Document of The World Bank FOR OFFICIAL USEONLY ReportNo: T7695-BD TECHNICAL ANNEX ONA PROPOSEDCREDIT INTHEAMOUNT OFSDR 10.5MILLION (USS16 MILLIONEQUIVALENT) TO THE PEOPLE'S REPUBLIC OFBANGLADESH FORAN AVIANINFLUENZA PREPAREDNESSAND RESPONSEPROJECT UNDERTHE GLOBAL PROGRAMFORAVIAN INFLUENZA AND HUMANPANDEMIC PREPAREDNESSAND RESPONSE June 11,2007 Sustainable Development Sector Unit Human Development Sector Unit South Asia Region This document has a restricted distribution and may be used by recipients only in the performance o f their official duties. Its contents may not 0th CURRENCY EQUIVALENTS (Exchange Rate Effective April 30,2007) CurrencyUnit = BangladeshiTaka US$1 = Tk69.225 SDR 1 = US$1.52493 FISCALYEAR July 1-June 30 ABBREVIATIONS AND ACRONYMS ADB Asian DevelopmentBank FMR FinancialMonitoring Report ADP Annual Development Plan FDIL FieldDiseaseInvestigationlaboratory AHITF Avian Human InfluenzaTrust Fund GAR GrossAttack Rate AI Avian Influenza GDP GrossDomesticProduct AIPRP Avian InfluenzaPreparednessandResponse GIS GeographicInformation System Project GLP GoodLaboratoryPractice APL AdaptableProgramLoan GPN GeneralProcurementNotice ARCS Audit ReportCompliance System GOB Governmentof Bangladesh BLRI BangladeshLivestockResearchInstitute GOJ Governmentof Japan BRAC BangladeshRuralAdvancement Committee GPAI Global Programfor Avian InfluenzaandHuman (an NGO) PandemicPreparednessandResponse BSL3 Bio-safetylevel 3 GPS GeographicPositioningSystem CAS CountryAssistance Strategy HPAI Highly PathogenicAvian Influenza C&AG Comptroller andAuditor General(GOB) H5N1 Influenzavirus H5Nl strain CDC Center for DiseaseControl(USA) HNPSP Health,Nutrition andPopulationSector Program CDIL CentralDiseaseInvestigationLaboratory IBRD InternationalBank for Reconstruction& CDOP CommunicableDiseaseOperational Plan Development(World Bank Group) (HNPSP) ICB InternationalCompetitiveBidding CGP CompetitiveGrantsProgram ICDDR,B InternationalCenter for DiarrhoealDisease CIDA CanadianInternationalDevelopmentAgency Research, Bangladesh CMSD CentralMedical StoresDepot IDA InternationalDevelopment Association(World CPAR CountryProcurementAssessment Report Bank Group) CPTU CentralProcurementTechnicalUnit (GOB) IFC InternationalFinanceCorporation(World Bank DA DesignatedAccount Group) Danida DanishInternationalDevelopmentAgency IEDCR Instituteof Epidemiology,DiseaseControl& DFID Departmentfor InternationalDevelopment Research DGHS DirectorateGeneralof HealthServices IHR InternationalHealthRegulations DIVA Differentiating Infectedfrom Vaccinated ILI Influenza-likeIllness Animals IMED ImplementationMonitoring andEvaluation DLS Departmentof LivestockServices Division (GOB) DOC day old chick JICA Japanese InternationalCooperationAgency ECTAD EmergencyCentre for TransboundaryAnimal M&E Monitoring & Evaluation Diseases, FA0 MIS ManagementInformation System EMP EnvironmentalManagementPlan MOEF Ministry of Environment& Forest EOP Endof the Project MOFL MinistryofFisheries& Livestock ESSMF Environmentaland Social Safeguards MOHFW Ministry of Health& FamilyWelfare ManagementFramework MOI Ministryof Information FA0 Food& Agriculture Organisationof the UN MOU Memorandumof Understanding FM FinancialManagement MTR Mid-termreview FMD Foot& MouthDisease NAC NationalAdvisory Committee(GOB) FOROFFICIAL USE ONLY NAIP National Avian InfluenzaandHumanPandemic RFP Request for Proposals InfluenzaPreparednessandResponsePlan RRT RapidResponseTeam (GOB) RT-PCR Real Time PolymeraseChainReaction NCB National CompetitiveBidding SARS SevereAcute RespiratorySyndrome NCSAP National CommunicationStrategyandAction SAARC SouthAsianAssociationfor Regional Plan(GOB) Cooperation NGO Non-GovernmentOrganisation SEDF SouthAsia EnterpriseDevelopmentFacility NMTF National Multi-SectoralTask Force (GOB) (IFC) NPV Net Present Value SOE StatementofExpenditure NRL NationalReferenceLaboratory SOP StandardOperatingProcedures OIE World Organisationfor Animal Health TAD TransbounderyAnimal Disease PCT ProcurementCore Team TCEO TechnicalCooperationfor Emergency PCU ProjectCoordinationUnit Operations PD ProjectDirector UN UnitedNations PFM PublicFinancialManagement UNDB UnitedNationsDevelopment Business PIP ProjectImplementationPlan UNDP UnitedNationsDevelopment Programme PPE PersonalProtectiveEquipment UNICEF UnitedNationsInternationalChildrens PRRP PublicProcurementReformProject(GOB) EducationFund PSC ProjectSteeringCommittee USAID United StatesAgency for International PWD PublicWorksDepartment Development PVS Performance,Vision and Strategy(OIE) WHO World HealthOrganization RAP RegionalOffice for Asia andPacific, FA0 Vice President : Praful C.Pate1 Country Director : Xianzhu Sector Directors : Constance A. BernardJulian F. Schweitzer Sector Managers : GajanandPathmanathadhabela Abreu Task Team Leaders : Mohinder S. MudaharDineshM.Nair This document has a restricted distribution and may be used by recipients only in the performance of their official duties. Its contents may not be otherwise disclosed without World Bank authorization. 1 ii BANGLADESH AVIAN INFLUENZAPREPAREDNESSAND RESPONSE PROJECT CONTENTS A. STRATEGIC CONTEXTAND RATIONALE 4 1. Country and Sector Issues 4 2. Rationale for Bank Involvement 6 B. PROJECT DESCRIPTION 7 1. The Plan, the Program and the Project 7 2. Financing Arrangements 8 3. Project DesignPrinciples 9 4. Project Development Objective and Key Indicators 9 5. Project Components 9 6. Avian InfluenzaComponent o f HNPSP 13 C. IMPLEMENTATION 15 1. Institutional and Implementation Arrangements 15 2. Monitoring and Evaluation o f Outcomes/Results 16 3, Sustainability, Critical Risks and Possible Controversial Aspects 16 4. Credit Conditions and Covenants 19 D. APPRAISAL SUMMARY 20 1, Economic and Financial Analyses 20 2. Technical 21 3. Fiduciary 22 4. Social 24 5. Environmental 24 6. SafeguardPolicies 25 7. Policy Exceptions and Readiness 26 Annex 1: Country and Sector Background 27 Annex 2: ResultsFramework and Monitoring 36 Annex 3: Detailed Project Description 49 Annex 4: Project Coordination and Implementation Arrangements 73 Annex 5: Project Costs and Financing 81 Annex 6: Procurement Arrangements 86 Annex 7: Financial Management and DisbursementArrangements 112 Annex 8: Environmental and Social Safeguards 124 Annex 9: Economic and FinancialAnalyses 127 Annex 10: Terms o f Reference for Technical Assistance 133 Annex 11: Project Preparation and Supervision 147 Annex 12: Documents inthe Project File 148 Annex 13: Statement o fLoans and Credits 149 Annex 14: Country at a Glance 151 MAPS:IBRD35246 and IBRD35247 iii iv BANGLADESH AVIANINFLUENZAPREPAREDNESS AND RESPONSE PROJECT TECHNICAL ANNEX SOUTH ASIA SASSD Date: June 11,2007 Team Leader: Mohinder S. Mudahar Country Director: Xian Zhu Sectors: General agriculture, fishing and Sector ManagerIDirector: forestry sector (50%); Health (50%) GajanandPathmanathadConstanceA. Bernard Themes: Naturaldisaster management(P); Other communicable diseases (P); Rural policies andinstitutions (S) Project ID: P102305 Environmental screening category: B Lending Instrument: Emergency Recovery Loan Project Einancing Data t * [ ] Loan [X I Credit [ ] Grant [ ] Guarantee [ ] Other: For Loans/Credits/Others: IDA Total Bank financing (uS$m.): 16.00 (AHITF) Total: 13.00 8.00 21.oo Note: Estimatedamount ofUS$2.999 m from AHITF is rounded to US$3.00 m. AHITF grant i s expectedto beprovided intwo tranches. The first tranche is expectedto be for US$2.00 m. Borrower: People'sRepublic o fBangladesh Responsible Agency: DepartmentofLivestock Services(DLS)underthe MinistryofFisheries and Livestock (MOFL) Building 6, Room 509, BangladeshSecretariat Dhaka- 1000Bangladesh Tel: 716-4700 Fax: 716-1117 fishlivsec@,moestab.gov.bd Does the project depart from the CAS in content or other significant respects? [ ]Yes [XINO Does the project require any exceptions from Bank policies? [ ]Yes [XINO Have these been approved by Bank management? [ ]Yes [XINO I s approval for any policy exception sought from the Board? [ ]Yes [XINO Does the project include any critical risks rated "substantial" or "high"? [XIYes [ ] No Does the project meet the Regional criteria for readiness for implementation? [XIYes [ ] N o Project development objective: The overall objective o f the Project i s to minimize the threat posed by highly pathogenic avian influenza (HPAI) to humans in Bangladesh by controlling such infections in domestic poultry, and preparing for, controlling, and responding to possible human infections, especially an influenza epidemic and related emergencies. Though the objective is specific to HPAI, the interventions are expected to contribute to the control o f other zoonotic diseases and other types o f infectious diseases, interms o fbuildingoverall response capacity inthe country. Project description: The proposed Avian Influenza Preparedness and Response Project (AIPRP) has three components: (i) animal health, (ii) awareness and information, and (iii) public implementation support and monitoring & evaluation. Animal Health Component: This component concentrates on enhancing prevention and preparedness, strengthening disease surveillance and diagnostic capacity, strengthening control programs, improving bio-security, providing support for surveillance o f migratory birds and establishing a contingency fund. The contingency fund would also consist o f a compensation program inorder to compensate the affected farmers for culled birds. Public Awareness and Information Component: This component i s designed to safeguard humanhealth, inparticular for extension staff, animal health workers, poultry producers, poultry traders, poultry processors and other stakeholders dealing with poultry, by improving public awareness andinformation about the HPAI. Communication i s extremely important to minimize negative consequences o fHPAIon poultry production, consumption andhumanhealth and has to be well adapted to conditions in Bangladesh. The project would finance capacity building, and information and communication services, including advocacy and collaboration with stakeholders; production and dissemination o f communication material; and development o f community-based communicationpilots. - 2 - Implementation Support and Monitoring & Evaluation Component: A Project Coordination Unit (PCU) will be established within the DLS. PCU will be headed by the Project Director. PCU will be supervised by the Project Steering Committee (PSC), headed by Secretary, MOFL. The PCU will be responsible for project implementation, coordination and management. It will contain a number o f national staff to handle communication, procurement, financial management, safeguards, operations and the management o f other Project activities. It will also have a technical assistance team (consisting o f international and national experts) hired through FAO. The project would provide support for national and international experts to assist with implementation, communication and management. The project would provide support for the incremental staffing needs o f the PCU, including Monitoring & Evaluation (M&E) staff, and incremental operational cost for the PCU. The project would also provide financial and technical support for regular internal M&E o f the Project as well as for an independent evaluation on a periodic basis. The M&Einthe PCUwill be responsible for monitoring & evaluation o f AIPRP. Which safeguardpoliciesare triggered,ifany? Environmental Assessment (OP 4.01) Significant,non-standardconditions: Ref.SectionC.4 Boardpresentation: June 26,2007 Loadcrediteffectiveness: October31,2007 Covenantsapplicableto projectimplementation: Ref. Section C.4 - 3 - A. STRATEGIC CONTEXT AND RATIONALE 1. Countryand Sector Issues 1. Bangladesh i s a high risk country as far as Highly Pathogenic Avian Influenza (HPAI) i s concerned, especially the H5N1 strain. Some 50 % o f the national poultry flock (a total o f about 185 million) is backyard poultry, with minimalbio-security. It has a large duck population(37 million). Bangladeshis visited annually in the winter monthsby 21 species of migratory birds that can carry the virus. Traditionally, it has imported a large number o f day old chicks (DOCs.) and it has porous borders with neighbouring countries (India and Myanmar) that have had outbreaks'. Bangladesh also experienced outbreaks o f H5N1 from February to M a y 2007. The problem is not yet over andit has affected boththe commercial farms andthe bockyard poultry. 2. Poultry disease surveillance at present is almost entirely limited to clinical surveillance based on trigger points or indicators (mortality). The Department o f Livestock Services (DLS), within the Ministry o f Fisheries and Livestock (MOFL), is responsible for a Central Disease Investigation Laboratory (CDIL) in Dhaka, and a national network o f 7 Field Disease Investigation Laboratories (FDILs).All these laboratories are invery poor condition with almost no equipment or staff trained in avian influenza diagnosis. Ineach o f the 464 Upazila Offices (sub-districts) o f the country, there are at least two DLS officers (one veterinarian and one livestock officer) and support staff that are responsible for disease surveillance and provision of basic veterinary and livestock services. However, many o f the staff positions are vacant and very few have reliable transport facilities or operational funding to enable them to undertake routine disease surveillance. 3. The M O F L i s also the parent ministry o f the Bangladesh Livestock Research Institute (BLRI) at Savar, just outside Dhaka. The BLRIis essentially a research facility and is currently recognised as the National Reference Laboratory (NRL) for AI diagnosis. Prior to the outbreak, it had analysed a large number o f samples taken from imported grandparent DOCs, all o f which were found negative for highly pathogenic avian influenza (HPAI). The DLS has received limited donor assistance in the past to strengthen its veterinary services. The diagnostic capability o f the laboratories at BLRI has received some support from Danida and JICA. However no assistancehas been provided for the central and field investigationlaboratories or to enable veterinary officers to undertake regular surveillance. The commercial poultry sector (sectors 1, 2 and 3), which accounts for another 50% o f the national poultry flock, has little interaction with the public veterinary services (see Annex 1 for characteristics o f main poultry production sectors inSoutheast Asia). 1 Following the H5N1 outbreak inIndia in2006, Bangladeshbanned the import o f day old chicks (DOCs) except for grandparent stock. However it is generally accepted that a considerable number o f DOCSare still being imported, as imports are considerably cheaper (imported DOCs sell for TklO as compared to over Tk30 for domestically produced DOCs). - 4 - 4. Some observers have attributed the lack o f detection o f HPAI until February 2007 in poultry in Bangladesh to the country's very limited diagnostic capacity. Under the circumstances, it seems probable that the country had been fortunate with no virus outbreak till February 2007, or that any introduction (most probably from migratory birds) hadnot established and spread as a result o f the special ecological features o f the country. The mainresting places for migratory birds are in the coastal areas where there is relatively little poultry production. Now that outbreaks have taken place, steps need to be taken urgently to prepare for more such outbreaks in the future. The special features o f the country may be providing some protection, butthis needsto be investigated as parto fthe global epidemiological studyo fthe disease. 5. Health care inBangladesh i s provided byboththe government andthe private sector. The MinistryofHealth and FamilyWelfare (MOHFW) leads a large sector wide program called the Health, Nutrition and Population Sector Program (HNPSP). HNPSP (2003-2010) has three components. The first focuses on accelerating the achievement o f the health-related Millennium Development Goals (MDGs), the Government's poverty reduction strategies and population policy objectives. The second component focuses on emerging challenges. These include the provision o f facilities to deal with accidents and emergencies, new emerging diseases as well as non-communicable diseases. The third component addresses major policy reforms in the health sector. These policy reforms will increase management capacity and the ability o f the Government to engage with other service providers, such as NGOs, the private sector and civil society. HNPSP is supported by the World Bank and other development partners. 6. Government health services are provided almost free, while charges are levied for private health services. There is very little linkage or exchange o f information between the public and private health care providers. The public sector consists o f a network of national, district and Upazila health complexes, with basic facilities and staffing. There i s at least one, 30-50 bed, health complex in each Upazila. At present, these hospitals are not well prepared for case management and would have difficulty handling even a modest outbreak o f HPAI influenza in humans.Similarly, the larger hospitals inthe urbanareas, that aremost likelyto beneededinthe event o f a humanpandemic, are also poorly equipped. Some steps have beentaken at the central level to purchase limited supplies o f personnel protective equipment (PPE) for health workers and rapid response teams, anti-viral medication (oseltamivir), antibiotics and antipyretics, and disinfecting supplies. A number o f sensitization training courses for medical staff have also been undertaken. 7. Bangladesh has a relatively weak public health surveillance and response system. The MOHFW has an extensive network o flocal, district, and regionalinstitutions, but the quality and accuracy o f information about reported diseases i s low. Most information comes from the public sector, while a large amount o f illness is seen in the private sector. In addition to passive, reportable disease data, the Institute o f Epidemiology, Disease Control, and Research (IEDCR), the agency responsible for national disease surveillance, recently established a network o f sentinel surveillance sites at the Upazila level in rural areas. Review o f data from these sites suggests low sensitivity for capturing routine diagnoses like acute upper respiratory infections, influenza-like illness (ILI) and pneumonias. The International Center for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) has well-established active surveillance sites and has been monitoring influenza-like illness. Unless and until adequate national level systems are - 5 - developed, IEDCR will have to continue to collaborate with ICDDR,B and other relevant non- governmental agencies to assure some level o f surveillance. More detail on the sector and the main agencies responsible for disease surveillance andcontrol i s provided inAnnexes 1and 3. 8. In response to concerns about HPAI, the Government of Bangladesh (GOB), with assistance from the World Health Organization (WHO) and the Food and Agriculture Organization (FAO), has prepared a National Avian Influenza and HumanPandemic Influenza Preparedness andResponse Plan (NAIP). This Plan, which conforms to the general standards for such plans set by FAO, WHO, and the World Organization for Animal Health (OIE), outlines specific strategies, institutional arrangements, and activities to be undertaken by concerned ministries to prepare for, prevent, contain andrespond to HPAIoutbreaks inpoultryandhumans. It also identifies the additional facilities and staff training needed to implement the plan. The NAIPwas approved bythe Office o fthe PrimeMinister inmid-April2006. 9. A National Advisory Committee (NAC), comprising the Ministers of the participating Ministries, i s the apex coordinating body for the NAP. Beneath the NAC, there i s a National Multi-Sectoral Task Force (NMTF) with representation from a wide range o f public and private sector agencies. Inaddition, intra-ministerialnational technical committees are being established within the three main participating ministries i.e. MOFL, MOHFW, and the Ministry o f Environment & Forest (MOEF) that is responsible inter alia for monitoring migratory birds. According to the NAIF', during the pre-pandemic phase (phase 1) o f HPAI, MOFL will have primary responsibility for implementation o f the Plan. Duringthe alert phase (phase 2 i.e. post pre-pandemic phase), responsibility will transfer to MOHFW. Inthe pandemic phase (phase 3) the Office o fthe PrimeMinisterwill take responsibility for implementationo fthe Plan. 10. A draft Avian Influenza Prevention Program has been prepared by the DLS, that describes inter alia a number o f actions and responsibilities that need to be undertaken during the various phases o f the disease. The document also briefly outlines the operational procedures, risk communication strategy, culling procedures and compensationplan. Duringimplementation o f the proposed project, it is envisaged that these manuals will be updated and expanded as new information becomes available. In particular, technical sections need to describe in detail the procedures for surveillance, laboratory diagnosis, containment (culling and disposal o f birds), human disease surveillance, diagnosis, curative care, environmental management, communication and compensation. 2. Rationale for Bank Involvement 11. The outbreaks o f H5N1 in early 2007 in Bangladesh, and in early 2006 in the neighbouring countries o f India and Myanmar, have highlighted the fact that Bangladesh i s a high risk country as far as HPAI is concerned. Given the risks o f future outbreaks, the present weakness o f the national veterinary services and limited national resources, there is an urgent need for assistance to help the government strengthen its veterinary services and related aspects, including surveillance, diagnostic capabilities, laboratory facilities, communicatiordpublic awareness and compensation policy. There i s also an urgent need to strengthensome sections o f the human medical services as there is very limited trained capacity and limited facilities dedicated to handling HPAI from surveillance, diagnosis through to curative care. Few - 6 - development partners are providing limited assistance to the government for HPAI activities. However, available resources are not adequate to meet the basic needs o f the veterinary services and facilities related to avian influenza, and there is thus a strong case for the provision o f resources from the World Bank's Global Program for Avian Influenza and Human Pandemic Preparedness and Response (GPAI). There i s also a global public goods argument in favor o f assisting Bangladesh to strengthen its AI response capacity as part o f a coordinated international and regional initiatives to minimize the risk o f spread o f any outbreak to neighboring countries andbeyond. 12. Furthermore, Bangladesh meets all the eligibility criteria for having access to funds under the Adaptable Program Loan (APL) insupport o f GPAI. The Government o fBangladesh (GOB) has already prepared a National Avian Influenza and Human Pandemic Influenza Preparedness and Response Plan (the Plan). This planwas approved by the Prime Minister inApril 2006. As a follow up to this Plan, GOB has also prepared (i)draft Avian Influenza Prevention Program a (which focuses on critical operational guidelines); and (ii) National Communication Strategy a and Action Plan for Avian Influenza and Human Pandemic Influenza. The GOB has also provided additional budgetary resources to improve AI surveillance and diagnosis. This clearly demonstrates Government's commitment and readiness to implement early detection and rapid response measures. While there i s a commitment, the country lacks financial resources, has very weak capacity andfaces a very highrisk o fHPAI. 13. While the proposed new project (Avian Influenza Preparedness and Response Project (AIPRP)) would finance AI activities related to animal health, the on-going project (HNPSP) would finance AI activities related to human health. HNPSP is a very large (US$4.3 billion), multi-year sector program financed by the GOB, the World Bank and development partners. The World Bank administers about US$760 million o f these pooled resources -- consisting o f US$300 million IDA credit and the US$460 million o f grant financing from other bilateral and multilateral development partners. The mainreasons for usingfunds from HNPSP, for the Avian Influenza Component, are (a) it makes logical sense to tap into a human health program that i s already under implementation; (b) HNPSP covers the entire health sector with appropriate implementation arrangements and i s equipped to manage project funds; and (c) it can start fundingAI activities almost immediately. HNPSPalready makes a specific provision for funding new and emerginghuman health challenges such as HPAI. B.PROJECTDESCRIPTION 1. The Plan,the Programandthe Project 14. As has been indicated above, the GOB has already prepared the Avian Influenza Plan entitled the National Avian Influenza and Pandemic Influenza Preparedness and Response Plan (2006-2008) which is known as NAIP or the Plan. The Plan provides a strategic national framework to control and contain any outbreak o f HPAIinBangladesh. At the request o f GOB, the World Bank has agreed to finance the Avian Influenza Program. The AI Program fiu-ther consists o f two parts: (a) the Avian InfluenzaPreparednessandResponse Project (AIPRP, a new - 7 - project that deals with animal health); and (b) Avian Influenza Component o f HNPSP, an on- going project that deals with human health. These two parts o f the proposed AI Program are closely linked and carefully coordinated by appropriate national agencies dealing with HPAI in Bangladesh. However, the NAIP did not work very well during the recent outbreaks and therefore appropriate lessons need to be incorporatedto strengthen NAIP, particularlyto improve implementationduringany future outbreaks. 2. FinancingArrangements 15. The AIPRP project would be financed by IDA credit under the GPAIAdaptable Program Loan (APL), with contributions from the GOB. Technical assistance and training under the project, to the extent possible, would be financed by the grant funds from the Avian Human Influenza Trust Fund (AHITF)', which i s being administered by the World Bank. On the other hand, the AI Component o f HNPSP would be financed from the on-going HNPSP and this agreement to finance has already beenendorsedby all the HNPSP partners'. Financing for avian influenza activities from HNPSP (which runs through December 2010) has already been initiated under the Communicable Disease Operational Plan (CDOP) which has a specific component for supporting new emerging diseases. Furthermore, the project aims at building and consolidating all GOB and donor initiatives related to HPAI in order to avoid any duplication and make the best use o f scarce resources. The proposed project and the AI program are estimated to cost US$21 million andU S 3 7 million, respectively(see Annex 5). 16. N o co-financing is envisaged for APRP, as no development partners have indicated an interest in direct participation. There is, however, a limited amount o f parallel financing for HPAI activities. The more significant include:(i) USAID supported (US$5 15,000) project being implemented by FAO, starting inNovember 2006. The project will support the updating o f the National Plan, and improved laboratory diagnosis and surveillance. (ii)The Government o f Japan (GOJ) has made available US$1.1 million to UNICEF in Bangladesh to prepare a communication strategy and to disseminate pre-pandemic information. (iii)Danida is contributing US$300,000 (and possibly more) for training o f staff in laboratory diagnosis and laboratory equipment, including the provision o f reagents to BLRI. (iv) The Asian Development Bank (ADB) has a regional project with an allocation of US$400,000 for Bangladesh. This project, also implementedby FAO, started with a review o f the current veterinary laboratory status of the country. In addition, GOB has also allocated additional resources to strengthen surveillance, diagnostics and communication. Contributors to the AHITF include the European Commission, DFID, Russia, Australia, China, South Korea, Iceland, Slovenia and Estonia. 2 World Bank is providing US$300 million for HNPSP. Inaddition, seven development partners are co-financing US$460 million for this program. These include DFID, Sida, the Embassy of the Kingdom o f the Netherlands and UNFPA who have signed administrative agreements with the Bank to co-finance the HNPSP. Two other development partners i.e. CIDA and the Federal Republic o f Germany through KfW, are expected to enter into co-financing arrangements with the Bank. Financing the AI Component from HNPSP would be independent of financing from the proposedAvian Influenza Preparedness and Response Project. 3. ProjectDesignPrinciples 17. Immediate action (improved national surveillance and diagnosis at the central level and stock piling o f emergency supplies) is needed in a number o f areas, but there i s also a long-term agenda (staff training and improvements insurveillance, diagnostic and curative facilities), given systemic shortcomings in both core public health functions and veterinary services. Therefore, work on both the short- and long-term fronts needs to proceed inparallel, and efforts should be made to ensure that short-term responses are consistent with and contribute to the proposed long- term interventions. To this effect and given limited institutional capacity, weak national veterinary services and poor facilities, the proposed project would be for a period o f five years. Inthe first three years of the project, the emphasis would be on strengthening surveillance and diagnosis, with a particular focus on high risk areas and hot spots. In the final years o f the project, the emphasis would be on consolidation, firther staff training, and provision o f funds to meet recurrent costs in order to ensure long-term sustainability. By concentrating on priority actions, the project would generate benefits duringnormal times as well as during a pandemic. 4. ProjectDevelopmentObjective and Key Indicators 18. The overall objective ofthe Project is to minimize the threat posedbyHPAIto humans in Bangladesh by controlling such infections in domestic poultry, and preparing for, controlling, and responding to possible human infections, especially an influenza epidemic and related emergencies. Though the objective i s specific to HPAI, the interventions are expected to contribute to the control o f other zoonotic diseases and other types o f infectious diseases, in terms o fbuildingoverall response capacity inthe country. 19. This objective will be achieved through three types o f interventions: (i) prevention; (ii) preparedness and planning; and (iii) response and containment. If these types o f interventions achieve their goals, the proposed project will reduce the burden o f HPAI in poultry and the consequent economic losses. It will also lower the risk o f human infection and the loss o f productivity attributable to human infections in Bangladesh. Finally, it would limit the risk o f HPAIinother countries. 20. At the end o f the Project, it is expected that (i) capacity o f the agencies involved in the HPAI containment, control and mitigation will be improved; (ii) threat to humanhealthinthe the highrisks areas of Bangladesh will be reduced; and (iii) general public will be made aware the andwill have adopted AI related human health, animal health and environmental safeguards. A comprehensive list o f indicators i s providedinAnnex 2. 5. ProjectComponents 21. The proposed AIPW has three components: (i) health, (ii) awareness and animal public information, and (iii)implementation support and monitoring & evaluation. A summary o f project components and activities i s givenbelow and more detail i s provided inAnnex 3. - 9 - I. Animal Health Component 22. This component concentrates on enhancing prevention and preparedness, strengthening disease surveillance and diagnostic capacity, strengthening control programs, improving bio- security, providing support for surveillance o f migratory birds and establishing a contingency fund. Due to limitedcapability o fthe DLS, aninternational disease control expert willbe fielded full time in the first year to ensure effective implementation and continued progress. He/she would visit for short periods duringall the succeeding years o f the project. (A) Enhancing Prevention and Preparedness Capability 23. AI -Adapting National Policy Framework. This would include (a) a review o f national policies for the control of livestock diseases; (b) an evaluation of the national veterinary services; according to OIE standards; and (c) a review o f national compensation policy. The sub- component would support national and international technical expertise to assist the DLS with the reviews andwould build onthe work started byother development partners. 24. A2 - Improving Prevention and Control Planning. There i s a need for NAP to be updated and, inparticular, for private sector and NGOs to be fully involved in the development o f the revised NAP. The Plan also needs to be tested with `tabletop' and `real life' simulation exercises which the project would finance. There i s also a need for better national and regional understanding o f the issues associated with HPAI, and the project would finance participation in selected national andregional conferences and workshops. (B) StrengtheningDiseaseSurveillance and Diagnostic Capacity 25. BI Strengthening of Veterinary Services. Following the review o f veterinary services - and regulations, the Project would support any amendments needed in legislation and also reforms inthe structure o f veterinary services, as part o fDLS. 26. B2 Strengthening Disease Surveillance and Laboratory Diagnosis. This would be a - major intervention o f the Project and would have a number o f sub-interventions, including (a) improving animal health information flow; (b) improving detection, reporting and follow-up o f reported cases; (c) public and community based surveillance networks; (d) epidemiological surveys and research to support strategic activity; and (e) improved laboratory diagnostic capacity. 27. B3 - Strengthening Applied Veterinary Research. The Project would support some applied research projects on HPAI in the form of competitive grants to veterinary colleges and faculties to fully understand the status and scenario o f the infection inBangladesh. (C) Strengthening Control Programs and Containment Plans 28. CI Targeting Virus Elimination at the Source. There is an urgent need to establish - rapid response teams trained, equipped and with operational funding to contain the disease in -10- infected places by effective quarantine. This will enable rapid action to cull and safely dispose o fbirds andother infected materials andthe disinfection o f infected sites. 29. C2 Fundfor Supporting Animal Vaccination. There is need to design a vaccination - strategy based on surveillance and epidemiological surveys, and on the basis o f usingvaccination in conjunction with culling, if necessary. The Project would support a contingency fund (see below) for the acquisition o f good quality HPAI vaccines for poultry produced in accordance with OIE guidelines. 30. C3 - Personnel Safety. Given the highly pathogenic nature o f the H5N1 virus, it i s important that all staff and workers, likely to be in close association with diseased birds, are trained in safe handlingprocedures. The Project would also provide the staff and workers with training andpersonal protective equipment (PPE), (0)ImprovingBio-Security in Poultry Production and Trade. 31. InBangladesh, in addition to the backyard poultry, the section of the poultry industry most at risk i s the level 3 or small commercial producers. These are low cost producers and they generally have limited bio-security measures. The proposedproject would support the DLS staff to encourage such producers to improve their bio-security measures. (E) Supportfor Surveillance of Migratory Birds 32. The Project would provide funds for the MOEF to improve surveillance and reporting o f the occurrence o f unusual wild bird deaths. The MOEF would also be provided with limited amount o f PPE and bio-secure containers in which to transport samples from migratory birds suspected o f dying from HPAIto a laboratory for analysis. (F) Contingency Fund 33. FI - Compensation Program. The project would support the establishment of a compensation program in case there i s a need to compensate affected poultry farmers for culled birdsinthe infectedareas, inaccordance with the guidelines that are beingestablishedby GOB 34. F2 - Personal Protective Equipment and Vaccines. The Project would provide contingency funds for procurement o f PPE, if required, for control and containment in the case o f an outbreak as well as procurement o fvaccines. II.PublicAwarenessandInformation Component 35. This component i s designed to safeguard human health, inparticular for extension staff, animal health workers, poultry producers, poultry traders, poultry processors and other stakeholders dealing with poultry, by improving public awareness and information about the HPAI. Communication is extremelyimportant to minimize negative consequences of HPAIon poultry production, consumption and human health and has to be well adapted to the Bangladeshi conditions. This Project would support implementation o f the National - 11- Communication Strategy and Action Plan, that has been prepared by GOB and the UNICEF (with financial support from Japan), by introducing innovative and best-practice examples to strengthen communication activities. The component would be implemented by the AIPRP PCU, in cooperation with MOFL, MOEF, MOHFW, MOI and other stakeholders. Inthis context, the South Asia Enterprise Development Facility (SEDF) o f the International Finance Corporation (IFC, the private arm o f the World Bank Group) can also play an important role since it works with commercial poultry industryinBangladesh. Improving public awareness and information has two sub-components: (A) Capacity Building 36. This sub-component will strengthen capacity o f the national and regional (within Bangladesh) massmedia (print,television and radio) to accurately report on HPAI. (B) Information and Communication Services 37. Bl Advocacy and Collaboration with Stakeholders. The multi-dimensional problems, - associated with HPAI infection, necessitate collaboration from a wide range o f stakeholders, which has to be supported by broad communications and information campaigns to improve public awareness. The sub-component would support activities designed to improve coordination and collaboration among all major stakeholders, including various ministries and agencies (e.g. Planning, Finance, Agriculture, Health, Information, Department o f Livestock Services, national research institutions and diagnostic laboratories), NGOs, civil society, private sector companies and associations (e.g. large poultry production companies, farmers' associations, veterinarians andfarmers at the grassroots level). 38. B2 - Production and Dissemination of Communication Material. Activities would include developing and testing messages and materials to be used during all stages o f HPAI and fbrther enhancing infrastructures to disseminate information from national to local levels and between the public and private sectors modules (web-based, printed, audio and video); presentations, slide sets, videos, and documentaries; and symposia on surveillance, treatment and prophylaxis. 39. B3 Developing Community-based Communication Pilots. This sub-component would - support the development and implementation o f training courses in communications methodology for extension and veterinary staff as well as health workers and NGOs at the national and local levels. It would include preparation o f local programs, preparation and dissemination o f information materials and the provision o f communications and information equipment for use at the local and national levels. III. ImplementationSupportandMonitoring&Evaluation Component 40. This component would have two sub-components. - 12- (A) Implementation and TechnicalSupport 41. A Project Coordination Unit (PCU) is being established within the DLS. The PCUwill be responsible for project implementation, coordination and management. It will contain a number o f national staff to handle communication, procurement, financial management, safeguards, operations and the management o f Project activities. It will also have a technical assistance team (consisting o f international and national experts) hired through FAO. The project would provide support for national and international experts to assist with implementation, communication andmanagement. Inparticular, the project will support (a) long- term international veterinary expertise to assist DLS; (b) a long-term national expert to assist in project implementationand will be based inthe Project Coordination Unit (PCU); and (c) a long- term national expert to assist with implementation and coordination o f the AI Component o f HNPSP and based in DGHS under MOHFW. The project would also provide support for the incremental staffing needs of the PCU, including M&E staff and operational cost for the PCU. (B) Monitoring and Evaluation 42. This sub-component would provide financial and technical support for regular internal M&E o f the Project as well as for an independent evaluation on a periodic basis. The M&E in the PCU will be responsible for monitoring & evaluation o f AIRPP. M&E will be part o f the Management Information System (MIS) that would be established inthe PCU. 6. Avian Influenza Componentof HNPSP 43. The NAP provides a strategy and framework for addressing all major aspects o f preparedness and response to humandisease from avian influenza. The HNPSP is a sector wide program covering the entire health sector with the mandate o f meeting the emerging health challenges facing the country. In the design o f HNPSP, MOHFW had anticipated the possible occurrence o f new and emerging communicable diseases that would require interventions. MOHFW has initiated the task of programming the envisaged avian influenza activities into HNPSP. These have been incorporated into the Communicable Disease Operational Plan o f the HSPNP and endorsed by appropriate GOB authorities. The activities under avian influenza can be divided into those representing improvements in general capacity for emerging and re- emerging diseases (such as information technology and laboratory enhancements) and those that are influenza-specific (such as acquisition o f antiviral medication). Both are important, but the former will probably have longer lasting impact. The Avian Influenza Component o f HNPSP would have three sub-components. (A) EnhancingPublic Health Program Planning and Coordination. 44. This sub-component will support (a) review o f the existing regulatory and legal framework in Bangladesh for surveillance, prevention, control activities and policies; (b) periodic assessments of capacity at the regional (division) and sub-regional (district) levels to address avian influenza; (c) development and dissemination o f guidelines and protocols for avian influenza surveillance, investigation, and case management; and (d) development and conduct of - 13 - tabletop and field simulations related to avian influenza. Technical assistance will be provided to conduct regulatory reviews, develop and conduct periodic capacity assessments, develop guidelines, and develop and conduct simulation exercises. (B) StrengtheningNational Public Health SurveillanceSystem 45. Bl Strengthening DiseaseMonitoring & Reporting. This sub-component will support - (a) training o f personnel on surveillance and investigation o f this disease to include the strengthening and enhancement o f sentinel surveillance for influenza-like illness (ILI); (b) upgrading o f priority infrastructure o f health surveillance services to provide for better national surveillance for viral pneumonia and other manifestations o f human disease caused by avian influenza; and (c) support for district and national rapid response teams to conduct field investigations related to avian andpandemic influenza. 46. B2 Strengthening Public Health Laboratory Network. Under this sub-component, - funds would be provided for (a) laboratory strengthening to diagnose avian influenza, including provision o f rapid diagnostic kits to regional laboratories and sentinel sites; and (b) development o f virus isolation capacity at IEDCR. Support for IEDCR to develop and operate real time polymerase chain reaction (RT-PCR) capacity is being provided by other donors. Technical assistance support will be provided for the development o f information technology related to disease surveillance and for the establishment o f a pre-fabricated bio-safety level 3 (BSL-3) laboratory for virus isolation. (C) Strengthening Health CareSystemPreparednessand Response Capacity 47. This sub-component would have four interventions. 48. C1 Personnel Safety Equipment. Acquisition o fpersonal protective equipment (PPE) - for use byhealth care workers andinvestigators. 49. C2 Purchase of Seasonal Vaccine Doses. Acquisition o f seasonal influenza vaccine - for highrisk health care workers, culling workers, and rapid response team members. 50. C3 Disease CaseManagement. This would include (a) training o f clinicians andhealth - care workers; (b) acquisition o f antivirals and other medications for disease prophylaxis and treatment; (c) acquisition o f hygienic and disinfecting supplies; and (d) renovation o f health care facilities for case isolation andmanagement. 51. C4 Pandemic Planning. This would include (a) development o f protocols for health - care system surge capacity and social distancing measures; and (b) equipment and materials for quarantineoperations andmortuaryservices. Technical assistanceto develop protocols for surge capacity, social distancing andmortuary services will be supported. - 14- C. IMPLEMENTATION 1. InstitutionalandImplementationArrangements 52. Implementation ofthe Plan: The Government o f Bangladeshhas designated MOFL and MOHFW to implement its national Plan (NAP), with appropriate support from other agencies, including MOEF and MOI. A National Advisory Committee (NAC), comprising o f 16 Ministers and a representative o f the Prime Minister's Secretariat, has been designated as the apex coordinating body. Beneath the NAC, a National Multi-Sectoral Task Force (NMTF) has been establishedwith representation from a wide range o fpublic andprivate sector agencies. The cost for implementingthe Plan is being borne by GOB. 53. Implementation of the Program: The Avian Influenza Program for Bangladesh consists o f two parts (a) Avian Influenza Preparedness and Response Project (AIPRP, a new project); and (b) Avian Influenza Component o f HNPSP. The supervision o f the Avian Influenza Program will include both the animal health (AIPRP) and the humanhealth (Avian Influenza Component o f HNPSP) aspects o f the avian influenza. The public health expert, provided under the AIPRP, but based inDGHS, will serve as the link between these two parts o f the AI program. The AI Component o f HNPSP will be implemented by MOHFW, using all the existing procurement and financial management arrangements. 54. Implementation ofthe Project: The World Bank supported AIPRP i s under the Global Program for the Avian Influenza andHumanPandemic Preparedness andResponse (GPAI). The AIPRP, an emergency project, is designed to provide assistance for avian influenza within the overall framework o f the GOB'Snational Plan. The project would be implemented over a period o f 5 years. A PCUi s being established inthe DLS under the Ministryo f Fisheries and Livestock (MOFL) to implement and coordinate the project activities, including communication, procurement, financial management, safeguards, monitoring andreporting. 55. The PCU inthe DLS will be headedby the Project Director (PD) andwill be responsible for the overall coordination o f project implementation and the project related activities. The Project Director will have all the authorities provided under the existing GOB regulations. The PCU will be supervised by the Project Steering Committee (PSC), headed by Secretary, MOFL, and would share information with MOFL, MOEF, MOHFW, MOIand the development partners, on a periodic basis. The PCU will monitor the implementation progress o f AIPRP during implementation and will produce progresshpecial reports. The PCU would be staffed by appropriate number o f staff and consultants for overall administration, coordination, procurement, financial management, communications, safeguards and internal M&E. 56. The project would provide support for national and international experts to assist with implementation, coordination andmanagement (see Annex 10 for terms o f reference). Most, not all, o f the consultants would be on a short-term basis. The project would also provide support for the incremental staffing needs o f the PCU, including M&E staff and operational cost for the PCU. Annex 4 provides details about project coordination andimplementation arrangements. - 15- 2. MonitoringandEvaluationof Outcomes/Results 57. The M&E unit in the PCU will continuously and systematically monitor project implementation activities, outputs and outcomes. The key indicators to be monitored include: preparation and approval o f contingency plans; extent o f animal surveillance and laboratory testing; training o fveterinary andhealth officers; readiness for outbreak containment; enactment of containment plans (as and when necessary); changes to legislation; fully developed human surveillance systems and equipped laboratories; training o f health workers; weekly/monthly disease reporting; preparation of communication material and communication strategy. Further details are provided inAnnex 2. 58. A national M&E specialist is included as a consultant to work withinthe AIPRP PCUfor the entire project period. He/she would be responsible for preparing the M&E program at the beginning o f the Project, for training central and district staff inhow to record and report data, and for producing regular reports for the PSC and the World Bank. He/she would work closely with the PCUinpreparing quarterly progress/special reports. 59. Inaddition, the PCUwill appoint, using agreed procurement guidelines (and preferably through FAO), a team of consultants for an independent impact evaluation o f the Project. This team will carry out a base line survey for the key performance indicators, collect data at a specified frequency, analyse those, and prepare a baseline, mid-tern and end-of-the-proj ect impact evaluationreports. 3. Sustainability,CriticalRisksandPossible ControversialAspects 60. Sustainability. Project sustainability depends on (i) continuous ownership o f the HPAI initiative by various stakeholders; (ii) political support at various levels; and (iii) strong adequate flow o f financial resources to carry out activities after the project closes. During implementation, the project would facilitate sustainability by: (i)strengthening programs to provide information and maintain public awareness o f the threat o f HPAI; (ii) sustained HPAI surveillance, diagnosis, prevention and control activities, particularly in high risk areas; (iii) strengthening capacity o f national institutions to manage the risk factors associated with the spread o f HPAI; (iv) improving effectiveness o f programs to control the spread o f HPAI from birdsto the general population inBangladesh; and (iv) strengthening the medical care network to cope with the increased demandand to prevent spreadof infection. 61. Critical Risks, A summary of critical risks for the Project and the likely mitigation measures are provided below: Risk I RatingI Mitigation Measure FromOutputs to Objective Decline inpolitical commitments to I H IContinuing support for inter-sectoral collaboration addressingHPAIand the threat o f a through information exchanges and dialogue, and Global Influenza Pandemic and other operationalization o f the NationalAvian Influenza infectious diseases, as a nationalpriority. and Human Pandemic & Influenza Preparedness and Response Plan (NAIP),which i s to provide general policies and guidance for avian influenza control. - 16- hadequacyor lack o f multi-sectoral M NAPwill facilitate coordinationand linkages 3articipation. across relevant agencies and international partners. Inaddition, GOBhas establishedaNational Advisory Committee WAC) and National Multi- Sectoral Task Force (NMTF) with representatives from various stakeholders. Low commitment at the local levels Implementationmechanisms explicitly address the means that strong central commitment linkbetween the requiredcentralized decision does not translate into action on the making (the principle o f `direct chain o f ground. command') with the needed implementation (at the local level); communication strategies and capacity buildingwill include agencies, staffand communities at the local level. Outbreaks are not recognized and Activities to strengthen surveillance and reporting, reported quickly enough to initiate including (i) initiation o f year-round influenza control measures. surveillance inanimals and humans;(ii) training o f front-line animal and human health workers in identification andreporting; (iii) improved communications infrastructure; and (iv) establishment o f appropriate laboratories. Intervention activities not effective in Activities would strengthenresponse capacity in containingthe spread o f avian influenza priority areas and lay the foundation for a more from birds to the humanpopulation. broadlybased strategy, including: Comprehensive awareness, information and communication campaigns are critical to containingthe spread o f an influenza pandemic. Choosingwell-designed, and cost-effective interventions. Interventions phased and carefully monitored, allowing for modifications and redesign, as needed. Service delivery decentralized with the appropriate use o f local governments and civil society. Good M&E systemto flag emerging issues. Lack o f independent internalaudit Ensure that robust internal audit function i s function. independent from operations and reports to top management and the NAC. GOB i s unable to react quickly to Procurement plan already prepared and critical outbreaks. staffing already identified. Trainedrapid response teams and stockpile o f equipment and vaccines. Appropriate communications and transportation support to ensure rapidresponse. MOHFWinitiative lackingin Incorporate progress on AI preparations as an mainstreaming Avian Fluactivities into agenda inthe Annual ProgramReview and HNPSP encourage discussions at HNP forum meetinns - 17- Project implementing agencies lack S Adequate arrangements are beingput inplace for sufficient authority, leadership and project implementation and strengthening o f capacity to take a leadingrole inavian capacity. influenzaprevention and control. Controlling the spread o fthe pandemic S Projectwill support advocacy and coalition may expose the Government to criticism buildingto sensitize key groups, includingpolicy concerning the curtailment o f civil rights makers and the media. This will be complemented due to the adoption o f quarantines and by carefully designed mass communication other related measures. campaigns to buildsupport amongthe population. Lack o f laboratory capacity for prompt H Project activities will be coordinated with efforts diagnosis and surveillance and o f undertaken by other international organization that sufficient quantities o f drugs and other have HPAIrelatedprograms inBangladesh, medical inputsneededto address the particularly relatedto strengthening laboratory needs o f the general population duringa facilities. pandemic. Inadequate institutional capacity to S Capacity building and institutional development is manage the project. one o f the project's key objectives and substantial resources are allocated to these efforts. Financial resources not accessible in a H Procurement and financial management timely manner; weak procurement arrangements will be handledby the experienced management. staff inPCU and capacity would be strengthened. Lack o f timely and predictable access to I M Project activities have been designed with assistance from leading multilateral agencies such as FA0 and WHO. Such assistance i s expected to continue over time. Alternative sources o ftechnical assistance will also be explored L o w priority given to public S Publication o f audit results and achievements; accountability and transparency in transparency indecision making and resource program management. allocation. Inadequate capacity for planned M Training and technical assistance for surveillance surveillance, surveys and monitoring & and epidemiologicalinvestigations; partnership evaluation. between local and international institutions will be provided. The M&E plan will include information on instruments for data collection, agencies responsible and a detailed time table. Cooperation agreement with ICDDR,B There i s an ongoing linkage being supported on surveillance and laboratory use not through the CDC initiative. These and other concluded. technical linkages will encourage cooperation. Misuse o f the Compensation Program Implementationarrangements for the facility. Compensation Programmust incorporate strong features o f transparency, community involvement, and ex-ante andex-post checks that have been found effective inthe country under other projects. Overall RiskRating: S RiskRating: H(HighRisk), S (Substantial Risk), M(Modest Risk), N(Negligible or LowRisk) -1 8 - 62. Overall, lack o f good governance has been recognized as a major problem in the World Bank's 2006-09 Country Assistance Strategy for Bangladesh. This project will be implemented in an environment o f weak governance and highperceived corruption. In addition to the risk mitigation measures highlighted above, the Project will place a special emphasis on disclosure andtransparency. Specific measures, incorporatedinthe design o f this project as well as during implementation, that would promote good governance are summarized below: Ex-ante controls. Appropriate ex-ante internal controls inthe poultry culling and compensation program will be implemented and ex-ante checks will be carried out before any compensation payments are made. Annual operational review. To supplement the annual project audit, an annual operational review will be carried out by external reviewers, acceptable to the World Bank, who will review the internal control, framework and procedures, particularly for the Compensation Program and the inventory o f drugs, vaccines, medical andveterinary equipment andother sensitive and/or expensive assets. Transparency andpublic information. The project will have its own website and relevant information about the project will be continually posted on the website. Intensive supervision. The project, including procurement and financial management activities, will be intensively supervised bythe Bank staff. 63. Possible Controversial Aspects. The project will support the implementation o f necessary actions to prevent, control and respond to possible influenza pandemic. Some o f the typical and necessary "social distancingmeasures" (such as quarantines, bans on mass gatherings andtravel restrictions) maybe socially andpolitically controversial. Culling for outbreak control among poultry is also likely to be controversial. Intensive and continuous dialogue i s needed among different stakeholders. This will be supplemented by a well designed communication strategy. A high degree o f political commitment i s needed for managing any controversies with respect to preventing andcontrolling influenza pandemic. 4. CreditConditionsandCovenants 64. EffectivenessConditions. (a) The AHITF Grant Agreement has been executed and delivered, and all conditions precedent to its effectiveness or to the right o f the Recipient to make withdrawals under it (other than the effectiveness o f the Financing Agreement) have been fulfilled; (b) The Recipient has established a Project Coordination Unit, with terms o f reference acceptable to the Association, andwith adequate staffing and resources; and (c) The Recipient has prepared and adopted an Operational Manual, in form and substance acceptable to the Association. - 19- 65. Disbursement Condition. There is an urgent need for GOB to finalize and approve compensation strategy and guidelines that would provide the basis on which compensation would be paid to the farmers. GOB also needs to work out the details o f the compensation strategy and its operational guidelines, including eligibility o f commercial as well as backyard poultry producers. Some guidelines on compensation, for consideration by the GOB, are provided in Annex 1. Finalization and approval o f compensation strategy and guidelines is a condition for the Bank to disburse for the compensation program from the IDA credit. 66. Covenant. The Recipient shall, no later than one month afier the date o f credit effectiveness, appoint two external members o f the Procurement Core Team, with terms o f reference, qualifications and experience acceptable to the Association. D. APPRAISALSUMMARY 1. Economicand FinancialAnalyses 67. It is difficult to make accurate estimates o f the economic impact o f the project in Bangladesh, mainly because o f lack o f scientific knowledge on the primary factors affecting the spread o f the HPAIinhumans and the probability o f its occurrence. It i s also the case that there are no measurable positive outcomes or benefits interms o f increased production or efficiencies arising from the investments. Instead there are only losses (in terms of poultry, humans, economic assets and economic benefits) saved or prevented. While such savings do have an economic impact, it i s impossible to calculate them accurately ex ante. This i s because the extent of the losses `saved' cannot be quantified until they occur. Earlier outbreaks of severe human influenza provide some background information about likely future losses. However, the data from past pandemics i s not very reliable and does not allow for advances in modern medicine and the impact o f globalization. What is also unknown is the severity o f any future human influenza pandemic derived from H5N1, Moreover, since HPAI preparedness and response projects arejust starting inmost countries, there are no indicators o f the extent o fprotection they may provide for reducing the impact o f AI. Given this, economic analyses have been carried out under a number of possible scenarios. 68. Economic analyses have been conducted for the proposed Avian Influenza Preparedness andResponse Project (AIPRP) and the Avian Influenza (AI) component o f the on-going Health, Nutrition and Population Sector Program (HNPSP). The analyses examine economic impacts o f AI interms o fcosts incurredwithout the AIPRP andthe AI component ofHNPSP andeconomic impacts o f AI in terms o f benefits and costs incurred with the AIPRP and the AI component o f HNPSP. Six different scenarios, inthe form of poultry and human "Gross Attack Rates" (GAR) have been considered, as shown in the table below. The first three scenarios represent real case situations inthe region, the last three scenarios are projections. - 20 - PossibleGrossAttack ScenariosConsidered GrossAttack Rate(GAR) Scenarios(YO) Population I I1 I11 IV V VI Poultry 0.7 10.0 20.0 20.0 20.0 20.0 Humans 0.0 0.1 1.o 15.0 20.0 30.0 69. Without the AIPRP and HNPSP, it is estimated that the economic impacts will range between US$154 million and US$1.228 billion which is approximately between 0.3% and 2.2% o f GDP inBangladesh. Loss o f humanlife inthe worse case scenario (scenario VI) i s estimated to be about 663,000 humandeaths. EstimatedEconomicImpactofHPAIinBangladesh I GrossAttack I Scenario Rates(YO) Impact As%of I Human Poultry Humans million I US$ II GDP deaths I 0.7 0.0 154 0.3 0 I1 10.0 0.1 203 0.4 2,000 Iv I11 20.0 1.o 283 0.5 22,000 20.0 15.0 740 1.3 332,000 V 20.0 20.0 902 1.6 442,000 VI 20.0 30.0 1.228 2.2 663.000 70. With the AIPRP, the AI component o f the HNPSP and the AI Program, in the case o f low GARs on the poultry and human populations, the costs incurred tend to outweigh the corresponding benefits (in terms o f net present value). However, in the event o f the GARs o f 10% in the case o f the poultry population and 1% in the case o f the human population, the benefits incurred tend to outweigh the corresponding costs over a period o f 15 years. The AIPRP provides benefits, especially if there is an outbreak of AI that impacts upon the poultry population, in Bangladesh, comparable with those that have occurred in South East Asia. The benefits of the AI component o f the HNPSP, and the AI Program as a whole, would be considerably greater inthe event o f an impact on the humanpopulation. Details o f the economic and financial analyses are provided inAnnex 9. 2. Technical 71. The technical proposals for both the animal health (Avian Influenza Preparedness and Response Project) and the human health (Avian Influenza Component of HNPSP) related AI activities are based on a phased and multi-disciplinaryapproach. These proposals take due cognizance o f a sound epidemiological approach to control and contain HPAIoutbreaks, and are tailored to the prevailing conditions in Bangladesh. The country i s currently at an inter- -21 - pandemic phase, according to the basic WHO classification during which the priority is to be able to detect andrespond to new outbreaks. 3. Fiduciary 72. Financial Management. With increasing reliance on country system and shifting the focus from creating a parallel system to using the existing public financial management (PFM) structure, system and policies, the AI Program will be implemented within the structure o f implementing ministries. The AIPRP will be implemented by the Department o f Livestock (DLS) o f the Ministry o f Fisheries and Livestock (MOFL) while the Line Director - Communicable Disease (LD-CD) o f the Ministry o f Health and FamilyWelfare (MOHFW) will implement AI component under the on-going HNPSP. As DLS has weak institutional capacity and little experience o fmanaging donor fundedprojects, a Project CoordinationUnit (PCU) will be established in DLS with reassigning existing staff to oversee project implementation. The project would provide necessary technical assistance, through both local and international experts. LD-CD o f MOHFW has been implementing the Communicable Disease Operational Plan under HNPSP, using the government system, its own structure and staff. The AI component will be implemented usingthe implementation arrangements that are already inplace under HNPSP. 73. DLS follows the GOB'S financial management (FM) system, including planning budgeting, accounting, internal controls, internal audit, reporting and external audit. For developmentprojects, there is a project accounting manual which outlines the GOB FMsystem. This system will be followed for the AIPW. DLS has agreed to designate two full time Accountants who will work under the overall guidance and supervision o f the Project Director. The two FM staff will work with the core implementation team in the PCU. The team will be assisted by the national and international experts who would provide technical support. DLS will, in collaboration with World Bank, provide disbursement, financial management and procurement training to its core staff who would be involved inproject management. 74. The project has allocated financial resources to compensate the affected poultry farmers for culled infected birds. For the management o f the compensation program, operational guidelinesoutlining the process and operational modality for accessing the level o fcompensation are being prepared. Appropriate ex-ante controls in the poultry culling and compensation program will be implemented. As additional oversight, an annual operational review will be carried out by an independent firm, acceptable to the World Bank, which will review the internal controls, framework and procedures, particularly for the compensation program and the inventory o f drugs, vaccines, medical and veterinary equipment and other sensitive andor expensive assets. 75. A control framework outlining major expenditure eligibility for the project andindicators o f fraud, corruption and collusion and coercion has been agreed for ensuring that the framework serves as a basis for any investigation that might be necessary as a result o f any reported ineligible expenditure from internal and external audit or additional annual review. The consolidated project financial Statements will be prepared by the DLS and will be audited by the Comptroller andAuditor General (C&AG). The C&AG i s considered as independent auditor and - 22 - acceptable to the Bank. Audit report o f the project will be submitted to the Bank within six monthsofthe end o feach fiscal year. Financial management anddisbursement details are given inAnnex 7. 76. Procurement. Bangladesh has undertaken procurement reforms which is a major step forward in improving the public procurement environment. Though key policy reform actions have already been completed, including mandating new procurement regulations with associated procedures and all documentations and recently the Parliament passed a procurement law, implementation of the regulations is still a key challenge and less progress has been made in achieving tangible outcomes on the ground. Clearly, this is only the beginning, and there are still number o f potential challenges in cross-cutting governance, institutional, and implementation issues, including inadequate enforcement o f regulations, inadequate adherence to the provision o f procurement approval process, delays in contract award, ineffective contract administration, allegations of fraud and corruption, and political interference. Considering all these factors, the procurement under the proposed project remains a challenge requiring special measures to address associated risks (see Annex 6 for more details). 77. Procurement Risks and Measures: As mentioned in the risks section, the project i s considered as a "high risk" operation from public procurement point o f view. The assessment i s based on general environment for public procurement inthe country as well as the procurement management capacity o f the DLS. A number o f special measures are underway in the country, and as part o f the ongoing procurement reform, a second follow-on reform project is expected to make the reform efforts sustainable. Concurrently, a number o f measures are specifically introduced inthis project to minimize procurement risks. 78. At the project level, measures taken are: (a) a Procurement Core Team (PCT) consisting o f at least five members, with two external independent experts included in it and recruited by using Bank guidelines. The PCT will provide oversight o f procurement under this project for large value contracts that are subject to prior review and will be specifically responsible for the following: (i) review the biddingdocuments for large contracts that are subject to prior review; (ii) bids,evaluatebids,andpreparebidevaluationreports,alongwithrecommendations receive for the award o f contract; (iii)carry out the ex-post review o f bidding procedures followed in smaller contracts that are not subject to prior review; and (iv) make field visits to a number of sites and check the quality o f procurement o f goods and works and performance o f the suppliers/contractors; (b) a credible system o f handling complaints will be put in place so that grievances are addressed in a timely manner with proper maintenance o f records; (c) disclosure o f information - procurement plan and publication o f contract awards in the website, including invitations to bids, status o f evaluation award and performance o f contractors, suppliers and consultants; and (d) a risk mitigation framework to address issues relating to inappropriate biddingpractices, including fraud and corruption. 79. Procurement Components and Responsibility - Avian Influenza Preparedness and Response Project: The proposed project is designed to provide assistance for AI and has three components: Animal Health (US$16.6 million), Public Awareness and Information (US$1.9 million), and Implementation Support and Monitoring and Evaluation (US$2.5 million). Total value o f the project i s US$21 million; total procurement o f US$16.30 million under the project - 23 - will involve goods o f US$10.75 million; followed by consultancy services o fUS$2.38; training, studies and workshops of US$2.45 million; and civil works o f US$0.72 million. These three components will be implemented by the Department o f Livestock Services (DLS), under the Ministry of Fisheries and Livestock (MOFL) (see Annex 6 for more details about the procurement arrangements andthe role o f FAO). 80. Procurement Componentsand Responsibility Avian Influenza Component of existing - HNPSP: The value o f the Avian Influenza Component o f the existing Health Nutrition and Population Support Project (HNPSP, P074841) i s US$ 16 million. Avian Influenza component will be implemented by the Ministry o f Health and Family Welfare (MOHFW) through the Director General o f Health Services (DGHS). The Line Director for Communicable Diseases in DGHS will manage this component and, depending on the type o f activity, will liaison with Line Directors Hospital, In-service Training and Communications. Central Medical Stores Depot (CMSD) will act as procurement entity for goods procurement and Public Works Department (PWD) will be responsible for procurement o f works (see Annex 6 for more details about the procurement arrangements andthe role o f WHO). 4. Social 81. The main social concern i s the maintenance o f livelihoods for poultry producers, especially sectors 3 and 4 producers, in the event o f future outbreaks o f HPAI. There are two main ways inwhich GOB can assist small producers. The first is through the establishment o f a compensation program that operates in a transparent and agreed way. That is to say there i s agreement between the producers and GOB on the amount o f compensation payable for each bird culled. Further discussion is needed between GOB and the industry to draw up compensation payment mechanisms. The second important thing i s for all stakeholders to develop and promote risk awareness messages that do not panic people into refusing to buy poultryjust because o f an outbreak in some parts o f the country. Some progress has been made on this front, but more needs to be done, especially with regardto news media. The Project will have significant positive social impact by protecting human lives through HPAI early warning, prevention and containment, improved poultry farming practices, increased public awareness o f HPAIand improvedhygiene and food preparation practices andwaste management. 5. Environmental 82. The Project i s assessedas a Category B (partial assessment) project based on the type o f interventions proposed under the project and the nature and magnitude o f potential environmental impacts. The project is likely to have limited adverse environmental impacts as the interventions are largely on public sector capacity building and improved readiness for dealing with outbreaks o f AI in domestic poultry. These prevention focused activities are expected to have positive environmental impacts because project investments in facilities, equipment, laboratories and training will improve the effectiveness and safety o f existing AI handling and testing procedures by meeting international standards established by OIE. This would be reinforced by the mainstreaming o f environmental safeguards into the protocols and procedures for culling and disposal o f animals inthe event o f anAI outbreak, decontamination o f production facilities and laboratory biosafety. However, adverse environmental health impacts, - 24 - mainly inadvertent spread o f HPAI, could occur when an emergency operation involves containment o f HPAIoutbreaks through quarantine, isolation and stampingout actions andwhen relevant mitigation measures are not inplace. Therefore, precautions have been taken under the Project to avoid or minimize such impacts by integrating environmental and public health safety aspects in the preparatioddesign and implementation o f the project. The potential adverse environmental impacts identified above will be mitigated by integrating environmental and public safety aspects in all stages o f the project. The Government has prepared guidelines for safe culling, transport and safe disposal o f carcasses, which will be supported under the project. The project will provide training to all relevant staff for implementation o fthe Guidelines as well as infrastructureneededinthe event o f an outbreak. 6. Safeguard Policies 83. Environmental Assessment i s the only safeguard policy triggered under this project, considering the scope o f activities financed under the project. There are no Social Safeguards triggered by the project because there will be no land acquisition, voluntary or involuntary, therefore there would be no displacement o fpeople. Ifany land is required, either temporarily or permanently, for burial pits for mass disposal of deadbirds, or for constructiono fincinerators or for open burning o f carcasses, or for the construction o f laboratories andor other medical or veterinary facilities, such land will be provided by the Government. Such lands will be free o f squatters or other encumbrances. An Environmental and Social Safeguards Management Framework (ESSMF) and an Environmental Management Plan (EMP), that outlines the measures proposed to address all potential adverse environmental and social impacts, has been prepared and will serve as a guide to ensure that the project will not result in any potential indirect andor long-term impacts (see h e x 8 for details). The preparation o f the guidelines has involved an evaluation of suitable alternatives for safe culling, transport and particularly for safe disposal o f carcasses. The project will finance the implementation o f the selected alternatives, according to the EMP. Inthe case o f the AI Component o f HNPSP, a Health Care Waste Management Plan already exists under the HNPSP and this will form the basis o f environmental management for avian influenza activities as well (no separate EMPwill therefore beprepared for the humanhealthcomponent). Safeguard Policies Triggered by the Project Yes N o Environmental Assessment (OPBP 4.01) [XI [I Natural Habitats (OPBP 4.04) [I [XI Pest Management (OP 4.09) [I [XI Cultural Property (OPN 11-03,being revised as OP 4.11) [I [XI Involuntary Resettlement (OP/BP 4.12) [I [XI Indigenous Peoples (OPBP 4.10) [I [XI Forests (OPBP 4.36) [I [XI Safety o f Dams (OPBP 4.37) [I [XI Projects inDisputedAreas (OPBP 7.60) [I [XI Projects on International Waterways (OPBP 7.50) [I [XI - 2 5 - 7. Policy Exceptions and Readiness 84. There are no policy exceptions required. The project meets the regional implementation readiness requirements. The General Procurement Notice (GPN) has been published in the UNDB online. Procurement plan and the implementation program for first year (year 1) has already beenprepared. DLSis inthe process o f establishing the PCU. A preliminarydraft of the Avian Influenza PreventionProgram by GOB has already beenprepared. The draft Operational Manual and draft Compensation Guidelines have been prepared and are being updated. The National Communication Strategy and Action Plan for Avian Influenza and Human Pandemic Influenza (2007-2008) has been prepared and approved by GOB. - 26 - Bangladesh Avian Influenza PreparednessandResponse Project Annex 1: Country andSector Background Background 1. With a population o f approximately 145 million persons and a land area o f 147, 570 sq. km, Bangladesh is one o f the most densely populated countries inthe world. About 75% o f the population lives in rural areas. It i s also among the less developed countries, with a per capita annual income o f less than US $500. These factors have important implications for the health situation inthe country. Average life expectancy i s 62 years, infant mortality is 61 per 1000 live births, and annual population growth rate i s 1.6 per cent. The ratio o f physicians to population i s only 2.6 per 10,000 persons. 2. Highpopulation density andlow socio-economic status are associated with a highburden o f infectious diseases, and Bangladesh i s no exception to this rule. As one example, the annual incidence o f tuberculosis is 229 cases per 100,000 persons, one o f the highest rates inthe world. Should the country experience an influenza pandemic, it would likely result in high morbidity and mortality and would be difficult to control. The highpopulation density would ensure rapid spread throughout the country. Therefore, it i s important to take steps to quickly recognize the presence o f avian influenza inthe country, identify the subtype and take appropriate measures to mitigate its impact on domestic poultry as well on public health. Avian Influenzaandthe Poultry Sector 3. Bangladesh experienced H5N1 outbreak from Februaryto May 2007. The problem i s not yet over. However, to date, there have beenno reports o f HPAI (H5N1) infection inhumans in Bangladesh. Many o f the recognized risk factors, listedbelow, are present inBangladesh: 0 224 known species o fmigratorybirds; 0 21 o f the migratory birdspecies are knownto carry H5N1virus; 0 Porous international boundaries with neighbouring countries (India and Myanmar) that have had outbreaks; 0 Numerous live birdmarketswhere mixingo f species occurs; 0 Numerous and extensive water surfaces, ponds and lakes; Significant domestic duck population; and 0 Numerous small-holder and semi-intensive poultry production units with minimalbio-security. 4. Some observers consider that the lack o f intensive duck rearing inthe country may partly explain why there have been no outbreaks o f H5N1 prior to February 2007, as intensive duck rearing is associated with the disease in a number o f Asian countries. It may also be that the - 27 - resting sites o f most migratory birds, with the exception o f the northeast region, are in remote coastal areas where there is little poultry raising. 5. The national poultry flock i s estimated by the Department of Livestock Services (DLS) (2004-2005) to contain 183.45 million chickens and 37.28 million ducks. Approximately 50% of chickens are kept by backyard owners invillages. The remaining 50% are raisedinan estimated 100,000 semi-intensivehtensive commercial enterprises. Main features o f HPAI are summarized in Attachment 1. Compensation should be seen as an important tool in avian influenza surveillance and control. However, establishment o f compensation program i s a complex subject where specific factors need to be considered. Some suggestions are provided in Attachment 2, Characteristicsof mainpoultryproductionsectors 6. As shown below (originally from FAO), the characteristics o f main poultry production sectors vary a great deal in Southeast Asia. InBangladesh, about 50% o fpoultry production i s in production sectors 1, 2 and 3 and the remaining 50% in production sector 4; whereas duck production would fall under sector 5: - 28 - MainAgencies Concernedwith AvianInfluenzain Poultry 7. Within the Ministry o f Fisheries and Livestock (MOFL), the two main agencies concerned with Avian Influenza (AI) are the Department o f Livestock Services (DLS) and the Bangladesh Livestock Research Institute (BLRI) at Savar, just outside Dhaka. The DLS i s headed by a Director General. It has five operational divisions: (i)Animal Health and Administration; (ii) Research, Training and Evaluation; (iii) Extension; (iv) Officers Training Institute; and (v) Production. Each division i s headed by a director. It is envisaged that all divisions, except the Production division, will be involved inproject implementation. The DLS has 5 Divisional Livestock Offices, 64 District Livestock Offices, 464 Upazila Offices, one Central Disease InvestigationLaboratory (CDIL) and 7 Field Disease Investigation Laboratories (FDIL). It has a large staff compliments with 2-3 Upazila Livestock Officers (including veterinarians) and support staff in each Upazila. The functions o f the Upazila Veterinarians include disease surveillance and reporting. The DLS facilities are in very poor shape centrally and in the districts, and are totally unable to undertake any avian influenza disease diagnosis work at present. The BLRIwas established in 1985. It i s a semi-autonomous agency within the MOFL.Ithas five researchdivisions: (i) Production; (ii) Production; (iii) Animal Poultry Animal Health; (iv) Systems Research; and (v) Goat and Sheep Production. The Poultry Production division has received considerable donor support in recent years and now has laboratories equipped to undertake poultry disease diagnosis. Both agencies suffer from a serious shortage o f operating funds. For example, the FDILs are reported to receive on average Tk5000 (US$72.0) annuallyfor laboratory analysis. The PublicHealthSector 8. A multi-tieredhealth care system is present in Bangladesh. The primary level is the Upazila, or sub-district level. EachUpazila has a population o f about 300-400 thousand persons. Health care personnel at this level include physicians, nurses, and allied health professionals. There is a minimum31bedin-patient health complex ineach o fthe 472 Upazilas. There are also health posts throughout the Upazila which offer simpler services for persons who cannot access the main health complex, and community health workers are present throughout the country. The intermediate level o f the health care system i s the district level. InBangladesh, there are 64 districts which are grouped into six divisions (regions). Each district has a hospital which offers a range o f primary and specialty services. In addition to the hospital, the district health center has a disease surveillance unit which collects and integrates data from the Upazilas and lower sub-units. Districts also have epidemiologic investigative teams (also known as rapid response teams). The highest level o f the health care system consists o f a national network o f medical college hospitals and specialized referral hospitals. For avian influenza, the Asthma Hospital in Dhaka has beendesignated as the national referral center. Private medical centers and hospitals are also present in Bangladesh. Outside o f the major urban centers, these hospitals are usually small clinics with minimal in-patient facilities. However, within the urban centers there are larger hospitals which can offer services at international standards. 9. A variety o f disease monitoring systems is present inBangladesh. The foundation is the management information system (MIS), which collects data on a number o f diseases and - 29 - conditions from the public sector medical facilities. Among these conditions are important infectious conditions, including respiratory diseases. The diagnoses included in the M I S are largely based on clinical impression and, therefore, are o f limitedreliability. This i s due to a lack o fwidely-utilized standardized definitions and specificity o f the diagnosis. MIS data submission i s variable, as is collection, analysis, and dissemination o f the information. While the MIS data are useful for trend analysis and prioritization, this system lacks the timeliness and accuracy necessary for an active public health response to emerging problems. The MIS i s supplemented by a number o f stand-alone (or vertical) programs, such as HIV and tuberculosis. There is an extensive network for collection o f information on vaccine-preventable epidemiology conditions, including acute flaccid paralysis (AFP) and poliomyelitis. Data collected within these vertical systems is likely to be more accurate than that found inMIS, as there is more financial support, standardized case definitions are used and there is confirmation by the laboratory. 10. National disease data are centralized at the Institute for Epidemiology and Disease Control Research (IEDCR), part o f the Directorate General o f Health Services (DGHS). However, vertical program-specific data are collected outside o f IEDCR. A list of reportable conditions i s maintained by the government. IEDCR has established a network o f sentinel sites for respiratory diseases but there i s little financial support. Review o f data from the existingsites indicates that the network i s currently o f limited value, as few cases are reported. 11. IEDCR also serves as the National Reference Laboratory for infectious diseases. Due to limitedfinancial support andpoor facilities, current diagnostic capacity at IEDCR is low. This is particularly true in the area o f virology, which is crucial to rapid identification o f influenza. Below the national level, limited microbiology i s done. District level facilities do have microbiology capability, but this appears to be underutilized and diagnostic accuracy i s difficult to evaluate. Most o f these facilities, even at the Upazila level, can do basic parasitic microscopy, gram stains, acid fast stains for tuberculosis, and have serology kits for conditions such as hepatitis B and C. 12. The International Center for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) i s an international health research institution located in Dhaka. With the changing trend in the world scenario inhealth andpopulation over the years, ICDDR,B has expanded its activities to address some o f the most critical global health needs. Incollaboration with partners from academic and research institutions throughout the world, the Center conducts research, training and extension activities as well as program-based activities. ICDDR,B receives some support from the Government o f Bangladesh and i s located adjacent to IEDCR. It has diagnostic capacity for a variety o f infectious conditions, including respiratory diseases such as influenza. ICDDR,B also runs active disease surveillance sites that monitor respiratory diseases, andhas set up a network of sentinel sites throughout Bangladesh for encephalitis surveillance. These sentinel sites are largely based at public sector medical colleges. ICDDR,B has been collecting respiratory samples for influenza virus isolation, but sends the strains outside the country for further analysis, including influenza A subtype. ICDDR,B has received outside financial support to upgrade their facilities to bio-safety level 3 (BSL-3) and to expand the sentinel site network to monitor for influenza. - 30 - 13. Unusual disease circumstances or outbreaks are investigated by a network of rapid response teams. Each district has at least one rapid response team composed o f specially trained clinicians, microbiologists, sanitarians, and other skills, as needed. These teams can receive back-up from national-level rapid response teams, when requested or when deemed to be necessary. National teams can also receive support from personnel at ICDDR,B. The rapid response teams and senior personnel from the districts have received training at IEDCR on avian influenza monitoring, investigation, and control. Personal protective equipment (PPE) has been obtained at the national level for the members of the rapid response teams to be able to safely conduct field investigations o fpossiblehumandisease due to avian influenza. - 3 1 - Attachment 1 MainFeatures of H5N1 1. Experience gained, duringthe current outbreaks o f HPAIdue to H5N1,in other countries o f the region provides some practical insights into the behaviour o f the disease in different environments. The key features, based on a number o f observations by veterinarians, which may helpindevelopingappropriate actionplansandoperationalmanuals, are listedbelow: The initial introduction o f virus into a previously unaffected country i s usually through virus shedding migratory waterfowl. Migratory waterfowl typically appear clinically normal but are carriers o f the virus. Recent evidence suggests that some o f these birds are more susceptible to the virus thanhadbeen previously thought and that they are in fact dying o f it when they bring it into a country. In some incidents, the virus may have been introduced by the importation o f affected birds, typically day-old-chicks (DOCS). As there is only limited importation o f poultry into Bangladesh (except for disease-free accredited grand-parent stock showing improved genetic material), it i s most likely that migratory waterfowl are the main danger; hence the need for active surveillance o f wild birds and effective quarantine procedures. Once present within a country, local spread is probably due largely to the movement o f poultry through the local marketing system, hence the need for effective movement control. The main method o f virus spread between birds is through the faecal-oral route. Thus spread is far quicker in birds on deep-litter floors, than in cages, or free range birds. The main disease outbreaks have occurred inSector 3 and some insector 2 farms, emphasizing the importance o f improving bio-security inthese enterprises. Outbreaks in backyard flocks (scavenging birds) in villages appear to be infrequent but catastrophic to the local people. However, from a national disease control perspective, they are largely locally contained, as these poultry flocks are generally for local (family, village) consumption. Village flocks are generally self-replacing with minimal introductions from outside sources and limited outward movement to markets. To have the opportunity to spread disease, the virus thus depends on dense concentrations o f susceptible birds in establishments with poor bio-security and management. The virus is highly susceptible to heat, dryness and disinfection. Thus even minimal attention to cleanliness and disinfection at the fadvillage level can have a pronounced beneficial effect. - 32 - The domestic duck is very critical for the establishment o f HPAI in a country. It appears to be the link betweenmigratory waterfowl and domestic chickens. Ducks are susceptible to infection but are less affectedby disease andthus provide both a vehicle and possibly a virus-multiplier in local situations. Countries with a significant HPAI problem also have intensive duck production systems (such as Vietnam and Indonesia). Countries with few ducks (such as Lao PDR and Cambodia) are less affected. The domestic duck population in Bangladesh i s mainly in the Northeast and in the village backyard situation with little evidence o f intensive commercial production. Fears have been expressed about the role o f pigs as the first mammalian species to be affected and provide the conduit for the development o f a humanpandemic. There are insignificant numbers o fpigs inBangladesh. Vaccination has been usefully applied only in situations where there i s a high incidence o f disease and i s used to reduce prevalence to a levelwhere other forms o f control will be effective. Being a killed vaccine which has to be physically injected into each bird on a number o f occasions, vaccination programs are labour-intensive and expensive. Clinically normal vaccinated birds may still shed virus and mask the disease. After sero-conversion, vaccinated birds will interfere with subsequent surveys designed to prove absence. Vaccination is effective only where a significant number o f the susceptible population is vaccinated (>80%). It i s understood that vaccination against HPAI is not allowed in Bangladesh, at present. 2. All the evidence available indicates that there has been HSNIoutbreak indomestic poultry inBangladesh from February to May 2007. This has been the case for both commercial farms andthe backyardpoultry indifferent partsofthe country. The problem is not yet over. - 33 - Attachment 2 Compensation 1. Compensation should be seen as a tool in disease surveillance and control. Where a disease spreads rapidly and causes highmortality and morbidity, and its control is a public good then it becomes very important that (a) there i s early detection o f outbreaks; and (b) producers fully participate inany control measures that are introduced. The only effective way to eradicate the causative virus o f HPAI in infected flocks o f poultry is by destroying and disposing o f all infected and in-contact birds. To encourage farmers and owners o f infected poultry to notify the suspected presence o f HPAI, it is generally acknowledged that timely and adequate compensation must be available to farmers. If compensation i s not available, there i s a highrisk that producers with affected birds will attempt to market their affected poultry through local agents and markets, thus rapidly spreading the disease to other areas and flocks. Any undervaluation o f the positive role o f compensation will encourage producers to seek more attractive ways o f avoiding the costs associated with reporting disease and/or participation in control measures. However, establishment o f compensation program and its operational guidelines are complex where specific factors need to be considered. The following are some ideas to consider: 2. It is essential that, in the likelihood o f a need for culling, poultry producers know in advance that some compensation will be paid. In neighbouring countries, at the time o f the outbreak the government announced that compensation would be paid before the birds were culled. Compensation would, however, only be paid for poultry culled and killed on known infected places, and poultry culled and killedwithin the infected zone (e.g. quarantined areas). A case can also bemade for compensation o f eggs and feed destroyed. Compensation should not be paid for birds that have already died, or for disposable items (curtains, feeders, temporary structures). Ideally the agency that i s responsible for reportingthe outbreak and recording the number o fbirds culled should not be the agency that makes compensation payments. 3. Ideally, producers should receive 100% o f the market price immediately after poultry are killed. However, it i s very difficult to justify paying the full market price as this itself varies quite considerably. Inpractice, countries inthe region have paid compensation equal to 75% o f the market pricejust before the outbreak. Alternatively, compensation can be based on payment of a percentage o f the production costs (variable costs, not fixed costs) plus a small amount for loss of profit, or replacement with comparable birds. The latter i s not usually popular, especially ifaproducerdoesnotwant to go backintopoultry. 4. InIndia, a flat rate was paid, dependingonthe age ofthe birds:Rs 10for birdsunderthree weeks; Rs 30 for broilers, Rs 40 for layers. This was a little more than the estimated wholesale price. It was paid in cash to the backyard poultry households at the time o f culling and undoubtedly helpedproducers bringforward birds to be culled. - 3 4 - 5. InPakistan, producers were paid 75% of the costs of production (DOCs/feed/medicines) up to the time of culling plus a small amount for labodprofit. This was agreed between the Government o fPakistan andthe PakistanPoultry Association. 6. In Turkey and Vietnam, producers were paid 75% of the ex-farm price at the time of culling. Fundingfor payment o f compensation comes either directly from government resources, or partly fiom government and partly from a levee raised by the national poultry association(s). The use o f insurance to cover livestock loses has generally not worked in the region. It i s very important that the Government o f Bangladesh identifies a reliable and sustainable source o f fundingto pay for compensation, as it is too riskyto rely on donor-funded initiatives. - 35 - Bangladesh Avian Influenza Preparednessand ResponseProject Annex 2: ResultsFrameworkandMonitoring 1. The results framework and monitoring for the avian influenza program i s divided into two parts. First, the results framework andmonitoring for the Avian InfluenzaPreparedness and Response Project refers to the new project only and will be implemented by the M&E arrangements in the Project Coordination Unit for AIPRP. Second, the results framework and monitoring for the Avian Influenza Component o f HNPSP refers to the existingproject only and will be carriedout bythe existing M&E arrangements for HNPSP. A. Avian InfluenzaPreparednessandResponseProject(AIPRP): ProjectDevelopment OutcomeIndicator Use of OutcomeInformation Objective To minimize the threat posedby Evidence o f improved effectiveness o f To determine whether or not the HPAIinfection and other participating animal and public health project objectives has been zoonoses indomestic poultry and services inresponding to the risk o f an achieved. to prepare for, control, and HPAIoutbreak andor pandemic: respond to an influenza National integrated preparedness, pandemic and other infectious control and response plans prepared disease emergencies inhumans. and acceptedby FAO, WHO and OIE; Contained and diminishingpattern o f H P A I infection inpoultry. Intermediate Intermediate Use of Intermediate OutcomeIndicator OutcomeMonitoring I.AnimalHealthComponent ComponentLA:Nationalpolicy Evidence o f timely and satisfactory To ensure adequacy o fpolicies framework defined and national progress toward delivery o f Component 1.A and actions to the changing strategy developed to prevent, outputs, as compared to the original plan, situation. control, and eradicate HPAI including specific indicators as follows: among the animal population. National AI StrategyPlanadoptedby the government and updated periodically; Operational Manual for the Plan conforms with the guidelines o f FAO/OIE and GPAI; Riskcommunication strategy approved and adopted by the Government; Compensation strategy, including its operational guidelines, for the affected poultry farmers approved and operational. Component1.B: Animal disease Evidence o f timely and satisfactory To assessthe level o freadiness surveillance and diagnostic progress toward delivery o f Component 1.B for disease surveillance and capacities strengthened and outputs, including specific indicators as diagnosis. training o f the veterinary services follows: designed and completed e Assessment o fveterinary services completed and development plan prepared; e Laboratory equipment and materials are procured, distributed and installed; Operational Manual updatedon a regular basis and strictly practiced; 0 Staff i s trained insurveillance and diagnostic methods; 0 Reporting and reaction time for suspected cases o f AI is reduced to the minimally acceptable levels; 0 Average monitoringcoverage o fhigh risk areas. Component1.C: Outbreak Evidence oftimely and satisfactory To ensure satisfactory and Containment Planprepared and progress toward delivery o f Component 1.C timely containment o fthe activated, as needed, inresponse outputs, including specific indicators as infection. to AI outbreaks. follows: 0 Periodical/annual desk top and field exercises organized to simulate the possible events o f outbreak; Emergency suppliesprocured and available at strategic locations inthe field; Ifappropriate,ringvaccinationaround infectedareas completed; 0 Culling, disposal and disinfection activities completed, as needed; 0 Compensation providedto poultry owners rapidly and ina monitorable way; e Movement control and quarantine measures are effectively enforced in Component11: Public IEvidence oftimely and satisfactory [To verify satisfactory andtimely inforktion onthe recommended progress toward delivery o f Component I1 progress in, or completion of, practices for control and outputs, including specific indicators as public awareness and eradication o fHPAIamong key follows: information activities. target groups developed, tested, 0 National communication strategy for and disseminated. pandemic influenza operationalized and materials and messages prepared and disseminated. e 100%oftargeted commercial poultry farmers adopt recommended practices; e 80% o f targeted backyard poultry farmers adopt recommended practices; e 80% o ftargeted people handling live poultry birds andprocessors are aware o f hazards associatedwithHPAI; 0 80% o ftargeted consumers o f poultry products are aware o f hazard associated with HPAI; 0 80% of targetedjournalists are aware o f goodpractices for reporting on - 37 - HPAI; 50 % o fmedia outlets producing quality reports on HPAI. 111. ImplementationSupport am Monitoringand EvaluationComponent Component 1II.A: Evidence o f timely and satisfactory Indicators will allow for the Coordination and progress toward delivery o f Component verification o f satisfactory and implementation o fproject 1II.Aoutputs, including these indicators: timely progress inprogram activities carried out, as planned. Programreports, financial monitoring, implementation, coordination procurement and disbursementreports, and management. audits, management and financial reports prepared and submitted periodically. Component 1II.B: Coordination Evidence o f timely and satisfactory Data collected through M&E and management of timely M&E progress toward delivery o f Component activities will be key for defining activities carried out ina 1II.Boutputs, including these indicators: what programadjustments are professional manner, as planned. needed. 0 Baseline developed for monitoring and evaluating Project impact. e Methodology defined andmonitoring and evaluationperiodically undertaken. NOTE: Shouldany disease outbreak occur duringproject implementation(avian influenzaor another communicable disease), the responseof the systemwill be examined for monitoring results and to ensure that lessonslearned will be incorporated during further implementationof this project. B. Avian InfluenzaComponentof HNPSP' ProjectDevelopment OutcomeIndicator Use of OutcomeInformation Objective To minimize the global threat Evidence o f improved effectiveness o f To determine whether or not posedby HPAIinfection and participating animal andpublic health services in the project objective has been other zoo noses indomestic responding to the risk o f an HPAI outbreak achieved. poultry and to prepare for, and/or pandemic: control, andrespond to an National integrated preparedness, control influenza pandemic and other andresponseplans prepared and accepted by infectious diseaseemergencies in FAO, WHO and OIE; humans. Contained and diminishing pattern o f HPAI infection inpoultry. 1HNPSP is under implementation since July 2005 and i s scheduled to close on December 31,2010. - 38 - Intermediate I Intermediate I Use of Intermediate Outcome OutcomeIndicator OutcomeMonitoring 4 natiooalprogramimplemented 90% o f sentinel sites (i)submittingweekly ITo verify satisfactory and for the identification, early reports on ILIincidence to the national timely progress in, or warning, prevention, surveillance unit on time; (ii)collecting and completion of component :ontainment and control o fH P A I testing at least five samples per month for activities. inthe humanhealth sector. influenza; and (iii) submittingsamples to IEDCRfor definitive influenza testing. At least 100influenza-related investigations done annually by district and national rapid response teams; 80% o f these investigations meet objective threshold standards o f quality (defined by WHO), as evidenced inwritten reports. 10% o f targeted health care workforce with `adequate' case managementknowledge, as defined by (i) general knowledge o f diagnosis; (ii) use ofpersonal proper protective equipmen; and (iii) appropriate use of antiviral medications, measured by post-training test results and direct observation duringregional capacity assessments. 80% o ftargeted district hospitals have functioning isolation units with at least 25 sets o f personal protective equipment, 25 treatment courses o f oseltamivir, and disinfection supplies. NOTE: Should any disease outbreak occur duringproject implementation (avian influenza or another communicable disease), the response o f the health system will be examined for monitoring results and to ensure that lessons learned will be incorporated during further implementationo f this project. - 39 - n =3 s0 x 3" 0 d x P p bo d 8 48 48 a, e, W 3 2 02 0 0 g m gE: sm s m L- L- P 3 -g s s g 3 m m b 0 m m g s m m hl tl 5 0 0 0 0 0 93 g g g 53 53 53 g g g g v, $1 $1 $1 0 0 0 0 0 0 0 0 v! EI v!EI v! EI 3x8 3i3 38 x W v, v, v, gm g g W 00 g$1 s 3 g W *B z s g g g 10 F d d d *B z s 2: s s 10 s 10 10 N N N z z g s s s N 2 $1 $1 0 0 0 0 0 I v1 L 0 c) .I a C Y 3 gY 0 5!3 d BE! v) & rg \o g s \o \o 0 0 0 0 0 0 E c, 0 at!fi W 0 0 3 3 32s 3 : p a 3 w c 0 N e x \o d p a w w c cc 3 0 Q 3 a Q a P x v) 3 .I v) 3 3 Px 0 0 3 Px '3> '8 02 I I I g d .4 m b E d a 0; 0 0 vl s m N N P x 3 0 0 0 I 3 3 0 r4 g g n v) P x " 2 W P x P x 3 E c, 0 3 H e 2 c, V 0 I - Bangladesh Avian Influenza Preparednessand ResponseProject Annex 3: DetailedProjectDescription 1. The purpose o f this annex is to describe in detail the two parts o f the proposed AI Program in Bangladesh: (a) the Avian Influenza Preparedness and Response Project (AIPRP); the Avian Influenza Component o f HNPSP. The AIRPR project has three components: (i) animal health; (ii)public awareness and information; and (iii)implementation support and monitoring & evaluation. The Avian Influenza Component o f HNPSP, on the other hand, has three sub-components: (i)enhancing public health program planning and coordination; (ii) strengthening national public health surveillance systems; and (iii)strengthening health care system preparedness andresponse capacity. 1. Avian InfluenzaPreparednessandResponseProject I.AnimalHealthComponent 2. This component has six sub-components, each with a number o f different activities. Overall responsibility for the component lies with the Ministry o f Fisheries and Livestock but it would be implemented by the Department o f Livestock Services (DLS). The sub-component that deals with migratory birds will be implemented by DLS, in collaboration the Department of Forest under the Ministryo f Environment and Forest (MOEF). A description o f the main sub- components i s provided below. Throughout the development o f this project, care was taken to ensure that it complemented the GOB'S National Avian Influenza and Human Pandemic Influenza Preparedness and Response Plan (NAIP). To assist inimmediate implementation and continuing progress, an international animal health expert with experience inPA1control will be recruited for the first 12 months, with repeated visits for at atleast 3 months in each o f the following years. To ensure long-term sustainability and effective utilisation o f these inputs, it is imperative that DLS receives adequate financial and personnel support from the GOB at the beginning, during and at the conclusiono f the project. A. EnhancingPreventionandPreparedness Capability Al. AdaptingNationalPolicyFramework a. Review of nationalpolicies in the light of International Standards (OIE) 3. As with all countries, the official policies o f the GOB for the control o f diseases in livestock need to be continually reviewed. Provision o f internationaltechnical assistanceto assist with this review is included to assess the appropriateness and effectiveness of policies as they 49 apply to HPAIspecifically and to livestock disease control ingeneral. Inparticular, assessments need to be undertaken on the current legislative support and legal status o f all activities that will be necessary to undertake an effective disease control and eradication program. This activity should be undertaken as early as possible in the project (year 1) and be facilitated by the appropriate internationally recognised UN agency for implementing livestock disease control programs (Le. FAO). 6. Evaluation of national veterinary services 4. To meet international standards set by the OIE, the National Veterinary Services need to develop and document appropriate procedures and standards for the implementation and management o f animal health measures and international veterinary certification activities. OIE has developed an instrument to assist the National Veterinary Services in carrying-out a self- evaluation and to establish their current level of performance, form a shared vision with the private sector, establish priorities, and facilitate strategic planning, entitled "Performance, Vision and Strategy for Veterinary Services". This instrument should be used for the evaluation of National Veterinary Services inBangladesh which would be supportedunder the project. 5. Initial assessment o f National Veterinary Services indicates that there are relatively adequate staff numerically at all levels but they lack the resources to undertake field activities and had limited understanding o f avian influenza. To ensure adequate and effective actions, there is an urgent need to develop and produce Standard Operating Procedures (SOP) for all activities, both in the field and laboratory. A good start has been made by DLS with the production o f a draft document entitled "Avian Influenza Prevention Program". However, this needs to be reviewed and expanded. The internal self-review should be undertaken by senior officers o f the DLS, as soon as possible, to assess the current status andidentify weaknesses. 6. To assist the GOB review national policies, evaluate veterinary services and develop effective SOPS, international experts are required to work in close collaboration with the DLS. This activity should also be undertaken as early as possible in the project (year 1) and be facilitated by the appropriate internationally recognised UN agency for implementing livestock disease control programs (i.e. FAO). c. Review of national compensationpolicy 7. Containment o f HPAIin an infected place (farm or village) is essential to prevent spread to adjacent areas. To be effective, it relies on early detection and reporting which depends on an adequate incentive for farmers to report sick poultry quickly. An adequate compensation i s an important element o f this strategy. Initial steps have been taken to develop and establish a realistic, practical and effective compensation policy and to identify a reliable and sustainable source o f fhding. To encourage progress in developing this policy, the DLS was providedwith a copy o f suggested guidelines recently prepared by the Agriculture and Rural Development Department (ARD)o f the World Bank. The project would support a national consultant, familiar with all aspects ofpoultry production inBangladesh, to consider these guidelines, adapt them to the unique and specific local conditions within Bangladesh and finalise this policy. For effective preparation to deal with outbreaks o f HPAI in Bangladesh, it would be highly desirable for this specific activity to be implemented duringyear 1o fproject implementation. 50 A2. ImprovingPreventionandContingencyPlanning a. Testing of national emergency contingencyplanfor HPAI 8. With technical assistance from FA0 and WHO, Bangladesh has prepared a National Avian Influenza and HumanPandemic Influenza Preparedness and Response Plan(NAIP). The Plan covers planning and coordination, surveillance and early warning, prevention and control, sector response and risk communication. However, representatives o f the private sector and NGOs indicated that they were not involved inthe preparation o f the draft plan. The National Poultry Producers Association has some 25,000 members who obviously have a vested interest in preventing the introduction o f HPAIinto Bangladesh and should intimately associated with any and all aspects of a national control program should the disease occur. The largenumber o f NGOs in Bangladesh i s intimately associated with the backyard poultry production systems o f the rural poor (through the micro-credit programs) in villages as it provides a direct contribution to food security and poverty alleviation. Experience gained with HPAIin many countries, and with other livestock diseases, underlines the absolute necessity for involving the private sector, NGOs and community organisations inplanningand implementation. The DLS i s strongly urged to correct this anomaly. 9. Once all parties agree on the plan, it should be tested in simulation exercises to identify any shortfalls. The first exercise should be heldwithin all levels o f the Animal Health Division o f the DLS, as the lead agency for disease control in livestock. A randomly selected location in Bangladesh would be identified as the place o f a "phantom" outbreak o f HPAI and the plan swung into action. Subsequent exercises should then involve other relevant sectors. Problems and shortfalls thus identifiedshouldbe addressedandcorrected before a repeat exercise at a later date. Project funds have been allocated to run2 simulation exercises (during first year). Lessons learnt from these would then be applied inrunning subsequent exercises each year o f the project. When the DLS is confident o f the effectiveness o f their plan, consideration should be given to invitingindependentobservers from neighbouring countries (andFAO) to attend the last couple o f exercises to assess their effectiveness inlight o f regional andinternational standards. b. Update of veterinary services on latest Information about disease control 10. To establish and maintain national cohesion and integration o f activities between all sectors and staff working on HPAIwithin Bangladesh, it will be necessary to update veterinary staff on the latest information on HPAI. These one-day meetings, to be held in each o f the 7 FDIL locations for maximum coverage and attendee convenience, should include people from the private and public sectors o f veterinary services, universities and NGOs. To establish and maintain contacts with people working on HPAI within the South Asian region, it will be necessary to invite an international regional expert (from FAO) to provide veterinarians and staff working directly inthe HPAIprogram with exposure to latest developments. The project would support this series o f 7 conferences to be held duringthe first year. For economy andmaximum utilisation o f the international expert, the one-day conferences should be held in sequence on alternate days with the international expert attending each o f these conferences. 51 B. Strengthening Disease Surveillance and Diagnostic Capacity 11. Strengthening surveillance for and diagnosis o f HPAI is currently the most urgent and important area that needs attention in Bangladesh. With the continued absence o f reports o f HPAI in Bangladesh, it would be particularly valuable to conduct extensive targeted active surveillance (both virus huntingintracheal and cloacal swabs and sero-surveillance) on domestic duck populations around already identified high-risk areas (e.g. in Sylhet district). In addition, all major poultry mortalities must be thoroughly investigated to rule out (or confirm) the presence o f H5N1 virus in the country. It i s now recognised that sero-surveillance in chickens for this virus has very little practical value, due to the high pathogenicity o f H5N1 in that species. B1. Strengthening of Veterinary Services 12. Once the evaluation o f veterinary and related services has been completed, support should be provided to strengthen National Veterinary Services to bring them in line with OIE standards. Such support would include essential technical support for strengthening governance and updating legislation. Emphasis must be placed on ensuring that all field activities undertaken for disease investigation, recognition, containment, elimination and eradication are undertaken within current legislation. Any deficiency must be identified and corrected. The project would provide necessary technical assistance to improve legislation, but actual enforcement will likely remain a continuing challenge. The project would provide technical assistance inthe form o fbothqualified veterinary and legal expertise. B2. Strengthening Animal DiseaseSurveillance and Laboratory Diagnosis a. Improving animal health information flow among relevant agencies 13. To improve the quality and quantity o f information on HPAI and other livestock diseases betweenrelevant agencies, there i s a need to establish a standardized disease information system. Currently there is a structured establishment within the public sector whereby each o f the 464 Upazilas has an average o f 2 veterinarians and livestock officers who collect livestock disease information from about 10 unions (each containing 3 wards, each o f which has several villages) within each Upazila. These veterinarians then collate the information and send reports twice a week to the respective district heads (64) o f livestock who then report to the (6) divisional headquarters and finally onto the National Center in DLS in Dhaka. This whole structure appears to be directed exclusively at the village level, and there is little evidence o f involvement of the private sector. The latter receives veterinary services from private and company employed veterinarians. As some 50% o f poultry i s in the commercial sector, they andor their veterinary agents must also be included in the national health information data base, be present at the specific training courses, introduce the data base to their offices and provide disease and surveillance data from their own activities in this area. Diagnostic services are also being provided to poultry producers, and surveillance activities being undertaken, by colleges of veterinary science. They also should become part of the national disease information data base. 52 14. To effectively manage and analyse the large amount o f data obtained and convert it to useful information, currently available software packages (e.g. the FA0 program for Trans- boundary Animal Disease Information "TAD Info") need to be used. To ensure accuracy and minimize transformation errors, attention should be directed at data entry at the lowest possible level with subsequent data transfer by electronic means through e-mail. To complement this major investment, training on the use o f TAD Info (or other suitable software) will be provided to the district and divisional staff by the recently trained epidemiologists from DLS, with technical support by this project andpossibly by FAO. 15. The project would support the instalment o f computers in all 64 district DLS offices, the 6 divisional DLS offices, each FDIL, the CDIL, BLRI and epidemiologists in the central office inDhaka. Inaddition, theprojectwillprovide for the installationandoperations costs ofinternet services for rapid transfer o f data and information. 16. This sub-component will also support the development o f a disease information system in Bangladesh which i s uniform with that operating inother participating countries, as part o f their control programs. This will provide better analytical capacity and enable them to participate in global disease information sharing, complying with their obligations as members o f the OIE, thereby contributing towards progressively better global and regional control and eradication. The system would be linked with rapid and standardized methods o f routine analysis o f surveillance data, which would demonstrate important changes in the H5N1 situation, and promptly supply this information to field personnel. To support this initiative, the project will supply GIS (Geographic Information System) software and GPS (Geographic Positioning System) instrumentation, and recruit a national expert to implement andprovide training ineach o f the districts. b. Detection, reporting andfollow-up of reported cases 17. Each o f the Upazilas are staffed by at least 2 veterinarians or livestock officers who supply the front-line animal health services to a large part o f the country's poultry producers. They are also the "eyes and ears" o f the DLS for disease reporting. 18. A number of training courses will be organized by experienced and knowledgeable DLS staff, together with a pathology lecturer from the nearby veterinary colleges. It is strongly recommended that the DLS should involve the universities inthis area as they are well equipped to provide professional instruction and supplement contributions from the government officials. University Veterinary faculties are located at Mymensingh, Sylhet, Chittagong, Barisal, Rajshahi and Dinajpur. Courses are scheduled to be held at each FDIL each year. The courses will provide training in disease investigation, history taking, clinical examination, necropsy techniques, sample collection and recording o f observations ina standardized format. Apart from the specific training provided, this close working and association o f official, private poultry and academic veterinarians will be o fmutual benefit to all. 19. Training will be supplemented by the provision o f basic post-mortem kits, vacuum tubes for the collection o f blood samples and swabs for cloacaVtrachea1swab specimens andpersonal protective equipment. 53 20. To ensure that these front-line field staff has the ability to visit farms and villages, the project will provide necessary transport facilities related to HPAI investigations. This will include the provision o f motor bikes, initially to the high-risk Upazilas, together with budget to cover operating costs and maintenance. In conjunction with the DLS, BRAC undertook a national survey to identify specific "hotspots" where migratory birds regularly reside and the results are summarized below: It is strongly recommended that these Upazilas with identified hotspots be the first to receive motor bikes. An assessment o f the impact o f this initiative will be made at the mid-termreview (MTR) and, ifpositive, motor bikes will be supplied to additional Upazilas. Additional support will be provided for operating costs and maintenance o f existing vehicles at the District and Divisional DLS offices. Finally, a contractual agreement between DLS and BLRI, under supervision o f MOFL, should facilitate the use o f BLRI facilities to analyze samples. The project will support such analysis to facilitate necessary diagnostic work for HPAI. c. Public and community-based surveillance networks 21. As some 50% o f the poultry population resides in the 90,500 villages throughout the country, it would be appropriate for community-based networks to be established and to contribute to the surveillance program. These could be established and maintained by the village heads or "lead" farmers (with the most chickens and having a vested interest in their success). The project would provide assistanceto facilitate the creation o f a community-based surveillance system through the Upazila veterinarians. Inaddition, public awareness programs need to be directed at poultry owners and producers to encourage them to report any suspicion o f HPAI (increased mortality, suggestive clinical signs, decreased egg production or feed conversion). These will be provided through the public media (newspapers, radio, television, posters and pamphlets at markets, etc.) under the "Public Awareness and Information" component o f the project. However, as many farmers in Bangladesh have little or no contact with the public media, the project would support farmers meetings to alert them about HPAI and what to do if they suspect it has occurred intheir poultry. The Planallows for approximately 480 workshops (1 in each upazila) at which there will be 2 farmers from each ward, providing direct involvement of approximately 27,000 farmers. This would also include workshops with major NGOs (such as BRAC) and others working directly with poultry owners, including privately employed veterinarians and those working with integrated commercial poultry farms and organisations. 54 d. Epidemiological surveys and research to support strategic actions 22. Serological surveillance to date appears to have been mostly o f the "convenience" category, the majority coming from imported DOCS at the point o f entry. To identify disease, emphasis should be directed at high-risk sites within the country, especially targeting the duck population. Surveillance inthe chicken population should primarilybe clinical and pathological examination, followed by virus detection in dead and clinically affectedbirds. Sero-surveillance inchickens hasvery little practicalvalue, dueto the highpathogenicityofH5N1inthat species. 23. Training will be provided by experienced and qualified epidemiologists into the correct methods o f undertaking surveys to either assess the prevalence o f HPAIifit occurs or to provide meaningful and credible evidence o f absence. Emphasis will be placed on establishing sample frames, on random selection techniques and on the statistical interpretation o f results. Courses will be aimed at veterinarians from districts, FDILs, veterinary colleges and the private sector. 24. The project would also provide support for the training o f a small number o f key, computer-literate personnel in establishing and maintaining an effective inter-active computerized data base to record (e.g. TAD Info), store and analyse all relevant data received and to convert it to useful information ina variety o f modes (tables, charts, graphs, maps, etc.). The course will be specifically directedat veterinarians working inthe epidemiologyunit ofDLS inDhaka. e. Improving diagnosticlaboratory capacity 25. The government diagnostic laboratory network inBangladesh i s within DLS and consists o f one Central Disease Investigation Laboratory (CDIL) in Dhaka and 7 Field Disease Investigation Laboratories (FDILs) located at Sylhet, Feni, Barisal, Manikgonj, Joypurhat, Gaibanda and Sirajganj. Each laboratory i s staffed by a Principal Scientific Officer (in charge), one Senior Scientific Officer, two to three Scientific Officers, Laboratory Technicians and sub- technical staff. The scientific staff are veterinary graduates with either a Master's degree or specialized training from within the country or abroad. A number o f previous and current projects (FAO, JICA, USAID, Danida and ADB) have supplied staff training for HPAI diagnosis and a range o f laboratory equipment to the network. A short-term international consultant and a long-term national consultant with FA0 have recently undertaken an assessment o f all DLS laboratories and identified key deficiencies. This project would provide additional inputs to complement these activities and address identified deficiencies. 26. The CDIL has a long way to go before it can fbnction as the National Reference Laboratory for HPAI diagnosis. The CDIL laboratory has BSL-1 capacity only and has preliminary capacity to diagnose avian influenza (type A infection). Recently, some funds have been provided by GOB for renovation o f one laboratory for AI work. However, it i s estimated that the laboratory would not be operational until 2008 at the earliest, and will need a high level o f technical assistance and staff training. The project would provide necessary equipment to ensure this facility can develop into a functional central laboratory in the long-term. There is a national desire to establish a BSL-3 laboratory at the CDIL. Given the current situation in Bangladesh, the time delay to provide such a facility and the high cost o f establishment, 55 operations and maintenance, the project would provide two BSL-3 bio-safety cabinets for immediate installation in the existing laboratory. This will allow the safe handling o f suspect and dangerous materials. However, it is recommended that an expert laboratory engineer be fielded to undertake a feasibility study o f the practicalities for providing the additional pre- bricated BSL-3 laboratory at the CDIL. 27. As they are at the forefront of disease investigation throughout Bangladesh, the most urgent need i s to rehabilitate and rejuvenate the 7 existing Field Disease Investigation Laboratories (FDILs). These laboratories are strategically located in key field areas. They are currently ina very rundown state and are bothunsafe and unsuitable for undertaking necropsies on chickens, examination o f specimens and undertaking diagnostic tests. The FDILs have very limited capacity to conduct post-mortem and pathological examination o f chickens, although they recently received ELISA kits for AI, together with plate readers to undertake sero- surveillance. Ina number o f cases, the scientific officer conducting the tests had not received any training and the testing procedures have no quality control. There was no evidence o f protective clothing for staff when a number o f these facilities were visited. The project will provide resources to partly rehabilitate these laboratories and make bench tops impervious to chemicals. BSL-2 bio-safety cabinets will be supplied together with backup generators to ensure regular electricity supplies and the provision o f staff training, specific equipment, materials and supplies to undertake meaninghl HPAI investigation, active field surveillance and the testing o f collected samples under safe conditions. Specific equipment (incinerators) for the safe disposal of dead birds and tissues will be provided to each o f the central and field diagnostic laboratories. In addition, training will be provided in laboratory management and GLP (Good Laboratory Practice). 28. The Bangladesh Livestock Research Institute (BLRI), located at Savar, is currently in a much better position to be regarded as the National Laboratory for HPAI diagnosis inthe short to medium-term. Administratively, it is responsible directly to the Ministry o f Fisheries and Livestock. A Poultry Disease Diagnostic Laboratory, developed by JICA and Danida, started work on HPAIand a recently implemented Danishproject i s assisting this laboratory to develop expertise on HPAIthrough 3-month training programs inCopenhagen and the supply o f specific equipment. The District Livestock OfficersLJpazila Livestock Officedfarmers send samples for disease diagnosis to BLRI. The laboratory is staffed by 5 scientific staff and 2 technicians and has dedicated sections for autopsy, histopathology, serology, virology, bacteriology, washing and sterilization. The virology section has egg inoculation and primary cell culture facilities which are being used for all poultry viruses, including avian influenza. They processed over 3000 samples for HPAI by virus isolation and 100by quick test kit, all with negative results (prior to the outbreak). The laboratory needs a dedicated space for HPAIdiagnostic work using Standard Operating Procedures in a bio-secure environment. The laboratory also has facilities for RT- PCR and required primers for influenza A virus H5 types. Limited standardization and application o f the technique has been used on field samples. Currently, the BLRI i s receiving assistance from Danida and JICA in both training and equipment. The project will supplement any shortfalls that are identified. 29. In addition to government facilities, the veterinary faculties/colleges in Bangladesh provide a front-line diagnostic service to poultry producers in their respective areas and should 56 be regarded as part o f the national laboratory network. The faculties at Bangladesh Agriculture University (BAU) Mymensingh, Rajshahi University, Chittagong University and Sylhet University; and the Government Veterinary Colleges at Dinajpur and Barisal have trained manpower, equipment and facilities for HPAIdiagnosis and provide diagnostic services to local producers as part o f their practical teaching curriculum. A proportion o f the antigen detection and ELISA kits purchased through the project should be supplied to these colleges for the provision o f a diagnostic service and the training o f the next group o fpracticingveterinarians. 30. Given the current situation inBangladesh, the poultry diagnostic laboratory at BLRIhas recently been recognized as the current National Reference Laboratory for HPAIuntilthe CDIL has the capacity and ability to assume this role inthe mediumto long-term. It is understood that a Memorandum o f Understanding (MOU), to this effect, has been signed by both agencies. To enable the BLRIto provide analytical services immediately, it will be supplied with two BSL-3 cabinets to be dedicated to work on HPAI. The feasibility study would also examine the need andprovision for a BSL-3 laboratory at BLRI. B3. StrengtheningAppliedVeterinary Research 31. Given the current situation inBangladesh andthe urgent need for basic capacity building, it is considered that undertaking research at this time shouldbe limited and focused on important issues. It would be useful to evaluate the current range o f rapid antigen detection tests to determine their specificity. Alternatively, a useful project would be to answer the obvious question o f "what are the unique epidemiological features o f H5N1 for getting established in Bangladesh?". With the involvement of university veterinary faculties in the program, it is possible that they could identify both suitable candidates and HPAItopics for competitive grants program (CGP) which will be supported by the project. Veterinary colleges are enthusiastic with the concept o f involving DLS staff in such projects leading to the acquisition o f post-graduate qualifications and to the use o ftheir staff intraining programs. C. StrengtheningControlProgramsand ContainmentPlans 32. This sub-component will provide support to contain outbreaks o f HPAI in Bangladesh. These measures, included in the National HPAI Control Plan and activity manual, are intended as a means o f rapid mobilization to respond quickly and effectively to HPAI outbreaks. They would consist o f guidelines for the rapid activation o f physical and human resources. Now that there has been an outbreak o f HPAIinBangladesh, there i s thus an urgent need to continue the development o f Standard Operating Procedures (SOPS) for such activities as containment o f infected places, destruction o f in-contact live birds, disposal of infected and destroyed birds and contaminated materials, disinfection o f infected places, clinical and pathological examinationo f sick poultry; collection, packaging and submission of specimens, undertaking the relevant range o f recommendedlaboratory tests, etc. 57 C1. TargetingVirus Eliminationat the Source 33. InBangladesh, plans for the specific HPAI control strategies and programs include the principle o f targetingthe disease at the source o f infection. This sub-component would support the following activities: (a) destruction o f infected and at-risk poultry (stamping out); (b) disposal o f carcasses and potentially infective materials in a bio-secure and environmentally acceptable manner; (c) enhanced bio-security at poultry farms and associated premises, through bio-containment and bio-exclusion; and (d) and training in culling, safe-disposal, bio- containment and quarantine measures. 34. The project would support contingency plans to cover the costs o f containment, the destruction and disposal o f affected poultry, the cleaning and disinfection o f infected places. Support would also be provided for the hiringandtraining o f the front-line people who would be involved inthese activities, iffurther HPAI outbreaks occurredinBangladesh. C2. Fundfor SupportingAnimalVaccination 35. With no reports of HPAI till February 2007, vaccination has not been undertaken; mass vaccination campaigns would only apply should the disease become widespread and was not controlled by more traditional methods o f stamping-out. However, vaccination might be considered if valuable breeding stock (parent and grand-parent flocks) and rare or endangered species (zoos, national parks) were considered at risk. In addition, ring-vaccination around infected places might be considered if outbreaks occur which are not effectively contained and eliminated. The use o f vaccination to control HPAI must go in parallel with other control procedures, strategic field surveillance and epidemiological studies to identify virus sources, selection o f priority hot spots, imposition o f transport bans, and post-vaccination monitoring. Serological monitoring, using the DNA (Differentiating Infected from Vaccinated Animals) principle and the use o f sentinel domestic ducks and chickens, are essential measures to monitor vaccinated domestic duck flocks. A specific contingency fund for the procurement o fvaccines is included. 36. If necessary, the project would support the purchase and use of good quality HPAI vaccines produced according to OIE standards and implemented according to FAO/OIE guidelines. The project would also provide capacity building in vaccination principles and practices at the national level to ensure that vaccines are used with a clearly defined objective andtime-phased exit strategy, linkedto strict post-vaccinationsurveillance andmonitoring. C3. PersonnelSafety 37. Due to the highlypathogenic nature o f the HPAI virus to humans, particularly the Asian H5N1 strain, training o f people in contact with live virus i s supported. This includes field workers involved in identification o f the disease, farm workers involved in culling, and laboratory workers involved invirus isolation and diagnosis. Project would support training and the provision o f Personal Protective Equipment (PPE -- overalls, boots, masks, goggles). Specific laboratory equipment, including bio-safety cabinets and appropriate personal protective clothing, would be provided to those working inCDIL, BLRIand FDILs. 58 D. ImprovingBio-securityinPoultryProductionandTrade 38. Improving bio-security in all poultry production systems and markets in Bangladesh i s regarded as a key means to prevent introduction and spread o f HPAIfrom diseased to susceptible birds. Bio-security at the farm should focus on making the facilities bird-proof to prevent the entry o f wild birds as well as preventing the entry of any other animals and non-essential personnel. Entryo f vehicles should be minimized (e.g. feed delivery vehicles and egg collection trucks should not enter but deliver and collect at the physical boundary o f the farm. Different species o f birds should be segregated on farms and inmarkets. Wherever possible, markets and processing centres should be completely de-stocked at the end o f each day's operations to allow thorough cleaning and disinfection before the following day's activities. Vehicles and cages used for the transport o f poultry and poultry products must also be cleaned and disinfected between loads. Standard Operating Procedures (SOP) need to be established and implemented with development o f a realistic monitoring procedure. The project would provide fimding to enable DLS staff to demonstrate how backyard and small poultry producers can improve their bio-safety, establish a number o f models on local farms to emphasize key points and improve facilities at wet, live birdmarkets and processing centers. E. Supportfor SurveillanceofMigratoryBirds 39. Given that there is currently a complete ban on the importation o f commercial poultry from outside Bangladesh, except for improved genetic stock from disease-free countries, the most likely source o f virus introduction would be by migratory waterfowl. There i s thus a need to support surveillance activities o f migratory birds. Field staff o f the Ministry o f Environment and Forest (MOEF) will be trained in recognition that a problem exists if dead wild birds are encountered, how to examine affected birds and the collection o f relevant samples by safe practices under safe conditions using protective equipment and procedures. The staff will also be trained to despatch the suspect materiaVdead bird to the nearest FDIL/CDIL/BLRI in a bio- secure manner. Given that many migratory birds visit remote areas o f Bangladesh, the project would support the formation o f local village groups for surveillance activities, particularly in hotspot areas. F. ContingencyFund F1. CompensationProgram 40. Giventhat compensation is usually requiredto encourage early notification and assist in eradication procedures and given that the GOB i s developing a workable compensation policy for this activity, the project would support the compensation program to implement this activity. However, to maintain this important function, it i s essential for the government to commit and allocate an adequate amount o f fimds to ensure sustainability. F2. PersonalProtectiveEquipmentandVaccines 41. The project would provide contingency funds for procurement o f PPE, if required, for control and containment inthe case o f an outbreak as well as procurement o f vaccines. 59 11. PublicAwareness andInformationComponent 42. The National Avian Influenza and Human Pandemic Preparedness and Response Plan (NAIP), 2006-2008, provides a strategic framework for coordinating activities within and between various sectors and stakeholders for preparedness and response to avian and human pandemic influenza in Bangladesh. Under this Plan, a National Multi-Sectoral Task Force (NMTF) has been formed that involves the government, private sector, NGOs, civil society, elective representatives, professional and business bodies and others. The Plan also envisages formulating a comprehensive, multi-sectoral and proactive communication strategy (communication policy i s already prepared but it needs pro-active implementation) to provide timely, adequate and effective information to various target groups, particularly health care personnel, stakeholders, and the media during each pandemic stage. This component deals with public awareness andinformation related to both the animal health andhumanhealth. 43. A Communication Technical Working Group (TWC), led by UNICEF, has prepared a National Communication Strategy and Action Plan (NCSAP) for Avian Influenza and Human Pandemic Influenza. Under the NAIP, the risk communication strategy envisages undertaking communication workshops involving media personnel, service providers and policy people. It also outlines production and dissemination o f various communication materials to raise public awareness about HPAI. In order to address the risk communication issues, the NCSAP has proposed the following to cover three different phases o f the epidemiological situation. These are: (i) pre-pandemic phase will aim at controlling avian influenza with the objective to the reduce the risk o f animal to animal transmission; (ii) the pandemic alert phase looks at issues about intensive hygiene and containment, with the objective to reduce the risk o f animal to humantransmission andimprove hygiene to limit spread of seasonal humaninfluenza; and (iii) the pandemic phase would reduce the risk o fhuman to human transmission. 44. The National Multi-Sectoral Task Force (NMTF) o f the Government i s the overarching management framework to manage and implement the Plan. Of the more than 15 government agencies, keyministries such as Environment andForest, Fisheries and Livestock and Health and Family Welfare will play the most prominent role in various stages o f the pandemic in Bangladesh. The objectives o f the government's national risk communication strategy are as follows: (i)to establish and ensure an integrated communication strategy responsive to public concerns; (ii)to ensure coordination among technical and communication staff regarding key messages; and (iii) to ensure media training for key technical and communications spokespeople. 45. For effective implementation o f national communication strategy, the Ministry o f Information (MOI) will play an important role. Building effective partnership with all relevant stakeholders through sharing o f information will be the greatest challenge for successful implementation o f the AIPRP. The role o f communication in managing inter-sectoral coordination will be crucial. Development o f key messages and timely dissemination of those messages in various multi-media formats will determine the effectiveness o f the communication interventions. While the Government will essentially follow the WHO'S Outbreak Communications Guidelines to undertake mitigation of risk communication activities, the World 60 Bank's support will help sustain national communication efforts to maximize the impact o f the interventions. 46. This component o f the proposed AIPRP will complement and supplement implementation o f the NCSAP. Thus, duplication o f communication activities can be avoided and it will give opportunity to introduce innovative and best-practices to strengthen ongoing national communication activities. This component will have two sub-components: (i) capacity building; and (ii) information and communication services. The latter sub-component will focus on three activities: (a) advocacy and collaboration with stakeholders; (b) production and dissemination o f communication materials; and (c) developing pilot models for community- based communication. A. CapacityBuilding 47. The development o f a strong, sustainable human resource base is one o f the most important objectives o f country-specific disease control strategies. This sub-component will support the needs assessment o f the people involved in the media and communication sector. This sub-component will strengthen capacity o f the national and regional media to accurately report on HPAI. A network of media personnel will be developed to build professionalism around the risk communication issues. A reporting guideline will be developed to help both the public and private sector media to follow the international best practices. Through workshops with editors, news editors and reporters o f the print and electronic media at the national and regional levels, this sub-component will help build a common understanding about the issues involved. B. InformationandCommunicationServices B1. Advocacy and Collaboration with Stakeholders: 48. The multi-dimensionalproblems associated with HPAIinfection necessitate collaboration among a wide range o f stakeholders, including various ministries, research institutions, diagnostic laboratories, NGOs and civil society organizations, private companies and associations (e.g., commercial poultry producers, farmers' associations), veterinarians and farmers. The sub-component will support activities designed to improve effective coordination and collaboration among these stakeholders. A well designed `advocacy plan," will assist in keeping the key political leaders, the Cabinet and the Parliament, updated on the situation, and visibly participative inthe public response. Other priority stakeholders andmedia managers will have to be identified and constantly briefed. As the epidemic moves from phase to phase, different government and civil actors will be brought into the scene. This needs to be planned and prepared well in advance, selecting and training spokespersons, preparing contents and actions plans, arranging for media coverage andbuildingupon the formal and informal networks o f social leadership. 61 B2. Production and Dissemination of Communication Material: 49. Activities to be supported include developing and testing messages and materials to be used inthe event o f a pandemic or emerging infectious disease outbreak, and further enhancing the infrastructure to disseminate information from national to state and local levels and between the public and private sectors. Communication activities will support cost-effective and sustainable methods such as "marketing" o f hand-washing via mass media, counselling and schools. These methods will be integrated into avian influenza specific interventions as well as ongoing outreach activities of ministries and services, especially the departments under the o f Ministries o fHealth and FamilyWelfare, Information, Fisheries and Livestock, and Environment andForest. 50. Support will be provided for information and communication activities to increase the attention and commitment o f government, private sector and civil society organizations, and to raise awareness, knowledge and understandingamong the general population about the risk and potential impact o f the pandemic and to develop multi-sectoral strategies to address it. In addition, support will be provided for the development and distribution o f basic communication materials on influenza, influenza vaccine, antiviral agents and other relevant topics; general preventive measures such as "dos" and "don'ts" for the general public; information and guidelines for health care providers; training modules (web-based, printed, and video); presentations, slide sets, and documentaries; and symposia on surveillance, treatment and prophylaxis. Networks o f the BRAC, ASA and PKSF will be tapped to reach the relevant stakeholders involved in both inward poultry and backyard poultry. Support will also be provided to strengthen networks o f communication offices, as well as mechanisms to increase coordination and consistency o f messages among risk communication managers. A web-site will be created, as part o f this project, for increasing awareness through sharing o f information and messages. B3. Developing Community-based Communication Pilots: 51. This activity will support `pilot' formation o f the community-based communication groups. It will provide a feedback mechanism to facilitate the flow o finformation from the grass- root level to project management and stakeholders. Such groups will monitor the preparation and dissemination o f informationmaterials. 111. ImplementationSupport andMonitoring& EvaluationComponent 52. This component has two sub-components. A. Implementationand TechnicalSupport 53. A Project Coordination Unit (PCLJ) is being established within the DLS. The PCUwill be responsible for project implementation, coordination and management. It will contain a number of national staff to handle communication, procurement, financial management, safeguards, operations and the management o f Project activities. It will also have a technical assistance team (consisting o f international and national experts) hired through FAO. The 62 project would provide support for national and international experts to assist with implementation, communication andmanagement. Inparticular, the project will support (a) long- term international veterinary expertise to assist DLS; (b) a long-term national expert to assist in project implementation and will be based in the Project Coordination Unit (PCU) within DLS; and (c) a long-term national expert to assist with implementation and coordination o f the AI Component o f HNPSP and will be based in DGHS under MOHFW. The project would also provide support for the incremental staffing needs o f the PCU, including M&E staff, and operational cost for the PCU. B. MonitoringandEvaluation 54. This sub-component would provide financial and technical support for regular internal M&E of the Project as well as for an independent evaluation on a periodic basis. The M&E in the Project Coordination Unit (PCU), which will be part o f broader Management Information System (MIS), will be responsible for monitoring and evaluation o f AIPRP. 2. Avian InfluenzaComponentof HNPSP 55. The Avian Influenza Component o f HNPSP i s designed to better position Bangladesh to recognize human disease caused by avian influenza or other strains o f influenza virus with pandemic potential; to prevent humaninfections, should avian influenza be recognized inpoultry or other avian species in the country; to prepare the health care system to care for persons with this disease during the pre-pandemic phase, if prevention and control measures fail to prevent human infection; and to cope with the consequences o f pandemic influenza, if and when it occurs. Given the significant challenges o f capacity building in a country with limited infrastructure and socio-demographics o f Bangladesh, accomplishing these objectives will take a concerted andmulti-year effort. 56. The component activities will focus on three sub-components. These include (i) planning and coordination, (ii) surveillance capacity development, and (iii) care system disease health preparedness and response. Detailed description for each o f these sub-components is provided below. A. EnhancingPublicHealthProgramPlanningand Coordination Al. Review of NationalPolicies 57. Bangladesh has had its share o f disease outbreaks and natural disasters and has been able to respond to them. However, there are unique challenges to responding to an influenza pandemic that may require application o f special measures. As part o f implementation, a review o f the legal and regulatory framework for disease control and prevention will be undertaken to make sure there are no gaps or corrective actions needed to be ideally situated to address avian andpandemic influenza. As one example, the country may have to impose a quarantine to limit disease spread. Existingregulations to do this shouldbe reviewed. Other issuesthat would need to be reviewed include the use o f unapproved products (e.g. pandemic vaccine) by the Ministry o f Health and Family Welfare in an emergency situation, and the use o f a volunteer workforce for provision o fmedical care duringa pandemic. The current framework for disease surveillance 63 and control should also be reviewed, including compatibility and compliance with the revised International Health Regulations (IHRs). The component will support an international technical expert to work with a national counterpart to conduct this review andmake recommendations for appropriate modifications to existing legislation or regulations. A2. Evaluation of Health Services and Needs Assessment at National and RegionalLevels 58. Manyo f the activities inthis component take place at the national level. However, some are focused on the regional, district, or Upazila levels, such as surveillance enhancements and health care facilities upgrades. It i s necessary to understand the degree to which lower levels o f the public health system are positioned to absorb these additional activities. It will also be necessary to periodically ascertain the level of preparedness, once activities to upgrade the system have been initiated. HNPSP will support such assessments, using standardized instruments to conduct them. One assessment in each o f the six Divisions will be conducted during the early phases o f implementation to establish baselines, followed by an annual assessment in each Division inthe following years. HNPSP will support international technical assistanceto develop the assessmenttools and assessment scheme, participate inthe assessments, and make recommendations for corrective actions. To accomplish the latter, HNPSP will support long-term technical assistance for participation inthe regional assessments by a national expert. To improve intersectoral coordination, these assessments should be undertaken jointly with animalhealthcounterparts. A3. Development and Disseminationof Guidelines and Protocols 59. Inorder to ensure adequate national capacity to address various aspects of humanavian and pandemic influenza, uniform national guidelines and protocols must be developed in Bangladesh. At present, some material has been developed by the government and some information is available from partner international agencies and non-governmentalorganizations. Distribution o f these materials and training activities using them has been spotty. Highquality protocols and guidelines for disease surveillance (including case definitions), for case and outbreak investigation, and for case management, have been developed in many other countries and are available from the World Health Organization (WHO). These materials must be adapted to be appropriate in the context o f the health care system in Bangladesh. Since subsequent training activities hinge on the availability o f such high quality guidelines and protocols, their development needs to occur very early. HNPSP will support their development, inconcert with technical consultants, and their dissemination in print and electronic versions. As an emerging disease, scientific information on avian influenza in humans i s rapidly evolving. Recommendations on optimal case management or disease control may change over the course o f the project. Therefore, it will be necessary to periodically (preferably annually) review the guidelines and protocols andmake revisions based on the latest information. A4. Tabletopand Field Simulations 60. Standardized guidelines and protocols are essential for health care system preparedness. However, their content, quality, and relevance cannot be easily evaluated until they are needed for disease control and prevention. In addition, the level o f preparedness o f the health care 64 workforce, the response community, and others critical to address this disease i s largely unknown. Tabletop and field simulations can help in ascertaining the current level o f preparedness, serve as a valuable training tool, and can identify significant gaps inpreparedness and response planning. For maximum benefit, simulations should be conducted as soon as possible and again when other aspects o f the component are underway (such as training activities and acquisition o f supplies and pharmaceuticals). High quality tabletop and field simulation exercises have been developed and executed in countries with infrastructure and circumstances similar to Bangladesh. Rather then invent such simulations from scratch, the exercises used elsewhere should be evaluated and adapted for the Bangladesh context. HNPSP will support outside technical assistance to develop and conduct periodic field and tabletop simulations (three tabletop simulations and six field exercises (one per division). For maximum effectiveness, the tabletop exercises should involve top governmental officials, should examine inter-governmental and inter-sectoral cooperation, should test health care effectiveness, and should assess preparedness around issues such as social distancing measures. Since similar exercises are planned for APRP, to the degree feasible the animal and human health exercises should be done jointly. B. StrengtheningNationalPublicHealthSurveillanceSystem B1. StrengtheningDiseaseMonitoringandReporting a. Training ofpublic health workers in disease surveillance 61. Training activities for district level surveillance and investigative personnel have been conducted at IEDCR, and limitedtraining o fhealth care personnel has also beendone. However, face-to-face assessments suggest that most health care workers have not yet received any formal training on how to care for persons with suspected avian influenza or those exposed to the disease. Training activities have also been done in the absence o f standardized and validated guidelines and protocols for disease surveillance and investigation. HNPSP will support training activities utilizing government training resources and using external training agencies, as necessary. There i s regular turnover of health care personnel andthe regulations, guidelines and protocols are still evolving. Therefore, over the course o f the program, the information would be reinforced and the component will also support periodic refresher courses. HNPSP will support training indisease surveillance o f around 7,500 staff at the national andregional levels. b. Upgrading of priority infrastructure of health surveillance services 62. Influenza-like Illness (ILI) surveillance, especially when coupled with specimen collection to isolate influenza viruses, i s an important activity inthe national and global effort to track the spread o f influenza. Sentinel surveillance for ILIinvolves representative sites around the country which monitor the number o f persons attending a health care facility (in-patient or out-patient) who fhlfil a standardized case definition for ILI. Such cases are counted and reported (usually on a weekly basis) as a proportion o f total visits. Baselines are then established, trends are monitored and reported, and aberrations (outbreaks) are identified and investigated. ILI sites can also monitor for viral pneumonia and other illnesses that might be indicators of the presence o f avian influenza. Specimens are collected from a representative 65 sample o f persons meeting the ILI case definition for influenza testing. In this way, influenza types and subtypes circulating inBangladesh can be tracked. 63. IEDCR has established a small network o f sentinel sites for ILIand other conditions, but the data currently beingcollected appear sub-optimal and are unlikely to reflect the occurrence o f ILIinthese locations (low sensitivity andpoor timeliness). HNPSP will support strengthening activities in existing sites to enhance sensitivity and data collection and establishment o f new sites. IEDCR has proposed that sentinel surveillance be conducted in three sites per Division (for a total o f 18 sites), representing the three levels o f the health care infrastructure in the country (primary, secondary, and tertiary). HNPSP will support the establishment or enhancement o f these 18 sites, including data collection and submission, and specimen collection from persons meetingthe case definition. A minimumo f five specimens per site per month (90 specimens per month) should be collected. These specimens can be tested on-site with rapid diagnostic kits (with positive specimens forwarded for further testing) or directly submitted to the IEDCR laboratory for testing, if rapid tests are unavailable. Specimens will be tested at IEDCR using standardized protocols (PCWvirus isolation) with further virus evaluation done at IEDCR and/or shipped to an international reference laboratory. Since ICDDRB, also operates a sentinel surveillance network (although not specifically for influenza) to the degree feasible the networks should be complementary and integrated and information derived from these networks should be shared. 64. For effective containment and prevention activities, Bangladesh must have a sensitive surveillance system for illnesses which may represent avian influenza. There must also be a system in place to track disease during an influenza pandemic. Data from other countries that have experienced human disease caused by avian influenza H5N1 indicate that most patients have a severe illness consistent with viral pneumonia. Therefore, surveillance efforts during the pre-pandemic period should include a component that focuses on persons with this condition who have a history o f exposure to sick and dying poultry or other birds, even when highly pathogenic avian influenza has not been confirmed inthese animals. Such human cases may be present at almost any health care facility. Therefore, to be effective, this system must be national inscope. Given the severity ofhumandisease up to this point, duringthe pre-pandemic phase efforts should focus on in-patient facilities. 65. IEDCR has proposed establishingviral pneumonia and avian influenza surveillance inall 64 districts by incorporating the activity into existing surveillance methods and structures. Such an approach strengthens the overall surveillance infrastructure rather than creating another independent vertical system. HNPSP will support this approach, including application o f standardized case definitions and detection methods, data collection, and rapid submission o f standardized information on potential cases. District-level surveillance teams will work with health care personnel at the district and Upazila level hospitals to rapidly detect possible cases, in concert with nationwide training on surveillance methods. IEDCR must develop mechanisms to include the sizeable private health sector in this surveillance effort and demonstrate such on- goingprivate sector participation. Computers and fax machines will beprovided for the conduct o f national surveillance in all 64 districts, along with the software for data entry and analysis. Transportation for conducting the surveillance activities (and for rapid response teams (see 66 below) will also be included. Ifinternet connections are available, electronic data transfer should be implemented and HNPSP will support the costs to accomplish this. 66. Although efforts are underway to modernize Bangladesh's surveillance infrastructure, in many locations information is collected and recorded manually and transmitted inconsistently. Quality o f analysis also varies. With respect to avian and pandemic influenza, it is important to have uniform, consistent, and rapid data collection and transmission in order to maximize opportunities for interventions. As noted above, HNPSP will support the procurement and instalment o f computers and fax machines for data entry and transmission. Ideally, all locations will be able to transmit data electronically. At the central level, information technology will also need to be enhanced. HNPSP will support procurement o f additional computers and auxiliary equipment, and the necessary software, in the epidemiology unit and laboratory at IEDCR. HNPSP will also support the establishment o f a web-site for posting data and information relevant to avian influenza, including guidelines and protocols, along with information on other reportable diseases. HNPSP will support the hardware and software for avian influenza surveillance and laboratory diagnostics, including the web site for public health-related data, and provide for an information technology/data management specialist and data entry personnel to accomplishthese activities. c. Reinforcement of rapid responseteamsfor outbreak investigation 67. As the surveillance infrastructure for avian influenza improves, and the likelihood that avian influenza will be identified in the animal health sector increases, the need for rapid and effective investigative capacity will also increase. Inorder to contain future outbreaks inpoultry, the system must identify persons who fulfil the surveillance case definition for possible avian influenza, and these cases must be looked into by trained professionals. Bangladesh has established a network o f rapid response teams at the district and national levels, and has begun training team members on avian influenza. HNPSP will support further training o f these individuals once necessary guidelines and protocols have been developed, will provide the necessary protective equipment, vaccinations, and antivirals for the investigators to safely perform investigations, andwill support field investigations. For the purposes o f cost estimation, it is presumedthat a total of 192field investigations will bedone bydistrict level response teams per year (three investigations per district), and that these investigations will need support from the national rapid response teams 20 times per year over the implementationof this component. Field investigations at the district level will average 2 days, those which require national level back-up support will last an average o f 5 days. HNPSP will support travel and per diem for the investigative teams and also provide the material needed to collect and transport specimens duringthese investigations. B2. StrengtheningPublicHealthLaboratoryNetwork 68. A fundamental aspect of surveillance for avian influenza is the ability to diagnose and confirm the disease inthe laboratory. At present, capacity to do this within Bangladesh's public sector does not exist. The ICDDR,B has the ability to collect samples and isolate influenza viruses, but must send specimens internationally for more specific subtyping and identification. Outside o fDhaka, there i s no capacity to conduct sample analysis. HNPSP will support a phased 67 approach to develop influenza laboratory diagnostic capacity inthe public sector inBangladesh. Because specimen transport to a reference laboratory i s not a major obstacle in the country, efforts will focus on fiont-line specimen collection, rapid diagnostics, and referral to a well- equipped and staffed central facility in Dhaka. Once there is a well-hctioning central laboratory, the MOHFW may consider an expanded network at the regional level for influenza diagnostics. While these capacities are specifically being developed for influenza, they can and should be utilized for other emerging viral diseases inBangladesh, and should be viewed as part o f overall capacity development. HNPSP will support supplies and equipment for laboratory enhancements, material for field specimen collection and shipment, andbiosafety precautions for personnel who will work in the central laboratories. HNPSP will also provide technical assistance in laboratory design, and if necessary, construction, since the necessary skill for design are not available within the country. Three types o f laboratory-related activities will be supported: a. Rapid diagnostickits 69. Simple-to-use rapid diagnostic kits are available to diagnose influenza A and B. These kits cannot differentiate influenza A subtype, and their sensitivity for avian influenza inhumans i s lower than for usual seasonal influenza disease (as the amount o f virus in upper respiratory secretions in avian influenza patients i s less than for regular human subtypes). However, they are a useful adjunct for influenza monitoring and, in a person with illness compatible with avian influenza, can give an early diagnostic clue to support the diagnosis. HNPSP will support provision o f rapid diagnostic kits to sentinel sites for influenza-like illness supported by HNPSP and to other referral centers in the country (medical colleges). Given the cost o f these kits, provision o f rapid diagnostic kitsto health care facilities at the district or Upazila level cannot be supported. HNPSP will, however, support re-supply o f these kits, as sentinel sites should be doing monthly testing o f persons meeting the case definition for ILL b. Development of real timepolymerase chain reaction (RT-PCR) capacity at IEDCR 70. RT-PCR i s the most rapid and sensitive method currently available to diagnose human disease caused by avian influenza subtype H5N1. Therefore, it is important to develop the ability to perform this assay at the Central Referral Laboratory at IEDCR. To do this, existing laboratory space at IEDCR must be renovated and upgraded, equipment and supplies must be procured, and staff must be trained. Other donors are supporting the development o f RT-PCR at IEDCR. HNPSP will support gaps in available funding for construction to assure available o f adequate space for this laboratory and for the equipment to be properly maintained. Given the critical need for this capacity within Bangladesh, the necessary steps to develop RT-PCR must begin as soon as possible, as operation o f the sentinel network and diagnosis of potential human disease depends on the availability o fPCR diagnostic capacity. c. Development of virus isolation capacity at IEDCR. 71. Virology capacity at the National Referral Laboratory at IEDCR, at present is virtually non-existent. Development of RT-PCR represents a significant upgrade, but will not allow public health authorities to adequately respond to the myriad o f viral disease threats that exist 68 within Bangladesh, including Nipah virus, encephalitis viruses, dengue fever, and avian and pandemic influenza. Work on many o f these viruses requires bio-safety level 3 (BSL-3) capacity, which will require investments in the infrastructure o f IEDCR. It will be prohibitively expensive to renovate existing antiquated facilities to handle this biosafety level, and new constructionwill take several years to complete. Therefore, HNPSP will support a pre-fabricated bio-safety level 3 (BSL-3) suite to perform avian influenza viral diagnostic work inBangladesh, along with the technical assistance for its installation, maintanence and operation. Because only one company produces such laboratories for the Asian market, a sole source contract for procurement o f this pre-fabricated laboratory should be issued to Techcomp Holding Company o f Hong Kong. Once a contract has been executed, it should take approximately six months to produce, ship, and install. HNPSP will also support provision o f supplies and equipment for this laboratory. HNPSP will support travel for IEDCR staff to visit a functioning Techcomp lab at the National Institute o f Communicable Diseases inIndia. The BSL-3 laboratory is expected to maintain international certification to operate at the BSL-3 level. There should also be assurances from the Government o f Bangladesh that the resources are available for continued operationof this facility after implementation o f HNPSP is completed. 72. Because the development o f capacity to perform RT-PCR and virus isolation for influenza will take time, IEDCR needs to have a firm agreement with ICDDRB for diagnostic support until it has the necessary capacity in place. HNPSP will support the development o f such an agreement, should it be necessary. HNPSP will also support shipment o f specimens to international referral laboratories, as needed over the course o f the project, and participation o f IEDCR in internationally-recognized quality assurance programs for influenza RT-PCR and virus isolationdiagnostics. C. StrengtheningHealthCareSystem PreparednessandResponseCapacity C1. Personnelsafety equipment 73. Steps must be taken to reduce the exposure o f persons involved in the care or the investigation o f avian influenza. This includes laboratory workers. The potential routes o f transmission are (i) respiratory, and (ii) with contaminated surfaces. To protect against contact these modes o f transmission, individuals use a standardized set o f equipment known as PPE (personal protection equipment). This includes mask (N95 standard), gloves, gowns, and booties. For aerosol generating situations, goggles are also worn. Because o f the hot and humid climate in Bangladesh, these items must be lightweight and disposable (except for the goggles which are re-useable). HNPSP will support acquisition and distribution o f PPE to in-patient facilities and to the central laboratory. All district hospitals and the national referral hospital should have at least 25 sets o f PPE present at all times. HNPSP will also support an initial central stockpile o f 10,000 sets o f PPE, and annual replacement o f 50% to cover usage until the end o f HNPSP. PPE should also be used by workers engaged in culling operations o f poultry with avianinfluenza. PPE for this group is covered inAIPRP that deals with animal health. 69 C2. Purchaseof seasonalinfluenza vaccine doses 74. Although trivalent seasonal influenza vaccine is an effective preventive measure to reduce the public health burden o f this disease, its role in prevention and control o f avian influenza i s limited. During the pre-pandemic phase when disease is largely acquired from poultry exposure and the virus has not acquired person-to-person transmission characteristics, seasonalinfluenza vaccine will reduce the likelihood o f co-infection o fpersons with both regular humaninfluenza virus and avian influenza virus. This will reduce the potential for the virus to reassort and acquire human influenza virus genetic material. Once sustained person-to-person transmissibility has been attained by H5N1 virus or other avian strains, there i s no role for seasonal vaccine. Because it is not feasible to vaccinate the entire population to prevent co- infection, vaccine i s usually reserved for those at highrisk o f exposure to avian influenza. This includes the same risk groups that would be offered prophylaxis, with the exception o fhousehold contacts o f cases, which cannot be predicted in advance. HNPSP will therefore support acquisition o f limited quantities o f seasonal influenza vaccine to immunize health care workers likely to take care o f patients with avian influenza during the pre-pandemic phase, investigative teams (animal and human health), culling workers, and laboratory technicians likely to handle live virus. This vaccine must be given annually to assure immunity is maintained. An annual total o f 19,000 doses will be acquired to cover health care workers and others. C3. Disease case management a. Trainingof clinicians, health care workers andparamedics 75. A well-trained public health and health-care workforce is crucial to approaching this disease and minimizing morbidity and mortality during a pandemic. Once guidelines and protocols have been developed, an aggressive training campaign must be initiated and HNPSP will support such activities, which should cover over 20,000 public healthpersonnel. b. Purchase, storage and distribution of antivirals 76. Antiviral medications are used for prophylaxis andtreatment o f avian influenza. Because the H5N1 viruses responsible for human disease have been resistant to M2 inhibitors, the only widely available option is the neuraminidase inhibitor oseltamivir. Prophylaxis is indicated for health care workers caring for persons with avian influenza, for disease investigative teams (animal and human), for close contacts (usually household members) o fpersons with the disease during the pre-pandemic phase, for laboratory workers with an unprotected exposure, and for culling workers. The dose and duration o fpost-exposure prophylaxis for adults i s one tablet (75 mg) daily for 10 days. Pre-exposure prophylaxis can be given longer (up to six weeks), but due to high cost it can be supported only in exceptional circumstances. For treatment, the adult dosage o f oseltamivir currently recommended i s one tablet twice daily for five days. For pediatric purposes, the drug i s dosed based on body weight. To be effective for treatment, oseltamivir should be administered within 48 hours o f illness onset. Therefore, it needs to be distributedthroughout the country and not all canbe kept ina national stockpile. Inall locations, drug must be maintained in conditions (temperaturekumidity) specified by the manufacturer. Bangladesh currently has two manufacturers o f this drug. Ifthese companies are certified by the 70 World Health Organization, local acquisition should be used since it will result in savings, will support local industry, and will facilitate distribution o f the drug. HNPSP will support acquisition and distribution o f around 120,000 courses o f antiviral drugs (including a national stock-pile). Furthermore, it will obtain 3,000 prophylaxis courses for culling workers. A 25% annual re-supply rate will be supported during each year. Oseltamivir should be obtained inboth the tablet and paediatric formulations at a ratio o f 3: 1(75% adult, 25% paediatric). e. Purchase of hygienic and disinfection supplies 77. Infection control i s very important inlimiting the spread o f influenza virus. This includes surface disinfection and hand washing during patient care. HNPSP will support acquisition o f sanitary items for use in health care facilities, particularly those with isolation facilities, and for rapid response teams. Disinfection materials include hypochlorite, absolute alcohol, and detergent. d. Purchase of supportivemedications 78. To properly care for persons with influenza, other types o f medications must also be available. These include antimicrobial agents to treat the secondary bacterial complications, and medications to treat the symptoms o f disease (anti-pyretics and antitussives). HNPSP will support limited quantities o f the latter. Concerning antimicrobial agents, the component will support acquisition o f agents that cover the most common pathogens producing secondary complications (Staphylococcus aureus, Streptococcus pneumoniae, and Haemophilus influenzae). HNPSP will also support limitedreplacement o f these medications (25% annually). Acquisition o f steroids cannot be supported as these have not been shown to be effective in the treatment o f avian or seasonal influenza. e. Health carefacilities upgrades 79. At present, the capacity to isolate persons with suspected or confirmed avian influenzain Bangladesh health care facilities i s limited. During both the pre-pandemic phase and during a pandemic, it i s important that such facilities are available to reduce the potential for spread. These facilities can also be used for other diseases that require patient isolation for optimal care, and where developed, should not be reserved exclusively for use by avian influenza patients. HNPSP will support limitedrenovations inhealth care facilities to create isolation spaces and to provide necessary low-technology equipment. This includes the 64 district level hospitals and the national referral hospital (the Asthma Hospital) in Dhaka. Included in the equipment category are items like oxygen generators and suction machinery. Acquisition of high technology equipment like mechanical ventilators i s not supported. If ventilation i s considered necessary, the patient should be transported to a facility that can provide this support. C4. PandemicPlanning 80. Appropriately responding to avian influenza and to an influenza pandemic requires planningand activities that may not often be utilized by public health officials. Duringthe pre- pandemic phase, this includes isolation and quarantine, and during both the pre-pandemic and 71 pandemic phases measures like school closures, business closures, and cancellation o f events that bring together large numbers o f persons (such events would facilitate rapid spread o f the organism). Accomplishing such measures requires careful planning that involves many other sectors of society, including other governmental bodies at the national, district, and local levels, the business community, religious and community leaders, non-governmental organizations, etc. These social distancing measures may have to be enforced by security and military personnel. HNPSPwill support the development o fplans for implementation o f social distancingmeasures. 81. Should an influenza pandemic occur, it will result in large numbers o f illpersons and widespread disruption to society. Among the illwill be the health care workers who need to be providing health care. Even if no health care workers became illthemselves, the health care workforce would still need to be supplemented to care for all o f the illpersons. HNPSP will support a planning process to address ways to supplement the health care workforce (surge capacity) including recruitment o f a volunteer workforce or re-activation o f persons formerly engaged in health care. HNPSP will also support planning for mortuary needs during a pandemic, and for limitedacquisition o f supplies that might be necessary for hygienic disposal o f remains during a pandemic. To develop these plans, technical assistance will be necessary. These plans should form the basis for table-top and field exercises discussed above. 72 Bangladesh Avian InfluenzaPreparednessandResponseProject Annex 4: ProjectCoordinationandImplementationArrangements 1. The implementation and coordination arrangements fall into three categories: (i) implementation o f the national plan (NAIP); (ii) implementation o f the AI program which, in turn, consists of AIPRP and AI Component o f HNPSP; and (iii) implementation o f the AIPRP project. The implementation o f the project i s put in a broader context o f the national Plan and the AI program. Furthermore, the annex highlights the linkages and the need for proper coordination between the Plan, the Program and the Project in order to minimize any overlap, makeefficient use of scarceresources andachieve the development outcomes. 2. Implementation of the National Plan: The Government o f Bangladesh has designated M O F L and MOHFW to implement its national Plan (NAIP), with appropriate support from other agencies, including MOEF and MOI. A National Advisory Committee (NAC), comprising 16 Ministers and a representative o f the Prime Minister's Secretariat, has been designated as the apex coordinating body (see Figurel). Beneath the NAC, a National Multi-Sectoral Task Force (NMTF) has been established with representation from a wide range o fpublic and private sector agencies (see Figure2). The cost for implementing the Plan i s being borne by GOB. 3. Implementation of the A I Program: The Avian Influenza Program for Bangladesh consists o f two parts (a) Avian Influenza Preparedness and Response Project (AIPRP, a new project); and (b) Avian Influenza Component of HNPSP. The supervision o f the Avian Influenza Program will include both the animal health (AIPRP) and the human health (Avian Influenza Component o f HNPSP) aspects o f the avian influenza. The public health expert, provided under the AIPRP but based inDGHS, will serve as the link between these two parts o f the AI program(see Figure3). 4. Implementation of the AIPRP Project: The World Bank supported AIPRP i s under the Global Program for the Avian Influenza and Human Pandemic Preparedness and Response (GPAI). The AIPRP, an emergency project, is designed to provide assistance for avian influenza within the overall framework o f the GOB'S national Plan. The project would be implemented over a period o f 5 years. A PCU i s being established inthe DLS under the Ministry of Fisheries and Livestock (MOFL) to implement and coordinate the project activities, including communication, procurement, financial management, safeguards, monitoring and reporting (see Figure 4 and Figure 5). 5. The PCU inthe DLS will be headed by the Project Director (PD) and will be responsible for the overall coordination o f the project related activities. The PD will have necessary responsibility and authority to make necessary decisions, as provided inthe GOB regulations for development projects. The PCU will be supervisedby the Project Steering Committee (PSC), headed by Secretary, MOFL, and would share information with MOFL, MOEF, MOHFW, MOI and the development partners, on a periodic basis. The PCU will monitor the implementation progress o f AIPRP during implementation and will produce progresshpecial reports. The PCU 73 would be staffed by appropriate staff and consultants for overall administration, coordination, procurement, financial management, safeguards, and internal M&E (see Figure 5). Component wise implementation arrangements are the following: Animal Health (Components I): This component will be implemented by DLS through its PCU, in collaboration with partner government agencies (BLRI and the Department o f Forest), private sector commercial poultry farmers' association andNGOsfor backyardpoultry farmers. Public Awareness and Information (Component 2): This component will be implemented by PCU, in collaboration with partner government agencies under the Ministry o f Information (MOI), private media partners, private sector commercial poultry farmers association, NGOs for backyard poultry farmers. A Technical Working Group (TWG), consisting o f representatives from all technical ministries, working in association with UNICEF team, has prepared a communication strategy which has been approved by the Government. An action plan and messages for different audience groups have also been prepared and some o f them have been disseminated following Government's approval process. This project would not only implement the relevant parts o f the communication strategy and action plan, but would also strengthen the strategy, action plan and messages dealing with the animal health aspects o f avian influenza. These messages will be disseminated following the Government's approval process. Furthermore, the PCU will coordinate all the communication related activities with MOHFW, MOI, NGOs andthe private sector. Implementation Support and Monitoring & Evaluation (Component 3): This component would support the establishment o f PCU, headed by the Project Director, who will be responsible for the overall coordination o f the project related activities. The PCUwill report directly to the Project Steering Committee. The PCU will also share information with DLS, MOFL, MOHFW, MOEF, M O I and the development partners, on a periodic basis. The PCU will monitor the implementation progress during implementation and will produce periodical progress reports and special status reports, as needed. 6. Technical Assistancefor AIPRP: The project would provide support for national and international experts to assist with implementation, coordination and management (see Annex 10 for more details). Most, not all, o f the consultants would be on a short-term basis. The project would also provide support for the incremental staffing needs o f the PCU, including M&E staff, and operational cost for the PCU. Monitoringand Evaluation 7. The M&E arrangement, which will be part o f the overall Management Information System(MIS) inthe PCU, will continuously and systematically monitor project implementation activities, outputs and outcomes. The key indicators to be monitored include: preparation and approval o f contingency plans; extent o f animal surveillance and laboratory testing; training o f 74 veterinary and health officers; readiness for outbreak containment; enactment o f containment plans (as and when necessary); changes to legislation; fully developed human surveillance systems and equipped laboratories; training o fhealth workers; weekly/monthly disease reporting; preparation o f communication material and implementation o f communication strategy. More details on the results framework andmonitoring are provided inAnnex 2. 8. Internal M&E: A national M&E specialist i s included as a consultant to work within the AIPRP PCU for the entire project period. He/she would be responsible for preparingthe M&E program at the beginningo fthe Project, for training central and district staff inhow to record and report data, and for producing regular reports for the PSC and the World Bank. He/she would work closely with the PCUinpreparingquarterly progress/special reports. 9. Independent Project Evaluation: In addition, the PCU will appoint, using agreed procurement guidelines and preferably through FAO, a team o f consultants for an independent evaluation o f the Project. This team will carry out a base line survey for the key performance indicators, collect data at a specified frequency, analyse those, andprepare a baseline, mid-term andend-of-the-project evaluation reports for the Government anddevelopment partners. 10. Implementation of the A I Component of HNPSP and Linkages with AIPRP: The AI Component o f HNPSP will be implemented by MOHFW. The avian influenza activities have been incorporated into the Communicable Disease Operational Plan under the Line Director Communicable Disease; human health activities relating to AI will be monitored under the HNPSP. To support an integrated monitoring and evaluation o f the AI Program, the MOHFW will provide the PCU for AIPRP all the necessary information on the progress o f AI component activities o f HNPSP. One public health expert and support for communication for the human health activities will be provided from the AIPRP; procurement, financial management, and reporting for human health activities will follow HNPSP agreed procedures. The public health expert, located inthe DGHS, would report to the Line Director and support the linkage with the AIPRP, dealing with the animal health. The monitoring indicators relevant to avian influenza activities will be incorporated within the Results Framework to be monitored under HNPSP by routine MOHFW systems. However, to provide an overall assessment o f the Avian Influenza Program, the HNPSP team will supervise the Avian Influenza Component and provide all the information to the AIPRP PCU and the Bank team to carry out a comprehensive assessment of the AI Program. 11. Linkages between the AI Program and the National Plan: According to the National Plan, N A C will coordinate the implementation o f the Plan through NMTF. NAC will meet quarterly and NMTF will meet on a monthly basis to review implementation status o f the Plan (the frequency o f the meetingsmay be adjusted, dependingon the outbreak or need). A national secretariat has been proposed in the Plan to facilitate coordination implementation. The AI Program i s broadly a part o f the national Plan. The ministers o f MOFL and MOHFW will chair the NAC, depending upon the pandemic phases. Inphase 1, the Honorable Minister o f MOFL will be the chairperson, while in phase 2, the Honorable Minister o f MOHFW will have the leading role. However, duringphase 3, HPAI activities will be carried out under the leadership o fthe Honorable PrimeMinister. 75 12. The NMTF will comprise o f representatives from relevant ministries, directorates, professional bodies, business bodies, NGOs, civil society and nominated members. The NMTF will take measures to implement decisions taken by the NAC. Each Ministry will establish a Technical Committee at the Directorate level. These Technical Committees will be responsible for developing sectoral strategies as well as ensuring effective and timely preparation and response activities at all levels within their sector. Figure 1 Implementation Arrangements for the National Avian Influenzaand Human Pandemic Influenza Preparednessand ResponsePlan for Bangladesh (The Plan) National Advisory Committee (NAC) (inter-ministerial) National Multisectoral Task Force (Nh4TF) - 1 National Technical National Technical National Technical PM's Office and Committee at - Committee at - Committeeat - other Relevant Directorate Level Directorate Level Directorate Level Ministries , (Health) (Livestock) (Wildlife) I I I Surveillance and Rapid Surveillance and Rapid Response Teams . . . . . . . . . . . . . . . . . . . . Response Teams . . . . . . . . . . . . . . . . . . . . .Surveillance. Teams. . . . . . . . . . . . . . . . . . Diagnostic Team . . . . . . . . . . . . . . . . . . . . Diagnostic Team . . . . . . . . . . . . . . . . . . . . Investigation Team _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ - Clinical Management Team . . . . . . . . . . . . . . . . . . . . Culling, Disposaland DistrictLJpazila Coordination DisinfectionTeam DistricVUpazila Coordination . . . . . . . . . . . . . . . . . . . . DistricVUpazila Coordination t Coordination Source: GOB 2006, National Avian Influenza and Human Pandemic Influenza Preparedness and Response Plan, Bangladesh. 76 Figure2 Coordination Arrangements for the National Avian Influenza and HumanPandemic Influenza Preparednessand ResponsePlan for Bangladesh (The Plan) National Advisory Committee Upazila Influenza Upazila Upazila Influenza Management Multisectoral Management Committee Coordination Committee (Health) Committee (Livestock) Source: GOB 2006, National Avian Influenza and Human Pandemic Influenza Preparedness and Response Plan, Bangladesh, Annex XII. 77 Figure 3 Implementation and Coordination o f the Avian Influenza Preparedness and Response Program Avian Influenza Preparedness and + ResponseProgram (TheAIProgram) h I Ministryof Ministryof Health and 1 I Fisheries and Family Welfare Livestock HumanHealth Animal Health ~ Avian Influenza Component Avian Influenza Preparedness o fHealth, Nutrition and and responseProject (AIPRP) Population Sector Program (TheProject) (HNPSP) I I 7 Project C;;-I? Unit 1 78 Figure4 Organizational Structure for the Implementation and Coordination o fthe Avian Influenza Preparednessand ResponseProject (AIPRP) Project Steering MOEF MOHFW Committee and (PSC) MOI ~ PCU DLS ------------_-_---- BLRI DLS Legend: MOFL MinistryofFisheries andLivestock MOEF MinistryofEnvironment andForest M O I MinistryofInformation MOHFW MinistryofHealthandFamilyWelfare DLS Department o f Livestock Services BLRI Bangladesh Livestock ResearchInstitute PCU Project CoordinationUnit HNPSP Health, NutritionandPopulation Support Program D M C Department o f Mass Communication DOF Department o f Forest AI Avian Influenza 79 Figure 5 Organizational Structure of the Project Coordination Unit (PCU) for the Avian Influenza Preparedness and Response Project (AIPRP) r Management Animal Health Communication ______________-___ PCU Safeguards DLS Financial Procurement Management I I Monitoring and Evaluation 80 Bangladesh Avian Influenza Preparednessand ResponseProject Annex 5: ProjectCosts And Financing Table 1:AvianInfluenzaPreparednessandResponseProject: EstimatedCosts by Components (US%'000) Yo of Components Total YO Base Local Foreign Total Foreign Costs 1.Animal health 9,826 5,700 15,526 37 79 1.1Enhancingprevention and preparednesscapability 50 0 50 0 0 1.2 Strengthening diseasesurveillance and diagnostic capacity 5,210 3,867 9,077 43 46 1.3 Strengthening control programs and containment plans 652 450 1,102 41 6 1.4 Improvingbio-security inpoultry production andtrade 500 0 500 0 2 1.5 Support for surveillance of migratory birds 1,389 143 1,532 9 8 1.6 Contingency fund 2,025 1,240 3,265 38 17 2. Public awareness and information 1,468 315 1,783 18 9 2.1 Capacity building 100 0 100 0 0 2.2 Informationand communication services 1,368 315 1,683 19 9 3. Implementation support and monitoring & evaluation 1,372 945 2,317 41 12 3.1 Implementation and technical support 1,122 945 2,067 46 11 3.2 Monitoring and evaluation 250 0 250 0 1 Total base costs 12,666 6,960 19,626 35 100 Physical contingencies (4%) 507 278 785 35 4 Price contingencies (3%) 380 209 589 35 3 Total AIPRP costs 13,553 7,447 21,000 35 107 Table 2: Avian InfluenzaComponentof HNPSP: EstimatedCosts by Components YOof Total Components (US% '000) YO costs Local Foreign Total Foreign Avian Influenza 1 Enhancingpublic healthprogramplanning and coordination 265 140 405 35 3 2 Strengthening national public health surveillance system 3,486 1,508 4,994 30 31 3 Strengthening healthcare systemprep & responsecapacity 4,423 6,178 10,601 58 66 Total base costs 8,174 7,826 16,000 49 100 Total AI program costs (including contingencies for AIPRF') 21,727 15,273 37,000 41 100 Note: Contingencies are excluded from the Avian Influenza Component o f the HNPSP because the HNF'SP i s linked to the Government o f Bangladesh's annual budget cycle, through a Medium Term Expenditure Plan, which allows for adjustments to be made inthe event o f cost fluctuations. 81 Table 3: Avian InfluenzaPreparednessandResponse Project: EstimatedCosts by Components and Sub-components % ofTotal Components/Sub-components US$ '000Base Costs 1.Animalhealth 15,526 79 1.1Enhancing preventionandpreparednesscapability 50 0 1.1.1Technical expertise onavianinfluenza 1.1.2 Adapting national policy framework 1.1.3 Improvingprevention and contingency planning 50 0 1.2 Strengtheningdisease surveillanceanddiagnosticcapacity 9,7077 46 1.2.1 Strengtheningofveterinary services 1.2.2 Strengtheninganimal disease surveillance and lab diagnosis 9,027 46 1.2.3 Strengtheningapplied veterinary research 50 0 1.3 Strengtheningcontrolprogramsandcontainmentplans 1,102 6 1.3.1 Targeting virus elimination at the source 552 3 1.3.2 Personnelsafety 550 3 1.4 Improvingbio-securityinpoultryproductionandtrade 500 2 1.5 Support for surveillanceofmigratorybirds 1,532 8 1.6 Contingencyfund 3,265 17 2. Publicawareness andinformation 1,783 9 2.1 Capacity building 100 0 2.2 Information and communication services 1,683 9 3. Implementationsupport andmonitoring& evaluation 2,317 12 3.1 Implementation andtechnical support 2,067 11 3.2 Monitoring& evaluation 250 1 Totalbase costs 19,626 100 Physical contingencies(4%) 785 4 Price contingencies (3%) 589 3 TotalAIPRP Costs 21,000 107 82 Table 4: Avian Influenza Componentof HNPSP: EstimatedCosts by Components and Sub-components YOof Total Components/Sub-components US$ '000 BaseCosts Avian Influenza 1.Enhancingpublic healthprogramplanningandcoordination 405 3 2. Strengtheningnationalpublichealthsurveillancesystem 4,994 31 2.1 Strengthening disease monitoring andreporting 3,2 18 20 2.2 Strengthening public health laboratory network 1,776 11 3. Strengtheningof health care systempreparedness and responsecapacity 10,601 66 3.1 Personnel safety equipment 613 4 3.2 Purchase of seasonal influenzavaccine doses 912 6 3.3 Disease cases management 9,013 56 3.4 Pandemic planning 63 0 Totalbasecosts TotalAI programcosts (including contingencies for AIPRP) 37,000 Note: Contingencies are excluded from the Avian Influenza Component of the HNPSP because the HNPSP is linked to the Government of Bangladesh's annual budget cycle, through a Medium Term Expenditure Plan, which allows for adjustments to be made inthe event o f cost fluctuations. 83 I z z N b m N c.l l n m 3 3 3 i2 .3 * ** n ? Z N b m N N I n m 3 - Bangladesh Avian Influenza PreparednessandResponse Project Annex 6: ProcurementArrangements Procurement Environment: The Country Procurement Assessment Report (CPAR), broadly accepted by the Government and issued in 2002, identified inadequate public procurement practices as major impediment affecting project implementation in Bangladesh. Procurement deficiencies include: absence o f a sound legal framework, protracted bureaucratic procedures allowing multi-point rent seeking, lack o f critical mass o f professionals to manage public procurement, inordinate delays in completing the procurement process and ineffective contract administration and absence o f mechanisms for ensuring transparency and accountability in public procurement. Procurement Reform Actions: To carry out procurement reform, following the CPAR recommendations, the Government i s implementing World Bank-supported a Public Procurement Reform Project (PPRP), which is scheduled to close in June 2007. As part o f the reform under PPRP, the Government has established a Central Procurement Technical Unit (CPTU) within the ImplementationMonitoring and Evaluation Division (IMED) o f the Ministry o f Planning, with staffing fimded from own resources. The Government issued Public Procurement Regulations 2003 and associated implementationprocedures, including streamlined procurement approval process, delegation o f financial powers, and standard set o f documents for procurement o f goods, works, and services. The Parliament has now passed a procurement law. The effectiveness o f the law andthe issuance o f the rules are expected to take place inthe near future. The law and the regulations contain most o f the international public procurement best practices. Notable features include: (i)non-discrimination o f bidders; (ii) effective and wide advertising o fprocurement opportunities; (iii) public opening o fbids inone place; (iv) disclosure of award o f all contracts above specified threshold in the CPTU's website; (v) clear accountability for delegation and decision making; (vi) annual post procurement audit (review); (vii) sanctions for fraudulent and corrupt practice; and (viii) review mechanism for handling bidders protests. Concurrently, in order to build procurement management capacity, CPTU, in collaboration with ILO and local institutes, has developed a critical mass o f 25 national trainers andprovided training to about 1500 staff of260 organizations. The new regulations are being implemented by all public sector entities with varying degrees. The landscape o f procurement has been reshaped in the last several years due to the procurement reform with harmonized procedures. The new regulations have also increased awareness among the stakeholders (such as the procuring entities, bidding community) by building confidence. Clearly, there are still a number o f potential challenges in cross-cutting governance, institutional, and implementation issues, including inadequate enforcement o f regulations and delegated financial powers, inadequate adherence to the provision o f streamlined procurement approval process, delays in contract award for large value contracts, ineffective contract administration, allegations o f fraud and corruption, andpolitical interference. 86 Avian Influenza Program: The proposed Avian Influenza Program consists o f two parts (a) Avian Influenza Preparedness and Response Project (new project); and (b) Avian Influenza Component o f the on-going HNPSP. Total Value o f the Program i s US$37 million. The procurement arrangements will be discussed separately for the new andthe existing projects. The associated procurement risks and capacity assessment are described inthe following. ProcurementArrangementsfor the Avian InfluenzaPreparednessandResponseProject: General: Total value o f the project is US$21 million; IDA Credit will finance US$16 million, Avian HumanInfluenza Trust Fund (AHITF) will provide a grant o f about US$3 million and GOB will finance US$ 2 million, in addition to in-kind contributions. Total procurement o f US$16.30 million under the project will involve goods o f US$10.75 million, followed by consultancy services o f US$2.38; training, studies and workshops o f US$2.45 million; and civil works ofUS$0.72 million. Procurement under the project would be carried out inaccordance with the World Bank's Guidelines: Procurement under IBRD Loans and IDA Credits o f May 2004, Revised October 2006 (Procurement Guidelines) and Guidelines for Selection and Employment o f Consultants by World Bank Borrowers of May 2004, Revised October 2006 (Consultant Guidelines). Within the overall context o f Bank guidelines, local procurement o f goods, works, and services (for which the shortlist entirely comprised o f national consultants) will follow the Government's Public Procurement Regulations 2003- PPR (goods: < US$300,000 per contract, works: < US$500,000 per contract, and consulting services- firms: -=US$200,000 per contract and individual consultant- < US$50,000 per contract) and in case o f any conflicts between the two procedures or ambiguous/conhsing interpretation Bank Guidelines will prevail. All expected major procurement of goods and consultants' services has been announced in the General Procurement Notice (GPN), published in the dgMarket and United Nations Development Business (UNDB), andit will be updated annually. Procurement Components and Responsibility: All three components o f the project, i.e., Animal Health, Public Awareness and Information, and Implementation Support and Monitoring and Evaluationwill be implementedby the MinistryofFisheries and Livestock (MOFL) through the Department o f Livestock Services (DLS). A Project Coordination Unit (PCU) in the DLS will handle the actual administration, coordination, and implementation o f these components, including procurement and financialmanagement. ProcurementCapacity and Risk Assessment: Procurement capacity assessment o f DLS has been carried out with a view to: evaluate the capability o f the implementing agency and o f the adequacy o f systems inplace to administer Bank-financed procurement and assess the risks that may negatively affect ability o f the agency to carry out the procurement process. DLS has no experience o f any World Bank-financed project. DLS is not immune from the systemic deficiencies mentioned above and have considerable weaknesses in terms o f internal control, award delays, transparency, management o f procurement process, and handling complaints. In order to safeguard against this and that general conditions for public procurement inthe country, the project is rated "high risk" from procurement operation and contract administration 87 viewpoint. In order to minimize the risk, several measures including a procurement risk mitigation framework havebeen introduced. Measuresfor ImprovingGovernanceinProcurement. Several measures have been introduced and agreed with the Government for improving governance in procurement and for minimizing procurement risks under the Project. All elements o f risk mitigation, described in the following paragraphs, are applicable not only to DLS and M O F L but also for other concerned ministries/implementing agencies involved in the implementation o f the Project, including MOHFWthat i s responsible for implementing the avian influenza component of the existing HNPSP. The three main pillars o f improving procurement related governance risk mitigation framework are: (a) establishment o f Procurement Core Team (PCT); (b) system o f handling complaints; and (c) disclosure o f information and procurement website. ProcurementCore Team (PCT): A PCT will be formed inDLS to oversee the procurement process under the project. The PCT will consist o f at least five members, o f which at least two external independent experts (technical and procurement) will be from outside the government/public sector entities andwill be recruited usingBank guidelines. These experts are likely to be of knownreputationfrom professional bodies, universities, academics, NGOs or the private sector. The PCT will: (i) review the bidding documents for large contracts that are subject to prior review; (ii) receive bids, evaluate bids, and prepare bid evaluation reports, along with recommendations for the award o f contract; (iii) out the ex-post review o f bidding carry procedures, followed in smaller contracts that are not subject to prior review; and (iv) make field visits to a number o f sites and check the quality o f procurement of goods and works and performance o f the suppliers/contractors. As per the government's delegation of financial powers and the public procurement processing and approval procedures within the overall framework o f the PPR, the PCT will submit bid evaluation report directly to the contract approving authority without tiers inbetween. The cost o f these two experts can be met from the Project. System for Handling Complaints: A credible system of handling complaints will be put in place inMOFL. The salient features o f the system will be an oversight o f a complaint database, a standard protocol with appropriate triggers for carrying out investigations, and taking action against involved parties. The systemwill be developed and managed by DLS, with an oversight o f the PCT. The system will be supported by a database containing information about all procurement steps and other relevant information such as official estimates (global unit prices), all bidders (individuals, companies, joint ventures, owners information, etc.), and all bids. Inthis regard, the CPTU's MIS database can be linked to these entities inphases. For ICB/international selection o f consultants and all contracts above US$lOO,OOO, the Bank prescribed complaint redress mechanismwill apply. Disclosureof InformationandProcurementWebsite: All information relating to biddingand procurement above the specified thresholds, as per PPR, will be published inCPTU's website, in addition to the Avian Influenza Preparedness and Response Project website. The information, among others, will include invitation to bid, biddocuments and RFPs, wherever applicable, latest 88 information on procurement pldcontracts, status o f evaluation once completed, contract award information with adequate details and poor performance o f contractors, suppliers and consultants, including list o f debarred firms. The website would be accessible to all bidders and interested persons equally and free o f charge. Inaddition, the following additional steps, whichhavebeendiscussedandagreedwithDLS, will be followed as a part o fprocurement andimplementation: Alert DLS officials/stafl The MOFL in reference to the provisions in the PPR and the legal agreement signed with IDA, will issue an alert letter to DLS, including their all field offices notifying about the possible consequences o f corrupt and similar behaviour in procurement practices and actions to be taken against the officials/staff ifget involved insuch practices. Moreover, the ministry will highlight that in case o f non-compliance o f the Bank's procurement guidelines, the Bank may take remedial actions (Le., withdrawal o f fund, misprocurement) against the concerned packages and slices. Alert bidders: DLS and its all field offices, through a notification, will alert all bidders on consequences o f corrupt practices (fraud and corruption, collusion, coercion, etc.). The alert message, among others, will include that if bidders are found to have adopted such practices, they would be debarred from subsequent bidding processes in conformity with PPR and the Bank's Guidelines, as appropriate. In addition, in the pre-bidmeeting, the bidders will be clarified for preparationo fbid correctly. Multiple Dropping: Multiple dropping o f bids (bids submitted inmore than one location and opened in one location) will not be permissible for all procurement underthe Bank-financedproject. Bid opening committee (BOC): A formal structured BOC will be constituted for each contract package, as per the provisions o f the PPR. For prior review contracts, the BOC will include at least one independent expert o fthe PCT. Bid opening minutes: During the same day o f bid opening, photocopies o f the bid opening minutes (BOM), signed by bid opening officials and the bidders' representatives, with readout bid prices o f participating bidders will be shared with the bidders and sent to the MOFL either by email, fax or special messenger. Also, for prior review packages, copy o f such BOM will be sent to the World Bankthe same day ofbidopening). Timeliness of bid evaluation and contract award: Inaccordance with the procurement approval process o fthe Government, bid evaluation reports will include certificates o f impartiality and will be submitted directly to the contract approving authority following the stipulated timelines. PCT will put extra effort to ensure award o f contract within the initial period o fbidproposal validity so that no extension o fvalidity i s required. PCT will closely monitor the timing, 89 takinginto account that the World Bankmay not finance contracts which are not awarded within the period o fbidvalidity. (vii) Sub-delegation of financial powers: DLS will sub-delegate decision-making authority to its field level, as per the GOB'S financial delegation notification, wherever appropriate in light o f Public Procurement Regulation (PPR) 2003. All field offices shall ensure exercise o f their authority inthe field o f bid evaluation, contract award, and contract administration without referring them to the higher authority. (viii) Action for corruptpractices -by bidders: Incases o f possible collusion found or established for reasons i.e. same hand-writing, identical unit prices in BOQs, consecutive serial numbers in bank guarantees for bid security etc, procuring entities will initiate actions, including debarring contractorshuppliers, as appropriate in accordance with PPR and Bank's guidelines. If any firm is debarred, the list o f debarred firms will appear in the web sites o f CPTU, and o f the entity, if applicable, and the debarment notice will be circulated to all field offices and other government/public sector offices, putting it as a lesson to discourage corrupt or similar behaviour. DLS will share such information with the World Bankregularly. (ix) Action for corrupt and similar practices - by GOB staf$ Incases ofpossible corrupt or similar practices, M O F L will thoroughly investigate it and if involvement o f GOB staff i s established, they will take appropriate/disciplinary action against those concerned, strictly in accordance with the services rules. In addition, sanction provisions as per the PPR will apply. (x) Low competition among bidders and high price of bids: The case(s) o f low competition (not solely based on number o f bidders) coupled with high priced bids will be reviewedby the PCT. The review and decision inthis regard would be in the context of qualification criteria, the contract size, location and accessibility o f the site, capacity o f the local contractorshuppliers (for smaller and non-attractive contracts), etc. In logical cases, DLS may go for changing the scope o fwork. (xi) Measures to reduce coercivepractices: Upon receiving allegations o f coercive practices resulting in low competition, DLS will look into the matter and take appropriate measures. For prior review contracts, observations o f DLS will be shared with the Bank, along with the evaluation reports. DLS may seek assistance from law enforcing agencies to provide adequate security for bidders during bid submission. For ICB contracts, provision for bid submission through InternationaVNational Courier Services will be allowed and confirmation o f the receipt o f the bidwill be informed to the bidder through e-mail. (xii) Rebidding: In case o f re-bidding, DLS will enquire into the matter, record and highlightthe grounds ofre-bidding(i.e. corruptionor similar, highbidprices etc.) along with recommended actions to be taken. For prior review cases, all such 90 detailed reports will be sent to the Bank. The Bank may not finance contracts recommended for rebidding and take W h e r remedial measures, if inthe opinion of the Bank, it is determined that collusion, corruption or similar practices have been adopted inthe biddingprocess. (xiii) Filing and record-keeping: DLS will preserve records and all documents regarding their public procurement, in accordance with provisions o f the PPR. These records will be made readily available on request for audit, investigation or review by the Bank. (xiv) Procurement Plan in websites: The procurement plan o f the project will be publishedinthe website o f CPTU andAIRRP, and updated semi-annually. (xv) Procurement monitoring information in websites: DLS will furnish to CPTU information o f their public procurement processing activities, as per provisions o f PPR. They will enter all information related to procurement monitoring into the database software (to be established) andtransmit the information to CPTU online or offline, to be incorporated into CPTU's central M I S database. Quarterly reports will be generated for monitoring procurement performance o f DLS and publishedinthe website o f CPTU and/or entities. These reports will be submitted to the Bank. (xvi) Publication of award ofcontract in websites: DLS, withintwo weeks o f contract award, will publish in its (if applicable) and CPTU's websites the following information: identity o f contract package, date o f advertisement, number o f bids sold, number o f submitted bids, number o f responsive bids, brief reasons for rejection o f bids, name o f the winning bidder and the price it offered, date o f notification o f award, date o f contract signing, proposed completion date o f contract as well as brief description o f the contract awarded. For contracts following International Competitive Bidding (ICB) procedures, Direct Contracting for goods and works, Single Source Selection o f consultants and all other pertinent consultant contract for firms, DLS will publishnotice o f award o f such contracts in UNDB Online and Development Gateway Market (dgMarket), in accordance with the provisions of the Bank's Guidelines. Contracts awarded under the NCB procedures should include publication ofresults o f evaluation and o f the award o fthe contract nationally/locally. (xvii) Complaints handling mechanism: DLS, for procurement under national competitive bidding (NCB), will enforce a complaint handling mechanism in accordance with the provisions o f the PPR including submission and disposal o f complaints within the timeline stipulated therein. Inthe offices o f PCU, they will introduce a complaint box and duringpre-bid meetings, bidders will be informed o ftheir rights to complain. For ICB, complaints will be handled as per the Bank's Guidelines. (xviii) Latepayments and liquidated damages: DLS will ensure timely payment o fbills o f the suppliers/contractors/consultants as per the provisions o f the contract. 91 Interest for delayed payments beyond a specified period will be stated in the bidding documents. For delays in implementation, liquidated damages will be imposed, as per the contract. (xix) Post procurement audit (review): As per the provision o f the PPR, DLS will carry out annual post procurement audit (review) based on sample contracts by hiringchartered accounting firm (with international affiliation), share the findings o f the report with the Bank, and will initiate actionshteps for improving procurement practices, as appropriate. This is in addition to the IDA's Procurement Post Review that would cover a minimum o f 20% post review contracts consistent with the level o frisk. (xx) Oversight by PCT: The PCT will provide this function. This monitoring team will review compliance with the above actions by all field offices, carry out time to time filed inspections, review the cases on corrupt and similar practices, review contract award and management issues (i.e. delays in award, liquidated damages, delayed payments, etc.), prepare reports on monitoring o f contracts and submit quarterly report to the Director General DLS, covering all the above items, and the same will be submittedto the Bank. (xxi) Special training course: Prior to the start o f the project, DLS will arrange a two- day special training course, covering Bank's Guidelines and PPR. All officials handling procurement are required to participate in this training. Besides, the training schedule stipulated below i s required to be fully met. No staff should be allowed to handle procurement without appropriate procurement training. (xxii) Training-bidding community: DLS will also conduct procurement workshops/ seminars for the bidding community on Bank's procedures, PPR, corruption and biddingprocess. (xxiii) E-Procurement: In order to minimize collusive and coercive bidding practices, with a medium term perspective, DLS will take initiative to introduce e- procurement in their system with its own IT infrastructure, under the overall framework o f CPTU's central portal. When the bidding environment in Bangladesh will be assessed as ready, they will adopt e- procurement on a pilot basis. (xxiv) NCB conditions to be added: i)Post biddingnegotiations shall not be allowed with the lowest evaluated or any other bidder. ii)Bids shouldbe submitted and opened in public in one location immediately after the deadline for submission. iii)Rebiddingshallnotbecarried-outwithouttheIDA'spriorconcurrence. Other Actions: Other actions taken or to be taken, during implementation to improve the procurement governance, are: 92 (a) contracts would be awarded within the initial bid validity period without any extension; (b) DLS will hire at least one independent procurement consultant and one independent technical expert to assist them as outlined in the above governance improvement plan. This i s in addition to one local procurement consultant to be hired for the entire project period. The same procurement expert can provide services to relevant agencies; and (c) DLS, by July 15, 2007, will submit a training plan for all concerned procurement staff that will undergo procurement training during the next two years. The Bangladesh Public Procurement Reform Project has adequate provision for training o fprofessionals for these two ministries involved inimplementing the AI Program. With the above arrangements, the procurement under the project is likely to be effective and transparent, resulting in smooth implementation o f the project leading to achievement o f the project development objectives. However, procurement process and implementation o f the contracts would be reviewed every six months by the Bank, and adjustments or corrections will be made, as appropriate. ProcurementArrangements: Overall procurement arrangements with tentative amounts are giveninTable A. Procurementof Works. Civil works are primarily in Component 1 related to improvement o f diagnostic laboratory capacity for animal health and some O&M works. Because o f the nature of the schemes, all civil works at this stage are expected to be small and may not attract international contractors, though some provisions have been kept. (i) International Competitive Bidding (ICB). Civil works contracts estimated to cost more than US$2.0 million equivalent per contract may beprocured usingICB. (ii)NationalCompetitiveBidding NCB:Civilworkscontractsestimatedtocostless - thanUS$2.0 millionequivalent per contract maybeprocuredusingNCB. Procurementof Goods. Generally goods will beprocuredusingICB (except vaccines, drugs, etc.), followed byN C B and national shopping for small valued contracts. (i) ICB: Goods and equipment contracts estimated to cost US$300,000 equivalent or more per contract will be procured using ICB. This includes large value laboratory and diagnostic equipment, medical equipment, etc. (ii) NCB: Goods and equipment contracts estimated to cost less than US$300,000 equivalent per contract may be procured using NCB. This includes office equipment andvehicles etc. (iii) Shopping S: Goods o f very small contracts or individual purchases o f off-the- - shelf items may be procured, through prudent shopping procedures. 93 (iv) Direct Contracting - DC: Computer software, books journals and training materials with individual contract costing less than US$2,000 equivalent may be procured following DC. Pre-fabricated BSL-3 LAB (Bio-safety level 3 laboratory) will be procured through direct contracting method from Techcomp Holding Company, HongKong. Estimatedcost for this LABi s around US$ 700,000. (v) Procurement from UN agencies: Procurement o f PPEs, critical vaccines and diagnostic reagents will be procured through FAO. Rationales for Direct Contracting of Prefabricated BSL-3 from Techcomp Holding Company, Hong Kong: The key reasons for direct contracting o f the pre-fabricated BSL-3 laboratory are as follows: The available current information and internet searches show only one supplier providing hlly equippedstate o f the art pre fabricated BSL-3 units; Enquiries inthe region reveal that the IndianNational Institute o f Communicable Diseases (NICD) in New Delhi has procured the prefabricated BSL-3 units from Techcomp Holding Company, HongKongthrough direct contracting; The emergency nature o f the program warrants that Bangladesh builds up its BSL-3 capacity quickly. A pre-fabricated BSL-3 laboratory has a lead time o f about 6 months and i s far shorter than setting up a new BSL-3 facility involving extensive construction; A major advantage would be in terms o f its regular maintenance by the only available supplier. This would make the operation and maintenance o f the prefab laboratorymuch easier; Consultation with NICD, New Delhi, reveal that the cost o f installing and operating a pre-fabricated laboratory i s much lower than building a new facility which will not be cost effective inBangladesh both from the point o f initial cost andrecurrent operational costs. Consultants' Services and Training Major consultancy assignments relate to training and technical assistance, besides substantial amount o f contracts to UNagencies. (a) Quality- and Cost- Based Selection (QCBS): Consulting services through firms estimated to cost US$200,000 equivalent or more per contract will be procured following QCBS. (b) Fixed Budget Selection (FBS): Services through firms estimated to cost less than US$200,000 equivalent per contract may be procured following FBS in accordance with the Borrower's Procurement Regulations. 94 Single-Source Selection (SSS): Specific consultants' services through firms, satisfjmg Consultants' Guidelines (paragraph 3.9 to 3.13) andwith estimated cost less than US$lOO,OOO equivalent per contract, with the Association's prior agreement, may be procured following SSS. Selection of UN agencies: FA0 will be contracted for all technical assistance services on sole source basis. Individual Consultants (IC): Services for assignments, estimated to cost US$50,000 or more, for which teams o f personnel are not required and the experience and qualifications o f the individual are the paramount requirement, will be procured through individuals in accordance with Section V o f the Consultants Guidelines. All other individual consultants may be selected following Borrower's Procurement Regulations. Individuals will be selected on the basis o ftheir qualifications for the assignment. Procurement through UNAgencies. Rationale for single sourcing of UNAgencies and for allowing them to use their own methods of procurement: Two UN agencies (FA0 and WHO) have been closely involved in the preparation of the Government's Avian Influenza Plan. FA0 i s also providing technical assistance services for avian influenza activities inBangladesh which are financed by USAID and ADB. The GOB and Bank have been working closely with FA0 and WHO during the preparation of the proposed Avian Influenza Program. The Government o f Bangladesh has proposed for continued involvement o f FA0 and WHO during implementation andwould like to hire them for providing TA services on sole source basis. Overall rationale: The rationales for their need in providing technical services during implementation are as follows: (a) The need for providingtechnical andoperational continuity; (b) The importance o f international experience and expertise that they bring, especially as avian influenza i s not an issue that Bangladesh has dealt with inthe past; (c) The value added in terms o f synergies with other activities being carried out by these agencies in the area o f avian influenza prevention and control - independent o fthe project; (d) The requirement o f the program to follow international norms and guidelines, which are generally prepared under the leadership o fthese organizations; (e) Well-known capacity constraints within the Government system; and (f) The emergency nature o f the problem which warrants a rapid reaction and response time, which is difficult under the existing Government rules andprocedures. Rationale to select FA0 for TA services: FA0 i s the lead technical agency in implementing the Global Strategy for HAP1control and prevention. FA0 will be responsible for providing technical services through a number o f experts (both international & national) for the Project. The keyrationales are as follows: 95 Given the emergency nature o f the project requiring mobilization of consultants (both short-term and long-term) to respond to the demand o f avian flu, it would be very hard for the GOB to identify and contract these consultants from the international market in a timely manner. Given limited capacity within DLS, technical services from FA0will be essential to implement this project; FA0 is maintaining a pool o f consultants (both international and national) with identified qualifications and experience in the region who could be rapidly mobilized. The Crisis Management Centre (CMC) at FA0HQhas been established solely with this purpose to deploy experts within 24-48 hrs inemergency; The selection o f experts inFA0 is highly competitive, based on their qualifications and international experience. As per the established practice, FA0 usually prepares the list o f consultants after thorough evaluation o f the CVs, their areas o f interest and international experience. FA0 identifies national consultants through FA0 Country Representations on a competitive basis; The Emergency Centre for Transboundary Animal Diseases (ECTAD) has been established in FAO, Rome. The Regional Office o f ECTAD has also been established in Bangkok in Thailand in order to quickly respond to avian influenza related emergencies. Rationale to select FA0 for supply of vaccines and diagnostic reagents: Majorjustifications are as follows: (a) There are more than 20 vaccine manufacturers across several countries manufacturing H5 vaccines for poultry; several o f them from China and some South-East Asian countries with uncertain quality assurance. FA0 recommends the use o f specified quality vaccines which are manufactured as per World Animal Health Organization (OIE) guidelines. Some o f the multinational pharmaceutical concerns are producingvery good quality vaccines which havehelpedincontrolling the disease in some o f the countries which sought direct assistance from FAO. As the lead technical agency inanimal health, FA0 has a definite advantage to identify the most suitable vaccine produced as per OIE guidelines for which the country capacity i s limited. Furthermore, FA0 also has its own competitive procedure to select their suppliers; (b) The diagnostic reagents are produced in the Reference Laboratories which respond to the request o f FA0 for the quick supply rather than responding to individual countries. Inmost o f the cases, the air freight charges far exceed the actual cost o f the reagents no matter how large the requirements are. Due to increased demand o f these reagents there i s usually a long waiting list whereas FAO's request is processed on a priority basis since FA0 i s the lead technical agency in implementing the Global Strategy for HAP1control and prevention. FA0 has a streamlined delivery systemwith substantially lower air freight charges. 96 IncrementalOperatingCosts. "Incremental Operating Costs" means: (i)expenditures incurred for the operation and maintenance o f facilities, equipment and vehicles used for Project implementation, including, without limitation, office rental, vehicle rental, hel, routine repair and maintenance of equipment, vehicles and office premises, communication costs, use o f internet costs, stationeries and other office supplies, and costs o f translation, printing, photocopying and advertising; (ii) transportation costs and subsistence allowances for staff in travel status for Project implementation; (iii) bank charges; and (iv) salaries and allowances o f incremental staff assigned for Project implementationbut excluding salaries o fthe Recipient's civil servants. ProcurementandSelectionPlanning The Borrower, at appraisal, developed a Procurement Plan for project implementation which provides the basis for the procurement methods. The Planwill cover the initial 18 months o f the project and will be updated annually covering always the next 18 months o f project implementation. It will also be available in the Project's database and in the Bank's external website. Prior to issuance o f any invitation for bids for procurement o f goods and works and selection o f services, the proposed Plan shall be furnished to the World Bank for its review and approval, in accordance with the provisions o f paragraph 1 o f Appendix 1 to the respective Guidelines. Procurement of goods and works and selection o f all consultants will be undertaken inaccordance withPlansapprovedbytheWorldBank. Use of Standard Bidding and Contract Documents. For ICB procurement o f goods and works, the use o f IDA'S Standard Bidding Documents (SBD) is mandatory. For NCB procurement, DLS may use the Government's Standard BiddingDocuments in form acceptable to the World Bank. For selection o f international consulting firms, the Bank's Standard Request for Proposals (RFP), including standard contract form will be used; for local consultants Government's procedure laid out in the national regulations will apply including its documentation. Depending on the type o f procurement, the Bank's or Government's Standard BidProposal Evaluation Formwill be followed for submission o f evaluationreports. 97 TableA: ProcurementArrangements(US$ Millions)I' Category ICB NCB Other2' N.B.F.3/ Total I I 1. CivilWorks II 0.72 II 0.72 (0.72) (0.72) 2. Goods 5.50 2.75 2.50 10.75 (5.50) (2.75) (2.50) (10.75) 3. ConsultingServices - 0.32 2.06 2.38 (0.32) (0.32) 4. Training,StudiesandWorkshops 1.51 0.94 2.45 (1.51) (1.51) 5. CompensationProgram 2.30 2.30 (1.15) (1.15) 6. Incremental OperatingCost 2.40 2.40 (1-55) (1-55) Total 5.50 3.47 9.03 3.00 21.00 (5.50) (3.47) (7.03) (16.00) I/ Figures inparenthesis are the amounts to be financed by the IDA Credit. All costs include contingencies. 2' Includes (i) goods to be procured through shopping; direct contracting (ii) consulting services to be procured following quality and cost based selection, selection under fixed-budget, least cost selection, single source selection, and individual consultants' methods, and cost o f training, seminar, workshops and other dissemination activities; (iii) Incremental Operating Cost. 3/ N.B.F. Not Bank-financed - Avian Human Influenza Trust Fund (AHITF). The estimated amount o f US$2.999 million is rounded to US$3.00 million. AHITF grant i s expected to be provided intwo tranches. The first tranche i s expected to be for US$2.00 million. PriorReviewThresholds Goods and Works: Duringthe initial 18 months o f the project, the World Bank will carry out prior review o f the following contracts: (i) first contract for goods by each implementingagency using NCB, and thereafter contracts estimated to cost US$ 300,000 equivalent or more, irrespective o f the procedures; (ii) for works- first package/contract usingNCB, andthereafter all contracts estimated to cost US$500,000 equivalent or more, irrespective o f the procedures. After 18 months, the above thresholds will be revieweddefinedredefinedin the revised procurement plan, ifnecessarybut subject to the prior review and "no objection". ConsultantsServices: The World Bank's prior review will be required for consultants' services contracts estimated to cost US$lOO,OOO equivalent or more for firms and US$50,000 equivalent or more for individuals. All single-source contracts will be subject to prior agreement by the World Bank. All TORSo f the consultants are subject to the World Bank's prior review. 98 Table B: Thresholds for Procurement Methods and Prior Review a/ Expenditure Contract Value Procurement Contracts Subject to Prior Category (Threshold) Method Review Works >=us$2,000,000 ICB All contracts. NCB Firstcontractregardlessofvalue inNCBandthereafter, all contractsvaluedUS$500,000 or more Goods >=US$300,000 ICB All contracts =us$200,000 QCBS All contracts. =US$50,000 IC- Qualifications, All contracts references. SectionV ofthe Consultant Guidelines =us$5,000,000 ICB All contracts =US$300,000 ICB All contracts or as indicated in I the procurement plan 100,000 QCBS All contracts. US$50,000 per Individual All contracts contract Consultant Selective contracts FBS Prior agreement Selective contracts LCS Prior agreement andmeetingthe requirementsof 3.6 and inaccordance with 3.1 & 3.6 of Consultant Guidelines Selective contracts sss Prior agreement andmeetingthe Ifnot, allcontracts requirementsof3.9 to 3.13 of the Consultant guidelines 108 Detailsof the ProcurementArrangement: (1) Goods andWorks. List o f contract packages to be procured following ICB anddirect contracting: Ref. No. Contract Estimated Number Procure- Domestic Review Expected Description cost of ment Preference byBank Bid- (US$ 000) Contracts Method (yesho) (Prior/Post) Opening Date 1 2 3 4 5 6 7 8 AVG-1 Personal 200 1 ICB N o Prior December Protective 2007 Equipment (PPE) sets AVG-2 Antiviral doses 1900 ICB N o Prior December, Oseltamivir 2007 capsules and suspensions) AVG-3 Other 625 ICB N o Medication (Antibiotics, Antipyretics, Cough suppressant and Hydro-cortisone) + AVG-4 Seasonal 340 1 ICB N o Prior December Influenza Vaccine doses AVG-5 Hygienic and 105 N C B N o disinfection Supplies -. Hypochlorite AVG-6 Hygienic and 210 N C B N o disinfection Supplies - Absolute Alcohol AVG-7 Hygienic and 80 NCB N o December disinfection Supplies - Detergent i"- AVG-8 Equipments for 45 NCB N o =-tG- December Eighteen (18) Sentinel -surveillancesites IT AVG-9 National 160 NCB N o March2008 Surveillance System- IT related support equipments. AVG-10 VEHICLE 8 nos 320 ICB N o 109 iVG-11 3quipment for 11 I NS No Post September Zentral 2007 ;urveillance site itIEDCR 4VG-12 Swabs for 77 NS No Post August specimen 2007 .. :ollection for RRT(Rapid response Team support) 4VG-13 Vaccum tubes for 37 NS No Post September RRT 2007 4VG-14 supplies for RRT 1 NS No Post September ~ 5 2007 4VG-15 Diagnostic kits 65 NS No Post September (For Influenza 2007 A/B) (1 kit =20 sets) 4VG-16 Improving 250 ICB No Prior December diagnostic 2007 Laboratory capacity - Equipmentfor IEDCR AVG-17 Improving 60 NCB N o Post December diagnostic 2007 Laboratory capacity - . Materials and consumable for IEDCR AVG-18 HealthCare 650 ICB N o Prior January facilities upgrade 2008 Equipments AVG-19 Prefabricated 800 1 D C N o Prior October BSL -3 lab at 2007 IEDCR AVW-1 Health Care 975 1 ICB N o Prior March facilities upgrade 2008 - Renovation Works AVW-2 Extension o freal 260 1 NCB N o Post January Time PCR 2008 laboratory at IEDCR AVW-3 Civil Works 14 1 NCB N o Post October Maintenance at 2007 IEDCR 110 (2) ConsultingServices Ref. No. Descriptionof Estimated Number of Selection Review Expected Assignment cost Contracts Method g/ (us$ooo.) by Bank Proposals (PriorPost) Submission Date 1 2 3 4 5 6 7 AVS-1* International& 300 1 sss Yes IDecember national Technical I Assistance 2007 * ThroughWHO. 111 Bangladesh Avian Influenza Preparedness and ResponseProject Annex 7: FinancialManagementandDisbursementArrangements ExecutiveSummary: The Government o f Bangladesh (GOB) has prepared a National Avian Influenza and Human Pandemic Influenza Preparedness Plan and Response Plan (NAIP) that provides the overall framework and prescribes interventions by concerned ministries to prevent, contain, and respond to AI outbreaks. The proposed Avian Influenza Program will be implemented through a new project (a) Avian InfluenzaPreparedness and ResponseProject (AIPRP), anda separate (b) Avian Influenza (AI) component o f the on-going Health Nutrition and Population Sector Program (HNPSP). Three components o f the AIPRP (i) Animal Health, (ii) Awareness and Information, and Public (iii)Implementation Support and Monitoring & Evaluation will be implemented by the Ministry o f Fisheries and Livestock (MOFL) through the Department o f Livestock Services (DLS). The AI component, under the HNPSP, will be implemented by the Ministry of Health and Family Welfare (MOHFW) through the LineDirectorate-CommunicableDisease (LD-CD). Under the AIPRP, the compensation program will compensate the affected poultry farmers for the culled birds. DLS has preparedpreliminary operational guidelines and eligibility criteria for accessing and managing the compensation program. To ensure appropriate controls and disbursements from the compensation program, project activities include extensive training, workshops and awareness programs, and extensive oversight. Disbursement o f IDA funds for the compensation program will be contingent upon GOB'Sapproval o f Compensation guidelines andprocedures for the compensation program. A key strength is the high level o f Government commitment for project implementation which i s evident from the formation o f a core project implementation team and various committees to monitor and supervise AI activities. A key weakness is the lack o f qualified staff to handle the financial management activities within DLS, the primary executing agency. Another weakness is inadequate exposure o f DLS staff for managing large contracts as well as financial management activities under the development budget. To address these weaknesses, the project will support extensive capacity building efforts for the core project staff as well as relevant DLS staff. Before mitigation, the overall FM risk i s rated as "Substantial" due to: (i)weak implementation capacity o f DLS, (ii) staff inexperience in implementing donor-funded projects, (iii) ofapprovedoperationalguidelinesforthecompensationprogram,and(iv) inadequate lack internal control systems. Because DLS and MOFL have agreed to the mitigation measures outlined below, the residual FMrisk i s rated as "Modest." 112 The consolidated project financial statements will be prepared by DLS and audited by the Comptroller and Auditor General (C&AG). In addition to an annual external audit, as an additional internal control measure, an annual operational review will be carried out by an independent private firm subject to TORSand selection processes acceptable to the World Bank. This will include a review o f internal controls, project operational framework, and procedures, particularly for the compensation program and the inventory o f drugs, vaccines, medical and veterinary equipment, andother high-value assetsprocuredunder the project. As part o f an enhanced focus to identify and minimize the risk o f leakage or misuse o f project funds, a risk migration table denoting expenditure eligibility and indicators o f fraud, corruption, collusion, and coercion is beingprepared and will be agreed during implementation. This tool will serve as a basis for any investigationthat might result from internal audit external audit, or operational reviewreports. To the extent possible, the project will follow the government budgeting, accounting, and reporting system. Transaction-based disbursement procedures will be used for withdrawal o f funds from the credit andAHITF grant. FMarrangementsfor the AI componentof HNPSPwill follow the FMarrangementsalready inplace for HNPSP. The US$21 million AIPRP aims to minimize the threat posed to poultry and humans by AI infection and other zoonoses by assisting the Government o f Bangladesh to identify, control andrespond to avian influenzapandemic andrelated emergencies. The project will be financed by IDA, under an Adaptable Program Loan (APL) for the Bank's Global Program for Avian Influenza (GPAI), Avian Human Influenza Trust Fund (AHITF), and the GOB. The project consists o f three components: (i)AnimalHealth, (ii) Awareness and Information, and (iii) Public Implementation Support andMonitoring & Evaluation. Over the years, there have been many initiatives to improve overall country financial management in Bangladesh. However, due to the fragmented approach to Public Financial Management (PFM) reforms there has been uneven improvement across the PFM system and government agencies and institutions. Various diagnostic studies report that piece-meal technical assistance driven by donors neither helped the Government to reap the full benefit o f reforms nor sustained the capacity developed. Country institutions are still not sufficiently developed to manage public resources and undertake project implementation effectively. Despite the weak overall country financial management environment, fiduciary risk in donor- fundedprojects has been greatly minimised due to the government policy stipulating additional implementation arrangements inthose projects. The AIPRP will be implemented by DLS, under the MOFL. With increasing reliance on country systems and the shift toward using the existing PFM structure, systems, and policies, the AIPRP will be implementedbythe line agency. A Project Coordination Unit (PCU) will be created in DLS with existing staff reassigned to oversee project implementation. Additional support will be provided by consultants to strengthenthe PCUbecauseDLS currently has no experience inmanagingBank-fundedprojects. 113 Governance Framework The GOB, with assistance from the World Health Organization (WHO) andthe Food and Agriculture Organization (FAO) has prepared a National Avian Influenza and Human Pandemic Influenza Preparedness and Response Plan (NAP). This plan provides specific strategies, institutional arrangements, and activities to be undertaken by concerned ministries to prevent, contain, and respond to AI outbreaks. A National Advisory Committee WAC) comprised o f the ministerso f the participating ministries is the apex coordinating body for implementationo f the Plan. Inaddition, Intra-MinisterialNationalTechnicalCommittees arebeingestablishedwithin the three main participating ministries (MOFL, MOHFW, and the Ministry o f Environment and Forest) to facilitate implementationo f the Plan. The MOFL and MOHFW have been designated to implement the GOB Planwith appropriate support from other agencies, including the Ministry o f Environment and Forest and the Ministry o f Information (MOI). The Animal Health, Public Awareness and Information, and Implementation Support and Monitoring & Evaluation project components will be implemented by M O F L through DLS. A Project Coordination Unit (PCU) within DLS will be responsible for overall administration, communication, procurement, financial management, safeguards, reporting and M&E o f the project. The HumanHealth component will be implemented by MOHFW through LD-CD. The Director General Health Services (DGHS) will be the operational focal point for interfacingwith the implementation team o fthe Animal Health component. The AIPRJ?will finance aprogram to compensate the affected poultry farmers for culling infected birds. To effectively manage the compensation program, DLS i s in the process o f preparing operational guidelines which will outline the process, eligibility criteria, and operational modality for accessing the compensation program. To ensure efficient and transparent management o f the compensation program, operational guidelines should include following minimum elements: (i)legal basis for establishing responsibilities for compensation program administration, (ii) financial need assessment, (iii) information on sources o f hnds and likely amounts from each source and mobilizing needed financing, (iv) identification o f the payment agencies to get the funds to the beneficiaries, (v) payment instruction (cash, bank transfer), (vi) basis o f payment (certification), (vii) time frame for payment, (viii) monitoring disbursement, (ix) operational and financial audits, and (x) social accountability mechanisms. Bank's clearance o f compensation program will be contingent upon incorporation of the above provisions. To ensure appropriate controls in poultry culling and use o f the compensation program, project activities include extensive training, workshops, awareness programs, and oversight. This will include specific actions viz (i) enhanced disclosure and transparency o f project related information i.e. after culling a list o f recipient farmers per village, including the amounts to be compensated will be disclosed in public space, and (ii)mechanism to handle complaints on a misuse of funds, especially for the compensation program. 114 Inaddition to an annual external audit, an annual operational review, including internal audit, will be carried out by anindependent private firm, subject to TORSand selection processes acceptable to the Bank. The terms of reference for the operational reviews should focus on confirming the legitimacy o f compensation payments made from a randomly selected sample o f villages As part o f an enhanced focus to reduce opportunities for misuse or misdirect project finds, an additional control framework outlining major expenditure eligibility and indicators o f fraud, corruption, collusion, and coercion will be prepared. Agreement has been reached with DLS for ensuring that this framework serves as a basis for any investigation that might be necessary as a result o f reported ineligible expenditures or indications of malpractice in external audit or annual operational review reports. Role of UN Agencies. Given the emergency nature o f avian influenza, weak institutional capacity o f DLS (and MOFL), generally long procurement process, and the need for highly specialized technical assistance, FA0 will be contracted to provide necessary technical services, PPE, vaccines, and reagents to expedite implementation o f the AIPRP. DLS has provided justification to the Bank for sole source selection o f FAO. Risk Analysis and Mitigation Before mitigation, the overall FM risk is rated as "Substantial". This is mainly due to weak implementation capacity o f the DLS staff not having experience in donor-funded projects, unapproved operational guidelines for the compensation program, and inadequate internal and external oversight. MOFL will have necessary guidance from the Ministry of Finance for policy and operational guidelines to be followed for the compensation program. An annual operational review will be carried out by an independent firm. Selection o fthe private firm will be subject to Bank clearance. The review will cover the internal control framework and procedures, particularly for the compensation program and the inventory o f drugs, vaccines, medical and veterinary equipment, and other highvalue assets. An additional control framework outlining major expenditure eligibility andindicators o f fraud, corruption, collusion, and coercionwill be prepared. Agreement has been be reachedwith DLS for ensuring that the framework serves as a basis for any investigation that might be necessary as a result o f ineligible expenditures or indicators from internal audit, external audit, or annual operational review. Subject to satisfactory implementation o f the following mitigation measures, the residual FMrisk i s rated as "Modest." 115 Risk [nitial RiskMitigation FMRisk Condition FMRisk After Rating Mitigation Inherent Risk Country Level H H P F M institutions and system lack A core team inD L S has capacity for detecting financial been established. Two irregularities ina timely manner, finance staff are being including taking corrective assigned full time. actions. Extensive training plan i s being prepared. EntityLevel (i) institutionalcapacity Weak S M The Minutes of might hinder project Negotiations implementation, especially inthe include provision short-term inD L S for FMstaff throughout project implementation. (ii) FMstaffinDLS Existing S Extensive staff training i s M have no exposure to Bank- being planned. funded projects and are not conversant with government rules Control Risk InternalControls: S Operational guidelines for S Disbursement o f Risk for misuse o f compensation compensation program are IDA funds for the program due to absence o f being developed which compensation operational guidelines and will include key elements program eligibility criteria stated ingovernance framework section and dissemination workshops are being planned Internal Control and Internal S Anoperational review M Audit: covering the internal Weak internal controls and weak control framework, finds internal audit might not prevent flow, and inventory will be improper use o f project finds conducted by an independent private fm under the World Bank- approved TOR. FinancialReporting: M Government and the World M Formats and With multiple implementing Bank will agree on a contents were agencies, project reports might customized report format discussed during be incomplete and delayed Negotiations and BLRI, the Ministry o f copy was attached Environment and Forest to the Minutes o f and the Ministry o f Negotiations Information will provide monthly statements o f accounts to D L S Residual FMRisk Rating S M 116 Strengths The project has the following strengths: (i) solid preparation in the form o f NAP, (ii) high-level Government commitment indicated by the formation o f a core project implementation team and various committees to monitor and supervise AI activities, and (iii) up front agreement on a number o f FM actions for ensuring adequate FM arrangement at project start up. These strengths will help to ensure smooth implementation o fthe project. Weaknessesand Action Plan One key weakness i s the lack o f qualified staff to handle financial management activities for the components to be implemented by DLS. Another related weakness i s the lack o f experience in managing large contracts as well as other financial management activities under the government's development budget. Significant Action Responsible Completion Weaknesses Date Weak staff capacity in DLS Identify and approve core team for DLS June 2007 for project management PCU/DLS DLS staff lack experience Training on disbursements, MOFL and Withinone inmanaginglarge contracts financial management, and wF3 montho fproject procurement will be developed and effectiveness delivered It has been agreed that the project will provide sufficient resources for capacity building o f the project staff which includes training on disbursement, financial management and procurement. The training will beconducted inclose collaboration with the Bank. Adequacy of Financial Management Arrangements Departmentt o f Livestock Services (DLS), a separate department under the MOFL, will be implementing a Bank-financed project for the first time under the overall supervision and control o f the Director General. DLS follows the government's financial management system; this includes planning, budgeting, accounting, internal controls, internal audit, reporting, and external audit. Due to simplification in the Bank's disbursement procedures that includes agreement on country financing parameters, project accounting ledgers will be maintained as per the country system. DLS will maintain separate books and accounts to monitor the expenses against project components and activities. In the DLS Administration unit, the Accounts and Budget Deputy Director is assisted by one Assistant Director and one Accounts Officer and six other support staff. In addition to implementing three components, DLS faces a major challenge to coordinate and report on project activities. To fhlfill this need, DLS has agreed to designate two full-time accountants who will work under the overall guidance and supervision o f the Project Director. The two FM staff will work with the core implementation team in the PCU. The team 117 will be assisted by the national and international experts who will provide technical support for project implementation. In collaboration with the Bank, DLS will provide disbursement, financial management, andprocurement training to its core project management staff. Provided that the operational guidelines for the compensation program are finalized and approved, the Operational Manual will include project expenditure eligibility criteria and remedies. After designated finance staff are on board and trained, FM arrangements for the components will be adequate for project implementation. To facilitate implementation o f the three components under the AIPRP, DLS will prepare its Annual Work Program and Budget for approval by the Project Steering Committee (PSC). The project will fully align with the government's treasury and budget management system. Programming and budgeting o f the project will follow GOB'S budgeting system which authorizes project expenditure under the approved Annual Development Plan. Project Financial Accounting and Internal Controls The financial accountingpolicies andprocedures inplace are sufficient to ensure that the DLS comply with minimum financial management requirements and maintain proper accounts for their respective project components. These include complying with internal controls and maintaining proper accounting procedures. The accounting systems will include: (i) application o f consistent cash accounting principles for documenting, recording, and reporting financial transactions; (ii)use of existing chart o f accounts that enables timely summarization of financial transactions for financial reporting purposes; (iii) use o f an asset register; and (iv) monthly closing and reconciliation o f accounts and statements. DLS will follow existing financial authority and payment responsibilities outlined in the Project Accounting Manual of the MOF. Because there is currently no computerized system inDLS, books o f accounts for the project will be initially maintained on a manual system. Within two years o f project implementation, DLS will switch over to a computerizedsystemwith support from the project. Internal Audit DLS follow the government system where Internal Auditors are responsible for carrying out internal audits o f various cost centers under respective Departments. But because the government's internal audit systemi s somewhat weak andreports are not timely available, DLS will undergo an additional annual operational review conducted by an independent private firm to cover internal controls over expenditures under the new AIPRP. Inclose consultation with the World Bank, an appropriate TOR for this review, including internal audit functions, will be prepared by June 30,2007. Financial Reporting and Monitoringfor all Components The PCU inthe DLS will be responsible for preparinginterim financial reports (IFRs) in a format to be agreed duringnegotiations. The IFRswill show all sources andusage o f funds and fundutilizationby each o fthe three components o fthe project. 118 After disbursements begin, required quarterly interim project reports will show: (i) sources and uses o f funds by disbursement category; and (ii)usages o f funds by project components after expenditures, consolidated based on governmental head o f accounts, compared with budget. The Government and the World Bank have agreed on a customized report format duringNegotiations, which is attachedto the Minutes o fNegotiations. External Audit The consolidated project financial statements preparedby the DLS will be audited by the C&AG. The C&AG i s considered to be an independent auditor acceptable to the Bank. Annual project audit reports will be submitted to the Bank within six months o f the end o f each fiscal year. The following audit reports will be monitored in the Audit Report Compliance System (ARCS). ImplementingAgency Audit Auditors Date DLS Project Financial C & A G 31 December o f Statements each fiscal year Fund Flow and Disbursement Arrangements For utilization o f IDA'Sshare o f eligible expenditure and AHITF grant, DLS will maintain two sepearte designated accounts (DA) (one for IDAportion and the other for the AHITF) under terms and conditions acceptable to IDA. The designated Project Director in DLS will be the authorizedperson for issuingchecks or payment advice and submittingreplenishment requests to IDA. For the program activities to be executed by the Bangladesh Livestock Research Institute (BLRI), the Ministryo f Environment andForest andMOI, the PCUwill disburse funds to these agencies against approved budget, work plan, or contractual agreement. The implementing agencies will provide monthly statements o f accounts to the PCU on the usage o f project funds. No hnds will be disbursed unless a proper fund utilization statement is submittedto the PCU. Withdrawal applications to the Bank will include actual expenditures accounted for in PCU books, not on the basis of funds disbursed to these agencies. Expenditures related to international and national consultants under the Technical Assistance part o f training expenditures will be financed from the AHITF grant as well as local payments to support these activities. The project i s likely to have access to about US $ 3m inthe AHITF. An agreement to this effect, outlining expenditure eligibility to draw funds from AHITF, will be completed after the grant is approved. The designated account for AHITF, will be used for eligible expenditures outlined in the agreement. To ensure appropriate control in using expenditures from IDA as well as AHITF, it has been agreed that IDA allocation will be utilized only after AHITF grant for a particular category i s exhausted. Transaction-based disbursement procedures will be applicable for withdrawal o f funds from IDA and AHITF. Disbursement under the project will be made as indicated in the table 119 below which indicates the percentage o f financing for different categories o f expenditureso f the project. It i s expected that IDA funds will be disbursed over a period o f five years. ExpenditureCategory Total IDA GOB AHITF Financing Percentage CivilWorks 0.72 0.72 100 Goods 10.75 10.75 100 2.38 0.32 2.06 100 Training, Studies and 2.45 1.51 0.94 100 ~~~~~ Workshops Compensation Program 2.30 1.15 1.15 50 Incremental Operating cost 2.40 1.55 0.85 65 Total Project Costs 21.00 16.00 2.00* 3.00** ** * Does not include in-kindcontribution. Estimated amount of US$2.999 million i s rounded to US$3.00 million. AHITF grant i s expected to be provided in two tranches. The first tranche i s expected to be for US$2.00 million. Hundred percentage (100%) for withdrawal for four (4) expenditure categories from the allocation o f above credit and grant proceeds i s combinedtogether and shown as one category in the FinancingAgreement, makingtotal disbursement categories three (3) for the project. Use of Statement of Expenditures (SOEs) The World Bank will require full documentation for all prior-review cases where contracts exceed the equivalent of: (a) US$300,000 for goods and US$500,000 works; (b) US$lOO,OOO for services with firms; and (c) US$50,000 for individuals. Expenditures below the above threshold and all expenditures under operating costs and training, studies and workshops will be claimed on SOEs. During the initial supervision by the World Bank, the team will review the SOE claims to ensure that funds are utilized for the intendedpurposes. Any deviation noticed during such reviews will benoted for remedyand improvements. Designated Accounts There will be two Dollar Special Accounts (DOSA) under AIPRP, one for the IDA portion and the other for AHITF. The ceiling o f Designated Accounts will be limited to 3-4 months estimated expenditure o f IDA and AHITF shares o f the project and will be documented inthe Disbursement Letters. Minimum Application Size: The minimum application size for direct payment to supplier or contractor from the Credit account or for issuance o f Special Commitment i s US$200,000. 120 Financial Management Action Plan An action plan, that summarizes required activities and timelines to help ensure that adequate Financial Management practices are in place during project implementation, i s presented below. Action Responsibility Completiondate Conditions 1. Finalize TOR for annual DLS June 30,2007 The Minuteso f operational review Negotiations include aaeed date 2. Finalize interim report DLS April 30,2007 formats (Done) 3. Identify and designate DLS June 30,2007 The Minuteso f FM staff into core team in Negotiations includes PCUIDLS staffDrovision 4. Draft agreement ERDIWB FAincludes outlining eligibility to Effectiveness draw funds from AHITF, Condition. including payment modality o fUNcontracts (AHITF from special account) 5. Develop additional DLSIWB June 30,2007 control framework outlining major expenditure eligibility and indicators o f fraud, corruption, collusion, and coercion 6. Finalize Operational DLS & MOFL October 31,2007 Disbursement Guidelinesfor accessing Condition for Compensation Program. withdrawal o f funds from compensation category 7. Provide orientation and DLS Within one month o f training on disbursements, credit effcetiveness financial management, and procurement to DLS project staff and all new recruits 8. Maintainproject DLS June 30,2008 accounts usingM O F develoDed software 121 Retroactive Financing Retroactive financing, not exceeding 20% o f the credit amount, will be available to reimburse DLS for procurement o f emergency goods and services; a preliminary list o f itemshas been agreed with DLS. It has been agreed that the Bankwill reimburse from the proceeds o f the credit only for payments for eligible expenditures incurred within four months before the expected date o f credit signing, as long as the government complies with the Bank's procurement andFMguidelines. Supervision Plan The initial supervision will focus on compliance with all agreed actions, terms, and conditions. Particular attentionwill bepaid to the compensation program to help ensure that only eligible farmers are paid and that proof o f infected birds culling i s provided and certified. In addition, supervision efforts will focus on samplingexpenditures below prior-review thresholds, reviewing payment processes against the defined control framework, and monitoring the progress of institutional preparedness and strengthening. Adequacy of Financial Management Arrangements for Avian Influenza component (AI) of HNPSP: Currently, the Line Director - Communicable diseases (LD-CD) is implementing the Communicable Disease Operational Plan under the health sector-wide program, HNPSP, financedjointly by IDA and bi-lateral donors under pooled funding. The humanhealth activities o f the avian flu program will be treated as one o f the sub-components o f the Communicable Disease Operational Plan o f the on-going HNPSP and activities covering humanhealth will be included inthe Communicable Disease Operational Plan for government approval. The LD-CD currently provides timely Statements o f Expenditure (SOEs) to MOHFW and fully accounts for all expenditures under HNPSP. The HNPSP follows existing country financial management systems for planning, budgeting, accounting, reporting, internal control, internal audit, and external audit. Audit Reports o f HNPSP have been received timely. Audit o f HNPSP has been conducted, as per agreed TOR. Accurate FMRs have been received based on which IDA made first disbursement o fpool donors share o f eligible expenditure. TOR for periodic internal audit byprivate audit firm has been cleared. Existing FM weaknesses as well as capacity building activities are being addressed through DFID assisted TA. LD-CD has experience in implementing HNPSP using government systems, its own structure, and staff so the human health activities will be implemented usingthe same implementation arrangements. LD-CD h c t i o n s under the overall supervision and management o f the Director General Health Services. The Finance Unit i s comprised of: one Finance Manager, four Accounts Officers, andtwo computer operators. Support from the finance team will be available to the LD- C D also for implementation o f the Avian Flu activities for human health under HNPSP and maintaining liaison with DLS. At project start up, core staff responsible for implementing the AI Component for human health will undergo training to help orient the LD-CD and the relevant 122 finance staff with a clear understanding about the new AIPRP project and its reporting obligations. Overall, the systems and procedures in LD-CD satisfy the Bank's minimum financial management requirements; the FM arrangements for the AI Component o f HNPSP for human health are adequate for project implementation. Budgeting,Fundflow, AccountingandReporting: The LD-CD will include annual budget for implementing the AI Component into the Communicable Disease Operational Plan under the HNPSP. Expenditures related to the AI Component o f US$16m will be financed under the ongoing HNPSP that follows existing treasury and government financial rules for fund management. Under HNPSP, the World Bank manages pool funds, o f which 40% i s IDA share. The AI Component will include both IDA and other pool donors finance which i s disbursed through a Forex Account maintained with Bangladesh Bank. As LD-CD, which already maintains a computerized system, the accounts will be merged with other components o f HNPSP. To help DLS in preparing consolidated project reports, LD-CD will provide quarterly SOE and quarterlyprogress reports to the PCU in DLS. Role of WHO: Given the emergency nature o f avian influenza and the need for highly specialized technical assistance, WHO (UNagency) will be contracted (on sole source basis) to provide necessary technical services, PPE, vaccines, and reagents to expedite implementation o f the AI Component o f HNPSP. Internal Audit: LD-CD activities relatedto AIwill be covered underthe internal audit ofHNPSP. Bank has cleared the TOR for the audit which will be conducted by an independent private firm. External Audit: The AI Component o fthe HNPSPwill be covered underthe existing audit o f HNPSPwhich i s conducted by the C&AG. Necessary documents related to legal amendments o fthe new AI Component o f HNPSP will be given to the auditor. 123 Bangladesh Avian Influenza Preparedness and Response Project Annex 8: Environmentaland Social Safeguards 1. The Highly Pathogenic Avian Influenza (HPAI) strain o f virus (H5N1) was first identified in South East Asia in 2003 and since then it has spread widely inAsia and to parts of the World, including Europe and Africa. Bangladesh is a high risk country as far as Highly Pathogenic Avian Influenza (HPAI), especially the H5N1 strain, i s concerned. Some 50 % o fthe national poultry flock (a total o f about 185 million) i s backyard poultry, with minimal bio- security. It has a large duck population (37 million). Bangladesh i s visited annually by 224 species o f migratory birds in the winter months; 21 o f the migratory birds species are known to carry the H5N1 virus. Traditionally, it has imported a large number o f day old chicks (DOCS) and it has porous borders with neighboring countries (India and Myanmar) that have had outbreaks. Bangladesh experienced H5N1 outbreaks from Februaryto M a y 2007. The problem i s not yet over. 2. However, in response to concerns about HPAI, the Government o f Bangladesh (GOB), with assistance from the WHO and the FAO, has prepared a National Avian Influenza and Human Pandemic Influenza Preparedness and Response Plan (NAP). This Plan, which conforms to the general standards for such plans set by FAO, WHO, and OIE, provides for specific strategies, institutional arrangements, and activities to be undertaken by concerned ministries to prepare for, prevent, contain and respond to HPAIoutbreaks inpoultry andhumans. It also identifies the additional facilities and staff training needed to implement the Plan. The NAP was approved by the Prime Ministers Office in mid-April 2006. GOB has sought IDA assistance in implementing the NAP through an Avian Influenza Preparedness and Response Project. The overall project development objective i s to minimize the threat posed to poultry and humans by H P A I infection and other zoonoses by assisting the Government o f Bangladesh prepare for, control, and respond to avian influenza pandemics and related emergencies. To achieve this, three areas are considered for support: (i)prevention, (ii)preparedness and planning, and (iii) response and containment. 3. Considering the type o f interventions proposed under the Project and the nature and magnitude o f potential environmental impacts, this Project has been assigned environmental safeguard classification o f a Category B Project. Activities under the proposed Project are expected to cause limited adverse environmental effects, since most activities o f the Project are considered to support preventive measures. The Project, due to its prevention focused nature, will generally have positive environmental and social impacts as the project's investments in facilities, equipment, laboratories, and training will improve the effectiveness and safety o f existing avian influenza handling and testing procedures. This would be reinforced by mainstreaming environmental safeguards into the protocols and procedures for the culling and disposal o f animals during AI outbreaks, decontamination o f production facilities, and laboratories. Most o f the key potential impacts will be avoided or minimized by integrating 124 environmental and public health safety aspects in the preparatioddesign and implementation o f the project activities. 4. Though no social safeguard policy is triggered by the Project, the Project i s designed to mitigate the negative impacts o f mandated culling o f poultry on small-scale backyard poultry producers. A compensation program under the Project will pay producers roughly 75% (or any other payment planagreed by GOB under the Compensation Policy) o f the market value o f their culled poultry. The Project will have significant positive social impact by protection of human lives through HPAI early warning, prevention andcontainment, improved poultry farming practices, increased public awareness o f HPAI and improved hygiene and food preparation practices andwaste management. 5. The mainrisks o f adverse environmental impacts canbe grouped into three categories: (i) Inadvertent human exposure and spread o f the virus due to improper culling and disposal o f dead birds (wild birds, sick and dead birds from backyard and commercial poultry farms); lack of, or improper use of, personal protection equipment (PPE); improper disposal o f farm waste (Le., bedding, manure, washings, etc. during andor after an outbreak); and inadequate lab bio-safety protocols. (ii) Inadvertent release of chemicals in the environment from unsatisfactory decontamination procedures (for personnel, poultry sheds, and transport vehicles, etc.). (iii) Release o f chemicals and infectious agents into the environment from inadequate laboratory and medical facility waste management. 6. The potential adverse environmental impacts identified above will be mitigated by integrating environmental and public safety aspects inall stages o f the project. The Government has prepared guidelines for safe culling, transport and safe disposal o f carcasses. An Environmental and Social Safeguards Management Framework (ESSMF) and an Environmental Management Plan (EMP) that outlines the measures proposed to address all potential adverse environmental and social impacts has been prepared and will serve as a guide to ensure that the Project will not result inany potential indirect andor long term impacts. The preparation o f the guidelines has involved an evaluation o f suitable alternatives for safe culling, transport and particularly for safe disposal o f carcasses. The Project will finance the implementation o f the selected alternatives, according to the EMP. 7. The ESSMF outlines the procedures and steps to be taken to assess and mitigate the environmental and social impacts arising from the project. Inadvertent humanexposure and the spread o f the virus will be minimized by strictly adhering to the guidelines prepared for safe culling, transport and disposal o f dead birds. The guidelines include the proper use o f personal protective equipment, proper disposal o f farm waste and proper bio-safety protocols. Guidelines in the EMP contain procedures to ensure that proper decontamination procedures are followed. Guidelines need to be prepared to deal with waste arising from laboratory and health facilities associated with AI so that waste disposal is in keeping with internally accepted standards and norms. If the borrower does not have adequate technical expertise to prepare the above mentioned guidelines, the Project will provide technical assistance to the borrower to achieve the 125 above. The borrower however, has adequate capacity to adhere to and implement the guidelines prepared under the project andbe able to implement the ESSMF andEMP infull. 8. There are no social safeguards triggered by the project because there will be no land acquisition, voluntary or involuntary, therefore there would be no displacement o fpeople. Ifany land is required, either temporarily or permanently, for burial pits for mass disposal o f dead birds, or for construction o f incinerators or for open burning o f carcasses, or for the construction o f laboratories andor other medical or veterinary facilities, such land will be provided by the Government. Such lands will be free o f squatters or other encumbrances. GOB i s developing operational guidelines for compensation policy to compensate affected farmers for culled infected birds. 9. The EMP has specific guidelines for handlingand disposal o f infected carcasses, excreta and waste (eggs, manure and feathers) with guidelines for disposal facilities. The EMP outlines procedures for disinfection, hazardous material (HazMat) workspace arrangements, worker health and safety and decontamination for animal containment, depopulation and wastes generated from HPAI outbreaks. However, it i s important to note that the EMP shall be further revised and updated with the evolving situation and conditions in the country with regard to AI even duringthe implementationperiod o f the project to reflect new procedures for treatment and disposal o fwastes inthe event o f future outbreaks. Inthe event that the EMPneeds revising, the project will follow the initial EMP and the operating procedures to manage and monitor potential negative impacts o f the disposal o f carcasses, excreta, litter, contaminated soils, disposal equipment in accordance with the advice o f a Technical Specialist in the Project Coordination Unit (PCU). These provisions will be included inthe Operational Manual (OM) as Guidance Notes. Any changes inthe EMPwill be done with IDA concurrence. 10. The project will finance activities to prevent spreading o f H5N1, surveillance indomestic poultry as well as inwild birds which will be strengthened in the country as Bangladesh has 21 species o fmigratory birdsvisiting annually that are known to carry H5N1 as well as a large duck population (37 million). Resources will be focused on the reduction o f close contacts between humans, domestic poultry andwildlife through better management practices and improved bio- security practices inpoultry production enterprises, especially those that are small and 'open-air', where domestic poultry and waterfowl are allowed to minglewith wild birds. 11. The control o f avian influenzainfection in wild bird populations, at this stage, is not feasible from a logistical, environmental andbiodiversity point o f view. Indiscriminate culling o f wild migratory birdpopulations would be ineffective in preventing further spread o f avian influenza andtheir huntingwould likely cause dispersion o fthe birds. 12. The investments in laboratory facilities, equipment and staff training will improve effectiveness and safety o f avian influenza handling and testing procedures by meeting international standards established by OIE. GOB'S handlingo f medical waste generated inhealthcare facilities are weak at best. Proper procedures haveto beinplace so that it couldbe used for management o f health care waste arising from an H5N1 outbreak. In order to address this, a Health Care Waste Management Plan already exists under the HNPSP and this will form the basis o f environmental management for avian influenza activities as well (no separate EMP will therefore beprepared for the avian influenzacomponent ofHNPSP). 126 Bangladesh Avian Influenza PreparednessandResponseProject Annex 9: Economicand FinancialAnalyses A. Introduction 1. This annex presents the results o f economic analyses o f the proposed Avian hfluenza Preparedness and Response Project (AIPRP) and the Avian Influenza (AI) component o f the on- going Health, Nutrition and Population Sector Program (HNPSP). The analyses examine economic impacts o f AI interms of costs incurred without the AIPRP and the AI component o f HNPSP and economic impacts o fAI interms o fbenefits and costs incurred with the AIPRP and the AI component ofHNPSP. B. Background 2. Outbreaks o f the H5N1 strain o f AI in birds have now been registered in more than 55 countries around the world (including Bangladesh), spreading from what was initially (in late 2003) an East Asian phenomenon. This has been accompanied by an increase in human cases from 144 in the period from 2003 until end 2005 to 86 in the first six months o f 2006l. Moreover, the virus has been extremely deadly on those infected with an estimated death rate o f 57% o f all humancases detectedsince 2003. 3. The mainglobal concern, interms o f economic impacts o fAI, relates to the possibility o f a future human pandemic through human-to-human transmission o f the H5N1 virus. To date transmissions have beenbird-to-bird with some cases o fbird-to-human transmissions. The main economic impact has been on poultry andrelated sectors, particularly inSouth East Asia. 4. Empirical evidence on the economic impacts o f AI points to two important conclusions. First, the overall impact on national GDP and GDP growth i s rather small (most countries affected in Asia continued to grow at approximately the same pace'). The reason for this is that the poultry sector accounts, on average, for only a very small share o f GDP (normally ina range o f slightly below 1%to a little over 2% o f GDP) and even a large drop insector output (e.g. 20% inVietnam) would result in a small overall effect. Second, evidence seems to suggest that the impact o f AI can actually be quite significant for certain segments of the population and for specific regions in a country. For example, despite less than 1% o f the national poultry population being affected by AI, commercial poultry producers in the capital o f Lao PDR seem to have lost as much as 40% o f their layer flock due to deaths and culling3. 1 WHO, July 14, 2006. These figures need to be considered cautiously since surveillance o f HPNl has also improved over the last few years, thereby leading possibly to more detected cases. With the exception ofThailand, which i s a large net exporter ofpoultry. 3 Rushton, J. et al. "Impact o f avian influenza outbreaks in the poultry sectors o f five South East Asian countries", FAO, 2005. 127 5. The probability o f a future humanpandemic i s difficult to assess, as i s the nature and severity o f the disease in the event of a future human pandemic through human-to-human transmissions. Most infection and death scenarios have been established through simulation models based on pre-defined probability distributions for key variables based on historical data. Data has been drawn from the Spanish flu (1918-19), the Asian flu o f 1957 and the Hong Kong flu of 1968-69. Some of the economic models have also used inputs and data available from the SARS outbreak in Asia. In an attempt to illustrate the order o f magnitude o f a possible human pandemic, the World Bank Prospects Group estimated a decline in world GDP in the range o f 0.7% and 4.8% o f GDP'. Moreover, the impact would be greater in developing countries (between 0.6% and 5.3% o f GDP) because o f greater population density, poverty and lower quality o f health care services. The Asian Development Bank has indicated that the impact on GDP growth rates for 2006 would range between 2.6% and 6.8% for selected countries from East, South and Southeast Asia2. Countries most open to trade, and in particular large net exporters o f services, would be most hit by a human pandemic, because o f the movement o f people inandout o f the country. C. EconomicImpactsof AI without the AIPRP andAI Componentof HNPSP 6. The status, performance and dynamics o f the poultry sector in Bangladesh are summarized in Table 1 and Table 2. The total bird population (fowls, 83% o f total; and ducks, 17% o f total) was 220 million in2005; almost evenly (50% each) divided between backyard and commercial poultry production. Average annual growth inthe birdpopulation inthe last 5 years has been about 6%. The meat production and birdpopulation ratio was 1.4 (in terms o f number o f kilograms) in2005. The egg production and birdpopulation ratio was 25 (interms o f eggs) in 2005. The poultry sector in selected South East Asian countries is presented in Table 3. Indonesia, Thailand and Vietnam are major poultry producers. The poultry population in these countries has also been seriously affected by AI outbreaks in the last few years. With the exception o f Thailand, backyard poultry accounts for a large share o f total poultry production. 7. There are several major difficulties in estimating the economic impact o f AI in Bangladesh, most o f which would also be valid for other countries. First, scenarios for "gross attack rates" (GARS)o f AI in the case o f a pandemic, based mostly on past events, are only approximate3. There i s a lack o f scientific knowledge on the primary factors affecting the spread o f influenza and scenarios are based on a small number of past observations for which data i s o f differing quality and i s also quite heterogeneous. Second, there i s no data to assist inpredicting the probability of any o fthe scenarios for which a possible impact o fAI canbe estimated4. World Bank Prospects Group, "Global Development Finance, 2006". See Bloom et al., "Potential Economic Impact o f an Avian Flu Pandemic on Asia", November 2005, ERD Policy BriefNumber 42. Gross Attack Rate (GAR) =percentage o f clinical influenza illness cases per population. 4 On this topic, see conclusions by Meltzer et al. "The Economic Impact of Pandemic Influenza in the United States: Priorities for Intervention", 1999, CDC Emerging Infectious Diseases. 128 Table 1:PoultrySector inBangladesh PoultryPopulation(millionbirds) Poultry Sector 2001 1 2002 I 2003 I 2004 I 2005 Fowls 142.68 152.24 162.44 172.63 183.45 Backyard 57.07 60.9 64.98 69.06 73.38 Commercial 85.61 91.34 97.46 103.57 110.07 Ducks 33.83 34.67 35.54 36.4 37.28 Backyard 33.83 34.67 35.54 36.4 37.28 Comiercial 0 0 0 0 0 Total 176.51 186.91 197.98 209.03 220.73 Growth (%) 5.9 5.9 5.6 5.6 Backyard 90.90 95.57 100.52 105.46 110.66 I Commercial I 85.61 91.34 97.46 103.57 110.07 I Source: Government of Bangladesh and private sector representatives Table 2: EstimatesofRatiosofMeat andEgg ProductionRelativeto BirdPopulationinBangladesh Item 2001 I 2002 I 2003 I 2004 I 2005 Total birdpopulation (million birds) 176.51 186.91 197.98 209.03 220.73 Total meat production (million kg) 210 220 230 250 300 Total eggproduction (million) 4094 4424 4777 4780 5625 Meat production/ birdpopulation(kg) 1.2 1.2 1.2 1.2 1.4 Eggproduction/ birdpopulation (egg) 23 24 24 23 25 Source: Government of Bangladesh and private sector representatives. Table 3: PoultrySectors andAI Impactin Southeast Asia Number TotalBird ShareinEachSector (YO) Country of Birds YOof Bird Population Sector Sector Sector Sectors Affected Population (number) 1 2 3 4&5 Cambodia 22,948 0.1 16,300,000 0 2 7 90 Indonesia 16,188,000 5.9 275,290,000 4 21 12 64 Lao PDR 150,920 0.8 18,865,000 0 1 9 90 Thailand 25,900,000 10.3 252,630,000 70 20 20 10 Viet Nam 43,170,000 16.5 261,864,000 0 23 18 60 Source: Rushton, J. et al. "Impact of avian influenza outbreaks in the poultry sectors o f five South East Asian countries", FAO, 2005. 8. A fair degree o f sophistication can be adopted in estimating the economic impact o f AI by, for example, differentiating between age -groups, for likelihood o f a medical visit, hospitalization or death (allowing for better use of data from past pandemics since there i s a differential impact across age groups). However, given the limitations o f data inBangladesh and 129 the uncertainty surrounding any estimates, the present economic analysis is based on six basic possible "Gross Attack Rate" (GAR) scenarios. These are described below and a summary of the scenarios andtheir assumptions are reportedinTable 4. Table4: PossibleGAR ScenariosConsideredfor EconomicImpact GAR Scenarios (%) Population I I1 I11 IV V VI I Poultry 0.7 10.0 20.0 20.0 20.0 20.0 Humans I 0.0 0.1 1.0 15.0 20.0 30.0 I 9. Scenario (I) the case o f countries such as Cambodia or Lao PDR where under one i s percent o f the poultry population was infectedby AI. Scenario (11) reflects a gross attack rate on the poultry sector similar to those registered in Indonesia and Thailand, together with a small number o f the human population being infected by the disease (essentially bird-to-human transmission). Scenario (111) reflects the worst case scenario interms of the poultry sector with a total bird population affected o f 20% (approximately the case o f Vietnam) but still a small number o f humans infected. Scenarios (IV) to (VI) consider a pandemic in birds and also in humans with variable GARSfor the latter'. As mentioned above these are only indications o f what may happen and are not intended to cover all possible scenarios. For example, one could theoretically have a humanpandemic with no major part o fthe birdpopulation being infected. 10. In the case of the poultry sector, two economic impacts are considered: (i) of value production lost, which depends on the GAR and assumptions concerning selling prices and average meat and egg production per bird; and (ii)one off 30% reduction in sellingprices due a to initial consumer fears about the disease (experience from other countries inthe region suggest that prices tend to recover very quickly following outbreaks, as more reliable information becomes available). Because o f a lack o f information on elasticities and sector details, the impact on other protein producing sectors, as consumers shift demand away from poultry products, has not been taken into consideration. The impact on trade from any restrictions imposed, inthe event of AI outbreaks, has also not been taken into consideration, as Bangladesh i s not a net exporter o f poultry products. However, it is an importer o f parent stock and the current banon imports from 53 countries, including India, has substantially increased the price o f day old chicks in the count$. This reported increase inprices for day old chicks, due to trade restrictions, has not been taken into consideration in calculating the economic value o f production since usingcurrent market prices would overestimate economic costs o f AI. 11. Inthe case o fthe humanspopulation, three economic impacts are considered: (i) of value working days lost due to illness; (ii) cost of hospitalizations; (iii) value o f earnings the present I WHO suggests that more than 25% o f world populationcanbe affected. Meltzer et al. assume gross attack rates between 15% and 35% for the US. InBangladesh, as compared with other countries, the highpopulation density may well cause a higher proportion of the population to be affected incase o f a pandemic. Based on interviews with private sector representatives, the increases in DOC prices were inthe order o f around 4 times since 2003 when outbreaks inneighboring countries took place. 130 lost due to deaths. The number of illness cases i s basically dependent on the GAR assumed and the size ofpopulation inBangladesh, which was at 147.4 million in2006 and i s assumedto grow at 1.5% per year. The number o fhospitalizations i s basedon WHO suggestedrates o f 10% of all infectedcases andthe number o f deaths is assumedto be 1.5% oftotal affectedpersons. 12. The main assumptions for estimating the economic impact o f AI are the following. For the poultry sector it is assumedthat: (i) impact is on the initial birdpopulation andthere is a the 4% annual growth rate assumed (lower than average growth rate over the last five years of 6%); (ii) isanaverageof1.4kgofmeatperbirdand25eggsayearperbirdatapriceofTk.60 there per kg of meat and Tk.3 per egg; and (iii) used are below the market prices, which were prices impacted by the import ban, at around 85 T k k g for broilers in2006. For the humanpopulation, it is assumed that: (i) value of working days lost amounts to 10 days at a cost per person o f the Tk.2Yday; (ii) the additional cost per person hospitalized is Tk.5,250 which is equivalent to about US$15 per day for 5 days; and (iii)the present value o f earnings per person is Tk.760Imonth and 10 years work discounted at a rate of 12%. 13. The results from the calculations indicate several possible AI impacts depending on the scenariosof poultry andhumantransmission considered, as shown inTable 5 below. The impact ranges from losses of US$154 million or 0.3% o f GDP in the case o f just 0.7% of the bird population being affected to US$1.2 billion in losses in the case o f both severe human and poultrypandemic, which would bemore than 2% of Bangladesh's GDP. Moreover, inthe human pandemic scenario, one couldexpect between2,000 and663,000 lost lives. Table5: EstimatedEconomicImpactofAI inBangladesh GAR(Yo) Impact Human Scenario deaths US$ As % o f (rounded Poultry Humans million GDP figures) I 0.7 0.0 154 0.3 0 I1 10.0 0.1 203 0.4 2,000 nJ I11 20.0 1.o 283 0.5 22,000 20.0 15.0 740 1.3 332,000 V 20.0 20.0 902 1.6 442,000 VI 20.0 30.0 1.228 2.2 663.000 D. EconomicimpactofAIPRP,AI ComponentofHNPSPandAI Program 14. In response to the threat of AI, the Government of Bangladesh has prepared an AI national Plan. The proposedAIprogram, comprisingthe proposedAIPRP and an AI component o f the on-going HNPSP, is broadly part of this Plan. The total cost of the AI program is estimatedto beUS$37 million, comprising US$21 million for the AIPRP and US$16 million for the AI component of the HNPSP, spread over 5 years. 131 15. The economic costs are derived from the financial datapresented inAnnex 5. The capital and recurrent costs o f the AIPRP andthe AI component o f HNPSP are spread over 5 years and it i s assumed that the recurrent costs, spread over a subsequent 10 years, are financed by the Government o fBangladesh. The benefits o fthe AIPRP are measured interms of: (i) loss income avoided due to saved production; and (ii) income loss avoided due price decreases. The benefits o f the AI Component o f the HNPSP are measured interms of: (i) working days lost avoided; (ii) hospitalisation costs avoided; and (iii) present value o f earning lost avoided. The benefits are the spread over 15 years so as to correspond with the 5 plus 10 years o f costs. A 15-year duration has been used as it represents the usefd life o f most investments supported during the project. The Net Present Value (NPV) - the value today o f benefits minus costs incurred in the future - uses a 12 % discount rate and has been calculated for both the AIPRP and the AI Component o f the HNPSP. The results are presented inTable 6. Table 6: EstimatedEconomicImpactof the AIPRP, AI Componentof the HNPSPandthe AI Program GAR (Yo) NPV (US$ million) Scenario AI Component AI Poultry I Humans AIPRP I ofHNPSP I Program I 0.7 0.0 -25 -22 -47 I1 10.0 0.1 14 -20 -6 lv I11 20.0 1.o 56 2 58 20.0 15.0 56 337 393 V 20.0 20.0 56 457 513 VI 20.0 30.0 56 697 743 16. The results o f the economic analysis o f the AIPRP, AI component o f the HNPSP and the AI Program summarize net present values under the six GAR scenarios. In the case o f low GARs on the poultry and humanpopulations, the negative N F V s indicate that the costs incurred tend to outweigh the corresponding benefits over a period 15 years. Inthe event o f the GARs in the region o f 10 percent in the case o f the poultry population and 1% in the case o f the human population, the positive N F V s indicate that the benefits incurred tend to outweigh the corresponding costs over the 15 years. The AIPRP provides benefits, especially if there i s an outbreak o f AI that impacts upon the poultry population, in Bangladesh, comparable with those that have occurred in South East Asia. The benefits o f the AI component o f the HNPSP and the AI Program as a whole, would be considerably greater inthe event o f an impact on the human population. 132 Bangladesh Avian InfluenzaPreparednessandResponseProject Annex 10: Terms of Reference for Technical Assistance The proposed draR terms o f reference, for part o f the technical assistance requirements, are divided into two parts: (A) The Avian Influenza Preparedness and Response Project (animal health); and (B) the Avian Influenza Component o f HNPSP (humanhealth). However, this list does not include all the technical assistance that would be needed during implementation o f the AIProgram. A. Draft Terms of Reference for the AIPRP 1. International Technical Assistance for Evaluation and Review of Veterinary Services and National Policies accordingto International Standards (OIE) Together with the national consultant and the Department o f Livestock Services o f the Ministry of Fisheries and Livestock, evaluate and review the capacity required by the Government o f Bangladesh for making emergency preparedness plans for controlling and eradicating highly pathogenic avian influenza (HPAI) in case o f its incursion inthe country. This will include, but not limitedto, the following: Assess, monitor andevaluate project progress; 0 Assess the status o f emergency animal disease preparedness inthe country and advise on the requirements to improve on this as per OIE guidelines: Performance, Vision andStrategy (PVS) for veterinary services (VS); Inrelationto the above, the consultant will specifically evaluate the following: 0 major risk factors for HPAI; 0 early reporting and response capacity, particularly at the level o f farmers and extension service; capacity inepidemiology; capacity inlaboratory diagnosis o f HPAI; institutional infrastructure andmanpower needs; public awareness and communications needs; fundingneeds; and other issues related to HPAIcontrol. Review progress in developing emergency preparedness planning and advise on the outcome; prepare a list o f equipment required immediately with detailed technical specifications; 133 Guide further development by making recommendations for implementing all activities under each sub-component; Prepare a brieftechnical report (inEnglish) on the findings; and Carry out any relatedtasks, as required. Qualifications: The International Consultant will be a veterinary graduate from a recognized university with a postgraduate qualification in veterinary epidemiology. He/she will have demonstrated broad expertise in evaluation o f veterinary services, control and prevention of animal diseases, especially those o f epidemic significance; and have competence and practical experience o f disease emergency preparedness planning. He/she will have at least 10 years o f relevant experience in reviewing national policies. Previous experience of work in South Asia with the ability to develop project documents is highly desirable. He/she must be fully proficient inEnglish. The consultant, who will bebased inDhaka, would initiallywork for about a month every year duringthe first three years. 2. NationalTechnicalAssistance for CompensationPolicy Incollaborationwith the Department ofLivestock Services, MinistryofFisheries and Livestock, private sector and NGOs, the incumbent will undertake the following activities: Prepare a detailed work planfor operational compensation policy to farmers; Prepare the compensation policy in collaboration with concerned government authorities at all levels (central, district, upazila and village), private sector and NGOs; Assist in and facilitate modifications in the policy in the event o f incursion o f the disease; and Assist in the development o f communication and training materials related to compensation. Qualifications: The National Consultant will be a veterinarian, preferably, with a post graduate degree in veterinary epidemiology/economics. He/she will have at least 7 years o f relevant experience in disease control andor disease investigation and diagnostics, including avian diseases. Someone who has prior experience in formulating and implementing compensation policywould be given preference. Fluency inEnglishi s required. The consultant would initially work for about a month every year duringthe first two years. He/she would be based in Dhaka with frequent travel throughout the country. 3. Technical Assistance for Data Management to Install and Train Personnel in TADinfo Application Under the general supervision o f the Technical Cooperation for Emergency Operations (TCEO) and in collaboration with the Regional Emergency Centre for Transboundary Animal Diseases (ECTAD) Officer, Regional Office for Asia and Pacific (RAP), FA0 and the Department o f Livestock Services, the incumbent will undertakethe following activities: 134 Assist in configuring the Java version o f TADinfo with administrative layers in Bangladesh and help inits installation at the central level; Train central and field staff on the use o f TADinfo data management software for animal disease data collection and analysis; Assist indeveloping the national animal disease reporting system; and Prepare a brieftechnical report (inEnglish). Qualifications: The TADinfo consultant will be a veterinarian with competence in information technology, database management or related field. He/she will have at least five years o f relevant experience with data management and be filly proficient inthe operation o f TADinfo. Fluency inEnglishis essential. The consultant wouldinitiallywork for one monthduringone assignment andwillbebased inDhaka. 4. International Technical Assistance for Strengthening Governance and Updating Legislation The consultant will have the overall responsibility to develop a detailedwork planadapted to the local circumstances and evolving needs for strengthening the governance and updating legislative issues pertaining to animal health delivery structure with in the Department o f Livestock Services. Depending on the identified priority needs, hisher contribution could include, but not limitedto, the following: Assess the status o f emergency animal disease preparedness in the country and advise on the requirements to improve legislative requirements on this; Assist with establishing a National Animal Disease Emergency Committee and advise on the process o f preparation o f national emergency preparedness (contingency) plans for livestock diseases; and Prepare a brieftechnical report inEnglish. Qualifications: The international consultant will have demonstrated broad expertise in control and prevention o f animal diseases, especially those o f epidemic significance; with competence and practical experience o f disease emergency preparedness planning. He/she will have at least 10years o frelevant experience inanimal disease emergency preparedness. Fluency inEnglishis essential. The consultant would initially work for one month during one assignment and will be based inDhaka. 5. NationalTechnicalAssistance for StrengtheningGovernanceandUpdatingLegislation The incumbent will undertake the following activities: Collaborate with the international consultant (updating legislation) and the Department o f Livestock Services, in updating the legislative requirements for major livestock and poultry diseases including avian influenza; Facilitate collaboration between international consultant and government authorities at all levels (central, district, Upazila, Union and village); and Collaborate with the international consultants inpreparing a technical report. 135 Qualifications: The National Consultant will be a veterinarian, preferably with a post graduate degree inveterinary epidemiology. He/she will have a good understandingo f national veterinary services, acts and rules with at least 7 years o f relevant experience in animal disease control planning and management, both at national and sub-national levels. Fluency in English i s essential. The consultant would initially work for a month andwill be based inDhaka. B. DraftTerms ofReferencesfor the Avian InfluenzaComponentof HNPSP Background Beginning in 1997, subtypes o f influenza A virus previous seen only in birds (also known as avian influenza viruses) began producing disease in humans. Since 2003, a subtype o f avian influenza (H5N1) has produced widespread outbreaks o f disease inpoultry, and more than 250 cases o f severe illness in humans with more than 50% o f these illnesses being fatal. So far no poultry or human infections due to H5N1 have been identified in Bangladesh. However, as surveillance improves, this situation is likely to change. There i s also growing concern that as H5N1 becomes better adapted to producinginfection and disease inhumans it will spark a global pandemic with a burden o f illness and mortality. Response to the threat o f avian influenza requires every country to take steps to monitor, detect, respond to, prevent and control this disease in animals and humans. The Government o f Bangladesh has developed a National Plan for dealing with avian andpandemic influenza, and has initiated activities to implement the plan. The Ministry o f Health and Family Welfare (MOHFW) i s the primary implementing agency for actions involving human avian influenza detection, prevention, and control. These actions will be taken inpartnership with other ministries, non-governmental organizations, the private sector and the international organizations. At the request o f the Government, the World Bank has agreed to support the proposed Avian InfluenzaProgram. 1. Avian InfluenzaTechnicalExpertfor HumanHealth At present, different officials in the Ministry are responsible for activities and commitments related to avian influenza, in addition to their other responsibilities. To most efficiently address this disease, there should be a technical expert whose primary responsibility will be to support the Director Communicable Diseases in avian and pandemic influenza. This individual will provide advice to the Ministryregardingthe disease, will implement activities inside the ministry and with external partners, and will monitor these activities for quality, efficiency, and timeliness. The individual will also work with district and local level authorities as they implement components o f the national plan, AIPRP and the AI Component o f HNPSP. The expert will be hired under the Project but will work inMOHFW. This positionwill ensure closer dialogue between the animal health and humanhealth components. This position will be an appointment in the Ministry o f Health and Family Welfare. Because most o f the activities related to humanavian influenza fall within the purview o f the Directorate General o f Health Services (DGHS) and since the position i s scientific and technical in nature, the individual will be placedinthe Directorate o f Communicable Diseases, but will be linked to the Institute for Epidemiology and Disease Control Research (IEDCR). The incumbent in this 136 position i s expected to be scientifically proficient and a technical expert on avian influenza- related issues, and will coordinate and monitor activities conducted under the AI Component o f the HNPSP. The expert needs to have a thorough understanding o f sector wide approaches (SWAPS), HNPSPandthe health system inBangladesh. The individualinthis position will: a assist and provide input on avian influenza related concerns to the Ministry and others, as necessary; a ensure integration o f human avian influenza surveillance, laboratory, response, supply, andcase management, andthe information derivedfrom these activities; a actively engage innational training efforts for surveillance, case management, and investigation relatedto avian andpandemic influenza; a actively participate inthe response to reports o f possible disease inhumans; a actively participant in assuring the safety o f the public and responders when incidents o f avian influenza inpoultry or other animals are recognized; a oversee and monitor implementation o f activities under the AI Component o f the HNPSP withinrequiredtime frames; 0 interact with partners, including WHO, other international organizations, NGOs, technical consultants, and the private sector; a participate in the technical and policy committees for avian influenza, and assure that humanhealth activities are consistent with the national avian influenza plan, includingfiture modifications; a provide linkage between the animal health and human health aspects o f AI i.e. betweenthe two partso f the AI Program; and a represent the MOHFW at national andinternational meetingsregarding avian and pandemic influenza as requested. The position will be based inthe Ministryo f Health and FamilyWelfare in Dhaka, ideally inthe Directorate General o f Health Services. The incumbent must possess an advanced degree in medicine or public health (MD or PhD) and have experience inpublic health programs related to communicable disease prevention and control. The individual should be fluent in English and speak Bangla, be able to travel within Bangladesh and internationally, if requested by the government. The term o f appointment will be for 12months. Based on satisfactory performance o f duties, the individual can be extended at 12 month intervals for the duration o f the project. MOHFWwill provide office space and administrative support for this position. 2. Information Technology and Data Management Specialist, Institute for Epidemiology andDisease ControlResearch(IEDCR) Successfilly addressing avian and pandemic influenza hinges on being able to collect, analyze, and disseminates information on what is happening in Bangladesh. A number o f surveillance mechanisms that will generate significant amounts o f data are being established, and the laboratory infrastructure i s beingenhanced. One aim o f the project i s to develop the capacity for electronic entry and transfer o f relevant data to the national surveillance center at IEDCR, and then post this information on an accessible web site. To accomplish this, IEDCR will need technical support for application o f information technology in the form o f an information technology specialist. 137 The consultant will organize and maintain in electronic fashion the data collected by the surveillance and laboratory units at IEDCR, and will provide computer support (hardware and software) to those working in these units. For the surveillance unit to properly function, an individual familiar with computer programs related to surveillance data is essential for rapid, timely, and accurate analysis o f the information. Inaddition, for those sources of data that are computerized, the consultant will develop and implement the means for electronic submission o f data to the central surveillance unit, including the necessary software. This individualwill also provide support for information technology related to influenza surveillance at the sentinel sites and in the districts. Finally, this consultant will help design a web-site for web-based data submission and to post information relevant to avian influenza, including surveillance data, guidelines, andprotocols. The specific activities o f this individual will include: Maintain and operate computer equipment inthe surveillance unit andlaboratories; Develop programs for surveillance and laboratory data entry and storage; Develop programs for surveillance and laboratory data analysis, including statistical programs; Develop programs for production o f tabular data andother data outputs; Develop capacity for electronic submission o f data from surveillance sources (e.g. district and Upazila health care facilities, NGOs, WHO) that have data transmission capacity; Assist with programs to produce periodic bulletins; Develop a web site for surveillance data andrelated information; and Assure confidentiality o f identifiable data entered into computer programs. The information technology specialist will be based in IEDCR in Dhaka. Some travel may be required to district health offices and sentinel surveillance sites for assistance with data management, or to other sources o f surveillance data. The individual should be conversant in English and Bangla. The individual should have a degree in computer science and be familiar with hardware and software relevant to public health surveillance and laboratory data. The duration o f the position i s 12 months, with the potential for extensions, contingent on successhl performance. IEDCR will provide office space and administrative support for the individual in thisposition. 3. World HealthOrganization(WHO) The World Health Organization is a major partner o f MOHFW in a variety o f programs and activities. It i s the leading international organization dealing with the human health aspects o f avian and pandemic influenza. Therefore, it is logical that WHO would provide support to the GOB as it implements its national plan and develops activities that are contained in the AI Component o f the HNPSP. WHO will support the following activities: (i) review o f the legal the and regulatory framework for avian and pandemic influenza prevention and control, (ii) assessments o f regional preparedness, (iii)development of guidelines and protocols, (iv) development and implementation o f field and tabletop simulations, and (v) development o f plans for pandemic control (including social distancing measures, surge capacity, and health care provision). Overall this will involve about 12 manmonths o f international expertise and 38 man 138 months o f national expertise. It is recommended that MOHFW, after consultation with WHO, initiate a draft MOU and seek clearance from the World Bank. Further details regarding these activities are providedbelow. (i) Legal and Regulatory Framework Review WHO will provide a technical expert who will review the current Bangladesh legal framework for disease surveillance, control, and prevention, as they relate to avian influenza and pandemic preparedness. These activities will be done in concert with a national legal expert who will continue the review after the international consultant has departed. If the technical experts identify gaps or insufficiencies in the current legal and regulatory framework, they will make recommendations to address them, including proposed legislative remedies. The review must include, at a minimum, the legal andregulatory framework for: 0 disease surveillance andreporting; disease investigations; social distancing measures, including quarantine and isolation, closure o f public places (including schools, sports venues, private businesses); use o f unlicensed products (e.g. vaccines and antiviral), including indemnification for adverse consequences o f their use, on an emergency basis; use o f unlicensed or retired health care workers inthe event o f the need for surge capacity during an influenzapandemic; and compatibility and compliance o f the current legal framework with the revised International Health Regulations. The expert should have an advanced degree in law, recognized in Bangladesh, have experience in dealing with medical or public health legal issues, and have familiarity with legislation and regulations. The duration o f the work performed i s part o f this activity should be not more than two (2) months. (ii) Regiona1PreparednessAssessments To successfully address avian influenza inBangladesh, and to accomplish many o f the program goals, activities must be carried out at the regional (division) and district levels. It i s important to ascertain the degree o f regional preparedness to fulfil these commitments, and if gaps and problems exist, take corrective actions. To meet this need, the MOHFW will conduct periodic assessments o f regional preparedness, to include assessment o f surveillance capacity, investigative capacity, and health care system preparedness. While these assessments will mainly be carried out by the MOHFW, WHO will provide technical assistance to assure that the assessments are carried out with adequate rigor and standardization. To this end, WHO will provide a technical expert to develop the survey instruments that will be used, to develop the assessment scheme, and assist in the actual conduct o f the assessments if necessary. The Ministry has proposed conducting an assessment in each o f the six regions over the first 12- month period of the project. These first year assessments will serve as baselines for subsequent evaluations, which will be repeated in all six regions each o f the two subsequent years o f the project. In each region, at least randomly selected districts should be surveyed for surveillance 139 capacity, for investigative capacity, and for health care facility capacity. In each region, at least one ofthe three sentinel surveillance sites should also be visited to ascertain how closely they are adhering to guidelines. Specific activities include: Develop survey instruments and methods for regional assessments. Because at least one round o f surveys needs to be conducted in the first 12-month period, these instruments should be available duringthe early phases o f the project; Submit the survey instrument to the MOHFW for review and approval before it i s to be utilized inthe actual surveys; Develop randomization methods for selecting districts to be evaluated duringeach regional visit; Training persons from the MOHFW engaged inthe regional surveys and assuring the survey instrument canbe appropriately administered; Participation inregional assessmentteams, as necessary; Assist with data entry and analysis o f survey information; Assist with dissemination (inthe form of reports) o f findings; and Recommendcorrective actions for deficiencies identifiedduring field evaluations. (iii) Protocol and Guideline Development WHO will assist the MOHFW in developing national guidelines related to avian and pandemic influenza inthe following areas: standardized disease surveillance; humandisease investigation and outbreak response to findings in either poultry or humans; and case management, including prophylaxis and treatment. It i s essential that these guidelines be developed in the early phases o f the project, as they will form the basis for subsequent training o f personnel performing these activities and caring for patients suspected to have this disease. Since such guidelines have been produced by a number o f international organizations and countries, for maximal efficiency these existingmaterials should be used as the basis for specific guidelines and protocols to be used in Bangladesh. Specific activities under this component will include: Collect and review existing guidelines for disease surveillance, case and outbreak investigation, and case management from selected international organizations and nationalpublic health agencies; Adapt these materials for the Bangladeshpublic health and clinical context; 0 Disease surveillance guidelines should include standardized case definitions for suspected and confirmed cases, reporting channels from the clinician to the national level, standardized case reporting and specimen collection forms, and information on proper specimen collection and submission; Develop standardized protocols that address sentinel surveillance for influenza- like illness; Case and outbreak investigation guidelines should include information on team composition, information necessary to be collected, standardized data collection forms, contact tracing, risk factor evaluation, specimen collection and submission, implementation o f prevention and control measures, follow-up, and report writing; 140 Case management guidelines should include information on case recognition and clinical presentation, notification, treatment and prophylaxis, isolation o f patients andcontacts, personal protective measures, andinfection control; Guidelines and protocols should be reviewed by external technical experts for content before submission to the MOHFW; All guidelines and protocols will be submitted to the MOHFW for review and approval before beingusedfor training or disease prevention andcontrol efforts; Guidelines and protocols should be reviewed at least annually for content and the need for modification or updating as new information becomes available or the international situation changes; Any modifications to existing guidelines should be submitted to the MOHFW for review and approval; Once any new or modified guidelines are approved, they should be made available in electronic and printed format for distribution to public health authorities, surveillance coordinators, rapid response teams, and clinicians throughout Bangladesh for use; and Once approved, protocols and guidelines should be provided to IEDCR and their trainingpartners to form the basis o ftheir training activities. (iv) Tabletop and Field Simulations Although it is critical to have written organizational diagrams, guidelines, protocols, and operational plans, it i s not possible to know how these perform and what gaps exist unless they can be exercised. There are two ways to do that. One is to respond to actual disease situations. This is not the time to determine that there are problems. The second is to perform simulations to identifyproblems ahead o ftime. The project supports the development o f simulations. WHO will develop two types o f simulation exercises. One i s tabletop exercises, where a scenario i s developed and the key players (government officials, NGOs, private sector, international partners) indicate how they will respond. The other i s actual field exercises, where mock illness occurs and various responders are tested to assess their knowledge and approach to handling this disease. WHO will develop and assist in the implementation of each type o f exercise. In order to identify gaps and problems, some o f these exercises need to be conducted during the early phases of the project. The project will support three tabletop exercises and six field exercises (one per region) over the first three years o f the project. At least one o f these exercises should involve utilization o f social distancing measures. Specific activities include: Collect and review simulation exercise protocols that are available from international organizations and other countries; Adapt these scenarios to the Bangladesh context as the basis for the tabletop and field simulations; Develop written versions o fthe scenarios; 0 One simulation exercise (tabletop and field) should involve findings o f avian influenza inpoultry, while the others should involve a case cluster or outbreak o f humanavianinfluenzadisease. The later scenario should include issuesrelated to implementation o f social distancingmeasures; 141 a Submit a synopsis (not the actual scenario) of the scenarios to the MOHFW for review and approval; a Working with the, MOHFW schedule the tabletop and field simulation exercises. For the tabletop exercises, issue invitations to relevant persons based upon the scenario; a Identifythe locations andvenues to conduct the tabletop and field simulations; a Field simulations should ideally test bothurbanandrural preparedness; a Develop the necessary materials for the exercises; a Distributenecessary material to relevant participants ahead o f each event so that participants can be best prepared; a Conduct the simulations; e Develop a post-exercise report, including lessons learned, gaps, and issues that mustbe corrected; a Submitthereport to appropriate national, district, andUpazila authorities; and a Modify guidelines, protocols, and training materials based on the results o f the exercises. (v) Plansfor Case Management, Health Care Worker Surge Capacity, and Social Distancing during an Influenza Pandemic WHO will assist in developing options and strategies for handling several critical aspects of response to an influenza pandemic. These include strategies to handle large numbers o f ill persons inthe midst o f a pandemic when the health care infrastructure (both out- and in-patient) will likely be overwhelmed; strategies to increase the health care workforce, emphasizing retired and nonworking trained health care workers, and a volunteer workforce; planning and implementing social distancing measures, including school, business, and other closures, and quarantine; and planningfor mortuary-relatedneeds. To do so, WHO will: Review a sample o f existing guidelines and policies regarding health care surge during a pandemic, expansion o f the health care workforce, implementation of social distancing measures, andmortuary needs; Hold discussions with a variety o f stake-holders regarding the issue, including (but not limited to) officials o f the , other relevant ministries (e.g. education, sports, communication, home, defense), NGOs, international organizations working inBangladesh, the business community, provincial and local authorities, andreligious institutions; Develop plans and strategies for health care surge, health care workforce expansion, social distancing, and mortuary services; Health care surge component should emphasize measures that do not require hospitalization or increasedutilization of overwhelmedhealth care facilities; Develop strategies for certifying personnel who may be recruited but unlicensed to provide care duringa pandemic; Provide guidelines and protocols to the regarding these four areas for review and approval; 142 0 Assure buy-in from other ministries, organizations, and entities that will be impactedor expected to play a role inresponse regardingapprovedprotocols; and 0 Participate in any field and tabletop exercises regarding these pandemic preparedness issues. The roles and responsibilities o f WHO under these terms o f reference can be implemented using the existing offices in Dhaka. The MOHFW should make available personnel and meeting facilities to expedite the implementationo fproject. Many o f the required activities have specific timelines. The overall agreement with WHO should be for a 12-month period, with the option for two 12-month extensions, based on satisfactory performance. Subsequent agreements may partition each o f the activities so that certain activities demonstrating adequate performance can be continued, while others not demonstrating satisfactory performance may be cancelled or modified. 4. InternationalCenter for DiarrhoealDiseasesResearch,Bangladesh(ICDDR,B) A major pillar o fthe nationalplanfor avian andpandemic influenza, andthe AI Program to implement the national plan, i s to upgrade the laboratory capacity o f the MOHFW. This will be done in several ways - procurement o f rapid diagnostic kits for use in sentinel sites and referral facilities, development o f real time polymerase chain reaction (RT-PCR) capacity at IEDCR, and the development o f virus isolatiodbiosafety level 3 capacity at IEDCR. The development o f the RT-PCR and settingup o f BSL-3 will take some time to implement, as both involve facilities improvements (in the case of RT-PCR, renovation; in the case o f virus isolation, a prefabricated laboratory). ICDDR,B i s creating similar capacities, and may have the ability to do these things before IEDCR. Therefore, while capacity i s being developed at IEDCR, there should be a formal memorandum of understanding (MOU) developed between the MOHFW and ICDDRB in three areas: (i)active sharing o f information from sentinel surveillance networks and laboratory findings; (ii) support for laboratory diagnostics (PCR and virus isolation) until such capacity exists at IEDCR, and (iii) back-up support to IEDCR in laboratory diagnostics, outbreak investigation, and engineering services once project activities have commenced. The M O U between and ICDDR,B should be for three years and subject to extension based upon need and performance. All activities should be able to be carried out within the facilities ofthe respective institutions. 5. Procurementof Pharmaceuticals,Biologics,EquipmentandSupplies There would be a need to procure a variety o fpharmaceuticals, biologics, equipment, and supplies for use in Bangladesh at the national, district, and sub-district levels. Although this procurement will be done by following agreed procurement guidelines, for maximum effectiveness the following terms o freference should be adhered to. 0 All materials purchased must be certified by WHO as meeting international standards when such certification is available. For material not certified by WHO, the products should meet the appropriate alternative body's certification standard; 143 Inthe case of pharmaceuticals andbiologics, the products must be approved for use inBangladesh; For pharmaceuticals, both adult and paediatric formulations will need to be obtained; Products obtained should have the longest possible shelf-life or expiration date reasonably available on the market; When available, generic WHO-approved drugs should be substituted for more expensive non-generic formulations; Vendors should assure the safe storage and transport for purchased material and products until they are handed over to the health authorities for distribution to end users; Personal protective equipment includes disposable masks (N95 or greater), gowns, gloves, and shoe covers, andre-useable goggles. The latter are usedonly for care o f severely illpatients and should be reserved for distribution to isolation or regional referral wards; Line Director for Communicable Diseases should consult with infectious disease specialists regarding the quantities and types o f antimicrobial agents to be obtained for use in referral facilities and district hospitals. The antimicrobial agents obtained should be compatible with the national formulary, be available in both adult and paediatric forms, and be in oral and intravenous formulations. Priority should be given to antimicrobial agents that are active against Staphylococcus aureus, Haemophilus influenzae, and Streptococcuspneumoniae. The least expensive but still effective products should be obtained duringthe first 12-month period o f the project. Once quantities o f each product are determined, sufficient product should be obtained in the next two 12-month periods for a 50% replacement rate o f the item; Surface disinfection and hand-washing are very important actions to reduce the spread o f respiratory pathogens, including influenza viruses. Low cost surface disinfectants should be obtained for use in health care facilities, including designated regional referral hospitals, district hospitals and sub-district health facilities. Hand-washing material (both soap and alcohol-based hand sanitizers) should be obtained andprovided for distribution to these facilities; and Supplies needed to administer seasonal influenza vaccine, intravenous medications, and surface disinfectants, should be obtained and distributed to the locations where these products will be administered during the first 12-month period o f the project. Once quantities are defined, sufficient product for a 50% replacement rate should be obtained. 6. Health Care FacilitiesRenovationand Upgrading for Case Management To provide effective patient care and reduce morbidity and mortality from avian influenza, there i s a need for specialized services for the isolation and treatment o f suspected or confirmed cases. At the moment, the health care system of Bangladesh is not ready to effectively meet this need. To mitigate this, the HNPSP will support the renovation o f district level hospitals (one hospital per district) as referral sites for persons with suspectedor confirmed avian influenza. The HNPSP will also support renovation o f wards designated for care o f 144 persons with suspected or confirmed avian influenza (isolation wards). It i s expected that these wards will be used to care for patients with other priority communicable diseases (especially those where isolation may be necessary) when they are not being used for patients with avian influenza. All activities needto be carried out according to the guidelines approved by the andin close collaboration with the hospital management team and district health department. Specific activities include: Selection o f a suitable place inside the hospital for the isolation and treatment o f avian influenza cases that can accommodate at least 5 beds. The site should be safely away from other patient care and visitor areas (either geographically or through adequate partition); Design and minor renovation o f the isolation ward and its related annexes so that it meets standards for care o fpatients with severe respiratory disease. Renovation should include bathroom facilities separate from other parts o fthe facility; Maintenance o f the isolation facility to assure it i s fully operational; Installation o f negative pressure ventilation through outside venting o f air with respect to hallways and other patient care areas; Procurement, installation and maintenance o f equipment for care o f patients with respiratorydisease (e.g. oxygen generators, suction equipment); Adequate storage and security o fmedications, PPE, and consumables; Selection o f competent staff for case management training; Utilization o f the ward for other purposes when not being used for avian influenza cases, with priority given to diseasesrequiring isolation; The ward should be immediately available for the isolation and care o f avian influenza cases upon arrival to the facility; Assure standards o f care based on the case management guidelines approved by WHO; Assure safeguard for adequate infection control are in place, including waste disposal; Reporting to district and national health authorities on the number and status o f cases cared for inthe facility according to surveillance guidelines; Cooperating with district and national health authorities in the conduct o f special epidemiologic studies relatedto avian influenza; and Updatingregularly the hospital management and district health department on the status o f operations. The MOHFW will provide the following inputs: (i)relevant available information about facilities, health-care status o f population, and results o f surveys and special studies, (ii) copies o f standard guidelines for case management and case reporting (including reporting forms); (iii) access to MOHFW training courses; (iv) copies o f key reports and investigations carried out in Bangladesh and important studies and background material from the international literature; (v) technical assistance, when needed; and (vi) antivirals, PPE, other drugs, consumables and equipment. The facility will provide the quarterly reports related to activities undertaken in fulfilment o f these terms o f reference. The quarterly report will include the following sections: (i) progress 145 made against the work plan; (ii) group is performing the work; (iii) what problems encountered and solutions undertaken. Such reports will be furnished within one month o f the end o f the quarter. Inaddition, the facility will follow surveillance requirements for reporting o f cases o f suspected or confirmed avian influenza. 146 Bangladesh Avian Influenza Preparedness and Response Project Annex 11:ProjectPreparationand Supervision Bankfunds expendedto date on projectpreparation 1.Bankresources:US$131,785.34 2. FAOKP: US$55,000.00 3. Total: US$186,785.34 EstimatedApprovalandSupervisioncosts: (a) Remaining costs to approval: US$30,000.00 (b) Estimated annual supervisioncosts: US$lOO,OOO.OO 147 Bangladesh Avian Influenza Preparedness and Response Project Annex 12: Documentsin the Project File A. GovernmentofBangladesh 1. NationalAvian Influenza and Human Pandemic Influenza Preparednessand Response Plan, Bangladesh, 2006-2008, April I 7, 2006. 2. Bangladesh: Avian Influenza Prevention Program, (draft), 2006. 3. Bangladesh: National Communication Strategy and Action Planfor Avian Influenza and Human Pandemic Influenza, 2007-2008, February 2007. 4. Environmental and Social Safeguards Management Framework (ESSMF) and the Environment Management Plan (EMP)for Avian Influenza Preparedness and Response Project, (draft), May 15, 2007. 5. Avian Influenza Operation Manual (draft), January 2007. 6. CompensationStrategy (draft), 2007. B. The WorldBank :Bangladesh 1. TechnicalReview Mission Aide Memoire, April 9-16, 2006. 2. Pre-appraisal Mission Aide Memoire, June 25 -July 10, 2006. 3. Appraisal Mission Aide Memoire, December 4-19, 2006. 4. Technical Annexfor theA I Program, June 2007. C. The WorldBank : Global I. Program Framework Documentfor the GlobalProgramfor Avian Influenza Controland Human Pandemic Preparednessand Response (GPAI), December 5, 2005. 2. Enhancing Control of highly Pathogenic Avian Influenza in Developing Countries through Compensation:Issues and GoodPractice, 2006. D. Others 1. BRAC-BDP Report on BRACAvian Influenza Prevention Programme, November 2005 -August 2006. 2. Protect Poultry -Protect People: Basic Advicefor Stopping the Spread of Avian Flu, ECTAD, FAO, 2006. 3. Avian Influenza :General Information, OIE, 2006. 4. NationalLivestock Policy, DLS, MOFL, August 2006. 5. Assessment of HPAI Capability in Laboratory Facilities in Bangladesh, draft mission report by international F A 0 Consultant, July 17, 2006. 148 Bangladesh Avian Influenza Preparedness and Response Project Annex 13: Statementof Loans andCredits Differencebetween expected and actual Original Amount inUS$ Millions disbursements Project ID FY Purpose IBRD IDA SF GEF Cancel. Undisb. Orig. Frm. Rev'd P100330 2007 BD Railway Reform Programmatic 0.00 40.00 0.00 0.00 0.00 40.29 0.00 0.00 DevPolicy PO98273 2006 Local Governance Support Project 0.00 111.50 0.00 0.00 0.00 112.33 -0.08 0.00 PO89382 2006 Investment Promotion Financing Facility 0.00 50.00 0.00 0.00 0.00 47.35 -1.25 0.00 PO74841 2005 HNP Sector Program 0.00 300.00 0.00 0.00 0.00 361.48 -56.05 0.00 PO86661 2004 iBD Water Supply ProgramProject - 0.00 0.00 0.00 0.00 0.00 39.57 0.77 0.00 PO83890 2004 Economic Management T A Program 0.00 0.00 0.00 0.00 0.00 19.64 8.74 0.00 (EMTAP) PO86791 2004 Reaching Out of School ChildrenProject 0.00 0.00 0.00 0.00 0.00 43.19 3.65 0.00 PO81969 2004 EnterpriseGrowth & Bank Modernization 0.00 250.00 0.00 0.00 0.00 140.99 50.42 0.00 PO74966 2004 Primary Education Development Program 0.00 150.00 0.00 0.00 0.00 99.36 2.92 0.00 I1 PO78707 2004 Power Sector Development T A 0.00 7.10 0.00 0.00 0.00 13.86 9.77 1.93 PO53578 2003 Social Investment ProgramProject 0.00 18.24 0.00 0.00 0.00 5.63 3.60 0.00 PO71435 2003 Rural Transport ImprovementProject 0.00 190.00 0.00 0.00 0.00 126.17 54.76 0.00 PO62916 2003 Central Bank StrengtheningProject 0.00 37.00 0.00 0.00 0.00 36.37 32.50 0.00 PO81849 2003 BD: Telecommunications Technical Assist. 0.00 9.12 0.00 0.00 0.00 7.82 5.10 1.89 PO74731 2002 Financial Services for the Poorest 0.00 5.00 0.00 0.00 0.00 1.78 1.07 0.00 PO75016 2002 Public Procurement ReformProject 0.00 4.50 0.00 0.00 0.00 0.34 -0.35 -0.48 PO71794 2002 Rural Elect. Renewable EnergyDev. 0.00 190.98 0.00 0.00 0.00 91.16 46.91 0.00 PO44876 2002 Female Secondary School Assis. I1 0.00 120.90 0.00 0.00 31.06 25.11 38.32 -5.35 PO74040 2002 Renewable Energy Development 0.00 0.00 0.00 8.20 0.00 1.97 6.21 0.00 PO69933 2001 HIVIAIDS Prevention 0.00 40.00 0.00 0.00 21.98 2.09 19.67 -0.33 PO57833 2001 Air Quality Management Project 0.00 4.71 0.00 0.00 0.00 2.65 2.15 -0.54 PO50752 2001 Post-Literacy & ContinuingEducation 0.00 53.30 0.00 0.00 0.00 29.37 21.26 -1.74 PO44810 2001 Legal & Judicial Capacity Building 0.00 30.60 0.00 0.00 0.04 15.03 10.57 0.00 PO41887 1999 Municipal Services 0.00 138.60 0.00 0.00 0.68 36.88 34.08 22.36 Total: 0.00 1.751.55 0.00 8.20 53.76 1.300.43 294.74 17.74 149 BANGLADESH STATEMENT OFIFC's HeldandDisbursedPortfolio InMillions ofUS Dollars Committed Disbursed IFC IFC FY Approval Company Loan Equity Quasi Partic. Loan Equity Quasi Partic. 2001 BRAC Bank 0.00 1.63 0.00 0.00 0.00 1.60 0.00 0.00 1997 DBH 1.91 0.65 0.00 0.00 1.91 0.65 0.00 0.00 1991 Dynamic Textile 0.00 0.00 0.00 1.48 0.00 0.00 0.00 1.48 GTFP DhakaBank 5.00 0.00 0.00 0.00 5.00 0.00 0.00 0.00 GTFP EasternBnk 2.59 0.00 0.00 0.00 2.59 0.00 0.00 0.00 2004 GrameenPhoneLtd 24.00 0.00 0.00 0.00 24.00 0.00 0.00 0.00 2006 GrameenPhoneLtd 59.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1998 IPDC 3.13 0.00 0.00 0.00 3.13 0.00 0.00 0.00 1998 Khulna 10.40 0.00 0.00 11.99 10.40 0.00 0.00 11.99 1998 Lafarge/Surma 35.00 10.00 0.00 0.00 35.00 10.00 0.00 0.00 2000 Lafarge/Surma 0.00 0.00 0.00 15.00 0.00 0.00 0.00 15.00 2003 RAKCeramics 7.20 0.00 0.00 0.00 7.20 0.00 0.00 0.00 2000 United Leasing 2.57 0.00 0.00 0.00 2.57 0.00 0.00 0.00 Total portfolio: 150.80 12.28 0.00 28.47 91.80 12.25 0.00 28.47 Approvals Pending Commitment FY Approval Companv Loan Eauitv Ouasi Partic. 2000 USPCL 0.00 0.00 0.00 0.00 1998 Khulna 0.00 0.00 0.00 0.00 Totalpendingcommitment: 0.00 0.00 0.00 0.00 150 BangladeshAvianInfluenzaPreparednessandResponseProject Annex 14:Countryat a Glance Bangladesh at a glance 5/9/07 POVERTY and SOCIAL South Low. Bangladeah Asla Income Development diamond. 2006 Population, mid-year (mllllons) 144.4 1,470 2,353 GNI per capita (Atlas method, US$) 460 684 560 Life expectancy GNi (Atlas method. US%billions) 69,9 1,005 1,364 Average annual growth, 2000-06 Population (%) 1.e 1.7 1.e Labor force (%) 2.2 2.1 2.3 Gross primary Most recent eatlmate (latest year avallable, 2000-06) capita enrollmenl Poverty I%of population below nationalpoverfy h e ) 50 Urban population (% of total population) 25 29 31 Life expectancy at birth (years) 63 63 59 i Infant mortality (per 1,000 live births) 56 66 60 Child malnutrition (% of children under5) 48 45 39 Access to imoroved water source Access to an improved water source (% ofpopulation) 74 84 75 Literacy (% of population age 15+) 41 60 62 Gross primary enrollmenl (% of school-age population) 109 110 104 - Bangladesh Male 107 116 110 Low-income group ~ Female 111 105 99 KEY ECONOMIC RATIOS and LONG-TERM TRENDS 1966 1996 2006 2006 Economlc ratios. GDP IUS$ billions) 21.2 40.7 60.0 62.0 Gross capital formationIGDP 16.7 20.0 24.5 25.0 Exports of goods and ServicesIGDP 5.4 11.1 16.6 17.6 Trade Gross domestic savingsIGDP 9,6 12.4 20.0 20.3 Gross national savingsIGDP 16.9 20.0 25.8 26.6 T Current account balance/GDP -5.1 -3.2 -0.9 0.9 Interest paymentsIGDP 0.7 0.5 0.4 Domestic Capital Total debVGDP 36.1 37.7 30.6 savings formation Total debt service/exporls 26.4 11.4 5.8 Present value of debVGDP 22.0 i Present value of debtlexports 96.5 Indebtedness 1986-96 1996-06 2006 2006 2006-10 (average annual growth) GDP 4.2 5.4 6.0 6.7 6.3 -Bangladesh GDP per capita 1.6 3.4 4.0 4.8 4.5 Low-income arouo Exports of goods and services 11.7 9.6 15.6 15.7 12.5 Industry 21.5 24.9 27.2 28.1 '0 Manufacturing 14.0 15.4 16.5 17.2 c < Services 46.5 49.5 52.6 52.4 I Household final consumption expenditure 85.8 83.2 76.4 76.1 O ? 02 03 04 05 06 General gov't final consumption expenditure 4.3 4.4 5.5 5.6 imports of goods and services 12.2 16.7 23.0 24.4 -GCF -GDP 2.3 3.6 2.2 4.5 I 'OT Gross capital formation 6.7 8.6 10.7 6.0 -Exports -O'lmporls Note: 2006 data are preliminary estimates. Group data are for 2005 *The diamonds show four key indicators in the country (in bold) compared with its income-group average. if data are missina. the diamond will be incomplete. 151 Bangladesh PRICESand GOVERNMENT FINANCE I986 1996 2005 2006 Domesticprices 1 Inflation c (% change) Consumer prices 6.7 6.5 7.0 ImplicitGDP deflator 8.0 4.2 5.1 5.2 Governmentfinance (% of GDP, includescurrentgrants) Current revenue 9.5 9.0 10.5 10.7 Current budgetbalance 4.1 2.2 2.1 2.2 Overall surplus/deficit -3.1 -4.5 -3.8 -3.3 TRADE 1986 1996 2005 2006 (US$millions) Export and import levels (US$mill.) i Total exports (fob) 819 3.884 8,573 10,422 Ii~nnn, Rawjute 124 91 96 117 Leather and leather products 61 241 221 269 Manufactures 486 3,205 7,819 9,506 Total imports (ciff 2,364 6,947 11,870 13,301 Food 356 570 1,607 1,801 Fuel and energy 342 274 1,602 1,795 Capitalgoods 1,003 1,918 1,794 2,010 Export priceindex (2000=?00) 46 85 119 122 00 01 M 03 04 05 OB Import price index (2000=100) 48 79 134 141 Exports Imports Terms of trade (2000=100) 96 108 89 87 BALANCE of PAYMENTS 1986 1996 2005 2006 (US$millions) Currentaccount balanceto GDP (%) c Exports of goods and services 1,043 4,437 9,750 11,718 Importsof goods and services 2,587 7,604 13,917 15,707 Resourcebalance -1,544 -3,167 -4,167 -3,989 Net income -126 55 -680 -786 Net currenttransfers 586 1,821 4,290 5,347 Currentaccountbalance -1,084 -1,291 -557 572 Financing items (net) 1,212 274 624 -207 Changes in net reserves -128 1,017 -67 -365 Memo: Reservesincludinggold (US$ millions) 1,878 2,929 3,488 Conversion rate (DEC, local/US$) 29.9 40.9 61.8 67.2 EXTERNAL DEET and RESOURCEFLOWS 1986 1996 2004 2005 (US$ millions) Compositionof 2005 debt (US$mill.) Totaldebtoutstanding and disbursed 8,062 15,341 20,129 18,935 IBRD 61 46 0 0 IDA 2,450 5,713 8,895 8,688 Total debt service 448 672 671 791 IBRD 5 8 8 0 IDA 28 92 208 223 Composition of net resourceflows Officialgrants 553 596 822 671 Officialcreditors 843 548 557 339 Private creditors 55 -30 -16 -9 Foreigndirectinvestment(netinflows) 2 14 449 802 Portfolio equity (net inflows) 0 -117 4 1 C:308 World Bank program Commitments 383 168 707 500 A IBRD E Bilateral ~ Disbursements 337 279 615 547 B IDA D Other multilateral - F Private - Principal repayments 8 54 148 153 C IMF --- G -Short-term Netflows 330 225 467 394 Interest payments 25 45 68 70 Nettransfers 305 180 399 325 Development Economics 5/9/07 152 IBRD 35246 TistaR. 89° 90° 91° 92° Panchagar BANGLADESH PANCHAGAR AVIAN INFLUENZA PREPAREDNESS THAKURGAON LALMONIRHA 26° Thakurgaon NILPHAMARI AND RESPONSE PROJECT 26° Nilphamari GEOGRAPHY T Lalmonirhat R. KURIGRAM ra DINAJPUR Rangpur put Kurigram ma DISTRICT CAPITALS DISTRICT BOUNDARIES Dinajpur RANGPUR Brah DIVISION CAPITALS DIVISION BOUNDARIES NATIONAL CAPITAL INTERNATIONAL BOUNDARIES Gaibandha GAIBANDHA JOYPURHAT Joypurhat SERPUR Sunamganj 25° NAOGAON 25° Serpur Jamalpur NETROKONA SYLHET Naogaon SUNAMGANJ BOGRA Netrokona Sylhet Bogra Jamuna JAMALPUR Mymensingh SYLHET NOWABGANJ RAJSHAHI R. MYMENSINGH Nowabganj RAJSHAHI DHAKA Kishorganj MOULVI BAZAR Ganges Serajganj Rajshahi Moulvi Natore HABIGANJ TANGAIL Bazar R. SERAJGANJ KISHORGANJ NATORE Tangail R. Habiganj PABNA GAZIPUR Meghna 24° Pabna Gazipur NARSINGDI BRAHMAN 24° KUSHTIA Narsingdi BARIA INDIA Brahmanbaria Kushtia Manikanj DHAKA MEHERPUR Meherpur MANIKGANJ RAJBARI Rajbari DHAKA NARAYNGANJ Chuadanga CHUADANGA Madhumati Naraynganj Jhenaidah R. Faridpur PaMUNSHIGANJ COMILLA Magura Munshiganj FARIDPUR dma JHENAIDAH R. Comilla MAGURA INDIA SARIATPUR CHANDPUR Jessore Narail MADARIPUR Sariatpur Chandpur Madaripur Khagrachhari JESSORE NARAIL GOPALGANJ KHAGRACHHARI 23° KHULNA Gopalganj Feni 23° LUXMIPUR Luxmipur FENI Khulna BARISAL NOAKHALI Noakhali Satkhira KHULNA Barisal Meghna PEROJPUR Bhola SATKHIRA Bagerhat Jhalukathi CHITTAGONG Rangamati JHALUKATHI R. Perojpur BAGERHAT RANGAMATI BARISAL CHITTAGONG Patuakhali KarnaphuliR. BHOLA PATUAKHALI Chittagong Borguna Bandarban BARGUNA 22° BANDARBAN COX'S BANGLADESH MY Dhaka ANMAR BAZAR Cox's Bazar INDIA Bay 0 25 50 75 100 KILOMETERS of MYANMAR Bay of Bengal 21° This map was produced by the Map Design Unit of The World Bank. 21° Bengal The boundaries, colors, denominations and any other information shown on this map do not imply, on the part of The World Bank Group, any judgment on the legal status of any territory, or any endorsement or acceptance of such boundaries. SRI LANKA 90° 91° 92° JANUARY 2007 88 89 90 91 92 Tetulia Panchagar Patgram Atwari PANCHAGAR Boda Baliadangi Dimla BANGLADESH Domar Debiganj THAKURGAON Hatibanda Bhurungamari NILPHAMARI 26 Jaldhake Thakurgaon Kaliganj 26 Khansama Nilphamari AVIAN INFLUENZA PREPAREDNESS Ranisonkail LALMONIRHAT Kishorganj Nageswari Fulbari Pirganj Aditmari Birganj Haripur Gangachara Lalmonirhat KURIGRAM AND RESPONSE PROJECT Kaharol Saidpur Kurigram Bochagan DINAJPUR Badarganj Rangpur Kaunia Razarhat Chirirbandar Taraganj RANGPURPirgachha Ulipur Biral DIVISIONS, DISTRICTS AND UPAZILAS Parbatipur Dinajpur Mithapukur Rahumari Chilmuri Sundarganj Fulbari Nowabganj Pirganj Razibpur Sadullapur Birampur GAIBANDHA Hakimpur Gaibandha Ghoraghat Palasbari Bakshiganj Panchbibi Fulchari Jhinaigati JAIPURHAT Gabindaganj Dewanganj Shapahar Dhamoirhat Jaipurhat Shaghata Sribardi Haluaghat Nalitabari Tahirpur Islampur Durgapur Kalmakanda Bishambarpur Dwarabazar Companiganj Jaintapur 25 Patnitala Kalai Dhubaura Porsha NAOGAON Khetal Sibganj Sonatola SHERPUR Gowainghat NETRAKONA Sunamganj Kanairghat Badalgachhi Jamalganj Chatak 25 Mohadebpur Akkelpur BOGRA Melandaha Sherpur Purbadhala Dharmapasha Bholahat Nakla Dupchachia Gabtali Madarganj Phulpur SYLHET Barhatta SUNAMGANJ R A J S H A H I MYMENSINGH Zakiganj Shariakandi Jamalpur Netrakona Sylhet Beani Gomastapur Niamatpur JAMALPUR Mohanganj Biswanatn Golapganj Bazar Manda Mymensingh Dirai Naogaon Adamdighi Kahalu Bogra Atpara Muktagacha S Y L H E T Shibganj Nachol Guaripur Jagannathpur CHAPAI Raninagar Dhunot Fenchuganj Nandigram Sarishabari Kendua Modan I N D I A NAWABGANJ D H A K A Balaganj Barlekha Tanor Sherpur Kazipur Khaliajuri Bagmara Atrai Madhupur Ishwarganj Sulla Chapai Phulbaria Golpalpur Trisal Nabiganj Rajnagar Nawabganj Mohanpur Singra Tarail Ajmiriganj Kulaura Godagari Nandail HABIGANJ RAJSHAHI Durgapur Raiganj Itna Sirajganj Moulavibazar Natore NATORE Ghatail Baniyachang Paba SIRAJGANJ Bhuapur Hossainpur Karimganj Puthia Taras TANGAIL MOULAVIBAZAR Gurudaspur Kamarrhandi Gafargaon Kishorganj Mithamoin Rajshahi Ullapara Katihati Bhaluka KISHORGANJ Kamalganj Srimangal Bagatipara Shakhipur Pakundia Astogram Habiganj Charghat Baraigram Belkuchi Katiadi Nikli Bahubal Chatmohar Delduar Lakhai Basail Sripur Bajitpur Bagha Lalpur Bhangura Shahzadpur Tangail PABNA Chauhali Faridpur GAZIPUR Kuliarchar Nasirnagar Chunarughat Ishardi Kapasia Monohardi Atgharia Bhairab Madhappur Daulatpur Bheramara Mirzapur Sarail 24 Bera Nagarpur Kaliakoir Gazipur Sibpur Belabo Pabna Santhia NARSINGDI Brahmanbaria 24 Mirpur Kaliganj Palas Raipur Note: Meherpur upazila has Daulatpur Saturia Sujanagar Dhamrai BRAHMANBARIA been divided into two upazilas: Kushtia Ghior Savar Narsingdi Meherpur and Mujibnagar. Gangni Kumarkhali Manikganj DHAKA Nabinagar KUSHTIA Sibalay Rupganj Akhaura Khoksa MANIKGANJ Singair Bancharampur Meherpur Araihazar Pangsa DHAKA Kasba MEHERPUR Alamdanga Harirampur NARAYANGANJ Sailkupa RAJBARIRajbari Sonargaon Nawabganj Muradnagar Harinakundu Faridpur Keraniganj NarayanganjHomna Brahmanpara Damurhuda Chuadanga JHENAIDAH Baliakandi Sripur Char Dohar Serajdikhan Bandar Bhadrassan Srinagar Debiduar CHUADANGA Gazaria Jhenaidah Madhukhali FARIDPUR Munshiganj Daudkandi Burichang Sadarpur Kotchandpur Magura Mohaminadpur MUNSHIGANJ Nagarkanda Lohajang Tangibari Chandina Jiban Nagar Kaliganj MAGURA Comilla Baghaichari Salikha Boalmari Bhanga Sibchar Janjira Matlab Barura Maheshpur Kachua SHARIYATPUR Muksudpur Chaugacha Alfadanga MADARIPURShariyatpur Naria CHANDPUR COMILLA Panchari Hajiganj Dighinala Bagherpara Chandpur Chauddagram Jessore Lohagara Kasiani Madaripur Bhedarganj Laksam KHAGRACHARI Narail Rajoir Shahrasti Pashuram Jhikargacha NARAIL Goshairhat Faridganj Khagrachari K H U L N A GOPALGANJ Kalkini Damudya Nangalkot Haimchar Sarse Ramganj 23 Gopalganj Matiranga Manirampur Abhaynagar Kalia Kotalipara Raipur Chatkhil Senbag Feni 23 JESSORE Muladi Tungipara Agailjhara Chhagalnaiya Hizla LAKSMIPUR Ramgar Mohaichar Laigadu Phultala Terakhada Gaurnadi Daganbhuiya Begumganj FENI Kalaroa Keshabpur Daulatpur Ujirpur BARISAL Laksmipur Mollahat Sonagazi Manikchari Nannerchari C H I T T A G O N G Mehendiganj Dumuria Khulna Banaripara Noakhali Rupsa Babuganj Satkhira Tala FakirhatChitaimari Nazirpur NOAKHALI Companiganj Mirsharai Laksmichari Barkal Batiaghata Sarupkati Fatikchari Bagerhat PIROJPURJhalakati Barisal Bhola Kachua Jurachari Nalchiti CHITTAGONG Kawkhali Rangamati Debhata BAGERHAT Kawkhali I N D I A JHALAKATI Daulatkhan Ramgati Sitakunda Asasuni Paikgacha Dacope Rampal Rajapur Pirojpur RANGAMATI SATKHIRA Bakerganj Rauzan Hathazari Kaptai Morelganj Bhandaria Burhanuddin Sandwip Rangunia Kaliganj Betagi Tajumuddin KHULNA Mongla Kathalia Bauphal BHOLA Mirzaganj Hatiya Boalkhali Rajasthali Belaichari Koyra Patuakhali Shyamnagar Sarankhola Chittagong Mathbaria Bamna B A R I S A LLalmohan Patia Dashmina Monpura Rowangachari This map was produced by BORGUNA Anwara Chandanais Char Fasson the Map Design Unit of The Galachipa Borguna Bandarbon World Bank. The boundaries, Amtali Satkania BANDARBON colors, denominations and Patharghata Ruma 22 any other information shown Lohagara on this map do not imply, on Banskhali 22 the part of The World Bank PATUAKHALI Group, any judgment on the Kalapara legal status of any territory, or any endorsement or Bay of Bengal Kutubdia Thanchi a c c e p t a n c e o f s u c h Chakaria Lama boundaries. Alikadam NEPAL BHUTAN Moheshkhali COX'S BAZAR Nakhyangchari Ramu I N D I A Cox's Bazar UPAZILA HEADQUARTERS BANGLADESH DISTRICT HEADQUARTERS Ukhia MY DIVISION HEADQUARTERS DHAKA ANMAR NATIONAL CAPITAL I N D I A UPAZILA BOUNDARIES 21 0 20 40 60 Kilometers DISTRICT BOUNDARIES Teknaf MY DIVISION BOUNDARIES JANUAR ANMAR 0 20 40 Miles INTERNATIONAL BOUNDARIES IBRD 35247 Y Bay of Bengal 2007 90 91 92