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Document o f The World Bank

FOR OFFICIAL USE ONLY

Report No: 35720 - TR

PROJECT APPRAISAL DOCUMENT

ON A

PROPOSED LOAN

IN THE AMOUNT OF € 27.3 MILLION (US$34.4 MILLION EQUIVALENT)

TO THE

REPUBLIC OF TURKEY

FOR AN

AVIAN INFLUENZA AND HUMAN PANDEMIC PREPAREDNESS AND RESPONSE (AMP) PROJECT

AS PART OF THE GLOBAL PROGRAM FOR AVIAN INFLUENZA (GPAI)

March 21,2006

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

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CURRENCY EQUIVALENTS

(Exchange Rate Effective March 3,2006)

A I A P L AIHP

B S L CDC CE

CEU DIVA EA E C ECA EMP ERA ERL FA0 FMR FY GDP GDPC

Currency Units = New Turkish Lira (YTL) YTL 1.639 = €1

FISCAL YEAR January 1 - December 3 1

ABBREVIATIONS AND ACRONYMS

Avian Influenza Adaptable Program Loan Avian Influenza and Human Pandemic Preparedness and Response Project Bio-Safety Level US Centers for Disease Control Catastrophlc Event

Central Execution Unit Differentiation o f Infected from Vaccinated Animals Environmental Assessment European Commission Europe and Central Asia Region Environmental Management Plan Emergency Recovery Assistance Emergency Recovery Loan Food and Agricultural Organization Financial Management Report Financial Year Gross Domestic Product General Directorate o f Protection and Control (of M A W

GF-TAD Global Framework for Progressive Control o f Trans-boundary Diseases GPAI Global Program for Avian Influenza HIVIAIDS Human Immuno-deficiency VirusIAcquired

Immune Deficiency Syndrome H P A I Highly Pathogenic Avian Influenza H5N1 Avian Influenza a Virus Subtype H5N1 I C B International Competitive Bidding IDA International Development Agency ILI Influenza-like I l lness LDDC Local Disease Crisis Centers MAP Mult icounm APL

MARA Ministry o f Agriculture and Rural Affairs M&E Monitoring and Evaluation MOEF Ministry o f Environment and Forestry

M O H Ministry o f Health NAPA National Advance Purchase Agreements NARES National Agricultural Research and

Extension Systems N C B National Competitive Bidding NPIAP National Pandemic Influenza Action Plan NDCC National Disease Crisis Center N P V Net Present Value OIE OP Operational Policy PDA Provincial Directorate o f Agriculture PHD Provincial Health Directorate PINAP Pandemic Influenza National Action Plan P M R Project Management Report P O M Project Operational Manual PP Procurement Plan NGO Non-governmental Organization

World Organization for Animal Health

S A B I M Ministry o f Health Information Communication Center S A R S Severe Acute Respiratory Syndrome SOE Statement o f Expenditures

SPO State Planning Organization TCP T e c h c a l Cooperation Program TF TrustFund UWDP United Nations Development Program USAID US Agency for International Development WAHIS World Animal Health Information System WHO World Health Organization VCRI Veterinary Control and Research Institute

Vice President: Shigeo Katsu Country ManagerDirector: Andrew Vorkink

Mark R. Lundell Sector Manager: Marjory-Anne Bromhead

Task Team Leader:

TURKEY AVIAN INFLUENZA AND HUMAN PANDEMIC PREPAREDNESS AND RESPONSE

CONTENTS

Page STRATEGIC CONTEXT AND RATIONALE .............................................................................................. 1

GLOBAL REGIONAL AND NATIONAL SECTOR ISSUES ........................................................................................ 1 RATIONALE FORBANK MVOLVEMENT ............................................................................................................ 7

B PROJECT DESCRIPTION 7 1 . LENDING INSTRUMENT 7 2 . PROJECT DEVELOPMENT OBJECTIVE ................................................................................................................ 8 3 . PROJECT COMPONENTS .................................................................................................................................... 8 4 . LESSONS LEARNED AND REFLECTED IN THE PROJECT DESIGN ........................................................................ 14 5 . ALTERNATIVES CONSIDERED AND REASONS FOR REJECTION ......................................................................... 16

C . IMPLEMENTATION ..................................................................................................................................... 16

1 . PARTNERSHP ARRANGEMENTS ..................................................................................................................... 16 2 . INSTITUTIONAL AND IMPLEMENTATION ARRANGEMENTS .............................................................................. 17 3 . MONITORING AND EVALUATION OF OUTCOMES/RESULTS .............................................................................. 18 4 . SUSTAINABILITY ........................................................................................................................................... 18 5 . CRITICAL RISKS AND POSSIBLE CONTROVERSIAL ASPECTS ............................................................................ 19 6 . MAIN LOAN CONDITIONS ............................................................................................................................... 20

APPRAISAL SUMMARY .............................................................................................................................. 20

1 . ECONOMIC ANALYSIS .................................................................................................................................... 20 2 . TECHNICAL ................................................................................................................................................... 21 3 . FIDUCIARY .................................................................................................................................................... 22

5 . SAFEGUARD POLICIES .................................................................................................................................... 24 6 . POLICY EXCEPTIONS AND READINESS ........................................................................................................... 25

A . 1 . 2 .

. ............................................................................................................................. ....................................................................................................................................

D .

4 . ENVIRONMENT AND SOCIAL ASPECTS ............................................................................................................ 23

ANNEX 1: KEY FACTS ABOUT AVIAN INFLUENZA AND AVIAN INFLUENZA A (H5N1 VIRUS) ...... 26

ANNEX 2A: SUMMARY OF THE FA0 AND THE OIE GLOBAL STRATEGY FOR THE PROGRESSIVE CONTROL OF HIGHLY PATHOGENIC AVIAN INFLUENZA (HPAI) ........................... 29

ANNEX 2B: SUMMARY OF THE WORLD HEALTH ORGANIZATION (WHO) STRATEGY ................. 32

ANNEX 2C: SUMMARY AND REVIEW OF THE AVIAN INFLUENZA CONTINGENCY PLANS OF THE REPUBLIC OF TURKEY 35

ANNEX 3: RESULTS FRAMEWORK AND MONITORING ............................................................................ 39

ANNEX 4: DETAILED PROJECT DESCRTPTION ............................................................................................ 50

ANNEX 5: PROJECT COSTS ................................................................................................................................ 59

ANNEX 6: IMPLEMENTATION ARRANGEMENTS ........................................................................................ 60

ANNEX 7: PROCUREMENT. FINANCIAL MANAGEMENT. AND DISBURSEMENT ARRANGEMENTS .................................................................................................................................................................................... 61

ANNEX 8: ECONOMIC ANALYSIS ..................................................................................................................... 70

..............................................................................................................................

ANNEX 9: SAFEGUARD POLICY ISSUES ......................................................................................................... 76

ANNEX 10: PROJECT PREPARATION AND SUPERVISION ........................................................................ 78 ANNEX 11: DOCUMENTS IN THE PROJECT FILE ........................................................................................ 79

ANNEX 12: STATEMENT OF LOANS AND CREDITS .................................................................................... 83

ANNEX 13: COUNTRY AT A GLANCE .............................................................................................................. 86

ANNEX 14: MAP ...................................................................................................................................................... 88

TURKEY

AVIAN INFLUENZA & HUMAN PANDEMIC PREPAREDNESS & RESPONSE PROJECT

PROJECT APPRAISAL DOCUMENT

EUROPE AND CENTRAL ASIA

ECSSD

Date: March 29,2006 Country Director: Andrew N. Vorkink Sector Managermirector: Marjory-Anne (30%);Agro-industry (30%) Bromhead Themes: Natural disaster management

Team Leader: Mark R. Lundell Sectors: Animal production (40%);Health

(P);Other communicable diseases (P);Rural policies and institutions (S);Other environment and natural resources management (S) Environmental screening category: Partial Assessment

Project ID: PO96262

Lending Instrument: Emergency Recovery Loan

[XI Loan [ 3 Credit [ ] Grant [ ] Guarantee [ ] Other:

For Loans/Credits/Others: Total Bank financing (US$m.): €27.3 m. (US$ 34.40 m. equivalent) Prouosed terms: VSL

Financing Plan (USsrn) Source Local Foreign Total

BORROWER 7.06 0.00 7.06 INTERNATIONAL BANK FOR 17.20 17.20 34.40 RECONSTRUCTION AND I I I DEVELOPMENT US: AGENCY FOR INTERNATIONAL 0.00 1 .oo 1 .oo DEVELOPMENT (USAID) EC: EUROPEAN COMMISSION 2.73 10.00 12.73 Financing Gap 0.00 0.00 0.00 Total: 26.99 28.20 55.19

Borrower: Undersecretariat o f Treasury Ankara Turkey Tel: (90 312) 213 0297 hazine@,hazine.gov.tr

Fax: (90 312) 212 8550

Responsible Agency: Ministry o f Agriculture and Rural Affairs rurkey Ministry o f Health Turkey

Project implementation period: Start June 5,2006 End: July 30,2010 Expected effectiveness date: M a y 3 1,2006 Expected closing date: November 30,2010 Does the project depart from the CAS in content or other significant respects?

As part o f the Global Program for Avian Influenza, this operation i s o f an emergency nature. I t was not foreseen in the CAS, but is not inconsistent with the CAS. Does the project require any exceptions from Bank policies? Ref: PAD 0 . 6 Have these been approved by Bank management? I s approval for any pol icy exception sought from the Board? Does the project include any critical r isks rated “substantial” or “high”? Ref: PAD C.5 Does the project meet the Regional criteria for readiness for implementation? Ref: PAD 0 . 6 Project development objective Ref: PAD B.2 The proposed project aims to minimize the threat in Turkey posed to humans by highly pathogenic avian influenza infection and other zoonoses in domestic poultry and prepare for the control and response to an influenza pandemic and other infectious disease emergencies in humans. To achieve this, three areas wil l be supported: (i) prevention, (ii) preparedness and planning and (iii) response and containment. Achieving these goals will contribute to diminishing the burden o f disease and loss o f productivity in Turkey, limiting the regional spread o f AI, and enhancing economic and social prospects at the national, regional, and global levels.

[ ]Yes [XINO

[XIYes [ ] N o [XIYes [ ] N o [ ]Yes [XINO

[XIYes [ ] N o

[XIYes [ ] N o

Project description Ref: PAD B.3, Technical Annex 4 Component I. Animal Health - this component targets the prevention, control and total eradication o f H P A I through: (i) strategy development and epidemiological studies and surveillance programs to inform the improvement o f disease control measures; (ii) strengthening the detection capacity o f reference and regional diagnostic laboratories to follow-up reported AI cases; (iii) support to activities related to the implementation o f the containment plan for AI outbreaks; and (iv) and restructuring o f the poultry sector.

Component 11. Human Health - this component targets the reduction o f the impact o f a pandemic influenza virus through: (i) year-round surveillance; (ii) effective and accurate

nethods o f diagnosis; (iii) social distance interventions; and (iv) strengthened medical services. The project wil l help the Ministry o f Health (MOH) to build its institutional capacity to mplement the recently prepared national pandemic influenza action plan in coordination with :he Ministry o f Agriculture and Rural Affairs (MARA).

Component 111. Public Awareness and Information - this component supports information and :ommunication activities to increase the attention and commitment o f government, the private ;ector, and c iv i l society organizations and to raise awareness, knowledge and understanding m o n g the general population about the risk and potential impact o f the pandemic. I t wil l also ;upport the National Zoonotic Disease in its roles o f triggering emergency responses by the MARA and MOH, monitoring the actions taken by them, coordinating public statements to the media, and executing project evaluation activities.

Which safeguard policies are triggered, if any? Re$ PAD 0 5 , Technical Annex 9 Only the Environmental Assessment safeguard is triggered by the Project. Since the Project i s being processed under emergency procedures and i s assessed as a B-category project, an Environmental Management Plan wil l be prepared during Project implementation under the Animal Health component and implemented with Project support.

Significant, non-standard conditions, if any, for: Re$ PAD C.6 Board presentation: None

Loadcredit effectiveness: The condition o f effectiveness for the Loan would be that the MARA and MOH have appointed their respective Project Coordinators.

Covenants applicable to project implementation: Disbursement conditions:

A disbursement condition for the Animal Health component i s the adoption by the Borrower o f an Environmental Management Plan satisfactory to the Bank. I t i s also required that the payments under the Compensation Fund and the selection and implementation o f Poultry Restructuring sub-projects are made in accordance with criteria and procedures set forth in the Project Operational Manual (POM).

Other covenants applicable to project implementation:

The adoption of a POM by the Borrower is a dated covenant (June 30,2006). In addition, the Borrower shall monitor and evaluate the project and report o n its progress through semi-annual Project Reports and prepare a mid-term review report by M a y 31,2008.

A. STRATEGIC CONTEXT AND RATIONALE

1. Global regional and national sector issues

(a) Introduction

1. The continuing outbreaks o f highly pathogenic avian influenza (HPAI), which began in late 2003 in several Southeast Asian countries and have occurred more recently in Central Asia, Europe, the Middle East and Africa, have been disastrous to the poultry industry in the these regions and have raised serious global public health concerns. As o f February 2006, nearly 200 mi l l ion domestic poultry had either died or been destroyed and over 170 people had contracted the infection (of which 92 have died). Recent increases in the number o f known cases o f avian influenza (AI) transmission have raised concerns over the potential emergence o f a pandemic, which could have devastating effects on human health and livelihoods.

2. At the same time, i t i s important to emphasize that there are many uncertainties about whether and when a pandemic might occur, as well as about i t s potential impact. Humans are not very susceptible to the disease, but if infected with the Asian H5N1 strain, they could exhibit a high case fatality rate. The geographical spread o f HPAI, the human dimension, and the potential enormous social and economic impact are unprecedented. Economic losses to the Asian poultry sector alone are estimated to date at around $10 billion. Despite control measures the disease continues to spread, causing hr ther economic losses and threatening the livelihood o f hundreds o f millions o f livestock farmers, jeopardizing smallholder entrepreneurship and commercial poultry production, and seriously impeding regional ‘and international trade, and market opportunities. The rural poor, who re ly for a larger share o f their income on poultry, have been particularly hard hit with income losses.

3. I t is impossible to anticipate when the next influenza pandemic may occur or how severe i t s consequences may be. O n average, three pandemics per century have been documented since the 16th century, occurring at intervals o f 10-50 years. In the 20th century, pandemics occurred in 1918, 1957 and 1968. The pandemic o f 1918 i s estimated to have k i l led almost 50 mi l l ion people in eighteen months, with peak mortality rates occurring in people aged 20-45 years. The pandemics o f 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 modem advances in medicine, an unparalleled to l l o f illness and death could result. Air travel might hasten the spread o f a new virus, and decrease the t ime available for preparing interventions. Countries’ health care systems could be rapidly overwhelmed, economies strained, and social order disrupted. With interventions proposed in this Project, and in collaboration with other national and international partners, i t should be possible to minimize a pandemic’s consequences in Turkey through advance preparation to meet the challenge.

(b) Socioeconomic Context

4. The recent epidemics or outbreaks o f animal origin (e.g. S A R S , avian influenza, Lassa virus, Ebola virus, Marburg virus, Nipah virus, West N i l e virus) have demonstrated the potential and real global impact o f zoonotic diseases o n the health and well-being o f the public, as wel l as the enormous humanitarian, socio-economic, and trade damage that this group o f diseases can cause to both developed and developing countries. They have also underscored the important

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role o f official veterinary and public health services in disease prevention and control, as wel l as the importance o f strengthening the capacity o f these services in compliance with the World Health Organization (WHO) and the World Organization for Animal Health (OIE) international standards (e.g. the local, regional, and global quarantine powers under the International Health Regulations; and the international standards, guidelines and recommendations under the OIE Terrestrial Animal Health Code). The epidemics have also demonstrated that there i s an urgent need for a global response to improve the local and regional preparedness and rapid response capacity to the threat from zoonotic disease.

5. Influenza i s a zoonotic disease (animal to human transmission) o f international importance because o f the ability o f the virus that causes the disease to mutate for a potential wide-scale human-to-human transmission. Outbreaks o f influenza in humans occur annually, as a result o f antigenic drift in the Influence A virus with a severity which varies f rom year to year, but i s typically moderate to mild. Nonetheless, these outbreaks occur in al l countries and exert an impact primarily through morbidity and reduced economic productivity because o f illness. In contrast, severe influenza pandemics occur infrequently, as a result o f antigenic shift, but have been unprecedented in the number o f infections and deaths caused over a short time-period. The worst such event in the 20th Century, the Spanish Flu pandemic o f 1918-19, had the highest mortality rate among healthy young people. Less severe pandemics occurred in 1957-58 and 1968-69, but st i l l had high attack rates, high case fatality, and major impact o n economic activity. The severity o f these influenza pandemics resulted from infection with a sub-type o f influenza virus to which humans had not been previously exposed and so had no immunity. Such a new sub-type o f influenza (known as H5N1) i s currently causing large outbreaks in birds and domestic poultry in East and Central Asia, Europe, the Middle East and Africa creating widespread concern that the risk o f a new and potentially severe human pandemic i s high'.

6. Addressing economic and social impacts must be an integral part o f a comprehensive response. A pandemic would have devastating economic and social consequences, including large-scale loss o f livelihoods as well as lives. The potential economic costs o f avian influenza are apparent in countries such as Vietnam, where impacts are already evident on the poultry sector, associated input and distribution channels, and the rural poor who rely on poultry for a larger share o f their income. Even if a pandemic does not occur, there could be important socio- economic effects resulting from the response to the perceived risks. Countries confront choices in balancing preparation versus action since both imply economic costs. At least three types o f economic costs or impacts should be considered under a human pandemic scenario: (i) effects o f sickness and mortality o n potential output; (ii) private preventive responses to an epidemic; and (iii) public sector responses.

(c) Key Issues

7. A coordinated global response should involve three types o f strategic activities: (i) preventing the occurrence and spread o f the disease in domesticated animals, thus lowering the

' Antigenic drift refers to a change in surface proteins o f a given strain o f influence virus in response to antibodies in human hosts who have been exposed to it. I t occurs continually in both type A and B influenza strains, thus the reason to re-engineer the influenza vaccine on a regular basis to prevent seasonal outbreaks or epidemics. Antigenic shift refers to the reassortment o f the animal influenza strain wi th the circulating human strain in the process o f moving from an animal to humans. T h i s antigenic shift i s more o f a concern since when it occurs, it results in pandemics due to generalized susceptibility to infection in humans.

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virus load in the environment; (ii) preventing and/or mitigating the effects o f an outbreak in humans; and; (iii) in the event o f a pandemic, helping affected populations cope with i t s effects. There i s a need to formulate a global response based on a common vision for undertaking these three sets o f activities. Such a vision should entail immediate measures while ensuring that these measures fit within a coherent longer-term strategy with respect to both animal and human health considerations. Key issues that have been identified include:

e Prevention and control of avian influenza is multi-sectoral in nature. It involves many players, including those in the areas o f health, agriculture, environment, economics, finance, and planning among others. At the country level, in particular, an integrated, multi and inter-sectoral response is needed based on shared objectives. Responses must address both the animal health and human health dimensions and also appropriate social measures (quarantines, transport restrictions, mass communication strategies).

e The risk of a human pandemic is real. The H 5 N 1 strain currently affecting several Asian countries has proven highly fatal to humans. The r isk that a pandemic virus wil l emerge depends on opportunities for human exposure and infection, which wil l persist as long as the H5N1 virus continues to circulate in animals. With the present situation, the potential o f the HPAI virus to become transmissible among humans needs to be a serious concern. If the virus adapts i t se l f to human-to-human transmission, lives may be threatened on a large scale.

e Avian Influenza virus is constantly evolving with unpredictable results. The HPAI viruses are o f particular concern because they undergo constant genetic change that can have unpredictable results. The constant and rapid evolution o f the virus necessitates a global approach to controlling the disease.

a The conditions for the emergence and local spread of HPAI have been exacerbated by the intensification and concentration o f livestock production in areas o f high-density human populations. The danger o f international spread o f HPAI has increased by the dynamics o f regional and international trade and the movement of people. A global approach to avian influenza, therefore, will have relevance to strategic control o f other livestock diseases, including zoonoses. Nevertheless, country strategies developed and owned by the governments facing the threat o f avian influenza should be the foundation o f a global response.

Market conditions have caused HPAI to spread rapidly.

e The geographic coverage of a response should be determined by both immediate and anticipated needs. Asia i s today the most affected region, but the disease i s currently spreading to other areas o f the world at an alarming rate and recent scientific evidence indicates that wild birds play a role in the spread o f the virus from one country or region to another. The response should, therefore, combine control measures in countries where the virus has been already detected, with prevention measures in countries at r i sks (countries neighboring infected countries and/or in migratory bird fly way paths). A minimum level o f preparedness i s essential in al l countries.

e An appropriate balance between short and long-term actions needs to be taken. Immediate action is needed in a number o f areas. The immediate to short-term objective i s to

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reduce the r isk to humans by preventing further spread o f HPAI in those countries that are currently infected. The long-term vision o f the strategy i s to minimize the global threat and r i s k o f HPAI in domestic poultry and humans, through progressive control and eradication o f HPAI. Achieving this goal will diminish the global threat o f a human pandemic, stabilize poultry production, enhance a robust regional and international trade in poultry and poultry products, increase human and food safety, and improve the livelihoods o f the rural poor.

e Global and regional aspects of the response need to be addressed and coordinated. Actions to secure borders and control international tradehravel in the event o f a pandemic, as wel l as measures to limit the effects o f disease transmission by migratory birds, are transboundary issues requiring regional and/or international coordination. Global and regional efforts should build o n existing mechanisms such as the joint OIE/World Bank initiative for the Prevention and Control o f Global Emerging and Re-emerging Diseases o f Animal Origin, and the joint Global Framework for Progressive Control o f Transboundary Animal Diseases (GF- TADs), a jo int FAO/OIE initiative and regional organizations such as the Association o f Southeast Asian Nations and South Asian Association for Regional Cooperation.

(d) The global dimension

8. The FAO/OIE’s Global Strategy. The long-term vision o f the strategy prepared by FA0 and OIE in collaboration with WHO i s to minimize the global threat and r isk o f HPAI in humans and domestic poultry, through progressive control and eradication o f HPAI, particularly that caused by H5N1 virus, from terrestrial domestic poultry. The global strategy wil l be implemented over three time frames: immediate to short (1-3 years), short to medium (4-6 years) and medium to long-term (7-10 years). During this period the spread o f HPAI, mainly of the H5N1 strain, will have been progressively controlled in domestic poultry o f a l l infected countries, and prevented from affecting those countries not currently infected, but at high risk. The strategy originally prepared to control HPAI in Asia is being revised by FA0 and OIE to take into account the current spread on the disease outside Asia. The strategy will be complemented by more detailed country specific HPAI control plans. FAO/OIE have also issued specific recommendations for avian influenza and OIE has recently issued recommendations for each region, in addition to i t s standards and guidelines provided for the prevention and control o f HPAI in animals (see Annex 2a for more details).

9. The Recommended Strategic Action plan prepared by WHO for “Responding to the Avian Influenza Pandemic Threat” lays out activities for individual countries, the international community, and WHO to prepare for a pandemic and mitigate its impact. The objectives o f the plan correspond to the opportunities and capacities to intervene and are structured in three phases: (i) pre-pandemic - supporting the FAO/OIE’s control strategy; increasing collaboration between animal and health services; (ii) emergence o f a pandemic - containing or delaying spread at the source - and (iii) pandemic declared and spreading internationally - reducing morbidity, mortality and social disruption; conducting research to guide response measures (see Annex 2b). WHO has also prepared a global plan and guidelines for pandemic preparedness and i s in the process o f developing a model country plan that wil l allow countries to assess their state of preparedness and identify priori ty needs.

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10. The Bank has developed a global facility through a multi-country adjustable program loan (MAP). In parallel, the Bank has initiated with the EU, WHO and FAO/OIE, and bilateral donors the establishment o f a multi-donor trust fund (TF) that primarily supports country level activities in conjunction with a smaller and complementary role at the regional and global level.

(e) The regional dimension

11. Cases o f avian influenza have already occurred in over twenty countries, including most recently in Western Europe, after having appeared in October 2005-January 2006 in Croatia, Romania, Ukraine, Greece, and Turkey. The earlier (mid-2005) Russian outbreak o f HPAI H5N1 has to date affected more than ten administrative regions, beginning in the Ura l Mountains and moving west to within 200 km o f Moscow. In the f i rst three weeks o f August 2005, outbreaks in poultry o f HPAI H5N1 were reported in four regions o f northern and central Kazakhstan. Other countries in the Balkan region and the Caucasus have experienced outbreaks as well due to their proximity to two main flyways, the East Africa-West Asia Flyway, which crosses Turkey, and the Central Asia Flyway. Both flyways cross areas in North-Eastern Europe, where avian influenza in wild and domestic fowl has also been diagnosed.

(Jl The national dimension

12. Up until Januarv 2006, Turkey had experienced one outbreak o f avian influenza, in the Manyas district o f Balikesir province. This outbreak was detected on October 1, 2005 when three turkeys died in a flock o f 1,800 turkeys being raised by a medium sized poultry contract farmer in an outdoor grazing environment facility three kilometers south o f Manyas Lake. This lake i s a natural habitat for migratory birds, which were abundantly present at the time. Most o f the rest o f the flock died over the next three days, during which time the district veterinary service and a private veterinarian working for the poultry sector developed the diagnosis o f avian influenza. Dead and live animals were sent to the Bornova reference laboratory (in Izmir), which detected the presence o f the H 5 strain (through inoculation and subsequent death in embryonated eggs). The EU reference laboratory in Weybridge (UK) confirmed the presence o f the HPAI H5N1 strain o n October 13.

13. Sanitary measures had been promptly initiated by the provincial veterinary service o n October 7, when a three kilometers protection zone was established with road signs and the presence o f the military police. All backyard poultry (over 10,000 head) within the protection zone were culled between October 8-16, and compensation was granted by the private poultry industry itself to the affected farmers. Within the protection zone, there were also nine larger commercial holdings, seven o f which were empty. The flock o f almost 16,000 in the remaining two enterprises was slaughtered on October 9. In addition to the protection zone, a 10 km radius surveillance zone was established, which contained roughly 45,000 backyard poultry, and 10 active larger poultry farms with a stock o f over 130,000 animals. Measure taken in the surveillance zone included a ban on the movement o f l ive poultry, regulation o f the transport o f table and hatching eggs, prohibition o f bazaar market trade o f poultry and o f hunting o f wild birds, and an immediate local awareness campaign to instruct farmers to confine backyard poultry and avoid contact with wild birds.

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14. Although the avian influenza outbreak was quickly contained, and there were no signs o f any transmission to humans, the economic impact has been severe. Within two weeks o f the outbreak, the consumption of poultry in Turkey (roughly 1.2 kilogram per capita per month) had dropped substantially and retail poultry prices had fallen by 30 percent. (The market capitalization o f the traded Turkish poultry f i r m s dropped by over 30 percent in the f i rs t week). This i s partly owing to the fact that Balikesir and the nearby regions o f Bursa, Izmir, Manisa, and Sakarya account for over 40 percent o f Turkey’s broiler enterprises and poultry production. Egg production i s similarly concentrated in these provinces, and its demand fel l from 12 eggs per capita per month by a rate similar to that o f poultry demand. As a result, the poultry and egg sector incurred losses o f roughly US$ 0.9 mi l l ion daily in October-December 2005. (Prior to the outbreak the GDP of the poultry and egg sector ranged US$ 1.2-1.5 bi l l ion annually)

15. In January 2006, a widespread outbreak occurred, starting init ial ly in northeastern Turkey along the border areas with Georgia, Armenia, and Iran. This area i s directly on the flight path o f migrating birds (the so-called Central Asia Flyway) and sits between three large lakes: Sevan in the east (Armenia), Van in the eastern Anatolia (Turkey), and Urmia in the south (Iran). The init ial outbreak in the provinces of Ardahan, Kars, Erzwum, Agn, Igdir, and Van was met quickly with cul l ing o f over 50,000 birds (in the f i rs t week o f January). In the second week o f January, the number of provinces reporting suspected or confirmed cases o f AI in poultry rose quickly. A s o f mid-March, its presence was confirmed in 58 o f Turkey’s 81 provinces. T o combat the intensification of the spread o f AI, the Government o f Turkey moved quickly ahead with the culling and the monitoring of any possible spread in the surveillance zones around villages in these provinces. A phone hotline was set up for people to report loose or sick poultry, and bazaar market trade of live poultry has been prohibited throughout the country. By mid- March, over 2.3 mi l l ion birds had been culled in the imposed protection zones around villages with confirmed cases.

16. However, a l l these measures have not prevented the occurrence o f animal to human transmission. A s of January 19, there were 21 human cases, including four deaths, although many o f those cases remained to be re-confirmed. Only 38 percent o f the cases were female, and seventeen o f the 21 patients were younger than 15 years old. The higher rate o f disease incidence in children i s believed to have occurred as a result o f their being directly involved in slaughtering, plucking and cooking the chickens infected with the HPAI virus (H5N1 strain). Most o f the cases were transferred to, and treated at, the University Hospital in Van. These cases were the first occurrence and death in humans from the H 5 N 1 strain o f AI outside o f Asia. On the other hand, the case fatality rate in Turkey has been lower compared with other countries due to improved early case detection and effective treatment.

17. Almost al l of the people with confirmed cases have a confirmed history o f close contact with sick birds, and there is st i l l no indication o f human-to-human transmission. Those who had access to antivirals in the f i rs t 48 hours after having been diagnosed with Influenza-like-Illness (ILI) responded relatively well, though treatment o f more severe cases necessitated the usage o f ventilators to aid patients in breathing.

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2. Rationale for Bank involvement

18. The justification for the Bank is the Global Public Goods aspect o f the HPAI, one o f many emerging and re-emerging zoonoses, and its strong link to poverty reduction. H P A I control programs require a multi-disciplinary approach to integrate technical, social, economic, political, policy, and regulatory issues in addressing a complex problem. The Bank i s well placed to build upon its knowledge base o n 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 in Turkey in 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.

19. Given the Bank’s work with FAO, WHO, OIE, EU and other partners in country and at the international level to address both preparedness and outbreaks and to assist with institutional assessments, the Bank can assist Turkey in leveraging additional resources from other international and bilateral agencies. In addition to i t s financial role, the technical assistance provided by the Bank has been important in similar global or regional emergency situations such as S A R S , Tsunami relief, and H N / A I D S . The Bank’s national and regional support will be closely linked with the activities o f FAO, WHO, OIE and the EU, and the proposed Project i s fully consistent with, and draws heavily on, the global strategies proposed by FA0 and WHO.

B. PROJECT DESCRIPTION

1. Lending instrument

20. The proposed Project i s supported by the Bank’s Multi-country Adaptable Program Loan (MAP) instrument, similar to the instrument already used to support the HIV/AIDS’ efforts in Africa and the Caribbean. The funds supplied from the M A P for the Global Program for Avian Influenza (GPAI) wil l complement activities supported by other international organizations and donor agencies and help ensure the availability o f adequate resources to fund the priority investments and technical assistance which Turkey has identified as critical needs in implementing its response to HPAI. Funds under the GPAI are available to countries which have demonstrated satisfactory preparation to implement an expanded response by preparing a project which has the following characteristics:

4 a national strategic plan showing understanding o f the issues and goals for addressing them;

national commitment and leadership, including wel l structured implementation arrangements;

b)

c) an implementation strategy that includes program execution through multiple ministries and through non-governmental organizations (NGOs), community groups and c iv i l society organizations; and

7

clearly defined institutional arrangements for, and readiness to initiate, monitor and evaluate project progress and impact.

d)

21. Loan Processing. The loan i s being processed as an emergency investment operation using procedures under OP 8.50 - Emergency Recovery Loan (ERL) Procedures. However, the loan st i l l meets a l l applicable Bank policies, practices and standards as discussed below.

2. Project development objective

22. The overall objective o f the Project i s to minimize the threat in Turkey posed to humans by HPAI infection and other zoonoses in domestic poultry and prepare for the control and response to an influenza pandemic and other infectious disease emergencies in humans. To achieve this, three areas wil l be supported: (i) prevention, (ii) preparedness and planning and (iii) response and containment. Achieving these goals wil l contribute to diminishing the burden of disease and loss of productivity in Turkey, limiting the regional spread o f HPAI, and enhancing economic and social prospects at the national, regional, and global levels.

3. Project components

23. The Project wil l finance activities under three components: (i) animal health; (ii) human health; and, (iii) public awareness and coordination support. Given the urgency o f the situation, following the recent experiences with HIV/AIDS projects in Africa and the Caribbean, priority has been given to detailing the activities to be included in the first year o f the project with subsequent activities for later years to be refined in more detail as part o f annual project reviews.

I. ANIMAL HEALTH COMPONENT

24. The Project wil l support activities to cover the needs in the short, medium or long-term, and ranging from prevention, to control and eradication o f HPAI, which have been based on an assessment o f the particular conditions, constraints and possibilities in Turkey (including a rapid assessment o f veterinary services and recent assessments o f the poultry sector). These activities fall into the main components and sub-components described below and total U S $ 30.86 million:

A. National policy framework and development of a national strategy sub-component

A1 : Policy development and enabling environment. The Project activities’ support will include strategy development and the improvement o f the regulatory framework to address key pol icy issues and ensure that disease control, prevention and eradication measures are implemented in a uniform and effective way in accordance with the Wor ld Organization for Animal Health (OIE) standards and guidelines. It wil l support definition o f disease control options and reviews o f existing regulations and policies and fund related pol icy studies, strategy development and dissemination workshops. The main outputs will be a detailed assessment o f the capacity o f i t s veterinary services and an integration o f the AI contingency plans o f the Ministry o f Agriculture and Rural Affairs (MARA) and the Ministry o f Health (MOH) into a National A I Strategy. (US$ 0.59 mil l ion)

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A2: Epidemiology and disease information systems. In this area, the Project wi l l support epidemiological studies and surveillance programs to inform the improvement o f disease control measures, which wil l be then adjusted and improved as new information becomes available. I t will also support the linking o f the laboratory information systems o f Turkey’s eight Veterinary Control and Research Institutes (VCRIs) to the existing module o f the World Animal Health Information System (WAHIS) maintained by the MARA General Directorate o f Protection and Control (GDPC). This wil l better enable Turkey to participate in global disease information sharing, complying with their obligations as members o f the OIE. Epidemiological studies wil l include a focus on scaling up the knowledge base o f the Ministry o f Environment and Forestry (MOEF) on movement o f migratory birds in the main areas o f their known transit. The disease information system wil l be linked with rapid and standardized methods o f routine analysis o f surveillance data in order to track important changes in the H 5 N 1 situation and promptly supply this information to field personnel. (US$0.48 million)

B. Strengthening Disease Surveillance and Diagnostic Capacity Sub-component

B1: Strengthening Animal Disease Surveillance and Diagnostic Capacity. Project support in this area wil l aim at strengthening the capacity o f the GDPC and i t s affiliated reference and regional diagnostic laboratories in detection, reporting and follow-up o f reported AI cases. This will cover the formation and equipping o f Bio-Safety Level 3 (BSL3) laboratories in Bornova and Pendik, as well as equipment (incubators, laminar f low cabins, etc.) for two regional laboratories (in Ankara and Konya). Consumables and reagents will be funded as needed for the implementation o f the National AI Surveillance Program and for regional laboratories and Provincial Directorates o f Agriculture linked to these laboratories for the execution o f their relevant roles in the MARA AI Contingency Plan (rapid serological tests and screening surveys and virological tests for confirmation and serotyping o f AI strains). (US$ 2.85 million)

B2: Veterinary Services Training and AI Surveillance. Training will target the personnel o f GDPC, including those o f the VCRIs and the affiliated staff in the Provincial Directorates o f Agriculture which wil l be expected to form the local Expert Groups o f the Local Disease Crisis Centers (LDCCs). The focus o f the training wil l be o n screening, sampling, and test procedures to be applied in case o f an outbreak, as we l l as on analyzing epidemiological data and performing risk assessments. Supported activities will also cover an init ial self-evaluation o f veterinary services, fol lowing OIE standards on quality and evaluation o f veterinary services to meet international requirements. Increased risk-based AI surveillance activities wil l also be supported at the provincial and district levels, coordinated through the VCRIs. (US$ 2.01 million)

C. Outbreak Containment Plan

25. The sub-component will provide support to activities related to the implementation o f the MAFL4 Contingency Plan for Avian Influenza which details the containment plan for AI outbreaks. The Contingency Plan details the roles o f the National Disease Crisis Center (NDCC) coordinated by the Animal Health Department o f GDPC, the Local Disease Crisis Centers (LDCCs) set up on the basis o f Animal Health Sections o f the PDAs, and the National

9

and Local Expert groups. Section 8 o f the Contingency Plan contains the operational manual for the containment plan. The sub-component wil l include the following activities:

C1: Targeting virus eradication at the source. In order to target the eradication o f the disease at the source o f infection, the Project wil l target the following activities: (i) culling o f infected and at-risk poultry and compensation to farmers and producing companies (at a reasonable market price); and (ii) disposal o f carcasses and potentially infective materials in a bio-secure and environmentally acceptable manner (through roughly 15 mobile incineration plants deployed to districts with A I outbreaks). (US$ 13.1 million)

Policies associated with virus eradication that the Government o f Turkey has already introduced and would trigger in outbreak areas include: enhanced bio-security at poultry farms and associated premises, through bio-containment and bio-exclusion, and control o f movement o f birds and products that may be infected, including controls at the interface o f infectednon- infected areas and border controls.

C2: Veterinary personnel safety. Due to the highly pathogenic nature o f the HPAI virus to humans, particularly the Asian H5N1 strain, training o f people in contact with l ive virus would be supported. This would include f ield workers involved in identification o f the disease, farm workers involved in culling and disposing o f manure, laboratory workers involved in virus isolation and diagnosis. Adequate resources would be allocated for training and equipment (bio- safety hoods and appropriate personal protective clothing). (US2 .85 million)

C3: Restructuring the Poultry Sector. Restructuring the poultry sector in Turkey will focus on the reduction of the practice o f backyard poultry raising, improving the opportunity for slaughtering o f layers (and subsequent processing and rendering), and promoting manure management o f backyard poultry that is in conformity with existing environmental regulations. Reduction o f backyard poultry farming could take the form o f banning such farming in protection zones around known areas of high prevalence o f migratory birds and investments in improving bio-security (penning o f animals and closing up o f barns) in small contracted poultry farms. Since it would be extremely costly for the state to fund widespread programs for poultry sector restructuring, the introduction o f restructuring modalities wil l be piloted under the Project with matching grants to be provided under a competitive proposal submission and award process (with at least 50% co-financing by private beneficiaries). (US$ 9.0 million)

11. HUMAN HEALTH COMPONENT

26. In the public health field, short-and long-term actions need to be taken and an appropriate balance struck between the two. W h i l e immediate steps can be taken to address the crisis, there is also a longer-term agenda given systemic shortcomings with respect to core public health fbnctions. Work on both the short- and long-term fronts, therefore, needs to proceed in parallel, and efforts should be made to ensure that short-term responses are consistent with and contribute to proposed longer-tern interventions. Setting priorities in both cases i s essential.

27. Building an effective national public health response wil l require an enabling environment and the necessary resources to bring proven interventions quickly up to nationwide scale. Thus, the Project will help to operationalize some elements that are contemplated as part

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o f the global strategic plan, expanding and intensifying the responses rapidly. As i t i s unlikely that the global spread o f a pandemic influenza virus could be prevented once i t emerges, the emphasis i s on reducing i t s impact. Several tools can help achieve this aim: (i) year-round surveillance; (ii) effective and accurate methods o f diagnosis; (iii) social distance interventions; (iv) vaccines (once they become available); (v) anti-viral drugs; and (vi) strengthened medical services. The interventions supported under the Project are based on Turkey’s epidemiological and programmatic needs, and well-assessed options for meeting them. The interventions wil l be grouped in three sub-components, totaling US$20.84 million.

A. Enhancing Public Health Program Planning and Coordination

28. The Ministry o f Health (MOH) in Turkey has recently prepared a National Pandemic Influenza Action Plan (NPIAP). The NPIAP i s very comprehensive in scope, with detailed sections on the context and epidemiological underpinnings o f an eventual influenza pandemic, the current legislative and regulatory basis for intervention, vigilance through routine surveillance and i t s implementation arrangements, case finding and ascertainment through serological testing and virological subtyping, prevention through immunization, symptomatic case management with anti-viral drugs. Most importantly, the plan details how the emergency response will be coordinated, the logistics involved, the protocols and algorithms to be followed for surveillance, diagnosis, immunization and anti-viral therapy during inter-pandemic, pandemic alert and pandemic periods, and the means o f communication and public information. Finally, i t provides a l i s t o f regional and reference laboratories and telephone numbers o f those who are directly in charge o f the operations.

29. The plan clearly indicates that the MOH will be in charge o f command and control and that the current laws and regulations are sufficient for i t to fully implement a l l aspects o f the NPIAP. However, the N P I A P ’ s focus on inter-sectoral cooperation and collaboration could be emphasized to go beyond a mere reference to MARA as a source o f information during Inter- pandemic Phase 11. There is also a need to estimate resource and training requirements for effective implementation and make the necessary arrangements that they are in place. Finally, the NPIAP should be subject to simulation exercises o n a small scale to assess i t s implementability as a coordinated action and put to test the chain and command structure. The Project wil l help MOH to build its institutional capacity to command and control in a coordinated fashion with MARA the implementation o f the NPIAP and assist the National Committee for the Control of Zoonotic Diseases, which has hitherto been a consultative entity, to become a truly functioning supra-ministerial coordinating agency between the two ministries and partnering with other sector representatives (Environment, Transportation, Interior, etc.). To this end, the proposed Project wil l support the fol lowing activities (US$ 14.88 million):

0

0

0 Improving health information and telecommunication systems at MOH’s Public

Equipping health personnel with protective gear and clothing; Upgrading o f drug storage facilities; and

Information Communication Center (SABIM) and the Crisis Management Center.

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B. Strengthening of National Public Health Surveillance Systems

30. In Turkey, there i s a hnctional Influenza surveillance monitoring committee and a well- defined protocol for surveillance in 10 health centers in each o f the 14 sentinel provinces, including a case notification form for ILI and a template on how to collect and transport specimen to laboratories. The committee monitors case reports on a bi-weekly basis in winter and monthly basis in summer. Case ascertainment i s made through virologic surveillance to report the number of clinical specimens tested for influenza and the number o f positive results by virus type and subtype. According to the protocol, al l specimens are to be sent to the two reference public health laboratories where virus isolation and typing could be made. I t i s not clear, however, whether the two BSL-2 laboratories wil l be able to cope with the increased demand in times of a pandemic. In addition, because of their location (Istanbul and Ankara) valuable time could be lost due to transportation of specimens from far away provinces. Cognizant o f the limited laboratory capacity and potential o f l ow supply o f material for specimen collection, transportation and laboratory supplies, MOH intends to upgrade i t s network o f seven regional public health laboratories to cope with the increased demand in case o f a pandemic. To this end, the proposed Project will support the following activities (US$ 5.86 million):

0 Improvements o f Laboratory Networks; 0

0 Training. Simulation exercises o f ILI case notification and ascertainment; and

C. Strengthening Health System Response Capacity

3 1. Non-pharmaceutical containment measures such as social distancing may contain pandemic spread and allow time for response measures. Therefore, the project will indirectly support through the implementation o f the NPIAP, “social distancing measures” -- such as quarantine, ban on mass gatherings and travel restrictions, backed up by a well-designed communication strategy. Additional preventive actions for health care workers involved in case detection, transportation and management such as distribution and use o f protective gear and masks wil l be supported, along with increased awareness and promotion o f community participation in slowing the spread of the pandemic. (US$ 0.1 mil l ion)

111. PUBLIC AWARENESS AND COORDINATION SUPPORT COMPONENT

32. This component wil l support strategic communication activities for stakeholders and beneficiaries. Similarly, resources will be allocated for improved coordination between MARA’s regulatory framework and contingency plans, and the MOH’s NPIAP.

A. Public Awareness through Information and Communication Services

33. Support under this sub-component will be provided for the research, design, implementation and evaluation o f an integrated communications strategy, addressing the needs o f priority populations at the national, provincial and local levels. The strategy wil l elevate knowledge and promote behavior-change in populations at-risk, to control the spread o f the virus, prevent infection, foster timely reporting and support containment actions. At the same

12

time, the strategy will educate vulnerable groups on preparedness plans and mitigation measures across pre-pandemic and pandemic phases. The communications strategy will incorporate measures called fo r in the Environmental Management Plan (EMP) for safe culling and disposal of backyard poultry (US$ 0.81 million).

B. Coordination Support

34. The multi-dimensional problems associated with H P A I infection necessitate collaboration from a wide range o f stakeholders within each country, which in Turkey include: the State Planning Organization (SPO), the Undersecretariat o f the Treasury, the MARA, the MOH, their associated diagnostic laboratories, NGOs and c iv i l society organizations, and private sector companies and associations (e.g. large poultry production companies, farmers’ associations, veterinarians and farmer involvement at the grass roots level). The sub-component wi l l support activities to improve the effective coordination and collaboration among these stakeholders and to bolster project implementation and monitoring capacity at existing project implementation structures in the MARA and MOH.

B1. National Coordination

35. The National Zoonotic Disease Committee (NZDC) wil l serve as the venue for coordinating the national awareness activities described above. I t wil l review the AIHP Project’s annual work plans and ensure coordination and linkages across relevant agencies and international partners. In AI outbreak situations, the N Z D C i s in charge o f triggering emergency responses by MARA and MOH, monitoring the actions taken, and coordinating public statements to the media. In this last area, the N Z D C wil l be supported by a Public Information and Communication Specialist hired under the AIHP Project.[(US$ 0.21 million).

B2. Project Implementation

36. The Central Execution Unit (of the Agricultural Reform Implementation Project) in the MARA and the Project Implementation Unit (responsible for the Health Transition Project) in the MOH will be entrusted with the fiduciary tasks o f procurement and financial management. The relevant structures will be strengthened with 3-4 additional fiduciary staff in each Unit. Both the MARA and the M O H wil l appoint Project Coordinators to liaise with the MAFL4 C E U and MOH PKJ, respectively, and to prepare annual work programs and budgets as wel l as semi- annual interim un-audited financial reports. The Project Coordinators wil l manage the respective component for which their ministry i s responsible and attend the periodic meetings o f the National Zoonotic Disease Committee. The MARA C E U wil l be responsible for consolidating the annual work plans, budgets and financial reports for submission to the N Z D C and the Bank. (US$ 1.25 million)

37. At the local level, implementation would be the direct responsibility o f each Provincial Directorate o f Agriculture (PDA) and Provincial Health Directorate (PHD). At times o f outbreaks, the provincial governor wil l guide implementation o f cross-sectoral activities, and if necessary set up local disease crisis centers to ensure cross-sectoral coordination.

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B3: Monitoring and Evaluation (M&E)

38. Support would be provided to enable project monitoring and impact evaluation assessments. T w o types of M&E are envisaged. First, the MAR4 C E U and the MOH PIU would collect relevant data from their ministries and other implementation agencies and then compile them into semi-annual progress reports focusing on output indicators and the status o f physical implementation by component and use o f project funds. For some output indicators, specific surveys will need to be conducted to obtain data for this purpose. These would be financed by the Project. As for the financial reports (noted above), the MAR4 C E U will be responsible for consolidating the ministerial progress reports into an integrated project monitoring report. (US$0.5 1 million)

39. Impact evaluation reports. The aim o f evaluation i s to find out whether the interventions are effective or the program is having the desired impact. The evaluation wil l include both quantitative and qualitative aspects and be conducted on a yearly basis. The quantitative aspects wil l rely o n new information systems and surveys implemented as part o f the various components o f the project, currently existing data sources, and primary evaluative data collection efforts. The goal o f the qualitative aspect o f the evaluation wil l be to document perceptions o f program managers, staff, patients, and local and national leaders. Qualitative information wil l be collected using site-visit interviews, focus groups, and respondent surveys..

4. Lessons learned and reflected in the project design

40. Relevant lessons for the design o f the proposed operation have been drawn from previous World Bank/IDA and FAO-supported emergency recovery projects. All these experiences and lessons learned have been taken into account in the design o f the proposed GPAI operation. These included the Vietnam Avian Influenza Emergency Recovery Project (approved in early FY05 under OP 8.50 procedures), which i s the only project that has been approved by the Bank in response to the Avian Influenza so far.

41. These lessons learned indicate that project success depends to a large extent on the speed o f the response provided and, particularly when dealing with smallholders’ production systems, a speedy, efficient and transparent distribution o f suitable key inputs i s clearly a major factor in limiting the impact o f a crisis and hastening recovery. A performance audit o f some o f the emergency projects supported by the Bank in various regions drew the fol lowing general lessons: (i) emergency projects should avoid pol icy conditionality; (ii) project design must be simple and take into account a realistic assessment o f the existing Borrower’s capacity; (iii) a speedy appraisal and approval are crucial to provide a prompt response and a substantial contribution to project success; (iv) procurement arrangements need to be flexible and should be finalized at an early stage; (v)mitigation and prevention measures should be included in the design to minimize impacts of a possible recurrence of the disaster; and (vi) realistic assessments should be made o f counterparts absorption capacity, as we l l as o f the effective communications and coordination mechanisms among al l relevant stakeholders.

42. Even though the Vietnam Avian Influenza Emergency Recovery Project has been in implementation for only about one year (effective on November 9, 2004), the main recommendations arising from i t s implementation have been the following:

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Preparedness i s a key factor. W h i l e Vietnam had a national strategy document to control Avian Influenza in the domestic poultry population, i t was not clearly understood and shared by al l relevant agencies and stakeholders and some aspects of the response have been lagging behind. A two-pronged strategy is recommended. This should include: (i) the control o f Avian Influenza at the source in high-risk regions (through aggressive measures including culling, movement control and vaccination campaigns for poultry); and (ii) simultaneously prepare with short and medium-term measures to minimize the risks to humans and prepare for an eventual pandemic. A revised “compensation framework” i s an essential element to obtain real cooperation from affected stakeholders (farmers/producers) and to ensure the efficacy o f the surveillance and diagnosis mechanisms. The importance o f strengthening the technical, scientific and operational capacity of the relevant participating agencies should not be overlooked. The AI crisis highlighted several weaknesses in the animal health as we l l as public health services systems, including: poor surveillance at the local level, weak diagnostic capacity, lack o f epidemiological expertise and information system, and inadequate operating budget to bear the additional costs o f physical and human cost to contain the spread o f the disease. There i s an urgent need to organize an effective national response, including al l technical ministries in charge o f agriculture/animal health and human health, as we l l as other relevant sectors, at the national and sub-national level, in case o f a human epidemic. I t i s extremely important to raise awareness in the public and private sectors from the initial moments, and to strengthen effective coordination mechanisms for the implementation o f the necessary technical responses, involving the Government, the donor community, the private sector and the c i v i l society. Attention should be given to support the integration o f each country to a regional and global framework for the control o f HPAI, and more broadly o f a l l transboundary animal diseases and other emerging infectious diseases, to increase cost-effectiveness and ensure the harmonization o f activities and responses

43. operations:

In terms o f public health, the following relevant lessons were derived from emergency

Key data needs should be anticipated and infrastructure developed to provide information that reduces the number o f assumptions (“what i s not known i s as important as stating what i s known”). The program should include mileposts for periodic re-evaluation, so that necessary changes can be made based o n new information. External reviews o f the program should be conducted periodically t o increase objectivity and improve decision making. Ensure that al l localities are able to respond to a pandemic and implement mass vaccination programs effectively. Provide funding to regional and local levels for preparedness and infrastructure development coupled with guidance and technical

15

support. National oversight and assistance i s important to assure nationwide protection and consistency o f the response. Surveillance systems should be in place, preferably, before starting the program. Communications materials should be developed to educate health care providers and the public.

0 Always keep in mind the principle: “expect and plan for the unexpected”.

0

5. Alternatives considered and reasons for rejection

44. Restructure of and “additional financing” to existing projects. An alternative that was considered was only to restructure ongoing projects and inject financing, in the form o f additional financing (loans) to support the implementation o f the activities contemplated under this Project. After considering this option, it was decided that the importance o f the issue and the need to scale-up the response at the country-level, requires additional focus and impetus to facilitate the implementation o f priority activities. A separate project option allows for the establishment o f a broader pol icy framework and alternative mechanisms to manage resource use and monitor the implementation o f activities. More specifically, a separate project allows the preparation o f a multi-sectoral national plan that includes the engagement o f different governmental institutions and c iv i l society, as well as scaled up efforts to serve the entire population. This will also facilitate advocacy and communication to mobilize political support at the highest political level needed for mounting effective and sustainable prevention and control efforts.

C. IMPLEMENTATION

1. Partnership arrangements

45. The international community and the World Bank can play a key role in the response to AI, especially at the country level where there is a need to develop an overall framework to guide national action plans that can be the basis for government and donor support. Such a framework should address both animal and public health aspects as well as economic impact. This project document and the associated documents which detail the description o f activities under the broader program developed by the Government o f Turkey and cooperating donors are an example o f a move in this direction. The overall design o f this program has been informed through the direct input from FAO, OIE, and WHO fact finding missions and assessments as wel l as direct collaboration with European Commission counterparts in Brussels and the Ankara delegation. Inputs from the U S Agency for International Development ( U S AID) assessments and technical assistance visits have also helped to form the overall program.

46. Turkey i s receiving support on the technical content o f an Avian Influenza response from key technical agencies -- WHO for public health and FAO/OIE for animal health. For example, FA0 has a regional Technical Cooperation Programs (TCPs) in the E C A region, in which Turkey wil l participate. The program’s primary objective i s to strengthen the capacity for generating and sharing HPAI disease intelligence and emergency preparedness planning. The program’s interaction with Turkey will, among other activities, target improved knowledge o f migratory birds’ role in HPAI transmission, strengthened laboratory capacity for HPAI diagnosis, and support for development o f Turkey’s National AI Strategy.

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47. In 2005, the European Commission established a task force to address AI which has been active in analyzing assistance options in various countries, including Turkey. In late January 2006 immediately following the Beijing conference on Avian Influenza (January 17-20, 2006), the European Commission gave preliminary approval to a request from the Government o f Turkey (a jo int MARA/MOH proposal) for a grant o f US$ 12.7 mi l l ion to parallel finance over U S $ 15 m i l l i on o f the activities covered under the A M P Program. This grant covers a substantial number o f the activities under both the Animal Health and Human Health components. At the same time, the U S A I D has agreed to provide a grant o f approximately US$ 1 .O million to co-finance training under the Public Information and Coordination component and the poultry sector restructuring fund under the Animal Health component. Taking the AMP Project as a base, the Bank will continue to support the efforts o f the Government o f Turkey to access multilateral and bilateral funding, the availability o f which i s expected to be clarified over the coming months. This i s especially important in view o f the evolving nature o f the AI challenge in Turkey.

2. Institutional and implementation arrangements

48. The Project wil l be implemented by existing project implementation structures in the MARA and the M O H . However, public information and project coordination arrangements wil l be overseen by the existing National Zoonotic Disease Committee. This Committee has been established jo int ly by the MARA and the MOH to deal with zoonotic emergencies and wil l provide general policies and guidelines for Project implementation. The Committee comprises representatives o f the MARA, the MOH, and other relevant ministries, agencies, and academic institutions. The Committee wil l review annual work plans and ensure coordination and linkages across relevant agencies and international partners.

49. Since the Bank i s financing both agricultural sector and health sector projects in Turkey, the existing project implementation structures within the MARA (the Central Execution Unit o f the Agricultural Reform Implementation Project, MARA CEU) and the MOH (the Health Transition Project Unit, M O H PIU) will be entrusted with fiduciary tasks o f procurement and financial management. (Additional staff will to be recruited in the MARA C E U and the MOH PIU as needed for these fiduciary tasks.) One senior officer from the MARA and one from the MOH will be designated as Project Coordinators in charge o f managing implementation o f their relevant ministries’ project activities and liaising with the MARA C E U and MOH PIU, respectively. These Project Coordinators will provide reports to the N Z D C and would be invited as observers to the N Z D C meetings. The N Z D C will also be supported by a Public Information and Communications Specialist (consultant) to support i t s public information efforts.

50. At the local level, implementation would be the direct responsibility o f the respective Provincial Directorates o f Agriculture and Health. At times o f outbreaks, the provincial governor wil l guide implementation o f cross-sectoral activities, and if necessary set up local disease crisis centers to ensure cross-sectoral coordination.

5 1. A Project Operational Manual (POM) i s being prepared to integrate the relevant aspects of each o f the Contingency Plans which have been prepared by the MARA and the MOH. This POM will guide the management and implementation o f the Project.

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3. Monitoring and evaluation of outcomes/results

52. Monitor ing and Evaluation (M&E) activities related to the project will be the responsibility o f the MARA C E U and the MOH PIU, with the participation o f the staff o f the departments o f the two ministries. These two implementation uni ts have built up M&E capacity, but some detailed surveys for M&E would be contracted out. Monitoring project progress and the achievement of objectives wil l entail a process for reviewing continuously and systematically the various project implementation activities. The purpose o f the M&E activities are to: (i) measure input, output and outcome indicators (see Annex 3); (ii) provide information regularly on progress toward achieving results and facilitating reporting to the government and the Bank (iii) alert managers, both in government and the Bank, to actual or potential problems in implementation so that adjustments can be made; (iv) determine whether the relevant stakeholders are responding as expected and intended by the project; and (v) provide a process whereby the coordinating and executing bodies can reflect and improve on their performance.

53. The results of relevant M&E activities will be reflected in the semi-annual progress reports. The progress reports wil l cover the progress with the works, the institutional activities, training and studies, performance indicators and financial reports. A section o f the progress reports wil l be devoted to issues identified during project implementation and the strategies and actions to be taken to resolve such issues that affect progress. The second semi-annual report o f each year will be an annual report, providing information o f the progress during the past year.

54. A comprehensive Mid-term Progress Report will be prepared approximately half-way during the implementation period (by M a y 3 1 , 2008). This report would support the Mid-tern Review exercise to be carried out by the Borrower and the Bank to discuss the experience accumulated during the first two years o f implementation and to discuss possible adjustment to the project design, implementation schedule and expected outcomes/results. Similarly, a final Evaluation Report should be prepared after the project completion (expected by July 31, 2010) providing detailed information on the accumulated impacts achieved by the project as well as the main lessons learned that could serve for similar operations outside the country.

4. Sustainability

55. Critical to the sustainability o f the Project would be the continuous ownership o f this initiative by the various stakeholders, coupled with strong political support and the availability o f an adequate f low of financial resources to carry out project activities. In addition, institutional sustainability would be ensured by: (i) strengthening o f programs to maintain public awareness of the threat o f avian influenza and other rapid spreading infectious diseases; (ii) sustained surveillance and prevention and control activities, particularly in high r isk regions; (iii) strengthened country capacity to manage at national and local levels the r isk factors associated with the spread of avian influenza and other infectious diseases; and (iv) effectiveness o f programs to control the spread o f avian influenza from birds to the general population.

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5. C r i t i c a l r i s k s and possible controvers ia l aspects

Project implementing agencies do not have sufficient authority, leadership, and capacity to take leading role in A I prevention and control.

Intervention activities not effective in containing the spread o f Avian Influenza from birds to the human population.

RATING

From Outputs to Objective

Decline in political commitment to A I and to the threat o f a global influenza pandemic.

M

S

Inadequate or lack o f multi-sectoral participation M

L o w regionaliprovincial-level commitment means that strong central commitment does not translate into action on .the ground.

From Components to Outputs '

expose the government to criticism for the curtailment o f c iv i l rights due to the adoption o f quarantines and other related measures.

Controlling the spread o f the pandemic may

Lack o f laboratory capacity for prompt diagnosis and surveillance and o f sufficient quantity o f drugs and other medical inputs needed to address the needs o f the general population during a pandemic Inadequate institutional capacity to manage project and perform effectively

Financial resources not accessible in a timely

Lack o f timely and predictable access to expert manner, weak procurement management

advice and technical support

surveys and monitoring and evaluation

M

M

S

M

M

M

Overall Risk Rating:

MITIGATION MEASURE

M

Continuing support for inter-country collaboration through information exchanges, dialogue, and mobilization o f international commitment and resources. Adequate implementation arrangements in place as a pre- condition o f Bank financing; careful monitoring o f leadership and project management during project implementation; technical assistance and training. Project activities will strengthen response capacity in selected priority areas in the short- and medium terms and lay the foundations for a broader-based strategy, including broad awareness and communication campaigns, which w i l l be critical to containing the spread o f a global influenza pandemic. Choosing well designed, cost-effective interventions. Interventions phased and carefully monitored, allowing for modifications and redesign as needed. Service delivery deconcentrated with the maximum use o f local governments and civi l society organizations. Good M&E to flag emerging issues National Zoonotic Disease Committee overseeing the program selected to be representative and given visibility; annual work programming transparent. Implementation mechanisms explicitly address provincial decision making, communication strategies include decentralized authorities as targets.

Project wil l support advocacy and coalition building to sensitize key groups including pol icy makers and the media. This w i l l be complemented by carefully designed mass communication campaigns to build support for the project among the wider population Project activities w i l l be coordinated with efforts undertaken by other international organizations such as WHO, that has established an international antiviral stockpile with donations from the pharmaceutical industry (e.g., Roche's donation o f three mi l l ion treatment courses o f the antiviral oseltamivir). Capacity building and institutional development as one o f the project's key objectives Emphasis on deconcentration and partnerships. Rapid disbursement procedures and simplified public sector procurement in accordance with OP for emergency operations. Project activities are designed and implemented with leading multilateral agencies such as FA0 and WHO; regional bodies such as the European Union; and bilateral and other donor organizations. Publication o f audit results and achievements; transparency in decision and resource allocation. Technical assistance and partnership between local organizations and international institutions wil l be provided. M&E plan will include information on instruments for data collection, agencies responsible and a detailed time table

[ (Modest Risk), N (Negligible or Low Rsk)

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56. The Project will support the implementation o f immediate term responses to an influenza pandemic -- the classic “social distancing measures”-- such as quarantine, bans on mass gatherings, and travel restrictions that may be politically and socially controversial. This means that dialogue and compromises are needed among different stakeholders, backed by a well-designed communication strategy. A high degree o f political commitment to preventing and controlling the spread o f infectious diseases such as an influenza pandemic would b e needed for managing controversies that wi l l undoubtedly arise.

Possible Controversial Aspects.

6. Main loan conditions

57. The key conditions needed to minimize the risks to the Project have been addressed by Turkey’s meeting the eligibility requirements for entering the GPAI (noted in para. 20 above). Specific provisions have been developed to meet the standard requirements covering organization and staffing of program units, management arrangements, and provisions for procurement and financial management. These were confirmed during Project appraisal. In addition, the MARA and MOH have prepared Annual Action Plans, satisfactory to the Bank, for the first year o f their respective components. The condition o f effectiveness for the Loan would be that the MARA and M O H have appointed their respective Project Coordinators.

58. A disbursement condition for the Animal Health component i s the adoption by the Borrower o f an Environmental Management Plan satisfactory to the Bank. I t i s also required that the payments under the Compensation Fund and the selection and implementation o f Poultry Restructuring sub-projects are made in accordance with criteria and procedures set forth in the Project Operational Manual (POM). The adoption o f a P O M by the Borrower i s a dated covenant (June 30, 2006). In addition, the Borrower shall monitor and evaluate the project and report on its progress through semi-annual Project Reports and prepare a mid-term review report by M a y 3 1,2008.

D. APPRAISAL SUMMARY

1. Economic analysis

59. Neither the timing nor the severity o f the next pandemic can be predicted, but with the virus now endemic in bird populations in Asia the r isk will not be easily diminished. Given the recent outbreaks in poultry in the Manyas Lake area and then more widely throughout al l o f Turkey’s regions, and in view of the spread to humans which is now occurring, the situation faced by Turkey i s urgent. The emergence o f a human influenza pandemic caused by a lethal virus would have a social and economic impact many times greater than the impact on the poultry sector. This would be through the costs associated with public and private efforts to prevent the emergence or spread o f the disease in humans and to treat i t s effects and the economic consequences of sickness or death resulting f rom the disease outbreaks. However, the much more uncertain predictability o f a human pandemic has caused the economic analysis o f the Project to focus on the economic losses in the poultry sector

60. In this treatment o f HPAI as an animal health issue, actions to be taken by Turkey are analyzed using the traditional “without project” and “with project” scenarios. These costs and

20

benefits estimated on the basis o f the recent outbreak in Manyas. Under the “without project” case, the l o w capacity o f government and the poultry industry to deal with outbreaks causes the sector to be increasingly vulnerable to a catastrophic AI occurrence. This catastrophic event (CE) would be characterized by multiple, simultaneous outbreaks leading to a spread o f the disease to large sections o f the country’s poultry flock, and eventually to a long-term reduction of the sector by 20-40%. This i s caused by massive public aversion to poultry consumption leading to a significant and sustained drop in prices and demand for poultry.

61. Under the “with project” scenario, the probability o f the CE i s reduced gradually to less than half that under the “without project” scenario (by year 4 o f the Project). The stream o f expected costs in this scenario i s calculated by multiplying these probabilities with the respective NPVs o f costs. Given project expenditures o f U S $ 55.2 million, the analysis yields an NPV o f US$ 415.9 mil l ion. (Annex 8 presents a detailed discussion o f the economic analysis and calculation o f the project’s NPV.)

2. Technical

62. Animal Health. The successful implementation o f the program depends on a phased multi-disciplinary strategy based on a sound epidemiological approach to control HPAI outbreaks. This strategy has to take into consideration a broad range o f epidemiological scenarios that exist in different poultry production systems in the affected countries and different levels o f incidence (ranging from high incidence with variable flock outbreaks, though low frequency disease outbreaks with partial flock immunity, to sporadic outbreaks). A balanced combination o f appropriate disease-control options, tailored to the specific characteristics o f each country and i t s farming systems i s essential for the achievement o f the program objectives.

63. important technical issues and presents substantial challenges. The main issues are:

The implementation o f the program and o f each o f the individual country projects raises

e The capacity o f Veterinary Services. The General Directorate for Protection and Control (and i t s associated regional laboratories) i s under-equipped to deal with the scope, severity and rapid spread o f the HPAI outbreaks. This i s particularly evident in the area o f surveillance and diagnostic capacity needed for the early detection and reporting o f an outbreak and to monitor the disease. e Bio-security measures. These are essential to prevent the spread o f the virus from infected premises (bio-containment) and to exclude the virus from uninfected locations (bio-exclusion). These have proven to be successful to date in Turkey, but local capacity and experience in practicing effective measures still needs strengthening. e Epidemiological expertise. The incorporation o f epidemiological studies linked to disease control programs, to generate quantitative and geo-referenced data o n infection and transmission dynamics, i s another key success factor. These are part o f the Project’s supported activities. e Harmonized disease information systems. The importance o f harmonized disease information systems, l inked to disease surveillance and epidemiological programs i s widely accepted. Turkey participates in the WAHIS, and the upgrading o f Turkey’s W A H I S module under the Project wil l support long-term control programs. e Wildlife species and reservoirs are a source of HPAI. Epidemiological studies suggest that some species o f migratory wild birds have played a role in the transmission of H5N1 viruses to domestic poultry. There i s major difficulty in applying bio-security measures aiming at avoiding the

21

contact between the migratory and other wild birds and domestic poultry. However, the small share o f backyard poultry (less than 5 percent) in Turkey appears to indicate that the eradication o f the virus to prevent H P A I infection may achievable. e Poor coordination between public agencies and weak linkages with the private sector. Less than efficient coordination between government ministries and agencies, as well as weak linkages with private sector actors, have hampered long-term planning for infectious disease control in a number o f countries. Given the zoonotic and transboundary nature o f this disease, a wel l coordinated public-private response i s essential. Turkey i s expected to build on the close cooperation which was evidenced during the October 2005 AI outbreak.

64. In terms o f public health, the swine influenza experience provides a benchmark for decision-making and public health response to the threat o f an influenza pandemic. Yet, how relevant are the experiences and lessons o f 1976 for a pandemic response today? Substantial changes in public health preparedness and infrastructure, in vaccine manufacturing and delivery, and in society have occurred which wil l affect a pandemic response. International surveillance for influenza and the strains that cause infection is much stronger than in 1976. The additional surveillance data available today wil l provide a much stronger basis for assessing the likelihood o f a pandemic. Experience has shown that new influenza strains can cause clusters o f human diseases without becoming widespread. Improvements also have been made in public health preparedness planning, and communications between the different levels o f a health system.

Public Health - Technical Considerations.

65. Despite these changes, many o f the lessons from the swine influenza experience remain relevant and, as demonstrated by the experience implementing smallpox vaccination, remain as significant challenges. The need to identify adverse effects following vaccination as coincidental or causal also remained problematic. Separating risk assessment and risk management, conduct o f external program reviews, improved communications planning, and strong surveillance for vaccine safety al l are areas where the lessons o f swine influenza were appropriately applied in the smallpox program.

66. Lessons from swine influenza also were considered in developing the pandemic influenza preparedness and response plan under the GPAI. The importance o f planning by Turkey’s M O H at the different levels o f the system during the inter-pandemic period o f strengthening key infrastructures, and o f exercising response plans needs greater emphasis and wil l be addressed by the Project.

3. Fiduciary

67. Financial management. The financial management functions o f the project will be handled by the Central Execution Unit (CEU) in MARA and the Health Transition Project Implementation Unit ( M O H PIU) in MOH. The M O H PIU and the C E U will be responsible for the flow o f funds, accounting and reporting in their respective ministries. Both units wil l be coordinating their work, but the overall responsibility for reporting purposes wil l l i e with the CEU. An action plan i s prepared to bring the financial management arrangements in both units to a satisfactory level and i s presented in Annex 7 o f the PAD.

22

68. A financial management assessment o f the MOH PIU, responsible for financial management o f the HTP, was undertaken in 2004 to determine whether the financial management arrangements are acceptable to the Bank. The financial management arrangements o f the MOH PIU have been reviewed periodically as part o f project supervision, and have been satisfactory. The MOH P I U has established and maintained a good financial management system for the implementation o f HTP. The financial management arrangements are considered capable o f supporting the implementation o f the Avian Influenza Control and Human Pandemic Preparedness and Response Loan after the action plan, presented in Annex 7, i s implemented.

69. Procurement assessments o f the MARA C E U and the MOH PlU have been made in accordance with the requirements o f OP 1 1 .OO. The agreements covering procurement methods and thresholds have been determined for Turkey according to its capacity and experience with Bank procurement and are consistent with ERA assistance guidelines. The procurement agreements have been appraised and detailed in the procurement plan for the f i rst three years of the Project (summarized in Annex 7). The General Procurement Notice i s to be issued on or about April 15,2006.

70. Procurement wil l be accelerated in the first six months o f the Project by allowing Shopping procedures to be used for a certain number of emergency contracts, whose size would usually be above the normal ceiling for Shopping. These cover mainly the following: safety gear for veterinary and health services personnel; equipment and rapid test kits, and other reagents for MARA reference laboratories and MOH laboratories; and, two mobile incineration plants and related containers for culling.

4. Environment and social aspects

71. Activities under the Project are not expected to generate any adverse environmental effects as they are focused largely on public sector capacity building and improved readiness for dealing with outbreaks of avian influenza in domestic poultry. These prevention-focused activities are expected to have a positive environmental impact as the Project's investments in facilities, equipment, and training for laboratories will improve the effectiveness and safety over existing avian influenza handling and testing procedures by meeting international standards established by the OIE. This would be reinforced by the mainstreaming o f environmental safeguards into protocols and procedures for the culling and disposal o f animals during AI outbreaks. In addition, whatever waste i s generated in laboratory facilities wil l be managed using existing guidelines in Turkey.

72. Though no social safeguard pol icy i s triggered by the Project, the Project i s designed to mitigate the negative impacts of mandated culling o f poultry on small scale backyard poultry producers. Even though this impact i s not expected to be large (likely no more than 5% o f backyard poultry producers' value of household consumption), mitigation measures have been designed, and their further refinement is envisaged during the init ial implementation period o f the Project. First, a state compensation fund wil l be set up under the Project (with an init ial reserve o f US$ 5 million) to pay producers roughly the full current value o f their culled poultry. A second project reserve (an additional US$ 4.5 mil l ion) wil l also be established to target the restructuring needs of the poultry sector which arise as a result o f the enforcement o f the cul l ing pol icy in areas affected by AI. This will be designed to mitigate the medium to long-term effects

23

on producers (mainly of the backyard type) who are required to discontinue poultry production in areas which have been affected by AI.

73. Third, the project team agreed with the Ministry o f Agriculture and Rural Affairs on the desirability o f using part o f the Village-based Participatory Investments Program (under the existing Agricultural Reform Implementation Project) on the needs o f poultry producers affected by the culling o f poultry in affected areas. Lastly, during the init ial stage of project implementation, the project team will pursue with the representatives o f the commercial poultry sector a voluntary initiative by the commercial poultry sector to provide poultry products free of charge to backyard producers who have been forced to discontinue poultry raising. This would be at the level o f household consumption formerly raised by backyard poultry producers and extended for a two to three year period.

5. Safeguard policies

Environmental assessment Environmental Category B

74. Environmental Assessment and Environmental Management Plan. Since the Project supports investments in incineration capacity for culled poultry (and potentially for disposal o f other livestock and laboratory wastes), the Project i s assessed as a B-category project. An Environmental Assessment (EA) and an Environmental Management Plan (EMP) for the deployment o f incineration capacity (mainly mobile but also potentially through stationary incineration units) wil l be necessary. This EMP will also cover the clean up o f animal wastes o f culled poultry by the local public veterinary services supported under the Project. The scope o f this EMP will be specified in early project implementation, as a waiver for the requirement to complete the EA and EMP during project preparation has been sought and obtained per para. 12 of OP 4.01. Preparation of the EA and EMP is expected early in project implementation, and the EMP's adoption by the Government i s set as a disbursement condition for the Animal Health component o f the Project.

Safeguard Policies Triggered by the Project Yes N o Environmental Assessment (OPBP/GP 4.01) [X 1 [I Natural Habitats (OPBP 4.04) [I [ XI Pest Management (OP 4.09) [I [ XI Cultural Property (OPN 1 1.03, being revised as OP 4.1 1) [I XI Involuntary Resettlement (OPBP 4.12) [I [X 1 Indigenous Peoples (OD 4.20, being revised as OP 4.10) [I [X 1 Forests (OPBP 4.36) [I [X 1 Safety o f Dams (OPBP 4.37) [I [X 1 Projects in Disputed Areas (OP/BP/GP 7.60)* [I [X 1 Projects on International Waterways (OPBP/GP 7.50) [I X[ 1

* By supporting the proposedproject, the Bank does not intend to prejudice theJinal determination of the parties' claims on the disputed areas

24

6. Policy Exceptions and Readiness

75. The only po l icy exception requested has been with regard to the waiver o f the completion o f the EA and EMP per para. 12 o f OP 4.01. This waiver has been approved by Bank senior management. The project meets the regional criteria for readiness for implementation,

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ANNEX 1 : KEY FACTS ABOUT AVIAN INFLUENZA AND AVIAN INFLUENZA A (H5N1 VIRUS)

TURKEY: AVIAN INFLUENZA AND HUMAN PANDEMIC PREPAREDNESS AND RESPONSE PROJECT

What i s Avian Influenza (bird flu)?

1. Bird flu i s an infection caused by avian (bird) influenza (flu) viruses. These flu viruses occur naturally among birds. Wild birds worldwide carry the viruses in their intestines, but usually do not get sick from them. However, bird flu i s very contagious among birds and can make some domesticated birds, including chickens, ducks, and turkeys, very sick and kill them.

D o bird flu viruses infect humans?

2. bird flu viruses have occurred since 1997.

Bird flu viruses do not usually infect humans, but several cases o f human infection with

What i s an avian influenza A (H5N1) virus?

3. Influenza A (H5N1) virus - also called “H5N1 virus” - i s an influenza A virus sub-type than occurs mainly in birds. It was first isolated from birds (terns) in South Africa in 1961. L i ke al l bird flu viruses, H5N1 virus circulates among birds worldwide, i s very contagious among birds, and can be deadly.

What i s the H5N1 bird flu that has recently been reported in Asia?

4. Outbreaks of influenza H5N1 occurred among poultry in eight countries in Asia (Cambodia, China, Indonesia, Japan, Laos, South Korea, Thailand, and Vietnam) during late 2003 and early 2004. As that time, more than 100 mi l l ion birds in the affected countries either died from the disease or were killed in order to try to control the outbreak. By March 2005, the outbreak was reported to be under control. Beginning in late June 2004, however, new deadly outbreaks o f influenza H5N1 among poultry were reported by several countries in Asia (Cambodia, China, Indonesia, Malaysia { f i rst time reports} , Thailand, and Vietnam). I t i s believed that these outbreaks are ongoing. Human infections o f influenza A (H5N1) have been reported in Thailand, Vietnam and Cambodia.

What i s the risk to human from the H5N1 virus in Asia?

5. The H5N1 virus does not usually infect humans. In 1997, however, the first cause o f spread from a bird to a human was seen during an outbreak o f bird flu in poultry in Hong Kong. The virus caused severe respiratory illness in 18 people, 6 o f which died. Since then, there have been other causes of H 5 N 1 infection among humans. Most recently, human cases o f H 5 N 1 infection have occurred in Thailand, Vietnam and Cambodia during large H5N1 outbreaks in poultry. The death rate for these reported cases has been about 50 percent. Most o f these cases occurred from contact with infected poultry or contaminated surfaces; however, i t i s thought that a few cases o f human-to-human spread o f H5N1 may have occurred.

26

6. So far, spread o f H5N1 virus from person to person has been rare and spread has not continued beyond one person. However, because all influenza viruses have the ability to change, scientists are concerned that the H5N1 virus could one day be able to infect humans and spread easily from one person to another. Because these viruses do not commonly infect humans, there i s l i t t le or no immune protection against them in the human population. If the H 5 N 1 virus were able to infect people and spread easily from person to person, “influenza pandemic” (worldwide outbreak o f disease) could begin. N o one can predict if and when a pandemic might occur. However, experts from around the world are watching the H5N1 situation in Asia very closely and are preparing for the possibility that the virus may begin to spread more easily and widely f rom person to person.

How are bird flu viruses different from human flu viruses?

7. There are many different sub-types o f type A flu viruses. These sub-types differ because of certain protection on the surface o f the flu A virus (hemagglutinin {HA} and neuraminidase {NA} proteins). There are 16 different HA sub-types and 9 different NA sub-types of flu A viruses. Many different combinations o f HA and NA proteins are possible. Each combination i s a different sub-type. All sub-types o f flu A viruses can be found in birds. However, when one talks about “bird flu” viruses, one usually refers to flu A sub-types that continue to occur mainly in birds. They do not usually infect humans, even though we know they can do so. Human flu viruses are referred to as those sub-types that occur widely in humans. There are only three known sub-types o f human flu viruses (HlN1, H l N 2 , and H3N2); i t i s likely that some genetic parts of current humans flu A viruses came from birds originally. Flu A viruses are constantly changing, and they might adapt over time to infect and spread among humans.

What are the symptoms of bird flu in humans?

8. Symptoms of bird flu in humans have ranged from typical flu-like symptoms (fever, cough, sore throat and muscle aches) to eye infections, pneumonia, severe respiratory diseases (such as acute respiratory distress), and other severe and life-threatening complications. The symptoms of bird flu may depend on which virus caused the infection.

How does bird flu spread?

9. Infected birds shed flu virus in their saliva, nasal secretions, and feces. Susceptible birds become infected when they have contact with contaminated excretions or surfaces that are contaminated with excretions. I t i s believed that most causes o f bird flu infection in humans have resulted from contact with infected poultry or contaminated surfaces.

What i s the risk to humans from bird flu?

10. The risk from bird flu i s generally l o w to most people because the viruses occur mainly among birds and do not usually infect humans. However, during an outbreak o f bird flu among poultry (domesticated chickens, ducks, turkeys), there i s a possible r i s k to people who have contact with infected birds or surfaces that have been contaminated with excretions from infected birds. The current outbreak o f avian influenza A among poultry in Asia i s an example o f a bird flu outbreak that has caused human infections and deaths. In such situations, people should

27

avoid contact with infected birds or contaminated surfaces, and should be careful when handling and cooking poultry.

How i s infection with H5N1 virus in humans treated?

1 1. The H 5 N 1 virus currently infecting birds in Asia that has caused human illness and death i s resistant to amantadine and rimantadine, two antiviral medications commonly used for influenza. Two other antiviral medications, oseltamavir and zanamavir, would probably work to treat flu caused by the H5N1 virus, though studies s t i l l need to be done to prove that they work.

I s there a vaccine to protect humans from H5N1 virus?

12. There i s currently no vaccine to protect humans against the H5N1 virus that i s being seen in Asia. However, vaccine development efforts are underway. Research studies to test a vaccine to protect humans against H5N1 virus began in April 2005. Researchers are also working on a vaccine against H9N2, another bird flu virus sub-type.

What does CDC recommend regarding the H5N1 bird flu outbreak in Asia?

13. In February 2004, CDC provided US. health departments with recommendations for enhanced surveillance (“detection”) in the US. o f avian influenza A (H5N1). Follow-up messages (Health Alert Network) were sent to the health departments o n August 12, 2004, and February 4, 2005, both reminding health departments about how to detect (domestic surveillance), diagnose, and prevent the spread o f avian influenza A (H5N1). It also recommended measures for laboratory testing for H5N1 virus. CDC currently advises that travelers to countries in Asia with known outbreaks o f influenza A (H5N1) avoid poultry farms, contact with animals in l ive food markets, and any surfaces that appear to be contaminated with feces from poultry or other animals.

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ANNEX 2A: SUMMARY OF THE FA0 AND THE OIE GLOBAL STRATEGY FOR THE PROGRESSIVE CONTROL OF HIGHLY PATHOGENIC AVIAN INFLUENZA (HPAI)


1. Vision and goal. The long-term vision o f the strategy i s to minimize the global threat and r i s k of HPAI in humans and domestic poultry, through progressive control and eradication o f HPAI, particularly that caused by the H5N1 virus, from terrestrial domestic poultry in Asia, Achieving this goal wil l diminish the global threat o f a pandemic, stabilize poultry production, enhance a robust regional and international trade in poultry and poultry products, increase human and food safety, and improve the livelihoods o f the rural poor.

2. A phased approach. The global strategy wil l be implemented over three t i m e frames: immediate to short (1-3 years), short to medium (4-6 years) and medium to long term (7-10 years). During this period the spread o f HPAI, mainly o f the H 5 N 1 strain, wil l have been progressively controlled in domestic poultry o f al l infected countries o f Asia, and prevented from affecting those Asian countries not currently infected, but at high risk.

3. W h e r spread of HPAI in those countries that are currently infected by H5N1.

The immediate to short-term objective i s to reduce the r i s k to humans by preventing

4. Over the medium to long-term (7-10 years), a more focused approach to HPAI wil l be mounted to progressively eradicate the disease from the remaining compartments o f infected domestic terrestrial poultry in the region. The medium-to-long term strategy wil l consider al l control measures, including vaccination, zoning and compartmentalization as defined in the OIE Terrestrial Animal Health Code. For the long-term success o f this strategy, restructuring o f the poultry sectors in the region wil l need to be seriously considered.

5. To prevent the threat o f HPAI from spreading to avian influenza-free countries, the long- term strategy supports the development o f active surveillance programs and emergency preparedness plans for non-infected, at risk countries. The application o f OIE standards relating to the international trade o f poultry and poultry products will further assist in preventing the spread o f HPAI virus across continents.

6. Capacity building. Inadequate capacity in many countries i s the principal limiting factor for effectively and quickly stamping out and controlling infectious diseases. Thus, the strategy suggests building a strong and sustainable human and physical resource capacity in the countries, to respond in a more effective and timely manner in stamping out not only HPAI outbreaks, but also other newly-emerging infectious zoonotic and trans-boundary animal diseases. Capacity building wil l be wide ranging and include al l aspects o f disease control as wel l as pol icy development and socio-economic impact analysis.

7. Strategic research. The global strategy recognizes that the dynamics o f the current rapid spread and persistence o f HPAI remain unclear. Therefore, the strategy will facilitate strategic research to investigate the epidemiology o f avian influenza, evaluate the efficacy o f vaccines in

29

domestic ducks to reduce the virus shedding in domestic duck reservoirs, and work in close collaboration with regional and international advanced research institutions to promote the development o f improved vaccines and rapid diagnostic tests. Risk analysis o f various poultry production systems and along marketing chains wil l be carried out to better target effective disease control.

8. Implementation. Implementation will be at the national, regional and international levels. At the national level, well-defined country specific projects wil l be formulated, which wil l be underpinned by the formation o f sub-regional HPAI support units. Through these units, sub-regional disease diagnosis and surveillance and socio-economic and pol icy analysis networks will b e established. These sub-regional networks wil l provide the lead in the development o f harmonized technical standards and regional policies related to the management of live animal movement, compensation plans, capacity building, disease reporting requirements and long te rm planning to restructure poultry sectors.

9. At the international level, coordination o f the national programs and sub-regional networks wil l be under the umbrella o f GF-TADs (global framework for the control o f transboundary animal diseases), a joint FAO/OIE initiative. The international coordination wil l provide technical backstopping to the sub-regional networks and national programs, promote international cooperation, and mobilize and coordinate resources for H P A I control.

10. Partners. The main partners in implementation o f the strategy wil l be infected and non- infected at-risk countries, and regional organizations, a l l o f which are committed to controlling trans-boundary animal and zoonotic diseases. Given the zoonotic nature o f the HPAI, and the complex interface between fanning systems, livestock trade, food safety and public health, a strong international partnership among FAO, OIE and WHO will be continued. A number o f other partners wil l be involved, important among these would be the private sector, NGOs, and regional national agriculture extensions systems (NARES).

11. national, regional and international HPAI control programs as outlined above.

Resources. The implementation o f the strategy will require funding to support the

Framework for Implementation

12. regional and international initiatives. It includes the following:

A Framework for Implementation has been developed by FAO/OIE, promoting national,

Nation a1 initiatives:

0 Development o f a National Strategy for each country specific to i t s own conditions. I t would address farming systems, presence/absence o f ducks, presence o f human cases or not, trade orientation, implementation capacity, and wi ld l i fe migration patterns;

0 Preparation o f contingency and emergency preparedness plans; 0 Development o f economic impact and pol icy frameworks; 0 Prevention o f avian influenza to non-infected at-risk countries through awareness, reporting, and

early detection; and

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0 Improvement in epidemiological information on source o f infection and transmission dynamics in farming system and marketplaces.

Regional initiatives:

0

0

0

Standardization o f diagnosis and reporting techniques among countries; Sharing o f disease information between countries; Development of a regulatory framework for management o f animal movements; and Promotion o f adherence to OIE guidelines to facilitate regional trade.

Global initiatives:

Strengthening of partnerships (FAO, OIE, WHO, UNDP, donors); Support for global networks (OIE Global Service Center supported by WB/DGF and donors); Support for sub-regional networks -- OIE/FAO epidemiology collaborating centers and Avian Influenza Network; Further development of control strategies for trans-boundary animal diseases (utilizing the GF- TADs mechanism); Development of a Global Early Warning System (FAO/OIE/WHO); Coordination of research on improved tools for avian influenza control; Provision o f global vision for avian influenza control; and Mobilization of resources through donor liaison and advocacy.

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ANNEX 2B: SUMMARY OF THE WORLD HEALTH ORGANIZATION (WHO) STRATEGY


1. The strategic plan lays out activities for individual countries, the international community and WHO to prepare for a pandemic and mitigate i t s impact. The objectives o f the plan correspond to the opportunities to intervene and are structure in the following three phases:

Phase - Pre-Pandemic:

(i) Reduce opportunities for human infection. An immediate priori ty i s to halt spread in poultry to reduce human exposure to the virus. More intensive collaboration i s needed between the animal and health sectors. Communication activities targeting stakeholders, particularly rural poultry holders, should be strengthened. Workers carrying out the culling o f poultry must be protected against infection by clothing and equipment.

(ii) Strengthen the early warning system. To assess r isks to public health and guide protective measures, information i s needed on the extent o f influenza infection in animals and humans and on circulating viruses. National surveillance systems must be improved urgently in potentially affected countries. When outbreaks in animals occur, active human case detection should be pursued by a coordinated animal-human health team.

Phase - Emergence of a Pandemic:

(iii) Contain or delay spread at the source. Aggressive containment measures such as isolation and prophylactic use of antiviral drugs may slow pandemic spread and allow time for response measures. An international stockpile o f antiviral drugs for an emergency response should be established, starting with a stockpile for targeted early use.

Phase - Pandemic Declared and Spreading Internationally:

(iv) Reduce morbidity, mortality, and social disruption. Although mass vaccination is the preferred intervention, serious issues related to the time lag between emergence o f the virus and vaccine production as wel l as production capacity constraints must be addressed. Anti-viral supply and production capacity are also limited. Therefore, the main responses in the immediate term should be classic “social distancing measures” such as quarantine, bans on mass gatherings, qnd travel restrictions, backed up by a well-designed communication strategy. For the longer term, options with industry to improve antiviral and vaccine capacity need to be explored.

(v) Conduct research during pandemic. Research i s needed for pol icy development and adjustments for current and future epidemics. The ma in elements include: assessing the epidemiologic characteristics; monitoring the effectiveness o f the interventions; and evaluating the medical and economic consequences.

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Recommended Strategic Actions

2. In view o f the immediacy of the avian influenza threat, WHO recommends that al l countries undertake urgent action to prepare for a pandemic. Advice on doing so i s contained in the recently revised W O global influenza preparedness plan (2005) and a new IYHO checklist for influenza pandemic preparedness planning (2005). Table 1 describes the phases o f increasing public health risk associated with the emergence o f a new influenza virus subtype that may pose a pandemic threat, and the overarching public health goals under each phase.

Table 1: Phases of Increasing Public Health Risk Associated with the Emergency of a New Influenza Virus Subtype that M a y Pose a Pandemic Threat

PHASES ~~

Interpandemic period Phase 1. N o new influenza virus subtypes have been detected in humans. An influenza virus subtype that has caused human infection m a y b e present in animals. If present in animals, the risk o f human infection o r disease i s considered to b e low. Phase 2. No new influenza virus subtypes have been detected in humans. However, a circulating animal influenza virus subtype poses a substantial risk o f human disease. Pandemic alert period Phase 3. Human infection(s) with a new subtype, but n o human-to- human spread, or at most rare instances o f spread to a close contact.

Phase 4. Small cluster(s) with l imited human-to-human transmission but spread i s hghly localized, suggesting that the virus i s not we l l adapted to humans.

Phase 5. Larger cluster(s) but human-to-human spread s t i l l localized, suggesting that the virus i s becoming increasingly better adapted to humans, but may not yet be h l ly transmissible (substantial pandemic

Pandemic period Phase 6. Pandemic: increased and sustained transmission in general population. a The distinction between phase 1 and phase 2 i s based o n the r isk oj

OVERARCHING PUBLIC HEALTH GOALS

Strengthen influenza pandemic preparedness at the global, regional, national and sub-national levels.

Min imize the risk o f transmission to humans; detect and report such transmission rapidly if it

Ensure rap id characterization o f the new virus subtype and early detection, noti f icat ion and response to additional cases. Contain the n e w virus withn l imi ted foc i or delay spread to gain t ime to implement preparedness measures, including vaccine develoDment. Maximize efforts to contain or delay spread, to possibly avert a pandemic, and to gain t ime to implement pandemic response measures.

M in im ize the impact o f the pandemic.

iuman infection o r disease resulting fiom circulating strains in animals.-The distinction i s based o n various factors and their relative importance according t o current scientific knowledge. Factors may include pathogenicity in animals and humans, occurrence in domesticated animals and livestock or only in wildlife, whether the virus i s enzootic o r epizootic, geographically localized o r widespread, andor other scientific parameters.

b factors and their relative importance according to current scientific knowledge m a y b e considered. Factors may include rate o f transmission, geo-graphical location and spread, severity o f illness, presence of genes from human strain (if derived from an animal strain), andor other scientific parameters. Source: WHO 2005

3. In order to accomplish the public health goals described for each phase, WHO recommends strategic actions that can be undertaken to capitalize o n each opportunity to

The distinction between phase 3, phase 4 and phase 5 is based o n an assessment o f the r i sk o f a pandemic. Various

33

intervene. Given the many uncertainties about the evolution o f the pandemic threat, including the amount o f t ime lef t to prepare, a wise approach involves a m i x o f measures that immediately address critical problems with longer-term measures that sustainably improve the world’s capacity to protect itself against the recurring pandemic threat.

4. The strategic actions are:

Reduce opportunities for human infection, including:

0

0

0

0

Support to the FAO/OIE control strategy; Intensify collaboration between the animal and public health sectors; Strengthen risk communication to rural residents; and Improve approaches to environmental detection o f the virus

Strengthen the early warning systems, including:

0 Improve the detection o f human cases; 0 Combine detection o f new outbreaks in animals with active searches for human cases; 0 Support epidemiological investigation; 0 Coordinate clinical research; 0 Strengthen risk assessment; 0

0

Strengthen existing national influenza centers throughout the risk-prone regions; and Give risk-prone countries an incentive to collaborate internationally.

Contain or delay spread at the source, including:

0

0

0

Establish an international stockpile o f anti-viral drugs; Develop mass delivery mechanisms for anti-viral drugs; and Conduct surveillance o f antiviral susceptibility.

Reduce morbidity, mortality and social disruption, including:

0

0 Introduce non-pharmaceutical interventions; 0

0 Augment vaccine supplies; 0

0

Monitor the pandemic in real time;

U s e o f antiviral drugs to protect priori ty groups;

Ensure equitable access to vaccines; and Communicate r isks to the public.

Conduct research to guide response measures, including:

0

0

0

Assess the epidemiological characteristics o f an emerging pandemic; Monitor the effectiveness o f human interventions; and Evaluate the medical and economic consequences.

34

ANNEX 2C: SUMMARY AND REVIEW OF THE AVIAN INFLUENZA CONTINGENCY PLANS OF THE REPUBLIC OF TURKEY


1. To have maximum impact on reducing the spread and cost o f a pandemic influenza, i t i s critical that Turkey begin implementing i t s own country preparedness and response plans. Achieving this i s one o f the development objectives o f the proposed project. As a first step, the Avian Influenza contingency plans o f Turkey have been reviewed and summarized.

Pandemic Preparedness Assessment Tool

2. To evaluate the preparedness status and readiness in Turkey, the existing tools prepared by the European Center for Disease Prevention and Control (ECDC), in collaboration with WHO and the European Commission have been used2. In using these tools, the objectives have been to:

a) To evaluate the status o f pandemic influenza preparedness in the country b) To determine a baseline o f preparedness, or to determine progress made since an earlier

assessment.

c) To identify weaknesses and strengths o f pandemic influenza preparedness. d) To identify steps for improvement.

3. The assessment has focused on the following issues:

I. Avian Influenza Preparedness (Animal Component)

I s there awareness o f the current situation in the work regarding avian influenzdconcern about i t s introduction into the country? YES

Contingency plan for an outbreak among birds available, including protection o f people living in the area and workers handling or killing affected birds? YES

Collaboration arrangements established with international agencies such as FAO? YES

I s there laboratory capacity to test animal specimens for influenza? YES

I s the Ministry o f Agriculture involved in pandemic preparednesdmember o f national pandemic committee? Y E S

Have exercises been conducted o n how to respond to an outbreak in birds? YES

0

0

0

0

0

0

ECDC with WHO and the EC, 2005, draft Assessment Tool for National Pandemic Influenza Preparedness.

35

11. Public Health Preparedness Seasonal Influenza:

0 Seasonal influenza surveillance systems in place and functional? YES (only in 14 provinces)

Seasonal influenza vaccination program for target groups in place? YES 0

Pandemic Influenza (national level) Planning and Coordination

Relevance of pandemic planning recognized by decision makers and preparedness policies developed and adopted? YES

Legal and ethical frameworks established coherent with international legislation (International Health Regulations)? YES

National Pandemic Planning Committee established? YES

Command and control structure in place outlining management and decision-making processes o f al l organizations involved in response to a health emergency? YES

Country has national influenza pandemic preparedness plan that i s consistent with international plans and periodically updated? YES3

Situation Monitoring and Assessment 0 National system available for influenza surveillance in both humans and animals? YES

(humans)

0 Access to at least one laboratory able to offer routine influenza diagnosis, typing and sub- typing, but not necessarily strain identification? Y E S

Outbreak investigation capacity available (inventory o f resources available)? LIMITED

Contingency plans developed for ongoing monitoring o f impact and resources needs during the pandemic phase. PARTIALLY (resources not identified nor costed)

0

0

Prevention and Containment

0 National guidance for public health response developed? YES

0 National guidance for c iv i l emergency response developed? NEEDS STRENGTHENING

0 Anticipated resource implications for implementation addressed? YES, DURING AMP PREPARATION

Tabletop exercises conducted and results used to improve planning? YES

Strategy to access antivirals for national use (e.g., stockpiling) developed? YES

0

0

Pending Minister’s approval.

36

0

0

Priorities and criteria for deployment and use o f antivirals defined? YES

Strategy to access pandemic vaccines exploreddeveloped; regulatory issues, liability, intellectual property rights addressed? YES

Priorities and criteria for use o f pandemic vaccines defined; preliminary priorities for pandemic vaccines use developed, based on expected availability? NO

Logistic and operational needs for implementation o f pandemic vaccines strategy reviewed? N O

0

0

Health System Response 0 Health services are informed about national pandemic influenza policies including

preparedness plan? N O

Contingency plans developed on how to maintain essential services? NO

Authorities, responsibilities and pathways identified for command and control o f health systems in the event o f a pandemic? YES

Pharmaceutical and other material supply needs estimated; arrangements to secure supply commenced? YES

Plans for health workers training in pandemic influenza response developed? NO

0

0

0

0

Communication 0

0

National communication strategy for pandemic influenza established? YES

Capacity planned and tested for meeting expected domestic information demands for diverse audiences, including professionalkechnical groups, the news media and general public? NO

Networks among key response stakeholders established, including r i s k communicators, non-health government departments, and professional and technical groups? NO

News media with national plans familiarized, including preparedness activities and decision-making related to seasonal and pandemic influenza? NO

0

0

Categorization o f Country Readiness

4. MODERATE

On the basis o f the results o f the preparedness assessment, Turkey i s assessed as:

5. Advanced: An eligible country would have a wel l developed and approved national preparedness and response plan showing understanding o f the issues and goals for addressing them, actions adapted from international guidelines and best practices to meet national priorities, evidence o f strong public support and a well balanced range o f stakeholders. I t would have identified investment priorities to support the implementation o f the plans, have included financing estimates of the needs; defined key indicators for monitoring and evaluating the

37

implementation o f national programs; and be conducting ongoing public dialogue andor involvement.

6. reliable financial estimations.

Moderate: As for “Advanced” but missing some key elements in the plans and without

7. requiring significant additional identification o f implementable actions and direction.

Low: Many key aspects missing, especially public dialogue and establishment o f goals,

38

ANNEX 3: RESULTS FRAMEWORK AND MONITORING


Project Development Objectives

Results Framework

Project Outcome Indicators

~~

Component 1.B: Strengthening Disease Surveillance and Diagnostic Capacity - Animal disease surveillance and diagnostic capacities strengthened and training of the veterinary services designed and completed.

To minimize the threat in Turkey Dosed to humans by HPAI infection md other zoonoses in domestic poultry and prepare for the control 2nd response to an influenza pandemic and other infectious jisease emergencies in humans.

Intermediate Outcomes

Component 1.B: Evidence* o f timely and satisfactory progress toward delivery of Component 1.B outputs, as compared to the original plan, including specific indicators as follows:

BSL-3 attained in two reference laboratories and other regional laboratories upgraded to reach 75% coverage o f at- threat areas; Self-assessment of the veterinary services executed;

animal and public health services in limiting the spread of an HPAI outbreak and consequent pandemic in Turkey;

Evidence* of widespread adoption of recommended practices for the prevention and control o f HPAI among poultry producers, distributors, and retail vendors;

Improving trend in poll o f experts designed to gauge HPAI

Evidence* o f improved effectiveness of participating

Containment Plan - supplies and incineration investments deployed in field and certification o f readiness

readiness in Turkey Intermediate Outcome Indicators For Each Component

Evidence* of timely and satisfactory progress toward delivery of Component 1.C outputs, as compared to the original plan, including specific indicators as follows:

LAnimal Health Component Component 1.A: National Policy framework and development of a national s t ra te0 - A country- specific strategy (and its corresponding information system) was developed, adopted, and disseminated to control and eradicate HPAI in areas at risk.

Component LA: Evidence* of timely and satisfactory progress toward delivery of Component 1.A outputs, as compared to the original plan, including specific indicators as follows:

Detailed assessment of the Animal Health Department of the MARA General Directorate for Protection and Control

National A I Strategy developed and adopted by govemm ent .

Linking o f Veterinary Control Research Institutes to the WAHIS maintained by the General Directorate for Protection

I andcontrol

I 1 Component I.C:

100% monitoring of poultry breeding stock farms. Component 1.C: Outbreak

for rapid response (necessary to control and eradicate an outbreak of HPAI) attained in areas at risk

Emergency supplies procured and available at strategic locations in the field; 15 mobile incineration units deployed and accessible by areas at risk; Certification of readiness rating obtained from FAOIOIE (following readiness review). Significant reduction in unconfined backyard poultry farming Compensation Fund established with clear operating

Use of Project Outcome Information

To determine whether or not the project objective has been achieved.

Use of Intermediate Outcome Monitoring

Component 1.A: To verify satisfactory and timely progress in, or completion o f Component LA.

Component 1.B: To verify satisfactory and timely progress in, or completion of Component I.B.

Component 1.C: To verify satisfactory and timely progress in, or completion of Component I.C.

39

Intermediate Outcomes

11. Human Health Component Component 1I.A: Enhancing

Intermediate Outcome Indicators For Each Component I U s e of Intermediate

Program Planning and Coordination -Improved command and control structures for quarantine and disease control in a health emergency were developed and implemented.

I

Component 1I.B: Strengthening National Public Health Surveillance Systems - Measures to improve communicable disease surveillance and control in human populations at risk were developed, tested and implemented.

Component 1I.C. Healthcare System Response Capacity - - ”Social distancing measures” such as quarantine, bans on mass gatherings, and travel restrictions, were developed and implemented backed up by a communication strategy. - Critical medical care networks were strengthened and readied to cope with increased demand for services, and to prevent the spread o f infection among high-risk populations and health care workers.

Component 1I.A: Evidence* o f timely and satisfactory progress toward delivery o f Component 1I.A outputs, as compared to the original plan, including specific indicators as follows:

Inter-institutional and multi-sectoral coordination arrangements in place with MARA

National Zoonotic Disease Committee fully operational; National strategic plans for improvement o f public health

surveillance and disease control systems prepared according to WHO recommendations, approved and h l ly resourced for implementation.

Component 1I.B: Evidence* o f t imely and satisfactory progress toward delivery o f Component ILB outputs, as compared to the original plan, including specific indicators as follows:

Increased surveillance and outbreak investigation capacity; Number o f public health laboratories available for routine

influenza diagnosis and typing rehabilitated and equipped, and with improved biomedical waste management systems;

Number o f public health laboratories that qualifies as national influenza center (NIC);

[Number o f provincial public health directorates wi th a computerized information and telecommunications systems in place and operational;]

computerized information and telecommunications systems in place and operational;]

Number o f health personnel trained in influenza virus surveillance and control;

Number o f sentinel site provinces complying with bi-weekly (winter) and monthly (summer) reporting on influenza occurrence;

Increased laboratory capacity to collect and analyze specimens per day for viral typing, sub-typing and isolation in times o f surging specimen load;

departments on compiled results o f national surveillance (ILIs and confirmed cases) introduced as feedback mechanism. Component 1I.C: Evidence* o f timely and satisfactory progress toward delivery o f Component 1I.C outputs, as compared to the original plan, including specific indicators as follows:

Number o f professionals and support personnel trained for active surveillance, case finding, and proper diagnosis, treatment and care to contain outbreaks and reduce occurrence and case fatality during both pre-epidemic and pan-endemic phases ;

m

[Number o f provincial public health laboratories with a

% o f specimens tested positive and sub-typed; % o f positive tests confirmed by reference laboratory; Evidence o f improved bio-safety in NICs; Biweekly report f rom NICs through M O H to provincial health

Cumulative incidence rate (CIR) % change in the AI case fatality rate.

Zomponent 1I.A: To verify satisfactory and imely progress in, or :ompletion o f Zomponent 1I.A.

Component 1I.B: To verify satisfactory and :imely progress in, or :ompletion o f Clomponent 1I.B.

Component 1I.C: To verify satisfactory and timely progress in, or completion o f Component 1I.C.

40

Intermediate Outcomes Intermediate Outcome Indicators For Each Component

111. Public Awareness and Coordin Component 1II.A: Public Awareness - -- Coordinated communications process involving MARA, MOH, Ministry o f Interior addressing information /communication needs o f priority audiences, during pre- pandemic and pandemic A-I phases; -- Informed at-risk communities adopting safe health practices, reporting, and contributing to outbreak control actions; -- Educated citizenry, aware of the impact and social containment measures needed if A I escalates across pandemic phases

Use of Intermediate Outcome Monitoring

Component 1II.B: Coordination Support - Coordination and management o f project implementation and M&E activities carried out in a professional manner

L P * - v ia reports from technical and eriodically und;.i;taken -

social audit teams (as required). T h e actual composition o f teams TBD, but likely would draw

Component 1II.A: Evidence* o f t imely and satisfactory progress toward delivery o f Component 1II.A outputs, as compared to the original plan, including specific indicators as follows:

Political and civic leadership organized around a national strategic risk communication plan;

Research-based risk communication strategies and products, responding to the needs o f priority audiences;

Consistent awareness-raising and behavior change interventions with population at risk using appropriate communications channels;

% change in reported hygiene and sanitation behaviors; Communications strategies and products highlighting the action

sand investments o f participating ministr ies and the mobilization o f group resources to contain the epidemic, generating social trust and credibility;

technologies, to promote reporting o f outbreaks, fast response and an uninterrupted social dialogue;

Production and dissemination o f informational products that educate priority audiences about possible scenarios and mitigation

Evidence o f consistent communication and information

and control actions to be undertaken. Component 1II.B: Evidence* o f t imely and satisfactory progress toward delivery o f Component 1II.B outputs, as compared to the original plan, including specific indicators as follows:

disbursement reports, audits, management and financial reports prepared and submitted periodically

Methodology defined and monitoring and evaluation

Program reports, financial monitoring, procurement and

Component 1II.A: To verify satisfactory and timely progress in, or completion o f Component 1I.A.

Component 1II.B: To verify satisfactory and timely progress in, or completion o f Component I1 I. B.

41

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ANNEX 4: DETAILED PROJECT DESCRIPTION


I. ANIMAL HEALTH COMPONENT

1. The Project wil l support activities proposed by Turkey. to cover the needs in the short, medium or long-term, and ranging from prevention, to control and eradication o f HPAI. These proposed measures comprise an integrated package maximizing the possibilities o f success based on a detailed assessment of the particular conditions, constraints and possibilities o f the country (including a rapid assessment o f veterinary services and recent assessments o f the poultry sector). In general, these activities fa l l into three major areas:

0 Improvements to the national pol icy framework, development o f strategies and

0

0

increasing preparedness. Strengthening disease surveillance, diagnostic capacity and applied research. Carrying out outbreak containment plans and restructuring o f the poultry sector.

A. National policy framework and development of a national strategy

A1 : Policy development and enabling environment

2. To ensure that disease control, prevention and eradication measures are implemented in a uniform and effective way and in accordance with OIE standards and guidelines, improvement in the regulatory framework and the harmonization and rationalization o f animal health governance and policy issues will be addressed. These are related to bio-security, vaccination, control o f animal movement, border control, culling and disposal o f carcasses, compensation, restructuring o f poultry industry, compartmentalization and zoning, and other regulations related to the poultry sector. Thus, the Project wil l support definition o f disease control options and reviews and strengthening o f existing regulations and policies, and will fund related pol icy studies and dissemination workshops. The main outputs will be a detailed assessment o f the capacity o f i t s veterinary services and an integration o f the AI contingency plans o f the MARA and the M O H into a National AI Strategy. (US$ 0.59 million)

A2: Epidemiology and disease information systems

3. In this area, the Project will support epidemiological studies and surveillance programs to inform the improvement of disease control measures, which will be then adjusted and improved as new information becomes available. I t will also support the linking o f the laboratory information systems of Turkey’s eight Veterinary Control Research Institutes (VCRIs) to the existing module o f the World Animal Health Information System (WAHIS) maintained by the MARA General Directorate for Protection and Control (GDPC). This will better enable Turkey to participate in global disease information sharing, complying with their obligations as members o f the OIE. Epidemiological studies wil l include a focus o n scaling up the knowledge base o f the Ministry o f Environment and Forestry on movement o f migratory birds in the main areas o f their known transit. The disease information system will be l inked with rapid and standardized

50

methods o f routine analysis of surveillance data in order to track important changes in the H5N1 situation and promptly supply this information to field personnel. (US$ 0.48 million)

B: Strengthening Disease Surveillance and Diagnostic Capacity

B1: Strengthening Animal Disease Surveillance and Diagnostic Capacity

4. Project support in this area wil l aim at strengthening the capacity o f the MARA GDPC and its affiliated reference and regional diagnostic laboratories in detection, reporting and follow-up o f reported AI cases. This will cover the formation and equipping o f Bio-Safety Level 3 laboratories in Bornova and Pendik, as wel l as equipment (incubators, laminar f low cabins, etc.) for six regional laboratories (Ankara, Konya, Adana, Samsun, Erzurum and Elazig). Consumables and reagents will be fbnded as needed for the implementation o f the National AI Surveillance Program and for regional laboratories and Provincial Directorates o f Agriculture PDA linked to these laboratories for executing their roles in the MARA AI Contingency Plan (rapid serological tests and screening surveys and virological tests for confirmation and serotyping o f A I strains). The costs o f funded activities (US$ 2.85 million) are composed as follows:

Cost in US$ Needs of National Reference Laboratory (Bornova, Pendik) Laboratory Equipments 957,400

3 18,528 Rapid Test Kits and Consumables Laboratory Rehabilitation 650,000 Needs of Regional Laboratories (Etlik, Konya, Adana, Samsun, Erzurum and Elazig) Laboratory Equipments 485,600 Test Kits 133,650 Laboratory Rehabilitation 300,000 Total 2.845.178

B2: Veterinary Services Training and AI Surveillance

5. Training wil l target the personnel o f the MARA General Directorate for Protection and Control, including those o f the VCRIs and the affiliated staff in the Provincial Directorates o f Agriculture which will be expected to form the local Expert Groups o f the Local Disease Crisis Centers (LDCCs). The focus o f the training will be on screening, sampling, and test procedures to be applied in case o f an outbreak, as well as on analyzing epidemiological data and performing risk assessments. Supported activities wil l also cover an init ial self-evaluation o f veterinary services, following OIE standards o n quality and evaluation o f veterinary services to meet international requirements. Increased risk-based AI surveillance activities will also be supported at the provincial and district levels, coordinated through the VCRIs. (US$ 2.01 million)

C. Outbreak Containment Plan

6. The sub-component will provide support to activities related to the implementation o f the MARA Contingency Plan for Avian Influenza which details the containment plan for AI

51

outbreaks. The Contingency Plan details the roles o f the National Diseases Crisis Center (NNDC) coordinated by the Head o f the Animal Health Department o f the MARA Protection and Control General Directorate (GDPC), the Local Disease Crisis Centers (LDCCs) set up on the basis o f Animal Health Sections o f the Provincial Directorates o f Agriculture (PDAs), and the National and Local Expert groups. Section 8 o f the Contingency Plan contains the operational manual for the containment plan. The sub-component wil l include the following activities:

C1: Targeting virus eradication at the source

7. Turkey’s HPAI control programs include the principle o f targeting the disease at the source o f infection. This refers predominantly to the backyard poultry sector. Wild birds are also implicated as reservoirs o f disease, but the Project does not address the eradication o f avian influenza viruses in avian wildlife. Policies associated with this sub-component that the Government o f Turkey has already introduced and would trigger in outbreak areas include: enhanced bio-security at poultry farms and associated premises, through bio-containment and bio-exclusion, and control o f movement o f birds and products that may be infected, including controls at the interface o f infectednon-infected areas and border controls.

8. support the fol lowing activities:

In order to target the eradication of the disease at the source o f infection, the Project wil l

(a) culling o f infected and at-risk poultry and compensation to farmers and producing companies (at the full current value o f their culled poultry) through the establishment o f a US$ 5 mi l l ion compensation fund;

(b) disposal o f carcasses and potentially infective materials in a bio-secure and environmentally acceptable manner through roughly 15 mobile incineration plants deployed to districts with AI outbreaks. (approximately U S $ 500,000 per plant, plus related containers, totaling US$ 8.09 million)

9. Assuming producer prices o f roughly 2.3 TLkg, l ive weights o f 1.5 kg per animal, and a 75 percent compensation rate, the init ial $5 mi l l ion reserve .fund would be able to cover the culling o f 2.5 mi l l ion birds (about 1 percent o f average poultry stocks). However, the role of the reserve is to assure the public (both producers and consumers) that a formal compensation pol icy has been devised, with operational procedures well defined and publicized, and ready to be used. Over time once producers are assured that the reserve fund i s wel l organized, administered in a timely manner, and effective in attracting backyard producers to bring forth potentially infected poultry animals, the Government o f Turkey may work out a mechanism whereby commercial poultry producers pay into the reserve fund, basically as a form o f “insurance premia”. Given the high potential losses from even a small, localized outbreak, commercial poultry producers would likely be willing to pay a small insurance premia o f this type if the overall AI Strategy were being well implemented.

10. The incineration plants to be deployed for disposal o f infected and suspect poultry in an outbreak situation would be owned and managed by the GDPC. The costs o f running these incinerators would be shared by the national budget and provincial budgets (with a relevant

52

policy o n this cost sharing to be worked out). In times o f outbreak, disposal o f infected and suspect animals would be done without costs to poultry producers.

C2: Veterinary personnel safety

11. Due to the highly pathogenic nature o f the HPAI virus to humans, particularly the Asian H5N1 strain, training o f people in contact with live virus wil l be supported. This would include field workers involved in identification o f the disease, farm workers involved in culling and disposing o f animal carcasses and manure, laboratory workers involved in virus isolation and diagnosis. Adequate resources wil l be allocated for training and equipment (biosafety hoods and appropriate personal protective clothing). (US$ 2.85 million).

Cost in US$ Equipment Needs o f 2946 Staff (70 items) 1,071,091 Equipment Needs o f 982 Teams (222 items) 1,527,754 Disinfections for the Teams (40 items) 255,320 Total 2,854,165

C3: Restructuring the Poultry Sector

12. Restructuring the poultry sector i s an important strategy to guard against the damaging effects o f HPAI, but also one o f the most complicated interventions to be undertaken since it requires taking into account the structure o f backyard versus commercial poultry production, marketing characteristics, and potential socioeconomic impact. Although backyard poultry accounts for no more than 15 percent o f production in Turkey, the ban on marketing o f live backyard poultry has necessitated a ban on the marketing o f l ive poultry layers (which are mainly in the commercial sector) in order to ensure compliance by backyard poultry producers. Thus, restructuring pol icy needs to carefblly consider this linkage. In any case, restructuring should be a gradual process, coordinated with an overall disease control strategy that includes bio-security, zoning and/or compartmentalization, and possibly vaccination, and be based on the following factors and principles:

0 Well-defined socio-economic impact analysis, taking into account the interests o f a l l stakeholders, particularly smallholder poultry farmers;

0 Public awareness to gain full support f rom these stakeholders (producers, consumers, government agencies, private sector institutions);

0 Market forces should drive the restructuring strategy taking into account commercial and smallholder poultry producers.

0 Public and private sectors should collaborate and be transparent in implementing restructuring strategies.

13. In this context, restructuring the poultry sector in Turkey wil l focus on the reduction o f the practice o f backyard poultry raising, improving the opportunity for slaughtering o f layers (and subsequent processing and rendering), and promoting manure management o f backyard poultry that i s in conformity with existing environmental regulations. Reduction o f backyard poultry farming could take the form of banning such farming in protection bands around known

53

areas o f high prevalence of migratory birds and investments in improving bio-security (penning o f animals and closing up of barns) in small contracted poultry farms. Since it would be extremely costly for the state to fund widespread programs for poultry sector restructuring, the introduction o f restructuring modalities will be piloted under the Project with matching grants to farms and enterprises provided under a competitive proposal submission and award process (with at least 50% co-financing by private beneficiaries). (US$9.0 million)

11. HUMAN HEALTH COMPONENT

14. In the public health field, short-and long-term actions need to be taken and an appropriate balance struck between the two. Immediate action is needed in a number o f areas, but there i s also a longer-term agenda given systemic shortcomings with respect to core public health functions. Work o n both the short- and long-term fronts, therefore, needs to proceed in parallel, and efforts should be made to ensure that short-term responses are consistent with and contribute to proposed longer-term interventions. Setting priorities in both cases is essential.

15. Building an effective national public health response wil l require an enabling environment and the necessary resources to bring proven interventions quickly up to nationwide scale. Thus, the Project wil l help to operationalize some elements that are contemplated as part o f the global strategic plan, expanding and intensifying the responses rapidly. As it i s unlikely that the global spread of a pandemic influenza virus could be prevented once it emerges, the emphasis i s on reducing i t s impact. Several tools can help achieve this aim: (i) year-round surveillance; (ii) effective and accurate methods of diagnosis; (iii) social distance interventions; (iv) vaccines (once they become available); (v) anti-viral drugs; and (vi) strengthened medical services. The interventions supported under the Project are based on Turkey's epidemiological and programmatic needs, and well-assessed options for meeting them. The interventions will be grouped in three broad categories:

A. Enhancing Program Planning and Coordination

16. The Ministry o f Health in Turkey already has a draft National Act ion Plan for Influenza (NIAF'). The NIAF' foresees the establishment of inter-sectoral command and control system structures and provides the legal basis for an effective response. The project will support meeting the resource requirements for field-testing (e.g., simulation exercises) and implementation involving regional and local levels, as wel l as supranational levels. More specifically, the project wil l support training of health personnel, provincial and local level meetings and workshops and procurement o f protective gear, clothing and sample transportation containers, upgrading o f drug storage facilities, and improving health information and telecommunication systems through the Public Information Center (SASIM) and the Crisis Management Center at the Ministry o f Health. (US$ 14.88 million)

54

Cost in US$ Protective Gear and Clothlng 7,778,000 Notebook Computers for staff involved in AI-PI interventions 50,000 Training for Province Health Managers and Communicable Diseases Division Chiefs 40,000 National EIS training 500,000 Regional, Provincial and Scientific Meetings 400,000 Preparation, Publication, and Dissemination o f Training Materials 300,000

Sample Transportation Containers 165,060 Prevention and Case Management (Drug Storage Facility) 1,250,000 SABIM Facilities Rehabilitation 500,000 SABIM ICT Hardware and Software 1,500,000

1,000,000 1,200,000

Total 14,883,060

Field Supervision Trips 200,000

Crisis Management Center Facilities Rehabilitation Crisis Management Center Communications Equipment and Software

B. Strengthening National Public Health Surveillance Systems

17. The detection o f novel influenza strains is done through clinical and virological surveillance o f human and animal influenza disease. Expanding influenza surveillance i s needed to provinces and areas where outbreaks o f HPAI was reported, specifically including: (i) active surveillance for influenza-like illness (ILI) in areas with reported HPAI outbreaks; (ii) collection of specimens for diagnostic testing and virus sub-typing; (iii) confirmation o f positive and a certain proportion o f negative results in a reference laboratory; and (iv) outbreak investigation in areas with confirmed human cases. To this end, the proposed Project wil l support:

B1: Improvement of Laboratory Networks

18. In Turkey there are two national reference public health laboratories for virology which act as National Influenza Center (NIC). Under this sub-component, financing will be available to upgrade existing national reference laboratories (NRL), including design, renovation and upgrade to Bio-Safety Level 3 (BSL-3) laboratory with concomitant physical containment requirements (P3), required for virus isolation and sub-typing to determine various strains. In addition, financial support will be provided to upgrade 7 regional public health laboratories to BSL-2 for rapid diagnosis and cell culture. Final ly support will be provided for procurement o f consumables and laboratory supplies (US$5.3 1 million).

Cost in US$ P3 Laboratories 1,398,600 Laboratory Equipment for Reference and Regional Laboratories 699,728 Additional Equipment for Regional Laboratories Test Kits, Reagents, and Laboratory Supplies

900,000 1,708,072

Central Laboratory Rehabilitation 600,000 Total 5,306,401

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B2: Training

19. Assistance will be provided to train staff at different levels o f the healthcare system in outbreak investigation and surveillance, case finding, laboratory diagnosis, laboratory bio-safety to improve the coordination between the public health agencies and the veterinary departments and facilitate jo int simulation activities (US$ 0.55 million).

Cost in US$ Lab Technicians Training 51,125 Training o f SABIM Call Operators 500,000 Total 551,125

C. Strengthening Healthcare System Response Capacity

20. Non-pharmaceutical containment measures such as social distancing may contain pandemic spread and allow time for response measures. Therefore, the project wil l indirectly support through the implementation o f the NPIAP, “social distancing measures” -- such as quarantine, ban on mass gatherings and travel restrictions, backed up by a well-designed communication strategy. Additional preventive actions for health care workers involved in case detection, transportation and management such as distribution and use o f protective gear and masks will be supported, along with increased awareness and promotion o f community participation in slowing the spread o f the pandemic. (US$ 0.1 mil l ion)

111. PUBLIC AWARENESS AND COORDINATION SUPPORT

2 1. This component wil l support strategic communication activities for stakeholders and beneficiaries. Similarly, resources wil l be allocated for improved coordination between MARA’s regulatory framework and contingency plans, and the MOH’s National Pandemic Influenza Action Plan (NPIAP) (US$ 2.78 million)

A. Public Awareness through Information and Communication Services

22. Support under this sub-component wil l be provided for the research, design, implementation and evaluation o f an integrated communications strategy, addressing the needs o f priority populations at the national, provincial and local levels. The strategy will elevate knowledge and promote behavior-change in populations at-risk, to control the spread o f the virus, prevent infection, foster timely reporting and support containment actions. At the same time, the strategy wil l educate vulnerable groups o n preparedness plans and mitigation measures across pre-pandemic and pandemic phases. The communications strategy will incorporate measures called for in the Environmental Management Plan (EMP) for safe culling and disposal o f backyard poultry. (US$ 0.81 million)

23. Specific actions to be supported under this sub-component include:

a) create communications capacity and allocate resources in the MARA and MOH to research, design, produce and implement communication strategies, according to the needs o f priori ty

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audiences. This i s intended to generate trust and credibility in the public response; preparedness for possible scenarios; foster an enabling environment for rapid reporting and containment efforts; promote understanding o f public policies to be enacted; provide for informed public participation; enable accurate and fast response to media requests; etc.

b) produce educational materials and products to support the activities o f the agricultural, rural development and health staff o f MARA, MOH and provincial authorities, working in at-risk and vulnerable regions; secure the participation o f community-based organizations in the design and testing o f materials to insure their effectiveness; research, inform and change risk- behaviors/practices; address the socio-economic and gender dimensions o f the rural poor.

c) invest in the existing infi-astructure of the call-in centers (such as SABIM), to facilitate social engagement, monitoring and evaluation o f the agricultural and health interventions.

d) develop informational and educational material for vulnerable populations about preventive health practices, containment measures and preparedness plans, during outbreaks and pandemic phases; highlight the investments and actions undertaken by the public and private sector to reduce the risk; assign spokespersons to the different “crisis management centers,” to manage a transparent disclosure pol icy at al l times; provide training courses in communications methodology to staff responsible for these activities; prepare and be ready to implement “risk- communication” activities when necessary.

e) negotiate in advance, with broadcasting and local communication agencies (formal and informal), media plans, budgets, responsibilities and designated spoke-persons; train the media o n the nature o f A-I and likely scenarios; involve the private sector, specially the eommercial- poultry sector, in the communications efforts; facilitate donor-coordination in the communication response.

B. Coordination Support

24. The multi-dimensional problems associated with H P A I infection necessitate collaboration from a wide range of stakeholders within each country, which in Turkey include: the State Planning Organization, the Undersecretariat o f the Treasury, the MARA, the MOH, their associated diagnostic laboratories, provincial authorities, NGOs and c iv i l society organizations, and private sector companies and associations (e.g. large poultry production companies, farmers’ associations, veterinarians and farmer involvement at the grass roots level). The sub-component wil l support activities to improve the effective coordination and collaboration among these stakeholders and to bolster project implementation and monitoring capacity at existing project implementation structures in the MARA and MOH.

B1. National Coordination

25. The National Zoonotic Disease Committee wil l be responsible for reviewing annual work plans and ensure coordination and linkages across relevant agencies and international partners. In AI outbreak situations, i t wil l be in charge o f triggering emergency responses by MARA and MOH, monitoring the actions taken, and coordinating public statements to the media. The

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N Z D C will be assisted by a Public Information and Communication Specialist,. (US$ 0.21 million)

B2. Project Implementation

26. The Central Execution Unit (of the Agricultural Reform Implementation Project) in the MARA and the Project Implementation Unit o f the Health Transition Project (MOH PIU) in the MOH will be entrusted with the fiduciary tasks o f procurement and financial management. The relevant structures wil l be strengthened with 3-4 additional fiduciary staff at most in each Unit. Both the MARA and the M O H will appoint Project Coordinators to liaise with the MARA C E U and MOH PIU, respectively, and to prepare annual work programs and budgets as well as semi- annual project reports. The Project Coordinators wil l manage the respective component for which their ministry i s responsible and attend the regular meetings o f the National Zoonotic Disease Committee. The MARA C E U wil l be responsible for consolidating the annual work plans and budgets for submission to the N Z D C and the Bank. (US$ 1.25 million)

27. At the local level, implementation would be the direct responsibility o f each Provincial Directorate o f Agriculture (PDA) and Provincial Directorate o f Health (PDH). At times o f outbreaks, the provincial governor wil l guide implementation o f cross-sectoral activities, and if necessary set up local disease crisis centers to ensure cross-sectoral coordination.

B3: Monitoring and Evaluation (M&E)

28. Support would be provided to enable project monitoring and impact evaluation assessments. Two types o f M&E are envisaged. First, the MARA C E U and the M O H PIU would collect relevant data from their ministries and other implementation agencies and then compile them into semi-annual progress reports focusing on output indicators and the status o f physical implementation by component and use o f project finds. For some output indicators, specific surveys wil l need to be conducted to obtain data for this purpose. These would be financed by the Project. The MARA C E U wil l be responsible for consolidating the ministerial progress reports into an integrated Project progress report. (US$0.51 million)

29. Impact evaluation reports. The aim o f evaluation i s to find out whether the interventions are effective or the program i s having the desired impact. The evaluation will include both quantitative and qualitative aspects and be conducted o n a yearly basis. The quantitative aspects wil l rely on new information systems and surveys implemented as part o f the various components o f the project, currently existing data sources, and primary evaluative data collection efforts. The goal of the qualitative aspect o f the evaluation wil l be to document perceptions o f program managers, staff, patients, and local and national leaders. Qualitative information wil l be collected using site-visit interviews, focus groups, and respondent surveys.

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ANNEX 5: PROJECT COSTS


Local Foreign Total U S $million U S $million U S $million Project Cost By Component and/or Activity

1. Animal Health Component 15.36 15.50 30.86 2. Human Health Component 9.35 1 1.49 20.84 3. Public Awareness and Communication Support 1.93 0.85 2.78 Total Baseline Cost 26.64 27.84 54.48

Contingencies 0.35 0.36 0.71 Total Project Costs 26.99 28.20 55.19

Front-end Fee 0.09 0.09 Total Financing Required 26.99 28.29 55.28

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ANNEX 6: IMPLEMENTATION ARRANGEMENTS


1. The Project wil l be implemented by existing project implementation structures in the MARA and the MOH. However, public information and project coordination arrangements wil l be overseen by the existing National Zoonotic Disease Committee. This Committee has been established to deal with zoonotic emergencies and wil l provide general policies and guidelines for Project implementation. This Committee has been established jo int ly by the MARA and the MOH to deal with zoonotic emergencies and wil l provide general policies and guidelines for Project implementation. The Committee comprises representatives o f the MARA, the MOH, and other relevant ministries, agencies, and academic institutions. The Committee will review annual work plans and ensure coordination and linkages across relevant agencies and international partners.

2. the the

Since the Bank i s financing both agricultural sector and health sector projects in Turkey, existing project implementation structures within the MAR4 (the Central Execution Unit o f

Agricultural Reform Implementation Project, CEU) and the MOH (the Health Transformation Project Implementation Unit, MOH PIU) wil l be entrusted with fiduciary tasks o f procurement and financial management. (Additional staff will to be recruited in the MARA C E U and the MOH PIU as needed for these fiduciary tasks.) One senior officer from the MARA and one from the M O H wil l be designated as Project Coordinators in .charge o f managing implementation o f their relevant ministries’ project activities and liaising with the MARA C E U and MOH PIU, respectively. These Project Coordinators will make reports to the NZDC. A Public Information and Communication Specialist (consultant) will be recruited to support the public information efforts o f the NZDC.

3. The Project Coordinators wil l be responsible for the preparation o f annual work programs and budgets and monitoring project implementation at the central and local levels. The MARA C E U and the MOH PIU wil l assist the Project Coordinators in preparation o f semi-annual project progress reports for the two ministries. The MARA C E U wil l be responsible for consolidating the annual work plans and budgets for submission to the N Z D C and the Bank.

4. At the local level, implementation wil l be the direct responsibility o f each Provincial Directorates o f Agriculture and Health, both o f whom should report to the same Deputy Governor o f the province (currently these Departments report to separate Deputy Governors). The Deputy Governor wil l be the key provincial off icial to be in contact with the N Z D C in times o f AI outbreak or other emergency situations. The existing provincial level coordination units comprising officials from the Provincial Directorates o f Agriculture and Health will work under the supervision and guidance o f the NZDC.

5. A Project Operational Manual (POM) i s being prepared to integrate the relevant aspects o f each o f the Contingency Plans which have been prepared by the MARA and the MOH. This POM will guide the management and implementation o f the Project and be updated as Turkey’s National Strategy for Avian Influenza and Human Pandemic Preparedness and Response i s finalized and updated periodically during the course o f the Project.

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ANNEX 7: PROCUREMENT, FINANCIAL MANAGEMENT, AND DISBURSEMENT ARRANGEMENTS

Procurement Method

1. ICB

2. LIB 3. NCB

3. Shopping

4. Shopping (for emergency)

5. Direct Contracting

6. Commercial practices


Procurement Method Threshold Prior Review Comments

> $ 1,000,000 - goods > $ 10,000,000 -works

< $1,000,000 - goods < $ 10,000,000 -works

Threshold All

All Goods >$500,000 Works >$ 5Million Plus- First two contracts o f Goods and Works

< $100,000 - goods None < $ 100,000 - small works < $2,000,000 - goods in urgent All contracts With Bank needs above <$500,000 Prior

approval All

10 % of the total contracts

A. Procurement

1. General. Procurement under the Project will be carried out in accordance with the Bank’s “Guidelines: procurement Under BRD Loans and IDA Credits” dated M a y 2004, and “Guidelines: Selection and Employment o f Consultants by World Bank Borrowers” dated M a y 2004, and the provisions enumerated below and stipulated in the Legal Agreement. The agreements covering procurement methods and thresholds have been determined for Turkey according to its capacity and experience with Bank procurement. The procurement agreements have been appraised and detailed in the procurement plan for the entire project period and summarized below. The General Procurement Notice i s to be issued o n or about April 15,2006.

2. Procurement wil l be accelerated in the first six months o f the Project by allowing Shopping procedures to be used for a certain number o f emergency contracts, whose size would usually be above the normal ceiling for Shopping. These cover mainly the following: safety gear for veterinary personnel; protective materials kits for M O H staff; two mobile incineration plants and related containers for culling and other goods with high urgency.

3. Goods and Works and Non-consulting (Technical) services

a) Prior Review Threshold: Procurement Decisions subject to Prior Review by the Bank as stated in Appendix 1 to the Guidelines for Procurement:

b) Pre-qualification: Not applicable

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c) Proposed Procedures for CDD Component: Not applicable

d) Reference to Project OperationaYProcurement Manual: N o t applicable

e) Any Other Special Procurement Arrangements: In order to address emergency needs; for high urgency items, goods estimated cost up to $2,000,000 per contract, may be procured under “Shopping” procedures with the Bank’s prior approval.

Procurement o f goods, works and services for restructuring o f poultry sector under the sub-projects (maximum o f $25,000) to be implemented by small farmers (with a maximum o f $ 25,000 per sub-project) and sub-projects to be implemented by small and medium sized enterprises (with a maximum o f $ 1,250,000 per sub-project) shall be carried out through commercial practices (CP) established in the country in accordance with paragraph 3.12 o f the Procurement Guidelines.

Logistic services required for the International and National Symposium, Seminars, Workshop, and other training programs shall be procured by Shopping procedures. In case o f very large International Symposiums and training programs shopping threshold may be increase on a case by case basis subject to Bank’s no objection.

The works contracts to cost less than $10,000,000 per contract and the Goods manufactured within the country and readily available in the local market to cost less than $ 1,000,000 per contract may be awarded through N C B . Any ambiguity regarding predominance o f the Bank’s procurement rules below from paragraph (i) to (xi) shall be discussed at the negotiations and made part o f the Loan Agreement.

i) Eliaibilitv

Bidding shall not be restricted to domestic bidders. N o restriction shall be applied to foreign bidders who wish to submit a bid.

ii) Procedures

Invitations to bid shall be advertised in the Off icial Gazette or in at least one widely circulated national daily newspaper or in an electronic portal o f free access allowing a minimum o f 30 days for the preparation and submission o f bids.

iii) Assessment o f the bidder’s qualifications

Where pre-qualification i s not used, the qualifications o f the bidder who is recommended for award o f contract shall be assessed by post-qualification, applying minimum experience, technical and financial requirements which shall be explicitly stated in the bidding documents and which shall be determined by a ‘pasdfail’ method.

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iv) Participation bv Government-owned Enternrises

Government-owned enterprises in the Republic o f Turkey shall be eligible to participate in bidding only if they can establish that they are legally and financially autonomous, operate under commercial law and are not a dependent agency of the Government. Furthermore, they wil l be subject to the same bid and performance security requirements as other bidders.

v) Participation by Joint Ventures

Participation shall be allowed from joint ventures o n the condition that such joint venture partners wil l be jointly and severally liable under the Contract.

vi) Bidding Documents

Procuring entities shall use the Bank’s sample N C B documents for E C A Region for Works and Goods and shall draft contract and conditions o f contract acceptable to the Bank.

vii) Bid Evaluation

Evaluation o f bids shall be made in strict adherence to the monetarily quantifiable criteria declared in the bidding documents and a merit point system shall not be used. Extension o f bid validity shall be allowed once only for not more than 30 days. N o hrther extensions should be requested without the prior approval o f the Bank. Contracts shall be awarded to qualified bidders having submitted the lowest evaluated substantially responsive bid. N o domestic preference shall apply under National Competitive Bidding.

viii) Price Adjustment

Works contracts o f long duration (e.g. more than eighteen (18) months) shall contain an appropriate price adjustment clause.

ix) Reiection o f All Bids All bids shall not be rejected and new bids solicited without the Bank’s prior written concurrence.

x) Contracts All contracts shall be in writing, signed and stamped by authorized signatories o f the Purchaser and the Supplier and contain identical terms and conditions o f contract to those included in the tender documents.

xi) Securities

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Bid Securities should not exceed 3 % (three percent) o f the estimated cost o f the contract; Performance Securities not more than 10 % (ten percent). No advance payments shall be made to Contractors or Suppliers without a suitable Advance Payment security. The wording o f a l l such securities shall be included into the bidding documents and shall be acceptable to the Bank.

Selection Method

1. Competitive Methods (Firms) QCBS/QBS/LCS/CQS

4. Selection of Consultants

Prior Review Comments Threshold

> $350,000 The first two QCBS contracts are subject to pr ior review

a) Prior Review Threshold: Selection Decisions subject to Prior Review by Bank as stated in Appendix 1 to the Guidelines Selection and Employment o f Consultants.

2. 3.

irrespective o f contract amount Single Source (Firms) All Individual Consultants > $100,000 The f irst two individual

No. Expected outcome / Activity Description

1 Procurement Training during Project Launch Workshop

consultant contracts and al l single source contracts are subject to Bank pr ior review irrespective o f contract amount

Estimated Estimated Cost ($) Duration Comments

- Two days To be provided by PAS

b) Short list comprising entirely of national consultants: Shortlist o f consultants for services, estimated to cost less than $ 200,000 equivalent per contract, may comprise entirely o f national consultants in accordance with provisions o f paragraph 2.7 o f the Consultant Guidelines.

c) Any other Special Selection Arrangements: Not Applicable

5. Implementing Agency Capacity Building Activities with Time Schedule. MOH PIU wil l be supported by the Project Management Support Unit (PMSU) o f the MOH in executing procurement o f the M O H portion o f the project. The P M S U have procurement specialists in place for the HTP and these arrangements will be relied until procurement specialist recruited for the MOH PIU from the proceeds o f the AIHP Loan. The Central Execution Unit (CEU) o f MARA is currently responsible for the implementation o f some o f the components o f the Agricultural Reform Implementation Project (ARIP) and will be responsible for the implementation o f the Animal Health component o f the AIHP project. The MARA C E U and MOH PIU will recruit a procurement specialist, disbursement officer and F M S consultants and relevant support staff for the implementation o f the AIHP project.

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B. Financial Management and Disbursement

6. Financial Management Arrangements. The Animal Health component will be implemented by the Ministry o f Agriculture and Rural Affairs (MARA), the Human Health component by Ministry o f Health (MOH) and the Public Awareness and Communication Support component by the National Zoonotic Disease Committee. The Project Implementation Unit (PIU) in MOH will be responsible for the implementation o f the Human Health component o f the AIHP project.

7. The Central Execution Unit (CEU) o f MARA is currently responsible for the implementation o f some of the components of the Agricultural Reform Implementation Project (ARIP) and wil l be responsible for the implementation o f the Animal Health component o f the AMP project as well as the project’s overall financial management. The Public Awareness and Communication Support component of the project wil l be overseen by the NZDC. This component forms a very small portion of the project and therefore the financial management arrangements for this component wil l be carried out through the C E U at MARA. Therefore, to ensure effective f low of funds, it is important to have the budget for this component under the MARA budget as well.

8. The MOH PIU and C E U will be responsible for assuring that the Project establishes and maintains: (i) adequate accounting systems and procedures; (ii) funds f low mechanisms including timely disbursement o f funds, and timely payments for goods and services; (iii) regular reporting on the use o f funds; and (iv) appropriate arrangements for regular financial audits. These responsibilities wil l be described in detail in a financial management manual by each ministry. The MOH PIU i s currently one o f the implementing agencies o f Health Transition Project and has established key internal control mechanisms on the application and use o f finds. The staff in the MARA C E U has experience in a prior IBRD financed project and established the necessary mechanisms for the AIHP project. The C E U wil l also be responsible from the payments made under the third component and for the reporting o f such transactions. Each ministry wil l be responsible for project financial management and will submit reports to the Bank. Additionally, the C E U will have the responsibility for establishing internal control procedures for the compensation payments to fanners, which will be developed to respond to specific r isks associated with this sub-component o f the project.

9. Disbursement and Funds Flow Arrangements. There will be two Special Accounts for the project for disbursements f rom the World Bank loan one for MOH and one for MARA. The Special Accounts wil l be in Euro and will be opened at the Central Bank o f Turkey. Disbursements from the loan will follow the transaction-based method i.e. the traditional Bank procedures (Statements o f Expenditure (SOEs), Direct Payments, Special Commitments). The financing percentage for the project will be 100 %, and therefore a l l payments to the contractors, suppliers and consultants will be made from this account. For certain payments, above the Minimum Application Size, as specified in the Disbursement Letter, the MOH PIU and C E U would submit withdrawal applications to the Bank for payments to suppliers and consultants directly from the Loan Account. Both the MOH PIU and C E U wil l specify authorized signatories, and payments from the special accounts will be made with the approval o f these authorized staff.

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Allocation of Loan Proceeds and Financing Percentage Expenditure Category Amount in Euro

(1) Goods (a) under Part I o f the Project (b) under Part I1 o f the Project

(c) under Parts 111.1 and 111.2 o f the Project

(2) Works

7,970,000

6,290,000 370,000

Financing Percentage

100%

100%

I I I

, I

(a) under Part I o f the Project

(b) under Part I1 o f the Project 760,000

2,700,000

(4) Compensation Fund under Part I. 3(a) o f the Project I 3,970,000~ 100%

(3) Consultants’ services (a) under Part I o f the Project

(b) under Parts I1 and 111.3 o f the Project (c) under Parts 111.1 and 111.2 o f the Project

100%

530,000 1,820,000 1.130.000

(5) Poultry Restructuring Sub-projects 990,000 50%

10. The project includes a compensation payment for farmers sub component to be used if such a need arises. Under this component, the C E U will receive and process requests for payments to the eligible farmers. The C E U wil l document the procedures to verify the eligibility o f the farmers and the accuracy o f the requests, as well as the payment procedures and the accounting o f such transactions in a manual. The General Directorate o f Protection and Control (GDPC) o f MARA has prepared a contingency plan for avian influenza. The plan includes basic guidelines for actions to be taken when an avian influenza pandemic arises. However, currently, i t does not include any financial management components since compensation payments were not envisaged. The C E U wil l review the documents included in this plan and will integrate the related internal control procedures for registering payments. Documents such as the ‘AI Epidemiological Inquiry Form’ completed by the Off icial Veterinarians o f PDA and the

(6) Operating Costs (a) under Parts 111.2 o f the Project (b) under Part 111.3 o f the Project

(7) Unallocated

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100% 120,000 100,000

550,000 100%

Laboratory Veterinarians can be used as an internal control tool as they include detailed information o n the farm and the number o f birds and species present in the farm.

1 1. In addition to that, when a farm i s put under restriction for suspicion o f AI, the document also includes a section providing information relating to the total number o f birds, total number o f ill birds, total number o f dead birds and total number o f birds depopulated. A pre-audit i s not envisaged since these payments will not be made on a regular basis but only when the animals are declared and submitted to the authorities for culling. These procedures wil l be detailed in the compensation payments section o f the financial manual.

12. Internal controls. The MOH PlU and the C E U will maintain an effective internal control system to ensure that project expenditures are properly authorized, supporting documents are maintained; accounts are reconciled periodically; project assets are safeguarded, and compensation payments are properly accounted for. Although project accounting will in o n the cash basis, detailed assethnventories register will be maintained as part o f the project internal control procedure. The PIU and MARA C E U wil l implement appropriate controls over inventories o f drugs, vaccines, medical equipment, and other sensitive andor expensive assets will be especially important for the project.

13. In connection to the Compensation Payments to Farmers component, the minimum internal control procedures to be implemented before the f low o f funds would include the following:

0 The C E U wil l document in the financial management manual, mechanisms for

In the event o f a verified outbreak o f AI among poultry, the necessary culling and

identifying those eligible for compensation payments, as explained in paragraph 14 above, ensuring that there wil l be no multiple claims.

carcass disposal wil l be done under the supervision o f the General Directorate o f Protection and Control (GDPC) o f the MARAGDPC. The C E U will determine which documentation produced by local authorities wil l be used for processing compensation requests for condemned animals. The procedures that wil l be included in the financial management manual, should detail the guidelines to be followed both by the registered farms/commercial poultry producers and by smallholders/peasants/individual livestock owners separately.

There will be no vouchers or animal replacements. The most appropriate find f low would be channeling funds directly to the beneficiaries through Ziraat Bankasi upon receipt o f eligible requests. These f low o f funds arrangements st i l l need to be agreed upon with MARA for making compensation payments, but such arrangements would need to be ready before disbursement for this component. The C E U will allocate staff to perform periodic visits to the community/village level to review claims for compensation payment requests submitted and paid by the C E U and the results o f these visits wi l l be documents and filed at the CEU.

the effectiveness and efficiency o f compensation payments which will include a review o f the reasonableness o f the accounting, reporting and internal controls for that component.

0

0 Compensation payment to livestock owners wil l be in through bank transfers.

0 In addition, the external auditors wil l be asked to perform an operational audit o f

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14. Staffing. The M O H PIU has a two financial management staff experienced in World Bank procedures and these staffs will be responsible for the AMP financial management in MOH. However, there are no designated financial management staff currently working at the C E U even though the staff o f C E U are experienced in World Bank financial management procedures. There is a need to hire additional staff to the C E U to strengthen the existing capacity and to allow for periodic visits to the community/village level to review claims for compensation payments. The financial management staff o f the C E U will report to the head o f C E U and wil l be responsible for disbursement functions, as wel l as project accounting - maintaining books o f accounts, reporting day-to-day transactions and preparing accounting reports and financial statements including the semi-annual interim un-audited financial reports.

15. Financial Reporting. Both the MOH PIU and C E U wil l maintain records and will ensure appropriate accounting for the funds provided. The MOH PIU has currently an accounting software in use for HTP and wil l either use this software or excel spreadsheets for the accounting and reporting o f AMP project. The C E U will use integrated excel worksheets for project accounting as we l l as for generating the semi-annual and yearly reports.

16. Both the M O H P I U and C E U wil l prepare interim un-audited financial reports for the project. The interim un-audited financial reports wil l include: (a) Project Sources and Uses o f Funds, (b) Uses of Funds by Project Activity, (c) Special Account Statement, (d) Physical progress report, and (e) Procurement report. Interim un-audited financial reports will be prepared semi annually and wil l be submitted to the Bank no later than 45 days after the end o f period. The f i rst report wil l be submitted after the end o f the f i rs t full six months after initial disbursement. The format and content o f the interim un-audited financial reports wil l be incorporated to the FM manuals that wil l be prepared by each ministry.

17. There will be annual audits o f the project financial statements, covering al l aspects o f the project, including specific requirements for the compensation payments to farmers component. The audits will be performed by the Treasury Controllers, in accordance with International Standards o n Auditing (ISA), and the World Bank’s guidelines on auditing as stated in the guidelines: Annual Financial Reporting and Auditing for World Bank- Jinanced Activities (June 2003). The audit will include both the audit o f financial transactions, an assessment o f the internal control, funds flow mechanisms, and the reasonableness o f the accounting, reporting and internal controls in respect o f compensation payments. There wil l be two annual audit reports for the project; one for M O H and one for MARA and each will provide an opinion on the financial statements prepared by each ministry. The financial statements wil l incorporate the project accounts, including Special Accounts Reconciliation, and SOE Withdrawal Schedules; as wel l as Management Letters. The audit reports wi l l be submitted to the Bank not later than six months after the end of the fiscal year to which they relate. Both the MOH PIU and the C E U wil l provide the auditor with full access to project-related documents and records. Sample TORS for project audit will be included in the Financial Procedures Manuals.

Financial Audits.

18. There wil l be annual operational audits in order to obtain a professional opinion on the efficiency and effectiveness in implementation o f the Compensation Payments to Farmers component. Specifically, the review should include a review o f the

Operational Audits.

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mechanism for identifying the farmers who are eligible for receiving compensation payments and the procedures used affecting the payments to the beneficiary farmers. The verification should cover transactions on a sample basis to ascertain that the procedures actually used are transparent and comply with the Agreed Manuals, including selection o f beneficiaries, and that adequate tracking and monitoring mechanisms are in place for the transfer o f financial support to beneficiaries. The operational audit will be carried out by Treasury Controllers.

- - - - investment program 2. Budget. Ensure that the budget for the Public Awareness and Coordination component i s included in the MARA budget 3. Staf f ing o f t he FM Unit o f the CEU. Recruitment o f FinanciaYDisbursement Specialist. 4. FM Procedures Manuals. FM Manuals to fully document the procedures for accounting and internal control, including disbursement and f l o w o f h n d s (including f l o w chart), financial reporting, including interim un-audited financial statements, annual reports and audit. 5. Project Account ing a n d F inancia l Repor t i ng System. Develop an accounting and reporting system- integrated excel worksheets- (CEU)/upgrade existing accounting sofbvare or create integrated excel worksheets (MOH PIU), t o reflect requirements o f the new project, including capacity to generate in ter im un-audited financial reports. Test the accounting and reporting system by producing sample financial reports for submission to the Bank for review and comments.

19. National Compensation fund. The Government will establish a national compensation fbnd from which the owners o f animals culled wil l be compensated. However, there are s t i l l uncertainties relating to the specific regulations, procedures and operational guidelines for establishing, financing and operating this fund. The Government’s operational instructions for the Compensation Fund would be completed in MarcWApri l in consultation with the Bank. The Project will provide US$5 mi l l ion to establish this find which wil l be disbursed only in the event o f actual need. It will be a condition o f disbursement for this sub-component that the modalities for operating the fund have been established and approved by the Bank, so as to provide sufficient resources for immediate needs. Procedures to be established for this purpose are detailed in paragraph 11 above.

PIU, and PMSU CEU

CEU

MOH PIU and MARA CEU

MOH PIU and MARA CEU

Ac t ion I Responsibi l i ty 1. Budget. Take action to have the project budget included in the 2006 I CEU,MOH

D u e Da te January 31,2006 January 3 1,2006 M a y 31, 2006 March 27, 2006

April 15, 2006

Financial Management Action Plan: There are a number o f actions required to ensure that the financial management arrangements o f both the M O H PIU and C E U are fully satisfactory for the proposed project.

69

ANNEX 8: ECONOMIC ANALYSIS


1. Evidence shows that the H5N1 strain o f Highly Pathogenic Avian Influenza (HPAI) i s now endemic in parts of Southeast Asia, where Cambodia, Indonesia, Laos, Thailand and Indonesia are the worst-affected countries. The continuing outbreaks that began in late 2003 and early 2004 have been disastrous for the poultry industry in the region. By mid-2005, more than 140 mi l l ion birds had died or been destroyed and losses to the poultry industry are estimated to be in excess o f US$10 billion. The costs were related to the death o f poultry from the disease itself, the cul l ing of poultry to stem i t s spread, and the costs to governments o f containing the epidemic in terms o f equipment, materials, transport and personnel.

2. In Vietnam, one of the most seriously affected countries, some 44 mi l l ion birds or 17 percent o f the total population of poultry, were culled at an estimated cost o f $120 mi l l ion (0.3 percent o f GDP)4. The costs would have been substantially higher if there had been a serious impact on tourism, where an estimated 5 percent drop in tourist and business arrivals would reduce GDP by a further 0.4 percent. (Fortunately, there has been only a small impact on tourism so far; the number o f tourist arrivals in Vietnam increased by 20.5 percent in 2004 and rose further by 23 percent in the f i rst seven months o f 2005.) In Indonesia, an FA0 survey indicates that in the most seriously affected parts o f the country, more than 20 percent of permanent industrial and commercial farm workers lost their jobs. So although the overall macro-economic effects have been relatively small, the impact on the poultry sector and on associated input and distribution channels has been severe.

3. Although HPAI i s mainly an animal health problem, more than ha l f o f the 120 human cases have been fatal. Moreover, i t is widely believed in the scientific community that a global pandemic o f human influenza i s overdue. Such a pandemic would be the result o f the emergence of a strain o f virus to which the world’s population had l i t t le or no immunity. A widespread epidemic needs not be severe or particularly deadly; the pandemics o f 1957-1958 and 1968-1969 were relatively mild. However, there i s the possibility that the H 5 N 1 strain could, through genetic re-assortment or a more gradual process o f adaptive mutation, become readily transmissible from human-to-human and become the basis o f a global pandemic comparable to that of 1918-1919, the “Spanish” influenza, which recent research has shown to have had its origin in an avian influenza virus.

4. Neither the timing nor the severity o f the next pandemic can be predicted, but with the virus now endemic in bird populations in Asia the r isk will not be easily diminished. Given the recent outbreak in Turkey in Manyas, the situation faced by Turkey i s urgent but uncertain, given the unpredictability of a human epidemic or pandemic. I t i s clear, however, that containing and eradicating the virus will be a desirable objective even if the problem were restricted to one o f animal health in Turkey. Thus, economic analysis o f the Project, which will be completed at

World Bank. (2004). Avian Influenza Emergency Recovely Project. Technical Annex. Appendix 2. Other earlier and widely cited estimates by Oxford Economic Forecasting had been rather higher, suggesting costs o f over $200 mi l l ion or around 0.6 percent o f GDP for Vietnam, and costs o f $10-15 bi l l ion for East Asia as a whole, about 0.3-0.5 percent of regional GDP .

70

Project Appraisal, wil l take into account the two main categories o f economic impacts: (a) the economic consequences and costs associated with public and private efforts to prevent the emergence or spread of the disease and to treat i t s effects; and (b) the economic consequences and costs o f sickness or death resulting from the disease outbreaks.

5. These two are clearly related as a greater effort at prevention and/or treatment for a given severity o f epidemic would be expected to reduce the spread o f sickness and/or the percentage o f mortality and thus reduce the economic impact and costs. There are also two “levels” o f potential economic costs. The present spread o f HPAI o f the H5N1 strain involves transmission between animals and (so far) a l imited incidence o f transmission between animals and humans; as such, given the lethal nature o f the virus, especially in poultry, i t i s principally an animal health crisis. However, the emergence o f a human influenza pandemic caused by a lethal virus would have a social and economic impact many times greater.

6. Thus, actions to be taken by Turkey are analyzed using the traditional “with project” and “without project” scenarios when the issue i s to treat HPAI as an animal health issue. These costs and benefits are to be estimated on the basis o f the recent outbreak in Manyas. However, the impact o f actions to be taken Turkey in the wider context o f the prevention or slowing down of a human influenza pandemic are much more difficult to estimate, since the actions undertaken in one country wil l have implications for the well-being o f the rest o f the world’s population.

Losses to the Poultry Sector, Related Industries, and Involved Populations.

7. The economic analysis follows a with-project scenario / without-project scenario approach to estimate net benefits o f the Project to Turkey. The analysis focuses on the benefit o f averting significant expected costs to the economy o f a catastrophic spreading o f the disease in Turkey’s poultry flock due to a reduction in the probability o f such a catastrophic event. The main costs averted that are considered in this analysis are:

0 dramatic reductions in poultry prices and quantities demanded resulting in large-scale decreases in value added in the poultry sector (adjusted however for the positive substitution effect into other sources o f protein, notably red meat and fish); loss o f capital assets due to decommissioning as a result long term-decreases in demand and o f poultry stock due to culling; and the cost o f culling in outbreak areas i tself (and other activities to stem the further spreading above and beyond what would be done in the with project scenario).

0

0

8. Costs related to illness or death o f humans (either in Turkey or internationally) as a result of infection from continual AI outbreaks in Turkey are not estimated owing to the current lack o f adequate information on the probabilities o f virus mutation and transmissibility. Given the time constraints and unavailability o f precise data o n some o f the variables used in the analysis, this should be treated as a simulation exercise that indicates that even under very conservative assumptions and with only few o f the benefits quantified, the returns o n the project investments are sizeable.

71

Scenarios Considered

9. The without-Proiect scenario: As a result o f the low capacity o f government and the poultry industry to deal with outbreaks, the sector i s vulnerable to a catastrophic AI occurrence. This catastrophic event (CE) would be characterized by multiple, simultaneous outbreaks leading to a spread o f the disease to large sections o f the country’s poultry flock. Significant numbers o f poultry would have to be culled with associated costs o f culling and compensation to the farmers incurred by the state and the private sector. Subsequently, there would be massive public aversion to poultry consumption leading to a significant and sustained drop in prices and demand for poultry.

10. In turn, the poultry sector remains depressed in the medium term, leading to large sunk costs in the form o f abandoned facilities. The public substitutes red meat, fish and other sources of protein for poultry. Prices o f such substitutes go up, leading to increased net revenues for those sector^.^ Overall consumer surplus decreases.6 (In the long term the sector recovers partially.) The economic analysis assigns the CE described above an annual probability o f occurrence.’ Under this scenario, this probability increases annually as the virus in the environment becomes endemic.

11. The project builds capacity on the part o f local government agencies and the private sector to respond effectively to outbreaks in such a way that multiple and simultaneous outbreaks may be contained with much higher efficiency, leading to a lower annual probability o f the worst case scenario occurring. This i s achieved through: (i) the adoption o f a country-specific strategy (and i ts corresponding information system) to control and eradicate HPAI in areas o f risk; (ii) the strengthening o f disease surveillance and diagnostic capacity; (ii) the implementation o f an outbreak containment plan, including deployment o f supplies and incineration investments in field and certification o f readiness for rapid response in areas at risk (all under Component 1: Animal Health).

The with-proiect scenario.

12. Significant support to public awareness raising (under Component 3: Public Awareness and Coordination Support) will also help to: (i) increase the level o f information among producer groups and their families and hence support the containment o f the disease in r i s k areas; and, (ii) increase public confidence that the outbreaks wil l be contained effective and hence not lead to widespread il lness among humans, which should reduce the risk o f significant drops in demand for poultry products. The positive impact under this with project scenario i s measured through a decrease in the annual probability o f a CE.

In the medium run, the red meat sector may expand, leading to a reduction in price levels. CS o f those consumers who have to switch to substitutes decreases because (i) those products are not their first choice; (ii) the price

increase in the other products. Consumers who are risk averse and continue to consume poultry products experience an increase in CS in the short run as poultry prices go down before the sector adjusts and supply decreases. Consumer surplus related to substitutes decreases as a result o f price increases, at least in the short run before the sector adjusts and supply expands. The overall impact on CS i s expected to be negative as consumers are forced to consume a m ix that does not represent their first preference. ’ There are several reasons for the focus in this analysis on a catastrophic event rather than multiple events o f varying degrees o f severity: (i) a probability distribution for events o f varying severity i s not available; (ii) related to the first point, employing an approach of the worst case scenario allows for simplicity in the analysis through the use a single variable probability. One can vary the assumed probability and see the impact on the net benefit due to the project.

72

Estimation of Benefits and Costs of the Project

Parameter 1 2 3 4

Annual probability o f CE occurring in first year o f w/out project scenario (2006) Annual increase in probability o f CE occurring Probability reduction factor due to project Decrease o f poultry sector added value due to CE, in year o f CE and in long t e r m new market eauilibrium

13. In this section we present the methods used to estimate the main costs and benefits o f the project, including assumptions made in this process. I t i s underlined that the objective o f the analysis i s to provide an order o f magnitude approximation rather than precise estimates. Table 1 summarizes base case assumptions on key parameters which are discussed below. 2004 GDP contribution values are used. An annual average exchange rate o f 1,340,000 TW$ for 2004 i s used to convert these figures into U S Dollars. The period o f analysis i s 15 years, beginning in 2006. An annual discount rate o f 12% i s used in calculating the NPV.

Value 10.0% 1 .O% 12%

40%, 20%

5 6

~~. ~~~ ~~

One time loss o f capital in poultry sector Increase in value added o f red meat and fish sectors, in year o f CE and in long

20% 20%, 5% 1

I I term new market eauilibrium - 1 I

14. Without Project Scenario In this scenario, the main costs to the economy o f multiple, simultaneous outbreaks that cannot be contained properly due to insufficient public and private sector capacity i s the net cost incurred as a result o f significant decrease in demand for poultry products, including meat and eggs.8 The net cost represents cost to the poultry sector and the positive impact o n alternative protein sources, notably the red meat and fish sub-sectors.

(9

(ii)

(iii)

15.

I t i s assumed that in the year in which the CE occurs, the impact on the poultry sector i s a 40% decrease in the added o f production o f meat and eggs. This i s a reasonable, albeit conservative assumption, in light o f price falls reaching 50% in the aftermath o f the Manyas outbreak in October 2005 and in Vietnam fol lowing a series o f outbreaks in 2004. In the subsequent three years, the value added in the poultry sector i s assumed to regain 80% o f the pre-CE level. A further, one-time cost to the poultry sector occurs in the form o f abandoned capital production assets as a result o f the permanent decrease in demand and poultry stock that has to be culled in response to the outbreaks. This loss i s estimated at 20% o f the capital stock. The value o f the poultry sector capital stock i tself i s assumed to be equal to three times the value o f annual production it the poultry sector. Gains to the red meat and fisheries sub-sectors that are alternative sources o f protein are assumed to be 20% o f the value added in the year in which the CE occurs, gradually decreasing to 5% over the following 3 years.

The Government and the private sector would also incur incremental cost associated to the administration o f containing the outbreaks. However, these costs are extremely dif f icult to estimate and are hence not included in this analysis. As discussed above, there i s a significant loss o f consumer surplus resulting from the perceived risk associated with poultry product

* In the aftermath o f the November 2005 Manyas outbreak, Turks showed clear aversion to eggs for fear o f being contaminated and egg consumption returned to normal at the pace at poultry meat consumption..

73

consumption. production values. However, shortage o f data makes it impossible to quantify this loss.

These losses are not captured in the GDP data uses since the latter reflect

Table 2. Values Year ‘06 ‘07 ‘08 ‘09

Costs due to a 1,195 1,195 1,195 1,195 CE (In NPV terms )

CE occurring (%) in the w/out project scenario Expectedcosts 119.5 131.4 143.4 155.3 in the w/out project scenario Probability o f 10 11 12 10.6 CE o c c d g (%) in the with project scenario Expectedcosts 119.5 131.4 143.4 126.2 in the with project scenario Expected costs 0 0 0 29.2 averted due to project Project cost 5.0 15.0 21.0 12.0

Probability o f 10 11 12 13

16. The stream o f total annual costs due to a C E in a particular year thus obtained i s summarized in the form on present value as o f the year o f the CE. This value i s then multiplied with the probability o f the CE occurring in a particular year to arrive at the expected cost. In the without project scenario, the probability o f the CE occurring i s assumed to be 10% in 2006, increasing annually at a rate o f 1.0% due to increasing presence o f the virus in the environment. This process results in an increasing stream o f expected costs for the period 2006 - 2020, as presented in Table 2.

ex-wessed in million US$ ‘10 ... ‘16 ‘17 ‘18 ‘19 ‘20

1,195 1,195 1,195 1,195 1,195 1,195

14 20 20 20 20 20

167.3 239.0 239.0 239.0 239.0 239.0

9.3 7.2 7.2 7.2 7.2 7.2

111.0 86.0 86.0 86.0 86.0 86.0

56.2 153.0 153.0 153.0 153.0 153.0

2.2

17. With-project Scenario I t i s assumed that the positive impact o f the project will be fel t starting in forth year o f project, 2009. In other words, the probability o f the full impact o f the catastrophic event being felt i s assumed to be the same from 2006 - 2008, as under the without project scenario. From year 4, the annual probabilities are halved thanks to the project. The stream o f expected costs in th is scenario are calculated by multiplying these probabilities with respective NPVs o f costs and presented in Table 2.

18. The total project cost i s estimated at U S $ 55.2, which would disburse over five calendar years: $5.0, $15.0, $21.0, $12.0, and $2.2 mi l l ion in 2006, 2007, 2008, 2009, and 2010, respectively.

Results of the Analysis

19. internal rate o f return o f 80.8 %.

Based on the above assumptions, the analysis yields an NPV o f $ 415.9 mi l l ion and an

74

Sensitivity Analysis

20. A sensitivity analysis was carried out to gauge the impact o f varying assumptions on the results o f internal rate o f return o f the project. The analysis indicates that the model i s robust as substantial reductions (or increases) in the assumed values are necessary for the IRR decrease to 12%, notably,

0 Holding al l other values constant, assuming a reduction o f capital loss in the poultry sector o f 7.22% (as opposed to the base case 20%);

0 Holding a l l other values constant, assuming a value added loss in the poultry sector to 20% in the C E year and 13.4% in the long term (as opposed to the base values o f 40% and 20% ); Reducing the losses sustained by the poultry sector in terms o f value added loss (from 20% to 10% in the CE year and from 20% to 7% in the long term), the capital loss from 20% to lo%, while also reducing the gain in the red meat an d fisheries sectors (from 20% to 10% in the f i rst year and from 10% to 5% in the long run);

0 Reducing the probability o f the CE in 2006 to 1% (from the base case value o f 10%) and the annual increase in probability to 0.1% (from 1%).

0

21. probability reduction factor.

The IRR was not found to be sensitive to variations in the value o f the C E occurrence

75

ANNEX 9: SAFEGUARD POLICY ISSUES


1. Activities under the Project are not expected to generate any adverse environmental effects as they are focused largely on public sector capacity building and improved readiness for dealing with outbreaks of avian influenza in domestic poultry. These prevention-focused activities are expected to have a positive environmental impact as the Project's investments in facilities, equipment, and training for laboratories wil l improve the effectiveness and safety over existing avian influenza handling and testing procedures by meeting international standards established by the OIE. This would be reinforced by the mainstreaming o f environmental safeguards into protocols and procedures for the culling and disposal o f animals during AI outbreaks. In addition, whatever waste i s generated in laboratory facilities wil l be managed using existing guidelines in Turkey.

2. Though n o social safeguard pol icy i s triggered by the Project, the Project i s designed to mitigate the negative impacts of mandated culling of poultry on small scale backyard poultry producers. Even though this impact i s not expected to be large (likely no more than 5% o f backyard poultry producers' value o f household consumption), mitigation measures have been designed, and their further refinement i s envisaged during the init ial implementation period o f the Project. First, a state compensation hnd will be set up under the Project (with an init ial reserve of U S $ 5 million) to pay producers roughly the full current value o f their culled poultry. A second project reserve (an additional U S $ 4.5 million) wil l also be established to target the restructuring needs o f the poultry sector which arise as a result o f the enforcement o f the culling pol icy in areas affected by AI. This wil l be designed to mitigate the medium to long-term effects on producers (mainly o f the backyard type) who are required to discontinue poultry production in areas which have been affected by AI.

3. Third, the project team agreed with the MARA o n the desirability o f using part o f the Village-Based Participatory Investments Program (under the existing Agricultural Reform Implementation Project) on the needs o f poultry producers affected by the culling o f poultry in affected areas. Lastly, during the init ial stage o f project implementation, the project team wil l pursue with the representatives o f the commercial poultry sector a voluntary initiative by the commercial poultry sector to provide poultry products free o f charge to backyard producers who have been forced to discontinue poultry raising. This would be at the level o f household consumption formerly raised by backyard poultry producers and extended for a two to three year period.

Environmental assessment Environmental Category B

4. Environmental Assessment and Environmental Management Plan. Since the Project supports investments in incineration capacity for culled poultry (and potentially for disposal o f other livestock and laboratory wastes), the Project i s assessed as a B-category project. An Environmental Assessment (EA) and an Environmental Management Plan (EMP) for the deployment o f incineration capacity (mainly mobile but also potentially through stationary

76

incineration units) will be necessary. This EMP will also cover the clean up o f animal wastes o f culled poultry by the local public veterinary services supported under the Project, The scope o f this EMP will be specified in early project implementation, as a waiver for completing the EA and EMP during project preparation has been sought and obtained per para. 12 o f OP 4.01. (The EA and EMP specification were launched in mid-January 2006, and would be completed no later than M a y 3 1,2006.)

Safeguard Policies Triggered by the Project Yes No Environmental Assessment (OP/BP/GP 4.0 1) [X 1 [I Natural Habitats (OP/BP 4.04) [I [ XI Pest Management (OP 4.09) 11 [ XI Cultural Property (OPN 1 1.03, being revised as OP 4.1 1) [I [ XI Involuntary Resettlement (OP/BP 4.12) [I [X 1 Indigenous Peoples (OD 4.20, being revised as OP 4.10) [I [X 1 Forests (OPBP 4.36) [I [X 1 Safety o f Dams (OP/BP 4.37) [I [X 1 Projects in Disputed Areas (OP/BP/GP 7.60)* [I [X 1 Projects on International Waterways (OP/BP/GP 7.50) [I X[ 1

a By supporting the proposedproject, the Bank does not intend to prejudice the final determination of the parties' claims on the disputed areas

77

ANNEX 10: PROJECT PREPARATION AND SUPERVISION

TURKEY: AVIAN INFLUENZA AND HUMAN PANDEMIC P R E P A R E D N E S S AND RESPONSE PROJECT

Planned Actual P C N review December 2005 December 2005 Init ial P ID to PIC December 2005 December 2005 Init ial ISDS to PIC December 2005 December 2005 Appraisal December 2005 December 2005 Negotiations January 25,2006 March 20,2006 Board approval February 2 1,2006 Planned date o f effectiveness Planned date o f mid-term review Planned closing date November 30,2010

March 3,2006 June, 2008

Key institutions responsible for preparation o f the project: Ministry o f Agriculture and Rural Development, Ministry o f Health

Bank staff and consultants who worked on the project included: Name Tit le Unit M a r k Lundel l Lead Agricultural Economist ECSSD H a l i l Agah Senior Rural Development ECSSD

Ke i th Sumption Animal Health Specialist FA0 Enis Barig Senior Public Heal th Specialist E C S H D Mar io Bravo Senior Communications Officer EXTRO Ibrahim Akqayoglu Operations Officer E C S H D Ibrahim Sirer Sr. Procurement Specialist ECSPS Elmas Arisoy Sr. Procurement Specialist ECSPS Ayge Seda Aroymak Sr. Financial Mngmt. Specialist ECSPS D i l e k Barlas Senior Counsel LEGEC Ti jen Arin Senior Environmental Economist ECSSD Andrina Ambrose-Gardiner Senior Finance Officer LOAGl Furuzan Bilir Finance Officer LOAGl Ebru Ocek Research Consultant ECSSD Zeynep La l i k Mete FM Consultant ECSPS Phillip Metcalfe Animal Waste Specialist Consultant, A D A S Nedret Durutan-Okan Consultant ECSSD Amy Evans Consultant ECSSD

Specialist

Bank funds expended to date o n project preparation: 1. Bank resources: us$120,000 2. Trust funds (FAO/CP): US$9,000 3. Total: US$129,000

Estimated Approval and Supervision costs: 1. Estimated annual supervision cost: US$lOO,OOO

78

ANNEX 11 : DOCUMENTS IN THE PROJECT FILE

TURKEY: AVIAN INFLUENZA AND HUMAN PANDEMIC PREPAREDNESS AND

A.

a

a

a

a

a

B.

a

e e

C.

a

a

a

a

a

a

a

a a

RESPONSE PROJECT BANK

Guidance notes to country teams on responding to AI Rapid assessment o f the economic impact o f public health emergencies o f international concern - the example o f S A R S - Milan Brahmhatt Vietnam Avian Influenza Emergency Recovery Project - Memorandum o f the President and Technical Annex Minutes o f the meeting o n the Emerging zoonoses and pathogens: A Global public goods concern - implication for the World Bank, April 19,2005 Issues Note on Avian Influenza in Africa, September 27, 2005. - Franqois L e Gal l and O k Pannenborg

OTHER DONORS

A global strategy for the progressive control o f HPAI - FAO/OIE in collaboration with WHO - M a y 2005 FAO’s response to the avian influenza crisis - September 19,2005 Technical Cooperation Program - Project descriptions for East Africa, West Africa, Europe and Central Asia, North Africa, and the Middle East - WHO 2005

PUBLIC HEALTH RELATED

Global avian influenza information from WHO Web site at www.who.int/csr/disease/avian influenza Information on U.S. influenza preparedness available at: www.hhs. gov/nvpo/pandemics/dhhs.html and www.cdc. aov/flu/avian WHO. 2005. Responding to the avian influenza pandemic threat. Recommended strategic actions. Geneva. WHO. 2005. WHO global influenza preparedness plan. The role o f WHO and recommendations for national measures before and during pandemics. Geneva. United States Department o f Health and Human Services. 2005. Pandemic Flu Fact Sheet. United States Department o f Health and Human Services. 2004. Pandemic Influenza Preparedness and Response Plan. Draft. Browner, J., and Chalk, P. 2003. The Global Threat o f New and Reemerging Infectious Diseases. Reconciling U.S. National Security and Public Health Policy. Santa Monica, CA: RAND. Dowdle, W.R. 1997. The 1976 Experience. J. Infect D i s 1997; 176 (suppl. 1): S69-72. Garcia-Abreu, A., Halperin, W., Dane1 I. 2002. Public Health Surveillance Toolkit. A guide for busy task managers. Washington, D.C.: Wor ld Bank.

79

0 Huffman, S., on the basis o f report by Daniel Miller and Asel Ryskulova. 2005. Epidemiologic Surveillance Systems in Eastern Europe and Central Asia: An Overview. Washington, D.C.: World Bank. Neustadt, R.E., Fineberg H.V. 1982. The Epidemic That Never Was. Policy Making and the Swine Flue Scare. Vintage Books.

0

D. ANIMAL HEALTH RELATED

OIE website on Avian Flu Official reporting, Scientific information, Standards, Guidelines, and Recommendations (www.oie.int)

FA0 website on Avian Flu General information, Communication, Publications, Projects proposals and reports (www.fao.org)

FAO/OIE. February 2005. Second FAO/OIE Regional Meeting on Avian Influenza Control in Asia. Ho Chi Minh City.

FAO/OIE. February, 2004. Recommendations of the Joint FAO/OIE Emergency Regional Meeting on Avian Influenza Control in Animals in Asia. Bangkok.

FAO/OIE. March 2005. Summary Report of the First Regional Steering Committee of GF-TADS (Global Framework for the Progressive Control of Transboundary Animal Diseases) in Asia and the Pacijk. Tokyo.

FAO/OIE/WHO. February, 2004. FAO/OIE/WHO Technical Consultation on the Control of Avian Influenza, 3-4 February, 2004: Conclusions and Recommendations.

OIE. May, 2005. OIE Report of the First Meeting of the Steering Committee of the Joint OIE/FAO Network of Expertise on Avian Influenza (OFFLU). OIE. Paris.

OIE/ASEAN. August 2005. The Southeast Asia Foot and Mouth Disease Campaign: Business Plan for Phase III(2006-2008).

OIE/FAO. Network of Expertise on Avian Influenza (OFFL U). Paris.

OIE/FAO. April, 2005. International Scientijk Conference on Avian Influenza, OIE Paris, France 7-8 April 2005: Recommendations. Pans.

E. BIBLIOGRAPHY OF RECENT REPORTS & OTHER DOCUMENTS

Bell, Clive and Maureen Lewis. October 2004. The Economic Implications of Epidemics Old and New. Working Paper Number 54, Center for Global Development. Washington, DC. (see also Powerpoint presentation, “Economic Implications of Epidemics Old and New”).

80

OIE. 2004. Emerging Zoonoses and Pathogens of Public Health Concern. Rev. sci. tech. Off. int. Epiz., 2004,23 (2).

FAO/OIE. February 2005. Second FAO/OIE Regional Meeting on Avian Influenza Control in Asia. Ho Chi Minh City.

FAO/OIE. February, 2004. Recommendations of the Joint FAO/OIE Emergency Regional Meeting on Avian Influenza Control in Animals in Asia. Bangkok.

FAO/OIE. March 2005. Summary Report of the First Regional Steering Committee of GF-TADS (Global Framework for the Progressive Control of Transboundary Animal Diseases) in Asia and the Paczjk. Tokyo.

FAO/OIE/WHO. February, 2004. FAO/OIE/DWO Technical Consultation on the Control of Avian Influenza, 3-4 February, 2004: Conclusions and Recommendations.

Ferguson, N e i l et al. 2005. Strategies for Containing an Emerging Influenza Pandemic in Southeast Asia. Nature.

OIE. May, 2005. OIE Report of the First Meeting of the Steering Committee of the Joint OIE/FAO Network of Expertise on Avian Influenza (OFFLU). OIE. Paris.

OIE/ASEAN. August 2005. The Southeast Asia Foot and Mouth Disease Campaign: Business Plan for Phase III(2006-2008).

OIEIFAO. Network of Expertise on Avian Influenza (OFFL U). Paris.

OIEBAO. April, 2005. International Scientijk Conference on Avian Influenza, OIE Paris, France 7-8 Apr i l 2005: Recommendations. Paris.

Sandman, Peter and Jody Lanand.2005. Bird Flu: Communicating. Perspectives in Health, Vol. 10, No. 2. Pan American Health Organization. Washington, DC.

Schudel, A. August 2005. Tackling Avian Influenza at Source. Avian Influenza Technical Discussion & Coordination Meeting (powerpoint presentation). Washington, DC.

Smolinski, Mark, Margaret A. Hamburg, and Joshua Lederburg (Editors). 2005. Microbial Threats to Pandemic Influenza. National Academies Press. Washington, DC.

WHO. 2005. W O Global Influenza Preparedness Plan: The Role of W O and Recommendations for National Measures Before and Dur ing Pandemics. Department o f Communicable Disease Surveillance and Response, Global Influenza Program. Geneva. WHO. January 2005. Influenza Pandemic Preparedness and Response: Report by the Secretariat. Executive Board, 1 15th Session, Agenda Item 4.17. Geneva.

81

World Bank. July 2, 2004. Technical Annex for a Proposed Credit of SDR3.5 million to the Socialist Republic of Vietnam for an Avian Influenza Project. Washington, DC.

82

ANNEX 12: STATEMENT OF LOANS AND CREDITS


83

ANNEX 13: COUNTRY AT A GLANCE

li %4 6$.$ 16.2 t S"8

18.; -1.61 3.1

38.1 33.c

1386434 Ibtr4.O.l.

4 5 3.1 2 3 1.4 1 4 11.1

T

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MAP SECTION

TTuzuzGGööllüü

HoyranHoyranGGööllüü

BaysehirBaysehirGGööllüü

AksehirAksehirGGööllüü

Prut

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MMuurraatt

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KKuuzzeeyy AAnnaaddoolluu DDaaggllaarr ii

TToorrooss DDaaggllaarr iiKaramanKaraman

KonyaKonya

AksarayAksaray

NigdeNigde

NevsehirNevsehir KayseriKayseri

MalatyaMalatya

AdiyamanAdiyaman

ElazigElazig

TTunceliunceli

ErzincanErzincan

BingBingööllMusMus

BitlisBitlis

DiyarbakirDiyarbakir BatmanBatman SiirSiirtt

SirSirnaknakMardinMardin

HakkariHakkari

VVanan

AgriAgriIgdirIgdir

ErzurumErzurum

KarsKars

ArArtvintvin

RizeRize

GGüümmüüshaneshane¸̧BayburBayburtt

GiresunGiresun

TTokatokat

SivasSivas

AmasyaAmasya

KastamonouKastamonou

ÇÇankiriankiri

KarabKarabüükk

BoluBoluSakarSakaryaya(Adapazari)(Adapazari)

KocaeliKocaeli(Izmit)(Izmit)

BilecikBilecik

EskisehirEskisehir

KKüütahyatahya

BursaBursa

YYalovaalova

IstanbulIstanbulTTekirdagekirdag

EdirEdirneneKirklareliKirklareli

ÇÇanakkaleanakkale

BalikesirBalikesir

ManisaManisaIzmirIzmir UsakUsak

AAydinydin

DenizliDenizliBurdurBurdur

IsparIspartata

AfyonAfyon

AntalyaAntalya

MuglaMugla

KirikkaleKirikkale

ÇÇorumorum

YYozgatozgat

KirsehirKirsehir

AdanaAdana

OsmaniyeOsmaniye

KahramanKahraman Maras Maras

GaziantepGaziantep

KilisKilis

SanliurSanliurfafa

ArdahanArdahan

ANKARAANKARA

AArraass

DDüüzcezce

SYRIAN ARABREPUBLIC

IRAQ

ARMENIA

GEORGIA

BULGARIARUSSIAN FEDERATION

AZER-BAIJAN

AZER.

To Batumi

To Kirovakan

ToMaku

ToSalmas

ToOroumieh

ToDahukTo Damir

KabuTo

Al Hasakah

ToAleppo

ToBurgasTo

Kurdzhali

Kuzey Anadolu Daglar i

To ros Daglar iKaraman

Konya

Aksaray

Nigde

Nevsehir Kayseri

Malatya

Adiyaman

Elazig

Tunceli

Erzincan

BingölMus

Bitlis

Diyarbakir Batman Siirt

SirnakMardin

Hakkari

Van

AgriIgdir

Erzurum

Kars

Artvin

RizeTrabzon

Gümüshane¸Bayburt

Giresun

Ordu

Tokat

Sivas

Amasya

Samsun

Sinop

Kastamonou

Çankiri

Karabük

BartinZonguldak

Bolu

Düzce

Sakarya(Adapazari)

Kocaeli(Izmit)

Bilecik

Eskisehir

Kütahya

Bursa

Yalova

IstanbulTekirdag

EdirneKirklareli

Çanakkale

Balikesir

ManisaIzmir Usak

Aydin

DenizliBurdur

Isparta

Afyon

Antalya

Mugla

Kirikkale

Çorum

Yozgat

Kirsehir

Icel(Mersin)

Adana

Hatay (Antakya)

Osmaniye

Kahraman Maras

Gaziantep

Kilis

Sanliurfa

Ardahan

ANKARA

SYRIAN ARABREPUBLIC

IRAQ

ISLAMICREP. OFIRAN

ARMENIA

GEORGIA

BULGARIARUSSIAN FEDERATION

AZER-BAIJAN

AZER.

GRE

ECE

GREECE

TuzGölü

HoyranGölü

BaysehirGölü

AksehirGölü

Lake Van

Çoruh

Murat

Kura

Aras

Firat

Tigris

Euphrates

Sakarya

Devrez

Kizil

Cekerek

Kizi

l

Seyh

an

Göksu

Ceyhan

Kelkit

B lack Sea

Medi terranean Sea

Sea ofMarmara

Gulf ofAntalya

Bosporus

Dardanelles

To Batumi

To Kirovakan

ToMaku

ToSalmas

ToOroumieh

ToDahukTo Damir

KabuTo

Al Hasakah

ToAleppo

To Ladhiqiyah

ToBurgasTo

Kurdzhali

ToKomatini

Kuzey Anadolu Daglar i

To ros Daglar i

Mt. Ararat(5166 m)

26°E 28°E 30°E 32°E 34°E 36°E 38°E

42°E 44°E30°E28°E 32°E 34°E

36°N

38°N

40°N

42°N

40°N

42°N

TURKEY

This map was produced by the Map Design Unit of The World Bank. The boundaries, colors, denominations and any other informationshown on this map do not imply, on the part of The World BankGroup, any judgment on the legal status of any territory, or anyendorsement or acceptance of such boundaries.

0 50 150100

0 50 100 150 Miles

200 Kilometers

IBRD 33501

JAN

UA

RY 2005

TURKEYPROVINCE CAPITALS*

NATIONAL CAPITAL

RIVERS

MAIN ROADS

RAILROADS

PROVINCE BOUNDARIES*

INTERNATIONAL BOUNDARIES

*Province names are the same as their capitals.

documents.worldbank.orgdocuments.worldbank.org/curated/pt/270731468317086497/pdf/35720.… ·...

Documents

Transcript of documents.worldbank.orgdocuments.worldbank.org/curated/pt/270731468317086497/pdf/35720.… ·...