Project Information Document (Pid) s50

PROJECT INFORMATION DOCUMENT (PID) Concept Stage Report No.: AB2446 Project Name Avian Influenza Control and Human Pandemic Preparedness and Response Project Region EUROPE AND CENTRAL ASIA Sector General agriculture, fishing and forestry sector (50%);Health (50%) Project ID P100470 Borrower(s) GOVERNMENT OF Romania Implementing Agencies National Sanitary, Veterinary and Food Safety Authority (ANSVSA) Ministry of Health

Environment Category [ ] A [X] B [ ] C [ ] FI [ ] TBD (to be determined) Date PID Prepared June 26, 2006 Date of Appraisal June 29, 2006 Authorization Date of Board Approval August 4, 2006

Country and Sector Background

1. Avian Influenza - the global dimension. The continuing outbreaks of highly pathogenic avian influenza (HPAI), which begun in late 2003 in several Southeast Asian countries and have now occurred in Europe, the Middle East, and Africa, have been disastrous to the poultry industry and have raised serious global public health concerns. As of February 2006, nearly 200 million domestic poultry had either died or been culled, and economic losses to the Asian poultry sector alone are estimated at around $10 billion. Despite control measures, the disease continues to spread, causing further economic losses and threatening the livelihoods of hundreds of millions of poor livestock farmers, jeopardizing smallholder entrepreneurship and commercial poultry production, and seriously impeding regional and international trade and market opportunities. The rural poor, who rely for a larger share of their income and protein consumption on poultry, have been particularly hard hit with income losses and negative nutritional consequences. Between February and May, 2006, the first cases of H5N1 (or H5) infections in poultry or wild birds were reported from an unprecedented 34 countries, marking the fastest and most extensive geographic spread of HPAI virus since the disease was first described in 1878. As of June 25, OIE had received official notification of the presence of AI (H5) from 58 countries in Asia, Europe, Middle East, and Africa.

2. So far, worldwide and even in South and Central Asia where many outbreaks have been observed, the H5N1 epizootic has only been associated with sporadic human cases. The available scientific evidence shows that the H5N1 virus is not well adapted to humans yet. However, genetic accidents (mutation or recombination of the H5N1 virus with the seasonal influenza virus) could trigger a pandemic. As of June 20, 2006 228 people have been infected by the disease in 10 countries, namely: Azerbaijan, Cambodia, China, Djibouti, Egypt, Indonesia, Iraq, Thailand, Turkey and Vietnam. Of the 228 people tested positive to H5N1, 130 died which means a lethality rate of 57%. Before June 2006, no cases of human to human transmission had been formally confirmed. However, in June 2006 in Indonesia, an outbreak involved eight members of a single family and seven of them died. The presence of the H5N1 virus was confirmed in all. This is the largest cluster of human H5N1 ever reported. While the case is under further investigation, it is now suspected that human-to-human transmission has occurred. The nature of the virus and the recent increases in the number of known cases of avian influenza (AI) transmission have raised concerns over the potential emergence of a pandemic, which could have devastating effects on human health and livelihoods.

3. It is impossible to anticipate when the next influenza pandemic may occur or how severe its consequences may be. On average, three pandemics per century have been documented since the 16th century, occurring at intervals of 10-50 years. In the 20th century, pandemics occurred in 1918, 1957 and 1968. The pandemic of 1918 is estimated to have killed up to 50 million people in eighteen months, with peak mortality rates occurring in people aged 20-45 years. The pandemics of 1957 and 1968 were milder, but many countries nevertheless experienced major strains on health care resources. If a major pandemic were to appear again, similar to the one in 1918, even with modern advances in medicine, an unparalleled toll of illness and death could result. Air travel might hasten the spread of a new virus, and decrease the time available for preparing interventions. Country health care systems could be rapidly overwhelmed, economies strained, and social order disrupted.

4. In collaboration with national and international partners, governments around the world are increasing their efforts to prepare and implement contingency plans and action programs in order to increase the general preparedness levels for the prevention and control of avian influenza and a potential human influenza pandemic. The proposed project would support such efforts undertaken by the Government of Romania, in close collaboration with its international partners.

5. International response. The leading international technical agencies - the FAO, OIE (the World Animal Health Organization) and WHO - have developed and promulgated global strategies, guidelines and norms intended to minimize the threat and risk of HPAI in humans and domestic poultry through progressive control and eradication of HPAI from terrestrial domestic poultry. These global strategies are expected to be complemented by and implemented through country-specific contingency plans and investment programs for prevention and control. Global coordination of the tracking of and response to disease outbreaks, as well as the coordination of bilateral and international financial support, has taken form following a series of global meetings since October 2005. Within this framework, the United Nations and World Bank have supported national preparedness planning, resource mobilization efforts, and the design and implementation of national investment programs to enhance the countries' prevention and response capacities.

6. Regional implications. Until recently, avian flu outbreaks were limited to Southeast Asia. In July 2005, however, first outbreaks were registered in domestic poultry and fowl in seven regions of Russia. Four months later, outbreaks of highly pathogenic H5N1 in poultry were reported in four regions of Kazakhstan. Over the past eleven months, the avian influenza virus spread fast across Asia and Europe with its first occurrence in Europe on October 1, 2005, on a poultry farm in Turkey, and three days later in Romania on a backyard farm. On January 5, 2006, the first human cases in Europe are reported from Turkey. As of June 25, 26 countries (Albania, Austria, Azerbaijan, Bosnia and Herzegovina, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, France, Georgia, Greece, Germany, Hungary, Italy, Kazakhstan, Poland, Romania, Serbia, Slovakia, Slovenia, Sweden, Switzerland, Turkey, Ukraine, United Kingdom) had reported outbreaks of HPAI (H5) and 9 persons had died of avian influenza in Europe and Central Asia. Except for Moldova, Romania is surrounded by countries in which the avian influenza virus has been detected. As of May 31, 2006, AI outbreaks had been reported in domestic poultry from Ukraine (22), Turkey (176), and Albania (2) (in parenthesis: number of the reported outbreaks) and in wild birds from Bulgaria, Croatia, the Czech Republic, Hungary, Poland, Slovakia, and Slovenia. While no new cases appeared in Romania since June 6, the spread of the disease continues in close proximity. On June 4, another HPAI infection (later confirmed as H5N1) was observed in domestic poultry (geese) in Hungary and further suspected cases have been reported on June 20. On June 11, HPAI was detected (on June 22, 2006, confirmed as H5N1) on a poultry farm (chicken, ducks, geese) in the Sumy region of Ukraine.

7. Seasonal migration of birds has long been assumed as the major factor in the long-distance transmission of new strains between geographical regions and countries. However, it has become increasingly clear that vectors related to the movement of goods and humans through local and international trade can be equally responsible for the emergence of the disease in a new location. Outbreaks have therefore prompted bans by the EU (and by other countries) on the import of poultry and poultry products from infected countries. In the case of Romania, the EU banned imports of live birds, meat and poultry products in 2005 after the confirmation of H5N1. At the end of the first wave, in May 2006, the EU accepted to limit import restrictions to affected counties. Similar import restrictions for Romanian poultry products were taken by Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Macedonia, Serbia and Montenegro, and Kosovo. With the re-occurrence and rapid spread of the disease in a second wave starting in May 2006, the EU decided on June 2, 3006, to re-extend the import ban for products from the entire Romanian territory.

8. HPAI outbreak situation in Romania. The H5N1 virus was first detected in Romania on a backyard farm in the Danube Delta (Tulcea County) on October 4, 2005, and confirmed and reported to OIE on October 13, 2005. 54 more outbreaks in nine counties (48 villages and two small towns) in the Danube Delta and Black Sea area, all in backyard poultry systems, followed in this first wave of AI which lasted until April 21, 2006, when the last outbreak location was officially declared closed. However, only three weeks later, on May 11, 2006 (date of first suspicion, with confirmation by virus isolation on May 15, 2006), a second avian influenza wave started in Brasov country, this time with an outbreak on a commercial farm and at a considerable distance from the Danube Delta. On May 21, 2006, the presence of HPAI was confirmed in Bucharest, triggering the quarantining of residential neighborhoods in the city. As of June 9, 2006, this second wave had caused 121 confirmed outbreaks (6 more suspected) in 19 of Romania's 42 counties, concentrated in but not limited to the center of the country. After the first wave of AI outbreaks which is believed to have been caused by wild birds in the Danube Delta region, this second wave revealed that inappropriate farm management and trade practices can have equally dramatic effects on the spread of the disease. Luckily, until today, Romania has not experienced any human cases. Of the 17 suspicious human cases that have been hospitalized, none tested positive. However, in the second wave of outbreaks alone, about one million birds had died or were culled; and the total cost of disease control and economic losses to the poultry and related industries is estimated to exceed EUR90 million.

Objectives

9. The project will support and constitutes an integral part of a national program to increase Romania's avian and human influenza preparedness, i.e. the country's capacity to prevent and control the spread of influenza among animals and humans. In this context, the overall development objective of the project is to reduce the threat posed to humans and the poultry sector in Romania by HPAI and other zoonoses, and to support the preparation for, control of, and response to influenza pandemics and other infectious disease emergencies in humans. To achieve this, the project will support activities in the three areas of prevention, preparedness and contingency planning, response and containment under the four components: (i) animal health; (ii) human health; (iii) public awareness and communications; and (iv) implementation support, monitoring and evaluation.

10. The key project outcome indicators will be: (i) evidence of institutional mechanisms for effective implementation of appropriate disease contingency plans; (ii) evidence of an effective surveillance system for both animals and humans for HPAI and other zoonoses; (iii) evidence of enhanced outbreak control capacities and general awareness, reducing the probability of virus transmission from animals to humans; (iv) evidence of increased capacities to handle human cases of infectious diseases.

Rationale for Bank Involvement

11. The justification for the Bank involvement is the Global Public Goods aspect of the HPAI, one of many emerging and re-emerging zoonoses, and its strong link to poverty reduction. HPAI control programs require a multi-disciplinary approach to integrate technical, social, economic, political, policy, and regulatory issues in addressing a complex problem. The Bank is well-placed to build upon its knowledge of multi-disciplinary approaches needed in the proposed Project, which draws on evidence and lessons learned in the various regions regarding emergency preparedness responses and multi-disciplinary approaches. The Bank's experience with multi-sectoral emergency response and risk-mitigation projects gives it considerable qualifications in bringing together the relevant ministries, government agencies, and the donor community, in understanding and addressing the social and economic impact, and in assuring high level political coordination.

12. Given the Bank's work with FAO, WHO, OIE, EU, USAID and other partners within Romania and at the international level to address both preparedness and outbreaks and to assist with institutional assessments, the Bank can assist Romania in leveraging additional resources from other international and bilateral agencies. In addition to its financial role, the technical assistance provided by the Bank has been important in similar global or regional emergency situations such as SARS, Tsunami relief, and HIV/AIDS. The Bank's national and regional support will be closely linked with the activities of FAO, WHO, OIE, and the EU and the proposed project is fully consistent with, and draws heavily on, the global strategies proposed by FAO and WHO.

Description

13. The project would finance activities under four components: (i) Animal Health; (ii) Human Health; (iii) Public Awareness and Communications ; and (iv) Implementation Support, Monitoring and Evaluation. Even though the activities are organized by sectoral components, the project strongly endorses an integrated national plan that ensures common objectives across sectors for dealing with the avian flu issue.

COMPONENT 1: ANIMAL HEALTH

Total component cost are estimated at EUR16.1 million,

(A)Strengthening National HPAI Preparedness and Prevention Capability

A1 - Strengthening the Institutional Framework

Evaluation of National Veterinary Services. The organizational and functional review of the main governmental veterinary services undertaken by experts from EU member countries and international organizations, and the rapid assessment undertaken by the Bank team, suggest the need for an in-depth assessment of the national veterinary services, followed by appropriate reforms as may be warranted. To meet international standards set by the World Organization for Animal Health (OIE), the EU requirements, and the recommendations developed by FAO and EU experts, the veterinary services need to develop and document appropriate procedures and standards for the implementation and management of animal health measures and international veterinary certification activities. As a basis for activities in support of institutional enhancements (below), the project will provide technical assistance to support the self-evaluation of and by the national veterinary services based on OIE's "Performance, Vision and Strategy for Veterinary Services" evaluation guidelines in order to establish the current level of performance, form a shared vision with service providers and clients in the private sector, establish priorities, and facilitate strategic planning.

Strengthening Veterinary and Food Safety Institutions. Once the evaluation of veterinary and related services (above) has been completed, the project will provide technical support for realigning institutional structures and resources with priority objectives, mandates, and tasks. In collaboration with and complementary to ongoing and planned advisory activities funded by donors and international organizations, the project will provide technical assistance for institutional and organizational restructuring at national and local levels as may be warranted; training of staff; equipment and materials, and upgrading of priority infrastructure (limited works for refurbishments) including support at the local level to enhance institutional arrangements, such as the recruitment and payment procedures for additional culling personnel, for the control of animal disease outbreaks. In particular, the project will support the establishment of animal disease control centers at the national and regional levels. A2 - Improving HPAI Prevention and Control Planning

Contingency Plan Implementation Guidelines and Manuals. While governmental authorities have developed individual contingency plans for animal and human health, overall national contingency planning and coordination still needs improvements. The Government has established a National Disease (AI) Control Center that has started a comprehensive process of reviewing, integrating, and consolidating existing contingency plans. The project will provide technical assistance to support this process of refining and finalizing the draft contingency plan(s) and to develop the necessary detailed implementation guidelines and manuals for all relevant agencies and services. Support will also be provided for the participation of veterinary experts and project staff in regional and international information exchanges on avian influenza as well as for working visits to other countries implementing similar activities.

(B) Strengthening Disease Surveillance, Diagnostic Capacity, and Research

B1 - Strengthening Monitoring and Surveillance Systems

Surveillance Capacity of Veterinary Services. The project will provide technical assistance and training for staff of veterinary service institutions at national and local levels, focusing on collecting and analyzing epidemiological data and performing risk assessments (support for serological testing under active surveillance schemes is provided under the diagnostic capacity component B2). The project will also support transportation facilities and arrangements for surveillance field work as needed. The procurement of mobile laboratories is being discussed.

Epidemiological Surveys. The second wave of outbreaks in Romania, starting on May 11, 2006, has shown that the lack of reliable epidemiological information, and the sound analysis thereof, has hampered the development of rational, targeted disease control measures and slowed down the containment of the disease. The project will provide technical assistance and training for epidemiological studies and surveillance programs to inform continuously adapted and improved disease control measures. In Romania where 70 percent of poultry is produced in backyard systems, small-scale and semi-commercial poultry production systems are the major control target.

B2 - Strengthening Diagnostic Capacity

Diagnostic capacity in Romania's national reference laboratory (IDAH) and regional laboratories. In order to equip existing laboratories for the increased work load under active surveillance schemes and to minimize the high risk period (the period between infection and control action, i.e. the time needed for detection, reporting, sampling, testing, and decision- making for response), the project will finance works for limited refurbishments and provide priority equipment and laboratory consumables including sampling kits, materials for transporting and conditioning of samples, reagents, as well as technical assistance and training, in order to increase the capacity for serological tests, screening surveys, and virological tests for the confirmation of the disease and the preparation for serotyping of AI sub-types. The sub- component will also provide personal protective and laboratory waste disposal equipment. Twinning arrangements with appropriate institutions outside Romania will be explored in order to facilitate sustained capacity strengthening.

Quality control of veterinary medicinal products. This sub-component will provide equipment, consumables, technical assistance and training for increasing the capacity of the Institute for Control of Biological Products and Veterinary Drugs to fulfill its responsibility in providing quality control for vaccine imports and other veterinary medicinal products for which formal quality assurance has to be provided by the state.

B3 - Strengthening Animal Diseases Information Systems

This sub-component will support the development of a comprehensive national animal disease information system which will enable Romania to participate in global disease information sharing and comply with its obligations as a member of OIE, contributing towards progressively better global and regional control and eradication. The system will be linked with rapid and standardized methods of routine analysis of surveillance data in order to track important changes in the H5N1 situation and promptly supply this information to field personnel. The system supported under the project is intended to enable an effective and efficient flow of information among relevant agencies and individuals (esp. field veterinarians, laboratory experts, epidemiologists, etc.), providing the necessary support to decision-makers charged with the prevention and control of animal diseases at local and national levels. The project will provide technical assistance, priority equipment and supplies, and training, for the design, establishment and use of the system. The animal health information system also includes a geo-referenced database for all poultry farms, in line with Decree NUMBERE which stipulates that mayors of all municipalities need to register all backyard flocks under their authority.

B4 - Strengthening Applied Veterinary Research Capacity

Applied Veterinary Research Program. This sub-component will support applied research on epidemiology, bird migration and ecology, and other subjects related to zoonotic diseases (a) by providing essential equipment, consumables, and technical assistance for ANSVSA's core monitoring and analytical responsibilities and (b) through a competitive research grant program. The grant program will be housed in and managed by ANSVSA, and research institutions within Romania will be invited to submit under competitive procedures research proposals on topics to be identified by ANSVSA in collaboration with relevant stakeholders in the country. Twinning arrangements with appropriate institutions outside Romania will be explored in order to facilitate sustained capacity strengthening.

Infectious disease research on live animals. This sub-component will build Romania's capacity to conduct vaccine tests on live animals for highly infectious animal diseases. These tests need to be conducted in a high-containment laboratory environment (BSL-4) for the design, establishment and use of which the project will finance works (minor refurbishments of existing facilities), equipment, consumables, technical assistance and training. The installation of this facility is envisaged to be installed at premises of the Institute for Control of Biological Products and Veterinary Drugs, and arrangement will be put in place which will allow other institutions in Romania to conduct - or have conducted - laboratory tests that require the highest bio- containment level.

(C)Strengthening HPAI Control Programs

C1 - Targeting Virus Eradication at the Source

Quarantine, Culling and Disposal. Although capable teams are in place to effectively control HPAI outbreaks, the recent wave of out outbreaks has overwhelmed authorities and veterinary services. The wide distribution of small flocks across a country where 70 percent of poultry are produced in backyard systems is a particular challenge for the control of the disease. The project will contribute to the enhancement of existing capacities for the control of HPAI outbreaks as required by existing national contingency plans. Weaknesses have been identified in the areas of quarantining (disinfection stations), culling of infected and at-risk poultry, and the safe disposal of poultry carcasses and potentially infectious materials in a bio-secure and environmentally acceptable manner. Culling is currently performed using plastic garbage containers filled with carbon dioxide, and carcasses are burned in trenches and ashes are covered. The safe disposal of carcasses in small-holder systems - which dominate Romania's poultry sector - is not sufficiently solved. Some disinfection stations and culling equipment is provided by the EU in parallel financing, however additional resources are required to upgrade culling capacity with appropriate carbon dioxide containers. The project will finance (i) equipment and consumables for disinfection stations and personal protective equipment; (ii) special containers designed for for the culling of birds using carbon dioxide, as well as carbon dioxide; and (iii) mobile incinerators with a daily capacity of about 20,000 kg per region in four geographic regions.

C2 - Supporting Vaccination Campaigns

Vaccination planning and implementation. A policy on the use of vaccination for the containment of HPAI outbreaks has not yet been formulated and capacities for the implementation of a potential vaccination campaign are considered to be insufficient. In situations where other measures failed to control the spread of the disease and where the virus has become endemic, vaccination might become an option for the containment of the disease. The project will therefore provide technical assistance and training to develop Romania's vaccination policy and action plan in the context of its near-future EU membership, and train officials in the implementation of vaccination campaigns and post-vaccination monitoring. The project will also be able to finance, as needed, the procurement of vaccines for ring-vaccination and for large-scale vaccination campaigns.

(D)Improving Bio-security in poultry production and trade

Bio-security on small-scale poultry farms. The level of bio-security both on commercial and on backyard farms is insufficient and represents a major risk for new waves of infections. The project will support enhancements of bio-security on small-holder farms with the following instruments: (i) Bio-security on poultry farms is - primarily - the result of managerial decisions and behavior (such as restricted access to poultry production farms, quarantining of new purchases, separation of sick animals, separation of species, personal hygiene, etc). The project will therefore support awareness campaigns and knowledge transfer activities - including on- farm demonstrations and training of farmers, extension agents, and other rural services providers - aimed at managerial and behavioral changes. (ii) The project would also finance technical assistance for a comprehensive poultry sector assessment which - together with improved epidemiological evidence - will help shape state support to increased bio-security on small- holder farms. (iii) Pilot projects for enhanced bio-security in small-holder poultry systems. Investment incentives (on a matching grant basis) for infrastructure upgrades on small-holder farms in compliance with enhanced bio-security requirements (such as fencing, compartmentalization, caging, and manure disposal.), based on the results of the poultry sector assessment and successful pilot activities, could be an option for project follow-up activities and were endorsed by the appraisal mission but have not been included in the final project design.

COMPONENT 2: HUMAN HEALTH

The Human Health Component will comprise three subcomponents at a total cost of EUR20.6 million):

(E) Enhancing Public Health Program Planning and Coordination

Activities under the first subcomponent will aim at enhancing coordination and program planning by providing financial and technical support for additional studies and research as well as for workshops, conferences and consensus meetings.

(F) Strengthening of National Public Health Surveillance Systems

The second subcomponent will help strengthen the national public surveillance system by: (i) Upgrading of the National Influenza Laboratory to BSL 3 through the financing of minor civil works (partitioning and creation of decontamination rooms), the supply and installation of additional security devices, and the installation of a system for maintaining negative pressure in the rooms; (ii) Strengthening of regional laboratories, in particular through the supply of real time PCR equipment and the training of staff; and (iii) Strengthening of the capacity of the regional and district public health teams to investigate and control outbreaks through the supply of equipment and - when needed - the training and re-training of staff.

(G)Strengthening Health System Response Capacity

The third subcomponent will help strengthen the capacity of the health care system to respond to the disease, through:

(i) The strengthening of the isolation and case management capacity in both national and regional hospitals. The project will finance equipment for the intensive care units of the two Bucharest infectious diseases hospitals and the establishment of isolation and intensive care units in 7 of the regional hospitals for infectious diseases (Brasov, Craiova, Constanta, Cluj, Iasi, Timisoara and Tg. Mures). According to the National Plan, during the inter-pandemic period, all suspected cases shall be transported to and isolated at the Institute of Infectious Diseases Prof Dr Matei Bals, where medical assistance can be provided by specialized dedicated personnel. The centralization of patient care is part of the MOH strategy to ensure high quality care to suspected or confirmed AI human cases. However, there is a need to develop isolation and intensive care capacities in regional infectious diseases hospitals.

(ii) The upgrading of the influenza vaccine production unit at the Cantacuzino Institute including the rehabilitation and equipment of the influenza production department, and the completion and equipment of the filling and sealing unit. A significant part of the vaccines needed in Romania during the inter-pandemic and pandemic periods can be produced by the Cantacuzino Institute. Making the Institute able to significantly increase up to 2.5 million doses and its production in full compliance with GMP standards requires the upgrading of both the production unit and the filling and sealing station. This intervention will help both to increase the production capacity and to ensure that the production is at the required Good Manufacturing Practice standards.

(iii) The purchase, stockpiling and distribution of anti-viral and other drugs.

COMPONENT 3: PUBLIC AWARENESS AND COMMUNICATIONS

The Public Awareness and Communications Component would support the GOR's efforts in designing and implementing an integrated and comprehensive communications strategy and action plan for AI at a total cost of EUR3.2 million. The component will be jointly implemented by MPH and ANSVSA, and would comprise the following three sub-components:

(i) Strengthening institutional capacity for MPH and ANSVSA: the project would support assistance for and training of communications staff, and additional equipment and operating costs for the communications teams in the two agencies.

(ii) Development of an integrated strategy and action plan based on qualitative and quantitative research: the project would build on the experience gained from the information campaigns of UNDP, UNICEF, USAID, as well as on the sectoral communications strategies of WHO and UNICEF, and the communications needs assessment of ANSVSA. The strategy would define parameters of specific audiences in various generic target groups, the degree of social acceptance of proposed hygiene and bio-security measures, the associated messages which would need to be persuasive without creating panic, and the most efficient delivery tools and vehicles for a nation wide campaign.

(iii) Delivery of several information campaigns: these would aim to obtain the public's support and participation in reporting and monitoring; to promote and induce a set of behavior changes which will diminish the possibility of AI outbreaks and contamination; and to educate different key audiences (farmers, people living in villages, traders, local authorities, media, children, teachers, health care workers, food inspectors, front line workers, consumers, other stakeholders). The campaigns, even if targeted especially for HPAI, will lead to other important positive externalities. The proposed biosecurity measures and associated campaigns will also affect the spreading and prevention of other animal diseases such as Newcastle disease, Classical swine fever, or Rabies, and will provide support for other on-going ANSVSA programs such as animal welfare, identification and registration of animals and traceability. Also, the campaigns will improve the general hygiene and sanitation of the population.

COMPONENT 4: IMPLEMENTATION SUPPORT, MONITORING AND EVALUATION

The project would be implemented by the MPH and ANSVSA, and would build upon the already existing Project Management Units in the two agencies. In order to ensure effective implementation of the project in accordance with Bank fiduciary and procurement policies and guidelines, the project would finance: (i) Incremental support to the two PMUs in terms of staff and operating costs; (ii) Studies, technical services, manuals; and (iii) Surveys for monitoring and evaluation.

Financing Source: EURO million BORROWER/RECIPIENT 6.8 INTERNATIONAL BANK FOR RECONSTRUCTION AND 35.10 DEVELOPMENT Total 41.9

Implementation

14. The Government of Romania has set up emergency response structures at the national and local levels, including the Governmental Commission for Defense against Disasters and the Anti-Epizootic Command Center; ANSVSA; MAFRD; the County Commissions for the Prevention of Disasters, the County Animal Disease Command Centers, and the County Sanitary Veterinary and Food Safety Units; and Local Animal Disease Command Centers at the municipality level. On May 24, 2006, the leadership of the Anti-Epizootic Command Center - which includes representatives from ANSVSA and 10 ministries was transferred from the Minister of Agriculture to the Prime Minister. The national Commission for Defense against Disasters and the Anti-Epizootic Command Center are responsible for the definition of the overall policy framework for disaster prevention and response and for the monitoring of its implementation.

15. In line with this overall HPAI emergency structures, the Prime Minister's Office together with the Ministry of Public Finance have taken the lead in project preparation and implementation, coordinating and collaborating with sectoral ministries and affiliated institutions as needed. A Project Steering Committee will be established comprising a representative of the Prime Minister's Office as Chair of the Committee, State Secretaries of MPF, ANSVSA and MPH, and the Component Coordinators for animal health and human health. The Steering Committee is responsible for the provision of broad guidance in project implementation and for ensuring that project activities conform to national emergency response strategies and policies. The Steering Committee will review project implementation plans including budget and procurement plans, and review and evaluate technical and financial monitoring reports. The Steering Committee will report to the Prime Minister on a regular basis about progress and impact of project implementation.

9. To facilitate the management and implementation of the Project, a Project Operational Manual (POM) is to be prepared as a Condition of Effectiveness.

Lessons Learned from Past Operations in the Country/Sector.

17. The project has been prepared under the Global Program for Avian Influenza Control and Human Pandemic Preparedness and response (GPAI) and has incorporated the lessons learned for the preparation of that project.1

Safeguard Policies (including public consultation)

Safeguard Policies Triggered by the Project Yes No Environmental Assessment (OP/BP 4.01) [X] [ ] Natural Habitats (OP/BP 4.04) [ ] [X] Pest Management (OP 4.09) [ ] [X] Cultural Property (OPN 11.03, being revised as OP 4.11) [ ] [X] Involuntary Resettlement (OP/BP 4.12) [ ] [X] Indigenous Peoples (OP/BP 4.10) [ ] [X] Forests (OP/BP 4.36) [ ] [X] Safety of Dams (OP/BP 4.37) [ ] [X] Projects in Disputed Areas (OP/BP 7.60)* [ ] [X] Projects on International Waterways (OP/BP 7.50) [ ] [X]

18. Since the Project is assessed as a B-category project, an Environmental Management Plan (EMP) would be prepared and implemented with project support (see project components). The EMP will address safe culling practices, and disposal of carcasses, laboratory wastes, and medical waste. This EMP will also cover the clean up of animal wastes of culled poultry by the local public veterinary services and minor civil works supported under the Project. A waiver for the requirement to complete the EMP during project preparation is being sought per para. 12 of OP 4.01. Preparation of the EMP is ongoing, and its adoption by the Government is set as a disbursement condition for the Animal Health and Human Health components of the Project.

List of Factual Technical Documents

Country Background and AI Situation Analysis  Highly Pathogenic Avian Influenza (HPAI) – Situation Analysis and Rapid Assessment of Country Preparedness (Prevention and Control Capacity), Draft of June 14, 2006.

1 See Program Framework Document for Global Program for Avian Influenza Control and Human Pandemic Preparedness and Response (GPAI), World Bank, December 5, 2005. * By supporting the proposed project, the Bank does not intend to prejudice the final determination of the parties' claims on the disputed areas  WB Aide-Mémoire: Romania – Avian Influenza Preparedness and Response Project; Assessment and Scoping Mission, March 21–31, 2006.  WB Aide-Mémoire: Romania – Proposed Avian Influenza and Human Pandemic Preparedness and Response Project; Preparation Support Mission, May 30 - June 14, 2006.  Regular briefings and mission reports during the second AI outbreak wave, multiple EMs sent by WHO and FAO, May 22-31, 2006.  CDC/WHO: Mission Report: Joint CDC/WHO Mission to Romania, 13-17 February 2006.

Animal Health  ANSVSA: Contingency (Emergency) Plan for Avian Influenza of Romania.  FAO Mission Report, Dr. Vladimir Savić; Avian Influenza Rapid Assessment Mission for Republic of Romania, 21. – 28. March 2006, Bucharest and surroundings.  Project proposals, various versions, prepared by ANSVSA and IDAH  FAO/OIE/WHO; Mission Report; Mission to Romania to give international assistance in the eradication of Avian Influenza; May 28 – June 10, 2006; Dr Andriy Rozstalnyy and Dr Frits Pluimers; June 10, 2006.

Human Health  WHO avian influenza support mission; Mission Report; Romania, May 24-31, 2006; Peter Ben Embarek & Cristiana Salvi; June 15, 2006.  Project proposals, various versions, prepared by Cantacuzino Institute, Matei Bals Institute, and MPH.

Communications and Information Management  WHO: Draft Plan on Communication for the Joint Anti-Epizootic National Committee during the AI Outbreak in Romania; Draft of June 8, 2006.  ANSVSA: Communication Needs Assessment of the National Sanitary Veterinary and Food Safety Authority; June 12, 2006.

Contact point Contact: Matthias Grueninger Title: Senior Agricultural Economist Tel: (202) 473-2458 Fax: (202) 614 -0698 Email: [email protected]

For more information contact: The InfoShop The World Bank 1818 H Street, NW Washington, D.C. 20433 Telephone: (202) 458-4500 Fax: (202) 522-1500 Email: [email protected] Web: http://www.worldbank.org/infoshop