AHI FACILITY Avian & Human Influenza 58049 LAO PDR Facility Supports a Coordinated and Effective Response to H5N1 in Lao PDR L ao PDR suffered its first outbreak of H5N1 in 2004 emerge as a regional epicenter for the disease, the and has had a series of outbreaks since then, with Government responded at the highest level. The National two deaths being reported in 2007. Committee for the Containment of Communicable Diseases was established under the chairmanship of the Prime Minister and below this the National Committee The Challenge for Communicable Disease Control. Monitoring and Information management was provided by the National Situated in Southeast Asia between Cambodia, Thailand Avian and Human Influenza Coordination Office and Vietnam, The Lao People's Democratic Republic (NAHICO). FAO and WHO procedures were implemented. (PDR) is home to over 6 million people, including a number of indigenous and minority groups and around The Government moved rapidly to prepare a National 47 distinct languages and dialects. Plan with five strategies and subsequently requested a grant from the AHI Facility, receiving an initial $2 million Lao PDR has a per capita GDP of under and a subsequent grant of $2.4 million. As in most We organized the US$1000 with over 45% of the population countries these funds have supplemented, leveraged Coordination Office living on under US$1/day. Over 80% of the and provided continuity to programs supported by the and two weeks later population maintain backyard poultry and donors and international agencies. The Facility and the mid-size operators manage duck and Bank staff involved in supervising the funds have played there was an chicken farms. Over 60 large scale an essential convening role and the funds have been outbreak of Avian commercial operators provide breeding used to plug gaps in resources provided from other Influenza. Timely. stock, broilers and eggs, predominantly for sources. Lao PDR, through the World Bank, also received the urban market. a further $2 million PHRD (Japan) Technical Assistance - Dr. Bounlay Phommasack Grant and a $4 million IDA grant. Many donors have The H5N1outbreak in 2004 affected primarily contributed directly to the effort. Dir. National Emerging commercial farmers. While there was some Infectious Disease response capacity on the animal health side, Coordination Office there was little coordination with health (NEIDCO) officials. Three provinces were affected and some 155,000 birds were culled. Responding to the Crisis Following the 2004 outbreak, and recognizing the severity of the situation, and the risk that Lao PDR could In 2007, Lao PDR suffered a major H5N1 outbreak, which affected five provinces and over 230 villages. More than 350,000 birds were culled. Government reports that the response was significantly enhanced by the existence of the National Plan and the coordination office, recently reconstituted as the National Emerging Infectious Disease Coordination Office (NEIDCO). Since the June 2007 outbreak, approximately US$500,000 has been paid for compensation. NEIDCO moved rapidly to draw together the various stakeholders trainers at the Provincial and District levels has effectively expanded and donor agencies - a key factor in the effectiveness of the available expertise and coverage. response. Together the parties were able to identify gaps and opportunities and refine the action plan based around the five Training has included biosecurity measures designed to minimize strategies. Much of the success of this approach was due to the the spread of future outbreaks at the farm level and beyond. The leadership provided by Government and the close alignment of Ministry of Agriculture and Forestry report that VVW in all Provinces the strategies with the mandates and capacities of both Government have been trained (around 3500 persons) with the help of the Departments and international donor agencies. All concerned have Facility, and targets have also been reached for Provincial and shown considerable flexibility and willingness to work together to District officers. Building on training provided by FAO, the Facility address identified gaps. is assisting Lao to reach its coverage targets, specifically for commercial and backyard farmers (38% reached from a target of 80%) The Ministry of Agriculture and Forestry has also assisted An Effective Response specific target groups, including owners of fighting cocks, to form associations to better manage information flow and crisis response. Significant progress has been made in the implementation of the strategies. Aided by its highly structured society, Lao PDR was able The Facility is also supporting the development of local training to rapidly organize stakeholder groups down to the village level courses, most recently a 3-month epidemiology course. This will and to use this network to diffuse messages supplement a longer course, available in and encourage behavioral change. Village Thailand. The Facility is also supporting chiefs and mass organizations such as the Lao Key Data overseas training. Women's Union and Lao Front for National Construction were effective in reaching women Grant Amount: $4.4 million In one of the most successful components and workers. Provincial authorities were supported by the Facility, a Compensation required to develop Pandemic Preparedness Disbursement( to end March 2010): program was implemented designed to Plans and have these approved by Central $2.05 million offset the losses experienced by families Authorities. In some cases, notably around the and poultry producers. The program has Closing Date: June 2011 Capital, Vientiane, the government instituted a evolved in several ways over the five ban on poultry farming and the sale of live birds years since the initial outbreak. The rate during one of the outbreaks. of compensation paid has evolved, from 40% of market value for live birds and 20% for dead (2004) to With the assistance of FAO and WHO, laboratory capacities were the current 60% live, 10% dead levels. A second change concerns strengthened to enable 24 hour turnaround on sample analysis time-to-payment. In early outbreaks, long lags occurred due to and further upgrading is being supported by the Facility. The the verification process and related bureaucracy. This reportedly laboratory of the Ministry of Agriculture and Forestry is being led to a considerable number of commercial farmers giving up completed and the Ministry of Health laboratory will be undergoing the poultry business. This was resolved by payments being made renovation. directly by District authorities with subsequent reimbursement by the Central government. Response teams were established at the Provincial and District levels, namely, culling teams, checkpoint/movement teams, sanitary teams, information and communication teams and Looking Forward compensation teams. A Memorandum of Understanding (MoU) between the Health and Agriculture sectors has led to a rapid and While it is challenging to assign direct causality, two H5N1 effective joint response to outbreaks without bureaucratic delays. outbreaks in 2008 were contained to Feb-March and Sept-October A hotline was also established and was reportedly used by a Village and the system was generally reported to have responded well. Veterinary Worker (VVW) to report an outbreak. There was no major production or consumption impact. Capacity building efforts supported by the Facility were carried out Challenges facing Lao PDR going forward include sustaining at a large scale, targeting Provincial and District officials, villages vigilance and response capacity in the face of diminishing outbreaks chiefs and teachers. As elsewhere, an emphasis on training of and evolving public health priorities. AHI The AHI Facility is a Multi-donor Trust Fund administered by the World Bank and supported by Australia, FACILITY China, the European Commission, Estonia, Iceland, India, Korea, Slovenia, the Russian Federation and the Avian & Human Influenza United Kingdom