Document of The World Bank

FOR OFFICIAL USE ONLY

Report No: T7667

TECHNICAL ANNEX

PROPOSED CREDIT

IN THE AMOUNT OF SDR 34.9 MILLION (US$50 MILLION EQUIVALENT)

TO THE

FEDERAL REPUBLIC OF NIGERIA

FOR AN

AVIAN INFLUENZA CONTROL AND HUMAN PANDEMIC PREPAREDNESS AND RESPONSE PROJECT

UNDER THE

GLOBAL PROGRAM FOR AVIAN INFLUENZA AND HUMAN PANDEMIC PREPAREDNESS AND RESPONSE (GPAI)

March 14,2006

Environmental, Rural and Social Development Central Africa (AFTS3) Country Department 12 Africa Regional Office

This document has a restricted distribution and may be used by recipients only in the performance of their official duties. Its contents may not otherwise be disclosed without World Bank authorization.

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CURRENCY EQUIVALENTS

(Exchange Rate Effective February 28,2006)

ADP AfDB A1 AICP APAs APL AVO CAS CBPP CC CDC CPAR CPS CQ CSSC CTA CVSN DFID DIVA EIA EIG EMP ERA ERC ERGP ERL EU Fadama I1 FA0 FCA FGN FLD&PCS FMARD FMD FMF FMOH

Currency Unit = Nigerian Naira (NGN) N128.20003 = US$1 US$1.43559 = SDR 1

FISCAL YEAR January 1 - December 31

ABBREVIATIONS AND ACRONYMS

Agricultural Development Program Africa Development Bank Avian Influenza Avian Influenza Control and Human Pandemic Preparedness and Response Project Approved Proposals and Agreements Adaptable Program Loan Area Veterinary Officer(s) Country Assistance Strategy Contagious Bovine Pleuro-pneumonia Component Coordinator United States Center for Disease Control and Prevention Country Procurement Assessment Report Country Partnership Strategy Consultant Qualification Community Stamping-out Supervision Committee Community Thematic Association College of Veterinary Surgeons of Nigeria Department for International Development Differentiation of Infected from Vaccinated Animals Environmental Impact Assessment Economic Interest Group Environmental Management Plan Emergency Recovery Assistance Emergency Recovery Credit Economic Reforms and Governance Project Emergency Recovery Loan European Union Second National Fadama Development Project Food and Agricultural Organization Fadama Community Association Federal Government of Nigeria Federal Department of Livestock and Pest Control Services Federal Ministry of Agriculture and Rural Development Foot and Mouth Disease Federal Ministry of Finance Federal Ministry of Health

FOR OFFICIAL USE ONLY

FMR FPM GDP GIs GP A1 GPN H5N1 HIVIAIDS HPAI HPPR HSDP I1 IBRD ICB IDA IDF IDSR IEA ILI IS A ISR JIC A LFD LGA LGD LGTC M&E MAP NAPA NCB NEEDS NGO NHIS NISCAI NTCAI NVMA NVQS NVRI O&M OIE OPBP PACE PAD PAN PDO PDOs PDR PFD PIM PIU PLWA PP

Financial Monitoring Report Financial Procedures Manual Gross Domestic Product Geographic Information System Global Program for Avian Influenza General Procurement Notice Influenza A Virus strain H5N1 Human Immuno-deficiency VirusIAcquired Immuno-Deficiency Syndrome Highly Pathogenic Avian Influenza Human Pandemic Preparedness and Response Health System Development Project I1 International Bank for Reconstruction and Development International Competitive Bidding International Development Association International Development Fund Integrated Disease Surveillance and Response International Epidemiological Association Influenza-Like Illness International Standards on Auditing Implementation Status Report Japanese International Cooperation Agency Local Fadama Desk Local Government Authority Local Government Desk Local Government Technical Committee Monitoring & Evaluation Multi-country APL National Advance Purchase Agreement National Competitive Bidding National Economic Empowerment and Development Strategy Non Governmental Organization National Health Information System National Inter-Ministerial Steering Committee on Avian Influenza National Technical Committee on Avian Influenza National Veterinary Medical Association National Veterinary Quarantine Services National Veterinary Research Institute Operation and Maintenance World Organization for Animal Health (Office International des Epizooties) Operational Policy & Bank Procedures Pan African Program for the Control of Epizootics Project Appraisal Document Poultry Association of Nigeria Project Development Objective Project Desk Offices Process Documentation Research Project Framework Document Project Implementation Manual Project Implementation Unit People living with HIVIAIDS Procurement Plan

This document has a restricted distribution and may be used by recipients only in the performance of their official duties. Its contents may not be otherwise disclosed without World Bank authorization.

PRP PVS QCBS SARS SDR SEEDS SES SFDO SIDA SPA SPIU SPDO STCAI SVD TA TCAI TCP TF TORS TOT UN UNDP UNICEF USAID VCN VS VTHs WB WHO WOAH WP WTO

Participatory Rapid Appraisal Performance, Vision and Strategy (PVS) for National Veterinary Services Quality and Cost Based Selection Severe Acute Respiratory Syndrome Special Drawing Rights State Economic Empowerment and Development Strategy Sanitary-Epidemiological Service State Fadama Development Office Swedish International Development Agency Sub-project Agreement State Project Implementation Unit State Project Desk Office State Technical Committee on Avian Influenza State Veterinary Department Technical Assistance Technical Committee on Avian Influenza Technical Cooperation Program Trust Fund Terms of Reference Training of Trainer United Nations United Nations Development Program United Nations Children and Educational Fund United States Agency for International Development Veterinary Council of Nigeria Veterinary Services Veterinary Teaching Hospitals World Bank World Health Organization World Organization for Animal Health Work Program World Trade Organization

Vice President: Gobind T. Nankani Country ManagerIDirector: Hafez Ghanem

Sector Manager: Joseph Baah-Dwomoh Task Team Leader: Simeon Ehui

FEDERAL REPUBLIC OF NIGERIA PROGRAM FOR AVIAN INFLUENZA AND HUMAN PANDEMIC PREPARDENESS

AND RESPONSE PROJECT

CONTENTS

........................................................................................................... BACKGROUND AND STRATEGY 1 ............................................................................................................ COUNTRY AND SECTOR BACKGROUND 1

.................................................................................................. OVERALL COUNTRY DAMAGE ASSESSMENT 4 ............................................................................................................................... REGIONAL IMPLICATIONS 4

............................................................................................................................. THE NATIONAL DIMENSION 5 COUNTRY STRATEGY IN THE CONTEXT OF GLOBAL PROGRAM FOR AVIAN INFLUENZA AND HUMAN

....................................................................... PANDEMIC PREPAREDNESS AND RESPONSE PROGRAM (GPAI) 6 ............................................................................................ COUNTRY RESPONSE TO THE HPAI EMERGENCY 7

............................................................................................................... COUNTRY ELIGIBILITY UNDER GPAI 8

BANK RESPONSE AND STRATEGY ....................................................................................................... 9 .................................... INTERNATIONAL SUPPORT TO THE AVIAN INFLUENZA EMERGENCY IN THE COUNTRY 9

..................................................................................................... RESPONSE GAPS AND BANK'S ASSISTANCE 9 ..................................................................................................................................... BANK JUSTIFICATION 10

LESSONS LEARNED ........................................................................................................................................ 11

................................................................................................. PROJECT DESCRIPTION SUMMARY 12 ........................................................................ PROJECT DEVELOPMENT OBJECTIVES AND KEY INDICATORS 12

.................................................................................................................................. PROJECT COMPONENTS 13 ................................................................................................................... PROJECT COSTS AND FINANCING 22

........................................................................................ STUDIES AND TECHNICAL ASSISTANCE REQUIRED 23

IMPLEMENTATION ARRANGEMENTS ............................................................................................. 25 ............................................................................... OVERALL PROJECT ORGAN~ZATION AND MANAGEMENT 25 .............................................................................. INSTITUTIONAL ARRANGEMENTS FOR IMPLEMENTATION 27

............................................................................................ FINANCIAL MANAGEMENT AND PROCUREMENT 28 ............................................................................................................................. RETROACTIVE FINANCING 28

ENVIRONMENTAL AND SOCIAL ASPECTS ....................................................................................................... 29 MONITORING AND EVALUATION .................................................................................................................... 30

............................................................................................... LOANICREDIT CONDITIONS AND COVENANTS 31 POLICY EXCEPTIONS AND READINESS ........................................................................................................... 31

FINANCIAL AND ECONOMIC JUSTIFICATION ............................................................................... 31 ......................................................................................................... ECONOMIC AND FINANCIAL ANALYSES 31

TECHNICAL ANALYSIS ................................................................................................................................... 32 ........................................................................... CRITICA~~ RISKS AND POSSIBLE CONTROVERSIAL ASPECTS 34

PROJECT BENEFITS AND RISKS ......................................................................................................... 36 PROJECT BENEFITS ........................................................................................................................................ 36 PROJECT RISKS .............................................................................................................................................. 36

......................................................................................................................... AGREED ACTION PLAN 37

.......................................................... Appendix I : International and Country Background 38 Appendix 2: Country Eligibility under GPAI ....................................................................... 46

........................................................................... Appendix 3: Detailed Project Description 47 ...................................................................... Appendix 4a: Implementation Arrangements 69

Appendix 4b: Project Coordination ..................................................................................... 76 ........................................................................... Appendix 5: Project Costs and Financing 78

............................................................................. Appendix 6: Procurement Arrangements 80 Appendix 7: Financial Management and Disbursement Arrangements .............................. 85

..................................................................... Appendix 8: Environmental and Social Issues 96 Appendix 9: Economic and Financial Analysis ................................................................... 99

........................................ Appendix 10: Results Framework. Monitoring and Evaluation 102 ..................................................................... Appendix 11: Documents in the Project File 108 ................................................................... Appendix 12: Statement of Loans and Credits 109

.................................................................................... Appendix 13: Country at a Glance 111 .................................................................................. Appendix 14: Map No . IBRD 34625 113

A. BACKGROUND AND STRATEGY

1. Country and Sector Background

1. Agriculture remains the single largest contributor to the livelihood of the Nigeria's rural poor, despite losing its position as Nigeria's prime foreign exchange earner to the oil sector. One of the most serious challenges facing Nigeria in the 21" century is achieving sustainable growth in the agricultural sector which provides employment and livelihoods to 65 percent of rural dwellers in a human population of about 130 million. Agriculture accounts for about 34.8 percent of Nigeria's Gross Domestic Product (GDP). Livestock (14 million cattle, 34.5 million goats, 22 million sheep, 3.4 million pigs and 175 million poultry), in turn, contribute about 13 percent to agricultural GDP. Based on Nigeria's 2004 GDP of US$50.2 billion, the country's livestock resources were estimated at US$2 billion during that year. Mixed farming systems are predominant. However, productivity is low and the demand for meat, dairy, pork and poultry outstrips domestic supply. Poultry production in Nigeria can be classified into extensive and intensive systems. The extensive system consists of over 143 million rural free ranging poultry. The intensive system is of two major types, urban backyard poultry flocks of about 200 to 2000 birds, and commercial enterprises with more than 2000 birds. Productivity in these systems is typically constrained by poor nutrition and diseases.

2. In Nigeria, like in most African countries, a substantial part of animal health services is managed by the public sector, which with declining funding has become increasingly weak. The three tiers of government, i.e., federal, states and local, are involved in the administration of agriculture, including veterinary services. At the federal level, government thrust is the development of policies and policy implementation protocols, monitoring and coordination of developmental programs, national disease control, tsetse eradication and development of relevant legislation. At the state level, Veterinary Services (VS) are headed by Directors at the State Ministry of Agriculture or, in a few cases, the Ministry of Animal Health, Livestock and Fisheries Resources. The Federal Department of Livestock and Pest Control Services (FDL&PCS) acts as a facilitator where interstate and international inspection, hygiene and trade of food of animal origin are concerned.

3. In addition to federal and state governments, local governments participate in VS mainly as mobilization and extension agents and liaise closely with the state Area Veterinary Officers (AVOS), livestock farmers, traditional institutions, law enforcement agents and other stakeholders to facilitate services delivery, disease reporting, control of livestock diseases and pests, etc. The Local Government VeterinaryILivestock Services are usually headed by the Heads of Agriculture Departments, which generally comprise veterinary services, poultry development, fisheries, forestry, crop production, and livestock production divisions.

4. The Federal Government of Nigeria (FGN) has introduced a number of policies to enable the private sector contribute and provide services to the farmers. Such policies in the livestock sub-sector include creating the enabling environment for the manufacture and distribution of veterinary drugs, agro-chemicals and livestock feeds by the private sector and encouragement of veterinary surgeons to go into private practice. Private veterinarians are mainly engaged in the supply and distribution of veterinary drugs, vaccines, equipment and livestock feeds, and in the

provision of routine clinical services, preventive herd health, and consultancy services. With the declining funding of the public sector and the increasing deterioration of infrastructure and equipment, the core public functions of VS need to be strengthened and the roles of the public and private sectors in the provision of services needs to be further defined. This is one of the major issues being tackled by the FDL&PCS through the Pan-African Program for the Control of Epizootics (PACE), which has developed a draft Act in an attempt to streamline the functions of the two major existing complementary legislations, the proposed Veterinary Practice Act.

5. Veterinary institutions play a vital role in the livestock sub-sector in Nigeria. One such important institution is the National Veterinary Research Institute (NVRI). This institute is the national reference laboratory for the diagnosis and investigation of livestock diseases and collaborates with international reference laboratories. NVRI is also involved in the production and testing of vaccines for the control of animal diseases in the country and conducts research and training in relevant veterinary fields. At present, Nigeria has five federal universities in Ibadan, Maiduguri, Nsukka, Sokoto, and Zaria, each with fully developed faculties of veterinary medicine and veterinary teaching hospitals (VTHs). These institutions train veterinarians at both undergraduate and postgraduate levels and conduct research in all areas of veterinary medicine. In addition, colleges of veterinary medicine were recently established in the three federal universities of agriculture in Abeokuta, Makurdi, and Umudike. Three colleges of animal health and production located in Ibadan, Kaduna, and Vom also provide training for sub-professional and technical personnel in various livestock related fields.

6. To enforce legislation of drugs, vaccines, agro-chemicals and meat hygiene regulatory bodies have been established, but are outdated and in need of review, in order to reposition the veterinary profession and animal health care delivery services in their proper place. In addition to inadequate public funding of animal health care delivery, the various tiers of government do not currently employ have sufficient numbers of veterinarians. Thus, there is a great potential to tap into the private veterinary manpower resources to implement core veterinary public health functions (e.g., preventionlcontrol/eradication of avian flu; prevention of human cases; and food inspection, etc.) under the overall control of official veterinary authorities.

7. To protect animal and human health, the existing laws and legislations (i.e., the Animal Diseases Control Act 10 of 1988, the States' Meat Hygiene Legislation of 1969, the Veterinary Surgeons Act of 1987, etc.) are being reviewed, while new ones, such as the proposed Veterinary Practice Act, are being developed to address issues related to:

Control and sales of veterinary drugs and biologicals as well as animal health inputs; Abattoir management and meat hygiene; Roles of private and public VS; Enforcement of laws and legislations; Control of veterinary drug residues and mycotoxins in food of animal origin.

8. At the post-appraisal meeting of February 23, 2006, the FGN team gave the assurance that the ongoing revision of existing laws will not have any negative impact on the Project since the proposed amendments to the Project are mainly intended to give veterinary authorities a

greater control in veterinary drug administration and meat hygiene. The amendment process has reached an advanced stage and the first draft has been cleared by the Federal Ministry of Justice.

9. The future presents very strong challenges for protecting animal and human health from major diseases, including zoonoses, food security and securing international trade. The main constraint lies in the current limited capacity of VS for the early detection and rapid response to outbreaks of highly contagious diseases of animal origin, as well as for food safety.

10. Constraints to the eradication of livestock diseases and zoonoses, inadequate policies and regulatory frameworks, and lack of veterinary training and funding are hampering the effectiveness of VS in Nigeria. The future direction for the public sector should point to the improvement of the enabling environment in which the private sector can thrive, the development of supporting legislation, strengthening regulatory institutions, enforcement of ethics, and disease surveillance and reporting. The private sector be geared towards providing full clinical services and input delivery. The complementary functions of private practitioners and the roles and functions of other para-veterinary professionals in animal health delivery need to be recognized and encouraged and harmonized. These objectives have been recently adopted by the Office International des Epizootics (OIE) of the World Organization for Animal Health, and are supported by specific international standards, guidelines and tools. The deterioration of animal health care delivery in Nigeria can be reversed collectively by improving technical, leadership and entrepreneurial skills.

1 I. With the outbreaks of Highly Pathogenic Avian Influenza (HPAI 5N1) in Nigeria, the VS have been severely challenged, increasing the need to critically examine the individual roles and functions of the various players and organizations involved in animal health care delivery services in the country. The existing laboratories that have been earmarked to carry out diagnosis of HPAI include the NVRI and VTHs at Ibadan, Maiduguri, Nsukka, Sokoto, and Zaria, but need to be strengthened. Laboratory diagnostic networking should include laboratories in neighboring countries and the West African sub-region. The prospect for a Technical Cooperation Project (TCP) to enhance HPAI diagnostic capacity should be explored with the Food and Agricultural Organization of the United Nations (FAO).

12. There are no rendering plants in Nigeria. Disposal of animal carcasses is done through burial or bio-thermal decomposition. Animal owners are, by law, required to inform a public veterinarian when an animal is suspected to have died of a notifiable disease, such as, CBPP, haemorrhagic septicemia, Anthrax, Rinderpest, African Swine Fever, etc. In the case of HPAI, FGN has adapted the contingency manual for A1 prepared by the Centro Regionale per 1'Epidemiologia Veterinaria (CREV) and by the Italian National Reference Laboratory for Avian Influenza, at the Istituto Zooprofilattico Sperimentale delle Venezie (see Appendix 3 for details).

2. Overall Country Damage Assessment

13. HPAI is a trans-boundary viral zoonotic disease (animal-to-human transmission) of international importance because of its devastating socioeconomic impacts and the potential capacity of the virus to 'transmutate' (through genetic re-assortments or mutations) from animal- to-animal, to animal-to-human transfer, into the final-stage human-to-human pandemic phase transmission. Humans are not very susceptible (low morbidity) but are very sensitive (high mortality rate) to the H5N1 strain, once infected. The H5N1 virus strain isolated in Nigeria is identical to the strain causing large outbreaks in wild and domestic birds in Asia and Europe, creating widespread concern of the increased risk of an emerging highly pathogenic strain that can cause a third-phase human pandemic. While it is uncertain whether the current HPAI outbreaks may lead to an influenza pandemic, it is certain that its consequences for human safety will be severe.

14. Most of the poultry production systems in Nigeria (extensive and intensive) are at a very high risk. There are few large commercial farms with adequate bio-security measures. Though the densities of human and poultry populations are generally lower in Africa than in south-east Asia (where the current strain of avian influenza emerged in late 2003), its poultry production systems have many similarities that can create multiple opportunities for human exposure. In Nigeria, poultry farming is mostly household-based with small flocks of chickens, usually free- ranging, and in close contact with wild birds as well as with human beings. Rural households are tend to depend on their livestock, especially poultry, as the main source of income and dietary protein. It is an urgent to strengthen the capacity of VS as the first responder to mitigate these economic and public health risks and attack the virus at its animal source. Such an approach is the first and most cost-effective measure to minimize further spread of the virus into the environment, allow it to become endemic, and prevent a human pandemic. It will also be necessary to strengthen the necessary diagnostic expertise, disease surveillance, and control and management systems to counter the emergence of a human pandemic.

15. The devastating socio-economic consequences of HPAI in Asia have underscored the importance of this Project to Nigeria and the West Africa region. In Asia to date, over 200 million domestic poultry have either died or have been destroyed and 175 people have contracted the infection, of which, at the time of writing, 93 have died as a direct result of HPAI infection. Over 200 million Asian households have lost their livelihood, and economic losses to the Asian poultry sector alone are already estimated at well over $10 billion, with enormous and unprecedented social and economic impacts.

3. Regional Implications

16. The incidence of newly emerging transboundary zoonoses is increasing worldwide as the result of the unprecedented confluence of people, animals and animal products. The current avian influenza epizootic demonstrates the global importance of newly emerging diseases in terms of human health and well-being. In addition, emerging zoonoses of public health concern are also a sobering reminder of the tremendous socio-economic and trade damages that such diseases can cause to the developed and developing countries.

17. The HPAI outbreaks in Nigeria pose serious threats to West and Central Africa, through the uncontrolled legal and illegal trade in infected domestic and wild birds or their products, as well as through migration of wild birds (see Figure Al , Appendix 1). Bird flu can spread rapidly among poultry and wild birds, including migratory species (especially the Anatidae family that includes ducks, geese and swan), and can be transmitted to humans through physical contact with infected animals or contaminated products. The probability of bird flu spreading across Nigeria is a realistic possibility, since the country, a regional economic power, has many trade links with many countries in the sub-region. Already, countries surrounding Nigeria (Benin, Cameroon, Chad, Ghana, Niger and Togo) have taken measures to increase surveillance and some have imposed import bans on poultry and poultry products from Nigeria. However, the limited resources and expertise available in these countries to enforce regulations are putting the entire region at risk. Should avian flu become endemic in Africa, the consequences for a region already devastated by hunger and poverty could be truly catastrophic. In addition, the prevalence of HIVIAIDS in Africa could increase the number of human cases, as the result of depressed immunity of persons infected with HIVIAIDS. Unlike other regions of the world that have well established plans to contain the spread of the bird flu virus, most African countries lacks such plans to fight such highly contagious zoonotic diseases.

18. The Bank and its UN partners are well positioned to provide technical, human, and material assistance to Nigeria and the region. If control measures are not undertaken, the disease will continue to spread, causing further economic losses and threatening the livelihoods of hundreds of millions of poor livestock farmers, jeopardizing smallholder entrepreneurship and commercial poultry production, and seriously impeding regional and international trade and market opportunities. The rural poor, who rely for a large share of their income on poultry, will be hard hit, particularly with income losses and social distress.

1

4. The National Dimension

19. Nigeria is the most populous country in Africa and is home to about 175 million domestic poultry, of which the vast majority of 143 million are free ranging. In January 2006, the first HPAI outbreak in poultry was reported on commercial farms in Kaduna, Kano and Plateau states in Northern Nigeria (see the Map, Appendix 14). By February 8, 2006, the Kaduna State outbreak was confirmed by the HPAI OIEIFAO reference laboratory in Padua, Italy as the HPAI H5N1 strain. The country is ill-prepared to contain the spread of the H5N1 virus and will need considerable support. Overall, diagnostic capacity for HPAI is very weak, as are quarantine services. With the ongoing importation ban of poultry and poultry products, long term enforcement of the ban is doubtful, creating risks not only for Nigeria but also for the region.

20. At donor community briefing of February 10, 2006, the Honorable Minister of Agriculture and Rural Development indicated that the virus may have had its source from the illegal importation of birds. In addition, Nigeria has large wetland habitats in the north which annually play host to a huge array of migratory birds. Disease reporting and infection is also constrained by lack of awareness training of farmers, and the availability of emergency funds for compensation. The international community welcomed the intention by the government to compensate farmers for losses from dead or stamped out poultry and for reporting the outbreak, as this should considerably improve the reporting of hture outbreaks. However, the appropriate

level and timeliness of compensation will be critical to the successful containment of the disease and the fostering of poultry farmer confidence. Under-reporting or illegal dispersion of birds may occur the compensation rate is below the going market rates for poultry. Already, past experience with Contagious Bovine Pleuro-Pneumonia (CBPP) and Rinderpest epizootics in the early eighties has shown reluctance by livestock owners to report cases of reportable diseases where this will result in stamping out the herd without compensation.

5. Country Strategy in the Context of Global Program for Avian Influenza and Human Pandemic Preparedness and Response Program (GPAI)

21. In December 2005, FGN set up a Technical Committee of Experts on the prevention and control of HPAI which identified the following nine strategies (see Appendix 3):

(i) a ban on importation of poultry and poultry products from countries where the disease (HPAI) is known to exist;

(ii) effective animal disease surveillance involving high risk areas, such as, poultry markets, wet lands and poultry located along known migratory birds routes, poultry abattoirs, borders and targeted farms;

(iii) improved and functional National Veterinary Quarantine Services (NVQS), including immediate rehabilitation and revitalization of existing veterinary quarantine infrastructure, control posts and enhanced manpower capabilities;

(iv) community-based training of rural backyard poultry farmers in various aspects of HPAI recognition and control, including bio-security procedures;

(v) enforcement of the requirement for import permits for poultry and poultry products;

(vi) development of a traceability mechanism for animals and strict monitoring of movement of poultry and poultry products through registration and licensing of poultry farms, hatcheries and other poultry enterprises;

(vii) development of a community based, participatory rural livestock and poultry disease surveillance system and integrating it into the existing epidemic- surveillance network;

(viii) training of veterinarians, auxiliaries, other categories of poultry farmers on HPAI prevention and control strategies, including aspects of bio-security; and

(ix) effective public enlightenment and awareness programs on HPAI.

22. The Federal Ministries of Agriculture, Health and Information are finalizing an integrated Avian Influenza Control and Human Pandemic Preparedness and Response Plan (AICP) to address outbreaks of HPAI in Nigeria. In the context of the World Bank's GPAI, the plan

focuses on both animal and human health and on promoting partnership between animal and human health agencies to facilitate control of zoonotic diseases.

23. The animal health component of the Plan is based on a review of the present status of the key institutions and services and their readiness to perform their intended tasks. It deals with four main themes, namely, surveillance, early detection and rapid containment, control at source in birds, and risk communication. The plan includes strategies for further prevention of introduction of HPAI into Nigeria, an HPAI surveillance network, early reaction contingency planning, response plan for HPAI, overall policy for HPAI emergency in Nigeria, and an action plan for HPAI control. FGN is still debating the merits and demerits of a vaccination policy against a policy on stamping out.

24. The human health part of the national plan aims at strengthening national capacity in key public health areas, including inter-sectoral coordination, epidemiological surveillance, laboratory diagnosis, disease prevention, clinical case management, and communication. It is composed of two main sections. The first section addresses the pandemic alert period (current WHO phase 3, but also phases 4 and 5) when animal and human cases may occur, but without sustained person-to-person transmission. The focus is on coordination with the VS as well as with relevant regional and international organizations, epidemiological surveillance, laboratory diagnosis, and clinical management of a limited number of human cases. It also addresses some elements of pandemic preparedness. The second section of the human health part addresses the pandemic period (WHO phase 6) when effective person-to-person transmission exists. The focus is on clinical management of a large number of patients over a relatively short period of time, some with severe respiratory infection which may require hospitalization in intensive care units.

25. For both the animal and human health components, the plan provides currently acknowledged limitations, proposed activities, and resource requirements.

6. Country Response to the HPAI Emergency

26. In anticipation of an eventual HPAI outbreak, FGN inaugurated on December 12, 2005, a Technical Committee of Experts for the prevention and control of HPAI. The committee devised strategies for the prevention of HPAI in the country consistent with the GPAI. Since the outbreak of February 8, 2006, FGN, under the personal leadership of President Obasanjo, moved fast to set up a National Inter-Ministerial Steering Committee on Avian Influenza (NISCAI) co- chaired by the Minister of Agriculture and Rural Development and the Minister of Health, with the World Bank as a member. FGN has also set up a National Technical Committee on Avian Influenza (NTCAI) chaired by both the Minister of State for Agriculture and Rural Development and the Minister of State for Health. The Technical Committee is responsible for the coordination and implementation of the emergency action plan and strategy proposed for the prevention and control of the outbreak.

27. FGN has taken emergency measures to control the outbreak at source, such as stamping out of affected and in-contact flocks, introduction of quarantine measures, animal movement bans, and increased bio-security of poultry farms. The Ministry of Health is planning emergency

measures to protect farm workers from infection with the virus, increase public awareness and information and assess the capacity of the system for effective surveillance and case management. Implementation of the preparedness plan by the Ministries of Agriculture, Health and Information will be a challenge. VS are weakand disease surveillance is severely constrained by lack of funds, and presently largely depends on external funding. The most significant support comes from Pan-African program for the Control of Epizootics (PACE), which is due to close in the third quarter of 2006. Even so, the mandate of PACE has been restricted to classical threats such as Rinderpest, Newcastle Disease, CBPP, and Foot and Mouth Disease (FMD), and is focused mainly on surveillance. Similar challenges exist in the human health system where the current disease surveillance system is weak and there is no routine human influenza reporting. The national laboratory capacity is limited and the coverage and capacity of the health system for effective case management is severely limited.

7. Country Eligibility under GPAI

28. The proposed Project falls under the GPAI, approved by the Bank's Board of Directors on January 16, 2006. GPAI support is to be provided using the horizontal Adaptable Program Loan (APL) instrument and within a global coordination framework. Under the global APL, individual countries may obtain separate loans and credits and grants, as they become available, to finance their own national projects, up to the global aggregate limit of US$5OO million. Since the GPAI is designed to provide emergency financing to participating countries to contain

Box 1: Country Eligibility Criteria under the GPAI

In view of the wide variation of individual countries' conditions, GPAI projects will need to reflect the environment in which they are to be implemented. Accordingly, country requests for assistance are eligible for financing under the GPAI when they meet the following criteria:

(i) Countries in endemic situation, where new human infections are being detected, will need to have prepared and be implementing an HPAI Control Strategy;

(ii) Newly infected countries, with an active outbreak of avian influenza among poultry but no human infection, will need to have in place an appropriate program of rapid response, detection and containment measures, including implementation and monitoring arrangements that the international agencies and donor community, including the Bank, could support;

(iii) Countries at risk, with no outbreaks or at an early stage of an outbreak, will need to demonstrate governmental commitment to addressing the situation and have in place an appropriate plan for early detection and rapid response, including implementation and monitoring arrangements that the international agencies and donor community, including the Bank, could support;

(iv) Countries with very low income levels and very low capacity will be considered against special criteria, and waivers will apply if a full-blown human pandemic were to materialize to ensure that assistance is available if and when needed, even if the country itself will hardly be able to generate or mobilize any effective HPAI response.

outbreaks of avian flu through early detection and rapid response measures, the country-specific operations, such as described for FGN, will be processed under the Bank's emergency policy, OP/BP 8.50. The GPAI will treat specific emergency response projects in each country as "phases" of a horizontal APL (similar approaches include the Multi-Country HIVIAIDS Programs for the African and the Caribbean Regions). Nigeria clearly meets the eligibility criteria for "countries newly infected" in GPAI category (ii) (see Box 1 above). But since the proposed Project is not included in the Country Partnership Strategy (2005-2009), the financial assistance for the Project will be provided as a credit.

B. BANK RESPONSE AND STRATEGY

1. International Support to the Avian Influenza Emergency in the Country

29. The outbreak of HPAI in Nigeria was the first such confirmed outbreak in Africa and has attracted considerable international attention. Nigeria is currently getting support from development assistance bodies such as the United States Agency for International Development (USAID), WHO, FAO, United Nations Children and Educational Fund (UNICEF) and the United Nations (UN) through NISCAI, set up by FGN. There is international consensus as to the necessity for granting support to Nigeria to control the epizootic, and for this purpose USAID has pledged US$25 million, to be focused on animal health, while WHO is providing technical assistance towards the investigation and control of infectious diseases. DFID has donated 15,000 sets of personnel protective wear and has pledged further support through WHO. UNICEF has also pledged technical assistance towards communication and behavioral change, with other pledges from UN, the European Union (EU), the Japanese International Cooperation Agency (JICA) and the bilateral assistance agency of France. The Government will review donor contributions in consultation with the Bank and other development partners to eliminate the issue of duplication of effort, and to facilitate fast-track disbursement, in line with an emergency operation.

2. Response Gaps and Bank's Assistance

30. There is an urgent need for further strengthening of the capacity of the agricultural and health sectors for the effective execution of national disease prevention and control strategies. As indicated, Nigeria is ill-prepared to contain the spread of the HPAI H5N1 and will need considerable support. Laboratory capacity for HPAI diagnosis is very weak and NVRI and Public Health laboratories have only limited capacity to identify the H5N1 virus strain. Quarantine services are also weak, so that with the ongoing blanket ban on importation of poultry and poultry products, the extent to which the import ban can be enforced is doubtful, creating risks not only for Nigeria but for the entire region.

31. Specifically, assistance will be required to implement the four components (animal health, human health, social mobilization, and implementation support for monitoring and

evaluation) identified in this proposal. If control measures are not undertaken, the disease will become endemic with continuous flare-ups, causing prolonged economic losses and threatening the livelihoods of hundreds of millions of poor livestock farmers, jeopardizing smallholder entrepreneurship and commercial poultry production, and seriously impeding regional and international trade and market opportunities. The rural poor who rely for a large share of their income on poultry will be hit the hardest by loss of income and social distress. In the background hovers the threat of a potential pandemic and its unimaginable global consequences.

3. Bank Justification

32. A key justification for Bank involvement is the Global Public Goods aspect of controlling HPAI - one of many emerging and re-emerging transboundary zoonoses. There is also the national Public Goods' perspective for countries to strengthen their VS, disease surveillance, and human health systems, as planned in this operation. HPAI control programs require a multi- disciplinary approach to integrate technical, social, economic, political, policy, and regulatory issues in addressing a complex problem. While the Bank's main comparative advantage vis-a- vis its partner agencies, e.g., FGN, WHO, F A 0 and OIE, is its ability to provide significant funds to countries at risk, it is also well placed to draw on its knowledge base concerning multi- disciplinary approaches needed in the proposed operation and to apply the evidence and lessons learned in various regions during emergency preparedness responses. The Bank can be helpful in bringing together the relevant ministries, government agencies and the donor community, and in helping ensure high level political coordination.

33. The proposed Project is in line with the Avian Influenza Agriculture and Health Strategies developed by the Government of Nigeria and supports the public health response strategies outlined by the Ministry of Health, with support from WHO, United States Center for Disease Control and Prevention (CDC), the World Bank and bilateral agencies. The Bank has been working with FGN, WHO, FAO, OIE, EU, bilateral agencies and other partners at the country and international levels to prepare its National Avian Influenza Contingency Plan. The GPAI, which has been accepted and endorsed by development partners globally, has been used in the preparation of Nigerian A1 emergency operation. The Bank can assist the Government in leveraging additional resources from other bilateral and international agencies. In addition, the technical assistance provided by the Bank has been important in similar global or regional emergency situations, such as, Severely Acute Respiratory Syndrome (SARS), post-disaster reconstruction, and HIVIAcquired Immuno-deficiency Syndrome (AIDS). The Bank has a proven comparative advantage in providing integrator skills and multi-sectoral perspectives and in addressing the institutional dimensions of the response to such emergencies. It can also contribute extensive experience and skills in understanding and addressing the social and economic impact.

34. The proposed Project contributes to higher-level priorities identified by the NEEDS, SEEDS and to the Country Partnership Strategy (CPS) approved by the Bank in June 2005. The NEEDS emphasizes the importance of empowering people through investment in health, education, environment stewardship and integrated rural development. The CPS, likewise, emphasizes the critical importance of health improved service delivery for human development, and improved agricultural production for improved environment and services for non-oil growth.

The Project will also put in place the institutional capacity to mitigate massive poultry losses to HPAI and minimize its impact to the agricultural economy, and to the rural poor by means of compensation for poultry lost to HPAI.

4. Lessons Learned

35. Relevant lessons for the design of the proposed operation have been drawn from previous and ongoing projects in the rural and health sectors in Nigeria. They have also been drawn from the design of previous World BankIInternational Development Agency (IDA) projects in other countries. Lessons drawn from the Kyrgyz case point to the following: (i) emergency projects should avoid policy conditionality; (ii) project design must be simple and take into account a realistic assessment of the existing governmental and other stakeholders' capacity; (iii) speedy appraisal and approval are crucial to provide a prompt response and a substantial contribution to project success; (iv) procurement arrangements need to be flexible and should be finalized at an early stage; (v) mitigation and prevention measures should be included in project design to minimize impacts of a possible recurrence of the disaster; and (vi) realistic assessments should be made of counterparts' absorption capacity as well as of the communication and coordination mechanisms among all relevant stakeholders.

36. Although the Vietnam Avian Influenza Emergency Recovery Project has been effective for only a little more than one year, the main recommendations arising from its implementation are the following:

Preparedness is a key factor. There was a national strategy document on controlling avian influenza in the poultry population, but it was not clearly understood and shared by all relevant agencies and stakeholders, and some aspects of the response have been lagging behind.

A two-pronged strategy is recommended. This should include: (i) the control of avian influenza at the source in high-risk regions (through aggressive measures including stamping out, movement control and vaccination campaigns for poultry); and (ii) simultaneously prepared short and medium term measures to minimize the risks to humans and prepare for an eventual pandemic.

For implementation arrangements, it is important to have a coordination structure which is empowered with multi- and cross-sectoral responsibilities, for instance, at the level of the President's Office, and to have full-time project coordinators to implement activities in a "crisis situation".

An effective and credible "compensation framework" is essential to obtain real cooperation from affected stakeholders (farmers/producers) and to ensure the efficacy of the surveillance and diagnosis mechanisms.

The importance of strengthening the technical, scientific and operational capacity of the relevant participating agencies should not be overlooked.

There is an urgent need to organize an effective national response involving all technical divisions of the Ministries of Agriculture and Health as well as other relevant sectors at the national and sub-national levels in case of a human epidemic.

It is important to raise awareness in the public and private sectors from the initial moments and to strengthen effective coordination mechanisms for the implementation of the necessary technical responses, involving FGN, donor community, private sector and civil society.

Attention should be given to support the integration of each country into a regional and global framework for the control of HPAI, and more broadly of all trans-boundary animal diseases and other emerging infectious diseases, so as to increase cost-effectiveness and ensure the harmonization of activities and responses.

37. Some important lessons learned from the response to the HIVIAIDS epidemic have also guided the design of the GPAI program and of the proposed Project. ' They include:

The need for high-level political commitment and leadership is key; A comprehensive multi-sectoral approach is needed; Monitoring and evaluation is critical in the scaling-up of a national response; Stakeholders at the country and international levels are important in dealing with the A1 threat; Building a strong fiduciary architecture is needed.

C. PROJECT DESCRIPTION SUMMARY

1. Project Development Objectives and Key Indicators

38. The proposed Avian Influenza Control and Human Pandemic Preparedness and Response Project (AICP) will support the efforts of FGN to minimize the threat posed by H5N1 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 to other parts of Nigeria not yet infected by the virus. To achieve these objectives, the Project will support three sets of interventions: (i) response and containment; (ii) control and prevention; and (iii) preparedness and planning.

39. The Project has four components: (i) animal health - support for a national program to develop and implement H5N1 containment, control, prevention, and eradication activities in the livestock sector, specific to the needs of FGN in the short- and long-term; (ii) human health - support for a national program to implement HPAI prevention, preparedness and planning,

' World Bank. 2005. Committing to Results: Improving the Effectiveness of HIVIAIDS Assistance. An OED Evaluation of the World Bank's Assistance for HIVIAIDS Control. Washington, D.C.

response and containment activities in the human health sector, specific to the needs of FGN in the short-, medium-, and long-term; (iii) social mobilization and strategic communication awareness and information - promotion of community education, public awareness, participation and improved coordination and the execution of the contingency plans and the national HPAI strategy; and (iv) implementation support, monitoring and evaluation. In the event of a declared influenza pandemic, the Project will finance emergency imports identified as necessary under a well-defined preparedness and response program to be prepared as part of project implementation.

40. The overall development objective is 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. To achieve this, support will be provided in three main areas: (i) response and containment, (ii) control and prevention and (iii) preparedness and planning. Key indicators of project outcome will include evidence of improved effectiveness of Government in responding to the risk of an HPAI outbreak and/or pandemic and contained and diminishing pattern of HPAI infection in poultry.

2. Project Components

41. In both the human health and animal health fields, short- and long-term actions need to be taken and an appropriate balance struck between the two. Immediate action is needed in a number of areas, but there is also a long-term agenda, given systemic shortcomings with respect to VS and core public health functions. Work on both the short- and long-term fronts, therefore, needs to proceed in parallel, and efforts will be made to ensure that short-term responses are consistent with and contribute to proposed long-term interventions. Setting priorities in both cases is essential. By concentrating the efforts on these, dual-use investments will generate benefits during normal times and in a pandemic.

Component 1 : Animal Health (US$29.20 million)

42. This component will support national prevention and control strategies proposed to cover the country's needs over the short, medium and long term, based on detailed assessments of the avian influenza epidemiological status, the capacity of national VS to cope with HPAI epidemic and the vulnerability of the poultry industry to new emerging infectious diseases. HPAI outbreaks must be addressed at source (i.e., on the animal side), as the threat to human health will persist as long as the problem persists in livestock and poultry flocks. It is, therefore, important that the primary focus of attention in the prevention of the introduction and perpetuation of the virus in the country is initiated from the animal health perspective.

(a) Strengthening HPAI Control Programs and Outbreak Containment Plans

43. The subcomponent will provide support for the implementation of HPAI control and eradication measures. These measures included in HPAI Control Programs or Emergency Outbreaks Containment Plans are intended as a rapid mobilization to respond quickly and effectively to HPAI outbreaks during the project lifespan. The following activities are planned:

Targeting virus elimination at the source: HPAI control strategies and programs will include the principle of targeting the disease at source of infection: (a) stamping out of infected and at-risk poultry (stamping out); (b) compensation to farmers and producing companies at a reasonable market-oriented price; (c) disposal of carcasses and potentially infective materials in a bio-secure and environmentally acceptable manner; (d) enhanced bio-security at poultry farms and associated premises, through bio-containment and bio-exclusion; and (e) control of movement of birds and products that may be infected, including controls at the interface of infectedlnon-infected areas and border controls.

(ii) Vaccination campaigns: This activity will support the vaccination of poultry. Ring vaccination will be employed around newly infected, depopulated hotspot areas, in parallel with stamping out and targeted, strategic field surveillance and epidemiological studies to identify virus sources, selection of priority hot spots, imposition of transport bans, and post-vaccination monitoring. A DIVA vaccine, using a strain different from H5N1, will be used to allow laboratory differentiation between vaccinated and infected poultry, especially during post-vaccination serological monitoring. The use of non-vaccinated sentinel domestic ducks and chickens is essential to monitor vaccinated domestic poultry flocks. The activity will also provide capacity building in vaccine quality control at the national level to ensure that the vaccines used conform with OIE standards. The adoption of a poultry vaccination policy for HPAI is still being considered by FGN, in the context of local poultry production systems.

(iii) Biosafety for at-risk stakeholders: Due to the highly pathogenic nature of the A1 virus to humans, particularly the Asian H5N1 strain, training of people in contact with live virus will be supported. Adequate resources will be allocated for training and equipment (bio-safety hoods and appropriate personal protective clothing) for laboratory workers, poultry farm workers and poultry vaccinators.

(b) Strengthening Disease Surveillance, Diagnostic Capacity and Applied Research

44. As part of the control strategy for a HPAI infected countries like Nigeria, the proposed subcomponent will support activities to strengthen national VS, including the private and related sectors operating under its authority, enhance animal disease surveillance, diagnostic and PAI- dedicated research capabilities. The subcomponent will consist of the following activities:

(i) Strengthening of veterinary services: Based on the evaluation of VS and related services, support will be provided to strengthen national VS to bring them in line with OIE standards. This would be a gradual process and, under the aegis of project objectives, would prioritize HPAI control-dedicated strengthening.

(ii) Strengthening animal disease surveillance and epidemiological analysis: The activity will support: (a) shifting from passive to active, targeted surveillance, supported by sound epidemiological principles, (b) improving animal health information flow among relevant agencies; (c) early detection and timely reporting and follow-up of suspected or positive cases; (d) public and community-based

surveillance networks by establishing a community-based early warning system, utilizing existing human health infrastructures at the village level,; and (e) routine serological surveys and epidemio-surveillance.

(iii) Upgrading diagnostic capacity: The activity will support the upgrading of the laboratories earmarked to carry out diagnostics for HPAI. The NVRI will be upgraded to contain a BSL-3 facility and will be expected to carry out virus isolation and identification and any other isolate characterization, while the VTHs at Ibadan, Maiduguri, Nsukka, Sokoto, and Zaria will be upgraded to conduct PCR and serological testing. An acceptable biosafe environment will be created in these laboratories.

(c) Strengthening of Veterinary Quarantine Services

45. This subcomponent serves to upgrade the technical capacity of quarantine inspectors in enforcing quarantine regulations, and improve inspection procedures. It contains the following activities:

(i) Strengthening information transfer: This is to ensure that disease information generated from quarantine inspection feeds rapidly to decision makers to allow for the timely banning of infected poultry and poultry products from infected countries.

(ii) Provide training in quarantine protocols, pre-entry inspections, reporting and in- transit clearance of livestock and poultry shipment at all land, sea and air-based ports of entry.

(d) Strengthening Applied Veterinary Research

46. While a range of methodologies and tools are available to control HPAI, there aspects of the disease that are not clearly understood. While some of these researchable issues are beyond the scope of this Program, it is proposed that funding be provided for applied research into and field studies dedicated to HPAI disease dynamics.

(e) Enhancing Legal and Regulatory Frameworks for Transboundary Disease Prevention and Preparedness Capability

47. This subcomponent supports strengthening the regulatory framework to address key policy issues to ensure that the recommended disease control, prevention and eradication measures are implemented in a uniform and effective way and in accordance with OIE standards and guidelines. In addition, support will be provided to review existing regulations and policies, will fund related policy studies and dissemination workshops and will include a focus on trans- boundary animal diseases. Specifically, this subcomponent will support key institutional issues, including the following activities:

(i) Rapid assessment of national veterinary services: The ability of Nigeria to prevent, detect and control an HPAI epidemic depends on the quality of its national VS. To be effective, national VS should operate on scientific principles and, to be effective,

be technically independent from political pressures. In terms of the 7mergency response, this will be a medium-term activity.

(ii) Updating the National Emergency Contingency Plan for HPAI: Building on existing preparedness and action plans to prevent and control HPAI epidemics in domestic poultry, water fowl and wild birds, a team of national and international consultants will assist the Federal Ministry of Agriculture and Rural Development (FMARD) to update the existing Emergency Contingency Plan. The Plan will be accompanied by operations manuals, outlining in detail the steps to be taken at all levels of VS.

(iii) Human capacity building: The activity will support participation of Veterinary and Livestock Services officials and project staff in regional and international information exchanges and dissemination on AI. Laboratory technicians will be trained in HPAI-dedicated diagnostic techniques, and epidemiology staff will receive refresher training in the epidemiological principles of active field surveillance and data analysis.

(Jl Improving Bio-security in Poultry Production and Trade

48. Improved bio-security in poultry production and trade is not only an important longer- term strategy to guard against the damaging effects of HPAI but also a complicated intervention that requires understanding of the entire market value chain. This component will support improved public hygiene in poultry shops and live-bird markets, biosecurity regulations for commercial farms, and devising rural poultry sector restructuring strategies to stop rural households from living in close proximity with poultry.

(g) Compensation and Economic Recovery

49. The following three areas highlight the compensation issue:

(i) Establishment of a national compensation policy and national compensation fund: Early detection and reporting as well as rapid response depend critically on the incentives for poultry owners to report sick andlor dead poultry to their veterinarians, and adequate compensation arrangements are absolutely essential. The existing Animal Diseases Control Act (1988) provides for compensation wherever mandatory stamping-out/depopulation of diseased animalshirds takes place. However, appropriate guidelines for implementation have to be worked out, including financing, fiduciary aspects, eligibility criteria, payment arrangements, flow of funds, and transparency.

(ii) Support to economically vulnerable groups: Smallholder poultry stakeholders have little or no access to animal health services and are therefore highly exposed to the consequences of an HPAI epidemic. This activity will provide support to low- income groups that are particularly vulnerable through activities specifically designed to increase small farmers' awareness, improving animal health services at the community level, and providing grants for additional compensation. This

includes the development of pro-poor exit strategies, including livelihood diversification, to benefit economically vulnerable poultry stakeholders who have been severely affected by HPAI.

(iii) Alternative livelihoods for affected stakeholders: This activity will support smallholder poultry farmers in a bottom-up, demand driven and equitable manner to resume poultry farming or undertake a different livelihood, based on demand-driven proposals made by stakeholders. The Project will provide:

a. advisory services that will support new investment or restocking activities in project areas on request by thematic associations; and

b. seed money, though a credit mechanism yet to be decided, to eligible stakeholders, based on their own proposals to undertake an alternative livelihood, to be approved by the Compensation Fund.

50. Beneficiaries of the Compensation Fund will receive technical and management assistance from reputable service providers, to be engaged by the State Project Office in order to equip them with the necessary skills to properly utilize the fund. The Project will: (i) support training and learning, knowledge sharing on good and bad practices; (ii) create and maintain a database of service providers which will be made accessible to all participating stakeholders; (iii) encourage the participation of service providers in the learning and experience sharing events that will be arranged by the State Project Desk Office (SPDO); and (iv) receive training on environmentally friendly practices for selected service providers.

51. Under the umbrella of the Community Thematic Association (CTA), the eligible stakeholders will present their proposals for alternative micro-enterprises to the service providers to evaluation and approval before receiving credit from the Fund, utilizing a credit mechanism similar to that of the Fadama I1 Project. Suitably qualified service providers will include, in addition to the public Agricultural Development Programs (ADPs), private enterprises, NGOs, research and educational institutions, other public sector departments, and international agencies. The CC at the SFDO, which coordinates the Project at the state level, will provide technical assistance to user groups for the evaluation of proposals from service providers.

Component 2: Human Health (US$18.25 million)

52. The human health component will support the implementation of HPAI prevention, preparedness, response, and containment activities in the human health sector as contained in the AIRP. The project, designed by the Rapid Response Team of the Federal Ministry of Health, in collaboration with WHO, CDC and other bilateral partners, took into consideration government health policy agenda. This is geared towards integration of the Avian influenza prevention and control strategies into a wider framework of strengthening the capacity of the health sector to effectively address infectious diseases control.

53. To forestall a third phase human-to-human outbreak, short-term emergency strategies will be supported while planning for long-term interventions. Initial support will focus on prevention and reporting of human cases through the protection of farm workers and others who

are in direct contact with sick birds, social mobilization and raising public awareness and strengthening of the surveillance and laboratory capacity in the affected states. The long-term strategy will mitigate the chances of a circulating pandemic influenza virus strain through: (i) year-round surveillance; (ii) effective and accurate methods of diagnosis; (iii) social distance interventions; (iv) vaccines (once they become available); (v) anti-viral drugs; and (vi) strengthened medical services.

(a) Enhancing Public Health Program Planning, Delivery and Coordination

54. Funding will be made available for: (i) coordination and management of response at federal, state and local government authority (LGA) levels; (ii) adaptation and establishment of appropriate Public Health legislation; (iii) identifying and addressing gaps in effective communication structures among the levels; and (iv) strengthening the capacity for effective planning and supervision of implementation of the response plans.

(b) Strengthening of National Public Health Surveillance Systems

55. To assess risks to public health and establish early warning systems to guide protective measures, information is needed on the extent of A1 infection in animals and humans and on circulating viruses. National as well as regional surveillance systems must be improved urgently in potentially affected countries. When outbreaks in animals occur, active human case detection should be'done by a coordinated animal-public health team.

56. National surveillance will be strengthened through the following activities: (i) review and assessment of the current Integrated Disease Surveillance and Response (IDSR) system; (ii) strengthening and harmonizing existing IDSR to include HPAI; (iii) supporting field serological and epidemiological surveys to increase case detection and sensitivity of the surveillance system; (iv) strengthening existing and establishing specific laboratories on Influenza Like Illness (ILI) in a phased approach; (v) providing technical assistance to states and LGAs; (vi) supporting capacity building and participation in scientific meetings; (vii) supporting hospital mortality studies; and (viii) enhancing community-based surveillance.

57. Current surveillance systems should be enhanced prior to the possible, start of a pandemic to assure that the high demand for timely information that can be anticipated in a pandemic can be met. It is also recommended to carry out active sero-surveillance of the population at risk to complement the animal health surveillance strategy. To this end, the Project will support the following activities.

Improvement of health information and telecommunication systems; Improvement of public health laboratory networks; Training; Studies and research in epidemiological surveillance; and Technical assistance.

(c) Strengthening Health System Response Capacity

58. Social distancing measures: The most effective measure to prevent contracting HPAI will be to limit contact of the virus with the public. Therefore, the Project will support the implementation of immediate term responses i.e., the classic "social distancing measures", such as school closings, backed up by a well-designed communication strategy. For the longer term, options with industry to improve anti-viral and vaccine capacity will need to be explored and supported. The social distancing measures will probably be enforced on advice from health institutions, but these will not be the enforcing agency. Financing will therefore be made available to develop guidelines on social distancing measures (in phases) to operationalize existing or new laws and regulations, support coordination among the Federal Ministries of Agriculture, Health and Information and other agencies and personnel involved in pandemic control activities.

59. Vaccination: Under this activity, support will be provided for seasonal influenza vaccination among high risk workers as a vital step to prevent an outbreak among humans. In case of an avian influenza pandemic, when a vaccine becomes available, hnding will be made available for implementing an influenza vaccination program that rapidly administers vaccine to priority groups and monitors vaccine effectiveness and safety. To this end, support will be provided for the rehabilitation, expansion, and equipment of cold chain facilities for vaccines and other perishable medical products. In addition, National Advance Purchase Agreements (NAPAs) of vaccines will be considered. This measure will help operationalize a public private partnership on influenza pandemic vaccines and achieve equitable distribution by matching capacity with total pandemic demand.

60. Procurement and distribution of drugs and other supplies: The use of anti-viral drugs, while not a panacea, will be part of the strategy to contain an avian influenza pandemic and to reduce morbidity and mortality. Project support will be provided for the purchase, stockpiling and distribution of anti-viral drugs and antibiotics; to determine the susceptibility of the pandemic strain to existing influenza anti-viral drugs, and target use of available supplies; and the adoption of measures to limit the development of anti-viral resistance and ensure that this limited resource is used effectively.

61. Medical services: Assistance will be provided to the health care system for preparedness planning to provide optimal medical care and maintain essential community services. Strengthened clinical care capacity could be achieved through financing plans for establishing specialized units in selected hospitals, treatment guidelines, and hospital infection control guidelines. Also, strategies will be developed to increase hospital bed availability. A substantial burden will fall on inpatient and outpatient health care services, and Project support will be provided to rehabilitate and equip selected health facilities for the delivery of critical medical services to cope with increased demand for services, develop intra-hospital infection control measures, mobilize additional health personnel, including local and international medical non- governmental organizations; training of health personnel, provision of drugs, vaccines, and other medical inputs, diagnostic reagents, including kits, other operational expenses such as those related to mobilization of health teams and salaries, and technical assistance.

Component 3: Social Mobilization and Strategic Communication (US$4.08 million)

62. This component is designed to promote public awareness, participation and improved coordination in the execution of emergency contingency plans as outlined under the National Avian Influenza Plan. The main challenges faced in fighting avian influenza relate to low risk perception, lack of motivation and trust, and livelihood issues. These are compounded by the lack of knowledge of avian influenza among the general public and a wide range of stakeholders, especially the small-scale family poultry farmers. To address these constraints, the Project will identify lines of communication, social beliefs, practices and perceptions which affect behavior and stakeholder habits, by improving public awareness and information. The component will support improved coordination of the execution of the national HPAI responses strategies and plans, And information and communication activities to increase the commitment of government, the private sector, and civil society organizations, and to raise awareness, knowledge and understanding among the general population about the risk and potential impact of the pandemic. Activities will include:

(a) Information and Communication Services

63. Communication preparedness: Activities will include developing and testing messages and materials to be used in the event of a pandemic or emerging infectious disease outbreak by enhancing the dissemination of information from the national to state and local levels as well as between the public and private sectors. Cost effective, sustainable communication activities will be developed through multi-media channels, counseling, schools, etc. These messages will be incorporated into avian flu-specific interventions, as well as outreach activities of involved ministries, especially the Ministries of Health, Education, Agriculture, and Transport. Community mobilization will take place by outreach to the general public, especially in rural areas, the church and local community leaders. Radio messaging will play an important role in outreach. Specifically, support will be provided for: (i) the development and distribution of basic communication materials on influenza, influenza vaccine, anti-viral agents, and other relevant topics; (ii) general preventive measures such as "dos" and "don'ts" for the general public; (iii) information and guidelines for health care providers; (iv) training modules (web- based, printed, and video); (v) presentations, slide sets, videos, and documentaries; and (vi) symposia on surveillance, treatment and prophylaxis.

64. Collaboration with stakeholders: The multi-dimensional problems associated with HPAI infection necessitate collaboration by a wide range of stakeholders, to be supported by broad- based communication and information campaigns to improve public awareness. The major stakeholders include various ministries (notably the members of the Inter-Ministerial Committee), traditional and religious leaders, NGOs, civil society, private sector companies and associations (e.g., large poultry production companies, farmers' and market women associations, veterinarians and farmers at the grass roots level). The activity will support activities designed to improve the effective coordination and collaboration among these stakeholders.

65. Developing capacity building modules and rapid social and communication assessment: This activity will support the development and implementation of training courses in communications methodology for several cadres of information and national orientation officers,

extension and veterinary staff as well as health workers at the central and local levels. It will include preparation of local programs,'preparation and dissemination of information materials, and the provision of communications and information equipment for use at the local and central levels as well as representatives of non-governmental and community-based organizations involved in social mobilization activities at grassroots level. A rapid social and communication assessment will be conducted to investigate household and individual health-related behaviors within their complex matrix of personal, organizational, and social realities. The assessment will explore opinions, attitudes, behavior, and motivations of affected communities, leading to understanding of health, livelihood and other social development issues relevant in designing an effective communication strategy.

Component 4: Implementation Support and Monitoring & Evaluation (US$ 6.89 million)

66. This component will support implementation costs associated with project management, coordination and monitoring and evaluation (M&E). In terms of project management and coordination, the Project will support the provision of technical assistance for procurement, financial management and technical assistanceltraining and coordination. The Project will support training in participatory monitoring and evaluation at all administrative levels, monitoring and impact evaluation assessments.

(a) Project Management Subcomponent

67. This subcomponent will support strengthening the effectiveness and quality of project operations. The Project Management subcomponent will support new or existing institutional entities and mechanisms at the federal, state and local levels of government for overall project coordination and supervision and would help to strengthen the effectiveness and quality of project operations. It will support, at the federal level, the Project Desk Office at the NFDO of FMARD and the Project Desk Office at the HSDP I1 - which will be responsible for overall project coordination. At the local government level, the Project will support a Local Government Desk (LGD) and a multi-stakeholder committee which would be responsible for, respectively, screening and approving project activities and compensation proposals submitted by the Community Thematic Associations (CTAs). The LGD will comprise of three officers including an Animal Health Officer, Human Health Officer and a Community1 Monitoring and Evaluation Officer.

68. Specific items and activities to be funded include equipment, vehicles, operations and maintenance costs, and minor civil works for office rehabilitation at the national, state and local government desks. It will finance specialized technical assistance and training at the federal, state, and local government levels aimed at developing capacity for coordination of implementation. Because this Project will be implemented at the grassroots level, the National Project Desk Office will maintain regular liaison with the state level offices and through that office with the LGD, to ensure effective reporting and backstopping.

69. The AICP organizational structure and the command chain (Appendix 3) should be seen as transitory, pending the emergence of a more relevant, tested and sustainable institutional arrangement. In the local context, the risk of rivalry between various specialists/professionals in

government institutions must be avoided. As soon as is feasible, while the management structure of Fadama I1 is being used to jumpstart the animal health component of the Project, the FDL&PCS of the Federal Ministry of Agriculture responsible for delivery of VS nationwide should strengthen existing VS delivery structures so that it can take full charge of implementing the animal health component.

70. In line with OIE's "Perfonnance, Vision and Strategy (PVS) for National Veterinary Services", the development of an appropriate framework and technical capability strengthening accompanied by human and financial capacity strengthening should lead to privatization of VS and greater interaction of veterinary service providers with the private sector.

(b) Support to National Technical Committee on Avian Influenza (NTCAI)

71. Under this subcomponent, the Project will support the enhancement of the current database and policy formulation capacity of the NTCAI. The Project will finance two main activities: (a) the establishment and operation of Avian Flu Control and Prevention data bank, building on the past experience of the relevant research institutes and governmental agencies; and (b) capacity building for policy and strategy formulation and implementation. The Project will finance the investment costs (mainly equipment) for establishing the data bank, training and international and national consultant services.

(c) Monitoring and Evaluation

72. This subcomponent will support the development of simple, but effective M&E systems in both implementing ministries and for the Project as a whole. It will also support the development of an action plan for M&E, training in participatory monitoring & evaluation at national, regional and local levels, and a mid-term evaluation workshop.

73. The Project will support training in participatory monitoring and evaluation at all administrative levels, and measurement of performance at various project milestones, including three main elements:

a Management Information System (MIS) integrating existing project M&E structures of Project Desk Office at NFDO and HSDP 11;

a Impact evaluation and beneficiary assessments to enhance project implementation performance;

a Monitoring the performance of project activities, and a Environmental Management Plan.

3. Project Costs and Financing

74. Government will utilize three World Bank financed projects to respond to the Avian threat as follows: (a) reallocation of US$7.2 million from the on-going Fadama I1 Project - the Development Credit Agreement (DCA) for Fadama I1 has been amended for this purpose; (b)

reallocation of US$5 million from the on-going HSDP I1 Project - no amendment is required in the HSDP 11; (c) utilization of US$5O.O million from the proposed emergency operation Credit.

75. Government has pledged that it will waive import duties and taxes on goods and services to be procured for the Project, using as rationale the "public goods" nature of preventing and controlling outbreaks of avian influenza. Details of project costs and financing arrangement are presented in Appendix 5.

76. At the Project post appraisal review meeting of February 23, 2006, it was pointed out that the Bank intends to expand the financial envelope for the battle against HPAI pandemic regionally. Under the regional program, Nigeria will be supported under a retroactive financing mechanism since the country has already started the implementation of an HPAI project under the GPAI. At the meeting, Nigeria indicated interest of serving as a regional hub, being the first African country to experience infection with HPAI. The Bank pledged to support Nigeria by providing two consultants to assist in the areas of assessment, auto-evaluation and preparation of relevant operation manuals for HPAI in Nigeria. It was emphasized that the possibility of a regional program with regional IDA credit based in Nigeria will not delay the ongoing A1 Project in Nigeria.

4. Studies and Technical Assistance Required

77. The list of investigations and technical assistance required are as follows:

(i) Assessment o f HPAI in Nigeria

There is the need for epizootiological investigations on the status of A1 virus, including the H5 and H7 strains that cause HPAI. This can be done through:

Serological tests (Haemaglutination Inhibition, Agar Gel Immuno-Diffusion, competitive Enzyme-Linked Immuno-Sorbent Assay (ELISA); Antigen detection (Immuno-fluorescent test, Reverse Transcriptase Polymerase Chain Reaction); Virus Isolation at NVRI; Virus characterization (Gene sequencing, detection and analysis; Haemaglutinin typing; Neuraminidase typing).

(ii) Technical assistance to u-pgrade diagnostic laboratories and veterinaw clinics

Several laboratories have been earmarked to carry out diagnosis of HPAI in the country: NVRI, VTHs at Zaria, Ibadan, Maiduguri, Nsukka and Sokoto for he agroculture sector, and laboratories at the University of Ibadan, Ibadan, Univensty of Maiduguri, Maiduguri, Asokoro Hospital, Abuja and four other zonal albortories to be identified. Each of these should have the capacity to carry out screening direct antigen detection tests, the immunofluorescence test and serological tests for antibody detection. The NVRI only would be expected to carry out virus isolation and identification and any other isolate

characterisation. The following interventions are needed to enable designated laboratories effectively discharge their functions:

Upgrading the diagnostic capacity of the six designated laboratories;

Refurbishing NVRI facilities into an biosafe environment, to minimize risks to laboratory workers handling live HPAI viruses;

Procurement of diagnostic reagents and kits ahead of any outbreak;

Standardisation of tests and interpretation of results, using OIE guidelines;

Training of laboratory staff in diagnosis of HPAI (may require international cooperation) - training should involve neighbouring countries;

Networking with designated laboratories in the West African sub region and other World reference laboratories (the OFFLU network).

It is also necessary to upgrade the veterinary clinics in the designated VTHs and selected state veterinary clinics/hospitals, to conduct sampling, sample processing and basic HPAI serology.

(iii) Strengthening epidernio10,pical capability and surveillance

Refresher training of epidemiologists in project-supported States in surveillance techniques, epidemiological principles, database preparation and management;

Developing surveillance strategies to cover the commercial and backyard poultry segments;

Surveillance techniques and strategies in wild bird---domestic poultry interactions

(iv) Strategic research and linkage with advanced research institutes and laboratories

Investigations are needed on: Socioeconomic asp