts on the poultry industry and rural livelihoods, along with the potential impact on human health, were considered significant. Country capacity for surveillance, outbreak responses and human health services was assessed by the PAD to be practically nonexistent. Therefore, there was a clear need for a rapid, coordinated response. The project objectives were fully consistent with the Bank's newly approved Global Program for Avian Influenza Control and Human Pandemic Preparedness and Response, as well as the country's National Plan for Avian Influenza Control and Preparedness. While the Bank's Country Partnership Strategy for FY12-16 does not explicitly prioritize epidemic preparedness, it is considered part of the cross-cutting theme to improve public sector management and alleviate poverty.

b. Relevance of Design:

Substantial. Project interventions - both for immediate animal infection control and preparedness for potential human outbreaks - were likely to lead to the intended outcomes. The project design was consistent with technical guidance from the World Organization for Animal Health, the World Health Organization, and the Food and Agriculture Organization. Livestock disease surveillance and veterinary care capacity were very low at the time of project appraisal, and thus project activities were strongly focused on capacity building in these spheres. Increasing immediate public awareness was also a critical project intervention to ensure control of the infection.


4. Achievement of Objectives (Efficacy) :

The project financed approximately 30% of the National Plan, and therefore the contribution of the project to overall program results is significant.

To minimize the threat posed to humans and the poultry sectors by avian influenza (AI)
Substantial, due to evidence of the limited spread of AI.

Outputs

    • Training of farmers and village veterinary workers on prevention measures and biosecurity improvement.
    • Training of commercial poultry producers, slaughter house and slaughter point workers on biosecurity improvement.
    • Development of AI communication strategy, including outreach efforts to school children, women, farmers, veterinary workers, and the general public.
    • Conducting of knowledge, attitudes and practices (KAP) surveys, including the baseline survey in 2006 and the endline survey in 2011.
    • Development of an animal health strategy and regulations, including management of AI risks, training guidelines, and movement restrictions of poultry flocks.
    • Implementation of a compensation mechanism for destroyed poultry, in order to encourage prompt and complete disease reporting.
    • Establishment of a telephone hotline to report suspected cases.

Outcomes
    • 100% of districts remained free of avian influenza outbreaks in the poultry sector. Ten outbreaks affecting 18 districts were reported during the project period but were effectively controlled to prevent further spread.
    • 98% of "backyard" poultry farmers had knowledge of AI by the next-to-last year of the project period, achieving the target of 95%. This declined to 92% during the last year of the project. The ICR (Data Sheet) suggests that due to the absence of outbreaks in the last year, public awareness and interest in AI may have declined.
    • 68% of "backyard" poultry farmers were doing at least 3 things to protect their poultry and/or family from AI, surpassing the target of 50%. In 2006, only 12% of farmers were doing at least 3 things for protection.
    • Among the general population, the share of people who know about AI increased from 57% to 92% by project closing. The share of people who know at least 3 ways to protect their poultry from contracting AI increased from 27% to 59%. The share of people who know at least 3 ways to protect themselves and their families from contracting AI or how AI can spread to humans increased from 38% to 86%.

To prepare for, control, and respond to influenza pandemics and other infectious disease emergencies in humans
Substantial, due to evidence of relevant and timely surveillance activities.

Outputs
    • Provision of training to laboratory staff and surveillance officers on AI and other influenza viruses.
    • Provision of training and equipment to provincial level rapid response teams.
    • Provision of training to health facility staff on infection control and case management.
    • Establishment of multisector AI teams and development of provincial pandemic preparedness plans in all provinces.
    • Construction of the National Animal Health Center and renovation of the National Center for Laboratory and Epidemiology.

Outcomes
    • 94% of provinces were sending weekly surveillance reports on various infectious diseases in a timely manner, surpassing the target of 85%.
    • 100% of suspected AI cases were investigated within 24 hours by the next-to-last year of the project period (no suspected cases were reported in the last year).
    • 100% of targeted influenza specimens were tested, surpassing the target of 80%.
    • 88% of trained staff demonstrated correct knowledge on infection control and case management, surpassing the target of 75%.

5. Efficiency:

Substantial. As noted in the ICR (page 16), the project's investment in early detection and control of AI (and other influenza viruses) can be viewed as low-cost "insurance" against potential future outbreaks. These potential outbreaks could have led to significant economic costs due to negative impact on the poultry industry and rural livelihoods, as well as health impact on humans. All critical prevention activities were completed early in the project period, contributing to the reported outcomes on prevention.

Additional aspects of the project that likely led to substantial efficiency was (i) prioritization of provinces according to highest human and poultry densities, and (ii) coordination of activities with donors such as use of common training materials.

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:


Relevance of the project objectives and design are rated Substantial. Achievement of the objective to minimize the threat posed to humans and the poultry sectors by avian influenza (AI) is rated Substantial, due to evidence of the limited spread of AI. Achievement of the objective to prepare for, control, and respond to influenza pandemics and other infectious disease emergencies in humans is also rated Substantial, due to evidence of relevant and timely implementation of surveillance activities. Efficiency is rated Substantial.


a. Outcome Rating: Satisfactory

7. Rationale for Risk to Development Outcome Rating:


Funding for certain avian influenza prevention activities is no longer being provided, such as the compensation scheme, training of village veterinary workers, and laboratory operations. This will pose high risk to outcomes if the avian influenza virus re-emerges. Although the project aimed to strengthen country systems for overall infectious disease control, technical capacity in the National Emerging Infectious Diseases Coordinating Office is unlikely to be sustained as the staffing was mainly consultants funded by donors.

a. Risk to Development Outcome Rating: High

8. Assessment of Bank Performance:

a. Quality at entry:

The project design drew upon global expertise to refine the government's National Plan, as well as the Bank's operational experience with emergency response and disease control programs. Donor coordination and inter-ministerial coordination was substantial given the multi-sectoral nature of the project design (i.e. affecting the agriculture sector and the health sector). Project implementation arrangements were highly detailed to mitigate identified risks such as inadequate local capacity, decrease in government commitment, and misuse of the compensation scheme. However, the issue of financial sustainability of the interventions beyond the project period received limited attention. The M&E framework was aligned with the National Plan's M&E framework, which relied on a single reporting system of the government, and included several KAP surveys to monitor progress on public awareness and behavior.

Quality-at-Entry Rating: Satisfactory

b. Quality of supervision:

The Bank team demonstrated a significant degree of responsiveness and flexibility during the project period, as reflected by the various financing reallocations due to changing support from donors and changing priorities of the National Plan in response to the evolving outbreak situation. Communication interventions were also well adjusted to changing circumstances and knowledge (gained from the KAP surveys). Donor coordination was effective, as evidenced by the fact that donors "adopted a good practice of harmonization among themselves, to promote transparency, effectiveness, and consistency of their technical and financial support" (ICR, page 8). The Bank led annual Joint Implementation Reviews with donors and the government, which played an important role in monitoring and coordinating donor support. However, the ICR does not explore whether the Bank identified and attempted to mitigate threats to the sustainability of the project's investments, especially given its role of coordinator of partners and interlocutor with government, and the opportunities presented by the Joint Reviews. There were some initial difficulties in the construction/renovation of the Animal Health Center and National Laboratory, caused by the preparation of technical specifications by one agency but construction and supervision by another agency. These issues were eventually resolved although the project period had to be extended to allow completion of the civil works. There were no major fiduciary or safeguards problems reported.

Quality of Supervision Rating: Satisfactory

Overall Bank Performance Rating: Satisfactory

9. Assessment of Borrower Performance:

a. Government Performance:

The government demonstrated strong commitment from the project preparation stage. A National Plan was already in draft form before the project began preparation. Provincial level plans were developed as part of the project's activities. The government's strong support for a coordinated donor framework contributed to the effective implementation of the National Plan.

Government Performance Rating: Satisfactory

b. Implementing Agency Performance:

The Ministry of Agriculture and Forestry, as well as the Ministry of Health, both implemented major components of the project and were effective in sharing information and coordinating activities, according to a joint memorandum signed in 2008. The National Emerging Infectious Disease Coordinating Office oversaw project management and was effective in implementing all planned activities, including M&E. Although there were some delays in civil works activities, overall there were no major fiduciary or safeguards problems reported.

Implementing Agency Performance Rating: Satisfactory

Overall Borrower Performance Rating: Satisfactory

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

a. M&E Design:

The project's M&E indicators were based on the National Plan's M&E framework, in an effort to harmonize donor and government efforts. Indicators were well-defined, including baseline and target values. The M&E design included KAP surveys to monitor progress of communication and prevention interventions.

b. M&E Implementation:

Project indicators were regularly monitored and informed progress on implementation and the achievement of outcomes. Indicators were refined during the project period to reflect changes in the outbreak situation. Three KAP surveys were conducted as planned.

a. M&E Utilization:

The ICR (page 10) reports that the government and partners utilized the M&E data, as well as the annual implementation reviews, to monitor progress and inform adjustments to the National Plan.

M&E Quality Rating: Substantial

11. Other Issues:

a. Safeguards:

The project was classified as an Environmental Category "B" project due to potential noise and pollution issues associated with the civil works projects. The safeguard policy on Environmental Assessment (OP/BP 4.01) was triggered. The ICR (page 11) reports that supervision at the construction sites "initially revealed a lack of adherence to proper environmental construction etiquette," but that these shortcomings were subsequently addressed. A health case waste management study was also conducted; however, there were delays in the completion of the study which led to delays in the procurement and installation of waste management equipment.

The Indigenous Peoples safeguard policy (OP/BP 4.10) was also triggered due to planned outreach activities to ethnic populations (which intended to ensure that all information about the disease risks and prevention were available in local languages and in formats understandable by those communities). The KAP survey results reflected the satisfactory implementation of these activities.

b. Fiduciary Compliance:

Procurement: Bank procurement staff provided effective support during the project period, including gathering baseline data for a logistical system and providing training to implementing agency staff. There were no major procurement problems reported in the ICR, aside from some minor shortcomings in the timely filing of documents.

Financial management: The ICR (page 12) reports that all financial audits were submitted in a timely manner and were unqualified. However, there was one instance of ineligible expenditures: per diems were provided for personnel during the South-East Asia Games that were not in accordance with the FM manual. The full amount concerned (US$17,724) was subsequently refunded to the Bank and cancelled from the grant.

c. Unintended Impacts (positive or negative):

d. Other:



12. Ratings:

ICR
IEG Review
Reason for Disagreement/Comments
Outcome:
Satisfactory
Satisfactory
 
Risk to Development Outcome:
High
High
 
Bank Performance:
Satisfactory
Satisfactory
 
Borrower Performance:
Satisfactory
Satisfactory
 
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:

Lessons drawn from the ICR (page 29-30), with adaption from IEG:
    • A more formalized arrangement among the Bank's sector units can help to ensure multi-sector collaboration and input, and minimize the risk of misalignment of sector approaches. In the case of this project, the HNP sector team had sole formal project management responsibility but could have benefited from involvement of the agriculture sector, given that a significant portion of the National Plan was implemented by the Ministry of Agriculture.
    • The transition from emergency response to longer-term systemic improvements should be a consideration in project design, including in situations where disease prevention efforts are successful and thus commitment to prevention efforts begins to wane. In the case of this project, the risk of a significant decline in donor resources and technical support following the end of the emergency was not considered or effectively mitigated.

14. Assessment Recommended?

No

15. Comments on Quality of ICR:

The ICR was clearly and concisely written. Data on outputs and outcomes were well utilized in the analysis of project achievements. Lessons were well drawn from project experience and articulated for future application.

a. Quality of ICR Rating: Satisfactory

(ICRR-Rev6INV-Jun-2011)
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