Document of The

FOR OFFICIAL USE ONLY Public Disclosure Authorized

RESTRUCTURING PAPER

ON A

PROPOSED PROJECT RESTRUCTURING OF AVIAN INFLUENZA CONTROL AND HUMAN PANDEMIC PREPAREDNESS AND RESPONSE PROJECT IDA GRANT NUMBER H272 KOS Public Disclosure Authorized

IN THE INITIAL AMOUNT OF SDR 2.0 MILLION (US$3 MILLION EQUIVALENT)

AND

A RESTRUCTURED AMOUNT OF SDR 2.0 MILLION (US$3 MILLION EQUIVALENT) Public Disclosure Authorized

TO THE

REPUBLIC OF

DECEMBER 18,2009

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

AH Lab Animal Health Laboratory AI Avian Influenza CF Compensation Fund FA0 Food and Agriculture Organization of the FVA Food and Veterinary Agency GPAI Global Program for Avian Influenza Control and Human Pandemic Preparedness and Response HPAI Highly Pathogenic Avian Influenza ICU Intensive Care Unit IDA International Development Association IPH Institute of Public Health MAFRD Ministry of Agriculture, Forestry and Rural Development MEF Ministry of Economy and Finance MOH Ministry of Health MTR Mid-term Review PDO Project Development Objective PISG Provisional Institutions of Self-Government SOP Standard Operating Procedure UNICEF United Nations Children’s Fund WHO World Health Organization

Vice President: Philippe H. LeHouerou Country Director: Jane Armitage Country Manager Ranjit Nayak Sector Manager: Dina Umali-Deininger Task Team Leader: Ibrahim Hackaj KOSOVO

Avian Influenza Control and Human Pandemic Preparedness and Response Project

TABLE OF CONTENTS

Page Data Sheet ...... 1 ANNEX 1: Proposed Changes ...... 3 ANNEX 2: Appraisal Summary Update ...... 7 ANNEX 3: Updated Critical Risk Framework ...... 8 ANNEX 4: Results Framework and Monitoring ...... 9

DATA SHEET

PROPOSED PROJECT RESTRUCTURING OF AVIAN INFLUENZA CONTROL AND HUMAN PANDEMIC PREPAREDNESS AND RESPONSE PROJECT IDA GRANT NUMBER H272 KOS

Environmental category: B

Borrower: Republic ofKosovo. Responsible agency: Office of the Prime Minister

RVP approved - Does the restructured project require any exceptions to Bank policies? -Yes X No Have these been approved by Bank management? -Yes No Is approval for any policy exception sought from the Board? -Yes X NO

Revised project development objective/outcomes.

The original PDO: The objective of the Project is to strengthen the Recipient’s capacity to prevent the spread OJ Highly Pathogenic Avian Influenza (HPAI) among poultry, to prevent the transmission of HPAI @om birds to other animals and humans, and to prepare for a potential pandemic of HPAI transmissible between humans.

The revised PDO: The Project Development Objective is to minimize the threat posed to humans by Highly Pathogenic Avian Influenza (HPAI) infection and other zoonoses to prepare for, control, and respond to influenza pandemics and other infectious disease emergencies in humans.

The expected outcomes of the revised Project are: (i) the development of a National Integrated Preparedness Plan for control and response to outbreaks and pandemics prepared in accordance with WHO recommendations; and (ii) a contained and diminishing pattern of HPAI and other zoonotic viral threats and infections in humans. 1 Does the restructured project trigger any new safeguard policies? NO

Source Local Foreign Total IDA Grant I Total I 1.93

2 ANNEX 1: Proposed Changes a. What are the proposed changes, as applicable, in the project‘s development objectives, outcomes, design, andor scope?

The proposed changes are:

1. Align the Proiect‘s Development Obiective (PDO) with the Global Program for Avian Influenza Control and Human Pandemic Preparedness Response (GPAI) PDO.’ Based on the February 2009 Mid-term Review (MTR) and follow-up discussion related to the recent A/HlNl pandemic, the Recipient has agreed that the PDO should be revised to expand the scope of planned interventions to other zoonotic diseases as a new target outcome, while preserving the integrity of the original Project design related to AI and aligning it with the GPAI PDO. The revised PDO is as follows:

“to minimize the threat posed to humans by Highly Pathogenic Avian Influenza (HPAI) infection and other zoonoses to prepare for, control, and respond to influenza pandemics and other infectious disease emergencies in humans. ”

2. Sumort the development of a National Pandemic Plan to establish mechanisms for management ofa pandemic situation.

3. Cancel Compensation Funds (CF). It was agreed to redirect the CF (US$537,300 equivalent) within the same activity category, to finance the adjusted Project scope, especially the activities for Human and Animal Health components and activities that exceed cost estimations.

4. Revise Project Activities: The MTR reviewed and appraised Project activities and priorities. Discussions were held with key stakeholders after the WHO pandemic alert was raised to level 6. The priority activities, as identified by the Recipient, to support the revised PDO and be funded under the redirected funds, are as follows:

(i) Public Awareness and Information component: The restructured Project will aim to address remaining knowledge gaps within the population on A/HlNl, influenza-like diseases, and other zoonoses.

(ii) Animal Health component: The restructured Project will finance necessary wastewater treatment for the Animal Health Laboratory (AH Lab) currently under construction; the restructured Project will also finance equipment, consumables, and furniture to make the AH Lab fully functional and a sustainable solution responsive to Kosovo’s current and forecasted laboratory diagnostic needs.

(iii) Human Health component. The restructured Project will support pandemic response, including the recently declared Pandemic level 6 alert, which creates an

‘The Executive Directors endorsed the GPAI PDO on January 12,2006 (Report No. 34386).

3 urgent need to scale up hospital preparedness and health sector response capacity. Based on the Recipient’s request, the Project would support additional measures to ensure adequate stocks of lab reagents, disinfectants, and personal protective equipment are available. The National Pandemic Preparedness Plan, prepared by the Institute of Public Health (IPH) in September 2008, should be revised according to WHO recommendations. More time is needed to capitalize on completed and ongoing activities, in particular to raise preparedness in the regions related to the diagnosis, referrals, and management of outbreaks and Pandemic. Some US$0.2 million is earmarked for additional activities and for existing activities that exceed original costs estimates.

(iv) Training and Technical Assistance. The Project would expand the scope of training and technical assistance activities to broaden capacity building primarily for human health but also for animal health. In particular it will focus on emergency management, triage, field epidemiology, clinical management, diagnosis laboratory of important diseases, especially zoonoses.

5. Revise outcomes. As summarized in Annex 4: Results Framework and Monitoring. b. What are the other complementary changes, as applicable:

Institutional arrangements --X Yes -No If, yes, please explain:

The institutional arrangements will be revised to reflect the new Law No. 03/L-016 on Food, establishing the Food and Veterinary Agency (FVA) as an Executive Agency of the Government2, respectively of the Prime Minister’s Office, rather than the Ministry of Agriculture, Forestry, and Rural Development (MAFRD) as at Project negotiation.

Financing mechanisdConduit -Yes -X-No If, yes, please explain: outputs - X-Yes -No If, yes, please explain:

Due to broadening of the Project scope, outputs ofthe Public Awareness and Information component will include TV spots, radio messages and leaflets on A/HlNl preventive measures.

The Assumption and Release Agreements, establishing the Republic of Kosovo as the legal Recipient of the Grant, have been signed on December 11,2009 and declared effective on December 17,2009. As a result ofsuch assumption, the Republic ofKosovo has replaced United Nations Interim Administration Mission in Kosovo as the Recipient, and the Provisional Institutions ofSelf-Government has been replaced with the Government ofKosovo. 4 With regard to the Animal Health component, in particular the establishment of a CF, although the Project original allocation will be redirected to other activities, a system with adequate legal and administrative provisions (Kosovo Assembly Law No. 2004/2 1 on Veterinary and MAFRD ‘Administrative Instruction No. 2005/24 on Fighting AI) is in place for rapid disbursement of national financing for prompt compensation of culled animals at market value.

Project Costs and financing plan (include summary tables) -X-Yes -No If, yes, please explain:

Changes in Project costs and financing plan reflect actual local and foreign expenditures as well as estimates for the remaining funds as per summary tables below. There has been an increase of local expenditures in almost all the activities due to, among others, increased availability of goods in the local market, additional expenditures for local consultants, and needs adjustment during Project implementation.

Local Foreign Total Public Awareness and Information 191.8 49.0 240.8 Animal Health 742.8 252.5 995.3 Human Health 795.4 699.3 1,494.7 Project Management 196.8 72.4 269.2 Total PROJECT COSTS 1,926.8 1,113.8 3,000.0

Local Foreign Total Civil works 393.0 393.0 Equipment, Materials and Supplies 1095.2 695.6 1,790.8 Technical Assistance 388.0 193.1 581.1 . Training 50.0 185.1 235.1

Financial management -Yes -X-No If,yes, please explain:

Disbursement arrangements -Yes -X-No If, yes, please explain:

Procurement -Yes -X-No If,yes, please explain:

5 Closing date -X-Yes -No If, yes, please explain:

The Recipients, through the Minister of Finance, requested an eight-month extension of the Project closing date, which would be December 31,2010. The extension would allow the time necessary to disburse the full grant amount as per the restructured Project, and to further contribute to capacity building and increase the overall Project impact.

Implementation schedule -X-Yes -No If, yes, please explain:

The implementation schedule will be revised to reflect the extended project closing date to December 3 1,20 10.

6 ANNEX 2: Appraisal Summary Update

Do the proposed changes result in significant change of impact (from original Appraisal Summary ofthe PAD) in the following:

Economic and financial analysis -Yes -X-No If, yes, please explain:

Technical -X-Yes -No If,yes, please explain:

With regard to the Animal Health component, in particular establishing an animal disease information system, during Project implementation, additional support has been made available to the FVA specifically to develop such a system. Since the magnitude and resources required for this activity exceeds Project scope, and given the availability of support from other donors, the Project will not support this activity.

Regarding the Human Health component, current pandemic shows significant burden to Intensive Care Units (ICUs) for life-saving procedures for pandemic flu patients. Therefore, the Project has supported establishing ICUs for contagious patients, including those with Influenza A\HlNl.

Social -Yes -X-No If, yes, please explain:

Environment -Yes -X-No If, yes, please explain:

Exceptions to Bank Policy -Yes -X-No If, yes, please explain:

7 ANNEX 3: Updated Critical Risk Framework

New Risks Identified During Implementation/RestructuringThat Might Jeopardize Achievement of the Restructured Project DOs or Outcome Targets:

Risks Risk Rating Risk Mitigation Measures Government does not L Government ensured that have enough funds to adequate financing resources are compensate for culling available, and there are ofanimals. arrangements in place for prompt compensation of culled animals. Kosovo has never had an outbreak ofAI. The Project has improved the surveillance system. The Project is not able S Since the beginning of Project to implement its implementation arrangements activities in North are in place to mitigate such risk, Mitrovica namely close coordination with intermediary partners such as UNICEF/WHO. In addition the Project relies on historical close cooperation of veterinary institutions at the local level. Slow implementation M Although procurement capacity due to limited has improved during Project procurement capacity implementation, international TA is in place to support the local expert. In addition the Bank will continue to prior review all procurement packages. H: High; S: Substantial; M: Moderate; and L: Low.

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