BACKGROUND: Project activities supporting Avian Influenza (AI) prevention, preparedness and planning, and response and containment are not expected to generate significant adverse environmental effects, they do present a moderate environmental and human health risk from inadvertent spread of the AI virus and waste management. Overall the AI prevention and response-focused activities are expected to have a positive environmental impact, as the investments in facilities, equipment, and training for veterinary and public health service staff and laboratories will improve the effectiveness and safety over existing avian influenza handling and testing procedures by meeting international standards established by the World Organization for Animal Health (OIE) and the World Health Organization (WHO). This would be reinforced by the mainstreaming of environmental safeguards into protocols and procedures for the culling and disposal of animals during AI outbreaks.
PROJECT OBJECTIVE: The overall development objective of the project is to minimize the threat posed to humans and the poultry industry in Turkey by AIHP and other zoonoses in domestic poultry, and to prepare for, control, and respond to influenza pandemics and other infectious disease emergencies in humans. To achieve this, three areas would be supported by the project:
i) prevention;
ii) preparedness and planning; and
iii) response and containment.
Achieving these goals will contribute to diminishing the burden of disease and loss of productivity in Turkey, limiting the regional spread of AIHP, and enhancing economic and social prospects at the national, regional, and global levels.
PROJECT DESCRIPTION: The Project consist of the following three components: i) Animal Health, ii) Human Health, and iii) Public Awareness and Coordination support:
I. Animal Health Component: The Project will support activities to cover the needs in the short, medium or long-term, and ranging from prevention, to control and total eradication of AIHP, which have been based on an assessment of the particular conditions, constraints and possibilities in Turkey (including a rapid assessment of veterinary services and recent assessments of the poultry sector). These activities fall into the three main and seven sub components described below and total US$ 30.86 million:
A. National policy framework and development of a national strategy sub-component
B. Strengthening Disease Surveillance and Diagnostic Capacity Sub-component
C. Outbreak Containment Plan
II. Human Health Component: In the public health field, short-and long-term actions need to be taken and an appropriate balance struck between the two. While immediate steps can be taken to address the crisis, there is also a longer-term agenda given systemic shortcomings with respect to core public health functions. Work on both the short- and long-term fronts, therefore, needs to proceed in parallel, and efforts should be made to ensure that short-term responses are consistent with and contribute to proposed longer-term interventions. Setting priorities in both cases is essential.
Building an effective national public health response will require an enabling environment and the necessary resources to bring proven interventions quickly up to nationwide scale. Thus, the Project will help to operationalize some elements that are contemplated as part of the global strategic plan, expanding and intensifying the responses rapidly. As it is unlikely that the global spread of a pandemic influenza virus could be prevented once it emerges, the emphasis is on reducing its impact. Several tools will help achieve this aim:
i) year-round surveillance;
ii) effective and accurate methods of diagnosis;
iii) social distance interventions;
iv) vaccines (once they become available);
v) anti-viral drugs; and
vi) strengthened medical services.
The interventions supported under the Project will be based on Turkey’s epidemiological and programmatic needs, and well-assessed options for meeting them. The interventions will be grouped in three sub-components, totaling US$ 20.84 million.
A. Enhancing Public Health Program Planning and Coordination
B. Strengthening of National Public Health Surveillance Systems
C. Strengthening Health System Response Capacity
III. Public Awareness and Coordination Support Component: This component will support strategic communication activities for stakeholders and beneficiaries. Similarly, resources will be allocated for improved coordination between the Ministry of Agriculture and Rural’s (MARA) regulatory framework and contingency plans, and National Pandemic Influenza Action Plan of the Ministry of Health (MOH).
A. Public Awareness through Information and Communication Services
B. Coordination Support
IMPLEMENTING and MONITORING: The Project will be implemented by existing project implementation structures in the MARA and the MoH. However, public information and project coordination arrangements will be overseen by the existing National Zoonotic Disease Committee (NZDC). This Committee has been established jointly by the MARA and the MOH to deal with zoonotic emergencies and will provide general policies and guidelines for Project implementation. The Committee comprises representatives of the MARA, the MOH, and other relevant ministries, agencies, and academic institutions. The Committee will review annual work plans and ensure coordination and linkages across relevant agencies and international partners.
Since the Bank is financing both agricultural sector and health sector projects in Turkey, the existing project implementation structures within the MARA (the Central Execution Unit of the Agricultural Reform Implementation Project, MARA CEU) and the MoH (the Health Transition Project Unit, MoH PIU) will be entrusted with fiduciary tasks of procurement and financial management. (Additional staff will to be recruited in the MARA CEU and the MoH PIU as needed for these fiduciary tasks.) One senior officer from the MARA and one from the MoH will be designated as Project Coordinators in charge of managing implementation of their relevant ministries’ project activities and liaising with the MARA CEU and MoH PIU, respectively. These Project Coordinators will provide reports to the NZDC and would be invited as observers to the NZDC meetings. The NZDC will also be supported by a Public Information and Communications Specialist (consultant) to support its public information efforts.
At the local level, implementation would be the direct responsibility of the respective Provincial Directorates of Agriculture and Health. At times of outbreaks, the provincial governor will guide implementation of cross-sectoral activities, and if necessary set up local disease crisis centers to ensure cross-sectoral coordination.
Monitoring and Evaluation (M&E) activities related to the project will be the responsibility of the MARA CEU and the MoH PIU, with the participation of the staff of the departments of the two ministries. These two implementation units have built up M&E capacity, but some detailed surveys for M&E would be contracted out. Monitoring project progress and the achievement of objectives will entail a process for reviewing continuously and systematically the various project implementation activities. The purpose of the M&E activities are to:
i) measure input, output and outcome indicators;
ii) provide information regularly on progress toward achieving results and facilitating reporting to the government and the Bank
iii) alert managers, both in government and the Bank, to actual or potential problems in implementation so that adjustments can be made;
iv) determine whether the relevant stakeholders are responding as expected and intended by the project; and
v) provide a process whereby the coordinating and executing bodies can reflect and improve on their performance.
BENEFITS: The Project will support the implementation of immediate term responses to an influenza pandemic -- the classic “social distancing measures”-- such as quarantine, bans on mass gatherings, and travel restrictions that may be politically and socially controversial. This means that dialogue and compromises are needed among different stakeholders, backed by a well-designed communication strategy. A high degree of political commitment to preventing and controlling the spread of infectious diseases such as an influenza pandemic would be needed for managing controversies that will undoubtedly arise. Activities under AI projects are expected to generate significant positive effect to poultry sector in Turkey as they are focused largely on public sector capacity building and improved readiness for dealing with outbreaks of avian influenza in domestic poultry. This would be reinforced by the mainstreaming of environmental safeguards into protocols and procedures for the culling and disposal of animals during AI outbreaks. In addition, restructuring of the poultry sector will be realized using the project supports.
PROJECT STATUS: The Loan will become effective on June 2006. Procurement will begin with the preparation of draft bidding documents for the laboratory equipments, consultancy activities and training requirements.
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