Avian Influenza Pandemic Preparedness and Response Plan

Islamic Republic of Afghanistan

National Avian Influenza Preparedness and Response Committee

National Avian Influenza Pandemic Preparedness and Response Plan

Afghanistan-2006

1 Executing Agency Afghanistan National Avian Influenza Committee

Project Title: National Avian Influenza Pandemic Preparedness and Response Plan

Sector: Animal Husbandry and Health Objective: To prevent the occurrence and spread of avian influenza in Afghanistan and to reduce the impact of AI on the human and animal health and economy of the affected population.

Beneficiaries: TOTAL: 22.5 million people of Afghanistan including Women, Children and Other groups: Disabled people, IDP, Returnees, Kochi etc. Implementing Agency: Ministry of Public Health and Ministry of Agriculture, Animal Husbandry and Food Project Duration: 24 Months Total Project Budget: US $ 10,551,289 Funds Requested for US $ 10,551,289 2005:

I Background

Human Influenza (flu) is caused by a virus that attacks mainly the respiratory system (nose, throat, bronchi) and transmitted through respiratory droplets. Most people recover easily within one to two weeks but in the very young, the elderly and people with some chronic diseases, influenza poses a serious risk. Influenza spreads rapidly around the world in seasonal epidemics, and imposes a considerable economic burden (health care and lost productivity). For most people affected, influenza will last several days but requires only symptomatic treatment. Antibiotics cannot eradicate the virus, and are used only to treat complications. The annual epidemics of influenza are due to minor changes in the virus, which allow it to escape the immunity that humans have developed after previous infections or vaccinations. Avian influenza, or bird flu, is caused by viruses that normally infect only birds (including chicken, ducks, geese, quails and wild birds), and, less commonly, pigs and other mammals. Domestic poultry are especially vulnerable to infection that can rapidly reach epidemic proportions. Mutations or reassortment of the bird flu virus into new and more aggressive strains occur regularly and have already caused several severe avian flu outbreaks in the past, some of them causing human fatalities. In 1997 in Hong Kong, China, 18 people were infected and 6 died, and in the Netherlands in 2003 several people were infected and one died. In both cases as well as in other similar outbreaks, spread of the virus was stopped by immediately culling the whole population of infected chickens.

From mid-December 2003 through 1st March 2006, 45 countries in Asia, Europe and Africa, Mediterranean Sea surrounded countries (Italy, Greek and Bulgaria)have reported outbreaks of the “H5N1” avian influenza in domestic poultry, including chickens and ducks, or wild birds. In seven of these countries, a total of 174 human cases had been confirmed as of December 2003, resulting in 94 deaths. Avian influenza or "bird flu,” is a highly contagious viral disease that is particularly lethal to domesticated birds. Public health experts are increasingly concerned that ongoing outbreaks of the avian influenza (AI) virus among poultry and humans in Asia could spark a worldwide influenza pandemic that would have disastrous effects on human health and the global economy. A global flu pandemic could result in airport closures and other travel restrictions – not to mention panic – that would stop global commerce and cut off supplies to Afghanistan and consumers around the globe. The greatest influenza pandemic occurred in 1918-1919, responsible for 40-50 million deaths worldwide. Today, vaccines, antibiotics and antiviral drugs are available. According to WHO and the CDC estimate that a pandemic is likely to result in 2 to 8 million deaths globally, with a very high economic cost, particularly for low income countries where health care resources are already constrained.

In response to these concerns the World Health Organization is strongly advocating influenza pandemic preparedness planning. The objectives are to enable countries to be better prepared to recognize and manage an influenza pandemic; to reduce the transmission of the pandemic virus; to decrease cases; hospitalizations and deaths; to maintain essential services; and to reduce the social and economic impact of an influenza pandemic. The World Health Organization has identified strategic goals during the Pre-pandemic phase:

3 Strengthen early warning systems Reduce opportunities for human infection Ensure early detection, notification and response Contain and limit foci of infection

At the country level, these strategic goals must be translated into action plans with specific objectives, to enhance disease surveillance and response preparedness. These goals have been addressed in plans for avian influenza developed in Afghanistan.

2. Avian Influenza in Afghanistan: Afghanistan is one of the world’s poorest countries, a post conflict country that has suffered from 23 years of war and had one of the lowest medical and social indicators in the world even before the Soviet invasion. Majority of it’s population is involved in agricultural crop and livestock production with 85 percent of the rural population (approximately 20 million) involved in this endeavour, with a 3.5 million cattle and 16.7 million small ruminants population and about 13 million of chickens1. Meat, milk and dairy products are important to the diet of the Afghan people.

Poultry are mainly kept by rural households with flock sizes below ten birds. Most birds are of local breed and fed on household waste and crop residues resulting in a productivity of 40-60 eggs per year per hen. Annual mortality of chicken under these conditions often exceeds 50 percent due to the poor management, Newcastle Disease and some other contagious diseases. In the past, intensive poultry production for eggs and meat was only initiated on few Government farms however, which are no more operational. Few larger poultry units with several hundred hens exists around the major cities which produce chicks and eggs similar to the village system, but with a higher input level. At present, rural poultry and their products still contribute more than 98 percent of the poultry products in the country.

The long years of conflict, poor living conditions, over-crowding, inadequate housing and poor environmental conditions, all contribute to the great burden of communicable diseases in Afghanistan. Diarrheal diseases, ARI (particularly, pneumonia, and influenza), meningococcal diseases, viral hepatitis, measles, typhoid, hemorrhagic fever, tuberculosis, cholera, malaria and leishmaniases constitute a huge disease burden. The lack of coordinated national surveillance to monitor, report and respond to epidemic- prone, emerging, and re-emerging infectious diseases in addition to the general absence of the diagnostic capabilities necessary to identify accurately pathogenic micro- organisms, and the insufficient numbers of trained health care professionals to investigate theses infectious diseases, further aggravate the problem..

Globalization, increasing urbanization and poverty, civil strife and political instability, climate change and exploitation of new environments, all contribute to the global amplification and spread of new diseases and the resurgence of those once considered to be under control. These outbreaks and epidemics repeatedly challenge national health services and disrupt routine control programs diverting attention and funds. The increasing resistance of micro-organisms to drugs further aggravates the problem by undermining available therapy, reducing opportunities for treatment and prevention and 1 FAO livestock census conducted in 2002-2003

4 significantly increasing the costs of health care, in our closely interconnected world, adverse events in one country may easily cross borders and intrude on another and, thus threaten the global health security.

Afghanistan has one of the highest under 5 year old mortality rates in the world, one of the main causes being death due to Acute Respiratory Infections. The country also suffers from regular outbreaks of acute respiratory diseases with significant morbidity and mortality, especially in villages and districts in isolated geographical areas of the country where health service coverage is inadequate, and public health such as vaccination programs have not covered the whole population. According to the World Health Organization Afghanistan is considered a co untry at ‘high risk’ for Avian Influenza as it lies along the migratory pathways of wild birds traveling south westerly from Siberia, and has several geographically distinct wetlands serving as transit points for migratory wild birds in the North and South of the country, and countries bordering Afghanistan have recently reported deaths of poultry due to avian flu Lying in the flight routs of Migratory bird, widespread practices of raising poultry in the home to supplement income, low community awareness and a health system that is in the early stages of delivering effective health services equitably makes Afghanistan especially prone to dangers of an outbreak of a virulent form of avian influenza. There is a critical need in Afghanistan for establishing a suitable disease surveillance, preparedness and response system, capable of early warning and effective response to epidemics. This surveillance and response systems requires, however, trained staff, improved communication, appropriate infrastructure, provision of necessary supplies, strong public health laboratories and links to international networks and all necessary.

Out of 1600 collected samples from wild and domestic birds from 15 high risk provinces in the country 6 samples are confined for H5N1, that 3 samples are from Kabul, 2 samples are from Jalalabad and one sample from Laghman province. As Afghanistan is on the migratory route of wild birds, the risk of re-emerging of new strains of the disease is always present in this country.

Generally Afghanistan lacks sufficient human and physical resources to address these issues, especially where poultry-migratory bird-human interactions are concerned. Common constraints to effective disease recognition and control include:  Poultry farming in the country is predominantly a rural, or backyard enterprise  Animal disease information is generally lacking  Wild birds and domesticated ducks are believed to be major H5N1 reservoirs  Levels of consumer and farmer awareness are low  Little emergency preparedness exists  Human resource capacities for human and animal health are limited

5 Inadequate technical knowledge of the producers, unavailability of vaccines for the prevention of important diseases and lack of other input supplies and health services are the most important constraints to the system.

3. Activities in Afghanistan to date:

There is a strong level of recognition by senior policymakers and government officials of the Islamic Republic of Afghanistan of the importance of preventing avian influenza, the Deputy Minister of Public Health (MOPH) leads an Avian Influenza Task Force within the MOPH, and one of the Vice-Presidents chairs an inter-ministerial, cabinet level emergency response team, which is beginning to address the coordination issues required for a country-wide Avian Influenza response. The MOPH AI TF includes representatives of all the major international health organizations (Ministry of Agriculture, Animal Health and Food, WHO,UNICEF, FAO, US Department of Health and Human Services, Centers for Disease control (HSS/CDC) NGO’S and donors such as World Bank, European Commission and USAID. The Task Force Meets biweekly and has produced several technical documents and plans on Avian Influenza for the Afghan setting, including

 Clinical case definitions for surveillance of avian influenza  Fact sheet in local languages for health care workers, and local population  Information, education and communication messages for patients and health care workers  Technical Guidelines for the prevention, isolation and control of Avian Influenza in the event of an outbreak  Plans and technical documents for a National Surveillance and Response System for Avian Flu in Afghanistan, including curriculums for training health care workers in surveillance and response

These technical documents and plans were developed with guidance from the World Health Organization, Ministry of Agriculture and Food, Food and Agriculture Organization (FAO), and local technical experts. A national preparedness plan for avian or pandemic influenza is in the early stages of development. The Ministry of Agriculture and Food have conducted sero-surveillance survey from 07-17 November 2005 the surveyed areas are the Sistan-Hilmand watershed (wetlands), the Ghazni Rod river/Bandi Sultan, the Band-i-Amir lakes, the Amu Darya and some forests in Jowzjan, Balkh, Kunduz, Takhar, Badakhshan, Nangarhar, Khost, Kabul, Kandahar and Heart in this survey sample of 1,500 wild birds in Afghanistan were collected to determine the existence of strains of avian influenza in Afghanistan . Recently there have been efforts by the Ministry of Public Health and the Ministry of Agriculture and Food to develop a comprehensive and coordinated plan for the control of avian influenza in the event of an outbreak in poultry or domestic birds

Currently, because of the above mentioned realities, Afghanistan has no active or passive national system of sentinel surveillance of diseases of high morbidity and mortality, and has little capacity to rapidly collect store and transport samples of suspected animal or

6 human cases to regional laboratories, with no laboratory capacity to identify suspected cases. Activities to educate and inform the public about avian/pandemic influenza (case recognition, prevention, risk behaviors, caring for the ill, etc.) exists, and materials specific to avian influenza have been developed through the Task Force with other partners. As there is a low level of awareness of the public with regards to avian influenza and no stockpiles of anti-viral exist in Afghanistan, but antibiotics are in good supply. There are no stocks of personal protective equipment, or equipment for isolation in the event of an outbreak. All these essential equipment and assistance must be made available for Afghanistan to have a minimum level of preparedness for avian influenza. Financial assistance is required for rapid expansion and improvement of surveillance, eg, payment for training activities, surveillance forms and reporting, sample kits for influenza testing, purchase of isolation equipment and supplies, technical assistance and support for an effective response in the event of an outbreak of Avian Influenza.

Areas of particular interest for partnerships include supporting AI prevention and containment by improving disease surveillance, laboratory diagnosis, and outbreak response in affected countries; and strengthening planning and preparedness to reduce the effects of a pandemic; Technical assistance from corporations and universities in establishing diagnostic laboratories, to increase capacity to establish and support diagnostic laboratories, improve timely sample collection, conduct field epidemiology, safe culling and disposal of infected animals, improve clinical management of human cases. Communications expertise from concerned organizations aimed at increasing public awareness and curbing behaviors that facilitate the spread of AI. Product donations from pharmaceutical and health care companies including vaccines, antiviral drugs, disinfectants, protective clothing, and lab and hospital equipment and support for acute respiratory Infections

4 Goals and purpose:

Objectives

1. The overall objective is to address the urgent short and medium-term actions that are to be undertaken by the Government to strengthen its capacity in order to rapidly detect the introduction of HPAI into the country and minimize its spread in the case of its occurrence.

2. Specific objectives

1. To prevent the occurrence and spread of avian influenza in Afghanistan and preparing the necessary resources for containing the disease in the event of an outbreak

7 2. to strengthen capacity and undertake disease surveillance and laboratory diagnosis for HPAI; 3. to safeguard human health by improving public awareness and information; 4. to develop emergency preparedness plans for HPAI.

The above objectives and activities should be viewed as the first phase of a longer term program aimed at strengthening the veterinary services system of Afghanistan to deal with other potentially destructive infectious disease outbreaks. The proposed project would therefore serve as an effort to evaluate the methodologies most suitable for emergency preparedness and long-term intervention.

5. Components

1. Training component o Surveillance and Outbreak Investigation o Isolation procedures o Control procedures o Treatment of Severe Acute respiratory infections o Supplies and Support for Outbreak investigation . Sample collection kits for respiratory secretions and tissue . Transport o Training of staff 2. Procurement and management of Equipment o Isolation equipment, personal protective equipment, tents o Control equipment and materials o Anti-virals and influenza vaccine for high risk groups e.g. health care workers, poultry culling workers and laboratory technicians o Strengthening of hospitals to treat Acute Respiratory Infection . On-call ambulance . Lab supply and equipment (microscopes, reagents etc.) 3. Information, Education and Communication o For professional medical staff o For the community . News stories and interviews . Drama for radio and TV spots . Posters and pamphlets o Awareness campaign . Mullahs through Ministry of Hajis, Martyrs and Religious Affairs . Women through Ministry of Women’s Affairs . Teachers through Ministry of Education 4. National Public Information Campaign, delivery of messages to the communities during Nation-wide house-to –house Polio Immunization Campaigns 5. Establishment of Surveillance System

8 a. Establishment of sentinel sites in selected provinces then I all provinces b. Integration into National Health System c. Expanding system to include other diseases of high priority in Afghanistan 6. Coordination between Ministry of Public Health, Ministry of Agriculture, Animal Health and Food, European Community, USAID World Bank, Asian Development Bank, FAO, WHO, ICRC, ARCS, other NGO’s, and related Line Ministries 7. Strengthening capacity and undertaking HPAI disease surveillance and laboratory a. Strengthening animal disease surveillance. b. Diagnostic capacity building. c. Assess the risk d. Regular surveillance and monitoring e. Regular random surveillance. f. Build capacity of veterinary services in epidemiology surveillance and disease reporting to combat major trans-boundary diseases.

8. Component B – Communication and public awareness

This Component is directed toward two issues:

1. The need to safeguard human 2. To improve opportunities of early warning of an incursion of HPAI by improving public knowledge of the disease and how to report suspect cases.

This Component will provide support by:

 carrying out a needs assessment of existing poultry extension and public information programmes;  developing community-based extension to farmers and enhance public awareness; and (c) monitoring and evaluation of public awareness and extension activities under the project.

 Capacity Building, in Communication and Public Information.  Developing Pilot models for Community-based Rapid Communication.  Developing farmers’ groups and/or associations

9. Emergency outbreak containment

 stocking emergency vaccine against HPAI,  development of a rapid mobilization  Bio-security

9  Smallholder households keep approximately 98 percent of the total poultry

 Develop emergency preparedness  Contingency arrangements of vaccines.  Review of legislation  Assess the poultry industry in Afghanistan

6. Outputs

1. Comprehensive response to an outbreak of avian/pandemic flu in Afghanistan that addresses all aspects of control 2. Health care staff trained in outbreak investigation, surveillance and response to avian influenza 3. Health care staff able to implement prevention, isolation, treatment and control measures in the event of an outbreak of Avian influenza 4. Stockpiling proper equipment in Afghanistan to respond to an outbreak of Avian Influenza. 5. Strengthening of hospitals to control and treat severe respiratory diseases 6. Early warning and quickly reporting any signs of disease in human and birds through surveillance system. 7. Rapid appropriate, adequate and timely responding to the emergency events 8. The risk of introduction will be thoroughly assessed. 9. In the event of introduction of HPAI into the domestic poultry population the persistence of the virus will be minimized. 10. The risk of human epidemic influenza in Afghanistan will be reduced, and safe trade in poultry and poultry products assured. 11. The Government of Afghanistan has the capacity to implement the emergency plans in the event of detection or an outbreak of HPAI. 12. The population is familiar with HPAI early detection indicators / indications. 13. Mechanisms at the household level for immediate reporting the occurrence of HPAI are in place. 14. Rehabilitation mechanism in place for people whose livelihoods are affected by HPAI. 15. A base established for longer-term intervention for strengthening national capacity for Avian Influenza prevention and control.

Timetable for implementation: 18-24 months

7 Main Activities

10 1. Establishment of Surveillance and early warning systems within health system of Afghanistan 2. Training and education for human and animal health care workers on avian influenza 3. Strengthening of Regional and Provincial Hospitals for surveillance, treatment and control of Avian influenza 4. Community Awareness through Information, education and communication on avian influenza for health care workers and communities 5. Community Involvement and Community Participation 6. Risk assessment of the introduction of AI through migratory birds 7. Establishment of Animal Health surveillance and early warning system and diagnostic capacity for the early detection of HPAI in domestic and wild birds 8. Developing an appropriate and rapid early response and applying control measures

8. Other partners who are currently involved

 FAO  WHO  UNICEF  Other line Ministries of the Islamic Republic of Afghanistan.  The World Bank  USAID  Asian Development Bank  Departments of Health and Human Services / CDC.

VII Monitoring plan and key indicators: to be developed

VIII Plan for disseminating results

 Official Reports from the MoPH and MAAHF , should be shared with the National AI commission without delay

 Workshops at Central level

9. Establishment coordination with WHO’s Global Influenza Network 10. Establishment coordination with Global Influenza Network in the region and with ECO Member State on AI

11 IX Budget Budget for AI Pandemic preparedness and Response Description Unit No. Unit Total Remarks Units Cost cost US$

(A) Surveillance system establishment Establishment of a Surveillance system 277,680 see annex a for details Office Equipment 100,000 For communicable diseases Surveillance program for 34 Provinces Satellite Phone & cards item 4 1,500 6,000 one time investment for national level Vehicle to rent item 15 800 per 288,000 15 vehicles for 15 month provinces for 24 months Support cost( general operating expenses, 1,374,519 contracts, support cost of Ministry of Agriculture) Subtotal 2,046,199 Personnel National Coordinator month 24 1,700 40,800 for national level, 2 year contract National Surveillance Officer month 24 1,000 24,000 for national level, 2 year contract Zonal supervisor month 24 800 19,200 for national level, 2 year contract Zonal desk officer month 24 500 84,000 7 personnel, for national level, 2 year contract Finance Officer month 24 500 12,000 for national level, 2 year contract 2 Office administrators month 24 300 7,200 for national level, 2 year contract Support staff 20,000 Provincial and central project support staff Provincial focal point month 24 100 81,600 For 34 provinces Staff cost ( consultants, Overtime, Travel, 1,510,190 Technical support services in the Agriculture ministry) Subtotal 1,798,990 Training Component

12 National AI Trainers month 48 500 24,000 Trainers on surveillance and control for 15 provinces Training( culling, monitoring etc) 450,000 Subtotal 474,000 (B) Case Management Equipment Hospital equipment item 200,000 Supplementary beds, oxygen tanks and nebulizers for hospitals for ARI Personal Protective Equipment item 2,000,000 Disposable gowns, gloves, masks, glasses, boots, apron, etc. Lab improvement services item 200,000 Lab equipment for hospitals, including reagents Running costs for collection and transport of item 200,000 Media for sample specimens transport, sample carrier and transport to Laboratory Antivirals 1,040,000 For high risk groups such as agricultural and health care workers, 2,000 workers, 60 days, $10/dose Flu vaccine item 15,000 2,000 workers, $7.5/dose Rapid screening kits for AI item 4,500 10 kits, $450/kit Internet communication for hospitals item 20,000 For regional hospitals Equipement related to culling, monitoring, of 1,985,000 poultry part of response Subtotal 5,664,500 ( C) Information, Education and Communication Information, Education and Communication 547,600 For details please see to annex D Internet communication for hospitals item 20,000 For regional hospitals Subtotal 567,600

Grand Total 10,551,289

13 Annex A:

Proposal for Human Surveillance in Afghanistan

Background:

Afghanistan is one of the world’s poorest countries, a post conflict country that has suffered from 23 years of war and had one of the lowest medical and social indicators in the world even before the Soviet invasion. This has resulted in the destruction of municipal, economic and social infrastructure. A significant number of the population of Afghanistan is internally displaced, having newly arrived from refugee camps in neighboring countries. Many of returnees lack basic shelter and may not have access to adequate health care, thereby being vulnerable to acute respiratory disease especially during the harsh Afghan winter. The long years of conflict, poor living conditions, over-crowding, inadequate housing and poor environmental conditions, all contribute to the great burden of communicable diseases in Afghanistan. Diarrheal diseases, acute respiratory infection (ARI), particularly pneumonia and influenza, meningococcal diseases, viral hepatitis, measles, typhoid, hemorrhagic fever, tuberculosis, cholera, malaria and leishmaniases constitute a huge disease burden. The lack of coordinated national surveillance to monitor, report and respond to epidemic-prone, emerging, and re-emerging infectious diseases in addition to the general absence of the diagnostic capabilities necessary to identify accurately pathogenic micro-organisms, and the insufficient numbers of trained health care professionals to investigate theses infectious diseases, further aggravate the problem.

Afghanistan has one of the highest under 5 year old mortality rates in the world, one of the main causes being death due to ARIs. The country also suffers from regular outbreaks of acute respiratory diseases with significant morbidity and mortality, especially in villages and districts in isolated geographical areas of the country where health service coverage is inadequate, and public health such as vaccination programs have not covered the whole population. As per Multiple Indicators cluster survey (MICS) that UNICEF and CSO (Central Statistic Office) have conducted in 2003 ARI prevalence in June-July 2003 is 19 per cent, while advice/ treatment sought is 29 per cent (rural = 27 per cent, urban = 34 per cent, east region = 26 per cent). There is a critical need in Afghanistan for establishing a suitable disease surveillance, preparedness and response system, capable of early warning and effective response to epidemics.

14 Objective:

 Strengthen surveillance activities for influenza-like-illness (ILI) in Afghanistan and coordinate surveillance and laboratory testing activities with National Lab facilities of MOPH and the Ministry of Agriculture (MOA).

 Restructuring the existing passive surveillance system (ARI) in the country and establishing a surveillance system to detect ILI cases in all provincial hospitals and through active surveillance obtain all ILI cases from district hospitals in 15 high-risk provinces.

Activities:

In order to set up an efficient surveillance and early warning system to detect potential cases of novel influenza (i.e. H5N1) in the country, the Ministry of Public Health, in collaboration with national and international partners, decided on the following activities:

1. Determination and dissemination of standard case definition for disease, which is consistent with national and international requirements;

2. Training of staff members involved in surveillance and treatment of suspect cases; and

3. Coordination Activities - Strengthening the routine Acute Respiratory Infection (ARI) reporting system to detect ILI cases from provincial hospitals in all 34 provinces, while expanding the system to district hospitals in 15 provinces designated as high-risk for avian influenza by the Ministry of Agriculture.

4. Health Surveillance for workers involved in Culling activities and healthcare workers treating exposed persons

I - Case Definition

Clinical criteria:

Any suspected cases of human infection with a novel influenza virus must first meet the criteria for influenza-like illness (ILI), defined as temperature of >38°C plus either sore throat or cough. Since lower respiratory tract involvement might result in dyspnea (shortness of breath), dyspnea should be considered as an additional criterion. Therefore, the full clinical criteria are: fever plus one of the following: sore throat, cough, or dyspnea.

Epidemiologic criteria:

Epidemiologic criteria for evaluation of patients with possible novel influenza focus on the risk of exposure to a novel influenza virus with pandemic potential. Although the incubation period for

15 seasonal influenza ranges from 1 to 4 days, the incubation periods for novel types of influenza are currently unknown and might be longer. Therefore, the maximum interval between potential exposure and symptom onset is set conservatively at 10 days.

Exposure risks — Exposure risks fall into two categories: travel and occupational.

Travel risks

Persons have a travel risk if they have: 1) recently visited or lived in an area affected by highly pathogenic avian influenza A outbreaks in domestic poultry or where a human case of novel influenza has been confirmed, and either 2) had direct contact with poultry, or 3) had close contact with a person with confirmed or suspected novel influenza.

Direct contact with poultry is defined as: 1) touching birds (well-appearing, sick, or dead), or 2) touching poultry feces or surfaces contaminated with feces, or 3) consuming uncooked poultry products (including blood) in an affected area. Close contact with a person from an infected area with confirmed or suspected novel influenza is defined as being within 3 feet (1 meter) of that person during their illness.

Because specific testing for human infection with avian influenza A (H5N1) might not be locally available in an affected area, persons reporting close contact in an affected area with a person suffering from a severe, yet unexplained, respiratory illness should also be evaluated.

Clinicians should recognize that human influenza viruses circulate worldwide and year-round, including in countries with outbreaks of avian influenza A (H5N1) among poultry. Therefore, during the Interpandemic and Pandemic Alert Periods, human influenza virus infection can be a cause of ILI among returned travelers at any time of the year. This includes travelers returning from areas affected by poultry outbreaks of highly pathogenic avian influenza A (H5N1) in Asia. As of October 2005, such persons are currently more likely to have infection with human influenza viruses than with avian influenza A (H5N1) viruses.

Occupational risks

Persons at occupational risk for infection with a novel strain of influenza include persons who work on farms or live poultry markets or who process or handle poultry infected with known or suspected avian influenza viruses, workers in laboratories that contain live animal or novel influenza viruses, and healthcare workers in direct contact with a suspected or confirmed novel influenza case.

16 II- Training of staff

The Ministry of Public Health will use the BPHS system in the country to disseminate the necessary forms and case definition to the service providers and ensure that NGO partners can train the medical staff in the provincial and district hospitals and health centers. The training costs will be determined by an evaluation of the quality of the data submitted to the Ministry at the present time. The forms will need to be evaluated and modified accordingly. Based on the findings, a training program can be promptly developed and implemented throughout the country.

All staff who are involved in the culling of birds, monitoring of culling activities, surveillance of disease and hospitalization and treatment of ILI suspected case should receive a specific orientation session and be fully aware that how cautious they should be , to protect themselves and prevent from spread of disease. The training should cover the taking on and off of PPE kit; personal hygiene especially hand washing techniques etc. All of these staffs should know a very simple case definition of disease and upon development of signs and symptoms like sore thought, fever, cough and or dyspnea should contact a designated consultant or hospital and preferably they have to notify the health workers before the go for consultation.

Active surveillance

MOPH, with all national and international partners, has decided to use active surveillance for detection of suspected cases for ILI in the areas and provinces that ranked high risk in the country by ministry of Agriculture and Animal Husbandry. These provinces are Kabul, Ghazni, Balkh, Baghlan, Kunduz, Khost, Kandahar, Herat, Jawzjan, Takhar, Badakhshan, Nimroz, Nangarhar, Laghman and Kapisa. Surveillance clerks of the Public Health Directorates, after receiving appropriate training, will go to the district hospitals and review all ILI cases from the previous week. Following the lead from the provincial department of agriculture, public health directorate can further assess the situation. The information is passed to MOPH and MOA in Kabul for further action. In the ministry level Information will be matched with information that Ministry of Agriculture has on the presence and types of Avian Flu virus in that area and locality, and appropriate actions will be taken once the information has been verified.

Passive surveillance

17 There are already some passive surveillance systems throughout the country. This is being used for monitoring disease trends. Two of them are the surveillance system for monitoring of ARI and Acute Watery Diarrhea (AWD) cases. The present system is not a very sensitive system but if ILI case definitions are applied properly and precisely, it will be easy to determine the ILI cases in the district and/or in the provincial hospitals. The system has already been in use in the country for at least four years and it has proved to be very essential to the early case identification, reporting, and monitoring of AWD and ARI cases. The system includes weekly and monthly reporting forms (ARI and AWD cases) system and other notifiable disease forms such as Viral Hemorrhagic Fever, Cholera.

In order to establish a long lasting and sustainable surveillance system in the country, one should build on the existing systems and not establish another system creating duplication and confusion in the health reporting system. Therefore MOPH will work with the NGO network in the provinces and districts to report the suspected cases of AI and to send the weekly reports to the ministry of public health through their existing communication system. In remote areas, there is at least one national or international NGO which the public health directorate will coordinate reporting of the weekly forms. At the moment, five of fifteen high-risk provinces, are very remote and it is always difficult to receive information from these provinces; thereby, the only reliable way of getting information is to use the communication system of the NGOs.

III – Coordination with the Ministry of Agriculture and Other Partners

All surveillance activity within the MOPH for human influenza must be coordinated with surveillance activities within the MOA. In addition, establishment of a fully functional surveillance system for avian influenza needs time, expertise, money and equipment not presently available to Afghanistan. Therefore, the MOPH, along with its partners, decided to utilize the existing system of ARI and AWD surveillance and modify it to serve as a sentinel surveillance system for influenza. The ARI and AWD surveillance systems were used in the control of ARI outbreaks in winter 2004-2005 and also in the preparedness and response activities related to the acute watery diarrhea outbreaks in summer 2005. The very low mortality rate in later outbreak proves the capability of system in the preparedness and response activities.

18 Within this system, all Provincial Health Directorates send their total admissions (mild, moderate, and severe cases of ARI) in the provincial to the MOPH in Kabul. As was decided, this system will be expanded within 15 provinces to include the district hospitals in the reporting system. Those provinces are Kabul, Ghazni, Balkh, Baghlan, Kunduz, Khost, Kandahar, Herat, Jawzjan, Takhar, Badakhshan, Nimroz, Nangarhar, Laghman and Kapisa.

If increased ILI or ARI cases are detected within the provincial or district hospitals, staff from the provincial health directorate will contact their counterparts in the provincial offices for the MOA and ask about current situation of morbidity and mortality among the wild and domestic birds in the community. No action with regard to avian influenza need be taken if there are no serious morbidity and/or mortality among the bird population. Conversely, if the provincial office of the MOA, through their routine surveillance system, detects an increase in bird morbidity and/or mortality, they in turn will notify the provincial health directorate of the situation. It will then be the responsibility of the provincial health directorate office to investigate and see if there are any unusual cases of ILI or ARI, which may not have come to the immediate attention of the district or provincial hospitals.

IV – Health Surveillance for workers involved in Culling Activities and Healthcare Workers Treating Exposed Persons

All staff involved in the management and control of AI should receive a specific orientation session on the safety measures related to his/her work; this includes personal hygiene e.g. hand washing practices, wearing the PPE kit and also proper discard of the PPE after use.

Ideally there should be an isolated hospital/clinic to deal in the case management of AI cases. These hospitals should be fully equipped with infection control equipment and all staff should judiously follow the infection control measures.

Vaccination of all workers against human influenza and antiviral chemoprophylaxis of staff who are in close contact with the diseased poultry and or human, are essential, but due to high cost, unavailability of avian human vaccine for the existing strain of the virus in the country, time for protection of the recipient, this is not feasible at the moment.

19 A sample case definition of disease should be taught to the workers and they should be educated that in case of development of any sign and symptom e.g. sore throat, fever, cough and breathing difficulties they should contact a designated doctor or hospital for health services. Ideally they should notify their health care provider that they may have been exposed to avian influenza.

With the exception of visiting a health care provider, individuals who become ill should be advised to stay home until 24 hours after resolution of fever, unless an alternative diagnosis is established or diagnostic test results indicate the patient is not infected with influenza A virus.

While at home, ill persons should practice good respiratory and hand hygiene to lower the risk of transmission of virus to others.

Financial requirements (Budget):

S/N Descriptions Unit Duration/ Unit cost Total (US$) month (US$) Passive surveillance 1 Communication - Mobile phones 34 6 200 6,800 - Top up card (for 6 34 6 300 10,200 months) Active surveillance Incentive of staff * 68 6 360 146,880 Transportation 34 6 200 40,800 2 Designing, 34 2,000 68,000 Implementing, and Monitoring of training

3 Stationary supplies 5,000 5,000 Total cost 277,680 * Incentive 10USD/day 3 days/ week 4 weeks per month

20 Annex B:

Standard Operations Procedure Islamic republic of Afghanistan

Standard operation procedures for Avian Influenza outbreak control and response

Dealing with Avian Flu suspected cases:

Patient with fever (>38 C) with influenza like illness (ILI) or pneumonia symptoms (cough, sore throat and breathing difficulties); The in charge medical doctor should ask the following 3 questions.  Live in the village where poultry deaths had been reported 2 weeks prior to illness?  Contact with feces or death poultry within one week prior to illness?  Closed or direct contact with any pneumonia patient within 10 days prior to illness? If the answer is yes to one or more of the question then The patient should be tested for evidence of Influenza-A infection, once MoA has confirmed the H5N1 strain of AI in the birds population in that area and close contact of affected person with infected birds. If the case is positive for Influenza-A or strongly suspected by the doctor;  The case should be reported immediately to the higher level (MoPH)  Put patient in isolation room  Prescribe anti viral medicine Tamiflu immediately (for adults one tablet of 75mg each in the morning and in the evening for 5consecutive days)

Higher level (regional & national level) dispatch investigation & response team for investigation (checking contact history and poultry death, to find any other patient, provide health education and trace close contacts for 10 days)

If the preliminary investigation reveals real dead poultries, ministry of agriculture should be notified as soon as possible.

If the ministry of agriculture find that the cause of death of the poultries is likely to be Avian Influenza  Quarantine; the findings should be immediately reported to the higher levels (provincial, regional and national) and the affected area will be declared sanitary cordon as epidemic/suspected epidemic zone.  Cull all poultry in the area and disinfect with antiseptic solution and start compensation for culled poultry. In case of lack of the fund, don’t wait for compensation.  Poultry conveying/traffic is absolutely prohibited  Poultry surveillance within 5 KM radius from the affected area/original focus for at least 3weeks (21 consecutive days).

21 Annex C:

District Name & Code Province Name & Code Date of Report BHC/CHC Name & Code Disease Identification Complete one form for each disease, or cluster of cases and send immediately to the PHD. Do not wait till the end of the month, to act on the cases or to send the report. Investigate the case(s) before reporting 2. Exact location of the cases 1. Notifiable disease (check only one box) Hemorrhagic fever AFP Meningitis …. 3. How did you discover the case(s) Rabies …. Cholera …. Plague …. Other, specify:

Identification of the case(s) Status Address Sex Age Date Ill Name SN 1 2 3 4 5 6 7 8 9 10

Action Action Taken:

Action / resources required:

Date Name/designation Signature

22 Annex D:

Proposal for Communication

Avian Influenza National Communication Plan Islamic Republic of Afghanistan

The following plan sets out proposed actions to be taken to prevent a pandemic of avian influenza, and immediate actions necessary should a pandemic be declared. Many preventative actions are now underway, and need to be taken to scale.

This plan builds upon an outline approach produced by the Government of Afghanistan in February. Specific details, such as volumes of materials and modalities for orientation of key communicators, need to be defined further, but the plan provides a clear structure for communication activities.

It is recommended that a communication working group, involving the Ministry of Public Health, Ministry of Agriculture, Radio Television Afghanistan, UNICEF, WHO and FAO, and combining communication specialists with technical experts, leads the following communication plan. Given the urgency of the issue, and the lead-in time required to produce effective communication materials, it is urged that the decision making and sign-off process for all materials is simplified, perhaps with one member of the communication group having final authority over approvals. In order not to delay implementation, the technical authority of members of the communication working group should be beyond question, and that full trust is placed in the group to develop and produce the right messages and materials required to reassure and inform the public.

A large of amount of technically sound and tested materials is available from other countries, and with the support of the National Avian Flu Task Force, much of this material can be quickly adapted to the Afghanistan context without the need for intensive consultation or debate.

23 It is estimated that an initial budget of US$ 430 000 is required for the pre-pandemic stage, subject to the volume of printed materials produced, and an estimated budget of US$100,000 for the pandemic stage.

Pre- Pandemic

Objective: 1. Reduce the risk of animal to animal transmission 2. Reduce the risk of animal to human transmission

1. Primary Audience Strategy focuses on rapid dissemination of key prevention messages through mass media, and some interpersonal communication with health workers, teachers and religious leaders. This initial phase would place emphasis on rapid dissemination of core messages through radio and television (both national and independent), through distribution of materials through schools, and the display of information posters in communities. Technical messages have already been developed and approved, and work is underway now to produce radio and television spots, and produce simple information posters. A technical information leaflet has also been produced, but simpler versions may be required. Media briefings need to be organized as a matter of urgency.

Timeline: March 15 – July 31

No Audience Messages drive Message to give IEC Tools Distribution Channel Group 1 Households Poultry handling, Wash hand; keep poultry away Radio and TV spots, National and Private Poultry keeping, from your living areas, report posters, leaflet, Radio and TV, print birds hunting on sudden deaths of poultry , Picture Card media, Friday Sermon don’t mix raw and cooked via by Religious poultry, stop hunting wild birds, Leaders, CHWs, cook poultry products Schools, thoroughly, avoid all unnecessary contact with birds, their feathers, faeces, and other wastes 2 School Touching sick or Avoid touching sick or dead Radio and TV spots , Teachers Children dead birds birds, wash hand Leaflet

4 Poultry Poultry handling, Wash hand; keep poultry away Radio and TV spots, Mass media, Local Farmers keeping poultry from your living areas, report leaflet, posters veterinary NGOs, local on sudden deaths of poultry, veterinary Dept, avoid all unnecessary contact community shuras . with birds, their feathers, faeces, and other wastes, others to be provided by Min of Agriculture and FAO 5 Poultry Poultry handling, Hand washing, washing, others Radio and TV spots, Mass media, Local wholesale and storing, to be provided by Min of Leaflet, posters veterinary NGOs, local

24 retailers transporting Agriculture and FAO veterinary Dept., community shuras 6 Individuals or Handling/touching to be provided by Min of Radio and TV spots, Mass media, Local groups using birds Agriculture and FAO Leaflet, posters veterinary NGOs, local birds as an veterinary Dept., entertainment community Shuras

2. Secondary Audience (Agents)

The strategic focus in this phase is on interpersonal communication between key influencers (agents) and householders and farmers. This will involve production of interpersonal communication tools by a suitably qualified agency, followed by limited pre-testing, finalization and distribution of materials, and orientation of communication agents on dissemination of prevention messages. Communication aimed at households would be led by MOPH and community health workers, as well as the Ministry of Religious Affairs and the religious community leaders, the Ministry of Education supporting dissemination of messages through schools, and UNICEF supporting media orientation. Shura communication would focus more on technical agricultural issues, and this element would be led by MOA and FAO.

It is envisaged that orientation of agents would be held on a provincial level, using the capacity of provincial departments of each line Ministry to lead orientation/training.

Timeline: Design and pre-testing of materials by 30th April, orientation of communication agents by May 1st , roll-out of interpersonal activities by May 15th

No Agents IEC Tools Distribution Channel Responsible Agencies

1 Community Health Workers Picture Card BPHS NGOs MoPH, UNICEF, WHO and other partners 2 Religious Leaders Leaflet Provincial Depts of Ministry of Religious MoPH, MORA, UNICEF, WHO and other Affairs partners 3 Teachers Leaflet Provincial Depts of Education Ministry MoPH, UNICEF, WHO and other partners and principal 4 Community Shuras Leaflet District governors Ministry of Agriculture, FAO and other partners 5 Journalists Leaflet, Media, journalists associations, MoPH, UNICEF, WHO, Ministry of background data briefings Agriculture, FAO and other partners

Pandemic

Objective: 1. Improve hygiene to limit spread of human flu 2. Contain an emerging human pandemic virus

1. Primary Audience

25 Main communication focus will be on mass media information messages, disseminated through radio and television, and some interpersonal communication. This interpersonal communication element can be extended, based on the timescale required to ensure messages reach audiences quickly and effectively. Once a pandemic has been announced, time will become a major issue, and therefore the focus will be mainly on rapid information dissemination through the media.

Timeline – mass media implementation within one week of pandemic being declared. Materials to be developed immediately, subject to agreed messages and approach being clarified by technical experts.

No Audience Messages drive Message to give IEC Tools Distribution Channel Group 1 General public Seeking If sick stay at home, limit Radio and TV spots, National and Private treatment; movement, take anti-viral posters, leaflet, Radio and TV, print Controlling according to MoPH /WHO Picture Card media, Friday Sermon transmission guidelines ; by Religious Leaders, through cover coughs and sneezes with CHWs, Schools, respiration handkerchief or tissue and habits, disposed of it carefully, wash hands after coughing and sneezing, if symptomatic wear a mask and avoid shaking hands, report suspected symptoms immediately, minimize close contact with other others 2 Poultry Continued To be provided by Min of Technical leaflets, Shuras, veterinarians, farmers, reporting of Agriculture and FAO radio and TV spots others to be provided keepers of dead birds, by FAO and Min of birds, poultry separation of Agriculture wholesale and flocks, non- retailers movement of birds

Afghanistan National Avian Influenza IEC Plan First Phase Objective: 1. Reduce the risk of animal to animal transmission 2. Reduce the risk of animal to human transmission total Coverage: Nationwide (34 provinces) Approx. 21 million population: Timeframe: 15 March-31 April 2006 (46 Days) Cost Per Total Unit General Activity Specific Activity Quantity Timeframe Unit Cost A. Material development

26 Campaign Logo $500.00 $500.00 1.1. concept, design and 1 layout 1

2.1 Script and Production 6 $500.00 $3,000.00 of Radio Spot 1 5

2.2 Script and Production 7 $1,000.00 $7,000.00 M

of TV spot a r c h

Mass Media - 2.3 Press Kit 1 $500.00 $500.00 3 1

2.4 Round Table 1 $200.00 $200.00 c h

2.5 Design and layout of $1,000.00 $1,000.00 6 2 leaflet for general public 1

Interpersonal 3.1. . Design, layout of 2 $500.00 $1,000.00 Communication leaflet 3

Pre-testing all above 4.1 All above mentioned 1 $2,000.00 $2,000.00 mentioned materials materials pre-tested 4 Sub-Total $15,200.00 B. Material production 7 1 A

1.3 printing of three types s p t

250,000 0.04 $10,000.00 r

of leaflets l

p 2 r 0 i l 0 -

Sub-Total $10,000.00 6

C Implementation 1

1.1 Airing of 6 Radio Spot s t

(Length 30 sec) - 90 $70.00 $6,300.00 A p 2 r

independent media -1 0 i l - 0 3

1.2 Airing of 6 TV Spot A

Mass Media (Length 1 min) - 45 $200.00 $9,000.00 p r i independent media l

Distribution of leaflets 250000 $0.02 $5,000.00

Sub total $20,300.00

Management and 1 $2,280.00 $2,280.00 Monitoring

27 Grand Total $47,780.00

Second Phase Objective: 1. Reduce the risk of animal to animal transmission 2. Reduce the risk of animal to human transmission total Coverage: Nationwide (34 provinces) Approx. 21 million population: Timeframe: 1st April-31 July (4 months)

Cost Per Total Unit General Activity Specific Activity Quantity Timeframe Unit Cost A. Material development

Mass Media $1,000.00 $6,000.00

2.3 Design and layout of 6

posters 6 1

A p r i l - 1

Interpersonal 5

$2,000.00 $2,000.00 A

Communication p r i l 2.4 Flip chart for CHWs 1

Pre-testing all above 4.1 All above mentioned 1 $2,000.00 $2,000.00 mentioned materials materials pre-tested 4

Sub-Total $10,000.00

B. Material production Printing of produced materials 1.1 printing of 6 types of 306,000 0.2 $61,200.00 posters 1

A p r i l 1.2 printing of Flip Chart -

10,000 2 $20,000.00 3

for CHWs and vaccinators 1

r i 2nd round of Printing of 210,000 0.04 $8,400.00 l general public leaflet

28 Sub-Total $89,600.00

C Implementation

1.1 Airing of 6 Radio

Spot (Length 30 sec) - 135 $70.00 $9,450.00 1 s t

dependant media 1 M a y - 3 1

1 Mass Media 1.1 Airing of 6 Radio Spot J u

(Length 30 sec) - 135 $300.00 $40,500.00 l y

independent media 2 2 0 0 6 1.2 Airing of 6 TV Spot (Length 30 sec) - 135 $200.00 $27,000.00 independent media

Distribution of posters and 414000 $0.04 $16,560.00 leaflets Sub total $93,510.00 Master Training 102 50 $5,100.00 1.3 CHWs and 1

vaccinators as ToT (75 2550 $20.00 $51,000.00 s t

people per province) M

1.4 Religious Leaders as a y -

ToT ( 75 people per 2550 $20.00 $51,000.00 Orientation 3 1

province) M

2 1.5 Teachers as ToT 2550 $20.00 $51,000.00 a y 2.1 Journalist as ToT 200 $20.00 $4,000.00

Sub total $162,100.00

e a a e b u P n f n n f a r t f o e d d e s d c i c e r s f o

e t u r t

f t h w s w l a l c e s

h k i e a

l e i m i v m l m e b n a o

p e p l i o n u m a l e t n i Mangement and a h i t m g o m

Monitoring and Evaluation 1 $26,760.00 $26,760.00 t r r i n r o e e Monitoring/Evaluation e e i n e n g d n g

u i t a m a a l w t a t t o

e i t r i o h n l l n

e t b h

3 Second phase Grand Total $381,970.00 1st and 2nd phase Grand Total $429,750.00

Third Phase Objective: 1. Improve hygiene to limit spread of human flu

2. Contain an emerging human pandemic virus

29 total Coverage: Nationwide 34 Provinces Approx. 21 million population: Timeframe: August -October 2006 (3 Months)

Cost Per Total Unit General Activity Specific Activity Quantity Unit Cost Timeframe Material development 2.1 Script and Production

3 $500.00 $1,500.00 of Radio Spot 2.2 Script and Production Mass Media 3 $1,000.00 $3,000.00 of TV spot 2.3 Design and layout of 3 $1,000.00 $3,000.00

posters 3 Interpersonal Design and layout of 3 3 $500.00 $1,500.00 communication leaflets Material production

printing of 3 types of 153,000 0.16 $24,480.00 Printing of produced posters materials printing of three types of 460,000 0.04 $18,400.00 leaflets

Pre-testing all above 4.1 All above mentioned 1 $5,000.00 $5,000.00 mentioned materials materials pre-tested Implementation

Airing of radio spots 135 $70.00 $9,450.00 (independent media) Implementation

Airing of TV spots 135 $200.00 $27,000.00 (independent media)

Distribution of posters and 613,000 $0.04 $24,520.00 leaflets Third Phase Grand Total $117,850.00 Estimated total budget $547,600.00

TERMS OF REFERENCE (TOR) FOR OUTSOURCED ASSIGNMENT

Project/Program Title and Work Plan Code number: 1. Background: – At the request of the Ministry of Public Health, UNICEF requires the services of a specialized company to undertake development of communication materials for prevention of Avian Influenza, as part of a joint initiative by the Government of Afghanistan 2. Purpose of project: To develop mass media and interpersonal communication materials, in Dari and Pashtu languages, for the prevention of Avian Influenza.

3. Duty station: Kabul, Afghanistan 4. Duration: 20 days

30 5. Supervisor: This assignment will be jointly supervised by the Head of Programme Communication at UNICEF Afghanistan, and nominated focal points from the Government of Afghanistan

6. Description of assignment:

Pre-pandemic phase Develop a series of communication tools, as shown below, based on six approved messages designed to prevent outbreak and spread of disease: 1. Concept and design of campaign logo 2. Develop script and manage production of 6 radio spots 3. Develop script and manage production of 6 TV spots 4. Develop design and layout of one information leaflet for the general public 5. Develop design and layout of one technical leaflet for health workers 6. Develop design and layout of one technical leaflet for poultry farmers and poultry dealers 7. Develop design and layout of one flip chart for use by community health workers and vaccinators.

Pre-testing Some pre-testing of all materials will need to be undertaken to ensure full understanding of messages by core audience groups. A summary report of the test findings should be provided, and if necessary, final amendments made to the materials based on the pre-testing.

7. End product/deliverable:

 Deliver all above materials on CDs in format to be agreed.  Short pre-testing (2-3 days) of all materials, summary report.

31 8. Time frame: First Phase Materials : 15 March -31 March 2006

9. Qualification or specialized knowledge/experience required for the assignment: Full service company specialized in communication with minimum 2 years working experience with adequate and appropriate manpower (survey personnel, sampling expert/statistician, data entry personnel, prepare graphs/tables/charts, consultants to analyze data and write reports) and management capability to conduct pre-testing of various materials, throughout Afghanistan.

10. Conditions: The total payment will be paid in Afghanis in two installments : 1. 1st installment on 1st April 2006 after satisfactory delivery of pre-pandemic materials 2. The contractor must allocate specific staff to this assignment, who would be based in the most part within the Ministry of Public Health, to ensure full collaboration with Government partners for the period of the assignment.

11. Prepared by:

Section Name and Title

Programme Communication Unit

Signature Date

12. Approved by:

Representative Date:

SECTION TO OBTAIN APPROVAL FROM REPRESENTATIVE/SPO/OO PRIOR TO SUBMISSION TO HR SECTION

32 Annex E:

Proposal of FAO and Ministry of Agriculture in AI Preparedness and Response

Islamic State of Afghanistan Ministry of Agriculture Animal Husbandry & Food National Committee for Control and Prevention of AI

Project Document

Country: Afghanistan

Project Symbol: AFG/ xxx/ xxx

Project Title: Detection, Prevention and Control of Avian Influenza in Afghanistan

Starting Date: April 2006

Completion Date: March 2008

Project Duration: 24 months

Responsible for Project Implementation: Ministry of Agriculture, Animal Husbandry and Food (MAAHF)

Contribution US$5319709

Signed...... Signed......

(For the Government) Date of signature: ...... Date of signature: ......

33 34 TABLE OF CONTENTS

I. BACKGROUND AND JUSTIFICATION...... 11

II. OBJECTIVES AND BENEFICIARIES...... 11 1. Objectives...... 11 2. Beneficiaries...... 11

III. EXPECTED MAIN OUTPUTS...... 11

IV. PROJECT COMPONENTS...... 11

V. IMPACT...... 11

VI. IMPLEMENTATION ARRANGEMENTS...... 11 1. Location...... 11 2. Organizational set-up...... 11 3. Technical support and project staff...... 11 4. Procurement...... 11 5. Coordination and complementarities with other interventions...... 11

VII...... INDICATIVE WORK PLAN 11

VIII...... INPUTS 11

IX. MONITORING, EVALUATION AND INFORMATION...... 11 1. Monitoring and Evaluation...... 11 2. Reporting...... 11 3. Visibility...... 11

X. RISKS, ASSUMPTIONS AND FACTORS ENSURING SUSTAINABILITY...... 11 1. Risks and Constraints...... 11 2. Factors ensuring sustainability...... 11

XI. GOVERNMENT CONTRIBUTION AND SUPPORTING ARRANGEMENTS...... 11

XII. BUDGET (US$)...... 11

35 ABBREVIATIONS AND ACRONYMS

AGAH - Animal Health Service of FAO

AI - Avian Influenza

DSA - Daily subsistence allowance

ECTAD - Emergency Centre for Transboundary Animal Diseases of FAO

EMPRES - Emergency Prevention System for Transboundary Animal and Plant Pest Diseases programme of FAO

FAO - Food and Agriculture Organization of the United Nations

GIS - Geographic Information Systems

HPAI - Highly Pathogenic Avian Influenza

MAAHF - Ministry of Agriculture, Animal Husbandry and Food

OIE - World Organization for animal health

TAD - Transboundary Animal Diseases

TCEO - Emergency Operations Service of FAO

TCP - Technical Cooperation Project

36 I. BACKGROUND AND JUSTIFICATION

Afghanistan is predominantly a country involved in agricultural crop and livestock production with 85 percent of the rural population (approximately 20 million) involved in this endeavour, with a 3.5 million cattle and 16.7 million small ruminants population and about 13 million of chickens2. Meat, milk and dairy products are important to the diet of the Afghan people.

Poultry are mainly kept by rural households with flock sizes below ten birds. Most birds are of local breed and fed on household waste and crop residues resulting in a productivity of 40- 60 eggs per year per hen. Annual mortality of chicken under these conditions often exceeds 50 percent due to the poor management, Newcastle Disease and some other contagious diseases. In the past, intensive poultry production for eggs and meat was only initiated on few Government farms however, which are no more operational. Few larger poultry units with several hundred hens exists around the major cities which produce chicks and eggs similar to the village system, but with a higher input level. At present, rural poultry and their products still contribute more than 98 percent of the poultry products in the country.

Highly Pathogenic Avian Influenza (HPAI), subtype H5N1, has affected poultry in Southeast Asia since 2003. Until recently, the outbreaks were confined to Indonesia, Vietnam, Thailand, Lao PDR, Cambodia and China. But since late July 2005, HPAI H5N1 has expanded in a north- westerly direction and Russia, Kazakhstan, Ukraine, Croatia and Turkey have reported outbreaks in poultry as well as in wild birds. The Russian outbreak of HPAI H5N1 has affected, to date, six administrative regions. In the bordering area to Kazakhstan, the disease affected several villages. Mongolia reported the death of some 90 migratory birds at two lakes in the northern part of the country in early August 2005. Influenza A virus subtype H5N1 was isolated from samples taken from dead wild water birds of two species. From April to June 2005 more than 6 000 migratory birds have been reported to have died due to H5N1 infection at the Qinghai Lake Nature Reserve in Qinghai Province, China. In China (Tibet), the death of 133 breeding hens H5N1 was reported.

These new outbreaks suggest that this highly pathogenic H5N1 virus is no longer restricted to Southeast Asia and is spreading progressively north-westwards. Migratory birds flying south from their summer habitats in Russia and Kazakhstan and rest on lakes and reservoirs in northern (Lake Tarbela) and southern Pakistan (Lakes Muncher and Keenjar). These lakes are surrounded by large cities and densely populated poultry belts. Central Asian countries have become exposed to HPAI by migratory birds, spreading the disease from infected neighbouring countries. Most of these countries (besides Kazakhstan and Pakistan) have weak laboratory diagnostic capabilities and surveillance systems for the detection of HPAI. From a geographical point of view, Central Asian countries represent a vast area in which introduction of AI is likely to occur, and where the sensitivity of the system for early detection of HPAI is low.

Once domestic birds are infected, avian influenza outbreaks can be difficult to control and often cause major economic impacts for poultry farmers in affected countries, since mortality rates are high and infected fowl generally must be culled in order to prevent the spread of the disease.

2 FAO livestock census conducted in 2002-2003

37 As a result of the ongoing outbreak in Asia, FAO estimates that around 20-25 million birds had been culled in the region as of 28 January 2004.

The complex overlapping of major flyways - Afghanistan is included in the Central Asia flyway (see below map) – and the lack of information on migratory species potentially involved in Avian Influenza (AI) disease spread make simple association of wild bird flyways with outbreaks of AI difficult.

Afghanistan currently has no indication of disease, but is at risk, being at overlapping of flyways. Death of migratory birds has been reported in north western of Iran (West Azarbayedjan along Aras River 10/10/05, source: media websites). The birds came from northern countries. To date, medical tests have ruled out flu (16/10/05 source Iran, State Veterinary Organization) and no evidence of avian influenza have been reported or detected on poultry farms.

Controlling the disease in poultry is key to the success in limiting the threat of human pandemic. Although it might appears that virus could have been spread over long distances by wild birds, there is more required to fully understand their role in their epidemiology of the disease and as today it is still not known which species might act as healthy carriers of the virus. A global meeting held in Geneva on 9 November 2005 has identified key components of a global action plan to control avian influenza in poultry and simultaneously limit the threat of a human influenza pandemic. The need for further strengthening of HPAI control at source in birds, surveillance, public awareness and contingency planning has been strengthened.

In the framework of a global strategy to fight bird flu, and development of national prevention, early detection and rapid response plans, such as awareness building, training, protective equipment, upgrading of laboratories, FAO has already assisted in the recent establishment of a diagnostic laboratory at the Department of Animal Health and Livestock Production, Ministry of Agriculture, Animal Husbandry and Food (MAAHF) and has organised a training workshop on HPAI for stakeholders directly involved in the poultry sector in Afghanistan on 27- 28 November 2005, in addition to a number of other regional training activities, it is necessary to launch surveillance of wild birds.

The first locations identified by the Ministry of Agriculture (Department of Animal Health and Livestock Production) for sero-surveillance are the Sistan-Hilmand watershed (wetlands), the Ghazni Rod river/Bandi Sultan, the Band-i-Amir lakes, the Amu Darya and some forests in Jowzjan, Balkh, Kunduz, Takhar, Badakhshan, Nangarhar, Khost, Kabul, Kandahar and Herat. Transboundary animal diseases (TAD), including zoonotic diseases, continue to give rise to increasing and widespread social and economic impacts in an increasingly globalized world. With a large and growing volume of regional and international trade in livestock and livestock products, and the rapid movement of large numbers of people across continents, several infectious zoonotic diseases have emerged and spread widely over large geographical regions. These diseases have wide-ranging impacts on the societies, but in particular livelihoods of communities, regional and international trade, food safety, public health, and international travel and tourism.

FAO has also begun a project in five Central Asian countries (Pakistan, Afghanistan, Tajikistan, Turkmenistan and Uzbekistan) which focuses mainly on rinderpest, foot-and-mouth disease and peste des petit ruminants (GTFS/INT/907/ITA). The project is providing these countries with laboratories facilities, training and equipment to strengthen their disease surveillance systems. Resources to address HPAI are presently not available, but several activities and objectives of the project can be complemented with avian influenza thereby providing better insight into the epidemiology of the disease. The present proposal is complementing the GTFS/INT/907/ITA project activities specifically directed to improve surveillance, diagnostic capabilities and public awareness in Afghanistan a country, among those beneficiaries of the GTFS/INT/907/ITA that needs additional assistance.

The principal issues to be addressed in preventing H5N1 from spreading into Afghanistan include, (a) risk assessment of the introduction of AI through migratory birds, (b) strengthening surveillance and diagnostic capacity for the early detection of HPAI in domestic and wild birds, (c) developing an appropriate early response system.

Generally Afghanistan lacks sufficient human and physical resources to address these issues, especially where poultry-migratory bird-human interactions are concerned. Common constraints to effective disease recognition and control include:  Poultry farming in the country is predominantly a rural, or backyard enterprise  Animal disease information is generally lacking  Wild birds and domesticated ducks are believed to be major H5N1 reservoirs  Levels of consumer and farmer awareness are low

39  Little emergency preparedness exists  Human resource capacities for human and animal health are limited

At present in Afghanistan, a USA-funded project for US$3 599 000 (GCP/AFG/030/USA) is supporting the development of rural poultry family production which is still the predominant poultry system in Afghanistan. Women almost exclusively deal with village poultry production. Under the traditional system annual mortality of chickens often reaches more than 50 percent of the population. Inadequate technical knowledge of the producers, unavailability of vaccines for the prevention of important diseases and lack of other input supplies and health services are the most important constraints to the system. Recently the Italian Government has expressed interest in supporting a project “Development of Rural Poultry production in Herat province”. Such efforts in developing and support initiatives for livelihood of people might be wasted if a disease such HPAI will be introduced into the country. The present project will be complementing the efforts done under GCP/AFG/030/USA.

This project is designed in collaboration with the Ministry of Agriculture, Animal Husbandry and Food (MAAHF) to capacitate the veterinary services to deal effectively and efficiently with an outbreak of Avian Influenza. This project is linked into the FAO Regional Technical Co- operation Project (TCP) on Avian Influenza and aims to address the urgent immediate, short and medium term requirements to be undertaken in Afghanistan to rapidly detect and control the spread of Avian Influenza in the country. It is envisaged that a longer term regional strategy will be drafted by various stakeholders during the period of this project to deal the longer term issues dealing with the Avian Influenza threat.

II. OBJECTIVES AND BENEFICIARIES

1. Objectives

The overall objective is to address the urgent short and medium-term actions that are to be undertaken by the Government to strengthen its capacity in order to rapidly detect the introduction of HPAI into the country and minimize its spread in the case of its occurrence.

Achieving this goal will significantly reduce the threat of human epidemic in Afghanistan and therefore in Central Asia and help safeguard the livelihoods of the rural and peri-urban population. The project will also significantly reduce the costs as the prevention measures are less costly on the national economy than the curative measures.

The specific objectives and activities of the proposed project are threefold for the prevention of an Avian Influenza Epidemic:

1. to strengthen capacity and undertake disease surveillance and laboratory diagnosis for HPAI; 2. to safeguard human health by improving public awareness and information; 3. to develop emergency preparedness plans for HPAI.

40 The above objectives and activities should be viewed as the first phase of a longer term program aimed at strengthening the veterinary services system of Afghanistan to deal with other potentially destructive infectious disease outbreaks. The proposed project would therefore serve as an effort to evaluate the methodologies most suitable for emergency preparedness and long- term intervention.

Objectives, expected results and activities of the project are also detailed in the Logical Framework presented in Annex 1.

2. Beneficiaries

Direct beneficiaries will be livestock and poultry stakeholders (poultry farmers and associations, live bird markets, poultry abattoirs, poultry traders, zoos and bird parks) who will benefit from improved animal disease prevention, control methodologies and awareness on how to recognize the disease and contact the veterinary services. Technical institutions will benefit from enhanced and improved service that should translate into better economic prospects for the livestock and poultry sector of the economy of the countries. Ultimate beneficiaries will be the general population of Afghanistan who will benefit from improved public health systems and food security.

III. EXPECTED MAIN OUTPUTS

Successful implementation of the project will result in the following major outputs:

1. The risk of introduction will be thoroughly assessed. 2. In the event of introduction of HPAI into the domestic poultry population the persistence of the virus will be minimized. 3. The risk of human epidemic influenza in Afghanistan will be reduced, and safe trade in poultry and poultry products assured. 4. Emergency preparedness plans are established. 5. The Government of Afghanistan has the capacity to implement the emergency plans in the event of detection or an outbreak of HPAI. 6. The population is familiar with HPAI early detection indicators / indications. 7. Mechanisms at the household level for immediate reporting the occurrence of HPAI are in place. 8. Rehabilitation mechanism in place for people whose livelihoods are affected by HPAI. 9. A base established for longer-term intervention for strengthening national capacity for Avian Influenza prevention and control.

41 IV. PROJECT COMPONENTS

Component A - Strengthening capacity and undertaking HPAI disease surveillance and laboratory

This Component is designed to strengthen epidemio-surveillance network for HPAI, expand and upgrade the existing diagnostic capacity of one central veterinary diagnostic laboratory to better identify HPAI. A rapid-response field surveillance and reporting system will be established to assist the laboratory in better identifying and reporting HPAI outbreaks.

Activities g. Strengthening animal disease surveillance. This activity will support the veterinary services and the Veterinary Field Units around the country by developing effective operating procedures at all levels and training of field staff in detection and reporting of clinical HPAI disease. h. Diagnostic capacity building. This activity will support diagnostic laboratory capacity through provision of technical assistance and training, laboratory equipment, test kits, reagent and training, to allow for HPAI detection and typing. i. Assess the risk of introduction and establishment of HPAI in domestic poultry and the likely consequences in terms of severity of disease and extent and rapidity of spread. j. Regular surveillance and monitoring of water bird migrations including determination of migratory patterns, timing and important locations, as well as risk assessment of migratory bird-domestic poultry and human interactions (see Annex 2 for wild birds species surveillance), using the Codan network already installed in 32 provinces of Afghanistan. k. Regular random surveillance of commercial and small holder poultry producers. l. Build capacity of veterinary services in epidemiology surveillance and disease reporting to combat major trans-boundary diseases.

Component B – Communication and public awareness

This Component is directed toward two issues:

3. The need to safeguard human health, in particular for extension staff, animal health workers, poultry producers and their families, by improving public awareness and information of the risk of contracting human disease from birds suffering HPAI. 4. To improve opportunities of early warning of an incursion of HPAI by improving public knowledge of the disease and how to report suspect cases.

This Component will provide support by:

 carrying out a needs assessment of existing poultry extension and public information programmes;

42  developing community-based extension to farmers and enhance public awareness; and (c) monitoring and evaluation of public awareness and extension activities under the project.

Activities

 Capacity Building, in Communication and Public Information. This activity will support the needs assessment of veterinary and livestock extension staff at the central, regional, district, and village levels, the preparation of training programs and materials, the training of trainers and the training of farmers in Increasing farmers’ general awareness through simple bio-security guidelines on Avian Influenza using publications in local languages and the provision of technical assistance.  Developing Pilot models for Community-based Rapid Communication. This activity will support a training course in communication methodology for extension and veterinary staff at the regional level, training of trainers, needs assessment on communications requirements for poultry producers, the preparation and dissemination of information materials, and the provision of communications and information equipment for regions and districts.  Developing farmers’ groups and/or associations to help improve awareness and dissemination of information.

Component C – Emergency outbreak containment

This Component comprises stocking emergency vaccine against HPAI, development of a rapid mobilization plan to respond quickly and effectively to possible outbreaks of HPAI. The Contingency Plan would contain guidelines for the rapid activation of physical and human resources to respond quickly to an outbreak. Physical resources, supported by project funds, would comprise farm and burial disinfectants, sprayers and protective clothing as well as compensation plan for farmers loosing their flocks. Human resources would entail the identification of, and project-supported contingency allowances for, of persons to be activated, in case of need.

Bio-security is the cheapest, most effective means of disease control available. No disease prevention programme will work without it. Bio-security is a concept for prevention of disease entry/escape that must be practiced by all farmers, cooperatives, abattoirs etc. Lack of bio- security measures increases the risk for disease or infection entry to the production unit, market, or any commercial operation. Farm management and marketing systems influence the probability of poultry being challenged (and becoming infected) with H5N1 HPAI. This is particularly the case for the backyard poultry system of Afghanistan, which is expected to increase the risk of the pandemic through favouring the transmission of the disease from wild birds to domestic chickens.

Smallholder households keep approximately 98 percent of the total poultry population in Afghanistan. Typically, Smallholder households own around 10 chickens per household and sell a bird occasionally to meet cash or domestic needs.

43 Moreover, as people live in close proximity with animals in rural peri-urban areas, such a situation would provide a dangerous crucible for the mixing of the bird and human viruses, vastly increasing the risk that the avian virus could gain the ability to readily spread among humans. Rural poverty is also expected to perpetuate high-risk behaviour through slaughtering or selling of infected chickens.

The main goal of a bio-security component is to develop clear guidelines and sensitize commercial and backyard poultry owners about the signs of serious poultry diseases, to ask them to report sick birds and to give them information on practicing bio-security to keep their birds safe and healthy. This will be achieved through careful assessment and planning of the measures needed and their applicability in Afghan context. All commercial poultry farms should develop and implement a formal bio-security plan as appropriate to the farm. It is helpful to document the bio-security plan and specify those responsible for its maintenance.

Bio-security practices do not have to be cumbersome or expensive. The usefulness of the measure depends on compliance by farmers and farm workers, who must have a basic understanding of the purpose of the measures. Breaches of bio-security can occur no matter how stringently the measures are implemented. Therefore, the proposed project will also assess the capacity and willingness of people to carry them out. This willingness depends on their perception of the risk form HPAI, the extent to which the government is also able to enforce written regulations, the importance of poultry to their livelihood, the cost of the recommended bio-security measures compared to profit from poultry and the availability of cash to make an investment, when weighted against the many other demands on income.

Activities

 Develop emergency preparedness plans for HPAI. It involves development of early warning and early reaction capabilities to an HPAI epidemic. This requires advanced preparation of written contingency plans and operating procedures. The testing of such plans and training of staff; the development of capabilities at the national, regional and local veterinary headquarters, including field and laboratory services; development of mechanisms to involve other necessary government and private sector services and farming communities in the emergency response; development of the capacity to apply all the necessary resources to counter the disease or other animal health emergency in the most efficient way (including equipment, personnel and finances); to compensate the farmers who have loss their chicken (a chicken costs around US$4.00 each); and, finally, advance establishment of the appropriate legal and administrative structures to deal with an emergency.  Contingency arrangements of vaccines that are highly efficacious, safe and affordable for strategic vaccination, as part of the overall integrated strategy to control the disease, and with a clearly defined exit strategy. Entails possible deployment OIE (World organisation for animal health) approved vaccines with strict post-vaccination monitoring, to progressively confining the disease to defined infected foci, in case of introduction.  Review of legislation to ensure that appropriate provision is in place for the necessary actions of disease control authorities to investigate and control HPAI.

44  Assess the poultry industry in Afghanistan and the opportunities for improving bio- security measures to prevent the spread of the virus from infected premises thereby reducing the risk of further infection.

V. IMPACT

This project directly impacts the livelihoods of millions of poor smallholder farmers, and contributes significantly to the achievement of the Millennium Development Goals. It is expected that these outcomes will also impact positively in the poverty reduction of resource-poor smallholder farmers, in improved food safety for consumers, and in better market opportunities for poultry producers at all economic levels.

As importantly such a project as well has possible far reaching positive impacts on not only Afghanistan, but also possibly the entire region in the prevention of the spread of Avian Influenza.

VI. IMPLEMENTATION ARRANGEMENTS

1. Location

Project management will be based in Kabul, at the Department of Animal Health and Livestock Production. Most of the field activities, including surveillance for AI and socio-economic studies will focus on areas assessed as being at highest risk from migratory bird contact with domestic poultry.

Communication and awareness activities will be conducted throughout the country. The strengthening of disease surveillance and reporting systems will be implemented as a country- wide initiative.

The project activities will be conducted throughout the country. However, most of the field activities including surveillance of AI and socio-economic studies will focus on areas assessed as being at highest risk from migratory bird contact with domestic chicken.

2. Organizational set-up

This will be executed by MAAH&F, in close collaboration with the MOPH and NEP Department.

This operations will be conducted under the technical direction of the Chief of the Animal Health Service. National consultant staff will be appointed locally and support staff will be recruited under Animal Health Department.

45 National consultant staff will work in close collaboration with staff of the Animal Health Department of the Ministry of Agriculture, Animal Husbandry and Food and with veterinary and livestock personnel of provincial departments.

There will be a strong emphasis on capacitation of field staff at regional, district and shura level. This will be accomplished by project’s staff spending extended periods of time in the field and provision is made for this by the internal travel budget line.

The Communication Component will involve close collaboration with the MOPH and NEP (including FAO and WHO) especially interests in addressing human health concerns.

The project will complement those of the Technical Cooperation Programme regional project on ‘Controlling Trans-Boundary animal Diseases in Central Asian countries’ (GTFS/INT/907/ITA). Other planned initiatives will also complement the Project work, including global studies on wild bird involvement in the dissemination of Avian Influenza.

3. Technical support and project staff

Technical support for the project will be provided through the following expertise:

- One International Project consultant will be appointed, based in Kabul, to establish contact and working arrangements with the Department of Animal Health and Livestock Production of MAAHF and other Departments and monitor project activities (Terms of Reference in Annex 1). - One National Communication Specialist (24 person months), based in Kabul, to collaborate with the National Coordinating Committee and Task Force for Avian Influenza in developing a communication strategy (Terms of Reference in Annex 2). - Six National Area Veterinarians Officers (24 person months each), based in the regional offices of Bamiyan, Herat, Kandahar, Kunduz, Mazar-i-Sharif , Nangarhar and Gerdez to undertake surveillance on wildlife and to determine migratory patterns and their potential for introducing Avian Influenza (Terms of Reference in Annex 3). - One National Consultant Geographic Information Systems (GIS) Specialist (three person months) to collaborate in mapping sites of entry of different species of migrating birds and the distribution of poultry within Afghanistan (Terms of Reference in Annex 4). - National support staff. - One National Consultant Epidemiologist (24 person month ) Terms of Reference in Annex 5. ..Procurement

The procurement of inputs and equipment, AI vaccine, Chemicals and Vehicle will be executed according to Government rules and regulations. Wherever possible, local contractors and suppliers will be utilized to provide basic services and supplies. Other items and related services (transportation, superintendence) will be purchased / contracted through National and international tenders by the Procurement Service of Government.

46 4. Coordination and complementarities with other interventions The Government project team will actively liaise with all stakeholders and agencies in order to avoid duplication of efforts and ensure local ownership of project activities.

VII. INDICATIVE WORK PLAN

The project will be implemented over a 24-months period, from April 2006 to March 2008. Activities indicated below are subject to final review and adjustment during the inception workshop at the start of project and during the course of project implementation, as may be deemed appropriate.

47 Activities Months 1 2 3 4 5 6 7 8 9 10 11 12 Inception workshop Mobilization and logistic arrangements Appoint project staff Reporting Component A - Strengthening capacity and undertaking HPAI disease surveillance A.1.1 & A.1.2 Purchase of vehicles & equipment A.1.3 Disease investigation & reporting procedures A.1.4 Regional training courses A.2.1. Laboratory equipment and reagents A.2.2 Laboratory training A.3.1 Field visits for risk assessment A.3.2 Poultry density mapping A.3.3 Poultry market systems evaluation A.3.4 Review poultry import restrictions A.3.5 Develop risk & consequence scenarios A.4.1 Design wild bird surveillance A.4.2 Equipment purchase for wild bird studies A.4.3 & A.4.4 Wild bird investigations A.4.5 Wild bird surveillance report A.5.1 Design poultry surveillance studies A.5.2 Poultry surveillance A.5.3 & A.5.4 Poultry sampling A.5.5 Report on poultry surveillance A.6.1 Improve disease reporting mechanisms A.6.2 Assistance with TAD active surveillance A.6.3 TAD risk assessment & data analysis Component B – Communication and public awareness B.1.1 Communication needs assessment B.1.2 Prepare guidelines for HPAI prevention B.2.1 Communication training courses B.2.2 Prepare information materials

48 B.3.1 Develop farmers’ groups Component C – Emergency outbreak containment C.1.1 National workshop on preparedness C.1.2 Develop national strategy C.1.3 Needs identification for national strategy C.1.4 Purchase of equipment C.1.5 Emergency control exercise C.2.1 Vaccine contingency arrangement C.3.1 Compensation mechanism C.4.1 & C.4.2 Review & recommend legislation C.5.1 Assess poultry industry C.5.2 Recommend changes for bio security

49 VIII. INPUTS

Goods and services to be provided under the Project are as follows:

Personnel (up to US$450,000) This budget line will allow the recruitment of: - one International Project consultant (24 months at US$10 500 / month); - one National Consultant Epidemiologist (24 months at US$1 000 / month); - one National Consultant Communication Specialist (24 months at US$1 000 / month); - six National Area Veterinarian Officers (24 months at US$1 000 / month); - one National Consultant Geographic Information Systems Specialist (6 months at US$1 000 / month).

Contracts (up to US$ 275 000) This budget line covers the flying hours contract for surveillance and the costs of reports translation for awareness campaign.

Locally contracted labour (overtime) (up to US$350 000) This budget line covers the costs of locally contracted administrative support staff (Secretarial services, drivers, laboratory technicians, casual labourers etc.) and the surveillance temporary staff.

Travel (up to US$ 626 500) This budget line covers the cost of national and international consultant travel costs, daily subsistence allowance (DSA) and hazard pay.

Training (up to US$450, 000) This budget line will cover the costs of conducting meetings and workshops as follows: Wild bird assessment technique, Capacity Building through workshops, Material Preparation, production and dissemination, Mass Media Dissemination and Information Impact Assessment Survey.

Expendable Procurement (up to US$1265 000) This budget line covers the cost of procurement, transportation and handling of consumables for surveillance (binoculars), laboratory rehabilitation and support; equipment, vaccines for persons handling birds & samples and Poultry HPAI vaccine.

50 Non-Expendable Procurement (up to US$720 000) To cover the cost of procurement, transportation and handling of field equipment, computers and accessories, printers, 10 vehicles equipped with Codan radios and other communication and surveillance equipment (Digital Cameras with zoom 500 mm, satellite phones with GPS). Technical support services ( up to US$ 83690

General Operating Expenses (up to US$ 9600 000) This budget line covers operational costs of the various activities of the project such as the inspection of procured goods, office running costs and locally incurred miscellaneous expenses related to the implementation of the project (office materials, communications, per diem of the national teams that support the activities of the project, hire, operation and maintenance of vehicles, insurance, support to testing of samples, and other miscellaneous items). This budget line also covers expenses related to the lay-out and printing of leaflets and the lay-out and installation of visibility boards. It covers the compensation budget of possible losses after culling of chicken because of AI disease.

This is to cover the technical expertise provided by MAAH&F to ensure the proper implementation, the monitoring and reporting of the project implementation to International standard. Direct Operation cost ( up to US$ 139,519) This budget line cover the standard direct operation cost.

IX. MONITORING, EVALUATION AND INFORMATION

1. Monitoring and Evaluation

Animal Health Department of MAAH&F will be responsible for constant monitoring of project activities with the support of the counterpart and implementing partners ( NGOs & FAO). The Technical Divisions of Animal Health will provide technical guidance for the monitoring and assessment of the project. Animal Health will establishes a simple internal monitoring system defining the performance indicators for further evaluations.

51 2. Reporting

Standard monitoring and evaluation guidelines will be followed. These include measurable indicators, reviews and evaluation reports of the project impact.

The project will produce the following reports:

(i) Inception report: at inception, the National Project Epidemiologist will prepare a detailed work plan including the timing of each activity and modalities. of project execution in consultation with Animal Health of MAAH&F. (ii) Progress report: a mid-term report prepared after six months of project implementation will be prepared by the National Project Consultant/ Epidemiologist. This report will assess in a concise manner, the extent to which the project’s scheduled activities have been carried out, the outputs produced and progress towards objectives realized with suggestions for any corrective actions if need be. (iii) A Final Report: towards the end of the project, the National Project Consultant will prepare a draft Final Report in accordance with Donors Trust Fund procedures. This report will contain a complete review of activities undertaken, major results obtained, problems encountered, progress towards achieving the specific objectives of the project and impact on the beneficiaries, A section on recommendations and lessons learned, presenting guiding principles for future interventions, will be included. The summary of the guidelines for the preparation of progress and final reports is given in Annex 10.

3. Visibility

Animal Health Department of MAAH&F will ensure full visibility to the donor through logos, boards, stickers and publications, as well as by inviting the donor to the opening ceremony of project activities. At the same time, Animal Health will ensure the maximum visibility of project activities through both national and international media and its own web-site and internal publications. The visibility plan will also include the preparation of a professional information material on the implementation project activities, to be broadcasted through national and international media and own MAAH&F media .

X. RISKS, ASSUMPTIONS AND FACTORS ENSURING SUSTAINABILITY

52 1. Risks and Constraints

The successful implementation of this project assumes that:

- The Government authorities, at all levels, realize the importance of stopping HPAI at its origin, are willing to put forward substantial changes, maintain a strong willingness for investing in the emergency plans, commit resources, participate in the control activities and are willing to adapt ad hoc import procedures. - The Government authorities are willing to provide suitable manpower in an acceptable technical environment and provide the basis for the capacity building. - The Government authorities are willing to collaborate with all the stakeholders involved in the detection and control of the Avian Influenza emergency. - The Government authorities, at all levels, as well as the beneficiaries, guarantee the highest commitment in participating in the awareness activities at household level, and stakeholders agree on recommended rehabilitation measures. - The security situation in the country and in the regions is not too volatile. - Vaccines are available worldwide.

2. Factors ensuring sustainability

The proposed interventions have been tailored to respond to the needs of the Government and to provide a sound basis for the development of the sector and the national society as a whole. These interventions are in line with the current Government policies and strategies and will be integrated into the ongoing development actions to ensure the sustainability of the process beyond the project duration.

The devolution of responsibilities to national structures is expected to contribute greatly to the sustainability of the intervention. The participatory approach to the implementation of key project activities will ensure legitimate and robust planning, decision-making and implementation.

The project will contribute to long-term sustainable economic and social development by enhancing the contribution of the sector to the economy. Improved information on the sector and possibilities for development will benefit the wider national community.

53 XI. GOVERNMENT CONTRIBUTION AND SUPPORTING ARRANGEMENTS

The Ministry of Agriculture, Animal Husbandry and Food (MAAHF) will be the Government responsible for the project. The Animal Health Department of MAAH&F of Government will:

- nominate a qualified and experienced National Project Coordinator who will work full-time for the project. FAO and who will assist in the implementation of the project facilitating involvement and collaboration with relevant national staff; - make available the services of qualified staff for the duration of the project as necessary; - ensure clearance of project inputs free of custom and excise duties;

The general provisions are detailed in Annex 11.

54 XII.BUDGET (US$)

Sub/Child Accts Input description Account Main Account 5013 Consultants 450,000 International Consultants 252,000 National Consultants: Epidemiologist, six Area Technical Officers, one 198000 Communication Specialist and one GIS Specialist 5014 Contracts 275 000 Flying hours Helicopters for Surveillance 200 000 Translation contracts for awareness campaign 75 000 5020 Overtime 350,000 Support staff / Temporary assistance 350 000 5021 Travel 626 500 In country travel costs and DSA 500 000 International Travel 100 000 National Travel 26500 5023 Training 450,000 Wild bird assessment technique 100000 Capacity Building through workshops 150,000 Material Preparation, production and dissemination 80,000 Mass Media Dissemination 60,000 Information Impact Assessment Survey 60,000 6000 Expendable Equipment 1265 000 Laboratory rehabilitation and support 465 000 Vaccines for persons handling birds & samples 100000 Poultry HPAI vaccine 300000 Poultry compensation 400000 6100 Non-expendable Equipment 720 000

55 Vehicles (10 pick-ups + 2 tracks) 440 000 Surveillance equipment (digital cameras with zoom, satellite phones, binoculars) 140 000 Other non expendable equipment (computers, printers, UPS and stabilizers) 140 000 5027 Technical Support Services 83 690 Reports 5 000 Technical Support Services 78 690 5028 General Operating Expenses 960 000 General Operating Expenses Budget 960 000 5029 Support Cost 139 519 Direct operating costs 139 519

GRAND TOTAL 5,319,709

56 Annex 1 – Logical framework

NARRATIVE SUMMARY OBJECTIVELY VERIFIABLE MEANS OF ASSUMPTIONS INDICATORS VERIFICATION Address the short and medium-term actions Overall Objective that are to be undertaken by the Government to strengthen its capacity in order to rapidly detect the introduction of HPAI into the country and minimize its spread in the case of its occurrence. (a) To strengthen capacity and undertake (a) Surveillance and diagnostic capacities for (a) Data collected at the (1) The Afghan Specific Objectives disease surveillance and laboratory HPAI of the Afghan authorities increased by beginning of the project Government maintains a diagnosis for HPAI. 80% by the end of the project. (a) Monitoring Reports strong willingness for investing in these (b) The capacity of the people to take (b) Data collected at the emergency plans. (b) To safeguard human health by appropriate precautions for HPAI increased beginning of the project improving public awareness and by 100% by the end of the project. (b) Monitoring Reports (2) The Afghan information. government, at all levels, (c) Emergency plans and their realizes the importance of implementation strategy designed. stopping HPAI at its origin. (c) To develop emergency preparedness plans for HPAI. (c) Project Documents (3) The Afghan (c) Documents approved by authorities provide the the MAAHF basis for the capacity building.

(4) The security situation in the country is not too volatile a) The risk of introduction will be (1a) The diagnostic laboratory capability for (1a) Project documents (1) The Afghan Outputs/Components thoroughly assessed. HPAI of the Department of Animal Health authorities provide and Livestock Production in Kabul upgraded suitable manpower in an by 75% by the end of the project. acceptable technical (2a) Training for HPAI detection and typing. environment.

1b) Major risks identified by the first quarter (2a) Training programmes (2) The Afghan of the project. and reports Government commits 2b) Practices of surveillance and monitoring resources b) Risk of human epidemic influenza in of wild birds and domestic as well as (1b) Project documents

57 NARRATIVE SUMMARY OBJECTIVELY VERIFIABLE MEANS OF ASSUMPTIONS INDICATORS VERIFICATION Afghanistan will be reduced, and safe trade commercial poultry designed by the first (3) The Afghan in poultry and poultry products assured. quarter of the project. (2b) Project documents authorities, at all levels, as well as the (1c) Logistic plans in case of outbreak beneficiaries guarantee designed by the first quarter of the project. the highest commitment c) Emergency preparedness plans are (2c) Capacity of technical staff at central, in participating in the established. regional, district, and village levels in awareness activities at applying specific emergency measures and household level. adopt new specific techniques is increased (1c) Emergency Preparedness by 75% by the end of the project. Plans (4) GoE actively (2c) Training programmes participates in the control (1d) Farmers are trained by the end of the and reports activities. project on simple techniques to inform the local population on basic bio-security (5) Stakeholders agree on guidelines on Avian Flu. recommended (2d) Beneficiaries aware of basic bio- rehabilitation measures. security guidelines on Avian Flu by the end d) The population is familiar with HPAI of the project. (6) Recognition of the early detection indicators / indications. (3d) Publications in local languages on basic need for additional and measures to prevent an outbreak of HPAI continuing support. published by the end of the project. (1d) Training programmes and reports (1e) Prompt report of suspected cases by household and involved field staff.

(f) Poultry owners assisted in the event of an (2d) Awareness creation outbreak. materials

(g) Government, donors and agencies (3d) Publications identify needs and mechanisms for further e) Mechanisms at the household level for strengthening Avian Influenza prevention immediate reporting the occurrence of and control. suspect HPAI are in place.

(f) Rehabilitation mechanism in place for (1e) Statistical data. people whose livelihoods are affected by HPAI.

58 NARRATIVE SUMMARY OBJECTIVELY VERIFIABLE MEANS OF ASSUMPTIONS INDICATORS VERIFICATION (g) A base established for longer-term intervention for strengthening national (1f) Project records capacity for Avian Influenza prevention and control.

(1g) Minutes of Meetings of National Avian Influenza Coordinating Committee and Task Force a) Strengthening animal disease 1a) Effective operating procedures in both (1a) Written procedures 1) The GoE ACTIVITIES surveillance. public and private veterinary services administration willing to Component A developed. put forward substantial 2a) Field staff trained in detection and changes. reporting of clinical HPAI disease. 2a) Training programmes and reports 2) Governmental b) Diagnostic capacity building. 1b) Diagnostic laboratory capacity of the Technical staff available Department of Animal Health and Livestock at all levels. Production upgraded. 1b) Project documents 2b) Primary diagnostic laboratory capacity 3) The Government of ten regional veterinary laboratories authorities willing to established. 2b) Project documents momentarily deploy all 3b) Technical assistance and technical the necessary staff (also trainings provided. those recruited for activities in other sectors) 1c) Information available for undertaking 3b) Project documents and for field work. (c) Risk assessment for HPAI socio-economic impact studies training programmes and 1d) Capacity for regular and specific reports 4) The Government surveillance and monitoring of water bird 1c) Project reports authorities willing to migrations empowered. collaborate with all the d) Capacity building on regular surveillance stakeholders involved in and monitoring of water bird migrations 1e) Regular random surveillance of the detection and control commercial and small holder poultry 1d) Surveillance and of the Avian Influenza e) Regular random surveillance of producers conducted. monitoring reports emergency. commercial and small holder poultry 2d) Project reports producers. 1f) Improved active and passive surveillance 1e) Surveillance reports for 2 major transboundary diseases. f) Build capacity of veterinary services in 2f) Improved data and risk analysis epidemiology surveillance and disease capabilities

59 NARRATIVE SUMMARY OBJECTIVELY VERIFIABLE MEANS OF ASSUMPTIONS INDICATORS VERIFICATION reporting.

1f) Project reports 2f) Animal Health Department reports a) Capacity Building in Communication and 1a) Simple bio-security guidelines on Avian 1a) Bio-security guidelines ACTIVITIES Public Information Influenza designed. available Component B 2a) Publications in local languages on Avian Influenza printed and established. (2a) Publications

b) Developing Pilot models for Community- 1b) General awareness on the risks of Avian based Rapid Communication (radio Influenza increased. (1b) Project documents broadcasting channels) 2b) A training course in communications methodology for extension and veterinary staff 2b) Training programmes and at reports the regional level organized.

1c) A needs assessment on communications c) Developing farmers’ groups and/or requirements for poultry producers conducted. associations. 2c) Communications and information equipment for regions and districts provided. 1c) Needs assessment study

2c)Purchase/distribution documents a) Develop emergency preparedness plans 1a) Contingency plans and operating 1a) Contingency plans 1) Vaccines available ACTIVITIES for HPAI. procedures for HPAI epidemic designed. worldwide. Component C 2a) Staff at all levels trained. 3a) Capacities at national, regional and local 2a) Training programmes and 2) The Government veterinary headquarters, including field and reports Customs Authority laboratory services, developed. 3a) Project documents willing to adapt ad hoc 4a) Mechanisms to involve other necessary import procedures. government and private sector services and 4a) Partnership documents farming communities in the emergency 3) Contingency response developed. provisions in place before 5a) Efficiency in the allocation and utilization the outbreak of the of resources improved. epidemics.

60 NARRATIVE SUMMARY OBJECTIVELY VERIFIABLE MEANS OF ASSUMPTIONS INDICATORS VERIFICATION 1b) Documented arranged for vaccine 5a) Project/Financial supply. documents

1c) Legal and administrative structures to 1b) Documents of letters of b) Contingency arrangements for vaccines. deal with an emergency amended as agreements required. c) Review of legal framework (1c) Legal/ Administrative 1d) Poultry industry in Afghanistan assessed. structures 2d) Bio-security measures to prevent the 2c) Legal framework spread of virus from infected premises and reduce the risk of infection improved. (1d) Assessment report d) Assess the poultry industry in 2d) Reports on former and Afghanistan innovative bio-security measures.

61 Annex 2 - Surveillance related to wild birds

Different species of wild birds have been found susceptible to Avian Influenza (H5N1). They might be migratory or not and these species, if present in Afghanistan, should be closely watched to identify if cases of mortalities, or more in general abnormalities are found.

Order Family English Name Latin Name Migratory Yes/No Podicipediformes Podicipedidae Great Crested Podiceps cristatus No Grebe Pelecaniformes Phalacrocaracidae Great Cormorant Phalacrocarax carbo No

Ciconiiformes Ardeidae Gray Heron Ardea cinerea Yes Ciconiiformes Ardeidae Little bittern Ixobrychus minutus Yes Falconiformes Accipitridae Red Kite Milvus milvus No Gruiformes Rallidae Eurasian coot Fulica atra Yes Charadriiformes Recurvirostridae Black Winged Himantopus himantopus Yes stilt Charadriiformes Recurvirostridae Pied Avocet Recurvirostra avosetta Yes Charadriiformes Laridae Black Headed Larus ribidondus No Gull

Surveillance component related to wild birds but specifically Anseriformes

This order of birds include the family of Anatidae (wild ducks) which are known to be carriers of the influenza viruses (in general). As it always is the situation is not simply black and white. Some birds of the Anatidae family have been found to be susceptible to the H5N1 virus as well. As for the information available as today the following birds have been found to be susceptible: Whooper swan (Cygnus Cygnus), Bar-headed goose (Anser indicus), Ruddy shellduck (Tadorna ferruginea), Eurasian teal (Anas crecca), Mallard (Anas platyrinchos), Common pochard (Aythya farina), Tufted duck (Aythya fuligula).

62 All of those are migratory. One feature which might seem to be important is that even though susceptible it seems that in the Anseriformes order mortality rate is lower than domestic or other wild susceptible birds and in some species infection can occur inapparently with the virus replicating in the intestine and eliminated through faeces.

63 Annex 3

Terms of Reference International Project consultant

Under the general supervision of MAAH&F and Technical supervision of Animal Health and Production Department of MAAH&F of Afghanistan, the International Project consultant will undertake management of project implementation including:

 Update and review the work plan to cover project activities.  Select National Consultants for appointment to the project.  Establish contact and working arrangements with appropriate staff of the Ministry of Agriculture, Animal Husbandry and Food and organizations.  Ensure liaison with government and donors.  Monitor expenditure.  Oversight of contract arrangements.  Set up a monitoring system, including performance indicators.  Monitor project activities, Ensure adherence to the work plan timeframe and make recommendations for any required procedures and changes to the project.  Undertake an impact assessment of the project and prepare a draft final project report to describe the outputs, conclusions and recommendations.  Ensure proper project reporting.  Perform other duties/responsibilities related to project implementation.

Reporting At the end of the mission, the Consultant will prepare a report describing in detail, for each point listed in the Terms of Reference. This report will contain a complete review of activities undertaken, major results obtained, problems encountered, and progress towards achieving the specific objectives of the project. A section on recommendations and lessons learned, presenting guiding principles for future interventions, will be included. The report should be submitted to Animal Health and production no later than two weeks after completion of the mission.

64 Qualifications: The consultant must hold a degree in Veterinary and/or agricultural economics with extensive experience in coordinating livestock programmes. Minimum fifteen years of experience from development and emergency projects in the sector, including extensive experience from project management. Knowledge of the institutional environment in the region and ability to operate in complex institutional environments. Excellent command of the English language, and strong oral and written communication skills.

Duration: two year

This position will be taken by the Animal Health and Production department in Kabul, as part of his duties in implementing Animal Health projects.

Duty Station: Kabul, with in-country travel as required.

65 Annex 4

Terms of Reference National Project Coordinator

Under the general supervision on TCEO and the FAO Representative in Afghanistan, the technical supervision of the Chief, AGAH, within the framework of the Emergency Centre for Transboundary Animal Diseases (ECTAD), and under the direct supervision of the Project Manager, the National Project Coordinator will take responsibility for day-to-day project implementation including:

 Assist the Project Manager in the appointment of other National Consultant staff.  Supervise project staff, coordinating the activities and monitoring their performance.  Collaborate with government staff in undertaking field activities.  Undertake the purchasing of equipment and reagents.  Make contractual arrangements for the socio-economic studies.  Arrange and participate in regional training courses for field staff in HPAI recognition, sample collection and reporting.  Identify needs and implement as required, in-country training for laboratory personnel.  Coordinate project activities with those other donors and agencies and with the FAO Regional TCP on Emergency Assistance for Early Detection and Prevention of Avian Influenza in the Central Asia Region.  Undertake other project-related activities as required.

Reporting Toward the end of the Project, the National Project Coordinator will prepare a report describing in detail the performance of the Project, in relation to the expected outputs. The report will include a review of the activities undertaken, the main results obtained, problems encountered and progress toward meeting the project objectives. It will also identify ongoing needs to meet future requirements for Avian Influenza prevention and control. The report will be submitted to ECTAD in the final month of the Project.

Qualifications: A degree in veterinary science, an excellent knowledge of transboundary disease control in Afghanistan with at least seven years of post-graduate experience. Demonstrated capability in project implementation and supervision of professional and technical staff is essential. An excellent knowledge of English is required.

66 Duration of the assignment: Twelve months.

Duty Station: Kabul, with in-country travel and attendance at regional meetings, as required.

67 Annex 5 Terms of Reference National Consultant Epidemiologist

Under the general supervision of MAAH&F and direct technical supervision of Head of the Animal Health and Production Department of MAAH&F Government of Afghanistan, the National Consultant Epidemiologist will:

 Plan and assist in the implementation of a surveillance programme for monitoring migrating wild birds and their potential involvement with the introduction of AI.  Plan and assist in the implementation of a surveillance programme for detecting AI in poultry, involving passive surveillance by strengthening reporting systems and active surveillance, as appropriate, involving structured inspections of target poultry populations and possibly serological surveillance.  Analyse the results of clinical surveillance and tests conducted for the detection of AI.  Undertake, in collaboration with government veterinary, poultry production, and wildlife staff, a risk assessment to determine the likelihood of Avian Influenza introduction (especially but not exclusively by wild birds) and the likely consequences of its introduction, in terms of potential for spread and impact on poultry enterprises.  Collaborate with personnel undertaking socio-economic studies in establishing realistic disease scenarios on which to model social and economic impact determinations.  Assess the needs of government, at the national, regional and district levels, for improvement of transboundary disease surveillance and reporting and assist with the upgrading of these activities.  Participate in in-country regional training courses for field staff.  Participate in international/regional workshops conducted as part of regional TCP activities, as required.  Undertake other activities as required to meet the requirements of the Project for improving understanding of the needs for AI control and prevention and the improvement of surveillance and reporting for transboundary animal diseases in Afghanistan. Reporting - Provide the Head of the Animal Health Department of MAAH&F with regular reports on risk assessment activities and the outcomes of surveillance for Avian Influenza. - Toward the end of the Project, provide a comprehensive report on the assessment of risk and potential impact of Avian Influenza in Afghanistan and the impact of the Project on improvements to transboundary disease surveillance and reporting.

68 Qualifications: A degree in veterinary science and post-graduate qualification in epidemiology. Demonstrated capability to design surveillance studies and to analyse results. A detailed knowledge of government veterinary structure and function within Afghanistan. An excellent knowledge of English is essential. Duration of the assignment: 24 months. Duty Station: Kabul, with frequent travel in-country and occasional travel to attend regional workshops.

69 Annex 6

Terms of Reference National Consultant Communication Specialist

Under the general supervision of MAAH&F and direct technical supervision of Head of the Animal Health and Production of Afghanistan, and under the direct supervision of the Project and Project International consultant the Communications Specialist will:

 Develop a communication strategy for addressing the prospect of outbreaks of disease in poultry and the possible occurrence of human influenza resulting from infection with the avian virus.  Address the specific needs for informing poultry producers and the public in general, of the threat of Avian Influenza and the need for cooperation with disease control authorities.  Assist national authorities in developing guidelines for distribution in local languages.  Collaborate with government and other agencies in conducting workshops in communication methodology.  Collaborate with government personnel in communication aspects for the development of farmers groups for improving poultry biosecurity.  Undertake other project-related field activities, as required.

Reporting The incumbent will report on the outcomes of activities against the identified communication needs within the Project. He/she will make recommendations on the needs for continued awareness of Avian Influenza and its prevention, with the community.

Qualifications: A degree or diploma in communication studies or journalism with a demonstrated capability to develop complex communications strategies. An excellent knowledge of English is essential. Previous experience in working with rural communities and with aid agencies is an advantage.

Duration of the assignment: 24 months.

Duty station: Kabul, with occasional in-country travel.

70 71 Annex 7

Terms of Reference National Area Veterinarians Officers (Six positions)

Under the general supervision of MAAH&F and direct supervision of Head of the Animal Health and Production in Afghanistan, the Area Veterinarian will:

 In collaboration with government veterinary and wildlife staff, undertake surveillance on wildlife and to determine migratory patterns and their potential for introducing Avian Influenza.  In collaboration with government veterinary and poultry production staff, undertake surveillance activities for Avian Influenza in poultry.  Assist field staff at regional and district level in improving surveillance and reporting procedures.  Participate in in-country regional workshops for transboundary disease surveillance and reporting.  Undertake other project-related field activities, as required.

Reporting Provide monthly reports on field activities and significant outcomes of surveillance.

Qualifications: A degree in veterinary science with at least three years post-graduate experience in livestock disease surveillance, control and reporting.

Duration of the assignment: 24 months.

Duty station: Kabul, with extensive in-country travel.

72 Annex 8

Terms of Reference National Consultant Geographic Information Systems Specialist

Under the general supervision of MAAH&F and direct supervision of Head of the Animal Health and Production Department of MAAH&F in Afghanistan, and the direct supervision of National Consultant Geographic Information Systems Specialist will:

 Collaborate with the Epidemiologist in mapping sites of entry of different species of migrating birds and for different time periods.  Collaborate with field staff and poultry production specialists in mapping the distribution of poultry within Afghanistan, with the different production sectors.  Assist with the interpretation of data in the form of a risk map for the introduction and spread of Avian Influenza.  Undertake other project-related field activities, as required.

Reporting Toward the end of the appointment period, provide a comprehensive report on the outcome of the work and make any recommendations for follow-up studies.

Qualifications: A diploma in information technology with expertise in GIS applications. A demonstrated capacity to map data on a spatial and temporal basis. A good knowledge of English is required.

Duration: six months.

Duty Station: Kabul.

74 Annex 9

Guidelines for the preparation of progress and final reports

The final report is submitted officially by Animal Health of MAAH&F to donors on the conclusion of Trust Fund projects operated by MAAH&F / Animal Health and Production Department.

The immediate objective of this report is to provide the donor with information on how the funds were utilized. The final report should be a concise account of the main results, conclusions and recommendations of the project, with minimal background, narrative and technical details. A beneficiary-centred approach to presenting information is preferable. The analysis of problems and the description of activities should lead logically and directly to the findings and recommendations presented.

The report should be written in clear language, and addressed to senior policy programme level in the donor government, avoiding the use of technical terms.

The report should not normally exceed 10 pages, without borders, boxes, shading, footnotes or endnotes. Digital photographs used to illustrate the activities undertaken and their impact should be separated together with a free-standing explanation or caption.

Presentation of the report: 1. Executive summary: one page maximum, the summary should sum up the entire report and should highlight the essential elements of the project. 2. Introduction: Background (impact of the disaster(s) on the agriculture sector; and Government and international response to the disaster); financial contribution of the donor, objectives, beneficiaries. 3. Project implementation: Implementation arrangements; activities; difficulties encountered during implementation. 4. Impact: On beneficiaries and secondary project impact. The evaluation will be based on comparison of indicators from the Logical Framework defined and refined during the project cycle. 5. Findings and recommendations pertinent to future agricultural assistance.

Annexes - Implementation information for different project activities (coordination, input distribution, animal health, fishery, training, coordination, capacity building).

75 - Impact information (results of coordination mechanisms set up by the project: regular meetings among humanitarian partners, concrete outcomes of these meetings, estimate of the number of agencies benefiting from this project). Number of seed producers made operational, number of agricultural households ultimately benefiting from the rehabilitation of the local seed production sector and expected impact of the intervention on the local economy. Impact of livestock/fishery assistance on food security and nutrition levels of beneficiaries. Number of livestock vaccinated or receiving care, number of families owning this livestock. Benefits to the local populations (direct impact on food security and livelihoods, improvement of their coping capacity, improving trade and income generation. The impact of training or capacity building activities and the effect of the introduction of new technologies.

76 Annex 10

General Provisions

1. The achievement of the objectives set by the project shall be the joint responsibility of the Government and FAO / TAD Project.

2. The Government shall make available the requisite number of qualified national personnel and the buildings, training facilities, equipment, transport and other local services necessary for the implementation of the project.

3. The FAO/TAD shall constitute the focal point for cooperation with Animal Health Department of MAAH&F.

4. Project equipment, materials and supplies provided out of the project funds will normally become the property of the Animal Health Department of MAA&F of Government immediately upon their arrival in the country.

5. Animal Health Department of MAAH&F will provide reports, Tape, Records and others as many require for the execution of the project.

6. The selection of project personnel, of other persons performing services on behalf of Animal Health Department of MAAH&F in connection with the project, and of trainees, shall be undertaken by the Animal Health Department of MAAH&F.

77 Annex F: Plan and proposal of Ministry of Health

Islamic Republic of Afghanistan Ministry of Public Health Preventive Health & PHC General Directorate

78 National Avian Influenza Pandemic Preparedness and Response Plan

Afghanistan-2006

79 Executing Agency Office of the President, Islamic Republic of Afghanistan Project Title: National Avian Influenza Pandemic Preparedness and Response Plan

Sector: Health Objective: To prevent the occurrence and spread of avian influenza in Afghanistan and preparing the necessary resources for containing the disease in the event of an outbreak

Beneficiaries: TOTAL: 22 million people Women,Chidlren and Other groups: Disabled people, IDP, Returnees, Kochi etc. Implementing Agency: Ministry of Public Health Project Duration: 24 Months Total Project Budget: Funds Requested for US$ 5,211,580 2005:

I Background

Human Influenza (flu) is caused by a virus that attacks mainly the respiratory system (nose, throat, bronchi) and transmitted through respiratory droplets. Most people recover easily within one to two weeks but in the very young, the elderly and people with some chronic diseases, influenza poses a serious risk. Influenza spreads rapidly around the world in seasonal epidemics, and imposes a considerable economic burden (health care and lost productivity). For most people affected, influenza will last several days but requires only symptomatic treatment. Antibiotics cannot eradicate the virus, and are used only to treat complications. The annual epidemics of influenza are due to minor changes in the virus, which allow it to escape the immunity that humans have developed after previous infections or vaccinations. Avian influenza, or bird flu, is caused by viruses that normally infect only birds (including chicken, ducks, geese, quails and wild birds), and, less commonly, pigs and other mammals. Domestic poultry are especially vulnerable to infection that can rapidly reach epidemic proportions. Mutations or reassortment of the bird flu virus into new and more aggressive strains occur regularly and have already caused several severe avian flu outbreaks in the past, some of them causing human fatalities. In 1997 in Hong Kong, China, 18 people were infected and 6 died, and in the Netherlands in 2003 several people were infected and one died. In both cases as well as in other similar outbreaks, spread of the virus was stopped by immediately culling the whole population of infected chickens.

From mid-December 2003 through 1st March 2006, 45 countries in Asia, Europe and Africa, Mediterranean Sea surrounded countries (Italy, Greek and Bulgaria)have reported outbreaks of the “H5N1” avian influenza in domestic poultry, including chickens and ducks, or wild birds. In seven of these countries, a total of 174 human cases had been confirmed as of December 2003, resulting in 94 deaths. Avian influenza or "bird flu,” is a highly contagious viral disease that is particularly lethal to domesticated birds. Public health experts are increasingly concerned that ongoing outbreaks of the avian influenza (AI) virus among poultry and humans in Asia could spark a worldwide influenza pandemic that would have disastrous effects on human health and the global economy. A global flu pandemic could result in airport closures and other travel restrictions – not to mention panic – that would stop global commerce and cut off supplies to Afghanistan and consumers around the globe. The greatest influenza pandemic occurred in 1918-1919, responsible for 40- 50 million deaths worldwide. Today, vaccines, antibiotics and antiviral drugs are available. According to WHO and the CDC estimate that a pandemic is likely to result in 2 to 8 million deaths globally, with a very high economic cost, particularly for low income countries where health care resources are already constrained.

In response to these concerns the World Health Organization is strongly advocating influenza pandemic preparedness planning. The objectives are to enable countries to be better

81 prepared to recognize and manage an influenza pandemic; to reduce the transmission of the pandemic virus; to decrease cases; hospitalizations and deaths; to maintain essential services; and to reduce the social and economic impact of an influenza pandemic. The World Health Organization has identified strategic goals during the Pre-pandemic phase:

Strengthen early warning systems Reduce opportunities for human infection Ensure early detection, notification and response Contain and limit foci of infection

At the country level, these strategic goals must be translated into action plans with specific objectives, to enhance disease surveillance and response preparedness. These goals have been addressed in plans for avian influenza developed in Afghanistan.

Avian Influenza in Afghanistan

Afghanistan is one of the world’s poorest countries, a post conflict country that has suffered from 23 years of war and had one of the lowest medical and social indicators in the world even before the Soviet invasion. This has resulted in the destruction of municipal, economic and social infrastructure. A significant number of the population of Afghanistan is internally displaced, having newly arrived from refugee camps in neighboring countries. Many of returnees lack basic shelter and may not have access to adequate health care, thereby being vulnerable to acute respiratory disease especially during the harsh Afghan winter.

The long years of conflict, poor living conditions, over-crowding, inadequate housing and poor environmental conditions, all contribute to the great burden of communicable diseases in Afghanistan. Diarrheal diseases, ARI (particularly, pneumonia, and influenza), meningococcal diseases, viral hepatitis, measles, typhoid, hemorrhagic fever, tuberculosis, cholera, malaria and leishmaniases constitute a huge disease burden. The lack of coordinated national surveillance to monitor, report and respond to epidemic-prone, emerging, and re-emerging infectious diseases in addition to the general absence of the diagnostic capabilities necessary to identify accurately pathogenic micro-organisms, and the insufficient numbers of trained health care professionals to investigate theses infectious diseases, further aggravate the problem..

82 Globalization, increasing urbanization and poverty, civil strife and political instability, climate change and exploitation of new environments, all contribute to the global amplification and spread of new diseases and the resurgence of those once considered to be under control. These outbreaks and epidemics repeatedly challenge national health services and disrupt routine control programs diverting attention and funds. The increasing resistance of micro-organisms to drugs further aggravates the problem by undermining available therapy, reducing opportunities for treatment and prevention and significantly increasing the costs of health care, in our closely interconnected world, adverse events in one country may easily cross borders and intrude on another and, thus threaten the global health security.

Afghanistan has one of the highest under 5 year old mortality rates in the world, one of the main causes being death due to Acute Respiratory Infections. The country also suffers from regular outbreaks of acute respiratory diseases with significant morbidity and mortality, especially in villages and districts in isolated geographical areas of the country where health service coverage is inadequate, and public health such as vaccination programs have not covered the whole population. According to the World Health Organization Afghanistan is considered a country at ‘high risk’ for Avian Influenza as it lies along the migratory pathways of wild birds traveling south westerly from Siberia, and has several geographically distinct wetlands serving as transit points for migratory wild birds in the North and South of the country, and countries bordering Afghanistan have recently reported deaths of poultry due to avian flu Lying in the flight routs of Migratory bird, widespread practices of raising poultry in the home to supplement income, low community awareness and a health system that is in the early stages of delivering effective health services equitably makes Afghanistan especially prone to dangers of an outbreak of a virulent form of avian influenza. There is a critical need in Afghanistan for establishing a suitable disease surveillance, preparedness and response system, capable of early warning and effective response to epidemics. This surveillance and response systems requires, however, trained staff, improved communication, appropriate infrastructure, provision of necessary supplies, strong public health laboratories and links to international networks and all necessary.

Activities in Afghanistan to date:

There is a strong level of recognition by senior policymakers and government officials of the Islamic Republic of Afghanistan of the importance of preventing avian influenza, the Deputy Minister of Public Health (MOPH) leads an Avian Influenza Task Force within the MOPH, and one of the Vice-Presidents chairs an inter-ministerial, cabinet level emergency response team, which is beginning to address the coordination issues required for a country-wide Avian Influenza response. The MOPH AI TF includes representatives of all the major international health organizations (Ministry of Agriculture, Animal Health and Food, WHO,UNICEF, FAO, US

83 Department of Health and Human Services, Centers for Disease control (HSS/CDC) NGO’S and donors such as World Bank, European Commission and USAID. The Task Force Meets biweekly and has produced several technical documents and plans on Avian Influenza for the Afghan setting, including

 Clinical case definitions for surveillance of avian influenza  Fact sheet in local languages for health care workers, and local population  Information, education and communication messages for patients and health care workers  Technical Guidelines for the prevention, isolation and control of Avian Influenza in the event of an outbreak  Plans and technical documents for a National Surveillance and Response System for Avian Flu in Afghanistan, including curriculums for training health care workers in surveillance and response

These technical documents and plans were developed with guidance from the World Health Organization, Ministry of Agriculture and Food, Food and Agriculture Organization (FAO), and local technical experts. A national preparedness plan for avian or pandemic influenza is in the early stages of development. The Ministry of Agriculture and Food in partnership with FAO has recently conducted a seroprevalence survey of a sample of 1,500 wild birds in Afghanistan to determine the existence of strains of avian influenza in Afghanistan. Recently there have been efforts by the Ministry of Public Health and the Ministry of Agriculture and Food to develop a comprehensive and coordinated plan for the control of avian influenza in the event of an outbreak in poultry or domestic birds

Currently, because of the above mentioned realities, Afghanistan has no active or passive national system of sentinel surveillance of diseases of high morbidity and mortality, and has little capacity to rapidly collect store and transport samples of suspected animal or human cases to regional laboratories, with no laboratory capacity to identify suspected cases. Activities to educate and inform the public about avian/pandemic influenza (case recognition, prevention, risk behaviors, caring for the ill, etc.) exists, and materials specific to avian influenza have been developed through the Task Force with other partners. As there is a low level of awareness of the public with regards to avian influenza and no stockpiles of anti-viral exist in Afghanistan, but antibiotics are in good supply. There are no stocks of personal protective equipment, or equipment for isolation in the event of an outbreak. All these essential equipment and assistance must be made available for Afghanistan to have a minimum level of preparedness for avian influenza. Financial assistance is required for rapid expansion and improvement of surveillance, eg, payment for training activities, surveillance forms and reporting, sample kits for influenza testing, purchase of isolation equipment and supplies, technical assistance and support for an effective response in the event of an outbreak of Avian Influenza.

84 Areas of particular interest for partnerships include supporting AI prevention and containment by improving disease surveillance, laboratory diagnosis, and outbreak response in affected countries; and strengthening planning and preparedness to reduce the effects of a pandemic; Technical assistance from corporations and universities in establishing diagnostic laboratories, to increase capacity to establish and support diagnostic laboratories, improve timely sample collection, conduct field epidemiology, safe culling and disposal of infected animals, improve clinical management of human cases. Communications expertise from concerned organizations aimed at increasing public awareness and curbing behaviors that facilitate the spread of AI. Product donations from pharmaceutical and health care companies including vaccines, antiviral drugs, disinfectants, protective clothing, and lab and hospital equipment and support for acute respiratory Infections

II Goals and purpose:

To prevent the occurrence and spread of avian influenza in Afghanistan and preparing the necessary resources for containing the disease in the event of an outbreak

III Components

4. Training component o Surveillance and Outbreak Investigation o Isolation procedures o Control procedures o Treatment of Severe Acute respiratory infections o Supplies and Support for Outbreak investigation . Sample collection kits for respiratory secretions and tissue . Transport o Training of staff 5. Procurement and management of Equipment o Isolation equipment, personal protective equipment, tents o Control equipment and materials

85 o Anti-virals and influenza vaccine for high risk groups e.g. health care workers, poultry culling workers and laboratory technicians o Strengthening of hospitals to treat Acute Respiratory Infection . On-call ambulance . Lab supply and equipment (microscopes, reagents etc.) 6. Information, Education and Communication o For professional medical staff o For the community . News stories and interviews . Drama for radio and TV spots . Posters and pamphlets o Awareness campaign . Mullahs through Ministry of Hajis, Martyrs and Religious Affairs . Women through Ministry of Women’s Affairs . Teachers through Ministry of Education 4. National Public Information Campaign, delivery of messages to the communities during Nation-wide house-to –house Polio Immunization Campaigns 10. Establishment of Surveillance System a. Establishment of sentinel sites in selected provinces then I all provices b. Integration into National Health System c. Expanding system to include other diseases of high priority in Afghanistan 11. Coordination between Ministry of Public Health, Ministry of Agriculture, Animal Health and Food, European Community, USAID World Bank, Asian Development Bank, FAO, WHO, ICRC, ARCS, other NGO’s, and related Line Ministries

IV Outputs

16. Comprehensive response to an outbreak of avian/pandemic flu in Afghanistan that addresses all aspects of control 17. Health care staff trained in outbreak investigation, surveillance and response to avian influenza

86 18. Health care staff able to implement prevention, isolation, treatment and control measures in the event of an outbreak of Avian influenza 19. Stockpiling proper equipment in Afghanistan to respond to an outbreak of Avian Influenza. 20. Strengthening of hospitals to control and treat severe respiratory diseases 21. Early warning and quickly reporting any signs of disease in human and birds through surveillance system. 22. Rapid appropriate, adequate and timely responding to the emergency events

Timetable for implementation: 18-24 months

V Main Activities

11. Establishment of Sentinel Surveillance system for Afghanistan 12. Training and education for health care workers on avian influenza 13. Strengthening of Regional and Provincial Hospitals for surveillance, treatment and control of Avian influenza 14. Community Awareness through Information, education and communication on avian influenza for health care workers and communities 15. Community Involvement and Community Participation

VI Other partners who are currently involved

 Ministry of Agriculture, Animal Health and Food  FAO  Other line Ministries of the Islamic Republic of Afghanistan.  The World Bank  USAID  Asian Development Bank  Departments of Health and Human Services

VII Monitoring plan and key indicators: to be developed

87 VIII Plan for disseminating results

 Official Reports from the Ministry of Public Health, in official meetings of coordination meetings such as the Consultative Group for Health and Nutrition, and the Technical Advisory Group, and through MOPH IEC, bulletins and interviews.

 Workshops at Central level

IX Budget

Budget for AI Pandemic preparedness and Response Description Unit No. Unit Cost Total Remarks Units cost US$ (A) Surveillance system establishment Establishment of 277,680 see annex a for details a Surveillance system Office Equipment 100,000 For communicable diseases Surveillance program for 34 Provinces Satellite Phone & item 4 1500 6,000 one time investment for national cards level Vehicle to rent item 15 800 per 288,000 15 vehicles for 15 provinces for month 24 months Subtotal 671,680 Personnel National month 24 1700 40,800 for national level, 2 year contract Coordinator National month 24 1000 24,000 for national level, 2 year contract Surveillance Officer Zonal supervisor month 24 800 19,200 for national level, 2 year contract

88 Zonal desk month 24 500 84,000 7 personnel, for national level, 2 officer year contract Finance Officer month 24 500 12,000 for national level, 2 year contract 2 Office month 24 300 7,200 for national level, 2 year contract administrators Support staff 20,000 Provincial and central project support staff Provincial focal month 24 100 81,600 For 34 provinces point Subtotal 288,800 Training Component National AI month 48 500 24,000 Trainers on surveillance and Trainers control for 15 provinces Subtotal 24,000 (B) Case Management Equipment Hospital item 200,000 Supplementary beds, oxygen equipment tanks and nebulizers for hospitals for ARI Personal item 2,000,000 Disposable gowns, gloves, Protective masks, glasses, boots, apron, etc. Equipment Lab improvement item 200,000 Lab equipment for hospitals, services including reagents Running costs for item 200,000 Media for sample transport, collection and sample carrier and transport to transport of Laboratory specimens Antivirals 1,040,000 For high risk groups such as agricultural and health care workers, 2,000 workers, 60 days, $10/dose

89 Flu vaccine item 15,000 2,000 workers, $7.5/dose Rapid screening item 4,500 10 kits, $450/kit kits for AI Internet item 20,000 For regional hospitals communication for hospitals subtotal 3,679,500 ( C) Information, Education and Communication Information, 547,600 For details please see to annex B Education and Communication Subtotal 547,600

Grand total US$ 5,211,580