Documentof The World Bank FOR OFFICIAL USEONLY ReportNo: T7686-VN TECHNICAL ANNEX ONA PROPOSEDCREDIT INTHEAMOUNT OFSDR13.5MILLION (US$20MILLIONEQUIVALENT) TO THE SOCIALIST REPUBLIC OF VIETNAM FOR A VIETNAM AVIAN AND HUMANINFLUENZA CONTROL AND PREPAREDNESSPROJECT UNDERTHE GLOBAL PROGRAMFOR AVIAN INFLUENZA AND HUMANPANDEMIC PREPAREDNESSAND RESPONSE(GPAI) FORELIGIBLE COUNTRIESUNDER THE HORIZONTAL APL February 15,2007 This document has a restricted distribution and may be used by recipients only in the performance of their official duties. Its contents may not otherwise be disclosed without World Bank authorization. CURRENCYEQUIVALENTS (Exchange Rate Effective February 14,2007) Currency Unit = Vietnamese Dong(VND) VND 15,977.50 = US$1 US$1.49 = SDRl FISCAL YEAR January 1 - December31 ABBREVIATIONS AND ACRONYMS AH1 Avian and Human Influenza ADR European Agreement concerning the InternationalCarriage of Dangerous Goods by Road AFD France Development Agency AI Avian Influenza AIERP Avian Influenza Emergency Recovery Project APL Adaptable Loan Program APM Administration for Preventive Medicine APMB Agricultural Project Management Board VSF Veterinarians without Borders B S L Biosafety Level CAHW Community Animal Health Worker CTA Chief Technical Advisor CVB Commune Veterinary Board DAH Department o f Animal Health DARD (Provincial) Department o f Agriculture and Rural Development DLP Department o f Livestock Production DOH Department of Health DPHC District Preventive Health Center DVS District Veterinary Station EIA Environmental Impact Assessment EMP Environmental Management Plan ERL Emergency Recovery Loan FA0 Foodand Agriculture Organizationof the United Nations GPAI Global Program for Avian Influenza and Human Pandemic Preparedness and Response HCMC H o Chi MinhCity HPAI HighlyPathogenic Avian Influenza IATA International Air Transport Association ICD InternationalCooperation Department IEC Information, Education and Communication IFR InterimFinancial Report IS International Shopping (procurement method) JSDF Japan Social Development Fund FOROFFICIAL USE ONLY L S Local Shopping (procurement method) MARD Ministryof Agriculture and Rural Development M O H Ministry of Health MONRE Ministryof NaturalResources andEnvironment NAP National Action Plan (for AH1control) NGO Non-GovernmentalOrganization NIAH National Institute of Animal Husbandry NlVR National Institute of Veterinary Research NSCAHI National Steering Committee for Avian and Human Influenza Control NSCAI National Steering Committee for Avian Influenza Disease Control and Prevention NVDC National Veterinary Diagnostic Center OIE World Organization for Animal Health OPI IntegratedNational Operational Program for the Avian and Human Influenza 2006 - 2010 ("The GreenBook") PAHI Partnership for Avian and Human Influenza Control PCU Project Coordination Unit PIA Project Implementation Agency PIP / PIM Project Implementation Plan / Project ImplementationManual PlT Provincial Implementation Team (DARD, DOH) PPC Provincial Peoples' Committee PPE Personal Protection Equipment PPMU Provincial Project Management Unit PPR Project Preparation Report PSC Provincial Steering Committees for Avian Influenza RVC Regional Veterinary Center SDAH (Provincial) Sub-Department of Animal Health SDLP (Provincial) Sub-Department of Livestock Production SOE Statement o f Expenditures SOP Standard Operating Procedure SBV State Bank of Vietnam VBARD Vietnam Bank of Agriculture & Rural Development vwu Vietnamese Women's Union WHO World Health Organization Vice President: James Adams, EAPVP Acting Country Director: Laurent Msellati, EACVF Sector Managers: Hoonae Kim, EASRE/ Fadia Saadah, EASHD Task Team Leaders: Severin Kodderitzsch, E A S E/ Samuel Lieberman. EASHD 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. VIETNAM VN Avian & HumanInfluenza Control& PreparednessProject CONTENTS Page A STRATEGIC CONTEXT AND RATIONALE . ................................................................................... 1 1. Introduction......................................................................................................................... 1 2. Country and Sector Issues................................................................................................... 2 3. Rationale for Bank Involvement......................................................................................... 4 4. Country Eligibility under GPAI ......................................................................................... 4 B NationalAvian Influenza Control and HumanPandemicInfluenza Planfor Vietnam . .................5 1. General Objectives.............................................................................................................. 5 2. Components of the National Plan ....................................................................................... 5 3. Institutional Aspects............................................................................................................ 6 C Project Description . ................................................................................................................................ 7 1. Project Development Objective.......................................................................................... 7 2. Project Components ............................................................................................................ 8 3. Lessons Learned and Reflected inthe Project Design...................................................... 13 D Implementation . .................................................................................................................................... 15 1. Partnership Arrangements ................................................................................................. 15 2. Institutional and ImplementationArrangements .............................................................. 16 3. Monitoring and Evaluation (M&E) of Project Outcomes and Results ............................. 21 4. Sustainability. Critical Risks and Possible Controversial Aspects ................................... 23 5. Credit Conditions and Covenants ..................................................................................... 25 E Appraisal Summary . ............................................................................................................................ 28 1. Economic and Financial Analysis..................................................................................... 28 2. Technical........................................................................................................................... 29 3. Fiduciary ........................................................................................................................... 31 4. Procurement ...................................................................................................................... 32 5. Social................................................................................................................................. 32 6. Environment...................................................................................................................... 33 7. Safeguards Policies ........................................................................................................... 33 8. PolicyExpectationandReadiness.................................................................................... 34 Appendix Appendix 1:ResultsFrameworkandMonitoring................................................................ 35 Appendix 2: DetailedProjectDescription............................................................................ 39 Appendix 3: ProjectCost...................................................................................................... 63 Appendix 4: FinancialManagementandAssessmentReport.............................................. 65 Appendix 5: ProcurementArrangements.............................................................................. 74 80 Appendix 7: Social Analysis................................................................................................. Appendix 6: EnvironmentalAnalysis................................................................................... 88 Appendix 8: EconomicAnalysis .......................................................................................... 90 Appendix 9: TechnicalNotes................................................................................................ 95 106 Appendix 11:Countryat a Glance...................................................................................... Appendix 10: Statement of LoansandCredits................................................................... 108 CountryMap with ProjectAreas ........................................................................................ 110 VIETNAM VIETNAM AVIAN & HUMAN INFLUENZA CONTROL & PREPAREDNESSPROJECT TECHNICAL ANNEX EAST ASIA AND PACIFIC EASRE Date: February 15, 2007 TeamLeaders: SeverinL.Kodderitzsch, Samuel Lieberman Acting Country Director: LaurentMsellati Sectors: Health (SO%);Animalproduction Sector ManageriDirector: Hoonae Kid Fadia (50%) Saadah Themes: Other CommunicableDiseases (P); RuralServicesand Infrastructure(P); Natural Disaster Management(P) ProjectID: P101608 Environmental screening category: Partial Assessment Lending Instrument: Emergency Recovery Loan Project FinancingData [ ]Loan [XI Credit [ ] Grant [ ] Guarantee [ ] Other: For Loans/Credits/Others: TotalBank financing (US$m.): 20.00 INTERNATIONAL DEVELOPMENT 18.00 2.00 20.00 ASSOCIATION JAPAN: MINISTRY OF FINANCE - 4.70 0.30 5.00 PHRDGRANTS FOREIGN MULTILATERAL 9.00 1.oo 10.00 INSTITUTIONS(UNIDENTIFIED) Total: 34.70 3.30 38.00 Borrower: Ministry of Agriculture and RuralDevelopmentand Ministry of Health 2, Ngoc Ha (MARD) 138A, GiangVo (MOH) Hanoi Vietnam Tel: 84-4-8433400 Fax: 84-4-7330752 icdmard0fpt.vn i ResponsibleAgencies: VAHIP will be an integrated operation implemented over a three year period. The Ministry of Agriculture and Rural Development (MARD) will be responsible for implementation o f Component A (HPAI Control and Eradication in the Agricultural Sector) and the Ministry o f Health (MOH) for Component B (Influenza Prevention and Pandemic Preparedness inthe Health Sector). MARD also will take lead responsibility to initiate the implementation o f subcomponent C (Integration and AH1 Coordination, Results M&E, and Project Management). Estimateddisbursements@aukFYIuS$m) ZY 2007 2008 2009 2010 2011 ~~ 4nnual 0.50 4.00 7.50 6.00 2.00 Zumulative 0.50 4.50 12.00 18.00 20.00 Does the project meet the Regional criteria for readiness for implementation? Ref. TechnicalAnnex E.8 [XIYes [ ] N o Project development objective Ref. TechnicalAnnex C.1 The project's development objective i s to increase the effectiveness of Government services in reducing the health risk to poultry and humans from avian influenza in eleven high priority provinces and thus contribute to addressing HPAI at the national level by controlling the disease at source in domestic poultry, by early detection and response to poultry and human cases, and by preparing for the medical consequences of a human pandemic, if it occurs, over the next five years. This i s in line with and supports the implementation of Vietnam's plans for the medium to long-term control o f avian and human influenza as outlined in its National Strategy, and i s fully consistent with the approach envisaged under the Global Program for Avian Influenza and Human Pandemic Preparedness and Response (GPAI). Project description Ref. TechnicalAnnex C.2 and Appendix 2 VAHIP will be implemented ineleven provinces and comprising three components: Component A: HPAI Control and Eradication in the Agricultural Sector - will strengthen veterinary services; enhance disease control, undertake surveillance and epidemiological investigations, support the Ministry o f Agriculture in analyzing and preparing for the restructuring o f the poultry sector; and develop and implement emergency outbreak containment plans. .. 11 Component B: Influenza Prevention and Pandemic Preparedness in the Health Sector - will improve the technical quality o f the surveillance and response systems; improve the technical quality and efficiency o f curative care preparedness; strengthen behavior change and communication (BCC) in health facilities and the community; and strengthen the preventive health system at local level. Component C: Integration and OPI Coordination, Results M&E, and Project Management - will support the integration and coordination o f the National Avian and Human Influenza Program, undertake monitoring and evaluation o f project but also national results, and undertake project management at the central and provincial level. Which safeguard policies are triggered, if any? Ref. TechnicalAnnex E.7; Appendices 6&7 Among the Bank's safeguards policies, the Environmental Assessment (OP4.01), Indigenous Peoples (OP4.10) and Involuntary Resettlement (OP4.12) are triggered. The project design incorporates the necessary mitigation measures for the potential adverse impacts associated with the activities involved inresponding to HPAIoutbreaks. Significant, non-standard conditions, if any, for: Ref. TechnicalAnnex D.5 Conditions of Effectiveness include: 1. The AH1 Facility Trust Fund Grant Agreement and the PHRD Grant Agreement have been executed and delivered and all conditions for their respective effectiveness or the right of the Recipient to make withdrawals under both of themhave been fulfilled; 2. At least one of the MARDor MOHPCUs has: (i)beenestablishedandstaffedwithatleastthefollowingkeystaff PCUdirector, procurement officer, accountant, technical managers for each sub-component o f the Project Component under the responsibility of the PCU; the PCU managers and staff should have qualifications, experience and terms o f reference acceptable to the Association; (ii) its respective Project ImplementationManual (PIM), which includes, adopted among others, financial management guidelines, an Ethnic Minorities Communication Plan and guidelines for the implementation o f environmental management procedures; as well as the Resettlement Policy Framework and the Resettlement Action Plan; acceptable to the Association; (iii)set up a computerized accounting system consistent with the financial management guidelines of the PIM, satisfactory to the Association; (iv)developed and implemented a comprehensive training and capacity building program for its financial management staff, in a manner satisfactory to the Association; and (v) adopted its respective Procurement Plan for the first 18 months of Project imdementation acceDtable to the Association. 111 ... Conditionsof Disbursement 1. For disbursement of the proceeds allocated to Components A and C (under the responsibility o f MARD), the MARD PCUhas: (i)beenestablishedandstaffedwithatleastthefollowingkeystaff PCUdirector, procurement officer, accountant, technical managers for each sub-component of the Project Component under the responsibility o f the PCU; the PCU managers and staff should have qualifications, experience and terms o f reference acceptable to the Association; (ii)adopted its respective Project Implementation Manual (PIM), which includes, among others, financial management guidelines, an Ethnic Minorities Communication Plan and guidelines for the implementation of environmental management procedures; as well as the Resettlement Policy Framework and the Resettlement Action Plan; acceptable to the Association; (iii)set up a computerized accounting system consistent with the financial management guidelines o f the PIM, satisfactory to the Association; (iv)developed and implemented a comprehensive training and capacity building program for its financial management staff, in a manner satisfactory to the Association; and (v) adopted its respective Procurement Plan for the first 18 months of Project implementation acceptable to the Association. 2. For disbursement of the proceeds allocated to Component B (under the responsibility o f MOH), the MOHPCUhas: (i)beenestablishedandstaffedwithatleastthefollowingkeystaff: PCUdirector, procurement officer, accountant, technical managers for each sub-component o f the Project Component under the responsibility o f the PCU; the PCU managers and staff should have qualifications, experience and terms o f reference acceptable to the Association; (ii) its respective ProjectImplementationManual (PIM), which includes, adopted among others, financial management guidelines, an Ethnic Minorities Communication Plan and guidelines for the implementation of environmental management procedures; acceptable to the Association; (iii)set up a computerized accounting system consistent with the financial management guidelines o f the PIM, satisfactory to the Association; (iv)developed and implemented a comprehensive training and capacity building program for its financial management staff, in a manner satisfactory to the Association; and (v) adopted its respective Procurement Plan for the first 18 months of Project implementation acceptable to the Association. 3. For disbursement of the proceeds allocated to the disbursement category corresponding to - . payments of compensation to farmers in the event of an outbreak and culling: studies on improving the compensation mechanisms have been completed and a Compensation i v Manual has been adopted by MARD, satisfactory to the Association. Other CovenantsandConditions(Non-Standard) 1. The Recipient shall maintain, throughout the period o f implementation o f the Poject, the National Steering Committee for Avian Influenza to provide overall guidance and direction in the implementation o f the Project. 2. The Recipient shall appoint a Project Director from MARD and a Project Vice Director from MOH, under TOR satisfactory to IDA; 3. Each Project Province shall establish, staff and maintain throughout project implementation, its PPMUunder the Provincial People's Committee; until the PPMUhas been established with adequate resources, staffing and TOR satisfactory to IDA, the Recipient shall not provide funding from the Credit for Project activities inthe Province. 4. By no later than April 15, 2007, the Recipient shall have completed an environmental assessment o f the Project and an environmental management plan, satisfactory to the Association and publicly disclosed the assessment and the plan. 5. The Recipient shall implement environmental measures acceptable to the Association and monitor and report on the implementation of those measures. 6. Inconnection with activities to control market-based avian influenza, the Recipient shall implement the Resettlement Policy Framework and the Ha Vi Resettlement Action Plan. 7. By no later than December 31, 2007, the Recipient shall have designed a results-based monitoring and evaluation system acceptable to the Association; and MARD PCU and MOH PCU shall have completed a baseline survey of Component A and Component B, respectively, and published the results o f that survey. 8. The two PCUs shall prepare annual work plans including budget and disbursement estimates for their respective components and, by November 1o f each year, provide them to the Association for discussion. These annual work plans will consolidate the annual work plans submitted by the Project Provinces. 9. The two PCUs shall prepare semi-annually progress reports, including quarterly interim financial reports, and provide them to the Association no later than 45 days after the end o f the quarter. 10. The Recipient shall discuss with the Association any proposed modification or amendment o f the Green Book before undertaking such modification or amendment. 11. A Project Mid-TermReview will take place 12months after Effectiveness. V A. STRATEGICCONTEXT AND RATIONALE 1. Introduction 1. Highly pathogenic avian influenza (HPAI) viruses of the H 5 N l subtype continue to be endemic and have caused widespread, severe disease in poultry and fatal disease in humans in Vietnam. The disease in chickens i s almost uniformly fatal with infected birds dying within a few days o f infection. Humans are infected occasionally through direct or indirect contact with infected poultry. When disease occurs in humans it i s often fatal, has a relatively long incubation period and late appearing distinguishingsymptoms, making diagnosis and treatment particularly challenging. 2. Vietnam has made great strides in fighting HPAI the presence o f which was first confirmed on January 8, 2004. Since then, Vietnam has experienced three successive but diminishing waves of infection in poultry, with outbreaks mainly occurring in the cooler winter months of the year. This coincides with the annual Tet festival, during which poultry sales and consumption are at peak levels. In each case the epidemic has been contained, but only through the application of stringent containment measures including the imposition o f strict poultry movement controls, closure of all live-poultry markets, the rapid culling of sick and unaffected birds, and the application of biosecurity measures in de-stocked commercial, smallholder and breeding operations. Importantly, while the virus i s known to circulate widely in the environment no cases in humans have been reported since December 2005, and the first poultry outbreak o f avian influenza reported since December 2005 occurred on December 6,2006 1. 3. Avian and Human Influenza (AHI) infection has been extremely costly for Vietnam in terms o f human life and economic impact. To date, Vietnam has reported 93 human cases, including 42 fatalities. This record places Vietnam second only to Indonesia in the number o f humanfatalities. Vietnam has experienced over 2,000 outbreaks -the most of any country inthe world - and control measures have resulted inthe destruction o f over 40 million poultry or about 15 percent of the national poultry population. The direct cost o f avian influenza in Vietnam i s estimated at over US$200 million, which reduced the 2004 GDP by 1.5 percent. The unexpected and massive HPAI epidemic initially overwhelmed Vietnam's veterinary services system. Lacking a strategic fine-tuned field disease surveillance infrastructure and sufficient laboratory capacity for large-scale diagnosis and monitoring, massive culling of sick and healthy birds was undertaken in an effort to stamp out the disease during the initial outbreaks. Additional measures were introduced inthe second half o f 2005, and these combined approaches have been successful in stemming the disease, and the epidemic presently appears under control. However, continued vigilance is essential as long as the risks of further outbreaks remain (especially those that might result from the reintroduction o f the disease into Vietnam from beyond its borders). 4. RegionalDimension.The HPAIepidemic that struck Asian countries inmid-2003 has so far resultedin244 human cases world-wide, of which 144 have been fatalities ',The human toll has been especially heavy in Asia. Avian influenza has now spread to 14 Asian countries, 1WHO Avian InfluenzaUpdate(H5N1).Vietnam.February 1, 2007. WHO WorldHumanCase Statistics, October 2006 1 resulting in 214 human cases (89% o f world cases) o f which 132 were fatalities (92% o f world fatalities)3 .Vaccination of poultry i s underway in four Asian countries (China, Vietnam, Indonesia and Pakistan), albeit with mixed results, depending on vaccination strategies, the efficacy of vaccine coverage and response, and the degree o f post-vaccination monitoring which governs the decision-making of vaccination strategies. 5. Global Response. The global response to AH1 in humans and domestic poultry comprises four key strategies: (a) progressively controlling and eradicating the spread o f the disease in animals by reducing the animal-origin virus in poultry flocks, thereby reducing the risk of human infection; (b) preventing and limitingthe spread of the disease inhumans, thereby reducing the chances o f the virus acquiring human transmissibility; (c) assisting human populations to cope with the eventuality of a possible pandemic; and (d) minimizing the social and economic impacts from the threat o f H5N1. A global response to this global threat i s essential, and requires multisectoral and multinational interventions in supporting the agriculture and health sectors, natural disaster planning, and financial, technical and physical assistance to enhance medical and veterinary services. The World Bank and its principal international technical partner agencies -- the Food and Agriculture Organization o f the UN(FAO), the World Organization for Animal Health (OIE), and the World Health Organization (WHO) -- and a host of other national and international agencies have responded to this challenge by establishing global networks. NGOs and development assistance organizations are contributing to the coordinatedresponse. 2. Country and Sector Issues 6. Usin its own resources, and supported by assistance from the international donor community ,Vietnam has addressed the avian influenza epidemic in ways that offer a model for F other countries that are responding to or are threatened by HPAI. On the technical side in both the veterinary and human health sectors, Vietnam has expanded its laboratory diagnostic capacity, improved epidemiological expertise and disease reporting, enhanced management capacity, improved its capacity to identify outbreaks rapidly and effectively, and organized emergency outbreak containment. In the animal health sector, it has undertaken targeted and risk-based poultry vaccination, introduced effective movement controls on poultry and contaminatedmaterials during outbreaks, and initiated an investigative research program. 7. Vietnam has been successful in containing the AH1 problem among humans so far by applying the different lessons and assets obtained from elimination and controlling vaccine- preventable diseases and micronutrient deficiency diseases. The results have contributed to lessening the national disease burden and reaching or surpassing targets for designated Millennium Development Goal (MDG) indicators. These achievements were facilitated by the multi-tiered network o f facilities and cadres o f staff with different skills deployed to provide curative care and preventive services. On the other hand, Vietnam still faces threats from communicable disease such as tuberculosis, malaria, and dengue fever while it i s clearly vulnerable to emerging infectious illnesses, notably AHI, Severe Acute Respiratory Syndrome (SARS), and HIV/AIDS. Here, Vietnam also offers lessons on readiness and capacity to react to FA0Aide Report, September, 2006 Some 26 agencies and NGOs work inVietnam on various aspects of avian influenza. 2 program weaknesses, notably its willingness to rethink and make adjustments in policy design and implementation modalities. This reflective and resourceful approach i s seen in recent government master plans and vision statements setting inmotion a recasting o f preventive health, redesign o f surveillance, and other achievements. 8. Vietnam's response as regards institutional change and resource mobilization also deserves commendation. The government established an inter-ministerial steering committee at the central level; developed national plans and instituted a number o f projects for AH1prevention and control and for pandemic preparedness; and adopted the `Integrated Operational Program for Avian and Human Influenza' (the OPI, or Green Book) in May 2006. Following donor pledges o f US$60 million for 2006-2008 to support the OPI, the `Partnership for Avian and Human Influenza Control' (PAHI), which coordinates donor support for Vietnam's health and agriculture sectors was officially established on November 1,2006. 9. Despite the measures outlined above, the Government's response has largely focused on short-term emergency preparedness measures, and the response has largely been a reactivation of the emergency system established during the SARS outbreak o f 2003, and directed by AH1 steering committees. The province-level steering committees have been guided by top-down directives from the central level and made use o f mass organizations and other well-tested social mobilization instruments and mechanisms. They report directly to the Provincial People's Committees and by so doing, they have effectively coordinated action across animal and human health sectors, mobilized budgetary resources for AH1activities and promoted accountability of the involved sectors to the highest provincial authority. Yet despite the seeming success o f these emergency measures in the control o f AHI, they will be difficult to sustain beyond the short term and in the absence o f an emergency atmosphere. Similarly, interest among the public, vigilance and adherence to regulations and recommendedpreventive measures will diminish, as the public may be lured into a false sense o f security by the diminishingnumber of outbreaks. 10. The ongoing presence of a circulating virus and the fact that HPAI i s unlikely to be Vietnam's last emerging communicable or zoonotic disease threat point to the need to deal with HPAI by addressing system constraints in order to institutionalize preparedness. The mechanisms and resources for practical implementation of the numerous orders and procedural guidelines issued from the central level by the lower levels remain limited. At present there are large gaps in national and provincial planning and preparedness, communication and coordination between responsible agencies are inadequate, and the overall awareness o f both the general public and staff are not satisfactory to meet the growing threat of AH1pandemic. 11. The AH1 experience in Vietnam has also shed light on serious human resource constraints within preventive medicine. This may be due to the limited financial incentives relative to those within the curative care system, though there may also be other factors at play. Human resource capacity must be addressed for this and other communicable diseases to be successfully controlled over the long term. Efforts need to be piloted to increase the recruitment, retention and motivation o f preventive medicine staff at all levels. 3 3. Rationalefor Bank Involvement 12. The Bank has been involved in assisting the Government with the avian influenza crisis since the early stages of the first outbreak. In March 2004, at the request o f the Government, the Bank assisted in reviewing the National Action Plan for the Control and Eradication of Avian Influenza, and subsequently prepared the Avian Influenza Emergency Recovery Project (AIERP) to directly assist with overcoming the crisis. FAO, the Government of Japan, the Vietnam Woman Union (VWU) and Veterinarians Without Borders (AVSF) also supported the Ministry o f Agriculture and Rural Development (MARD) in the implementation of AIERP through a series o f strategic studies and poultry restocking in ten of the country's worst affected provinces. The Bank led a multi-donor mission to assist with preparation of the OPI, and then coordinated in the multi-donor conference in Hanoi which raised more than US$60 million for animal and human influenza control. As a senior partner, the Bank also plays a significant part in PAHI. With VAHIP, the Bank will continue to assist Vietnam enter a consolidation phase for avian influenza control, in which gains from previous experience are broadened and a gradual restructuring o f the poultry industry towards disease-free production i s undertaken. 13. The `Integrated National Plan for Avian Influenza Control and Pandemic Influenza Preparedness and Response' (Red Book) which was presented at the International Pledging Conference co-organized by the Government o f China, the European Commission and the World Bank in Beijing in January 2006; and the `Integrated Operational Program for Avian and Human Influenza' or OPI (Green Book) o f May 2006, establish the framework for AH1 activities and outline wide-ranging goals, but not the discrete incremental steps necessary to achieve them. This is mainlydue to the emergency scenario which underpinsthe OPI, and it will be important to identify priorities as the emphasis shifts from emergency actions to the institutions and responses required to maintain the response in the medium term. In so doing, the project will support integration o f AH1 surveillance, response and preparedness activities into the normal functions o f the health sector, thus increasing flexibility and allowing a sustainable and adaptable level o f readiness, regardless o f perceived risk among policy makers and the general public. Examples of this assistance include developing an intervention-driven approach to communicable disease surveillance and creating flexible methods for managing intensive care resources or introducing bio-security guidelines along the value-chain, including poultry farms, live-bird markets and slaughterhouses. 4. Country Eligibility under GPAI 14. The project fully conforms to the eligibility criteria o f the GPAI, approved by the Bank's Board of Directors on 16 January 2006. GPAI support i s to be provided under the horizontal Adaptable Loan Program (APL) financial instrument, within the global coordination framework. Under the global APL, individual countries may obtain separate loans, credits and grants as they become available, to finance their own national projects, up to the global aggregate limit of US$500 million. Since the GPAI is designed to provide emergency financing to participating countries to contain outbreaks o f avian influenza through early detection and rapid response measures, the country-specific operations will be processed under the Bank's emergency policy OPBP 8.50. GPAI treats specific emergency response projects in each country as phases of a * GlobalProgram for Avian InfluenzaandHumanPandemic PreparednessandResponse. 4 horizontal APL, much like the Multi-Country HIV/AIDS Programs for the African and Caribbean Regions. Vietnam clearly meets the eligibility criteria specified in the GPAI document, given that, (a) the disease i s now endemic and has resulted in 93 human cases with 42 fatalities and the death or destruction of over 40 million poultry, (b) the OPI or Green Book - considered a best practice world-wide - has been endorsed by Government, integrating the human health and animal health and production sectors into the medium-term roadmap towards the eventual control o f the disease, and (c) the activities included in this proposal are fully consistent with the provisions and objectives o f GPAI. B. NATIONALAVIAN INFLUENZA CONTROL AND HUMAN PANDEMIC INFLUENZA PLAN FOR VIETNAM 1. GeneralObjectives 15. As stated in the OPI, the overall objectives of Vietnam's plans for the medium to long- term control of avian influenza i s to reduce the health risk to humans from avian influenza by controlling the disease at source in domestic poultry, by early detection and response to human cases, and by preparing for the medical consequences of a human pandemic if it occurs over the next five years. The proposed project will contribute to this overall objective by enhancing Government effectiveness in veterinary and public health services across eleven priority provinces. 2. Componentsof the National Plan 16. Agricultural Sector. For the animal health sector, the overall goal is to progressively control and eradicate HPAI from poultry in Vietnam. The specific short to medium-term objectives are: to strengthen veterinary services in order to control HPAI and other potential zoonotic disease threats; to control HPAI using a cost-effective phased approach that addresses each poultry production sector 6; and to plan poultry sector restructuring so that it enables better control of HPAI while minimizing the loss of livelihood and environmental pollution. The OPI outlines the strategy the Government o f Vietnam will adapt to control and progressively eradicate H5N1HPAIinpoultry. This will occur inthree phases: a control phase, in which the incidence o f outbreaks i s reduced by the stamping out o f outbreaks, mass vaccination, and the commencement o f improvements in biosecurity of poultry production and marketing practices. It i s expected that the Control Phase will continue throughout 2007, with some reduction in the scope o f the national mass vaccination in2007 and further reductions planned for 2008 and beyond; 6 The poultry sector is classified into four production systems: Sector 1-private sector vertical integrators; Sector 2 - independent private producers; Sector 3 - small-scale private producers; and Sector 4 -free-ranging backyard poultry. 5 a consolidation phase, in which gains are maintained, further restructuring of the industry i s undertaken, farms in the industrial sector demonstrate freedom from HPAI, and disease- free compartments are expanded. The Consolidation Phase will occupy the remainder o f the VAHIP project horizon (to 2010). National eradication programs will be built on gains made in the consolidation phase supported by VAHIP; and an eradication phase, in which freedom from disease i s achieved on a national or sectoral basis Health Sector. The specific objectives for the health sector's response to HPAIare: to minimize the incidence of, and mortality caused by, avian influenza; to reduce the risk o f an influenzapandemic occurring; and to take steps to reduce the impact of a possible influenza pandemic. The principle underlying the health sector's response is to link activities targeting HPAI to a broader agenda o f strengthening the capacity o f the sector to detect, control, and respond to emerging infectious diseases, especially zoonotic diseases. 3. Institutional Aspects 20. Vietnam has set up coordination mechanisms at the central level, which are also replicated at the province, and in many cases, at the district level. At the central level, inter- ministerial coordination has been functioning through the National Steering Committee for Avian Influenza Disease Control and Prevention (NSCAI). The NSCAI was established in January 2004 (Decision N o 13/2004/QD-TTg, dated 28/1/2004) as the national coordination mechanism for HPAI planning and supervision. NSCAI i s chaired by the Minister o f MARD, with the Vice Ministers of MARD and MOH as vice chairs. The official members are the Ministry of Finance, Ministry of Trade, Ministry of Public Security, Ministry of Transport, Ministry of Natural Resources and Environment, Ministry of Culture and Information, and the Ministry of Foreign Affairs. The Department of Animal Health (DAH) in MARD and the Administration for Preventive Medicine (APM) in M O H are also formal members.7 This Committee meets on a weekly basis to brief the Government on the evolution o f the disease situation and report on the implementation of the control measures. The Prime Minister and Deputy Prime Minister have chaired several o f these meetings. NSCAI's primaryfocus has been on poultry, but it has also addressed wider questions of coordination. In addition, as per Prime Minister's Decision N o 348/2006/QD-TTg, dated 21/2/2006, the National Steering Committee on Influenza Pandemic Prevention and Control in Human evolved from the National SARS Steering Committee established in 2003. This Committee i s chaired by the Minister for Health, with participation o f other concerned ministries and sectors. At the provincial and in some cases the district levels, Steering Committees for Avian Influenza have also been established under the People's Committees. They play an important role in local coordination, but this role varies from locality to locality. 'AlthoughDAHi s supportingNSCAIwith secretariatfunctions, this i s not part of the official Decisionregarding the NSCAI. 6 21. The continued risks of a pandemic demand the further strengthening o f overall coordination and collaboration. To this end, the OPI envisages that NSCAI would become the National Steering Committee for Avian and Human Influenza (NSCAHI) and be the primary forum to enhance cross-sectoral pandemic preparedness and response. NSCAHI would include MOET, MPI, other key ministries, the People's Army, as well as representatives from the Vietnam Red Cross and mass organizations. 22. Donor Coordination. NSCAI has effectively been entrusted with responsibility for government-donor coordination and meets on a regular basis with the International Community. Inparticular, the Department of Animal Health (DAH), with the help of MARD's International Cooperation Department (ICD), has played a central role in government-donor coordination in recent months, especially for the Joint Government-UN Program to Fight Avian Influenza, which receives funds from seven bilateral donors. The Administration for Preventive Medicine in the Ministryof Health (MOH) and other departments and institutions are also engaged. In2005, the European Union, represented by the Netherlands and the United Kingdom and with support from FA0 and WHO, organized technical meetings as well as briefings for the donor community, NGOs, and representatives of the private sector. The Joint Government-UN Program has supported government-donor coordination meetings since October 2005. It has also mobilized a donor coordination specialist who has brought together information on all donor and international NGO assistance and has started to support NSCAI and particularly MARD and M O H in working with several other donors. InJuly-September 2006, the preparation of a Phase 2 of the Government-UN Joint Program (JP-2) took place. This included the identification o f a follow-up operation to the on-going AIERP and the drafting o f Memorandum of Understanding on a Partnership for Avian and Human Influenza Control (PAHI) to coordinate donor- government activities more effectively in the longer term. VAHIP i s fully coordinated with all these initiatives. 23. FinancingRequirements.The total cost of the OPI is estimated to be US$250 million for the period 2006-2010. This comprises public sector and ODA support o f US$31 million for enhanced coordination activities (Part l), US$116 million for HPAI control and eradication activities in the agricultural sector (Part 2), and US$102 million for influenza prevention and pandemic preparedness in the health sector (Part 3). Additional private sector finance o f about US$225 million i s expected for poultry industry restructuring. Similarly, M O H anticipates additional needs of about US$222 million for a range o f other second-level priority activities for influenza preparedness and response inthe human health sector. C. PROJECTDESCRIPTION 1. ProjectDevelopmentObjective 24. The project's development objective i s to increase the effectiveness o f Government services in reducing the health risk to poultry and humans from avian influenza in eleven high priority provinces and thus contribute to addressing HPAIat the national level by controlling the disease at source in domestic poultry, by early detection and response to poultry and human cases, and by preparing for the medical consequences o f a human pandemic if it occurs over the next five years. This i s in line with and supports the implementation of Vietnam's plans for the 7 medium to long-term control of avian and human influenza as outlined in the OPI, and i s fully consistent with the approach envisaged under GPAI. 2. Project Components 25. The Project comprises three components and it will be implemented in eleven provinces: Lang Son, Ha Tay, Thai Binh, Thanh Hoa, Ha Tinh, Thua Thien-Hue, Binh Dinh, Tay Ninh, Long An, Tien Giang, and Dong Thap (see IBRD Map 35196). Selection criteria are provided in Appendix 9, Technical Note 4. Through implementation of these components, VAHIP will help consolidate the gains made under the AIERP and under various health sector programs to date by (a) further strengthening veterinary and human health services, (b) improving the quality and scope o f disease control and surveillance and public awareness, and (c) supporting integration of animal and human health activities and OPI coordination. The proposed project will focus on support for activities not already coveredby other donors and financiers. 26. Project Cost and Financing. Total project costs are estimated to amount to around US$38.0 million. Component A i s estimated to cost around US$17.2 million, Component B US$16.0 million and Component C US$4.8 million. The project will be funded through (i) an IDA Credit inthe amount of US$20.0 million equivalent; (ii)grant from the AH1Facility Trust a Fund in the amount of US$lO.O million, (iii) PHRD grant from the Government of Japan a amounting to US$5.0 million; and (iv) Government contributions in the range o f US$3.0 million. See Appendix 3 for details. 27. ComponentA -HPAI Control and Eradication in the Agricultural Sector (US$17.2 million). Component A will be implemented in each o f the eleven project provinces listed above and will comprise five subcomponents: 28. SubcomponentAl: Strengthening of Veterinary Services (US$2.6 million). This subcomponent has 3 activities. (a) A needs and capacity assessment of veterinary laboratories undertaking avian influenza testing for this project (namely, the National Institute o f Veterinary Research (NIVR), National Center for Veterinary Diagnosis (NCVD), five Regional Veterinary Centers and the Lang Son Provincial veterinary laboratory) will be conducted to evaluate their capacity to undertake the incremental diagnostic workload required by project activities and to ensure that the necessary manpower, equipment and consumables are provided. In addition, quality management systems will be strengthened to enable the laboratories to operate to I S 0 17025 standards. A cost recovery mechanism through revolving funds acquired from fees-for- services will be developed and instituted selectively to ensure the operational sustainability o f diagnostic laboratories. (b) A portable BSL-3 * unit will be established at the Regional Animal Health Office No. 6 in H o Chi Minh City to enable laboratory workers to isolate viruses under biosafe conditions. (c) Commune-based disease reporting by community animal health workers (CAHWs) will be expanded from 30 project districts under AIERP to include some 90 project districts. The project will provide equipment, technical assistance, training, consumables, contracted laboratory staff and other operational support. BSL-3Biosafety level 3 is a levelof biosafety requiredfor safe isolation of H5N1avian influenza virus. 8 29. Subcomponent A2: Enhanced Disease Control (US$3.5 million). This subcomponent comprises five activities conducted in live-bird markets, slaughterhouses, poultry farms and border areas to consolidate gains already made in avian influenza control. (1) As a first activity, market-based avian influenza control will be introduced at the H a Vi live-poultry market in Ha Tay province, which supplies around 50 percent o f consumer demand for poultry to Hanoi. The feasibility of upgrading additional markets in the other project provinces will be assessed and appropriate renovations and changes to market procedures will be implemented. (2) A second activity will develop procedures to break the infection chain between farms and slaughterhouses by developing appropriate, science-based testing, inspections and pre-movement certification for poultry, providing advice and training to slaughterhouse inspectors, management and staff in 12 poultry slaughterhouses on facilities and procedures required for the cleaning and disinfection of transport cages and vehicles before leaving the slaughterhouse, and by developing manuals on recommended Standard Operating Procedures for the entry and exit o f poultry transport vehicles and pre-sale testing and poultry monitoring for live bird markets and slaughterhouses. (3) A third activity will develop pilot disease monitoring systems for large, commercial poultry farms to demonstrate sustained freedom from infection with H 5 N1 avian influenza, thereby moving towards the creation of avian influenza-free farms and compartments. (4) The fourth activity supports five vaccination related activities (covering grazing meat ducks; field trials of vaccination of minor poultry species; training o f animal health workers in ring vaccination to be used in the event o f localized disease outbreaks; feasibility of local vaccine production for H5N1 HPAIfor poultry; and upgrading of the vaccine cold chain). (5) The fifth activity will strengthen animal quarantine activities in the border province o f Lang Son, a major route for illegally smuggled poultry into northern Vietnam. 30. SubcomponentA3: Surveillance and Epidemiological Investigations (US$1.5 million). This subcomponent focuses on disease surveillance, which i s necessary to determine where and how avian influenza viruses are circulating, and i s an essential element o f avian influenza control. Without surveillance, the extent of infection i s unknown and control programs are based on incomplete field intelligence, limiting the applicability o f risk-based interventions recommended in the OPI. (a) Disease surveillance will support all project elements in subcomponent A 2 (above), providing data to support M&E o f these activities. It will be conducted in live-bird markets to demonstrate improvements arising from changes in market practices and related market-driven disease control measures; in slaughterhouses and farms to assist in determining the effectiveness o f measures to break the infection chain and the disease status of poultry; in duck flocks following vaccination, and inborder areas to assess the infection status of smuggled poultry. (b) Additional surveillance will be conducted in wild birds in areas deemed to be at high risk o f infection. (c) Intensive rapid assessments o f 4 project provinces not previously included in AIERP (Thanh Hoa, Ha Tinh, Tay Ninh, Lang Son) will also be undertaken to develop risk profiles and review current surveillance activities so as to develop plans for sustainable HPAI control in these provinces. Lastly, (d) strengthening o f data management capacity. The project will provide consumables, equipment, travel, contracted surveillance staff, office support, and technical assistance in data collection, consolidation, management and analysis. 31. SubcomponentA4: Preparing for Poultry Sector Restructuring (US$1.3 million). Consolidation o f gains made in the control o f avian influenza requires improvements in farm level disease prevention through implementation of appropriate biosecurity measures and 9 restructuring o f the poultry sector. This subcomponent will facilitate this process by (1) providing the Department of Livestock Production (DLP) with the analytical and planning capacity for restructuring the poultry sector, (2) planning and demonstrating biosecure poultry farm models, and (3) upgrading the biosecurity of existing small scale poultry farms in selected project areas. As outputs, guidelines for planning the restructuring o f the poultry sector with the objective of increased biosecurity will be developed, and biosecure poultry farm models that are equitable, economically viable and environmentally sound, will be demonstrated. The project will provide equipment, technical assistance and training allowances. See also Technical Note 1, Appendix 9. 32. SubcomponentA5: Emergency Outbreak ContainmentPlan (US$8.3 million). This subcomponent will implement six activities: (a) Enhancing early reporting o f disease outbreaks by villagers to animal health authorities to ensure effective outbreak control, which depends on the rapid detection and reporting o f disease. Villagers and smallholders must notify authorities if there i s disease in their farm but do not always do so in a timely manner. To facilitate timely reporting, villagers will be provided, through a broad BCC campaign, clear information on the trigger points for reporting, what to expect when they report outbreaks (including compensation arrangements), and how to handle dead or sick poultry (this will be led by, and integrated with, efforts undertaken in Component B summarized below). This activity will be initially introduced to five project provinces and then subsequently extended to cover all project provinces. Telephone hotlines will be established to allow villagers and smallholders cost-free access to report disease outbreaks, overcoming a currently existing communications constraint. (b) Simulation exercises in avian influenza outbreak containment will be conducted to ensure that veterinary authorities, including CAHWs, district, provincial and regional staff respond rapidly to contain disease outbreaks once disease i s reported by villagers or smallholders. (c) Protective gear and consumables will be stockpiled in strategic locations in order to allow teams o f first responders to mobilize rapidly so as to investigate suspected outbreaks. These teams will also have access to financial resources to employ contract staff to assist in emergency disease containment operations, including stamping out. Emergency equipment and PPE, vaccines and disinfectants will be stockpiled at the six DAH Regional Veterinary Centers for immediate distribution and use in their service regions. (d) Emergency contingency to cover the cost of large scale vaccination in case o f widespread outbreaks. In the event of outbreaks o f avian influenza all provinces potentially affected in Vietnam, not just those associated with the eleven Project Provinces could benefit from the two aforementioned activities (Le. A5(c) and A5(d)). (e) Studies on streamlining compensation payments for rapid disbursement in the event of avian influenza outbreaks will be undertaken to enhance cooperation from farmers affected by stamping out exercises. For compensation to be most effective it should be provided rapidly and close to the time o f culling (this has been a constraint in past outbreaks). (f) A compensation contingency for smallholders and villagers who have had poultry culled after reporting outbreaks of avian influenza to authorities under this subcomponent will be established to pay compensation. The project will finance disinfectants, disinfection equipment, protective clothing, training, emergency contingency funds, simulation exercises, telephone hotline charges, vaccination consumables and equipment, vaccine pools, contract services to support emergency workers and vaccinators, technical assistance, and compensation funds. 10 33. Component B - Influenza Prevention and Pandemic Preparedness in the Health Sector (US$16.0 million). Component B will be implemented in the following eight project provinces: Lang Son, Ha Tay, Thai Binh, Thua Thien-Hue, Binh Dinh, Long An, Tien Giang, and Dong Thap. The government has mobilized a robust and generally effective response from authorities at each level to respond to the AH1problem, drawing on the exceptional ability o f the Vietnamese system to address public health emergencies. Given the endemic nature o f this pathogen in Vietnam and the near certainty that that this threat will remain present into the future, new and longer term approaches must be developed to meet the needs o f a prolonged epidemic. Weaknesses in Vietnam's preventive and curative health systems -most notably in infectious disease surveillance and response, laboratory testing, infection control, health communications, human resources, and coordination with other relevant sectors - expose Vietnam to great risk from epidemics. This component will address the different system constraints (management, human resources, infrastructure and logistics) within an institutional framework which can provide the "glue" to maintain the response when the sense o f emergency wanes. Providing a framework that allows provinces, districts and perhaps even communes, to develop their own plans and establish mechanisms to implement them may not only lead to better overall preparedness, but may also help to develop essential planning capacity at the local level that will be critical should a pandemic occur. 34. Subcomponent B1: Improving the Technical Quality of the Surveillance and Response System (US$2.9 million). This subcomponent will support the government in improving surveillance for AI, integrating this into the regular surveillance system and in so doing, strengthening the routine surveillance system in general. This subcomponent will finance staff training, selected equipment items, stockpiles o f protective material, simulation tests and technical assistance. It will comprise: (1) an assessment o f the current surveillance system, its performance at different levels (from the community to the provincial levels) and comparisons with other countries' systems, (2) piloting interventions geared towards improving the surveillance systems in the project provinces, based on the above-mentioned assessment, (3) improving the quality of reporting and management of data to enhance its use for decision making, (4) implementing an Early Warning and Response System (EWARS) with extensive penetrationto the community through the VHWs, (5) selection and training o f a Rapid Response Team that effectively responds to suspected outbreaks and collaborates with other sectors, (6) building Capacity for surveillance and adequately equipping and protecting staff involved in investigations, and (7) fostering coordination and collaboration with other key sectors such as animal health workers in surveillance. 35. SubcomponentB2: Improving the Technical Quality and Efficiency of Curative Care Preparedness (US$5.3 million). This subcomponent will provide support to MOH to: (a) develop the strategy (and action plans) to respond to an overwhelming epidemic or public health emergency; (b) review the curative care sub-sector's strategy to respond to HPAI, focusing on the roles and responsibilities o f the central and provincial authorities, as well as o f health care facilities operating at each level; and (c) provide an estimate o f the baseline demand for intensive care services and mechanisms to reduce the mismatch between supply o f and demand for these services across the project provinces. On the basis of these reviews, the subcomponent will support staff training, acquisition o f medical equipment, rehabilitation o f isolation facilities, and revision o f clinical care and infection control guidelines. It will also support the revision o f epidemic response action plans at the central and provincial levels, set up o f an emergency 11 hospital management structure linked to the PPC and the DOH, complete the stockpile o f personal protective equipment and supplies and materials for establishing field hospitals, and a contingency budget in the case o f an outbreak. Finally, it will finance epidemic simulation exercises to test preparedness measures and coordination structures. 36. Subcomponent B3. Strengthening Behavior Change Communication (BCC) in HealthFacilities and the Community (US$2.7 million). The subcomponent will help to bring about behavior change in the target population through strengthening o f BCC skills o f health workers at all levels (provincial, district, commune and village), and supporting activities to promote the adoption of AI prevention and control behaviors. The project will provide training and supervision to improve the health workers' BCC skills, and IEC aids to assist them in this work. The project will also help to mobilize the community through support for community- based and mass media awareness-raising activities, which can incite the adoption o f preventive and control measures by the target audience both as a community and as individuals. 37. Subcomponent B4: Strengthening the Preventive Health System at Local Level (US$ 5.1 million). This subcomponent will support efforts by MOH to operationalize new preventive health strategic direction and policies in practical and locally relevant ways. These efforts are critical in order to more effectively prepare for and respond to recently emerging complex communicable diseases at the local level. This subcomponent will seek to test and refine new approaches based on comprehensive appraisals o f the current constraints and challenges facing the health care system. Innovative preventive health pilot efforts will be designed with strong local participation, implemented and rigorously evaluated. Special attention will be placed on understanding barriers and critical pathways to surmounting them in the local health system restructuring process. New coordination modalities will be forged with DARD to promote better integrated and more timely responses to potential avian and human disease outbreaks. In addition, this subcomponent will address underlying weaknesses in current human resource capacity and systems at the local level. The preventive health pilots will be supported through sub-grants, and the Project Implementation Manual (PIM) will establish eligibility criteria and review and approval procedures for this purpose. 38. Component C - Integration and OPI Coordination, Results M&E, and Project Management (US$4.8 million). Component C will support the integration and coordination between MARD, MOH and other concerned ministries and agencies in implementing the OPI. It will also support the design, establishment and implementation of a result-based M&E system to evaluate the project's (and to the extent possible, OPI's) progress, performance, and impact at the sector and regional levels. Lastly, this component will strengthen institutional capacity in order to undertake project management in terms o f planning, coordination, and actual implementation o f the overall project at the national, provincial, district, and commune-levels. As such, Component C envisages three subcomponents. 39. Subcomponent C1: OPI Integration and Coordination (US$0.2 million). The subcomponent will provide support for (a) the establishment o f a Secretariat under the nascent National Steering Committee for Avian and Human Influenza (NSCAHI, see Section B3 above); (b) development of coordination mechanisms between the animal and human health sectors at various levels (for instance, undertaking coordination meetings, joint programs, national HPAI outbreak simulations, and the like); and (c) conducting regional outreach activities beyond 12 Vietnam (for instance, leading regional and international policy coordination and knowledge- sharing initiatives, including workshops, training, information sharing, increased surveillance, laboratory networking, sample exchanges, joint supervision, etc.) bilaterally with China, Thailand, Cambodia, and Laos but also multilaterally with the Greater Mekong Region and APEC at large. During implementation, specific activities will be identified, prepared and undertaken by the NSCAHI Secretariat. The Secretariat will also periodically prepare OPI implementation reviews, and suggest policy lessons for further refinement of the Green Book. The subcomponent will finance technical assistance, field activities, incremental operating costs, training and workshops, equipment and facilities to carry out the activities. 40. Subcomponent C2: Results M&E (US$1.O million). The subcomponent will provide support for the detailed design, establishment and implementation of a result-based M&E system to (1)evaluate the project's progress, performance, and impact at the sector and regional levels. It will also (2) be an integral part of GOV efforts at monitoring results and evaluation impacts under the OPI. To that effect, the results M&E system should enable monitoring o f the effectiveness o f implementation processes and incorporation of lessons learned into future planning o f and linked to MARD and MOH's monitoring system. The subcomponent will finance consulting services needed to carry out base-line studies; short-term technical assistance for the design; establishment and testing o f the M&E system; training and workshops; M&E- related equipment, travel costs o f project staff and incremental staff and operating costs of the M&Eefforts. 41. Subcomponent C3: Project Management (US$3.6 million). This subcomponent will provide the institutional capacity necessary to plan, coordinate and manage the implementation o f the overall project at the national, provincial, district, and commune-levels. In doing so, resources to establish and operate two Project Coordination Units (PCU), one each under MARD and MOH, respectively, will be provided. This involves the development o f planning, technical, and management skills to be able to produce quality and timely annual work plans and budget; anticipate and resolve implementation problems quickly; and make adjustments based on implementation progress and feedback. The project management would also monitor activities in the provinces to ensure they are in compliance with the safeguards (i.e. environment, ethnic minority development, involuntary resettlement, and gender) by preparing a safeguard action plan satisfactory to the Bank during the first six months of project implementation and subsequently undertaking this action plan during the remainder o f the project. The subcomponent will finance incremental operating costs; contractual staff; project management-related technical assistance; training and workshops; renovation of project office and office equipment and furniture; and project vehicles. 3. LessonsLearnedand Reflected inthe Project Design 42. Previous World BanWIDA supported emergency recovery operations provide a number o f relevant lessons for project design. Lessons learned o f particular relevance to an emergency AH1 project include: (a) emergency projects should avoid policy conditionality, (b) project design must be kept simple and in accordance with borrower and other stakeholders' capacity, (c) speedy appraisal and approval are crucial to providing a timely response and contribution to project success, (d) procurement arrangements need to be flexible and should be finalized at an early stage, (e) counterpart's absorption capacity should be realistically assessed, and (e) 13 effective communications and project monitoring should be in place to avoid implementation delays as the result of delayed identification and resolution of problems. 43. Implementation of AIERP over the last two years has also yielded some important lessons: Integration. Strong coordination mechanisms and collaborative working arrangements between the human and animal health sectors are critical for the success of an Avian and Human Influenza Control and Prevention Program. AIERP was designed and implemented by MARD through three technical departments. Although the responses to outbreaks so far have been effective, VAHIP in turn should involve MOH and employ a joint approach, especially at the provincial level. Two-pronged Strategy. VAHIP should include the dual approach o f (1) controlling avian influenza at its source in high-risk regions (through aggressive measures including culling, movement control and vaccination campaigns for poultry and ducks); and (2) simultaneously preparing short and medium-term measures to minimize the risks to humans and prepare for an eventual pandemic. High Level Government Commitment. It is important to have a coordination structure which has the capacity to undertake multisectoral responsibilities. This coordination structure would have to be established at a highlevel of government, such as at the Prime Minister's Office level. Moreover, this high level coordination structure should foster a coordinated and integrated national response, involving all technical ministries in charge of agriculture, animal health and human health, as well as other relevant sectors, at the national and sub-national level. 0 Effective Implementation Mechanisms at Local Levels. Human resources shortages, inadequate skills, and the lack o f incentives and decentralized authority pose fundamental challenges to implementation. Therefore, implementation procedures and funding mechanisms should be designed flexibly and decentralized to provincial level to ensure the responses to epidemics more timely and effectively. Linking HPAI Control Strategy and Preparedness Plans with Broader Agenda of Regulatory and Institutional Reforms. A revised compensation framework is an important element to obtain real cooperation from affected stakeholders (farmers and producers) and to ensure the efficacy o f the surveillance and diagnosis mechanisms. Other long term reforms include the restructuring of the poultry industry and the development of food safety regulations. The link with the broader agenda o f regulatory and institutional reforms equally applies to the health sector. Strengthening Technical, Scientific and Operational Capacity of Participating Agencies, and especially national veterinary services, but also for preventive and curative health care. The AI crisis highlighted several weaknesses in the animal health as well as public health services systems, including: poor surveillance at the local level, weak diagnostic capacity, lack of epidemiological expertise and information system, and 14 inadequate operating budget to bear the additional costs o f physical and human cost to contain the spread of the disease. Inclusion of Awareness Raising and Public Information Campaigns in Control Strategies. Information, education and communication (IEC) represents an essential element in the response to HPAI. Awareness raising campaigns should be developed to assist in the coordination o f the response and the implementation o f necessary technical responses in the areas of animal and human health. Campaigns - using a variety o f appropriate communications media - should address the public and private sectors and the general population and should place particular emphasis on groups at particular risk o f infection. Regional Collaboration.Attention should be given to support the integration of each country within a regional and global HPAI control framework so that the response to HPAI and to emerging infectious and transboundary diseases can be addressed in a consistent and cost-effective manner. The response in Vietnam should seek to be consistent and supportive o f regional programs implemented by FAO, WHO and OIE, as well as with similar operations in neighboring countries, mainly Cambodia, Lao and China. 44. VAHIP's components and overall design reflect the lessons learned from AIERP and other emergency recovery operations. It also reflects the experience gained by M O H in responding to HPAI in the health sector. Further information on lessons learned in addressing HPAIinVietnam is presented inAppendix 9, Technical Note 3. C. IMPLEMENTATION 1. PartnershipArrangements 45. Partnerships between the Bank and Vietnam's donor community inthe fight against avian influenza are longstanding, and developed shortly after the first avian influenza outbreaks began inlate 2003. The response by the international community to the epidemic has been substantial. FAO, OIE and WHO each sent teams and experts to assist the government in containing the outbreak, and several bilateral assistance agencies and NGOs donated protective clothing, disinfectants and other goods and services. The FA0 Resident Office in Hanoi estimated that, by end-February 2004, some 160 person-months of expert input hadbeen provided to deal with the outbreak. As the HPAIepidemic spread across Southeast Asia, FAO, OIE and WHO called two regional emergency meetings to discuss control strategies, share information, and forge linkages between the affected and non-affected countries in the region. FA0 approved regional and country-focused emergency assistance to assist MARDDAHwith disease containment strategies and strengthening o f the diagnostic system, and a follow up FA0 Technical Cooperation Program i s under implementation. 46. The World Bank responded to a request by the Government to prepare an emergency recovery project in February 2004. The Bank team collaborated closely with a mission from Agence FranCaise de DCveloppement (ADF), and the resulting project, AIERP, began implementation in July 2004. In 2006, the Bank led a multi-donor mission to assist with 15 preparation of the OPI, and then participated in the multi-donor conference in Hanoi which raised funding for animal and human influenza control. As a senior partner, the Bank also plays a significant part in PAHI. With VAHIP, the Bank will continue to assist Vietnam with the consolidation phase of avian influenza control. VAHIP is being prepared under the aegis of the Bank's Global Program for Avian Influenza (US$15 million IDA credit through GPAI), and will be supported by grants from the multi-donor AH1 Facility Trust Fund and the Government of Japan (through a PHRD Grant). Several bilateral donors have indicated their interest in the parallel financing of specific project activities. 47. On June 2, 2006, the Ministry o f Agriculture and Rural Development and the World Bank hosted a Joint Government-Donor Meeting in support of the Vietnam Integrated Operational Program for Avian and Human Influenza for the period 2006-2010 (the Green Book). At the meeting, high-level representatives from the Government o f Vietnam, 23 donor countries, 7 international agencies, and 3 international NGOs discussed challenges in controlling Avian and Human Influenza and commended the Government for the preparation of the Green Book. With an estimated budget o f US$ 250million, the Green Book sets aims to progressively control and eradicate HPAI from poultry in Viet Nam; minimize the incidence and mortality of human avian influenza infections; reduce the risk o f the occurrence o f a human influenza pandemic; and take steps necessary to reduce the impact o f a pandemic, if it does occur. The Government expects to finance up to half of the total estimated cost for its implementation and donors have thus far committed more than US$60 million. 48. The Green Book provides the overall framework for donor support and the establishment of the Partnership for Avian and Human Influenza Control (PAHI) contributes to enhancing ODA efficiency and mutual accountability. The proposed VAHIP, co-financed with other agencies mainly the European Commission and the Government of Japan, and the Phase 2 o f the Government-United Nations Joint Program, with US$35 million and US$16.5 million respectively, represent the main financial instruments to support the implementationof the Green Book. In addition, ADB i s providing funds mainly through the regional support to Prevention and Control o f Avian Influenza in Asia and the Pacific and the Transboundary Animal Disease Control in the Greater Mekong Subregion Projects. Other agencies are providing bilateral assistance, consistent with the Green Book, including: USAID which i s supporting directly FAO, WHO and NGOs, Government of Japan, which is supporting UNICEF, FA0 and OIE, as well as the MOH in the construction of an advanced bio-security laboratory, and AFD which i s supporting the regional networks of Pasteur Institutes inCambodia, Lao and Vietnam. 2. InstitutionalandImplementationArrangements 49. VAHIP will be an integrated operation implemented over a three year period. MARD will be responsible for implementation of Component A and M O H for Component B. MARD also will take lead responsibility to initiate the implementation o f subcomponent C1. Implementation arrangements aim to anchor policy coordination, program management and component implementation o f VAHIP (Le. a key building block for the implementation of the Green Book) within the relevant Government Ministries while simultaneously ensuring effective execution o f fiduciary (i.e. procurement, financial management) and safeguard functions. 16 50. A Project Mid-Term Review will take place 12 months after Effectiveness. This will allow MARD, M O H and IDA to review and correct possible deficiencies in implementation performance and arrangements early on. It will also provide an opportunity to critically revisit (and possibly restructure) the project's fit with the OPI and changing circumstances in addressingHPAIand other zoonosis and/or contagious diseases inVietnam. 51. Central Level. Overall strategic guidance will be provided by the existing National Steering Committee for Avian Influenza Control (NSCAI). This Committee will evolve to become the National Committee for Avian and Human Influenza Control (NSCAHI). A Secretariat will be established under NSCAHI (with support provided by VAHIP) to assist the Committee in coordinating and managing the overall implementation of the OPI. To that end, the NSCAHI Secretariat will also periodically prepare OPI implementation reviews, suggest policy lessons for its further refinement, and take the lead in Vietnam's regional outreach on HPAI. This Secretariat will be responsible for implementing activities under C1, as well as guide and support implementation of activities under C2 and C3. 52. MARD and MOH will jointly implement VAHIP, and the Vice Ministers of the respective ministries will report to NSCAHI on project implementation. MARD and M O H will be responsible for policies guidelines, the review of annual work plans, ensuring coordination among relevant agencies and the overall monitoring and evaluation of results under VAHIP. Project entities (outlined in more detail below) at the ministerial, provincial, and district levels (Le. PCU, PPMU, PIT) will be responsible for day-to-day project implementation, supervision, and monitoring of VAHIP components, subcomponents, activities including fiduciary and safeguard functions. The International Cooperation Department (ICD) in MARD and the Vietnam Administration for Preventive Medicine (APM) inM O Hwill assist incoordinating with other Government ministries and with donors in the implementation of VAHIP. 53. There will be two Project Coordination Units (PCUs): one each in MARD and M O H for coordinating project activities under Components A (and C2a and C3a) and B (and C2b and C2b), respectively. The PCU under Component A will also be responsible to initiate and launch activities under Subcomponent C1. The PCU for Component A will be placed with the Agricultural Project Management Board (APMB) under MARD. The PCU for Component B will be in the Administration for Preventive Medicine (APM) under MOH. The Director of the VAHIP PCU with the APMB / MARDand the Director of the APM at MOH will be the Project Director and Vice Director, respectively, accountable to their respective Vice-Ministers. Two Designated Accounts (DAs) will be opened for each PCU to receive funds from (a) the blended IDA andAH1Facilityfunds, and (b) the PHRD grant. 54. For Component A, on the part of MARD, DAH will take overall responsibility for Component A (and C1, C2a and C3a). DLP will be responsible for Subcomponent A4. The PCU for Component A will be placed with the APMB under MARD. The Deputy Director of DAH will be assigned (part time) as Senior Technical Advisor to the PCU. The DAH will also second a senior staff member as Deputy Director to this PCU. Four Technical Managers (TMs) will be externally recruited (senior national consultants) to assist the Project Director in implementing the subcomponents Al, A2, A3, A4 and A5. An international Chief Technical Advisor (CTA) would advise and support the Project Director on all matters related to the management and implementation of Component A (and Cl). The PCU will also hire one national specialist for 17 monitoring and evaluation to partially coordinate and partially directly undertake activities under Subcomponent C2a. DAHand DLP will support the implementation of VAHIP with its technical staff as required to ensure integration of activities under Component A with the overall OPI program. The PCU will provide adequate procurement and financial management and safeguard capacity in sufficient number for the duration of project implementation. 55. The PCU, DAH and DLP will be supported through technical assistance and services in the management, coordination and implementation of Component A (and C). An experienced Chief Technical Advisor for Component A will also be recruited. OIE will undertake the vaccine production assessment on the basis of their uniqueexperienceinthis area. 56. For Component B, the PCU would be with the APM at MOH. The PCU would include technical staff appointed by (a) APM for subcomponentsB l and B4 and for M&E, procurement, and financial management, (b) the Departmentof Therapy for subcomponents B2, and (c) APM inclose coordination and cooperation with the Center for HealthCommunication and Education for B3 . In addition, core staff including two accounting and six project officers will be either secondedfrom the current departments or newly recruited. A local full time Project Coordinator and an international Project Advisor (consultant) will also be recruited over the project lifespan. In addition, Technical Managers (TMs) will be mobilized from the concerned departments of MOH to assist the PCU Director in implementing the four subcomponents. The PCU will also recruit one national specialist for monitoring and evaluation to partially coordinate and partially directly undertake activities under Subcomponent C2a. 57. For Component C, MARD's PCU will also take lead responsibility for launching activities under subcomponent C1, which includes, but is not limited to, the development of coordination mechanisms between the animal and human health sectors at various levels (for instance, undertaking coordination meetings, joint programs, national HPAI outbreak simulations, and the like) and conducting regional outreach activities beyond Vietnam (for instance, leading regional and international policy coordination and knowledge-sharing initiatives). Component C2 (C2a and C2b) and C3 (C3a and C3b) will be implementedby the PCUs underMARD and MOH, respectively. 58. The two PCUs will be responsible for: overall project implementation of Component A, B and C -- including coordination of subcomponents and activities at central level and across provinces, the procurement and financial management, supervision of project activities and results monitoring and evaluation -which it will carry out inaccordancewith the agreementsbetween GOV andIDA and underthe guidance of MARDor MOH, respectively. developing and implementing mechanisms to ensure coordination with other concerned agencies on policies, program and projects (both funded by Government but also by other donors) insupport of the OPI; providing guidance and support to the Provincial Project Management Units (PPMU) in establishing annual work plans includingrealistic and feasible targets, inimplementing work plans, in monitoring PPMU progress as well as in ensuring compliance with safeguard policies through the PPMU; 18 preparing, issuing and communicating internal project implementation guidelines for the provincial, district, and commune levels and supervising their respective operations; consolidating work plans and budgets, including procurement plans from PPMUs for the project for submission to the respective line ministry for approval and to IDA for review and no-objection; developing and maintaining sound project accounting systems, in accordance with the procedures required by government and IDA, including the financial management o f the Designated Accounts (DAs); handling all ICB and NCB procurement packages and the selection o f international consultants, as well as all other procurement matters for which central management i s more efficient compared to provincial level management.; and Setting up project management and reporting systems, including M&E at all project levels, and managing the decision making flow in accordance with project requirements. 59. Provincial Level. The existing Provincial Steering Committees for Avian Influenza that government established under the Provincial People's Committees (PPCs)will provide general policy guidance for all activities to be implemented in the eleven project provinces and ensure strong coordination among the relevant line agencies. The Provincial Steering Committees are also responsible for reviewing and approving all activities that have been decentralized to the provincial level, including the provincial work plans, budgets and procurement decisions. 60. At each of the participating provinces there will be one Provincial Project Management -(PPMU)whichwillberesponsibleformanagingandimplementingprojectactivities Unit associated with Components A, B and C which are carried out at the provincial level. The PPMU will report to the Provincial Steering Committee. The Vice-Directors o f D O H and DARD will be the PPMU Director and Vice Director, with the relative scale o f project activities under Components A and B determining whether the PPMU will be located in DOH or DARD. The PPMU will have the following key positions: PPMU Director, Accountant(s), Procurement and M&E Officers, and senior technical staff from DARD, DOH, DOF, DPI, and the Provincial Treasury. A single Project Account (PA) will be opened at each PPMUto receive advance funds from the PCUs' Designated Accounts (both IDNAHI Facility blended funds and PHRD funds) to facilitate timely project implementation inthe province. 61. The functions and responsibilities of the PPMU are as follows: under the guidance of the PPC and in coordination with the PCUs as well as the provincial departments, implement components A, B and C in the respective province; develop and implement mechanisms to ensure coordination with other concerned agencies on policies, program and projects (both funded by Government but also by other donors) in the respective province; prepare, issue and communicate internal guidelines for district and commune level project activities; and guide, support and supervise the districts and communes in carrying out project activities; prepare work and budget plans as well as implementation and monitoring reports for submission to the PCUs for consolidation and PPC approval, and to IDA for review and no- objection; 19 manage and carry out procurement activities that have been decentralized to the province; prepareand submitprocurement decisions to the PPC for approval; develop and maintain a sound project accounting system in accordance with the procedures required by government and IDA, including the financial management of the project account (advance funds); and set up project management and reporting systems, including M&E at the provincial, district and commune levels, and manage the flow of information for decision making in accordance with project requirements. 62. Under the PPMU two Provincial Implementation Teams (PIT) will implement activities at the provincial, district and commune level: one in DARD, responsible for the implementation of Component A, and one in DOH for Component B. For Component A, the PIT will consist of technical staff from the sub-departments o f Animal Health, Livestock, and Agricultural Extension. For Component B, the PIT will include technical staff from DOH and the Provincial Center for Preventive Medicine. The PITs will function independently and report directly to the Director and Vice Director o f their PPMU, and will cooperate and coordinate their activities in the field. 63. The functions and responsibilities of the msare as follows: under guidance of their PPMU, be responsible for project implementation, management and supervision o f the activities inthe respective component; coordinate with other implementation agencies to ensure effective project implementation; ensure that realistic targets are set and met, and be responsible for the implementation o f safeguard policies intheir respective components; prepare work plans and budgets for their component for submission to the PPMU for consolidation; set up component management and reporting systems at the provincial, district and commune levels; and manage the flow o f information for decision making in accordance with project requirements; and, be responsible for the technical implementation and reporting to the PPMU to make decisions on procurement and financial-related matters. 64. District and Commune Level. A number of project activities envisage implementation at the District and Commune level. Specific implementation and coordination arrangements aiming to reflect local conditions and needs will be established during project start-up by the provincial, district and commune authorities with support from the respective PPMU and PITS. 65. Project Implementation Manual. To guide the implementation o f the Project, the MARD PCU and MOH PCU will prepare and adopt a Preparation Implementation Manual (PIM) acceptable to the Association. These PIMs will set forth: (i)the implementation arrangements at the central, provincial and local levels; (ii)guidelines for the preparation and technical review of provincial annual work plans; (iii) in respect of Part A.4(c) of the Project, eligibility criteria and review and approval procedures for small grants to undertake basic biosecurity improvements; (iv) in respect o f Part B.4(b) of the Project, eligibility criteria and review and approval procedures for sub-grants to support pilot approaches and systems for district preventive health centers; (v) detailed guidelines for financial management and 20 procurement, including procedures and requirements for disbursements o f funds, internal control arrangements, record keeping, reporting and auditing o f Project records and accounts; (vi) guidelines for the implementation of environmental management procedures; (vii) the Ethnic Minorities Communication Plan; (viii) in case of Part A.2 of the Project, the Resettlement Policy Framework and the Resettlement Action Plan; and (ix) the work plan for the calendar year 2007. The Borrower will not amend or waive any part of the PIM without prior concurrence of the Association. 66. Fund Flows. There will be two main sources of funds, namely: (i) funds from blended the AH1Facility and IDA credit; and (ii) the PHRDGrant. The PHRD Grant will finance mainly technical assistance activities in the subcomponents. The AH1 Facility and IDA Credit will be blended to finance the remaining project activities on a percentage share basis. The project will use traditional disbursement methods as per the IDA'Sdisbursement guidelines. 67. At the central level there will be a total of four Designated Accounts (DAs). Each PCU will have two DAs - one for PHRD funds and the second for the blended IDA credit and AH1 Facility funds. DAs will be opened in a commercial bank with terms and conditions satisfactory to IDA. 68. At the provincial level, each PPMU will have one project account in VND opened in a commercial bank to receive advances from the four PCUs' DAs for project expenditures. The accounting system and records will account for the expenditures by component and source of funds. The advance amount to the PPMUs' project account will follow the 90 day-advance account procedure and will be determined based on the approved quarterly work plan of the province, the progress of field implementation, and the reimbursement. Each quarter, the PPMU would send an advance request with summary and detailed reconciliation o f (i) value o f the the next quarter's planned activities; and, (ii) the unspent balance of the previous advance (that is, the opening balance less the amount spent inthe last quarter). 3. Monitoring and Evaluation (M&E)of Project Outcomesand Results 69. Project monitoring and evaluation activities will track and measure the project's results at various levels o f the results chain. These activities will also support monitoring o f results and evaluation of impacts for the overall implementation o f the OPI. Intended results, results indicators and specific arrangements for project results monitoring are specified in the Results Framework (see Appendix 1). Baseline surveys will be undertaken early during project start-up. Monitoring and evaluation activities are envisaged across the various subcomponents and designed to provide the information necessary to both routinely manage the project effectively and to assess project impact. 70. Animal Health Component. Proactivemonitoring, problem identification and resolution will be strengthened by incorporating these activities within the respective Subcomponent activities. The M&E schedule (Appendix 1) provides verifiable indicators towards this goal. Project Officers with the PCU will be assigned to each subcomponent to ensure that monitoring o f all component activities takes place, and that problems are identified, reported and addressed in a proactive and timely manner. The CTA will backstop decisions involving technical issues associated with the M&E approach. The PCU will actively coordinate with MARD in 21 incorporating M&E arrangementsunder this component with those establishedby MARD for the overall OPI. 71. Monitoring results will be reflected and reviewed in semi-annual project progress reports to (a) alert implementing agencies, the government and the Bank to actual or potential problems so that adjustments can be made, (b) determine whether the relevant stakeholders are responding as expected, and (c) allow the respective agencies to review and improve on their performance. M&E reports will form a standard part of the biannual project supervision reports, and will be presentedin standardized format. The monitoring findings will cover civil works, procurement, institutional activities, training and studies, performance indicators and FMRs. They will also cover issues identified during implementation, and strategies and actions undertaken. The fourth quarterly progress report of each year will be an annual report, covering progress made during that year. In addition to the Mid-Term Review, a First Year Progress Review will be scheduled to assess a review of early project implementation and make adjustments where needed. This will provide a joint opportunity by Government, specialized agencies, implementers and donordfinanciers the opportunity to review progress and discuss adjustments, where necessary. An Implementation Completion Report will be prepared by the specialized agencies and the Bank within six months of the project closing date. 72. Human Health Component. At the outset of the project, a monitoring and evaluation plan will be developed based on the project's results framework. This plan will amplify the results indicators and arrangements for results monitoring. It will also include the development of project assessment and supervision tools to be used during monitoring and supervision visits over the life of the project. The PCU will actively coordinate with M O H in incorporating M&E arrangementsunder this component with those establishedby M O Hfor the overall OPI. 73. Monitoring and supervision field trips will be conducted routinely by project management staff at provincial and central levels. Semi-annual management reviews will be conducted by the World Bank in conjunction with implementing partners. At provincial level, annual project implementation review workshops will be organized. These meetings will serve as a forum to assess project progress, share lessons learned and prepare project annual plans for submission to CPMU. CPMU staff will participate in these annual workshops to ensure that cross-provincial information is shared and good practices promoted. Annual workshops may be coordinated within regions for enhanced project learning and wider dissemination of successful approaches. 74. The project will use outbreak simulations as both a diagnostic and a monitoring approach to assess the readiness of systems and personnel at each level and to gain insights into the linkages and coordination between levels and between sectors. This will provide a better understanding of the impact of project capacity building activities and the effectiveness of coordination and managementfunctions supportedby the project. 75. Several important features of the project will be separately studied and evaluated. Due to the significant scale of project training interventions, a training evaluation will be conducted to assess training content, methodology, follow up and impact in each of the relevant subcomponent technical areas. Project surveillance and DPHC pilots will also be separately evaluated so as to provide a strong evidence base for guiding M O H policy and systems 22 strengthening. Evaluation findings will serve as a key input to MOH in determining national surveillance guidelines. Likewise, the evaluation of pilot DPHC's will assist the MOH in providing effective national leadership and guidance on the roll out o f this new system. 76. An external technical agency will support M&Eplanning and tools development and will carry out specialized project assessments and evaluations. This agency will also be responsible for designing and assisting with a project Mid-Term Review to be conducted in conjunction with Component A. 4. Sustainability,CriticalRisksandPossibleControversialAspects 77. Sustainability. Sustained ownership of project objectives and activities, coupled to strong government commitment, implementation incentives and the timely flow o f financial resources, will be critical factors in assuring effective project implementation. The consolidation o f project activities i s designed towards this goal. The project will benefit from experience already gained from AIERP, fortified by the need to expand avian flu control measures to prevent further outbreaks and the resulting damage to the poultry sector and human safety. The sustainability of laboratory services, which will increase as the result o f increased operating costs to maintain new equipment, provide consumables, and pay additional staff, will be supported by introducing regulatory measures to allow veterinary laboratories to charge fees for services to commercial clients to defray operating costs. Provincial budgets to support Regional Veterinary Centers (RVC) will also be increased. Project Officers assigned to the PCU will ensure that the project activities targeted at improving the quality assurance o f veterinary services will be effectively implemented. Market-driven poultry marketing and slaughtering will provide incentives along the market chain to improve farm biosecurity, slaughter hygiene and marketing, to break the infection chain. 78. As regards human health, what drives this project is the need to maintain a sustainable level of vigilance and establish mechanisms for surveillance and response that can be sustained through and beyond the natural life cycle of this particular virus. It i s relatively easy to identify the activities necessary to address a resurgence in sporadic human cases resulting from poultry exposure. However, achieving the right balance in pandemic preparedness i s more challenging, since the timing or severity o f the next pandemic, or even if it will be due to this or any other influenza virus, i s not known. In the absence o f a predictable scenario to plan for, it i s only appropriate to set up reasonable contingencies, understanding that, in the event o f a severe pandemic, no amount of preparations will ever be adequate. The hope instead i s that those that are made will also be applicable to other emergency scenarios. 23 79. Critical Risks Risk Rating Mitigating Measures FromCoqoner 1tooutputs Ebbing government commitment to control Continued discussions with government on OPI objectives and continued support from PAHI Decentralization to the provinces of funds for disbursement. selected activities; proactive attention by PCU staff Lack of FMcapacity at central and Appoint acceptable financial staff at central and provincial level including: inexperienced provinces; development FMguidance in the PIM; financial staff, lack of computerized provide training on FMdisbursement; establish accounting system, clear FMguidance to effective internal controvaudit function coordinate, lack of internal audit mechanism. Limited capacity by central and provincial Ensure that incremental project support scheduled DOH, DAHand DLP to take leading role in for these agencies i s at hand, and train DLP staff in managing project activities on a sustained management skills basis Inadequate coordination between MOH and S Promote appropriate operational coordination M A R D may undermine effective leadership mechanisms at each level with strong People's and management of the project. Committee engagement; strong program implementation & management linkages in key areas such as training, IEC, surveillance, planning and supervision Human health components have been M Project activities are designed to reinforce the role of designed to build AH1capacity within a AI prevention and preparednesswithin a larger broader system's framework. It will be public health context. difficult to achieve, sustain and scale up lasting integration of various components. Innovation may be resisted by M O H and Design and implement pilots that are closely other authorities. I H monitored and well evaluated with results widely disseminated; identify and involve innovation champions within the MOH, DOH'Sand other key stakeholders. Volume of in-service training may overload S Detailed implementation planning at local level; capacity of trainers and trainees; in absence provision of TA indesign of training; close of strong health training system, training monitoring and discrete evaluation of training quality and necessary follow up is difficult strategies and activities to ensure. 24 l Disease surveillance results do not cause S 1 Surveillance data is properly analyzed, transferred improvements in control measures and acted upon; Surveillance sampling is correctly done and processed. Commune-based disease reporting and S Provide close M&E on the relevance and other surveillance mechanisms are not presentation of training activities; conduct simulation responding satisfactorily exercises to identify problems; provide reporting incentives. Fn nOutputstoObjectives Resources cannot be moved easily from one S I Contingency funds and stockpiles of key equipment area to another. Should a major outbreak and materials available at central level for immediate occur in a non-project province, project deployment as needed in the event of an outbreak resources may not be available to respond adequately Harmonization with the diverse S WB and MOHparticipation inkey coordination stakeholders now working at scale with meetings, AH1networks, andjoint missions as MOHis difficult appropriate will mitigate duplication and facilitate value added linkages Inadequate implementation of poultry farm M Strong support i s incorporated into project activities surveillance for certified disease-free for DAH and SDAH to undertake adequate poultry status, combined with weak enforcement of farm auditing for disease, and for behavior changes same, fails to improve the marketing of in market operations avian flu-free poultry The surveillance program fails to decrease S Project support for DAH-initiated surveillance i s circulating virus in poultry comprehensive and provides the necessaryinputs to effectively carry out the program Poultry sector restructuring i s constrained S Human capacity strengthening at DLP, combined by weak DLPplanning capacity and with the provision of planning and guidelines, implementation of guidelines at the District ensures adequate restructuring oversight and level assistance OverallRisk Rating: S liskrating: H(highrisk); S (substantial risk); [ (modest risk); N(negligible or low risk) 5. Credit Conditionsand Covenants 80. Conditions o f Effectiveness: a. The AH1 Facility Trust Fund Grant Agreement and the PHRD Grant Agreement have been executed and delivered and all conditions for their respective effectiveness or the right o f the Recipient to make withdrawals under both o f them have been fulfilled; b. At least one of the MARDor MOHPCUshas: (i) beenestablishedandstaffedwithatleastthefollowingkeystaff PCUdirector, procurement officer, accountant, technical managers for each sub-component o f the Project Component under the responsibility o f the PCU; the PCU managers and staff should have qualifications, experience and terms o f reference acceptable to the Association; 25 (ii) adopted its respective Project ImplementationManual (PIM), which includes, among others, financial management guidelines, an Ethnic Minorities Communication Plan and guidelines for the implementation of environmental management procedures; as well as the Resettlement Policy Framework and the Resettlement Action Plan; acceptable to the Association; (iii) upacomputerizedaccountingsystemconsistentwiththefinancialmanagement set guidelines of the PIM, satisfactory to the Association; (iv) developed and implemented a comprehensive training and capacity building program for its financial management staff, in a manner satisfactory to the Association; and (v) adopted its respective Procurement Plan for the first 18 months of Project implementation acceptable to the Association. 81. Conditions of Disbursement a. For disbursement o f the proceeds allocated to Components A and C (under the responsibility o f MARD),the MARD PCUhas: (i) beenestablishedandstaffedwithatleastthefollowingkeystaff:PCUdirector, procurement officer, accountant, technical managers for each sub-component o f the Project Component under the responsibility o f the PCU; the PCU managers and staff should have qualifications, experience and terms of reference acceptable to the Association; (ii) adopted its respective Project ImplementationManual (PIM), which includes, among others, financial management guidelines, an Ethnic Minorities Communication Plan and guidelines for the implementation of environmental management procedures; as well as the Resettlement Policy Framework and the Resettlement Action Plan; acceptable to the Association; (iii) upacomputerizedaccountingsystemconsistentwiththefinancialmanagement set guidelinesof the PIM, satisfactory to the Association; (iv) developed and implemented a comprehensive training and capacity building program for its financial management staff, in a manner satisfactory to the Association; and (v) adopted its respective Procurement Plan for the first 18 months o f Project implementationacceptable to the Association. b. For disbursement of the Credit proceeds allocated to Component B (under the responsibilityo f MOH), the MOHPCU has: (i) beenestablishedandstaffedwithatleastthefollowingkeystaff PCUdirector, procurement officer, accountant, technical managers for each sub-component of the Project Component under the responsibility o f the PCU; the PCU managers and staff should have qualifications, experience and terms of reference acceptable to the Association; (ii) adopted its respective Project ImplementationManual (PIM), which includes, among others, financial management guidelines, an Ethnic Minorities Communication 26 Plan and guidelines for the implementation o f environmental management procedures; acceptable to the Association; (iii) upacomputerizedaccountingsystemconsistentwiththefinancialmanagement set guidelines o f the PIM, satisfactory to the Association; (iv) developed and implemented a comprehensive training and capacity building program for its financial management staff, in a manner satisfactory to the Association; and (v) adopted its respective Procurement Plan for the first 18 months of Project implementationacceptable to the Association. C. For disbursement o f the proceeds allocated to the disbursement category corresponding to payments of compensation to farmers in the event of an outbreak and culling: studies on improving the compensation mechanisms have been completed and a Compensation Manual has been adopted by MARD, satisfactory to the Association. 82. Other Covenants and Conditions (Non-Standard) a. The Recipient shall maintain, throughout the period o f implementation o f the Poject, the National Steering Committee for Avian Influenza to provide overall guidance and direction inthe implementation o f the Project. b. The Recipient shall appoint a Project Director from MARD and a Project Vice Director from MOH, under TOR satisfactory to IDA; C. Each Project Province shall establish, staff and maintain throughout project implementation, its PPMUunder the Provincial People's Committee; untilthe PPMUhas been established with adequate resources, staffing and TOR satisfactory to IDA, the Recipient shall not provide funding from the Credit for Project activities inthe Province. d. By no later than April 15, 2007, the Recipient shall have completed an environmental assessment o f the Project and an environmental management plan, satisfactory to the Association and publicly disclosed the assessment and the plan. e. The Recipient shall implement environmental measures acceptable to the Association and monitor and report on the implementation of those measure. f. Inconnection with activities to control market-based avian influenza, the Recipient shall implement the Resettlement Policy Framework and the Ha Vi Resettlement Action Plan. g. By no later than December 31, 2007, the Recipient shall have designed a results-based monitoring and evaluation system acceptable to the Association; and MARD PCU and MOH PCU shall have completed a baseline survey of Component A and Component B, respectively, and publishedthe results of that survey. h. The two PCUs shall prepare annual work plans including budget and disbursement estimates for their respective components and, by November 1of each year, provide them 27 to the Association for discussion. These annual work plans will consolidate the annual work plans submitted by the Project Provinces. i. ThetwoPCUsshallpreparesemi-annuallyprogressreports,includingquarterlyinterim financial reports, and provide them to the Association no later than 45 days after the end of the quarter. j. The Recipient shall discuss with the Association any proposed modification or amendment o f the Green Book before undertaking such modification or amendment. k. A Project Mid-TermReview will take place 12months after Effectiveness. D. APPRAISAL SUMMARY 1. Economic andFinancialAnalysis 83. The measures proposed under this project will reduce the risk o f AH1 outbreaks and thereby help to prevent an emergence o f a pandemic strain o f human influenza. The benefits o f preventing a pandemic and avoiding its potentially severe economic impacts are not confined to Vietnam. If action i s not taken in Vietnam to control infection, the risk to the rest o f the world's population increases. The project thus provides a global public good. Even though the level o f risk of emergence of a human pandemic influenza virus from currently circulating H5Nlviruses in poultry is unquantifiable and the timing of such an event is unknown, the costs of such an event, if it were to occur, are so high that actions to control H5N1 HPAIcan be justified on this basis alone. Therefore, a traditional economic analysis o f the project's costs and benefits i s not particularly useful. 84. Control and eradication of HPAI can only be achieved by using a combination o f measures. The composition of measures must be chosen and adapted according to the conditions in the country and its disease status, and must be phased. The aim is to ensure a minimumcost composition o f control measures to achieve this objective. 85. The suite o f control measures employed in 2005 provides a baseline cost for the control o f avian influenza in Vietnam. For example, the cost of vaccination alone amounts to some $20 million per annum. N o outbreaks have been reported in Vietnam since the introduction o f the 2005 suite o f measures (although H5N1 viruses are still present in the country). However, concerns have been expressed that in the long term the current government driven mass vaccination o f smallholder and village poultry i s not sustainable given the significant time and effort required to implement this properly. The resources allocated in VAHIP to control HPAI should therefore be assessed against their contribution in reducing the overall costs of HPAI control in a sustainable way in the long term. To achieve this, sustainable changes in existing marketing and production practices must be implemented and veterinary institutions strengthened. 86. In Vietnam, where the bulk of poultry production is still undertaken by backyard producers, the costs of controlling for avian influenza have fallen mostly on individual rural households. Survey data show that the poorest quintile o f households relies more than 3 times as 28 much on poultry income than does the richest quintile, so there are also adverse distributional effects. Reductions in poultry income due to avian flu or to potentially ill-designed avian flu control strategies will thus tend to worsen income distribution in Vietnam. Project subcomponents proposed in this project aim to ensure that the effects on the poor o f this disease and the control measures implemented are minimized through activities such as use o f ring vaccination, studies on streamlining o f compensation and finding ways to allow smallholders to keep accessing markets. 2. Technical 87. Component A: HPAI Control and Eradication inthe Agricultural Sector. The design and implementation of Component A benefits from the experience and lessons learned from AIERP. Several of these are referred to in Lessons Learned (above) and in Appendix 9, Technical Note 1. Component A addresses the consolidation phase o f Vietnam's fight against avian influenza, during which gains are maintained, voluntary restructuring o f the poultry industry aiming to increase bio-security in a socially and environmentally sustainable manner i s undertaken, poultry vaccination becomes more focused and cost effective, farms in the industrial sector demonstrate freedom from HPAI, and disease-free compartments are expanded. Several technical and institutional issues will impact on the successful implementation: 88. Public and Private Sector Capacity of Veterinary Services. Although substantially strengthened with support from the Government, the Bank, its GPAI partners and the donor community, veterinary services remain understaffed and short o f the quality assurance in diagnostic and epidemiological outputs that i s required to build confidence in decision makers. More focused and in-depth technical training through the institution o f a laboratory quality assurance program -- that aims for accreditation of HPAI diagnosis -- will provide much o f the impetus needed to achieve this goal. Private sector veterinary services remain on the sideline o f public sector animal disease interventions, and need to be brought into the process by means o f working partnerships that build trust and cooperation. Collaboration in poultry sector restructuring, market-based disease surveillance and general poultry surveillance, as planned, could do much to achieve this goal. 89. Regulatory Framework. Adequate enforcement of the existing regulatory framework that governs the implementation of veterinary services remains questionable. Despite repeated external and internal reviews and adjustments, enforcement of Decrees and Decisions continues to pose a significant constraint in ensuring that regulatory matters move from paper to farm and market. The introduction o f pilot market-based disease control would provide a practical link between regulatory design and legal practice, by introducing incentives (i.e. the delivery o f vaccinated poultry from health-certified farms as a point of entry) to comply with regulatory requirements. Similarly, guidelines prepared for poultry restructuring, backed up with on-the- ground models, would provide the incentive to gradually enforce regulations. 90. Biosecurity Measures. Biosecurity measures remain widely misunderstood and misapplied, as evidenced by the practice o f routine spraying of poultry as a way o f "disinfecting" them (the infective virus resides inside the birds, and i s not killed by external disinfectants). Despite continuous messaging, many smallholders have only limited awareness o f the principles o f biosecurity and disinfection. Clearly, more well-targeted and designed messaging i s needed, 29 . albeit in the correct mode and manner, and to the right audience. A clear need exists to evaluate messaging and decide on what works and what does not -- quality assurance in Information, Education and Communication (IEC) i s as important as it i s inveterinary services provision. 91. Standardized Disease Reporting. Standardized disease reporting remains a wish rather than reality, and presents a major constraint incomprehensive disease reporting at all levels. The lack of a unified national reporting mechanism i s related to the relative autonomy o f the provinces, which devise their own measures and systems incoping with disease control. A major institutional constraint in maintaining a national reporting network has been the lack o f epidemiology support staff at DAH, compoundedby the lack o f such staff and the SDAH level; a deficiency that will be corrected by project inputs. Linked to additional epidemiology training inputs,TA and enhanced DAHcapacity, a harmonized reporting network is one of the objectives of Component A. 92. Poultry Sector Restructuring. Voluntary and private sector-led poultry sector restructuring i s a significant challenge for the newly established Department of Livestock Production (DLP). A small, weak and poorly trained DLP i s facing a national program well beyond its present capacity and capability. Lack o f coordination between DLP and the provinces and the districts in which restructuring will actually take place has resulted in confusion, lack o f clarity in restructuring guidelines, and lack o f resources (land, capital, incentives) by the industry to effectively respond to restructuring. Component A will address some o f these deficiencies by providing capacity building, guidelines and the development o f pilot restructuring models. (However, the extrinsic factors to restructuring remain beyond the scope of the project. Further details are found inAppendix 9: Technical Note 3.) 93. Component B: Influenza Prevention and Pandemic Preparedness in the Health Sector. Consistent with successful AI control efforts globally, the human health component o f VAHIP i s designed to prevent or limit transmission from animals to humans, appropriately identifying, responding to and treating any human cases that do occur, and preparing for a potential pandemic. The approach being adopted in this project signals a strategic shift in two principal ways: The first i s the shift from an emergency preparedness-only approach, to planning for the medium term. The second i s by moving the interventions closer to the community and fostering local ownership by encouraging participation o f the district and community levels. The subcomponents under this component include (1) strengthening routine surveillance, (2)building capacity o f the district and provincial health centers, (3) enhancing positive behavior change through effective communication and knowledge dissemination, and (4) strengthening the preventive health care functions. 94. Surveillance System. A good surveillance system is fundamental to any effort to prevent, detect, and contain an outbreak o f HPAI. A surveillance system for communicable diseases i s in place in Vietnam providing information for 26 notifiable diseases. This system i s not without its challenges. Reporting i s still fragmented (in order to accommodate the requirements o f different vertical programs), case definitions are not universally applied, and data generated i s often neither accurate nor routinely used for decision making by those generating the information. These constraints are most severe at the lower levels from the district to the community. The surveillance system subcomponent will support MOH in the assessment and piloting improvement o f the surveillance system in the project provinces involving all levels 30 from the community to the province. It will also support the implementation of an early warning system, the creation o f rapid response teams, improved information management, capacity- buildingand supply of equipments to facilitate early detection andresponse to outbreaks. 95. Curative Care Readiness. Vietnam has had some experience with managing human AH1cases in hospitals. Reported cases were managed in very specialized hospitals in Ho Chi Minh City and Hanoi. Potential outbreaks still pose a credible threat to the hospital systems especially at the district level where patients are likely to present initially. Therefore, a more systematic approach for improving the capacities of these hospitals i s crucial. The curative care readiness subcomponent will assist the hospitals through the development o f preparedness plans, investment inthe needed equipments and supplies, and training o f staff inthe hospitals. 96. Behavior Change and Communication. Given the likelihood o f persistence o f circulating influenza viruses (H5N1 and other subtypes), prevention of animal to human transmission i s the bedrock o f controlling AI in humans and preventing a pandemic. It i s therefore critical that people are well informed and adopt practices (personal and environmental) that effectively mitigate this risk, and that they take part in the reporting and containment of outbreaks. The BCC subcomponent adopts a two-pronged approach of improving the BCC skills of health workers at all levels, and conducting community-based BCC activities, within the framework o f appropriately designed provincial level BCC plans. 97. Preventive Health System. The newly introduced preventive health strategies of MOH will form the foundation for future comprehensive and systematic approaches to preventive health in Vietnam. Any effort to sustain preventive health interventions will need to build on this new framework or take it into account. This framework remains largely untested and has only been implemented in a few provinces. The preventive health system subcomponent will assist M O H in operationalizing this in the provinces and adapt it to local circumstances. It will support appraisals o f the system, piloting of innovative preventive efforts with active local participation, coordination with DARD, and addressing HR constraints. 3. Fiduciary 98. An assessment of the project's financial management arrangements was conducted in October 2006 and updated in December 2006. Although this i s a follow-up project to AIERP, there are significant changes in the implementation arrangements with implementation substantially decentralized to the provincial level, new coordination arrangements between two ministries, and new staff being appointed and responsible for financial management. The FM risk is assessed as substantial due to the: (i) of capable staff at the central level and lack especially at the provincial level when the functions o f planning, budgeting, procurement and financial management are delegated to the provinces; (ii) of clear guidance on coordination lack between two implementing ministries to achieve consolidated and timely management o f funds flows, budgeting and financial reporting; (iii) o f practical and consistent computerized lack accounting arrangement to support accounting and financial monitoring; (iv) potential delays in the provision o f counterpart funding from provincial government budgets; and (v) lack o f an effective oversight mechanism such as an internal audit function. The above risks and mitigating measures have been analyzed by the mission and a detailed Action Plan to improve Financial Management has been prepared. It i s concluded that with the completion o f that Action Plan (see 31 Appendix 4), the Project will have capacity to meet the minimum requirements of the Bank's OP/BP10.02. 4. Procurement 99. Procurement Methods. The emergency nature of the project requires the use of methods that would allow procurement to be completed in the shortest possible time while still ensuringa reasonable degree of competition and transparency. Given the small value and nature o f most o f the procurement packages, the proposedmethods include shopping, procurement from specialized UN agencies for vehicles, selection based on consultants qualification, individual consultants and single source selection in accordance with the provisions o f the Bank Procurement Guidelines and Consultant Guidelines, April 2004. 100. Procurement Plan. A procurement plan was developed by MARD, MOH and Provincial People Committees (PPCs) (that is, the proposed project implementing agencies). In addition, the PIM to be prepared before project effectiveness will include a section on procurement. Technical assistance services from OIE will be procured using sole-source selection. 101. Procurement Capacity Assessment. An assessment o f the procurement capacity of the proposed project implementing agencies was conducted as part o f the appraisal mission and the capacity was found inadequate. 102. Procurement Risks and Corrective Measures. The overall project risk in respect o f procurement i s high. The procurement issues and risks for implementation o f the proposed project are mainly related to: (a) inadequate procurement knowledge and experience o f the project implementing agencies; (b) the potentially heavy workload due to the emergency nature o f the proposed project in addition to the workload which might be required by other potential projects to be funded by other donors; (c) the possibly slow or delayed government internal procurement approval process; and (d) the potential abuse of shopping and statement o f expenditures procedures. The main measures envisaged to address these risks under a Procurement Action Plan include inter-alia: (a) MARD/MOHPCs to provide a simplified review procedure for internal approval; (b) a procurement consultant should be recruited for each central PIA; (c) each PIA will assign one procurement officer to work full-time at the CPU(s); (d) procurement training should be provided for project staff; (e) advertising for shopping packages above thresholds established for this project i s mandatory; and (f) enhanced measures for monitoring and control o f procurement which i s undertaken on the SOEbasis. 5. Social 103. The project i s expected to contribute to minimizing the impact o f avian influenza outbreaks and a human pandemic by having in place a surveillance and response system to minimize the potential impact o f unreported outbreaks in poultry. Furthermore, the project will support a follow-up study on compensation policy implementation, including merits and sustainability. By minimizing the circulation of infective HPAI virus in the poultry population, the chances of the virus transmuting to humans i s equally minimized. The project will focus heavily on further strengthening disease surveillance and reporting, combined with more finely 32 tuned awareness messages that result in public behavior change, especially of rural populations at the commune/village level. A preparedness plan, backed with contingency funds for incremental outbreak containment, i s supported by the project. The project's support to improving surveillance, conducting public awareness campaigns (including translation o f messages into ethnic languages), and puttingin place a preparedness plan, could help to prevent or, in the event of a pandemic, reduce the impact on the population. The integrated surveillance system to be supported by the Project will reinforce the multi-sectoral character o f project responses. 104. The Bank's two social safeguards policies - Indigenous Peoples (OP4.10) and Involuntary Resettlement (OP4.12) - are triggered. Although the Indigenous Peoples safeguard applies, the Project i s expected to have no adverse impacts on ethnic minority groups. An Ethnic Minority Communication Plans will be developed to ensure that these ethnic minorities will benefit from the project in a way which i s culturally appropriate and gender inclusive. To support this goal further, public information materials will be produced in local minority languages to ensure that all concerned ethnic groups are informed (see Appendix 7). The design o f subcomponent B3 - Strengthening Behavior Change Communication (BCC) in Health Facilities and the Community will reflect the Ethnic Minority Communication Plan. The Involuntary Resettlement safeguard policy i s triggered by the acquisition o f about 1.7 ha o f land under the project for the H a Vi live-poultry market in Ha Tay Province. There i s no housing on the land to be acquired. MARD has prepared and approved a Resettlement Framework Policy for Component A and a Resettlement Action Planfor the H a Vi Market. 6. Environment 105. The project i s not expected to have any large-scale, significant and/or irreversible impacts as activities focus largely on public sector capacity building and ensuring readiness for tackling outbreaks of HPAI in domestic poultry as well as preventing or reducing possible human infections by strengthening emergency preparedness and response. The project design envisages other beneficial measures on the animal health side such as improved biosecurity in farms, disease control and poultry industry restructuring. On the human health side, the preventive activities include enhanced surveillance, curative care preparedness and awareness raising. All measures are aimed at increasing the effectiveness and safety over the existing AH1practices and will have positive human health and environmental impacts. An outline of the Environmental Management Plan (EMP) i s found in Appendix 6. This outline will be developed into a complete draft by M A R D N O H after consultation with various stakeholders. The EMP will be finalized and disclosed at publicly accessible locations in Vietnam and at InfoShop in Washington by April 15, 2007. The project Finance Agreement reflects implementation o f the EMP. 7. SafeguardsPolicies 106. Among the Bank's safeguards policies, the Environmental Assessment (OP4.01), Indigenous Peoples (OP4.10) and Involuntary Resettlement (OP4.12) are triggered. The project design incorporates the necessary mitigation measures for the adverse impacts associated with the activities involved inrespondingto HPAIoutbreaks. 33 Safeguard Policies Triggered by the Project Yes No EnvironmentalAssessment(OPBP 4.01) [XI [ I NaturalHabitats(OP/BP 4,04) [ I [XI PestManagement(OPBP 4.09) [ I [XI CulturalProperty(OPBP 11,03) [ I [XI 'InvoluntaryResettlement(OPBP 4.12) [XI [ I Indigenous Peoples(OP/BP 4.10) [XI [ I Forests(OP/BP4.36) [ I [XI Safety of Dams (OP/BP 4.37) [ I [XI Projectsin DisputedAreas (OP/BP7.60) [ I [XI ProjectsinInternationalWaterways (OPBP 7.50) [ I [XI 8. Policy ExpectationandReadiness 107. Since the Project i s being processed in accordance with emergency procedures (OPBP 8.50 ERL), clearance has been received by the Regional Safeguard Advisor, EAPVP and OPCS VP to delay the preparation and disclosure of the EMP to April 15,2007 (Le. to around 120 days or four months after appraisal). This i s consistent with the exemptions allowed under paragraph 12 of OP 4.01, referring to the Environmental Assessment o f Emergency Recovery Projects. A dated covenant indicating when the EMP must be disclosed i s included in the Finance Agreement. Duringappraisal the following filters on client project readiness have been discussed and reconfirmed: (a) Project Implementation Manual; (b) agreed upon implementation arrangements, complete with staffing and other gaps identified; (c) requirements for financial management, procurement and the M&E structure; (d) bidding documents for the first year of project implementation; and (e) audit arrangements. 34 Appendix 1:ResultsFrameworkandMonitoring VIETNAM: VN Avian & HumanInfluenzaControl& PreparednessProject ResultsFramework To increase the effectiveness of .Increased number of annual Government services at reducing suspectedHPAIcases in VAHIP was achieved. the health risk to poultry and poultry reported and fully humans from avian influenza investigated (both laboratory both in eleven selected provinces and field) in the eleven project as well as country-wide by provinces controlling the disease at source 9For both veterinary and health indomestic poultry, by early sector, reduced reporting time detection and responseto poultry of new outbreaks and return of and human cases, and by laboratory confirmation to the preparing for the medical affected commune. consequences of a human 1Reduced fatality rate of human pandemic if it occurs over the H5N1 cases reduced compared next five years. to 2004l05 in the eleven project provinces. I I IntermediateResults ResultsIndicatorsfor Use ofResultsMonitoring OneperSubcomponent EachSubcomponent ComDonentA: Animal Health Al. Veterinary services relatedto . 1 Number of laboratories Results will be used to diseasediagnosis and field working at IS010725 increase the focus on surveillance are strengthened standards for AI testing laboratories not meeting standards so as to speed-up the improvement process. A2. Disease control enhanced, 1 Percent of positive samples for 1 Results will be used to assess and action based on surveillance H5N1 virus in Ha Vi market the effectiveness of measures data over 3-month rolling average and speed-up changes if progress i s slow. A3. Surveillance activities show 1 Number of commercial farms 1 Surveillance data will be used improved disease status along the in which freedom from HPAI to alter disease management poultry marketing chain from infection is demonstrated strategies and ensure that processor to farm. appropriate samples are collected for future surveillance. A4. Develop sustainable bio- . Number of small-scale poultry . Use for extension services to security systems for small-scale farm models demonstrated promote bio-secure small- poultry farms holder poultry production. A5. Emergency outbreak Number of rapidresponse Iftargets are not met training containment ready and effective teams demonstrating effective for response team will be response to simulation or enhanced. actual outbreaks 35 Intermediate Results One per Outcome Indicators Use of Result Monitoring Component Improved surveillance system % of reports that are accurately To assess the effectiveness of completed. disease surveillance system % of reports that are received on time at the province. Pandemic preparednessplanning % of provinces with Pandemic To assess the progress of preparednessplan developed interventions & evaluate the and desk-top exercise effectiveness of intervention implemented SubcomponentB3: StrengtheningBCC inhealth facilities and community Increased awareness and adoption of key % of target population that can To assess the impact of BCC preventive behaviors among the target accurately identify and have activities population practiced at least one key preventive behavior. Subcomponent B4: Strengtheningthe Preventive Health System at LocalLevel New Preventive Medicine personnel I% of provinces with revised 1To assess the effectiveness of policies are in place in at least 50% of preventive medicine policies in new personnel policies in project provinces place. addressing HR problems % of staff satisfactorily performing tasks they are trained for. District PreventiveMedicine Centers are No. of DPMC in 8 provinces are Reports by provinces on the improved and are able to fulfill their fully equipped and have activities of DPMC and project functions and responsibilities adequate capacity to implement completion report their responsibilities and functions in compliance with the DecisionNo. 26/2005/QD-BYT by M O H on Preventive Medicine at district and Drovincial citv level 36 I Enr + - m 3C 2 d @ F, 00 m N E 2 ,8 0 d 0 . . I . c - 3 c S d S m 4c 4c 0 2 3 0 g g vi 4 - v i v i x) N * b 0 0 0 vi d d fata 3 t ;tr ta, L- .I c, Ea 8t 8 cr 0 3 0 3 0 i b 48 i2 .m a, 3P .I I m Q c, .-t I E 3 a i c, 8 5Y 0 c.. .I s2 a, P Y 2 Appendix 2: Detailed Project Description VIETNAM: VN Avian & HumanInfluenza Control & PreparednessProject Component A -HPAI Control and Eradication inthe Agricultural Sector (US$17.2 million) 1. The OPIoutlines the strategy that the government will adopt to control and progressively eradicate H5N1 HPAIinpoultry. This will occur in three phases: 2. A Control Phase, inwhich the incidenceof outbreaks is reducedby the stamping out of outbreaks, mass vaccination, and the commencement of improvements inbio-security o f poultry production and marketingpractices; 3. A Consolidation Phase, inwhich gains are maintained, further restructuring of the industryis undertaken, farms inthe industrial sector demonstrate freedom from HPAI, and disease-free compartments are expanded, and 4. An EradicationPhase, inwhich freedom from disease is achieved on anational or sectoral basis. 5. It is expected that the Control Phasewill continue untilend-2007. Some reductions inthe scope of the national mass vaccination were introduced in 2006 and further reductions are plannedfor 2007 and beyond. The Consolidation Phase will occupy the remainder of the VAHIP project horizon (to 2010). Nationaleradicationprograms will be built on gains made in the consolidation phase, supported by VAHIP and other programs. 6. The Animal Health Component has five subcomponents inline with the OPI: A 1 - Strengthening of Veterinary Services; A 2 - Enhanced Disease Control; A3 - Disease Surveillance and Epidemiological Investigations; A4 - Preparingfor Poultry Sector Restructuring, and, A5 -Emergency OutbreakContainment. 7. Subcomponent A1 Strengthening of Veterinary Services (US$2.6 million).This - subcomponent contains three activities: (a) a needs and capacity assessment and developing quality management procedures inveterinary laboratories; (b) biosafe virus isolation capacity at HCMC Regional Veterinary Center, and (c) commune-based disease reporting. 8. Activity A l a Needs and Capacity Assessment, and Developing Quality - Management Procedures. Activity A1a serves to ensure that veterinary laboratories conducting avian influenza testing have the necessary capacity and resources to undertake the incremental workload generated by project activities related to avian influenza control at a level that will allow laboratory users and decision makers to have full confidence in the results. To accomplish this, a needs andcapacity assessment, dedicated to HPAIdiagnostic work, will be carried out at the NIVR, NCVD, the five RegionalVeterinary Centers (RVC) located at Haiphong, Vinh, D a Nang, H o Chi MinhCity and Can Tho, and at the provincial veterinary laboratory inLang Son border province. Based on recommendations from this assessment, extra laboratory staff will be contracted and additional equipment and consumables procured to meet the demands of the 39 incremental workload resulting from the increased surveillance and post-vaccination monitoring under this subcomponent. The needs assessment will ensure that appropriate procedures are in place for the proper and safe disposal of laboratory wastes arising from influenza diagnostic activities. Technical support will ensure that quality management o f laboratory operations relating to avian influenza testing i s appropriate. This will allow sustainable operation of these laboratories at a technical level commensurate with accreditation to I S 0 17025 standards (the international standard required for laboratory accreditation). To support on-going operating costs, the possibility of developing a revolving fund to capture fees from diagnostic services will be investigated and, if feasible, will be implemented. 9. Outputswill include capacity to perform all requiredincreasedtest demands, the use of standardized test regimes with appropriate quality management programs for the diagnosis o f HPAIand a cost recovery mechanismthrough revolving funds, if feasible. The project will provide equipment, technical assistance, training, consumables, contracted laboratory staff and other operational support. 10. Activity A l b -Isolation of Viruses under Biosafe Conditions. A portable BSL-3 laboratorywill be installed at the H o Chi MinhCity (HCMC) RVC to enable laboratory workers to isolate avian influenza viruses under biosafe conditions. A back-up generator will supply power incase of grid failure. A portable facility i s preferred so that if the HCMC laboratory relocates, it can be moved (relocation i s plannedbut will not occur during the life of this project and therefore will not incur project costs). With the BSL3 unitinplace, veterinary laboratories in the south will be able to submit samples for virus isolation directly to the HCMC laboratory instead o f to NIVR in Hanoi, thereby significantly shortening turn-around time. The Project will support procurement of the BSL3 unit, replacement HEPA filters', the back-up generator, installation costs and training. 11. Activity Alc -Commune-based Early Warning and Disease Reporting. Activity A l c aims to improve disease reportingby CAHWs to veterinary authorities so as to enhance the quality and quantity of disease information collected at the commune level. This i s achieved by training CAHWs inbasic disease recognition and reporting disease when encountered in standardformat to allow amalgamation of field information into national disease information databases. This information can then be usedby provincial and central animal health authorities inplanning disease control strategies and activities. This process hasbeen seriously constrained by the limiteddata available from the commune level. This programbegan under AIERP and will be expanded from 30 Districts to include some 90 districts inthe project provinces under VAHIP, with 30 districts added ineach of three project years. District veterinary staff and selected CAHWs will be trained using a cascade system ("training of trainers") by contracted NGOs inenhanced early warning, avian influenza recognition, disease reporting and proper procedures for sample collection, packing and transport. This information will cascade down to CAHWs and result in improved reporting o f disease information (this links to Subcomponent A5 which promotes training o f villagers on early disease detection and notification). Training programs will be carefully tailored to meet the trainees' level of comprehension. Relevant training sessions on disease recognition will also include commune and village level human health workers to achieve better reporting and to facilitate information exchange between Special filters able to trap virus particles usedto filter air before it i s expelled from the BSL-3 unit 40 medical and animal healthworkers. The program will be assessedto ensure its effectiveness by reviewing disease reporting before and after the training and making adjustments where necessary. Specimen transport containers complying with international transport regulations for infectious substances will be provided to all district offices and these will be used when submittingsamples to veterinary laboratories. Operational support will also be providedto the 90 project districts to ensure adequate follow up on disease reports from CAHWs. 12. Outputswill include regular, reliable andrapid disease reporting by trained CAHWs, with data to be utilized centrally indisease management and planning. The Project will finance training, training resources and materials, NGO program management, consultants, and mobilization and implementationcosts. 13. SubcomponentA2 Enhanced Disease Control (US$3.5 million). This subcomponent - comprises five activities conducted inlive-bird markets, slaughterhouses, poultry farms and border areas to consolidate gains made already in avian influenza control. 14. Activity A2a Market-basedAvian Influenza Control. This subcomponent focuses on - the upgrading o f hygiene standards of live-poultry markets. It involves upgrading hygiene standards at large live-poultry markets and back along the market chain through the introduction of market-based avian influenza control, thereby interrupting infection along the market chain and preventing the spread o f viruses. Activities will center initially on one large live poultry market (Ha Vi market inHa Tay province) to form a pilot model for upgrading facilities and procedures in other live-bird markets. Plans are well advanced to relocate this market, including site selection and provincial approval for the project, and this opportunity will be taken to upgrade the facilities and design. Under this activity, procedures and rules for reducing the risk o f spread o f HPAIvirus from farms, by transporters and within markets will be developed in conjunction with market stakeholders. This will commence even before the market i s relocated. Implementationwill be phased to minimize shifts of trade to unregulated markets. Several sub- activities will be undertaken to implement this activity, involving the upgrading o f facilities and market procedures. Plans for the new relocated market will be developed and specific facilities relating to improved market hygiene such as holding cages, vehicle washing facilities and waste water treatment will be funded. A socio-economic study on the effects o f market upgrading and its comparative advantages will be conducted. These interventions will foster appropriate behavioral change inpoultry traders, farmers and transporters through specific, targeted training and BCC activities. Studies will be conducted on ways for smallholders supplyingnative (Le. backyard, free-ranging) poultry to comply with new disease control measures, providing them continued access to the upgraded market and providing consumers with safe native poultry sold through regulated markets. To better assess the disease risk to market traders inhandling poultry, stall owners and staff will be invited to participate in serological monitoring for evidence o f exposure to AI virus. The feasibility o f upgrading additional markets inthe other project provinces will be assessedand appropriate renovations and changes to market procedures implemented. This will be linked to studies assessing the risk these markets pose in maintaining and spreading avian influenza viruses. This program will build heavily on the experiences from 41 the WHO `Healthy Food Market"' program with strong cross linkages to human health activities. 15. Outputswill include: an upgraded, pilot live-poultry market with enhanced hygiene measures; evidence o f behavioralchange inmarket staff, traders, poultry transporters and farmers usingor supplyingthe market; reduced levels o f AI infection inproject markets, concrete plans and action for improved management and hygiene in other markets, and methods for the sourcing and supply o f native poultry to markets that minimize the risk o f infection with AI. The Project will finance civil works for market renovations, market equipment, training, studies, technical assistance and workshops. 16. Activity A2b-Breaking InfectionChainsbetweenFarmsand Slaughterhouses. This activity will develop procedures to break the avian influenza infection chain between farms and slaughterhouses. Current pre-movement veterinary certification o f poultry on farms does not guarantee freedom from infection with H 5 N1avian influenza when these birds are sent for slaughter. This certification i s often based on expensive laboratory tests performed on samples collected several weeks prior to sale. These tests provide no information on disease status when these birds are sent for slaughter, which wastes valuable resources and may provide a false sense of security. Workshops with Provincial SDAHs, DAHand international disease management experts will be held to develop and apply appropriate, science-based testing, inspections and pre- movement certification for poultry. This subcomponent will also examine the facilities and procedures required to prevent transfer o f infection to farms via non-disinfected vehicles and transport cages that leave slaughterhouses. The activities will be carried out through selection and mobilization o f 12 slaughterhouses that process poultry from project provinces. An assessment of existing hygiene procedures for transport vehicles and cages will be performed at these slaughterhouses and, as a result of this assessment, practical hygiene measures for slaughterhouse managers and workers will be recommended. Slaughterhouse inspectors and management will be trained in the new requirements, checking o f poultry movement health certificates, ante mortem inspection o f poultry, and procedures to adopt if dead poultry are found inconsignments on arrival. Practicalmanuals of recommended standard operatingprocedures will be developed for DAHon the entry and exit of poultry transport vehicles and pre-sale testing and poultry monitoring for live-bird markets and slaughterhouses. 17. Outputswill include: 12 slaughterhouses provided with plans for upgradingfacilities and procedures; lessons learned from these measures communicated via manuals of operating procedures to DAHfor application in other slaughterhouses and farms, pre-entry testing requirements for on-farm poultry are science-based, and animal health staff at the provincial ' level fully understand the rationale for testing and interpretation. The Project will provide technical assistance, workshops, training and hygiene monitoring support. 18. Activity A2c-Certified freedomof HPAIinPoultry Farms. The aim of this activity i s to develop and implement a pilot disease monitoring system to demonstrate sustained freedom from circulating AI viruses inlarge, commercial poultry farms, thereby creating avian influenza- free farms and compartments as an important step towards eventual eradication. This i s one o f lo See WHO http://www. who.int/entity/foodsafety/publications/capacity~ealthym~ket~uide.pdf 42 the main objectives o f the consolidation phase o f the Animal Healthcomponent as described in the OPI. The SDAHs ineach of 4 project provinces will engage ten large Sector 1or 2 poultry 19. farms" to participate inthis pilot. To accomplish these goals, proposals will be developed on appropriate biosecurity standards that these farms should achieve. Inaddition, methods will be developed for auditing biosecurity implementation on poultry farms along with systems for demonstrating disease freedom on poultry farms. Services will be contracted to conduct the necessary biosecurity auditing. SDAH and district staff will be trained to develop a sound understanding o f the monitoring system's objectives and will implement it. Once the system i s established in these farms the monitoring system will then be extended to 30 additional farms inother project provinces, based on lessons learned from the initial pilot farms. 20. Outputs will include: on-going demonstration o f freedom o f infection in a minimumo f 40 poultry farms demonstrating through audit that they are meeting established farm biosecurity standards; a sound understanding by animal health staff at the provincial and district levels will be fostered o f the rationale for and value of the monitoring system. The Project will support incremental laboratory services, training, studies, contracted services and technical assistance. 21. Activity A2d Poultry Vaccination. This subcomponent supports five vaccination- - related sub-activities, covering (1) development and introduction of appropriate methods for vaccination of grazing meat ducks; (2) field trials o f vaccination o f minor poultry species (quail, goose and pigeons) for which appropriate vaccination methods are not yet available; (3) training of animal health workers inring vaccination to be used inthe event of localized disease outbreaks; (4) assessment of the feasibility o f local vaccine production for H5N1HPAIfor poultry, and (5) upgrading of the vaccine cold chain through supply o f walk-in cold stores for vaccine storage managed by SDAHinproject provinces. (for further details on vaccination- related activities see Appendix 9, Technical Note 2). 22. Outputs include: practical methods for meat duck vaccination are established and carried out in all grazing duck flocks inproject (and other high-risk) provinces; guidance i s provided to DAHon vaccination strategies for minor poultry; a demonstrated capacity exists to undertake ringvaccination quickly inthe event of an outbreak inproject provinces; the feasibility of local vaccination manufacture has been assessedand recommendations provided to MARD, and an effective cold chain has been set up for the storage of vaccine supplied to project provinces. The project will provide consumables, vaccines and vaccine equipment, other equipment, travel, contracted staff and technical assistance. 23. Activity A2e Enhanced Border Protection. This subcomponent will support - strengthening o f animal quarantine in Lang Son province, a major route for illegally smuggled poultry into northern Vietnam. Such poultry present a potential infectious hazard that can precipitate new outbreaks. One o f the main transit routes for illegal poultry from China into Vietnam passes through this province. The animal holding unit will be renovated, a vehicle and cages for collection of seized poultry will be purchased, and an incinerator for the proper 11FAOIOIEclassification of poultry production sectors. Sector 1farms are large fully integrated farms that practice high levels of biosecurity. Sector 2 farms are independent poultry farms that practice reasonable to high level biosecurity. The standards of biosecurity are not harmonized globally. One objective of this activity would be to define for Vietnam the standards of biosecurity that Sector 2 farms should achieve. 43 disposal of confiscated poultry will be installed. Contract staff will be employed to assist inthese activities and trained in animal disposal in accordance with the National Emergency Disease Contingency Plan for Control o f Highly Pathogenic Avian Influenza inVietnam approved by MARDin2005. Pressure sprayers, stocks of disinfectants andpersonalprotection equipment will be provided to allow proper disinfection of vehicles. Cross-border meetings with Chinese counterparts will be arranged to facilitate discussion on ways to reduce the risk from illegal cross-border trade inpoultry. 24. Outputs include safe handling and disposal of seized smuggled poultry usingapproved methods and reduced risks from the entry of illegally smuggled poultry. The project will support equipment, consumables, cross-border meetings, staff, training, technical assistance, and minor civil works for renovation. 25. SubcomponentA3 -Disease Surveillance and Epidemiological Investigations (US$1.5 million). This subcomponent focuses on disease surveillance, which i s necessary to determine the distribution and amount of circulating influenza viruses. It i s an essential element of avian influenza control programs. Without surveillance, the extent o f infection i s unknown and control programs are based on incomplete field intelligence, limiting the applicability o f risk-based interventions, as recommended in the OPI. This subcomponent will support all project elements in subcomponent A 2 (above), providing data to support M&Eo f these activities. It will also provide much needed assistance in data analysis to DAHand undertake additional epidemiological studies on the poultry industry in selected provinces. 26. Activity A3a - Market-based Surveillance. Weekly surveillance for viruses will be conducted inthe Ha Vi market to obtain on-going data on the amount of avian influenza virus circulating in the market (at least 200 samples per week). Samples from the first few months o f the program will be used as base line data for subsequent monitoring and evaluation o f the project and the effects o f hygiene measures inthe market. Similar testing will be implemented in markets inother project provinces on a monthly basis. 27. Activity A3b Slaughterhouse Surveillance. Testing will be performed on samples - collected in slaughterhouses to assist indetermining the effectiveness o f measures to break the infection chain between farms and slaughterhouses and, where appropriate, to assess the disease status o f poultry from certified clean farms. This will include tests on poultry found to be dead on arrival at the slaughterhouse. 28. Activity A3c -Surveillance for disease freedom on f a r m . The appropriate samples to collect on farms under activity A2c that will allow demonstration of freedom from infection with H5N1 HPAIviruses will be collected and tested. The precise details o f this testing program will be determined after workshops are held between consultants and national and provincial veterinary staff, but will likely include samples from "routine" dead poultry.12 The testing will include government owned grandparent farms. 29. Activity A3d Duck Surveillance. Samples will be collected from duck flocks to - assess the response to vaccination. Unvaccinated sentinel ducks in some flocks will be kept and l2Inallpoultry flocks low level mortality i s expected. Testing of these dead birdsis recommended as one method for detecting low levels of infection with HPAIin vaccinated flocks 44 tested regularly for evidence of exposure to field virus. This information will be used to assess whether and, if so, how much virus i s circulating in areas where ducks are vaccinated. 30. Activity A3e -Border Security Surveillance All interceptedconsignments of smuggled poultry inLang Son will be tested to assess whether the birds inthe seized shipment are currently infected, or have been infected (or vaccinated) inthe past. 31. Activity A3f - Wild BirdStudies and Surveillance. Additional surveillance studies will be conducted inwild birds in areas deemed to be at highrisk o f infection with HPAIviruses. These studies will focus on areas where HPAIhas occurred, where wild birds can contact poultry (either directly or indirectly) or where no apparent source o f the virus was established for outbreaks inpoultry. These studies will assist indetermining the possible role o f wild birds inthe spread and carriage o f HPAIviruses. 32. Activity A3g Developing Risk Profiles for Project Provinces. Intensive rapid - assessments of the four project provinces not previously included inAIERP (Than Hoa, H a Tinh, Tay Ninh, Lang Son) will be undertaken to develop risk profiles and review current surveillance activities so as to buildplans for sustainable HPAIcontrol inthese provinces. This will include an assessment of the structure of the poultry sector including movement patterns, results from surveillance programs gaps inknowledge that need to be filled, and information on vaccination o f poultry inthe province. 33. Activity A3h - Support for DataManagement At present there i s insufficient capacity inDAHto analyze all data collected and this problem will be exacerbated as additional surveillance i s performed. This activity will provide additional contract staff to undertake analysis o f data. They will be supported by an international epidemiology specialist who will provide assistance and guidance on the collection and analysis o f complex data. 34. Outputsof Subcomponent A3 include well structured surveillance data and other information, for use indeveloping and modifying disease control and hygiene programs and for monitoring and evaluating project activities under subcomponent A2; information on the role o f wild birds inthe persistence of spread of HPAI, and riskprofiles of four provinces that did not participate in AIERP. The Project will support national and international technical assistance, consumables, equipment, travel and office support. 35. Subcomponent A4 Preparing for Poultry Sector Restructuring (US$l.3 million). - This subcomponent has three activities that will prepare and strengthen the capacity of DLP and provincial agricultural authorities. This will allow DLP to address poultry sector restructuring in an environmentally compatible manner, takinginto account farmbiosecurity, production risk and the livelihood o f stakeholders. See Technical Note 1, Appendix 9 for further details. 36. Activity A4a Capacity Building at DLP. As the line agency responsible for poultry - sector planning and restructuring, DLP requires well trained professional staff. Under this activity three DLP staff will receive postgraduate training in agricultural economics. 37. Activity A4b Planning and Demonstrating Biosecure Poultry FarmModels. This - activity will support the modeling of biosecure poultry farms by means of spatial planning, 45 training and workshops for stakeholders, technical assistance, and the establishment of pilot model farms inthree provinces. 38. Activity A4c Biosecurity upgrading for existing small scale poultry farms. - Guidelines will be developedto increase biosecurity on Sector 3 small-scale poultry farms, supported by small grants to undertake basic biosecurity improvements. 39. Outputsfrom this subcomponent will include: Sufficient capacity achieved inDLP and pilot restructuringprovinces to plan and implement poultry sector restructuring; guidelines for planning the restructuring o f the poultry sector with the objective o f increased biosecurity will be developed; and, biosecure poultry farm models that are equitable, economically viable and environmentally sound will be demonstrated. The Project will support: technical assistance and training, training allowances, office support, small grants to eligible recipients, and postgraduate training. 40. Subcomponent A5 - Emergency Outbreak Containment Plan (US$8.3 million). This subcomponent will implement six activities including enhancing early reporting o f disease by villagers; simulation exercises of avian influenza outbreaks to test emergency response; availability of resources to employ contract staff for disease control activities; stockpiling of equipment, supplies and vaccines; studies on streamlining compensation payment, and compensation for smallholders and villagers who report cases o f avian influenza. 41. Activity A5a - Enhancing Early Reporting of Disease Outbreaks by Villagers to Animal HealthAuthorities to Ensure Effective Outbreak Control. This activity depends on the rapid detection and reporting o f disease. Villagers and smallholders must notify authorities if there i s disease intheir farm. However they do not always do so ina timely manner. To facilitate early reporting, villagers will be provided, through a broad BCC campaign, clear information on the trigger points for reporting, what to expect when they report outbreaks (including compensation arrangements and information on what will happen to neighboringpoultry (Le. ring vaccination), and how to handle dead or sick poultry (this will be ledby, and integrated with, efforts undertaken incomponent B).This activity will be initially introduced to five project provinces and extended to cover all project provinces. Telephone hotlines will be established in all project provinces to allow villagers and smallholders cost-free access to report disease outbreaks, overcoming a currently existing communications constraint. 42. Activity A5b Simulation Exercises inAvian Influenza Outbreak Containment. - These simulations will be conducted to ensure that veterinary authorities, including CAHWs, and district, provincial and regional staff respond rapidly to contain disease outbreaks once disease i s reported by villagers or smallholders. This will be linked closely to activity A2d (training inring vaccination) 43. Activity A5c Stockpiles of Emergency Supplies. Protective gear and consumables - will be stockpiled in strategic locations inorder to allow teams of first responders to mobilize rapidly so as to investigate suspected outbreaks. These teams will also have access to financial resources to employ contract staff to assist inemergency disease containment operations, including stamping out. Emergency equipment and PPE, vaccines and disinfectants will be 46 stockpiled at the six DAHRegionalVeterinary Centers for immediate distribution and use inthe regions they service. 44. Activity A5d Stockpile of Emergency Vaccine. A stockpile of vaccine will be - established incase o f widespread outbreaks. This will contain sufficient doses to vaccinate 15 million poultry (about 10% of the chicken population) inthe event of widespread outbreaks o f disease necessitating emergency. A stockpile i s required because o f the long lead time between orders for vaccine and delivery. 45. Inthe event of outbreaks of avian influenza all provinces potentially affectedinVietnam, notjust those associated with the eleven Project Provinces could benefit from the two aforementioned activities (Le. A5(c) and A5(d)). 46. Activity A5e Streamlining Compensation. Studies into streamlining compensation - payments for rapid disbursement inthe event o f avian influenza outbreaks will be undertaken to enhance cooperation from farmers affected by stamping out exercises. For compensation to be most effective it should be provided rapidly (close to the time o f culling). This has been viewed as a constraint to reporting inpast outbreaks. 47. Activity A5f Compensation for Smallholders inProject Provinces. A compensation - contingency for smallholders and villagers who have had poultry culled after reporting outbreaks of avian influenza to authorities under this subcomponent will be established. This will only be activated when farmers inproject provinces targeted by the BCC campaigns report cases o f disease that result in the destruction o f their poultry. Disbursements for small holder compensation will be subject to the preparation and approval by MARD and IDA o f a compensation manual reflecting also the review o f streamlined compensation procedures above. 48. Outputsfrom this subcomponent will include enhanced early reportingby smallholders and villagers of disease outbreaks, proven capacity o f appropriately resourced teams to respond to outbreaks, recommendations from a study on streamlining compensation. The project will finance disinfectants, disinfection equipment, protective clothing, training, emergency contingency funds, simulation exercises, telephone hotline charges, vaccination consumables and equipment, vaccine, contract services to support emergency workers and vaccinators, technical assistance, and compensation funds 49. Component B - InfluenzaPrevention and Pandemic Preparednessinthe Health Sector (US$16.0 million) 50. The project will assist the government to implement the OPIthrough providing support for three elements under the program for Influenza Prevention and Pandemic Preparedness inthe Health Sector: strengthening surveillance and response; 0 strengthening curative care capacity; public awareness and behavioral change. 47 5 1. Inaddition, the project will assist the MOHto achieve more flexible andbetter coordinated systems, and strong human resource capacity in order to be able to respond rapidly and effectively to AI and emerging diseases. 52. Subcomponent B1- ImDroving the Surveillance and Response Svstem (US$2.9 million). Vietnam already has in place a surveillance system for communicable diseases with 26 reportable diseases. Some reporting i s carried out routinely, and some i s specific to the requirements of certain vertical programs such as malaria control. Significant challenges persist and this project attempts to address some o f these. Firstly, reporting i s usually done only for diagnosed cases. There are no clear definitions for clinical case diagnoses available to health workers which limits the ability to detect certain clusters of symptoms and leads to variation in reporting based on individual clinician's skills and vigilance. Reported data are sometimes incomplete and inaccurate and are often times manually collated. Surveillance i s often fragmented as some diseases are part of vertical programs with their unique reporting requirements that are not integrated. Data that are received are analyzed at the central level without timely feedback to the reporting entities to utilize inmakingdecisions. 53. Activity B l a Review and Assessment of the National Surveillance System. The - specific needs of the surveillance system vary from province to province depending on available human resources, equipment and infrastructure and how these function together. To accurately determine what the needs are, this subcomponent will support a detailed review o f the current surveillance system especially for infectious diseases, consulting previous evaluations of the system and with other partners working inthis area such as WHO, CDC and ADB. This assessment will examine the structure o f the system as well as how well it i s functioning, using simulation exercises and other methodologies. 54. The assessmentwill entail a thorough review of the performance of the system at different levels from the community to the central level inthe project provinces, including the data management and reporting processes, available resources, and equipment. The assessment will identify key aspects of the surveillance system requiring improvement. 55. To obtain comparisons and learn from experience from other countries ineffectively incorporatingAI surveillance into their systems, a study tour will be organized for key staff. 56. Outputs: A detailed assessment of the surveillance system in Vietnam which will be disseminated to key stakeholders inthe country; a study tour for MOHpersonnel incharge of surveillance. 57. Activity Blb PilotingImproved Surveillance Systems inthe Project Provinces. - Upon completion o f the review, the provincial and district teams will prioritize the interventions necessary to improve the surveillance system intheir respective provinces. This approach will ensure that flexibility i s retained while addressing the unique needs of each province, within the overall OPIframework. Table-top and field-based simulation exercises, and training activities necessary to implement these interventions inproject areas will be conducted. Investmentin equipment will also be made. Evaluations to assess the impact of the interventions will be evaluated usingcomparison with baseline information obtained from the initial review of the surveillance system. 48 58. Outputs:Provincial action plans and strategies developed andimplementedleading to improved surveillance systems at the provincial level. 59. ActivityBlc Improvingthe Quality and Timelinessof Reportsfor Decision- - Making.Datamanagement is fundamental to any effective surveillance system. Surveillance information i s currently not properly reported, collated, analyzed and utilized, nor are these activities always carried out ina timely manner. This activity will use a review of data management (probably as part of the review o f the surveillance system) to identify the type o f data needed for making both short and long term decisions, how reporting occurs and the channels for dissemination. In addition, the timeliness o f reporting, the quality of reports producedand the response time to reports will be assessed. This activity will identify any constraints inthe different aspects of data management. Syndromic surveillance (e.g. for influenza-like illnesses) which i s based on the use o f case definitions and reporting o f suspected cases i s an important part o f the system, but the current reporting methods do not adequately allow for this. There i s a need to accommodate this within the reporting system and for revisions of the reporting template. Staff at the provincial and district levels will also need to be trained on how to use information systems to manage data. This component will in addition, support the provision o f computers and access to information systems for the district and provincial preventive health centers. Finally, the technical capacity o f the reporting staff will need to be strengthened through training. 60. Outputs: Improved reportingwith arevisedreporting template accommodating syndromic surveillance measures, new case reporting logs and templates, preventive health staff and staff managing data trained and provided with logistical support intheir use. 61. ActivityBld EarlyWarningandResponseSystems(EWARS).An EarlyWarning - and Response System (EWARS) i s currently being piloted over a small area o f the country. This activity will expand EWARS to the project provinces and integrate it into the routine surveillance system for AI and other communicable diseases, instead o f makingit a stand alone surveillance mechanism operating inparallel with other activities. The EWARS will be backed upby mobile rapid response teams. A baseline survey of the early warning systems will first be conducted which will identify needs and support required. The early warning and surveillance structure inplace will be expanded to the level of the community, by actively involving frontline workers such as the VHWs who are inclose contact with the people. These frontline, community-basedworkers will be trained to increase their vigilance, minimize reporting time and to alert the responsible authorities (includingthe DAH) early. The system will be tested through simulation exercises as described under Activity Ble. Inaddition, the current training materials for EWARS will be reviewed and updated. 62. Output: Functionalearly warning and response system and rapidresponse teams. 63. Activity Ble RapidResponseMechanisms.The benefit of anearly warning system is - enhanced when there i s capacity to respond to a reported potential outbreak. Activity Bl e i s therefore a logical follow up to the above Activity BId. Activity B l e aims to facilitate a rapid response to outbreaks through conducting rapid investigations and institutionalizing containment measures. It will involve establishing, training, equipping and operationalizing the rapid response teams. These teams will be set up at the provincial and district levels and are responsible for 49 investigating syndromic clusters and analyzing risks in order to address potential public health threats. Since the frequency o f outbreaks and extent o f investigations i s unknown, these teams will be made up of existing preventive medicine staff at the district level designated for this role. They will require practicaltraining and the use of simulation exercises to improve their skills, as well as access to some contingency funds during outbreak investigations inthe field. The rapid response teams should also involve representatives from other sectors, such as veterinarians who will take part ininvestigating potential sources o f outbreaks, sample collection and active surveillance for animal cases. This subcomponent will also finance selected equipment, stockpiles o f protective material, and technical assistance. 64. Outputs: Rapid Response Teams identified, trained and equipped at provincial and district levels. 65. Activity Blf Capacity-buildingfor Surveillance. Staff at different levels, from the - community to the central level, including staff at the provincial MOHlevels, the members o f the Provincial AI Steering Committee and key technical officers inMOH, will be given hands-on training and operationally-focusedactivities such as tabletop and field-based simulation exercises. Surveillance capacity building and training activities will also be extended to the frontline staff inthe field such as VHWs on reporting, case identification, referrals and collaboration with veterinary sector. Evaluations o f the competence of staff will be conducted after the training. 66. Guidelines will be developed for protecting and monitoring staff involved in investigating outbreaks, poultry culling, vaccination campaigns and other at-risk animal and human health care workers. Staff will be trained to use these guidelines and will be provided with the appropriate kits, PPE and vaccinations. 67. Outputs: Increased capacity of surveillance workers at all levels; guidelines for protecting workers established and used. 68. Activity Blg Coordination with Veterinary and Other Sectors on Surveillance. - This activity seeks to promotebetter coordination with the Veterinary Sector and other sectors on surveillance. There i s a need for better coordination o f surveillance activities and information sharingespecially inthe field which will reduce the time it takes for the sectors involved to receive information necessary for increasingvigilance. Initially, the coordination arrangements between health and other sectors will be reviewed to identify areas where there are gaps in coordinatiodcommunication. This will form the basis for interventionsto foster more integration and better coordination. Activities will include developing a protocol for coordination, table top simulations, training of frontline staff such as VHWs and AHWs in application o f the protocol. 69. Outputs: A protocol for multisectoral collaboration which has been tested intable-top and field-based simulation exercises, and used if the need arises. 70. SubcomponentB2 Improving the Technical Ouality and Efficiency of Curative - Care Preparedness (US$5.3 million). This subcomponent will help hospitals inthe project provinces address two scenarios: (i) an influenza epidemic scenario with overwhelming patient demand for hospital care, and (ii) a continuation of the current situation of sporadic human HPAI 50 cases requiring intensive care treatment. It has four activities: (a) ensuring preparedness o f health care facilities for a pandemic situation; (b) technical assistance to review and update guidelines, and develop training manuals on the preparedness and response to AI influenzdpandemic in curative care settings; (c) training of health care managers and workers on the operational and technical guidelines; (d) improving capacities o f healthcare facilities at the provincial and district levels. The first activity addresses the response to a pandemic scenario while the last three activities addresses the status quo. These four activities will focus on selected issues in hospitals' HPAIresponse so far, namely the (a) lag in staff training to use recently acquired equipment items and the oversupply o f some services in some provinces; (b) still largely undefined functioning o f the inter-agency and hospital referral system under outbreaks o f different scale; and (c) gaps inplanning, staff skills, facilities, and materials that reduce the technical quality of services needed to respond effectively to HPAIand that would limit the response in a pandemic. 71. Activity B2a EnsuringPreparednessof Health Care Facilitiesfor a Pandemic - Situation.The response to a pandemic scenario is contained ina facility preparedness plan. The response plan activities will be based on an estimate of the baseline demand for and maximum capacity to deliver intensive care and isolation services. The plan will include mechanisms to improve the match between supply o f curative services and demand, such as the redeployment o f stock between provinces, from provinces to the central level, or to a stockpile able to be deployed rapidly. This will guide the investment inmedical equipment and supplies under the subcomponent. 72. Inaddition, alternative means to provide medical care to large numbers of patients in field settings once hospital capacity i s overwhelmed will be included. This capacity depends upon rapid triage systems and delivery of relatively simple, cost-effective treatments backed up by staff already well versed intheir roles and responsibilities and the command structure. The plan shall also contain flexible mechanisms to redistribute initial investments on high-tech equipment such as ventilators according to demand. Activities to promote cooperation in providing services betweenprovinces and the central level will be considered especially inthe redeployment of human resources. Lastly, case containment strategies and its implementation plan will become part o f the health facility pandemic response plan. 73. The project will finance a review o f options to respond to an overwhelming epidemic or public health emergency inthe project provinces and the investments to make this operational. These will include revising action plans at the central and provincial levels, establishing an emergency hospital management structure linked to the PPC and the DOH, completing the stockpile of personal protective equipment and materials for establishing field hospitals, and allowing for a contingency budget inthe case of an outbreak. A planning workshop will be designed to finalize a facility preparedness plan and obtain consensus from various stakeholders. 74. It will also finance epidemic simulation exercises to test preparedness measures. On-site simulation exercises will be developed and conducted at the provincial level while desk-top simulation exercises will be implemented at the district level. 51 75. Outputs:A facility preparedness plan with estimates of the requirements (equipment, supplies, drugs) for a pandemic situation at the project sites, stock piles and contingency funds, and alternative options for augmenting resources during a surge o f demand. 76. Activity B2b - Review and Update Guidelines, and Develop Training Manuals on the Preparedness and Response to AI and an AI Pandemic inCurative Care Settings. This consists mainly o f updating and clarifying roles and responsibilities, formulation o f a functional structure, establishing a communication, coordination, funding and monitoring mechanism among national and provincial agencies involved inAI and AI pandemic prevention and control. Similarly, this activity will support provision o f consultancy services to update and develop guidelines to clarify the roles and responsibilities among the MOHunits involved inAI control and prevention such as the central command, expert panel, secretariat, communications unit, external affairs and logistics, surveillance and epidemiology, quarantine, field and hospital operations. 77. Managing an AI pandemic as well as eventually bringingAI under control and eradication will require inter-agency collaboration. Since health care facilities are potential entry points o f AI cases, its managers both at the central and facility level would need to know clearly how to interact horizontally with other agencies and vertically with the MOHhierarchy. Operative guidelines will ensure the appropriate response o f health facility managers in an expedient manner and documentation o f these guidelines will serve as their reference material. 78. At the health facility level, technical guidelines covering clinical management of AI, infection control, management of respiratory failure and the operations of ventilators will be updated and/or developed. Inthe absence of a definitive treatment for AI, the most logical means to control its spread i s to break the "chain o f transmission." These technical guidelines will ensure appropriate management o f suspect and confirmed cases as well as protectiono f other patients and health care workers involved inthe treatment. 79. Once the operational and technical guidelines are updated, a workshop will be organized to further refine its contents and obtain consensus from the involved stakeholders. These guidelines will then be consolidated into a training manual to be used as reference in the roll out activity. 80. Outputs: A training manual that contains operational and technical guidelines to be used as reference material for the training o f health care managers and workers to ensure a standard and coordinatedprocedure for the management o f human avian influenza ina curative setting. 81. Activity B2c Trainingof HealthCare Facilitieson the OperationalandTechnical - Guidelines.Recent efforts to strengthen hospital capacity haveplacedundueemphasis on acquiring equipment rather than on providing staff with the training needed to make full use of the equipment and to help develop a cadre o f well-trained public health practitioners. Greater attention has been paid to acquiring equipment than to ensuring staff skills (both inusingthe equipment and in creating a cadre o f well-trained public health practitioners) and, more broadly, to ensuring good quality preparedness and response plans which address the different dimensions o f the response. 52 82. Activity B2c consists of developing the roll out strategy and training schedule for hospital managers and clinical and support personnel. It will need to take into account the most effective and efficient means to do this. The training program will be implemented inthe eight (8) project sites covering the provincial and district levels. Its implementation nationwide may eventually be considered through other funding sources. 83. Outputs: A training strategy androllout schedule for hospital facilities inthe eight project sites at the provincial and district level, and completion o f the training program within the first two years o f the project. 84. ActivityB2d ImprovingCapacitiesof HealthCareFacilitiesat the Provincialand - DistrictLevels.The more vulnerable level of the curative healthcare system will be the district and provincial levels. This will be the most likely entry points o f AIpatients and most often, patients with influenza-like illness (ILI)waiting for diagnosis confirmation. Considering the widespread distribution of these facilities and current capabilities of its health care workers, it i s anticipated that there will be numerous breaks inthe infection control protocol. This activity ensures that there are adequate and appropriate facilities to break the "chain o f transmission" in the provincial and district hospitals. 85. This activity supports the development of a checklist to determine the readiness and capacities o f the provincial and district hospitals. A subsequent survey will be done to determine these capacities. Facility gaps (comprising o f equipment and infrastructure) will be identified and proposed for funding.The survey will be focused on gaps inthe isolation rooms and wards and intensive care facilities, and laboratory equipment that support treatment of respiratory failure (that is, ABG machines). Equipment for the confirmation o f the diagnosis (that is, Polymerase Chain Reaction equipment) i s not included. 86. Inaddition, the survey will also include identification of gaps inthe readiness of the facility to respond to a sudden surge in the demand for intensive care and isolation room services including their containment strategy and activation plan. This portion of the survey will feed into the component which i s to ensure preparedness o f health care facilities for a pandemic situation. 87. Outputs: A facility checklist developed and used for identifying gaps requiring remedial support for the isolation area, intensive care units and laboratory equipment to support management o f respiratory failure inthe provincial and district hospitals. 88. SubcomponentB3 StrengtheningBehavior ChangeCommunication(BCC) in - HealthFacilitiesandthe Communitv(US$2.7 million). Preventionis key to the longterm solution for the AI problem. Personal and environmental hygiene, poultry handling and raising, and care seeking practices will need to change among the population. In the short-term, BCC can also encourage voluntary participationof the population incontainment of the disease during animal and human outbreaks, such as inreporting, culling and usingprotection. These behavioral changes require concerted efforts to persuade people to adopt and sustain desired behaviors using mass media and interpersonal communication channels, and community mobilization. The importance of BCC has been recognized and programs have received inputs from the government and donors notably USAID, DANIDA and the UNJoint Programme. 53 89. This subcomponent will enhance the results of past efforts and expand BCC activities to the target provinces using a two-pronged, mutually reinforcing approach: (a) improve the BCC skills o f health workers at all levels, and (b) conduct community BCC activities. 90. Activity B3a Knowledge, Attitudes and Practices ( U P ) Survey. A population-based - knowledge, attitudes and practices (KAP) survey on AI will be conducted at the beginning of the project to provide baseline data against which impact on knowledge levels and behavior change can be measured. Although some surveys have been conducted inthe past, the situation i s rapidly changing so that a survey o f current KAP will provide up-to-date information. The survey will identify knowledge gaps and gaps between current and desired attitudes and practices which BCC activities can target. Results will be disseminated to the decision makers and technical personnel for use inplanning and message development, and for M&E. 91. Output: A baseline and an evaluation KAP survey on AI prevention and control. 92. Activity B3b Development of Provincial BCC Action Plans. A comprehensive BCC - strategy i s being developed at the national level with the support of the UNJoint Programme and the participation of the various ministries, donor agencies and NGOs involved inAI-BCC activities. The strategy i s to be finalized by early 2007. The strategy covers the non-pandemic and pandemic scenarios and proposes short, medium and long term objectives. This project will implement the BCC strategy at the provincial level. 93. The project will beginby developing a provincial action plan to implement the BCC strategy inthe health sector from the provincial to the community level. Decision makers and representatives of stakeholders will be brought together to develop the action plan which will outline actions to achieve the goal and objectives, timeline, resources required and assign implementation responsibilities. Havingthe plan will provide direction for and help the implementerso f the activities to plan ahead. 94. The action plan will be reviewed at mid-term by the same group o f stakeholders to assess progress and identify problems and solutions inimplementation. 95. Output: A provincial BCC action plan for each of the 8 provinces. 96. Activity B3c Training. The health worker i s an important and trusted source o f health - information for people and can often influence the personal decision-making process. Health workers, however often do not possess the skills to be effective inbringingabout behavior change. Training of health workers involved incarrying out BCC to the population will be provided to up-grade their BCC skills. The training will assist these health workers to change from the traditional top-down approach incommunication to a more participatory one. They will learn to provide guidance to their clients to identify and adopt solutions to their problems and encourage them to take the desired actions rather than give directives which often end up not being followed. This participatory approach has been found to be more effective inbringing about behavior change. These BCC skills are notjust applicable to the AI situation but can be applied to the prevention of other health problems requiring behavior change, so that the training will help to build the capacity o f health workers for BCC in all areas. 54 97. Due to their heavy workload, the ability o f the health facility workers to provide outreach i s very limited at present. This role i s fulfilled by village health workers (also called health motivators) who are volunteers providing primary health care and healtheducation to the community. Vietnam has an extensive network o f village health workers with at least one in each village which forms an important communication channel. 98. Training will be provided for two different groups o f health workers: (a) health workers at the health facility, and (b) village health workers. A training needs assessment will first be conducted on health workers inthe health facilities at the provincial, district and commune levels, and on village health workers (VHWs). The training needs assessment will provide both quantitative and qualitative information on health worker AI knowledge and their attitudes towards the problem, training they have received on AI and BCC, their BCC skills, their AI- related tasks and responsibilities, constraints and problems they face intheir AI-related work, and their proposals for solving these problems. Based on the assessments, a training curriculum and materials will be developed for each group o f health workers. An AI-BCC training manual and materials have already been developed under another project which can be adapted for this project. 99. A cascade training approach will be used. Training of trainers (TOT) will first be conducted for a team o f provincial trainers with the participation of a trainer from the central level. The team will then proceed to train health workers from the provincial and district levels. Another team o f trainers will be formed with trainers from the provincial and district levels who will train the large number of health workers from the commune level. The trainees at the provincial and district levels will come mainly from the Provincial and District Preventive Medicine Centers. Staff from the Centers for Health Communication and Education as well as selected curative health staff who have responsibility for health communication inthe hospitals and clinics will also participate. At the commune level, the trainees will be health staff from the commune health stations who have responsibility for health communication and education. Curative staff will be provided with a set o f key messages for AI prevention and control to communicate to their patients when appropriate, and trainingon these messages will be part of their training in other subjects under this project. 100. Follow-up supervision of the trainees after they return to their workplace will be conducted by the trainers, and each will be visited at least once. The project will provide support for the logistics to carry out this supervision. Duringthe supervisory visit, the trainer will observe the trainee duringhisher work, provide feedback and hands-on training to reinforce the initial training, and assist the trainee to problem-solve as required. Information gathered on these visits will also be used to plan for refresher training, and for monitoring and evaluation. 101. The trainees will attend a refresher training workshop around one year after the initial training, where they will be given an up-date on AI, and exchange experiences and ideas on how to improve their work in AI-BCC. Such gatherings serve to not only maintain the workers' skills but also to motivate them. 102. The trainees will also be provided with IEC materials and aids for them to use intheir work (e.g. flip charts, flash cards). 55 103. Training of health facility workers will be organized and conducted by APDM, while the training o f VHW will be conducted by the Center for Health Communication and Education (CHED).CHEDhas already conducted this training in 3 of the 8 project provinces with USAID and UNICEFsupport. The project will cover the provinces which have not receivedthis support. 104. An evaluation of the training will be conductedduringthe last year of the project, the results o f which will be fed into the overall evaluation as well as provide lessons learnt for future training activities. 105. Outputs: Provincial, district and commune health facility workers and village health workers trained and carrying out AI-BCC activities effectively. 106. Activity B3d CommunityMobilization.Community involvement is vital to successful - AIprevention and control. The VHW will be the pivotal personto mobilize the community. Shehe will need the collaboration and support o f other groups inthe community such as the mass organizations (Women's Union, Farmers' Union and Red Cross). Together with community leaders, they will identify and organize awareness-raising activities for AI prevention and control to be supported by the project. Ideas and initiatives may be discussed with, reviewed and approved by the local People's Committee and other community leaders. Some activities may reinforce and integrate AI prevention and control activities by other sectors such as animal health and education. Examples o f awareness-raising activities may include a local campaign on a specific behavior or behaviors, campaign for an "AI-free village," clean farmyard competition, demonstration farm with safe poultry-raising practices, community theatre on AI prevention themes, etc. Such activities can help to not only increase public awareness but demonstrate actions that can realistically be undertaken by the community and by the individual. 107. Due to the community-basednature, complexity and scope of this activity, responsibility for the implementationof this activity will be given to one o f the mass organizations. 108. An evaluation of these activities will be conducted after 2 years of project implementationwhich will provide findings and lessons learned to be used by other communities duringthe third year of the project. Successful pilot BCC activities can be replicated inother communities. 109. Outputs:Awareness-raising activities organized by the community ineach commune. 110. Activity B3e IEC MaterialsandMassMediaCampaigns.The project will not need - to develop new IEC materials (leaflets, booklets and posters) for the general public. These materials have already been developed under other donor-funded projects but distribution has been limited. The project will reproduce selected existing materials which may be adapted if necessary, and disseminate them widely inthe project provinces. Generic materials have also been developed by UNICEF for a pandemic situation which can be quickly adapted and produced if a pandemic were to begin. IEC materials targeting special groups such as market traders will be developed inthis project as described inComponent A. 111. TV has been found to be the most widely cited source of AIinformationby people and a number o f TV spots have been producedfor mass media campaigns. They have been broadcasted mainly on national TV channels but have not reached some o f the target audiences 56 inthe provinces whose preference is for the local provincial channel. The project will fundthe re-broadcast of selected TV spots on the provincial channels where they have not been aired before. The spots may be dubbed in local languages where necessary. 112. Outputs: IEC materials reproduced and distributed to the village level. TV spots re- broadcasted on provincial channels. 113. SubcomDonent B4 Strengthening the Preventive Health Svstem at the LocalLevel - fUS$5.1 million). This subcomponent will support critical efforts by MOHto operationalize new preventive health strategic directions and policies inpractical and locally relevant ways. It will also seek to test and refine new approaches based on comprehensive appraisals o f the current constraints and challenges facing the healthcare system. Innovative preventive health pilot efforts will be designed with strong local participation, implemented, and rigorously evaluated. Special attention will be placed on understanding barriers and critical pathways to surmounting them inthe local health system restructuring process. New coordination modalities will be forged with DARDto promote better integrated and more timely responses to potential avian and human disease outbreaks. Inaddition, this subcomponent will address underlying weaknesses in current human resource capacity and systems at the local level. 114. Together, these activities will both address and mitigate the immediate threat of HPAIin project provinces while also undertaking to strengthen preventive health systems ina sustainable and replicable fashion. It i s expected that the project will provide the evidence base and key guidance for national scale improvements inthe Preventive Health system duringthe 2010-2015 government planning and budgeting cycle. 115. The following three aspects o f the preventive health system will be addressed at the local level: 116. Activity B4a Strengthening Preventive HealthHuman Resource Capacity, Policies - andStructures. A public health system that does not address problems with its staff levels, quality and retention will be unable to effectively address significant public health issues and respond appropriately to new challenges as they arise. As Vietnam prepares to launch its new DPHC system nationally, it faces daunting human resource concerns. Little understood and with neither the status nor income generating potential of the curative care profession, the preventive health field faces major challenges in attracting and retaining talented young professionals. 117. The project will make important investments inhuman resource development. In addition to the extensive in-service training package in each o f the project's subcomponents, graduate training inpublic health and preventive medicine for more than 100professionals will be supported by the project. VAPM i s committed to attracting talented young professionals and to diversifying the current preponderance o f medical doctors inthe preventive medicine field in Vietnam. Under current MOHpolicy, beneficiaries of graduate studies scholarships will be required to serve two years for each year of study, thus ensuring that this investment i s not lost. This activity represents a critical medium-long term investment inbuildinga stronger cadre of qualified young preventive health professionals inVietnam. 57 118. Existingpersonnel policies within the MOHstructure are widely believedto disfavor preventive over curative health care. Inaddition, they may inhibitpreventive health staff from performing essential field monitoring, outreach and surveillance functions. The human resource component of the DPHC assessment will be designed to shed further light on the nature of these suspected problems and point the way towards viable solutions. M O H will form a Human Resource Working Group whose task it will be to review the assessment findings and formulate them into recommendations for MOHpersonnel policy changes. The Working Group will examine good global practice in HR management and consider how these might be adapted for use in Vietnam. It i s also anticipated that new personnel policies will be tested and evaluated as part of the DPHC pilot initiatives. 119. Outputs: At least 100professionals with graduate training inpublic and preventive health; an active M O H Personnel Human Resource Working Group; formal recommendations to M O H for personnel policy changes that strengthen preventive medicine inVietnam and support new Government Preventive Health Policy Directives made by the Working Group. 120. Activity B4b Testing Models that Apply andAdapt the 2005 Preventive Health - DecisionNo. 26. As the HPAIresponse moves from an emergency mode to one which mustbe sustainable into the medium term, improvements inVietnam's preventive health system will prove critical. With technical support from the MOHPCU, project provinces will develop and pilot locally relevant approaches to improving the performance o f key systems and structures. Pilot projects will be guided by new MOHpolicy directives that set forth the future framework for Vietnams' preventive health system. The framework addresses standards and norms for DPHCfacilities, equipment, staffing, training and core functions. Project pilots will enable one or two districts in each province to adapt and apply this framework to its unique context. Pilot designs will be informed by a comprehensive assessment o f the current preventive health system covering all three regions of Vietnam. The assessment will include a training needs appraisal for preventive health staff. This appraisal will guide the development o f a new core training package for preventive health staff and shape final training plans for the project as a whole. It will also look carefully at existing personnel policies and how they impact on the preventive health care system. Finally, the assessment will contribute to the development of key performance indicators that will be used for standardized monitoring o f new DPHC's during this transition period. 121. Pilot efforts at the district level will address well known system-level constraints including staff motivation and performance management, participation o f private sector doctors inthe surveillance system, information sharingbetween the preventativeandcurative sectors, and management o f important hospital initiatives such as nosocomial infection control. They will take into account the role of the district preventive health centers (DPHC) as newly created entities within the health system. Their roles vis-&vis district hospitals, how they can reduce redundancy and increase efficiency, and how they can support commune level health centers and surveillance activities at all levels will be major design features o f the pilots. It i s expected that provinces will suggest original ideas for pilot projects to address the key constraints they face, and that they will develop them with a view toward long-term operations of successfully piloted activities. Pandemic simulations will be used as a pilot monitoring and evaluation methodology. An independent evaluation of the pilots will be undertaken to better understand these central issues and to guide the future expansion of the DPHC network nationally. 58 122. Outputs: Comprehensive district preventive healthsystem assessment conducted; DPHC key performanceindicator framework developed; DPHC core training package designed, tested, produced and disseminated; DPHC pilot initiatives undertaken in each o f 8 provinces; Pandemic simulations conducted; and independent evaluation carried out o f district pilots. 123. Activity B4c - Developing and Piloting New Models for Effective Local Coordination and Management of AH1and Other Complex Public Health Threats. As with any complex health and development problem, a multisectoral approach that ensures effective coordination, communication and integrated action i s essential. Achieving meaningful integration within Vietnam's highly verticalized and centralized structures i s an enormous challenge. However, opportunities for sustained integration or preparedness and response are widely believed to be most feasible at local level where institutional stakeholders share resources and live inclose proximity to each other. 124. The main focus of this subcomponent will be developing and testing novel approaches to coordinated activities with animal health and other community stakeholders so as to reduce overall community vulnerability to AH1and other similarly complex public health threats requiring new modes o f cross-sectoral collaboration. It will provide seed money for local human and animal health authorities, together with local People's Committees, mass organizations and other authorities, to fashion new coordination mechanisms that can function inthe medium term as Vietnam seeks to institutionalize disease control structures at local levels, including hamlet, commune, district and provincial levels. 125. Project staff will assist local authorities in designing new coordination structures for planning and oversight o f integrated AH1activities locally, including development o f standardized mechanisms for communicating across sectors, joint planning and monitoring, and responding as an integrated team. 126. Outputs: Innovativeintegrated and community basedapproaches to AH1preparedness, coordination and management will be developed, tested and evaluated for their effectiveness, sustainability and replicability. 127. Component C: OPI Integration & Coordination, Results M&E, and Project Management (US$4.8 million) 128. This component will support the integration and coordination between MARD,MOHand other concerned ministries and agencies inimplementing the OPI. It will also support the design, establishment and implementation of a result-based M&E system to evaluate the project's (and to the extent possible, OPI's) progress, performance, and impact at the sector and regional levels. Lastly, this component will strengthen the institutional capacity to undertake project management in terms of planning, coordination, and actual implementation o f the overall project at the national, provincial, district, and commune-levels. As such, Component C envisages three subcomponents. 129. SubcomponentC1: OPIIntegrationand Coordination(US$0.2 million). The subcomponent will provide support for: 59 130. (a) the establishment o f a Secretariat under the nascent National Steering Committee for Avian and Human Influenza (NSCAHI, see Green Book, page 8, para 34); 131. (b) development of coordination mechanisms betweenthe animal and human health sectors at various levels (for instance, undertaking coordination meetings, joint programs, national PHAIoutbreak simulations, and the like); and 132. (c) conducting regional outreach activities beyond Vietnam (for instance, leading regional and international policy coordination and knowledge-sharing initiatives, including workshops, training, information sharing, increased surveillance, laboratory networking, sample exchanges, joint supervision, etc.) bilaterally with China, Thailand, Cambodia, and Laos but also multilaterally with the Greater Mekong Region and APEC at large. 133. Duringimplementation, specific activities will be identified, prepared andundertaken by the NSCAHI Secretariat. The Secretariat will also periodically prepare OPI implementation reviews, and suggest policy lessons for further refinement o f the OPI document (that is, the Green Book). The subcomponent will finance technical assistance, field activities, incremental operating costs, training and workshops, equipment and facilities to carry out the activities. 134. Implementationo f subcomponent C1 i s contingent on the establishment of the National Steering Committee for Avian andHuman Influenza (NSCAHI). The purpose of this subcomponent i s to support the far-reaching integration and coordination efforts envisaged by the OPI. It i s also hoped that this Subcomponent would provide policy guidance and keep the OPI document up-to-date for future outbreaks o f contagious diseases, HPAIor others. 135. A small permanent secretariat would be established that would maintainclose contact with the expanded list of concerned ministries and agencies envisaged under the NSCAHI. The secretariat would also be responsible for conveying NSCAHImembers to both policy and technical events (such as national simulation exercises). It would also help link Vietnam, on behalf of the NSCAHI, to regional and international efforts at addressing PHAI. 136. The initial setting-up of the NSCAHIsecretariat would be supported by the MARDPCU for this project. The latter would oversee and manage the recruitment o f key staff, and the procurement of office facilities and equipment untilthe time that the secretariat i s capable o f managing its own affairs. 137. Subcomponent C2: ResultsM&E(US$1.O million). The subcomponent will provide support for the detailed design, establishment and implementation of a result-based M&E system to (1) evaluate the project's progress, performance, and impact at the sector and regional levels. Itwill also (2) be an integralpartof GOV efforts at monitoring results and evaluation impacts under the OPI. To that effect, the Results M&E should also (a) enable monitoring o f the effectiveness o f implementation processes and incorporation of lessons learnedinto future planning, and (b) be linked to the MARDand MOH's monitoring system. The subcomponent will finance consulting services needed to carry out base-line studies, short-term technical assistancefor the design, establishment and testing o f the M&E system, training and workshops, M&E-related equipment, travel costs of project staff and incremental staff, and operating costs o f the M&Eefforts. 60 138. Monitoring and Evaluation for Component A: HPAIControl and Eradication inthe Animal Health Sector / MARD 139. Monitoring and Evaluation for Component B: Influenza Prevention and Pandemic Preparednessinthe Health Sector / MOH. 140. Instrengthening the M&Ecapacity at all levels of project implementationthis subcomponent will draw on the lessons learned from AIERP inthe case o f Component A and on the lessons learned from other health projects in Vietnam inthe case o f Component B. 141. M&Ewill be the direct responsibility o f the subcomponents' Technical Managers, who will supervise and conduct M&E as a routine part of their responsibilities, inaccordance with pre-set indicators and performance criteria. M&E reports will be included in standard format project in all project implementationprogress reports, clearly outlining issues and their state o f resolution. M&Ewill become a proactive tool with which to identify and remedy implementation problems at an early stage. Financial management will be conducted by independent auditors in accordance with Bank guidelines for financial management. The Project will provide office support, contractual staffing, transportation, and budgets for operations, travel, supervision and M&E. 142. Subcomponent C3: Proiect Management (US$3.6 million). This subcomponent will provide the institutional capacity necessary to plan, coordinate and manage the implementation of the overall project at a national, provincial, district, and commune-levels. Indoing so, resources to establish and operate two Project Coordination Units (PCU), one each under MARD and MOH, respectively, will be provided. This involves the development o f planning, technical, and management skills to be able to produce quality and timely annual work plans and budget, anticipate and resolve implementation problems quickly, and make adjustments based on implementationprogress and feedback. 143. The project management would also monitor activities inthe provinces to ensure they are incompliance with the safeguard policies (i.e. environment, ethnic minority development, involuntary resettlement, gender, and others) by preparing a safeguard action plan satisfactory to the Bank during the first six months of project implementation and subsequently undertaking this action plan during the remainder of the project. The subcomponent will finance incremental operating costs, contractual staff, project management-related technical assistance, training and workshops, renovation of project office and office equipment and furniture, and project vehicles. 144. Ministry of Agriculture and RuralDevelopment Project Management and - Institutional Support. This subcomponent provides resources to the PCUunder MARDto carry out effective management of Component A. The MARDPCU will be located inDAHand will be provided with two office clerks, a financial officer and a procurement officer. The four Technical Managers responsible for implementing Subcomponents Al, A2, A3 and A4, and the Chief Technical Adviser will also be stationed inthe PCU. The PCU will be responsible for reporting, project supervision, reporting, communications, transportation and office support. Four Technical Managers will be contracted full time, and will be responsible for the M&E of each o f their subcomponents. A Chief Technical Adviser (CTA) will be contracted full time to provide overall technical guidance and vision to the successful implementation o f Component A. 61 At the at the provincial level, the 11PPMUswill be staffed by an office clerk, and accountant and procurement officers to handle project implementation. The Project will provide office support, contractual incremental office and technical staff, a PCU office vehicle and budgets for travel, supervision, workshops, M&E and meetings. 145. Ministry of Health-Project Management and InstitutionalSupport. This subcomponent provides resources to the PCU under MOHto ensure effective overall management of Component B. The MOH PCUwill be located within the VAPM and will be led by a dedicated Project Director, Vice Director and Project Coordinator. Inaddition, Project Officers will be newly recruited or appointed from relevant M O H departments to provide technical support to each subcomponent o f the project. Further technical assistance i s envisioned through an International Technical Advisor (9 months over life o f project) and other short term international consultants. Two accountants, two secretaries a clerk and a driver will support PCUoperation, finance and administration functions. This team will be responsible for project management, implementation, and supervision. It will provide critical coordination and leadership for the project with central level and provincial partners as well as liaising with external partners and stakeholders. At the provincial level, eight PPMU's will be established and staffed by Project Officers, Accountants and support staff. The PPMUwill be ledby a Project Director and Vice Director drawn from either the DOHor the DARD, according to the local situation. 146. SafeguardsAction Plan. The project management would also monitor activities inthe provinces to ensure they are incompliance with the safeguards (i.e. environment, ethnic minority development, involuntary resettlement, and gender). 62 Appendix 3: Project Cost VIETNAM: VN Avian & HumanInfluenzaControl & PreparednessProject TOTALPROJECTCOST PERACTIVITY (US$ MILLION) Component B: H u m a n Health 1.23 9.61 4.19 0.96 16.0 Component C: Integration 0.54 0.86 0.53 2.9 4.8 I Project total: I 3.00 I 20.00 I 10.00 I 5.00 I 38.00 I TOTALPROJECTCOSTPEREXPENDITURECATEGORY (IN US$MILLION) Note: Identifiable taxes and duties are US$4.6million and the total project cost, net of taxes, i s US$33.4 million. Therefore, the share of project cost net of taxes i s about 88%. AHIF figures are net of taxes, as per AHIF rules. 63 COMPONENTA: HPAICONTROL AND ERADICATION INTHE AGRICULTURAL SECTOR PROJECTCOST PEREXPENDITURECATEGORY (US$ MILLION) I 1.Civil Works I -- I 0.45 I 0.23 I -- I 0.68 I 2. Goods -- 6.43 3.68 -- 10.11 3. Training and Workshops _- 1.12 0.56 -- 1.68 4. Consultant Services -- 0.92 0.46 1.14 2.52 5. IncrementalOperatingCosts 1.23 0.57 0.29 -- 2.09 I6. FarmCompensationPayment I -- I 0.07 I 0.03 I -- I 0.10 I Project Total I 1.23 I 9.53 5.28 I 1.14 I 17.18 COMPONENT B: INFLUENZAPREVENTION AND PANDEMICPREPAREDNESSINTHE HEALTH SECTOR PROJECT COST PER EXPENDITURECATEGORY (US$MILLION) 1. CivilWorks -- -- _ _ __ -_ 2. Goods __ 3.99 1.99 -- 5.98 3. Training andWorkshops -- 4.55 2.27 -- 6.82 4. Consultant Services __ -- -- 0.96 0.96 5. IncrementalOperatingCosts 1.23 0.67 0.33 -- 2.23 Project Total 1.23 9.61 4.19 0.96 15.99 COMPONENT c:OPIINTEGRATIONAND COORDINATION, RESULTS M&E, AND PROJECT MANAGEMENT PROJECTCOSTPER EXPENDITURE CATEGORY (US$ MILLION) 1. CivilWorks __ __ -- -- -- 2. Goods __ 0.36 0.18 -- 0.54 3. Training andWorkshops -- 0.27 0.13 -- 0.40 4. Consultant Services -- __ _- 2.90 2.90 5. IncrementalOperatingCosts 0.54 0.30 0.15 -- 0.99 Project Total I 0.54 I 0.86 I 0.53 I 2.90 I 4.83 I Note: Identifiable taxes andduties are US$0.6million 64 Appendix 4: Financial Management and Assessment Report VIETNAM: VN Avian & HumanInfluenza Control & PreparednessProject 1. An assessmentof the project's financial management arrangements was conductedin October 2006 and updated inDecember 2006. Although this i s a follow-up project to AIERP, there are significant changes inthe implementation arrangements with implementation substantially decentralized to the provincial level, new coordination arrangements between two ministries, and new staff being appointed and responsible for financial management. The FM riskis assessed as substantial due to the: (1) lack of capable staff at the central level and especially at the provincial level when the functions o f planning, budgeting, procurement and financial management are partially delegated to the provinces; (2) lack of clear guidance on coordination between two implementing ministries to achieve consolidated and timely management o f funds flows, budgeting and financial reporting; (3) lack o f practical and consistent computerized accounting arrangement to support accounting and financial monitoring; (4) potentialdelays inthe provision of counterpart funding from provincial government budgets; and (5) lack of an effective oversight mechanism such as an internal audit function. The above risks and mitigating measures have been analyzed by the project team and a detailed Action Plan to improve Financial Management has been prepared. It i s concluded that with the completion of that Action Plan, the Project will have capacity to meet the minimumrequirements o f the Bank's OPh3P10.02. Country Issues 2. The 2001 Country Financial Accountability Assessment (CFAA) for Vietnam concluded that there i s a certain degree of fiduciary risk inthe use of public resources and the public financial management (PFM) system. Since 2001, a large number of recommendations o f the CFAA have been implemented, or are inthe process o f being implemented. The 2005 Public Expenditure Review-IntegratedFiduciary Assessment (PER-FA) also recognizedimprovements intransparency and accountability. 3. Despite progress made to date, the key challenges remain, including: (1) implementation of the legislative frameworks which are largely inplace; (2) strengthening the effectiveness of the State Audit o f Vietnam; (3) streamlining the internal control framework; (4) building financial management (FM) capacity, particularly at the sub-national level; and (5) adopting international public sector accounting standards. The implementation o f the PER-FA recommendations i s being supported by the PRSC program and grant funds. RiskAnalysisand Mitigating Measures 4. The project inherent risk i s assessedas substantial primarily due to: (1) the decentralized implementation arrangements for planning, budgeting, procurement and financial management being delegated to the provincial levels, (2) new Ministry (MOH) and provincial staff (PPMUs) involved infinancial management who have not hadexperience with Bank FMrequirements, (3) potential for delays inprovision of counterpart fundingfrom provincial government budgets, and (4) need for good coordination between two implementing ministries to achieve consolidated and timely management of funds flows, budgeting and reporting. 65 5. The project control risk i s assessedas substantial primarilydue to: (1) limited financial management capacity and inexperience inproject planning and budgeting processes at provincial level which may result in delays inimplementation and disbursement o f funds; (2) risk o f non- qualified or staff with inappropriate qualifications being appointed to FMpositions; (3) different accounting softwares being usedby different provinces may not satisfy all accounting and reportingrequirements by the Bank and create difficulties inconsolidation for project monitoring; and (4) the lack of an effective oversight mechanisms such as an internal audit function for managing and controlling project financial management systems for the project. 6. To mitigate the risks, the Bank will seek early commitment from M O F to make counterpart funds available throughout the implementation of the project. MARDand MOH's PCUs will take the leading role in coordinating and consolidating all components under the project. The Ministries and provinces will ensure adequate staffing especially at provincial level and a comprehensive training and capacity buildingprogram will be developed and delivered for all participating provinces and PPMU's staff inprocurement and financial management. Full- time accountant(s) will be appointed at each PCU and PPMU. The current accounting software of the MARD's PCUmay be upgraded and installed in all PPMUsto enhance provincial accounting and reporting and PCU's consolidation. The project will be requiredto implement internal control supervision (such as internal audit) for regular review of project activities and financial management. 7. The proposed mitigating measures, if successfully carried out, will reduce the project overall risk to moderate which i s considered as acceptable to the Bank. ImplementationArrangement 8. MARDandMOHwilljointly implement the project, and Vice Ministers of the respective ministries will report to NSCAIor NSCAHI (the envisaged successor committee) on project implementation. There will be two Project Coordination Units (PCUs): one inMARD and one inM O Hfor coordinating project activities under Components A (andpartially C), andB (and partially C), respectively. The PCUs will be responsible for budgeting, accounting and financial management for central level project activities, consolidation of reports from provincial level, funds flows to PPMUs, providing assistanceand supervisingprocurement and financial management arrangements inthe project provinces. 9. The PCU inMARD would include technical staff appointed by DAHand DLP and some core staff of the AIERP PCU as Accounting and Procurement Office staff. MARD's PCUwill be responsible for consolidating total project budget and reports (including all components under the project) and submittingthe budget and required reports to the World Bank for the overall project. 10. At the provincial level, the Provincial Steering Committee for Avian Influenza (PSC) will provide general policy guidance for all project activities to be implementedinthe province and to ensure strong coordination among relevant agencies. The PSC also will be responsible for reviewing and approving all activities decentralized to the province including the provincial work plans, budgets and procurement. 66 11. Each province will establish a single Provincial Project Management Units (PPMU)to manage all project activities to be implemented inthe province including Component A for Animal Health, Component B for HumanHealth, and Component C for Results M&E. The PPMUwill report to the ProvincialSteering Committee, which inturn reports to the Provincial Peoples' Committee (PPC). Depending on the avian influenza and human influenza risks inthe province, the PPMU will be located either inthe Department of Health (DOH) or the Department of Agriculture and Rural Department(DARD). The Vice-Directors of DOH and DARDwill be the PPMUDirector and Vice Director, with the relative scale of project activities under Components A and B determining whether the PPMUwill be located in DOH or DARD.The PPMU will have the following key positions: PPMU Director, Accountant(s), Procurement and M&EOfficers, and senior technical staff from DARD,DOH, DOF, DPI, andthe Provincial Treasury. The PPMU will manageall sources of the project funds allocated to the provinces and be responsible for all procurement activities and financial managementfunctions decentralized by the ministries to the province. 12. Full-time accountant(s) with qualification and experience acceptable to the Bank will be appointed for each PCU and PPMU. Budgeting 13. The PPMUs will prepare provincial work plans andbudgets which are to be approved by the PSC. The budgets will be basedon the annual activity plan and procurement plan of the province. The PCUs will be responsible for coordinating and consolidating the budgeting process, for both funding from IDA and counterpart funding from the government, and from provincial level. 14. MARD's PCUwill beresponsible for consolidating total project budget for the whole project (including all components). The budgets will be usedfor monitoring financial progress of the project. Accounting Policies and Procedures 15. The Project will use accounting policies andproceduresacceptableto IDA. For reporting purposes, International Public Sector Accounting Standards (IPSAS) should be usedby the Project. The current accounting and reporting systems and internal controls of the MARD's PCU for existing World Bank-funded projects will be used, and modifiedas necessaryfor this project. 16. It is proposed that the current accounting software usedby the MARD'sPCUbe upgraded to cater for this project's requirements and be installed at each PPMUto provide a consistent accounting and reporting function. Internal Control and Internal Auditing 17. Internal Control. The project's internal controls will be documentedinthe Financial Management Manual (FMM)which will be updatedregularly to take into account any changes inprocedures. The FMMwill bepreparedjointly by the two Ministriesandis to bereviewed 67 annually to ensure it i s up-to-date and relevant. The FMMmust be preparedprior to effectiveness o f the project (condition o f effectiveness). 18. InternalAuditing. An effective oversight mechanism such as an internal audit function mustbe implementedfor managing andcontrolling project financial management systems. It is proposed that the project develop an internal audit function which will have responsibility for ongoing review and reporting on the project internal control systems, implementation progress, administrative efficiencies and proper use o f funds and assets. Internal audit positions may be placed inthe PCUs and will report to the PCUDirectors with copies o f their reports to the PSC. ReportingandMonitoring 19. QuarterlyIFRs.The PPMUwill be responsible for preparationof quarterly interim financial reports (IFR), by Component, for the province. The two PCUs will then consolidate provincial IFRsfor their respective component. MARD's PCUwill be responsible for consolidating total project IFRs for submission to the Bank on a quarterly basis. The IFR formats and contents will be agreed at negotiations. The IFRs should be part o f the periodic Project Progress Reports submittedby the PCU and the PCUwill submit the IFRsto the Bank within 45 days o f each quarter. 20. AnnualFinancialStatements.MARD's PCUwill prepare annual project financial statements incompliance with IPSAS. The Project Financial Statements will consist o f (i) a Statement of Sources and Uses of Funds/Cash Receipts and Payments; (ii) the Accounting Policies Adopted and Explanatory Notes; and (iii) a Management Assertion that Bank funds have been expended in accordance with the intended purposes as specified in the relevant World Bank legal agreement. ExternalAudit Arrangements 21. Financial statements o f the project will be audited on an annual basis in accordance with international auditing standards and incompliance with the independent auditing regulations o f Vietnam and terms o f reference acceptable to IDA. The audited financial statements and audit report must be submitted to IDA within six months of the end of each fiscal year. The auditor who i s acceptable to IDA would express a single audit opinion covering the Project Accounts, the use of Statements of Expenditures and the Designated Accounts. A management letter addressing any internal control weaknesses o f the implementing agencies (PCUs and PPMUs) will also be provided by the auditor together with the audit opinion report. FundsFlowsandDisbursementArrangements 22. The project i s being financed by a credit from IDA, grants from AHIF and the PHRD Fundand counterpart resources from Government. 23. The PHRD Grant will finance 100% o f consulting services under Subcomponent Al, A3, and A5, and under Component B and C. 24. Other expenditure categories would be co-financed by IDA and AHIF (67% and 33% respectively o f total costs including taxes). Inline with the AHIF agreement, local taxes and 68 duties will not be financed from the AHIF. The financing shares of IDA and AHIF o f 67% and 33% respectively have been determined factoring inthat no taxes and duties should be financed from the AHIF (see computation intable below). All taxes and duties on these categories would be financed by IDA.13 Computation of Financing Arrangements for Expendituresco-financed by IDA and AHIF Total costs I funded FinancingArrangements bylDA and AHIF IDA IAH1 Facility (US$ (US$ (US$mill) mill) percent mill) percent Cost excludinqtaxes and duties $26.40 $16.40 62% $10.00 38% Estimated taxes (fully IDA funded) $3.60 $3.60 100% $0.00 0% Cost includingtaxes $30.00 $20.00 67% $10.00 33% 25. The project financial statements and audit would confirm adherence to the stipulated financing shares, thereby also confirming that taxes and duties have not been financed from the AHIF.14 26. The following Table 1 indicates the amounts allocated and the percentage of project expenditures financed by expenditure category and financing source. l3The Vietnam country financing parameters allow for IDA financing of all taxes and duties. IDA has appraised that taxes and duties do not constitute an excessive share of project costs (estimated at about 12% of project expenditures on these categories. l4 For clarity, the Notes to Project Financial Statements would state that the financing shares between IDA and AHIF financing stipulated at the beginning have beendetermined inamanner as to exclude any financing of taxes and duties from the AHIF; and confirm that these agreed financing shares have been adhered to, and therefore no taxes and duties have been financed from the AHIF. 69 Table 1-Total Project Financing by Expenditure Category and by Source. Training and Workshops 8.9 5.93 2.97 67 33 Consulting Services ComponentA: Subcomponent 1.14 1.14 100 Al, A3, A5 Subcomponent A2, A4 1.38 0.92 0.46 67 33 Component B 0.96 0.96 100 Component C 2.9 2.9 100 Compensation Fund 0.1 0.07 0.03 67 33 Incremental Operating Costs 5.3 1.53 0.77 3 30(a) 15 (a) 55 Project Total Cost 38 20 10 5 3 (a) Share of IDA/ AHIF are 67/33 after deduction of Governmentfunding for IncrementalOperating Costs. 27. The table included in the Attachment 1to this Appendix, present the allocation o f funds from the three sources (plus Government counterpart funding) by Expenditure Category and by Component. 28. Dedicated Accounts. At the central level, there will be a total of four Designated Accounts (DAs). Each PCU will have two DAs - one for the PHRD funds and the second for the blended IDA credit and AH1 Facility funds. DAs will be opened in a commercial bank with terms and conditions satisfactory to IDA. Authorized Allocations for the two DAs in MARD would be US$ 1.6 million (for the blended IDA and AH1Facility funds) and US$500,000 (for the PHRD funds), Authorized Allocations for the two DAs in M O H would be US$ 1.6 million (for blended IDA and AHI) and US$500,000 (for PHRD) respectively. 29. At the provincial level, each PPMU will have one project account in VND opened in a commercial bank to receive advances from the four PCUs' DAs for project expenditures. The accounting system and records will account for the expenditures by component and source of funds. 30. The advance amount to the PPMUs' project account will follow 90 day-advance account procedure and will be determined based on the approved quarterly work plan o f the province, the progress of field implementation, and the reimbursement. For each quarter, the PPMU would send an advance request with summary and detailed reconciliation o f (1) the value of the next 70 quarter's planned activities; and (2) the unspent balance of the previous advance (that is, the opening balance less amount spent inlast quarter). 31. Disbursement Methods. The project will use traditional disbursement methods as per the Bank's disbursement guidelines. Below i s the table o f project cost with disbursement percentage. 32. Reporting on Eligible Expenditures Paidfrom the Designated Accounts. Withdrawal applications reporting eligible expenditures paid from the designated account will be submitted monthly, with the following documentation: 0 Use of Statements of Expenditures. For works costing less than US$lOO,OOO equivalent per contract, goods or non-consulting services costing less than US$100,000 equivalent per contract, services provided by consulting firms costing less than US$lOO,OOO equivalent per contract and services provided by individual consultants costing less than US$50,000 equivalent per contract, withdrawals under the Credit Agreement will be made on the basis o f Statements of Expenditure. The related payment documents will be made available for the required audits, as well as to the Bank supervision missions upon request. 0 Other Expenditures. All other expenditures above the expenditure thresholds will be submitted on the basis of full documentation which will include copies o f receipts, supplier invoices, and bills of lading. 33. Counterpart Funds. Each PCU and PPMU will open a deposit account at the State Treasury to receive counterpart funds. The PPMU i s responsible for annual budgeting o f counterpart funds for the project activities within the province. The two PCUs will be responsible for coordinating and consolidating the budgeting process from provincial level for their respective component. MARD's PCU will be responsible for consolidating total project budget for the whole project (including all components) for both donors funds and counterpart funds. 34. Retroactive Financing. Retroactive financing i s allowed for payments made on or after December 15, 2006, up to an aggregated amount equal to the Retroactive Financing Amount o f US$300,000 from the IDA Credit / AHIF Grant. Financial Management Action Plan Actions Responsibility Date of Completion Identify and appoint full time project accountant(s) at Effectiveness (1" PCUs and PPMUs with qualifications and experience PCU) / Condition acceptable to IDA of Disbursement MARDNOH/PROVINCES (2nd PCU) / Condition o f Disbursement PPMU (for each of 11provinces) Agree on the content and format of IFRs M A R D N O H During Negotiation 71 Finalize and adopt financial management section in 1 the overall project implementation manual MARDMOH Effectiveness I Establish a consistent computerized accounting Effectiveness (1" system at PCUs and at PPMUs to provide a sound PCU) / Condition basis for accounting and reporting. of Disbursement MARDMOHPROVINCES (2nd PCU) / Condition of Disbursement PPMU (for each of 11provinces) Develop a comprehensive training and capacity building program on project financial management to MARDMOHPROVINCES Effectiveness project accountants Develop internal audit function in each PCUs 3 months after: (identify and appoint auditor staff; establish procedure, workplan, reporting and monitoring (1'' PCU) / ii arrangements). M A R D M O H Condition Disbursement (2nd PCU) Supervision Plan 35. Supervision of project financial management will be performed on a risk-based approach at least twice a year with field visits to selected provinces and PPMUs to review provincial financial management arrangements, funds flows, budgeting, accounting records and internal controls. The supervision will review the project's financial management system, including but not limited to the operation of Designated Accounts, Project accounts, internal control and financial reporting. The supervision visits to the project implementing agencies will be supplemented by reviews o f the internal control supervision reports, review o f the quarterly IFRs, and the annual audit reports of the project. Financial management supervision will be conducted by IDA'Sfinancial management specialist. 72 ATTACHMENT 1-DISBURSEMENTSBY EXPENDITURECATEGORYANDBY SOURCE &.qT PROJECTTOTAL Financing by Sol :e Expenditure category 1. Civilworks 1 1 0.68 I 1 (a) Component A 0.68 0.45 0.23 67 33 I I 2. Goods 16.63 I (a) Component A 3.68 67 33 I I (b) Component B 1.99 67 33 -t+ (c) Component D 0.54 I 0.36 0.18 67 33 3. Training and Workshops (a) Component A 0.56 67 33 (b) Component B 2.27 11 1I 67 33 (c) Component C 67 33 I L 4. Consulting Services 6.38 (a) Component A 2.52 0.92 (b) Component B (c) Component C 2.9 5. Farm Compensation * Payment 0.03 67 33 6. Incremental Operating costs (a) Component A 0.29 1.23 30 15 (b) Component B 2.23 I 0.67 0.33 I I 1.23 (c) Component C 0.15 I I 0.54 Project total Cost 53 after deduction 10 5 3 3)Share of IDA/ AHIF are 6: Governmentfunding for IncrementalOperatingC 'StS. 73 Appendix 5: Procurement Arrangements VIETNAM: VN Avian & Human Influenza Control & PreparednessProject 1. As described inOP 8.50 for Emergency Recovery Assistance (ERA), inaddition to emergency assistance, the Bank may support operations for prevention and mitigation in countries prone to specific types o f emergencies. This may comprise: (a) developing a national strategy; (b) establishing an adequate institutional and regulatory framework; (c) carrying out studies o f vulnerability and risk assessment; (d) reinforcing vulnerable structures; and (e) acquiring hazard reduction technology. Given the threat that avian and human influenza may pose to the economic and social fabric o f the country, as well as to the health o f the population because o f the risk of an influenza pandemic, the Project will be financed through IDA Grant to be approved following ERA procedures. 2. Procurement for the proposed project would be carried out in accordance with World Bank "Guidelines: Procurement under IBRD Loans and IDA Credits", May 2004; and "Guidelines: Selection and Employment of Consultants by World Bank Borrowers", May 2004 and the provisions stipulated in the Legal Agreement. The general description o f various items under different expenditure categories are described below. For each contract to be financed by the Grant, the procurement methods or consultant selection methods, estimated costs, prior review requirements, and time frame are given in the General Procurement Plan covering the first 18 months of the project implementation provided by the Project Implementing Agencies (PIAS)prior to the negotiations. The Procurement Plan will be updated at least annually or as required to reflect the actual project implementation needs and improvements in institutional capacity. Civil Works 3. Civil Works estimated at an aggregate amount of US$0.7 Million with contracts estimated to range from U S10,000 to US$250,000 per contract, include construction for upgrading markets, cold room stores, renovation of isolation rooms, and construction of quarantine rooms in the project provinces. All the works will be procured through the shopping procurement method. The Bank's Sample Documents for procurement o f very small work contracts will be used. Goods and Non-Consulting Services 4. Goods estimated at an aggregate amount of US$16.6 Million to be procured under the proposed project include, but are not limited to, laboratory equipment and consumables, vaccines, personal protective sets, computer and office equipment and supplies, training material printinganddistribution, communicationequipment, vehicles andmotorcycles. 5. The amount of each contract, with the exception of vehicles and motorcycles, i s generally expected to range from US$lO,OOO to US$150,000. Goods, including vehicles and motorcycles urgently required at the start-up o f the Project, estimated to cost less than $250,000 per contract may be procured through the Shopping method. This threshold i s higher than the country threshold for shopping ($30,000) normally used for conventional projects. This exception i s justified due to the emergency nature of the project, and the same threshold was also used under 74 the earlier Avian Influenza Emergency Recovery Project (AIERP). Given that most o f the procurement of goods under the Project would fall under the Shopping method, the invitation for quotations for each contract for goods and works procured under shopping procedures and estimated to cost more than US$60,000 equivalent shall, in addition to any direct invitations, also be advertised in the Ministry o f Planning and Investment's Procurement Newspaper and Website, and prospective bidders shall be allowed at least 10days to submit quotations. Vehicles and motorcycles each estimated to cost less than US$250,000 per contract may also be procured under the Procurement from United Nations Agencies method using IAPSO. Goods estimated to cost more than US$250,000 per contract shall be procured under the International Competitive Bidding(ICB) method. The model Request for Quotation document agreed with the Bank will be used for procurement o f Goods under the Shopping method, and the Bank's Standard Bidding Documents for Goods shall be used for all ICB procurement. Limited International Bidding (LIB) may be used for procurement of vaccines subjects to appropriate justification in accordance paragraph 3.2 o f the Procurement Guidelines. 6. Direct contracting o f television broadcasting o f project education campaign would be used since this i s the only option available given the Government monopoly o f television broadcasting. ConsultingServices 7. Consulting Services estimated at an aggregate amount o f US$6.4 Million include but are not limited to, consulting services on various research and studies and specialized technical subjects, surveys, surveillance, simulation, education and training, and project management. With the exception of consulting services mentioned in the following paragraph which are to be procured on single source selection, the rest would mainly be o f small-value services requiring hiring of individual consultants who would be selected in accordance with Section V of the Consultant Guidelines. Some consulting services requiring hiring o f firms and estimated to cost up to US$200,000 may be procured using the method of Selection Based on Consultant Qualifications (CQS). Services requiring hiring o f firms and estimated to cost more than US$200,000 shall be procured through the Quality and Cost Based Selection (QCBS) method. Inaddition, there maybe a needto use, with the Bank's prior agreement, Single Source Selection (SSS) for consultancies o f a specialized nature. Least Cost Selection (LCS) may be appropriate for contracting the audit firm. Quality Based Selection would also be appropriate in certain cases. 8. The project envisages one contract with OIE (US$150,000) on the basis o f single source selection to provide technical services and assistance under Component A. The World Organization for Animal Health (OIE) i s the global regulatory and standard-setting authority for animal health and has worldwide expertise in disease reporting, animal health certification and regulatory matters related to national or world animal health. OIE i s equally involved in the worldwide campaign against HPAI, through developing vaccination policy, disease-free certification and veterinary service assessments in countries requesting assistance from the international donor community in controlling or preventing avian influenza. OIE health certification i s important in international livestock trade and the official declarations of freedom of disease, and has on staff and as consultant resources a number of livestock policy specialists. 75 WorkshopsandTraining 9. An extensive training program including in-country workshops, training courses and study tours i s estimated to cost about US$8.9 Million. The Government's applicable procedures for carrying out training programs and workshops will be followed. Firms and individuals hired under contract for carrying out the training program and conducting workshops will be selected following the applicable methods of selection mentioned above under Consultant Services. OperatingCosts 10. Operating Costs estimated at an aggregate amount of US$5.3 Million includes reasonable costs of incremental expenditures incurred by implementing the project, namely the costs of communication, travel and per diem expenses, office rental and consumables, and salaries for contracted staff, however, excluding salaries and salary supplements o f civil servants. 11. The annual and/or semi-annual training program and operating costs expenditures plans, including in-country workshops, seminars, official travels, etc., shall be conducted in accordance with agreed procedures to be provided inthe Project Implementation Manual based on programs with detailed itemized budgets approved by the appropriate government agencies and the Bank. The plans shall provide the objectives, criteria for selection of participants, number o f participants, venues selected, timing o f activity and detailed estimated costs including travel, living expenses, shopping list, unit costs, etc. Activities and expenditures incurred under these activities and included in the Statement-of Expenditures shall be supported by documentation evidences such as invoices, receipts, list of participants, per-diem received, etc., and signed by an official responsible and accountable for ensuring that the resources are spent strictly in accordance with the agreed plans with hisher statement confirming that this rule has been properly observed). These activities and documents shall be subject to regular and/or non-regular verification and inspection by the Bank staff and/or independent technical, financial, management inspectors. SmallGrants 12. Guidelines for accessing the grants will be designed during implementation and, subject to their acceptance by IDA, these guidelines will be included inthe PIM. Farmer Compensation 13. Guidelines for accessing farmer compensation will be designed during implementation and, subject to their acceptance by IDA, these guidelines will be reflected in a Compensation Manual. The Bank'sProcurementReviewRequirements 14. The following contracts shall subject to the Bank prior review in accordance with the Procurement Guidelines or Guidelines for Selection of Consultants: a. The first contract for goods or non-consulting services procured by each 76 implementing agency regardless o f value, and all subsequent contracts o f US$lOO,OOO equivalent or more per contract. b. The first contract for works procured by each implementing agency regardless of value, and all subsequent contracts o f US$lOO,OOO equivalent or more per contract. c. All contracts procured under direct contracting procedures. d. The first consultant contract with a firm and the first contract with an individual by each implementing agency regardless o f value, and all subsequent consulting services o f US$lOO,OOO equivalent or more per contract for firms and US$50,000-equivalent per contract for individuals respectively. e. All single source selection contracts. 15. All other contracts shall be subject to post review in accordance with the Procurement Guidelines or Guidelines for Selection of Consultants: B. PROCUREMENTCAPACITYASSESSMENT 16. A procurement capacity assessment was conducted during the project appraisal. The procurement capacity of the proposed project implementing agencies (MARD,MOH and Project Provinces) was found to be inadequate. To be noted i s the possibility o f using staff from the existing MARD's CPU for the AERP project. This CPU i s fully functional and staffed with procurement staff with adequate procurement experience gained over the last 3 years implementation of IDA funded project, but this arrangement would need to be finalized, if indeedrequired. 17. The procurement issues and risks for implementation o f the proposed project are mainly related to: (a) inadequate procurement knowledge and experience o f the project implementing agencies; (b) the potentially heavy workload due to the emergency nature o f the proposed project in addition to the workload which might be required by other potential projects to be funded by other donors; (c) the possibly slow or delayed government internal procurement approval process; and (d) the potential abuse of shopping and statement of expenditures procedures. 18. An action plan for strengthening the procurement capacity of the project implementing agencies was agreed duringthe appraisal mission and includes the following: a. PIAs will provide the updated Procurement Plan for the first 18 months of project implementation to the Bank prior to negotiations. b. PIAs, Line Ministries, and PCs will issue an instruction on the project procurement work including a simplified government approval procedure and measures to ensure transparency and economy o f the shopping and statement of expenditures procedures by the project effectiveness. c. PIAs will select a qualified Procurement Consultant by the project effectiveness. d. PIAs will assign one Procurement Officer to work full time at the CPU(s) by the time of project effectiveness. e. Each participating agency will assign one staff with responsibility for providing the PCU (s) with technical support for procurement of their respective subproject components. 77 f. PCU (s) will organize a procurement workshop with the Procurement Consultant as the main resource person and with assistance from the MARD/MOH within one month following project effectiveness. g. PCU(s) will establish the project procurement record and filing system by the time of project effectiveness or to comply with the Condition of Disbursement associated with the 2ndPCU. h. PCU(s) will explore possibilities of experience sharing with the on-going World Bank-funded project managedby MARD/MOH/PCs. 19. The overall project risk inrespect of procurement is high. C. PROCUREMENTPLAN 20. A general procurement plan was developed by Government to cover the first 18 months of project implementation. In addition, the PIM to be prepared before project effectiveness will include a sectionon procurement. D. FREQUENCYOFPROCUREMENTSUPERVISION 21. In addition to prior reviews, the capacity assessment of the PIAs indicates that biannual implementation reviews should be undertaken in order to visit the field to carry out post-review of procurement actions. E. DETAILS OF PROCUREMENT ARRANGEMENTS INVOLVING INTERNATIONAL COMPETITION Goods,Works and Non-ConsultingServices. (a) List of contract packages which will be procured following ICB and Direct contracting: Contract I Estimated IProcurement I 1Domestic 1Review 1Expected 1Comments 1 Description Cost Method P-Q Preference byBank B i O (US$lOOo) 78 (b) Contracts for goods and works estimated to cost more than $100,000 equivalent and all contracts procured through Direct Contracting regardless of value will be subject to prior review by the Bank. Consulting Services. (a) List o f Single Source Consulting Assignments 1 2 3 4 5 6 7 Ref. No. Description of Estimated Selection Review Expected Comments Assignment cost Method by Bank Proposals (US$1000) Submission Date Technical assistance 150 Single Prior Tbd by OIE source (b) Consultancy services by firms estimated to cost US$lOO,OOO or more per contract, all Single Source selection of consultants (firms) and consultant services by individuals costing $50,000 or more will be subject to prior review by the Bank. (c) Short lists composed entirely of national consultants: Short lists o f consultants for services estimated to cmt less than US$200,000 equivalent per contract may be composed entirely of national consultants in accordance with the provisions of paragraph 2.7 of the Consultant Guidelines. 79 Appendix 6: EnvironmentalAnalysis VIETNAM: VN Avian & HumanInfluenzaControl& PreparednessProject 1. Background 1. The Highly Pathogenic Avian Influenza (HPAI) epidemic that struck Asian countries in mid-2003 has so far resulted in 244 humancases, o f which 144have been fa tali tie^'^. The human toll has been especially heavy in Asia. Avian influenza has now spread to 14 Asian countries, resulting in 214 human cases (89% o f world cases) of which 132 were fatalities (92% of world fatalities)16. Vaccination of poultry i s underway infour Asian countries (China, Vietnam, Indonesiaand Pakistan), albeit with mixedresults, depending on vaccination strategies, the efficacy of vaccine coverage and response, and the degree of post-vaccination monitoring which governs the decision-making o f vaccination strategies. 2. Avian and Human Influenza (AHI) infection has been extremely costly for Vietnam in terms of human life and economic impact. To date, Vietnam has reported 93 human cases, including 42 fatalities. This record places Vietnam second only to Indonesia in the number o f human fatalities. Vietnam has made great strides in fighting avian influenza since the World Organization for Animal Health (OIE) first officially declared the disease present in that country on 8 January, 2004. Inthe two and one-half years since that date, Vietnam has experienced three successive but diminishing waves of infection. Typically, outbreaks have struck the country during the rainy season that coincides with the annual Tet festival, during which poultry sales and consumption are at peak levels. In each case the epidemic has been contained, but only through the application of stringent containment measures including the imposition of strict poultry movement controls, closure of all live-poultry markets, the rapid culling o f sick and unaffected birds, and the application o f biosecurity measures in de-stocked commercial, smallholder and breeding operations. 3. Usin its own resources, supported by assistance from the international donor community ,Vietnam has addressed the avian influenza epidemic in ways that offer a model for IF other countries that are responding to or are threatened by HPAI. On the technical side, Vietnam has expanded its laboratory capacity, improved epidemiological expertise and disease reporting, enhanced management capacity, improved its capacity to identify outbreaks rapidly and effectively, organized emergency outbreak containment, undertaken targeted and risk-based vaccination, introduced effective movement controls on poultry and contaminated materials duringoutbreaks, and initiated an investigative researchprogram. 2. EnvironmentalPolicy 4. Vietnam's regulations for environmental review of investment projects are similar to the World Bank's requirements. However, three key differences are the lack o f a formal requirement for public consultation and disclosure o f potential environmental impacts, differences in how projects are categorized with respect to their potential impact, and the absence of an explicit WHO World Human Case Statistics, October 2006 l6FA0Aide Report, September, 2006 Some 26 agencies and NGOs work in Vietnam on various aspects of avian influenza 80 requirement for an Environmental Management Plan (EMP). The 2005 Environmental Protection Law that came into effect on July 1, 2006 has substantially narrowed the gab between the World Bank requirements and Vietnam environmental regulations. Nevertheless, as there are still important differences between World Bank and Vietnam requirements on environmental review, the project will follow World Bank requirements. 3. Applicabilityof the Bank's SafeguardsPolicies 5. The project i s not expected to have any large-scale, significant and/or irreversible impacts as activities focus largely on public sector capacity building and ensuring readiness for tackling outbreaks of AI in domestic poultry as well as preventing or reducing possible human infections by strengthening emergency preparedness and response. The project design incorporates other beneficial measures on the animal health side such as improved biosecurity in farms and live markets, disease control and poultry industry restructuring. On the human health side, the preventive activities include enhanced surveillance, curative care preparedness and awareness raising. All measures are aimed at increasing the effectiveness and safety over the existing AI practices and will have positive human health and environmental impacts. As such, the project i s assigned an Environmental Category B. 6. The project triggers the Bank's safeguards policies on Environmental Assessment (OP 4.01), Indigenous Peoples (OP 4.10), and Involuntary Resettlement (OP 4.12). The project is being processed under OP 8.50, Emergency Recovery Assistance, and the task team i s in the process of requesting concurrence from the EAP Vice President to delay preparation and disclosure o f the Environmental Management Plan under the exception granted under OP 4.01, paragraph 12. Environmental Assessment (OP 4.01). The key environmental and human health issues include: (1) personal safety issues precluding disease transmission from animals to humans or between humans; (2) proper management of laboratory specimens and laboratory waste; (3) adverse impacts of construction activities; (4) humane culling o f poultry; (5) safe disinfection of farm areas; (6) secure disposal o f carcasses; (7) live market safety; (8) infection control at hospitals, inclusive o f waste and wastewater management; and (9) responsible operation of an incinerator for confiscated poultry. All the above issues are important to prevent the inadvertent spread of Highly Pathogenic Avian Influenza virus, as this virus i s harmful to human health. Furthermore, some activities can have an adverse impact on the environment through emissions to the atmosphere, wastewater discharge or groundwater contamination. Natural Habitats (OP 4.04). This Bank policy i s not triggered because the project will not convert or degrade any protected areas, known natural habitats, or established or proposedcritical natural habitats as defined under the policy. Pest Management (OP 4.09). This Bank policy i s not applicable because the project will not procure pesticides nor will the use of pesticides increase as a result o f the project. However, the chemicals to be used for the disinfection of farm facilities/personal protection equipment will be evaluated on a case-by-case basis for conformity with the OP 4.09 for Pest Management. The selected disinfectants will conform to the Bank's Pest 81 Management Policy. Use of hazardous disinfectants would necessitate providing training insafe transport, handling, andapplication. Physical Cultural Resources (OP 4.11). This Bank policy i s not triggered because the project will not affect sites with archeological, paleontological, historical, religious, or unique natural values in the project area. However, appropriate clauses will be included in all construction contracts regarding the procedures to be followed in the event of chance find of culturally significant artifacts or sites. Indigenous Peoples (OP 4.10). It has been determined that this Bank policy does apply since ethnic minorities, who form the poorest sector of the population, are among the vulnerable to loss of poultry and the income derived from it. However, compensation of farmers for the loss of poultry has been incorporated into the project design. The project also ensures that ethnic minorities will benefit from the project in a way which i s culturally appropriate and gender inclusive. An Ethnic Minority Communication Plan will be developed to support this goal. Public Information materials will be produced in local minority languages to ensure that all concerned ethnic groups are informed (see Appendix 7). Involuntary Resettlement (OP 4.12). This Bank policy i s triggered by the acquisition of about 1.7 ha of land under the project for the Ha Vi live-poultry market in H a Tay Province. There i s no housing on the land to be acquired. As a condition of Negotiations, MARD will have preparedand approved a ResettlementFramework Policy for Component A and a ResettlementAction Plan for the Ha Vi Market. Forestry (OP 4.36). This Bank policy i s not triggered because the project will not involve significant conversion or degradation of critical forest areas or related critical natural habitats as defined under the policy. The project will not involve significant conversion or degradation of critical forest areas or related critical natural habitats as definedunder the policy. Safety of Dams (OP 4.37). This Bank policy i s not triggered because the project will not construct or rehabilitate large dams as definedunder this policy. International Waterways (OP 7.50). This Bank policy i s not triggered because there are no known project components involving international waterways as defined under the policy. DisputedAreas (OP 7.60). This Bank policy is not triggered because there are no known project components involving international waterways as definedunder the policy. Public Disclosure (BP 17.50). Because the project i s being processed under OP 8.50, Emergency Recovery Assistance, safeguards issues will be addressed using accepted good practice and sound design principles. Safeguards documents will not be prepared prior to appraisal. The draft documents will be disclosed as they are preparedand again when they are finalized. 82 4. Environmental and Human Health Impacts and Mitigatory Measures to be Addressed under the Government's AH1Program and the Project 7. The potential environmental impacts and mitigation measures to be addressed under the Government AH1 Program, including this project, are described below. All o f these mitigation measures have been incorporated into the design of this progradproject. This section i s an outline of the Environmental Management Plan. This outline EMP shall be developed into a complete draft by MARDMOH and finalized during the first six months of project implementation. The finalized EMP will then be disclosed within Vietnam and in Washington D.C. (at the Infoshop), and the project legal agreement will reflect implementation o f the EMP. 8. Impacts and Mitieatorv Measures Common to both Components: Some environmental and human health issues are common to both the Agricultural and Health Sector Components. These are associated with the following activities: A. Person Safety Issues B. Storage and Transport of Laboratory Specimens C. Management of Laboratory Waste D. Civil Works A. Person Safety Issues. Due to the highly infectious nature of the HPAI virus to humans, particularly H5N1, training will be conducted for all people that are exposed to live virus. This will include field workers involved in identification o f the disease, farm workers involved in culling, laboratory workers involved in virus isolation and diagnosis, and healthcare workers occupied with treatment o f infected patients. All concerned persons will be trained and provided with PPE whenever required. Training will also cover on the use and disinfection of the PPE kits. Furthermore, guidelines will be developed and distributed to all persons involved in such activities. B. Storage and Transport o f Laboratory Specimens. The surveillance system has written procedures for storage, packaging with the appropriate information (laboratory forms), and shipment of the samples by motor vehicle. Specimen transport for all collected samples should follow national and international rules on transport of infectious substances, such as the UN Recommendations on the Transport of Dangerous Goods. Packing must be compliant with the ADR's packing instructions P650. The appropriate packing standard for diagnostic specimens that might contain a highly pathogenic avian influenza virus will be provided to all project provinces, so that all district offices have at least five suitable kits. Any international shipment of samples for analysis abroad are packaged, labeled and shipped in accordance with the requirements of the IATA regulations. Allowance has been provided for training o f field staff in the above. C. Management o f Laboratory Waste. Appropriate methods will be used for handling and disposal of laboratory waste from the laboratories involved in testing samples for highly pathogenic avian influenza. These procedures are already in place in laboratories handling human and animal samples, as these follow national standards, IOE '*andWHOl9guidelines. l8OIE Quality Standard and Guidelines for Veterinary Laboratories: Infectious Diseases 83 To further strengthen safety, the H o Chi Minh Regional Veterinary Center in HCM City, which does the most diagnostic work in Vietnam, will be improved with the procurement o f a BSL-3 laboratory. Duringproject implementation it will be verified that all laboratories handling highly pathogenic avian influenza samples do have a written waste management plan covering the handling, segregation and treatment/disposal o f wastes. Furthermore, it will be verified that the personnel operating the waste management system i s trained. D. Civil Works. The project may be involved with building isolation rooms at hospitals and/or market stalls. During any construction activity, the adverse impacts o f construction such as dust and noise must be mitigated. These adverse impacts will be mitigated by including inthe construction contract a clause regarding observation of standards for good construction practices. Construction will be supervised to observe compliance with these good construction practices. 9. Information and education materials for farmers and the public will be issued in minority languages where deemed necessary, so that all citizens are fully aware of how to minimize their exposure to the HPAIvirus. 10. Component A: Animal Health Sector. The main environmental and human health issues under the Animal Health Component of the Government's AH1 Program and the project are associated with the following activities: A. Compensation for Loss of Livestock B. Cullingof Poultry C. Disinfection of FarmSurfaces, Equipment and Materials Disinfection D. Disposal of CulledBirds E. Improved LiveBirdMarket Hygiene F. Incinerator for ConfiscatedPoultry A. Compensationfor Loss o f Livestock. For the past 12 months, there have been no reported outbreaks o f HPAI in Vietnam. To ensure that any disease i s reported promptly, the project contains a contingency fund for rapid compensation of farmers in the event that their flock has to be culled inthe event o f an outbreak. B. Culling o f Poultry. It i s important that culling of poultry be conducted in a humane, safe, and efficient manner. The following methods for culling poultry are identified through in OIEFAO guidelines: (a) neck breaking (manual), (b) neck cutting (using mechanical devices), (c) gassing with inhalation agents (e.g. carbon dioxide), (d) electrocution, or (e) poisoning. Based on consideration for humane, safe and efficient culling and experience from the previous AH1 outbreaks in Vietnam, the most appropriate culling methods are identified as the manual breaking o f the neck for small flocks and gassing for commercial farms. All culled poultry i s placed inplastic bags for disposal. The procedures are described inDecision No. 3400 QDLBNN- TV 19WHO LaboratoryBiosafety Guidelines for HandlingSpecimensSuspectedof ContainingAvian InfluenzaA Virus (12 January 2005) 84 C. Disinfection o f Farm Surfaces, Equipment and Materials. The Standard Operating Procedures for the Destruction and Disposal of AfSected Poultry and Disinfection of HPAI Infected Places (Contingency Plan for HPAI in Vietnam) will be followed and describe all required mitigating measures in detail. The SOP state the requirements for cleaning and disinfecting clothes, implements, facilities, vehicles, buildings, carcasses and any other parts o f the surrounding environment that come into contact with AI pathogens. It i s important that the disinfectants that the selected disinfectants do not have adverse impacts on the environment and human health. The selected disinfectant, which will be specified in the SOPs, will comply with the World Bank's Pest Management Policy (OP4.09). D. Disposal o f Culled Birds. The Standard Operating Proceduresfor the Destruction and Disposal of AfSected Poultry and Disinfection of HPAI Infected Places (Contingency Plan for HPAI in Vietnam)will be followed and describe all required mitigating measures in detail. It is important that the selected disposal methods for animal carcasses do not have adverse impacts on humans and the environment. For example, improper burial practices may cause contamination o f ground or surface water, and a poorly built pyre may result in incomplete combustion o f the carcasses. The SOP i s to cremate the carcasses on pyres or to bury them. If cremation or burial i s not feasible on-site, the AH1 infected animal carcasses and farm wastes will be transported for off-site treatment and disposal. In this case, all proper measures will be taken to ensure that the transportation does not spread the virus outside o f the infected farm areas. Under this project, transportation of carcasses and farm wastes to another site for disposal will be avoided to the maximumextent possible. However, if transportation is required, then the SOPs will specify the specific requirements for vehicle design and operation as well as containment o f carcasses and farm wastes for transportation. These SOPs will also include decontamination of vehicle surfaces (e.g. tires) prior to exiting the farm and after unloading the animal carcasses at the new site. E. Improved Live BirdMarket Hvrriene. The project will support the H a Vi live-bird market inHaTay province to produce a pilot model for replication elsewhere. Securingthe market from infectious disease i s a major step forward in controlling avian influenza, thereby protecting the public and poultry workers from this disease. Improved market design, proper hygiene, surveillance o f poultry and fomites should protect both the public and poultry workers against the HPAI virus. The project will ensure that the market wastewater i s disinfected prior to discharge. Markets staff and inspectors will receive training in disease control and market hygiene; SOPs will cover disease control, hygiene and wastewater disinfection. F. Incinerator for Confiscated Poultry. The project will ensure that the incinerator's staff i s properly trained, that a thorough Operating and Maintenance Manual i s prepared and that sufficient funds are budgeted to cover all operation and maintenance costs. Discharged wastewater must meet environmental standards and all residues from then incineration process mustbe deposited in alandfillapproved to receive incinerator ash. 11. Comoonent B: Human Health Sector. Healthcare facilities treating humans infected with the avian influenza will follow MOH guidelines, as well as the WHO infection control guideline for health care facilities.*' The principal environmental and human health issues under 20Avian influenza, includinginfluenzaA (H5N1),inhumans:WHO interiminfectioncontrolguideline for health care facilities (last revised24 April 2006). 85 the Human Health Component o f the Government's AH1Program and the project are associated with the following activities: A. Safe Infectious Waste Management at Hospitals B. Other InfectionControl Measures at Hospitals C. Safe Wastewater Management at Hospitals A. Safe Infectious Waste Management at Hospitals. Adverse impacts to human health can occur through the inadvertent spread o f the HPAI virus, if the healthcare waste i s not safely handled at hospitals treating patients infected with AHI. All Vietnamese medical establishments must follow the Decision No. 2575/1999/QD-BYT of August 27, 1999 promulgating the Regulation on Medical Waste Management. These regulations cover the separation o f waste, packaging, handling, transportation and treatment. For any hospital receiving patients infected with AHI, it i s essential that Decision No. 2575/1999/QD-BYT be properly implemented. The project will assist MOH review the clinical care and infection control guidelines; help ensure that staff i s appropriately trained; ensure that sufficient materials (bags, disinfectant, etc.) are stockpiled to supply central and provincial level medical facilities in case o f an outbreak. The project will also ensure that the MOH estimates the maximuminfectious waste quantities in case o f a pandemic. Should the existing treatment capacity be insufficient, contingency plans must be established, for example stipulating the disinfection and burial o f the excess infectious waste that cannot be incinerated. In case o f a pandemic field hospitals will be established; again SOPs and stockpiles must exist for the safe handling and disposal of infectious waste from these provisional facilities. B. Other Infection Control Measures at Hospitals. During an AH1pandemic, it i s essential that hospitals apply the utmost case in containing the disease. This includes handling o f food (relatives should not be allowed to prepare food for patients), disinfection o f linen and equipment, and safe procedures for the handling of any deceased patients. Based on the sound experience o f the Bach Mai Hospital's Institute for Infectious and Tropical Diseases 21 and the WHO infection control guideline; 22training plans and SOPs will be drawn up to assist all facilities that may receive AH1 patients in case of an outbreak. It will also be made certain sufficient equipment and materials are stockpiled to supply medical facilities in case of a pandemic. C. Safe Wastewater ManaPement at Hospitals. Decision No. 2575/1999/QD-BYT covers the requirements to the treatment of wastewater from hospitals. As part o f project assisted MOH review o f clinical care and infection control guidelines, the status o f the individual medical facilities' wastewater treatment will be established. Where required, materials and SOPs will be established to ensure that the wastewater i s disinfectedprior to discharge. 5. ConsultationandDisclosure of the Project'sEnvironmentalManagementPlan "SeetheBachMaiHospital'sRegulationonInfection Control(2000) 22Avian influenza, including influenza A (H5N1),in humans: WHO interiminfection control guideline for health care facilities. 86 12. This outline Environmental ManagementPlan shall be developed into a complete draft by M A R D M O H after consultation with various stakeholders (e.g., the National Institute for Veterinary Research, MONRE and the commercial poultry associations) and non-governmental organizations (NGOs). The draft EMP will be issued to the stakeholders for comments prior to finalization. The EMP will be finalized during the first six months o f project implementation and disclosed at publicly accessible locations in Vietnam and at InfoShop inWashington. The project legal agreement will reflect implementation o f the EMP. 6. Reporting on the Implementation Progress of the Project's Mitigation and MonitoringMeasures 13. Procedures for providing information on the progress of project implementation and results o f mitigation and monitoring measures have been structured to facilitate project supervision and review. Accordingly, each national implementation agency will prepare and submit biannual progress report to their respective international agency. Each international implementing agency will submit a biannual report to the World Bank. The biannual reports will indicate the activities conducted, the remaining activities to be conducted, the products generated, the major issues encountered and how these issues have been resolved as well as the outstanding issues, the expenditures in comparison with the budget. Each international implementing agency will also submit a copy o f the EMP-related specific activity reports (e.g. the waste management plan) to the World Bank for review, comments, and no objection (if satisfactory). 87 Appendix 7: SocialAnalysis VIETNAM: VN Avian & HumanInfluenzaControl& Preparedness ProjectBeneficiaries 1. Project activities will cover eleven provinces in Vietnam, and will benefit commercial and backyardpoultry farmers, traders, and processors in improving their poultry management practices to reduce the risk o f an outbreak o f avian influenza. Backyard poultry farmers are, in many cases, poor farmers living at subsistence levels, and include indigenous peoples. Women play a key role inthe backyardpoultry sector as they often are responsible for poultry production and obtain food products and income from their poultry flocks. A national campaign will provide information and educate farmers as well as the general public about the risks of avian influenza. This information and education campaign will be designed to take into account the diverse stakeholders and characteristics o f the sectors covered (that is, commercial and backyard producers, traders and processors). Multiple media tools will be used and relevant campaign material will be translated into key indigenous peoples languages. 2. Since 2004, poultry farmers have received partial compensation in cases o f avian influenza outbreaks that lead to deaths and/or culling o f poultry. The Project will undertake assessmentsto evaluate the best options for compensation schemes and criteria. 3. Key beneficiaries of the Project will be government agencies and staff, particularly inthe agricultural and health sectors. These will benefit from training exercises, institutional strengthening and enhanced management practices. The general population o f Vietnam will benefit from enhanced institutional set-up, management practices and awareness concerning poultry production and the health sector. The risk for an outbreak o f avian influenza and subsequent pandemic will be minimized and the ability of key stakeholders (e.g. health practitioners and poultry farmers) to address a possible outbreak and pandemic will be enhanced. Consultation 4. Consultations have been held with a large number of government representatives in the respective sectors receiving support under the Project. These consultations have taken place at national as well as provincial levels. MARD has held consultations with commercial and backyard poultry farmers concerning measures to avoid and address outbreaks o f avian influenza. Feedback from these consultations has been incorporated into the Government's strategy supported by the Project. Further consultations and information and education campaigns will be undertaken with various stakeholders during implementation, including commercial and backyard poultry farmers. BeneficiaryandNGOConsultationandInvolvementinProjectImplementation 5. Many development NGOs in Vietnam work with poor farmers, including activities supporting small livestock such as poultry. Several such NGOs, including VSF, have been consulted during Project preparation. These NGOs will be an important target group for increasing their awareness o f national policy and measures to address the risk o f avian influenza, and will continue to be consulted during implementation. Civil society organizations will 88 participate in project implementation, mainly concerning the public information campaign. District and commune facilitators will be trained and participate in implementing the public information campaign. 6. The Bank Involuntary Resettlement safeguard policy i s triggered by the acquisition of about 1.7 ha of land under the project for the Ha Vi live-poultry market in Ha Tay Province. There i s no housing on the land to be acquired. A Resettlement Policy Framework (RPF) and the Resettlement Action Plan for the Ha Vi Market were developed. As a condition o f Negotiations, MARDwill have approved the RPFandthe Resettlement Action Plan for the HaVi Market. 7. Compensation for loss of poultry due to AH1may be provided under the Project, and the criteria and mechanism for providing such compensation will be designed during project implementation. Impact on the Livelihoodsof EthnicMinorities 8. The Project does not adversely affect ethnic minorities. Instead, Project activities will take place in selected areas of the country and ethnic groups will benefit from an enhanced understanding o f the AHI, of ways to improve biosecurity, of measures to be taken in case of outbreaks, and of the compensation for loss of poultry due to an outbreak. Ethnic Minority Communication Plans will be developed to ensure that ethnic minorities will benefit from the project in a way which i s culturally appropriate and gender inclusive. To support this goal further, the public information campaign will be designed to ensure it i s also appropriate for the ethnic minorities in Vietnam, and the materials will be produced in local minority languages to ensure that all concerned ethnic groups are informed. The design o f subcomponent B3 - Strengthening Behavior Change Communication (BCC) in Health Facilities and the Community will buildinto the Ethnic Minority Communication Plan. Resettlement, LandAcquisition and Livelihoods 9. The Bank Involuntary Resettlement safeguard policy i s triggered by the acquisition of about 1.7 ha of land under the project for the Ha Vi live-poultry market in Ha Tay Province. There i s no housingon the land to be acquired. As a condition of Negotiations, MARDwill have prepared and approved a Resettlement Framework Policy for Component A and a Resettlement Action Plan for the Ha Vi Market. 10. Compensation for loss of poultry due to AH1may be provided under the Project, and the criteria and mechanism for providing such compensation will be designed during project implementation. 89 Appendix 8: Economic Analysis VIETNAM: VN Avian & HumanInfluenza Control & PreparednessProject 1. The costs to the economy of avian influenza fall into four main categories; the direct costs to the poultry sector of the disease and associated control measures, the indirect effects of losses as consumers shun poultry and markets for poultry collapse, losses to other sectors of the economy such as the tourism sector, and the public health costs, including those associated with the emergence o f a human pandemic strain of influenza virus. 2. Global Public Good. The proposed measures to control AH1represent a global public good. 3. The threat of emergence of a human influenza pandemic i s the main driver of global efforts to stem infection with H5N1 HPAI in poultry. The global community has concluded that the uncontrolled multiplication of H 5 N1HPAIviruses in poultry represents an unacceptable risk and therefore measures must be put in place to control these viruses. If action i s not taken in Vietnam to control infection, the risk to the rest o f the world's population increases. 4. GPAI (see Annex 8 "Economic Analysis") concludes that "by definition, no single country can protect itself against an influenza pandemic, and the importance of actions taken in one country may well have implications for the well-being o f the rest o f the world's population that are incalculable." When actions are taken by a country in the wider context of the prevention or slowing down of a human influenza pandemic, the traditional "with and without project" type o f cost-benefit analysis "begins to enter the realm of fantasy." In these circumstances, the most useful economic analysis will be the assessment o f the relative cost efficiency o f alternative measures to prevent or contain a pandemic. 5. Even though the level o f risk of emergence o f a human pandemic influenza virus from currently circulating H5Nlviruses in poultry i s unquantifiable and the timing of such an event i s unknown, the costs of such an event, if it were to occur, are so high that actions to control H 5 N l HPAI can be justified on this basis alone. The cost estimates for the emergence of a human pandemic strain o f H 5 N l influenza vary considerably but losses in the order o f hundreds of billions of dollars to the global economy have been proposed.23 6. Locally, the emergence o f a pandemic strain o f human influenza (either emerging in Viet Nam or elsewhere with subsequent spread to Vietnam) would be accompanied by major disruptions and economic losses in line with those that would occur in all other countries. The Oxford Economic Forecasting Group conservatively estimated costs o f US$ 10-15 billion for East Asia as a whole, or about 0.3 - 0.5 percent of regional GDP. Helping to prevent such losses by controlling H5N1 HPAIinVietnam (and therefore providing less opportunity for such a strain to emerge) would easily result in an acceptably positive cost-benefit ratio for activities proposed inVAHIP, even without taking into account the considerable benefits to the poultry industry. 23 http://web.worldbank.org/WB SITE/EXTERNAL/NEWS/O..contentMDK:20978927-menuPK:34472-~agePK:3437 O-~iPK:34424-theSitePK:4607,00.html 90 7. Measures to prepare for a pandemic and to improve surveillance in both animals and humans can still be justified even if a human pandemic strain of H5Nlinfluenza virus does not emerge. Serious new infectious diseases o f humans (often derived initially from animals) have been emerging steadily over the past 30 years, and it i s expected that this trend will continue. The most recent example i s the emergence o f SARS, which had a major detrimental impact on the global economy. Activities proposed under VAHIP that strengthen animal and human health institutions provide solid foundations on which to tackle emerging diseases. Improved animal and human disease surveillance systems developed for influenza will allow these new diseases to be recognized earlier and their treatment and control will be enhanced through stronger animal health responses and enhanced hospital facilities. 8. Global Reputation and Tourism. Vietnam has been widely praised by the global community for its responsible attitude in reducing the possibility o f emergence of a pandemic strain o f influenza virus and this provides confidence to tourists that Vietnam i s a safe place to visit, contrasting with other Asia countries in which the disease remains poorly controlled. However if the gains made so far in controlling this disease are not consolidated and uncontrolled outbreaks of disease in humans and poultry recurs the country's credibility could be damaged. This has implications for other parts o f the economy, especially the rapidly growing tourism sector. 9. Although there was no indication that the tourism industry was adversely affected to any significant extent in 2004 when HPAI in poultry first emerged in Vietnam, tourism in other countries has probably been affected as a result o f adverse publicity concerning avian influenza (e.g. Indonesia). However, the impact would be far greater if an H5N1 virus were to convert to a human pandemic strain, or appeared to be doing so (e.g. clusters o f human-to-human transmission). Ifthis were to occur, individuals would start to practice voluntary social isolation, bringing the tourism industry to a standstill. The adverse effects of SARS in Vietnam on international tourism have already demonstrated the likely magnitude o f this effect following emergence or even signs of emergence o f a pandemic strain of human influenza. Losses associated with SARS were estimated at perhaps 2 percent o f East Asian regional GDP in the second quarter o f 2003 with tourist arrivals plummeting in early 2003 when SARS emerged in Vietnam. 10. Costs of Avian Influenza to the Poultry Industry in Vietnam. The costs incurred by Vietnam as a result o f outbreaks of avian influenza have been reviewed by the Bank in 200424 and 200525. These costs include the direct costs from the uncontrolled disease and control measures, and also indirect costs to the poultry sector and other parts of the economy. 24 http://www. worldbank.org.vn/news/avian%20influenza%20euide~c%20uauer%20ene.~df 25 httP://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/EASTASIAPACIFICEXT/EXTEAPREGTOPHEA NUT/EXTEAPAVIFLU/O.,contentMDK:20985331-pa~ePK:64168445-uiPK:64168309-theSitePK:2706883,OO.ht - ml 91 11. The first large outbreak o f avian influenza in Vietnam, in the winter o f 2004 resulted in the value of output o f the poultry sector declining by roughly 15 percent. The share of poultry in total GDP in 2003 was estimated at 0.55 percent, so that the decline was the equivalent of a drop intotal GDPby about 0.08 points. Another way to arrive at this figure is to consider the number o f heads of poultry lost because of the avian influenza outbreak. It i s estimated that 45 million poultry were culled or died during the first large outbreak. The average farm-gate price o f a bird i s roughly one dollar. The value o f the stock lost between 2003 and 2004 was then 45 million dollars. Given that total GDP in 2004 reached 45 billion dollars, this loss i s the equivalent of roughly 0.1 percentage points of GDP. 12. While the most visible impact of an avian influenza outbreak i s on poultry production, there are other effects on agricultural output. This i s because o f agricultural activities which are either complements or substitutes o f poultry production. Eggs are the most obvious complement. Total egg production fell from 4,852 million units in 2003 to 3,939 million in 2004. Assuming that the decline was entirely due to the avian influenza outbreak, the value o f the output loss was around 46 million dollars. Given an average ratio o f value added to output o f 65 percent, the loss was equivalent to 0.07 percent o f GDP. 13. Although these effects on the overall economy were considered relatively minor, the impact on individual producers was severe especially for those farmers who lost their livelihood. The direct costs o f disease to farmers o f subsequent outbreaks were lower because they were detected earlier, the stamping out program was modified so that only affected flocks were culled (instead of those in an area around the outbreak in early 2004) and the last wave in 2005 was halted by the introduction of a suite o f measures including vaccination and market closures. While these measures were effective, some o f them had major economic effects on farmers who no longer had access to urban markets for their produce. The exact magnitude of these losses has not been calculated but this demonstrated the major negative effects on many rural households o f rapid policy shifts on rules relating to sales o f poultry and access to markets. The past 12 months has seen stability return to the poultry sector and this stability helps to ensure that poorer farmers can invest inpoultry with more confidence, provided they retain access to market outlets. Moving from cost-benefit to cost-effectivenessanalysis 14. Control and eradication o f HPAI are complicated tasks that can only be achieved using a combination o f measures. N o single measure i s likely to be appropriate and effective. The composition o f measures must be chosen and adapted according to the conditions inthe country and its disease status, and must therefore be phased. The aim i s to ensure a minimum cost composition o f control measures to achieve this objective. 15. The introduction o f the suite of measures in 2005 provides a baseline cost for the control o f avian influenza in Vietnam. For example, the cost o f vaccination alone amounts to some $20 million per annum. 16. As of late November 2006 (Le. the time of appraisal), no outbreaks have been reportedin Vietnam since the introduction o f this suite of measures. Therefore the baseline against which the economic benefits to the poultry industry o f VAHIP can be measured i s a situation with no HPAI disease outbreaks reported (although H5Nl viruses are still present in the country) The 92 resources allocated in VAHIP to control HPAI should therefore be assessed against their contribution in reducing the overall costs o f HPAI control in a way that does not lead to an increase in the incidence of the disease. To achieve this, sustainable changes in existing marketing and production practices must be implemented and veterinary institutions strengthened. The benefits o f these improvements should be judged on whether the current favorable disease status i s retained and, whether, in the long term, the costs of control are reduced. 17. For example, enhanced hygiene in live poultry markets through investment in new procedures and facilities, as proposed in VAHIP, will reduce the overall levels o f infection in these markets and the level o f risk to producers in market catchment areas, whose poultry could be infected by traders traveling from markets back to farms. The benefits o f these improvements would accrue over a number of years as the risk o f disease falls and investments in other measures such as mass vaccination are reduced through better targeting, and may eventually be stopped. These are public good activities that accrue to all poultry farmers and to all people exposed to poultry through the reduction inthe risk o f encountering infected birds. 18. Vaccination in the commercial sector will continue as long as farmers feel the risk of infection to their flock remains and that the insurance provided by vaccination i s worth the premium paid. This i s a commercial decision. Targeted vaccination in highrisk populations will also be required for some time (e.g. grazing ducks) but this i s less taxing to implement than blanket programs. However, concerns have been expressed that in the long term the current government driven mass vaccination of smallholder and village poultry i s not sustainable given the significant time and effort required to implement this properly. Experiences with other animal vaccination programs suggest that even if vaccination remains compulsory, `vaccination fatigue' will set in eventually, especially if no cases o f disease occur. This can eventually lead to reduced vaccination coverage and once national or regional flock immunity falls, the disease will re-emerge. Therefore, other measures to achieve sustainable reductions in the level o f infection must be introducedto consolidate and maintain recent gains before this `fatigue' sets in. 19. The suite o f activities outlined in Component A aim to reduce the need for blanket vaccination while maintaining or improving the current risk o f disease in poultry and humans and to reduce the cost of control. 20. Pro-poor Control Measures. The costs of avian influenza differ for different social groups, such as poor rural households or small commercial poultry producers. The proportion of poultry production undertaken by backyard and small commercial systems i s much higher at lower levels o f per capita income. In Vietnam, where the bulk o f poultry production i s still by backyard producers, the impact has fallen mostly on individual rural households, and has only partly been offset by government compensation to farmers. Survey data show that the poorest quintile o f households relies more than 3 times as much on poultry income than does the richest quintile, so there are also adverse distributional effects. Research has shown that income from poultry i s much more equally distributed than overall income. Reductions in poultry income due to avian flu or to avian flu control strategies will thus tend to worsen income distribution in Vietnam. 93 21. Project subcomponents proposed in this project aim to ensure that the effects on the poor of this disease and the control measures implemented are minimized through activities such as use of ring vaccination, studies on streamlining o f compensation, finding ways to allow smallholders to keep accessing markets (e.g. studies on safe production of native chickens) through live poultry markets any measure controlling the disease, enhancing community animal health worker training, raising awareness of avian influenza and therefore providing better animal health services, which also benefit them both directly and indirectly. The control of this disease improves the stability of markets and reduces the uncertainty o f losses. 94 Appendix 9: Technical Notes VIETNAM: VN Avian & HumanInfluenza Control & Preparedness Project Technical Note 1 -Poultry Sector Restructuring 1. Objective and Rationale. The poultry sector restructuring subcomponent will support the restructuring activities o f the poultry sector that will contribute to strengthening HPAI control. The poultry sector restructuring activities are based on the OPIproposed supports for poultry sector restructuring and are part o f the strategy for long-term control of HPAIdefined by DAH. 2. In moving from the control phase to consolidation phase of HPAI in Vietnam, control measures preventing the re-infection of the poultry production and marketing chains will become increasingly important. Sustainable HPAI disease control can be achieved by improving the biosecurity level of the poultry production and marketing chains. This will require both behavior changes towards biosecure production and marketing practices, as well as incremental investments in increasing biosecurity in production, marketing and processing facilities. Such changes must be made in a socio-economically equitable manner that does not lead to increased environmental damage or inadvertently increase the risk of disease outbreaks through the over- concentration o f poultry. 3. Structural changes o f the poultry sector in Vietnam are in progress and the role of the Vietnamese government in regulating and enforcing externalities are becoming increasingly important. However, introducing stricter biosecurity regulations can limit access by smallholder producers who are not able to comply. DLP i s in the process of developing the necessary incentives, guidelines and regulatory framework to guide the future development o f the poultry sector in a social and environmentally sound manner. The objective of this subcomponent i s to support DLP in developing and demonstrating poultry production models and development schemes that are efficient, equitable and environmentally sound. 4. Background and Assessment of the Poultry Sector. The Vietnamese poultry sector i s characterized by small scale and scavenging chicken production. Prior to the HPAI outbreaks in late 2003, about 8.3 million households were keeping 250 million poultry. Out of the 8.3 million poultry keeping households, less then 500,000 households owned more than 50 birds (as average flock size). 5. It i s estimated by the government that about 45 millionpoultry were culled or died due to the HPAI epidemic. Since the last major outbreaks in 2005, the poultry sector i s rehabilitating gradually. Poultry farms are gradually restocking their production facilities and poultry production i s again relatively profitable. Poultry keeping i s a tradition with a strong consumer demand for free ranging native poultry and the income share from poultry production i s relatively higher for lower income households. In the long-term, a structural shift towards more intensive production can be anticipated. However, the competitiveness o f the sector i s limitedby about 20% higher feed costs compared to other countries in the region. With WTO accession soon to realized, the domestic poultry industry will face increased competition due to market liberalization. However, the bulk o f demand for poultry products over the mid-term will continue to be supplied by small scale poultry producers. 95 6. Due to increasing disposable household incomes in urban areas, increased consumer demand for poultry meat can be expected. Given the profitability o f poultry production arising from this demand, private investments inthe poultry sector are certain to continue. This implies a need for an appropriate regulatory framework from the public sector that sets the right incentives to guide future private investments in the development o f the poultry sector towards more biosecure and environmentally sound production. The construction design o f new production farms and processing plants needs to incorporate hygiene, disease control and environmental standards. At the same time, existing sector I11farms, still generating the majority of poultry, remain important for to maintain an adequate supply o f poultry products. Therefore the development of appropriate production models for upgrading biosecurity and environmental standards on existing farms i s essential. 7. Support Proposed under this Subcomponent. This subcomponent will support restructuring activities of the poultry sector that contribute to HPAI control and take social and environmental issues of poultry production into consideration. Activity A. Capacity Building within the Department of Livestock Production (DLP) 8. The ongoing restructuring activities by DLP are providing the opportunity to assist developing the necessary regulatory framework that would guide the structural change in those sectors o f the industry that can adopt enhanced standards towards more biosecure production. In order to enable staff in DLP and DARD to conduct the necessary steps involved in implementing a policy change inpoultry production capacity building i s required. 9. This will include postgraduate MSc training for DLP staff members, and training courses insocial, economic, environmental and riskimpact assessments.The resultingmaster thesis must be strongly linked to various aspects o f poultry sector development and planning so that the students have to work on issues of direct interest to the project. The budget i s provided for them on the condition to come back to (MARDDLP) and use their knowledge and findings for fieldwork. Activity B. Planning and Demonstrating Biosecure Poultry ProductionModels 10. A spatial planning and risk assessment will be conducted to determine indicators for the most suitable areas for poultry production in terms o f public health, economic viability and environmental pollution. The conclusion will be used to revise the regulatory framework and investment incentives accordingly. 11. Technical assistance will be provided to train, and develop, together with DLP staff, biosecure, economically viable and environmentally sound poultry house construction plans, tailored to smaller scale broiler and layer farms. These plans will be made available for individual producers wishing to invest inpoultry production. Leaflets containing this information will be distributed through District Veterinary Health Stations and poultry feed retailers. 12. A program to assist districts of the VAHIP provinces with their restructuring activities will be advertised. Three districts, which have already made land resources available, will be 96 selected to assess and study their restructuring planning and activities. This will include an economic, social and environmentalimpact assessment. Generic guidelines about the necessary operational steps to implement the restructuring activities will be composed. Monitoring and studyingof the investmentsinpoultry productionserves to review and adjust the new developed poultry production models. Findings are submitted to other provinces and the private sector by workshops. An initial assessment of the ongoing planning and implementation process with regard to the affected stakeholders and their participation in the decision process will be conducted. This will include an economic, social and environmental impact assessment of allocating and developing a new poultry productionarea. Generic guidelinesabout the necessary operational steps to implement the restructuring activities will be composed. Private investors interestedinproducingpoultry incompliance with the developedpoultry productionmodels will be assisted. About one third of the investment costs will be provided by the project to the investor conditioned on being trained in biosecure poultry production practices, developing a businessplan and external monitoring of the productionprocess.The supportedinvestmentsare restrictedto poultry productionunitswith a maximumof 1000birds. Monitoring and studyingof the investments in poultry production serves to review and adjust the new developed poultry production models. Findings are submitted to other provinces and discussed with the private sectorby workshops. Activity C. Biosecurity Upgrading for ExistingSmall Scale Poultry Farms 13. The market-basedavian influenza control program in Ha VI live-bird market in Ha Tay province will result in heightenedpoultry health requirements for supplyingpoultry farmers. On the basis of this market driven demand for improved biosecurity, interested sector I11poultry farmers will be supported. Beneficiaries are small scale sector I11farmers with a maximum of 1000birds. Trainings from a national consultant on biosecure poultry production practices and advice in upgradingthe facility biosecurity will be made available to them. In addition simple systems for collecting and storing the produced poultry manure will be developed in order to limit environmentalpollution. Small renovation grant will be made available by the project to partly cover investmentcosts for biosecurityand manuremanagement upgrading. The upgrading of biosecurity and manure management will be monitored and assessed in order to develop guidelines and a regulatoryframeworkfor upgradingof existingsector I11farms. 97 TechnicalNote2 Poultry VaccinationStrategies - VAHIP and Vaccinationof Poultry againstH5N1Highly PathogenicAvian Influenza inVietnam 14. , H5N1 HPAI was first identified as a serious problem in Vietnam in late 2003. This disease was initially tackled through the use of widespread culling o f poultry, leading to the death or destruction o f some 45 million poultry. This reduced the number o f avian infection cases, but did not stem the flow o f human disease. By mid-2005, Viet Nam had recorded the highest number of human cases o f all infected countries. 15. Due to concerns regarding the pandemic potential o f uncontrolled infection inpoultry and subsequent exposure o f humans, new control measures were implemented in the second half o f 2005. These measures included compulsory vaccination o f high risk poultry, which was introduced as an emergency measure from August 2005, with the first round completed by December 2005. This aimed to reduce the risk o f infection during the cooler winter months of 2005-06 when a resurgence o f cases was expected inline with previous years. Since vaccination was fully implemented there have been no reported cases o f disease in poultry or humans, although infection has persisted. 16. It is simplistic to attribute all of this improvement to vaccination alone as other measures were also introduced. However, properly vaccinated poultry are known to be less susceptible to infection with H5N1 HPAIand, if they do become infected, excrete significantly lower levels of virus than unvaccinated poultry. They are largely protected from clinical disease. Therefore, vaccination would have reduced the levels of infection by reducing the number o f susceptible poultry and the amount of circulating virus. 17. When vaccination was introduced, the difficulties of sustaining such an intensive program for more than a few years were recognized. As more information becomes available regarding the levels o f risk, the vaccination campaign should be focused more on high risk populations (such as grazing ducks) and commercial poultry reared under conditions of poor biosecurity and sold through large live poultry markets. 18. Inthe future, it is possible that in some areas not all poultry will be vaccinated (except following outbreaks o f disease, in which case ring vaccination would be considered). Such changes to vaccination policy are still to be decided. The proposals for vaccination under VAHIP have taken into account the possibility of modifications to the vaccination policy, but do not assume that any specific changes will be implemented. 19. Vaccination and VAHIP. The following five issues, relating to vaccination, will be addressedunder VAHIP. 20. Vaccination of Grazing Ducks. At present many flocks of grazing ducks are unvaccinated. However, recent surveillance conducted under AIERP has shown that infection i s 98 persisting in these birds and that they pose a threat to other poultry, especially as many are sold inlive-poultry markets where they mix with andcan infect other poultry. 21. The main reason why grazing ducks are not vaccinated i s that practical methods for doing so have not been developed. These ducks travel over considerable distances makingit difficult to vaccinate them once they are grazing paddy fields. This issue needs to be explored so that these ducks are given two doses o f vaccine before they are allowed to graze. 22. Under VAHIP, several districts in two major duck rearing provinces (Dong Thap and Long An) will be selected for studies to be conducted in order to establish practical methods for vaccinating ducklings before these birds are sent out for grazing. Once practical methods are established, vaccination will be undertaken and samples collected from vaccinated flocks to assess whether virus excretion i s persisting and to monitor serological response to vaccination. Eventually this practice i s expected to be extended to all grazing ducks if viable vaccination methods are established. 23. Vaccination of minor poultry species. At present, vaccination of quail, pigeons and geese against avian influenza i s not done because there i s little or no information on the response of these poultry to vaccine (quail and pigeon), or the information available suggests that the response to vaccination in these poultry i s poor (geese). Under VAHIP, selected flocks o f these birds in the field will be vaccinated and the response to vaccination monitored. Results will be analyzed and if suitable methods are found then highrisk flocks of these poultry will be included inthe nationalvaccination campaign. 24. Ring Vaccination. The OPI suggests that in future outbreaks o f H5N1 HPAI, ring vaccination will be undertaken around outbreak sites after culling of the infected poultry in the center of the ring. This method has not yet been used in Vietnam and requires rapid response teams trained in methods of ring vaccination that minimize the risk o f spread o f disease by vaccinators. These teams will also implement appropriate movement controls in the area around the outbreak to stop the spread of infection. Unless the response occurs soon after the initial reports of infection, the disease will spread. 25. Under VAHIP, teams comprising regional, provincial, district and commune staff will be given practical training in responding to reports of disease and the use o f ring vaccination. The effectiveness o f this training will be tested through tests of ring vaccination tied to mock outbreaks (see component A5). These teams would have access to emergency supplies o f vaccine and protective clothing and other resources that would allow them to respond immediately to any outbreak. 26. Feasibility of Local Vaccine Production. At present, supplies of avian influenza vaccine are imported from other countries, with most o f the vaccine sourced from China. Government i s interested in producing vaccine locally and has already made a small batch o f vaccine for testing. A feasibility study will be conducted to assess whether large scale production of H5 vaccine i s technically and economically viable. Once this study i s completed and the report compiled, the government can make a decision on whether to proceed with proposals to 99 produce this vaccine locally or to continue to purchase vaccine from reliable manufacturers elsewhere. 27. Cold Chainand Vaccination. Surveillance of vaccinated poultry after the initialrounds of vaccination have shown that there i s insufficient capacity to store large quantities o f vaccine under appropriate conditions at the provincial level. This i s likely to be one o f the factors contributing to the lower than expected response to vaccination seen in some provinces after the first round. 28. Under VAHIP, project provinces will all be supplied with a suitable walk in cold room with a backup generator that will allow proper storage of vaccine at the provincial level. The effect o f this will be assessed through post-vaccination surveillance, regular monitoring of cold room temperature records, and use o f temperature sensitive indicators that will be included in selected consignments o f vaccine to ensure that these are kept cool at all times26. These tags would be checked and recorded at both the provincial and district level. *%ee, for example, http://www.fdcpackaging.com 100 TechnicalNote3 LessonsLearnedfromAddressingHPAIinVietnam - 29. In discussions during a Technical Workshop on Avian Znfiruenza Control and Preparedness, held on December 12, 2006, in Hanoi, several observations and conclusions came forward that are of interest to the preparation and implementation of the follow-up VAHIP operation to AIERP. The discussions also covered lessons from the health sector, gained from project implementation o f Bank-supported and other projects. Many o f the remarks made by workshop participants regarding lessons learned, and the implementation arrangements of the upcoming VAHIP, were o f similar nature and found general consensus by the audience. They are valuable lessons to learn in the preparation and implementation of VAHIP. A number of observations pertaining to the workshop discussion are set forth below. The AnimalHealthSector 30. Speed of implementation,especially of an emergency operation such as AIERP and the upcoming VAHIP, i s if the essence, although AIERP was institutionally constrained by numerous upstream and downstream review stops, combined with a rather inflexible approach to matters of procurement and disbursement. A more direct procurement and disbursement mechanism would greatly facilitate this constraint. 31. Decentralization of project implementation to the project provinces was widely promoted by same, especially where subsidiary project accounts are concerned. This preference by many provinces stemmed from their frustration with the often slow and cumbersome procurement and disbursement procedures encountered under AIERP. However, procurement might be further delayed by provincial (PPIU) procurement staff unfamiliar with procedures. Moreover, a strong financial management structure would have to be in place. Decentralization would, however, give the provinces more leeway in tailoring and implementing their respective project activities. 32. Increased incremental project support for participating project agencies was commonly expressed as a constraint to effective implementation by provincial and district project staff, laboratory and animal health workers, and district officials, who often perform project duties such as transportation and supervision at personal time and expense. Whereas this constraint can be temporarily alleviated during the project lifespan, its sustainability beyond that time i s in question. 33. The PCUshould be a free-standingentity, capable of giving the project its undivided attention, and thereby be solely responsible for the implementation of VAHIP. This was not the case with AIERP, causing delays in implementation and responsiveness by the PCU. It was universally agreed that VAHIP would be implemented by a separate Human and Animal Health PCU, each solely addressing their respective components. 34. Consolidation and quality assurance will be two important objectives of VAHIP / Animal Health. Gains made under AIERP in equipping laboratories and human resource development will be expanded, and quality control instituted in diagnostic work and field surveillance data collection and analysis, to ensure that diagnostic and surveillance results can be trusted to provide the correct information to decision makers. Commune-based disease 101 surveillance will not only be expanded, but CCAHW training better monitored for quality and appropriateness. 35. The monitoring and evaluation of AIERP was weak and inadequately implemented. Rather than providing a centralized M&E structure at the PCU level, M&E will be conducted at the implementation level of each subcomponent activity, supported by oversight from Project Officers responsible for the implementation o f each Subcomponent. This will strengthen implementation momentum and quality control, supported by the proactive identification of implementation problems and their resolution. 36. Communication linkages are weak and fragmented. The vertical command structure of the Vietnamese bureaucracy discourages lateral networking, a tendency encountered between project agencies at different levels. Although the regulatory aspects of disease reporting are generally in place, enforcement and incentives for reporting from commune to province are weak, or even negative. Incentive mechanisms for adequate and accurate reporting must be found to overcome this constraint. In some provinces, bonuses are paid to those promptly reporting unusual die-offs, or poultry hidden from vaccination. 37. Lack of clarity of project objectives and implementation arrangements was frequently mentioned as a chronic implementation constraint. Although these terms are normally spelled out in project implementation documents, they need to be better highlighted and explained at implementation workshops and the like, so that everyone, from lowest to highest level involved in the project, clearly understands his or her role and responsibilities. This matter should receive considerably more attention during project negotiations and implementation start- UP. 38. Public awareness and information was fully implemented under AIERP, although the extent o f its impact on the public at large remains uncertain, as the result o f inadequate monitoring o f messaging quality and distribution. Villagers at the commune level were found by project supervision teams to be unclear about the danger and consequences of avian influenza. Posters and leaflets appear to be a less favorite vehicle than i s radio messaging. 39. Rarely mentioned were: (a) Spin off effects to other infectious disease control programs, by upgrading veterinary services to address HPAI; and (b) joint medicalheterinary V A H I P project activities, mentioned by Vice Minister Bui near the end of the workshop. Little agreement seems to exist for working together at the implementation level. HumanHealthSector 40. The health sector has been very active in its response to the HPAI threat since the first human cases were detected in Vietnam and has accumulated significant experience and lessons. At the workshop, the presentation by MOH representatives brought out some important lessons and these helped to set priorities amongst the numerous challenges facing the sector in its response to HPAIand epidemic human influenza. 102 41. Changing Context of HPAI in Vietnam. With the last reported outbreak occurring in December 2005, there has been a slowing down in the momentum o f response, hence the need for a change of the context within which HPAIresponse i s approached. This changing context of HPAI in Vietnam was presented as a major issue in the sector's response going forward. The challenges of maintaining momentum during "intervals o f outbreak" and especially in non- emergency situations were highlighted, especially given the fact that the pace and quality o f implementation may be difficult to sustain if and when the sense o f urgency related to HPAI and pandemic influenza moderates. There i s therefore a need to make routine, the same level and quality o f response that helped curtail the outbreaks. The VAHIP project i s designed with this medium term approach in mind by addressing these core public health functions (such as strengthening surveillance) and integrating them into the health system. 42. Institutional Arrangements. At the institutional level, the health sector has been directing its response through a steering committee and a series o f sub-committees (surveillance and control; therapy; education; logistics) at the national and provincial levels. At the central level, these committees have set policy and guidelines and played a role in monitoring the provinces, while their provincial homologues have dealt with implementation under the additional supervision o f the PPCs' AI Steering Committees. These committees made use o f mass organizations (such as the women's unions) and other effective social mobilization mechanisms due to their effective reach to the community. The importance o f strong political will and commitment was also stated. The VAHIP project by emphasizing provincial level planning as well as interventions at the district level, with active involvement o f the respective people's committees will help to foster local ownership and commitment. 43. Systemic Constraints. In its previous response to the HPAIoutbreak, M O H mobilized government and donor resources for investments in the HPAI response. These were primarily in equipment (ventilators, refrigerators, disinfectant sprayers, personal protective equipment, etc.), revision o f clinical care guidelines and training for curative care staff in influenza patient care and for preventive medicine staff in EWARS. These were backed up by outbreak simulation exercises in seven areas. In the course o f its implementation, it was observed that most of the challenges faced were not specific to HPAI, but were associated with the usual performance constraints of the system in general that limit the capacity to deliver the required technical responses in surveillance and curative care, such as: Human resource shortfalls - low numbers, poor motivation, inadequate technical skills in both preventive medicine and curative care; Infrastructure and equipment inadequacies in hospitals and preventive medicine. However, the VAHP project will address the mismatchbetween demand and supply by ensuring that district level plans are based on rigorous assessmentsof needs and capacity; Poor quality data from surveillance because of inadequate forms and weak data collection, flows, and use. 44. These areas identified above are all being addressed in various subcomponents under VAHIP. 45. Communicationand Coordination. The importance of coordination and information sharing within the sector and with MARD at various levels has also been highlighted and the 103 VAHIP project, drawing from the lessons learned, is incorporating mechanisms for joint programs at the provincial level for the two sectors. One such area i s in communication. Limited communication with health staff and the public about risk and mitigating measures was identified as one of the challenges of previous efforts, therefore VAHIP (through its BCC strategy) will adopt approaches to provide comprehensive information to workers in both the human health and animal health sectors at all levels, and to the public to foster positive behavior change. 104 Technical Note 4 -Selection Criteria for Provinces included under VAHIP 46. MARD and MOH each developed selection criteria to rank provinces for possible inclusion under VAHIP. 47. Selection criteria used on the part o f MARDwere: e Total number of poultry by province and by region (North, Central, South) e Prior participation inAIERP e Capacity of province to manage and implement e Level of loss caused by HPAIoutbreaks in2004 and 2005 e Capacity o f veterinary service e Number of fatal human H5N1 cases and return o f the disease during the three outbreaks (2004 and 2005) e Large cities with highpopulation densities and heavy traffic e Location near border and presence o f quarantine station 48. Onthe part of M O H the following criteria have been applied: e Provinces selected by MARD e Confirmed human H5N1cases and number o f poultry affected e Highrisk of AH1due to uncontrolled smugglingof poultry and quarantine activities e Provincial hospital i s served as referral hospital for receiving and treating infectious cases e Bigcities, busytransportation routes, highpopulation density e Qualified staff o f provincial preventive health centers to manage and coordinate project activities. 49. Provinces Selected. Based on the above criteria and with an aim to ensure efficient implementation, MOH limited the number o f provinces to be included to einht which are also included on MARD's list. Hence Component A and B will be implemented by MARD and MOH, respectively in: Lang Son, Ha Tay, Thai Binh, Thua Thien-Hue, Binh Dinh, Long An, Tien Giang, and Dong Thap. In addition, MARD will implement activities under Component A in a further three provinces Thanh Hoa, Ha Tinh, and Tay Ninh. Hence, the total number of provinces included under VAHIP i s eleven. 105 Appendix 10: Statementof Loansand Credits VIETNAM: VN Avian & HumanInfluenzaControl& PreparednessProject Difference between expected and actual Original Amount inUS$Millions disbursements Project FY Purpose IBRD IDA SF GEF Cancel. Undisb. Orig. Frm.Rev'd ID PO86361 2006 VN-PRSC V 0.00 100.00 0.00 0.00 0.00 100.74 0.00 0.00 PO75407 2006 VN-RT3 0.00 106.25 0.00 0.00 0.00 108.92 1.oo 0.00 PO85071 2006 CustomsModernization 0.00 65.90 0.00 0.00 0.00 66.58 -0.25 0.00 PO73361 2006 VN -Natural DisasterRisk Mngt Project 0.00 86.00 0.00 0.00 0.00 81.73 -3.06 0.00 PO84871 2006 VN-TRANS & DISTRIB 2 0.00 200.00 0.00 0.00 0.00 200.79 6.67 0.00 PO77287 2006 VN-RRD RWSS 0.00 45.87 0.00 0.00 0.00 45.75 1.69 0.00 PO79344 2006 VN -1CT Development 0.00 93.72 0.00 0.00 0.00 90.43 0.97 0.00 PO79663 2006 VN-Mekong RegionalHealth SupportProj 0.00 70.00 0.00 0.00 0.00 72.46 0.03 0.00 PO74688 2005 VN-RURAL ENERGY 2 0.00 220.00 0.00 0.00 0.00 215.74 34.43 0.00 PO66051 2005 VN - Forest Sector Development Project 0.00 39.50 0.00 0.00 0.00 49.11 3.23 0.47 PO73763 2005 VN-WATER SUPPLY DEV. 0.00 112.64 0.00 0.00 0.00 109.10 5.05 0.00 PO80074 2005 VN-GEF-RURALENERGY 2 0.00 0.00 0.00 5.25 0.00 4.95 0.20 0.00 PO82604 2005 VN-HIV/AIDS PreventionProject 0.00 0.00 0.00 0.00 0.00 28.40 -1.42 0.00 PO82627 2005 Payment SystemandBank Modernization2 0.00 105.00 0.00 0.00 0.00 99.57 28.83 15.67 PO74414 2005 VN - GEFForest Sector DevelopmentProj 0.00 0.00 0.00 9.00 0.00 8.50 1.83 1.32 PO85080 2005 VN-ROAD SAFETY 0.00 31.73 0.00 0.00 0.00 29.26 2.47 0.00 PO85260 2005 VN-EFA Support Program 0.00 50.00 0.00 0.00 0.00 46.04 15.00 0.00 PO88362 2005 VN-Avian InfluenzaEmergencyRecovery 0.00 5.00 0.00 0.00 0.00 2.68 2.24 0.00 PO70197 2004 VN-URBAN UPGRADING 0.00 222.47 0.00 0.00 0.00 203.56 3.29 0.00 PO65898 2004 VIETNAM WATER RESOURCES 0.00 157.80 0.00 0.00 0.00 148.42 18.36 0.00 ASSISTANCE PO59663 2004 VN-ROAD NETWORK IMPROVT 0.00 225.26 0.00 0.00 0.00 211.89 83.52 0.00 PO71019 2003 VN-GEF DEMAND SIDE MGMT & 0.00 0.00 0.00 5.50 0.00 3.21 0.81 0.00 ENERGY PO75399 2003 Public FinancialManagementReformProj. 0.00 54.33 0.00 0.00 0.00 51.86 29.63 0.00 PO44803 2003 VN-PRIMARY EDUC FOR 0.00 138.76 0.00 0.00 0.00 175.19 44.15 0.00 DISADVANTAGED CHILRE PO73778 2002 VN-GEF-System Energy Equitization- 0.00 0.00 0.00 4.50 0.00 3.61 3.61 0.00 Renewa PO73305 2002 VN-RegionalBlood Transfusion Centers 0.00 38.20 0.00 0.00 0.00 38.39 26.29 0.00 PO72601 2002 VN - RuralFinanceI1Project 0.00 200.00 0.00 0.00 0.00 40.61 -60.29 0.00 PO66396 2002 VN-SYSTEM ENERGY, EQUITIZATION 0.00 225.00 0.00 0.00 0.00 188.33 145.60 26.18 &RENEWAB PO59936 2002 VN-NorthernMountains Poverty Reduction 0.00 110.00 0.00 0.00 0.00 41.15 7.11 0.00 PO51838 2002 VN-PRIMARY TEACHER 0.00 19.84 0.00 0.00 0.00 12.52 9.52 5.19 DEVELOPMENT PO42927 2001 VN-MEKONG TRANSPORT/FLOOD 0.00 110.00 0.00 0.00 0.00 56.64 40.64 -4.82 PROT. PO52037 2001 VN-HCMC ENVMTL SANIT. 0.00 166.34 0.00 0.00 0.00 155.94 90.71 83.46 PO62748 2001 VN - COMMUNITY BASED RURAL 0.00 102.78 0.00 0.00 0.00 57.87 30.91 0.00 INFRA. PO56452 2000 VN-RURAL ENERGY 0.00 150.00 0.00 0.00 8.82 22.25 25.17 7.26 PO42568 2000 VN - COASTAL Wetnrot Dev 0.00 31.80 0.00 0.00 0.00 5.22 3.31 3.31 106 PO51553 1999 VN-3 CITIES SANITATION 0.00 80.50 0.00 0.00 0.00 38.73 33.45 21.41 PO04845 1999 VN - MEKONGDELTA WATER 0.00 101.80 0.00 0.00 0.00 31.10 26.44 -15.45 PO04828 1999 VN-HIGHER EDUC. 0.00 83.30 0.00 0.00 0.00 23.37 17.06 17.68 PO45628 1998 VN-TRANSMISSION & DISTR 0.00 199.00 0.00 0.00 39.69 47.36 79.36 18.07 PO04844 1998 VN-AGRIC. DIVERSIFICATION 0.00 66.90 0.00 0.00 0.00 11.28 9.68 6.80 Total: 0.00 3,815.69 0.00 24.25 48.51 2,929.25 767.24 186.55 VIETNAM - STATEMENT OF IFC'S Held and DisbursedPortfolio InMillionsof US Dollars Committed Disbursed IFC IFC FY Approval Company Loan Equity Quasi Partic. Loan Equity Quasi Partic. 2003 ACB-Vietnam 0.00 5.02 0.00 0.00 0.00 5.02 0.00 0.00 2002 CyberSoft 0.00 0.06 0.00 0.00 0.00 0.06 0.00 0.00 2002 DragonCapital 0.00 0.00 1.05 0.00 0.00 0.00 1.05 0.00 2002 F-V Hospital 5.00 0.00 3.00 0.00 5.00 0.00 3.00 0.00 2005 Khai Vy 6.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1998 MFLVinh Phat 0.13 0.00 0.00 0.00 0.13 0.00 0.00 0.00 1997 Nghi Son Cement 10.09 0.00 0.00 1.88 10.09 0.00 0.00 1.88 2004 Olam 20.00 0.00 0.00 0.00 20.00 0.00 0.00 0.00 2005 PaulMaitland 7.20 0.00 0.00 0.00 7.20 0.00 0.00 0.00 2001 RMIT Vietnam 7.25 0.00 0.00 0.00 3.50 0.00 0.00 0.00 2006 SABCO 20.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2003 Sacombank 0.00 2.77 0.00 0.00 0.00 2.77 0.00 0.00 2004 Sacombank 0.00 2.31 0.00 0.00 0.00 2.31 0.00 0.00 2005 Sacombank 0.00 2.05 0.00 0.00 0.00 2.05 0.00 0.00 2006 Sacombank 0.00 3.05 0.00 0.00 0.00 3.05 0.00 0.00 2002 VEIL 0.00 0.00 2.00 0.00 0.00 0.00 2.00 0.00 2003 VEIL 0.00 7.41 0.00 0.00 0.00 7.41 0.00 0.00 2007 VEIL 0.00 6.15 0.00 0.00 0.00 6.15 0.00 0.00 Totalportfolio: 75.67 28.82 6.05 1.88 45.92 28.82 6.05 1.88 Approvals PendingCommitment FY Approval Company Loan Equity Quasi Partic 2000 MFL-AA 0.00 0.00 0.00 0.00 2006 CCS-Asia 0.02 0.00 0.00 0.00 2000 Interflour 0.01 0.00 0.00 0.01 2006 CII-Vietnam 0.00 0.00 0.00 0.00 2000 MFLMondial 0.00 0.00 0.00 0.00 2002 F-VHospital 0.00 0.00 0.00 0.00 1999 MFLMinhMinh 0.00 0.00 0.00 0.00 1999 MFLChauGiang 0.00 0.00 0.00 0.00 ~~~ ~~~ Totalpendingcommitment: 0.03 0.00 0.00 0.01 107 Appendix 11: Country at a Glance VIETNAM: VN Avian & Human Influenza Control & Preparedness Project East POVERTY and SOCIAL Asia & Low- Vietnam Pacific income Development diamond' 2005 Population, mid-year (miiiions) 83.0 1.885 2,353 GNIpercapita (Atiasmethod, US$) 620 1,627 580 Lifeexpectancy GNI(Atias method, US$biiiions) 51.4 3,067 1,364 T Average annual growth, 1999-05 Population (%J 1.1 0.9 1.9 Labor force (4 2.1 1.3 2.3 GNi Gross per primary M o s t recent estimate (latest year available, 1999-05) capita enrollment Poverty pAofpopulation beiownationaipovertyiine) 29 Urbanpopulation (%of totalpopuiation) 26 41 30 Lifeexpectancyat birth (pars) 70 70 59 1 Infantmortaiity(perlOO0iivabirths) 77 29 80 Chiid malnutrition pkofchiidrenunderti) 26 15 39 Access to improvedwatersource Access to an improvedwatersource (%ofpopulation) 65 79 75 Literacy (%ofpopulationage Ed 90 91 62 Gross primaryenroilment pkofschooi-agepopuiation) 98 115 x)4 -Vietnam Male x31 1s In Lowincomegroup ~ Female 94 114 99 KEY ECONOMIC RATIOS and LONG-TERM TRENDS 1985 1995 2004 2005 Economic ratios. GDP (US$ biiiions) 14.1 20.7 45.2 52.4 Gross capitalformationIGDP 27.1 35.6 Exports of goods andserviceslGDP .... 32.8 66.4 Trade Gross domestic savings1GDP 8.0 26.3 Gross nationalsavingsiGDP .... 8.2 32.2 Current account baianceiGDP -3.8 -u.5 -3.6 interest payments1GDP 0.0 0.4 0.7 Total debt1GDP 0.4 P2.6 39.4 Total debt servicelexports .. 4.7 2.6 Presentvalue of debtiGDP 34.1 Present value of debtiexports 50.4 Indebtedness - 1985-95 1995-05 2004 2005 2005-09 (averageannuaigroMh) GDP 6.5 6.9 7.7 8.4 7.5 Vietnam GDP percapita 4.3 5.6 6.6 7.4 6.4 Low-income group Exports of goods andservices 25.2 15.8 27.9 15.0 15.0 ~ STRUCTURE of the ECONOMY I,. 1985 1995 2004 2005 pkofGDP) Growlh of capital and GDP (Oh) Agriculture 40.2 27.2 21.8 Industry 27.4 26.8 40.1 Manulacturing 20.5 15.0 20.3 Services 32.5 44.1 38.2 0- Householdfinal consumption expenditure .. 73.8 65.3 00 01 02 03 04 05 Generalgov't final consumption expenditure 8.2 6.4 -GCF &GDP Imports of goods andservices .... 41.9 73.6 1985-95 1995-05 2004 2005 (averageannuaigrowth) Growth of exports and imports ( O h ) Agriculture 3.5 4.1 3.5 Industry 7.3 m.0 w.2 Manufactunng 4.3 11.0 d.1 Services 6.4 5.7 7.5 I Householdfinalconsumptionexpenditure .. 5.2 7.1 Generalgov't finalconsumptionexpenditure .. 3.8 7.8 00 01 02 03 04 Gross capital formation 25.8 9.8 m.5 -Exports -irrports imports of goods andsewices 24.2 E.5 25.2 O5 Note:2005 data are preiiminaryestimates. This table was producedfrom the Development Economics LDB database. 'Thediamonds showfour keyindicators inthecountry(in bold) comparedwithits incomegroupaverage. if dataaremissing,thediamondvili be incomplete. 108 Vietnam PRICES andGOVERNMENT FINANCE 1985 1995 2004 2005 Domestic prices Inflation (X) I (%change) Consumer pnces 7.8 8.3 Implicit GDP deflatoi T7.0 7.9 8.4 Government finance (%of GDP,includes current grants) Current revenue 23.3 23.1 Current budgetbalance 6.0 6.6 1 Overall surplusldeficit 0.7 -1.4 -GDPdeflator -CPI I TRADE 1985 1995 2004 2005 (US5mi/lions) Export and Import levels (US$ mill.) Totalexports (fob) 507 5,198 26,503 Rice 547 950 Fuel 1,063 5,671 30,000 Manufactures 1,785 14,842 Total imports (clf) 930 7,543 31,954 20,000 Food Fuel andenergy 856 3,574 10.000 Capital goods 2,097 8,624 O M Export price index(2000=WO) M8 M7 99 00 01 02 03 04 05 Import price index(2000=WO) M3 106 IExports IIworts Terms of trade (200O=WO) M6 x)1 BALANCE Of PAYMENTS 1985 1995 2004 2005 (US5 mlillons) Current account balance to GDP ( O h ) Exports of goods andservices 7,607 30,363 Imports of goods andservices M,603 33,608 Resource balance -496 -2,996 -3,245 Net income -90 -279 -940 Net current transfers 52 474 2,484 Current account balance -534 -2,801 1 -1,701 Financing items (net) 265 3,301 2,395 Changes in net reserves 269 -500 -694 -1,261 Memo: Reserves including gold (US5 millions) 1,376 6,314 7,575 Conversion rate (DEC,localfUS5) 6.3 11,038.3 15,772.3 15,987.1 EXTERNAL DEBT and RESOURCE FLOWS 1985 1995 2004 2005 (US5 millions) IComposition of 2004 debt (US$ mill.) Total debt outstanding anddisbursed 61 25,428 IT825 IBRD 0 0 0 0 IDA 54 231 3,039 3,187 G 2,U6 R ' R ORQ Total debt service 2 364 781 IBRD 0 0 0 0 IDA 0 2 37 44 Composition of net resourceflows Official grants 38 348 387 Official creditors 7 58 1,278 Private creditors 0 356 M Foreign direct investment (net inflows) 0 0 16% Portfolioequity(net inflows) 0 0 0 1 E 9,249 World Bank program Commitments 0 265 711 Disbursements 7 47 A - IBRD E- Bilateral 444 391 B - IDA D. Other mltilatwal F - Private Principal repayments 0 1 8 14 C - I M F G. Short-teri Net flows 7 46 436 378 Interest payments 0 2 29 31 Net transfers 7 45 407 347 Note:This table was producedfrom the Development Economics LDB database. 8it3106 109 102° 104° 106° 108° 110° To Guangnan To C H I N A Kunming 4 Hà Giang 5 Cao Bang ` Lào Cai To Phong Tho Hong 40 Nanning 2 3 4A 1 (Red) 3 9 Bac Can ` 22° 70 8 22° Tuyên Lang 7 Quang , Son Da 32 Thai (Black) Yên Bái 13 Nguyen 10 1 2 4B 6 Viêt Trì12 Co To Diên Biên Phú Vinh Yen Vinh Thuc Són La 11 Bác Giang 14 Cai Chien 6 16 Bác 15 Cai Bau HANOI 17Ninh20 18 Ha Long Co To To Hà Dông 5 Haí Sopxang Hòa 18 19 Dúóng Hai Phong Bình Hung Yen 21 Cat Ba 10 22 Halong Hà Nam 24 Ma 23 Bay To NamThái Bình Luang Prabang Ninh Bình Dinh 15 20° 25 26 Bach Long Vi 20° 27 LAO PEOPLE'S To Thanh Hóa Luang Prabang G u l f 1 DEMOCRATIC REPUBLIC Me o f Hainan I. 28 Nghi Son (China) 7 Ca T o n k i n Vinh 8 Hà Tinh ~ 29 To 18° Khammouan 18° Mekong 15 Dông Hói 30 Con Co Dông Hà 9 31 To Huê Savannakhet 32 33 16° Dà Nang 16° Cham T H A I L A N D 1 34 Tam Ky Ly Son 14 Re 102° Quàng Ngai 35 V I E T N A M 36 AVIAN AND HUMAN 24 INFLUENZA PROJECT (VAHIP) Kon Tum 38 PROJECT PROVINCES: 14° 19 14° Play Cu Quy Nhon HPAI CONTROL AND ERADICATION IN THE AGRICULTURAL SECTOR 37 (COMPONENT A/MARD) To Xanh HPAI CONTROL AND ERADICATION IN THE AGRICULTURAL SECTOR Stung Treng (COMPONENT A/MARD) AND INFLUENZA PREVENTION AND PANDEMIC PREPAREDNESS IN THE HEALTH SECTOR (COMPONENT B/MOH) 14 Da Rang 39 Tuy Hòa 9 NATIONAL ROADS PORTS 40 C A M B O D I A Buôn Ma PROVINCE ROADS PROVINCE CAPITALS Thuôt 26 RAILROADS NATIONAL CAPITAL Gom RIVERS PROVINCE BOUNDARIES 42 Nha Trang AIRPORTS 41 27 INTERNATIONAL Tre To BOUNDARIES Gia Nghia 12° Phnom Penh Dà Lat 12° PROVINCES: 43 14 1 Lai Chau 33 Da Nang 45 Dông 44 2 Dien Bien 34 Quang Nam Xoái 3 Lao Cai 35 Quang Ngai Mekong 20 Phan Rang- 22 Tháp Chàm 4 Ha Giang 36 Kon Tum 46 To 5 Cao Bang 37 Gia Lai 48 Phnom Penh 13 Tây Ninh 47 6 Son La 38 Binh Dinh Thu Dãu 49 1 7 Yen Bai 39 Phu Yen To Phnom Penh Môt Biên Hòa Phan Thiêt 8 Tu Yen Quang 40 Dac Lac 50 9 Bac Can 41 Dac Nong To 10 Lang Son 42 Khanh Hoa Ho Chi Minh City Kampong Som 54 52 51 11 Phu Tho 43 Binh Phuoc 91 Cao Lanh 51 Tan An Phu Quy 12 Vinh Phuc 44 Lam Dong 56 53 13 Thai Nguyen 45 Ning Thuan Long Xuyên Vinh Long ~ My~,Tho Vung Tàu ~ 14 Bac Giang 46 Tay Ninh Bên Tre Phu 15 Quang Ninh 47 Binh Duong Quoc 80 60 57 55 10° 16 Ha Noi 48 Dong Nai 10° Nghe Rach Giá Cân 10° Tho Hai 17 Bac Ninh 49 Binh Thuan Tre 59 61 18 Ha Tay 50 T.P. Ho Chi Minh Rai Trá Vinh Vi Thanh MEKONG DELTA 19 Hung Yen 51 Ba Ria-Vung Tau Nam Du 58 20 Hai Duong Gulf 52 Long An 62 Sóc Trang 21 Hai Phong 53 Tien Giang 1 0 25 50 75 100 125 150 Kilometers 22 Hoa Binh 54 Dong Thap 63 Tho Chu 23 Ha Nam of55Ben Tre Cà Mau Bac Liêu 24 Thai Binh 56 An Giang 0 25 50 75 100 Miles 25 Ninh Binh 57 Vinh Long 64 26 Nam Dinh 58 Tra Vinh 27 Thanh Hoa Thailand 59 Kien Giang Con Dau DECEMBER 28 Nghe An 60 Can Tho This map was produced by the Map Design Unit of The World Bank. IBRD 29 Ha Tinh 61 Hau Giang The boundaries, colors, denominations and any other information shown on this map do not imply, on the part of The World Bank 30 Quang Binh 62 Soc Trang Khoai Group, any judgment on the legal status of any territory, or any 35196 31 Quang Tri endorsement or acceptance of such boundaries. 2006 63 Bac Lieu 32 Thua Thien102 Hue ° 64 Ca Mau 104° 106° 108°