Document of The World Bank Report No: ICR00003260 IMPLEMENTATION COMPLETION AND RESULTS REPORT ON A THE EUROPEAN COMMISSION AVIAN AND HUMAN INFLUENZA TRUST FUND (EC-AHI)—TF012273 IN THE AMOUNT OF US$10.00 MILLION EQUIVALENT TO THE GOVERNMENT OF NEPAL FOR A ZOONOSES CONTROL PROJECT (P130089) September 15, 2014 Agriculture Global Practice (GAGDR) Health, Nutrition and Population (GHNDR) South Asia Region NEPAL ZOONOSES CONTROL PROJECT (ZCP) CURRENCY EQUIVALENTS (Exchange Rate Effective 20 May 2014) Currency Unit = Nepali Rupee NRS 93.77 = US$1 US$ 1.00 = NPRs 0.97 FISCAL YEAR July 16 – July 15 ABBREVIATIONS AND ACRONYMS AHIF Avian Human Influenza Facility (Trust Fund) MOHP Ministry of Health and Population AI Avian Influenza NARC Nepal Agriculture Research Council AICP Avian Influenza Control Project NRS Nepali rupee BSL 2 Level 2 Biosecurity Laboratory NZCP Nepal Zoonosis Control Project DOHS Department of Health Services OH One Health DOLS Department of Livestock Services OIE Office International des Epizooties ECTAD- Emergency Centre for Trans boundary Animal PAD Project Appraisal Document RSU Diseases- Regional Support Unit (World Organization for Animal Health) EMP Environmental Management Plan PAF Poverty Alleviation Fund EU European Union PDO Project Development Objective EWARS Early Warning Alert and Response System PID Project Information Document FAO Food and Agriculture Organization of the United PMU Project Management Unit Nations FY Fiscal Year PPAR Project Performance Assessment Report GDP Gross Domestic Product PPCR Pilot Program for Climate Resilience GoN Government of Nepal PVS Performance of Veterinary Evaluation GPAI Global Program for Avian Influenza ROI Return on Investment HPAI Highly Pathogenic Avian Influenza SC Steering Committee HPED Highly Pathogenic and Emerging Disease TC Technical Committee ICR Implementation Completion Report TTL Task Team Leader ISN Interim Strategy Note WB World Bank KAP Knowledge, Attitude and Practice WHO World Health Organization of the UN M&E Monitoring and Evaluation ZCP Zoonoses Control Project MOAD Ministry of Agricultural Development ZDs Zoonotic Diseases Vice President: Philippe Le Houerou Country Director: Johannes C. M. Zutt/Takuya Kamata Sector Manager: Simeon K. Ehui Project Team Leader: Norman Bentley Piccioni ICR Team Leader: Purna Bahadur Chhetri NEPAL ZOONOSES CONTROL PROJECT (ZCP) CONTENTS Data Sheet A. Basic Information B. Key Dates C. Ratings Summary D. Sector and Theme Codes E. Bank Staff F. Results Framework Analysis G. Ratings of Project Performance in ISRs H. Restructuring I. Disbursement Graph Main text 1. Project Context, Development Objectives [or Global Environment Objectives] and Design ....................................................................................................................................... 1 1.1 Context at Appraisal ..................................................................................................................1 1.2 Original Project Development Objectives (PDO)......................................................................1 1.3 Main Beneficiaries: ....................................................................................................................1 1.4 Original Components: ................................................................................................................2 2. Key Factors Affecting Implementation and Outcomes ....................................................... 2 2.1 Project Preparation, Design and Quality at Entry ......................................................................2 2.2 Implementation ..........................................................................................................................3 2.3 Monitoring and Evaluation (M&E) Design Implementation and Utilization ............................4 2.4 Safeguards and Fiduciary Compliance ......................................................................................4 2.5 Post Completion Operation ........................................................................................................6 3. Assessment of Outcome .......................................................................................................... 6 3.1 Relevance of Objectives, Design and Implementation ..............................................................6 3.2 Achievement of Project Development Objectives .....................................................................7 3.3 Efficiency ...................................................................................................................................8 3.4 Justification of Overall Outcome Rating ..................................................................................9 3.5 Overarching Themes, Other Outcomes and Impacts .................................................................9 3.6 Summary of Findings of Beneficiary Survey and/or Stakeholder Workshops ..........................9 4. Assessment of Risk to Development Outcome.................................................................... 10 5. Assessment of Bank and Borrower Performance .............................................................. 11 5.1 Bank .........................................................................................................................................11 5.2 Borrower Performance .............................................................................................................12 6. Lessons Learned .................................................................................................................... 12 7. Comments on Issues Raised by Borrower/Implementing Agencies/Partners ................. 14 Annex 1. Project Costs and Financing .......................................................................................... 15 Annex 2. Outputs by Component ................................................................................................. 16 Annex 3. Economic and Financial Analysis (including assumptions in the analysis) ............... 19 Annex 4. Bank Lending and Implementation Support/Supervision Processes ........................ 24 Annex 5. Beneficiary Survey Results ........................................................................................... 26 Annex 6. Stakeholder Workshop Report and Results ................................................................. 27 Annex 7. Summary of Borrower’s ICR and/or Comments on Draft ICR) .............................. 28 Annex 8. Comments on Implementing Completion Report by the Implementing Agency and Partners .................................................................................................................................. 30 Map of locations covered by the Nepal Zoonosis Control Project -- IBRD 33455.................... 32 A. Basic Information (some fields are entered by the system) Country: Nepal Project name: Zoonosis Control Project Project ID: P130089 L/C/TF Number(s):TF12273 ICR Date:May 22, 2014 ICR Type:1 Core Lending Instrument: Special Investment Loan Borrower: Government of Nepal Original total commitment: USD 10 million Disbursed amount: USD 8.46million Total Cancellations: USD 1.54 million Environmental category: B Implementing Agencies: Ministry of Agriculture Development, Ministry of Health & Population Co-financiers and Other External Partners: N/A B. Key Dates (all fields are entered by the system) Process Date Process Original Date Revised/Actual Date(s) Concept review: Jan 26, 2012 Effectiveness: Jul 05, 2012 Appraisal: Apr 05, 2012 Restructuring(s): 12/09/2013, Level 2 Approval: Apr 30, 2012 Mid-term Review: N/A Closing: Dec 31, 2013 Mar 31, 2014 C. Ratings Summary2 C.1 Performance Rating by ICR Outcome: Satisfactory Risk to Development Outcome: Moderate Bank Performance: Satisfactory Borrower Performance: Moderately Satisfactory C. 2 Detailed Ratings of Bank and Borrower Performance Bank Ratings Borrower Ratings Quality at Entry: Satisfactory Government: Moderately Satisfactory Quality of Supervision: Satisfactory Implementation Agency/Agencies: Moderately Satisfactory Overall Bank Satisfactory Overall Borrower Performance: Moderately Performance: Satisfactory 1 Core or Intensive Learning (CIL) ICR. 2 All ratings given by the ICR should use a six-point rating scale (Highly Satisfactory, Satisfactory, Moderately Satisfactory, Moderately Unsatisfactory, Unsatisfactory, or Highly Unsatisfactory); except for the rating of Risk to Development Outcome (or Global Environment Outcome) that uses a four-point scale (Negligible to Low, Moderate, Significant, and High). i C.3 Quality at Entry and Implementation Performance Indicators (all fields are entered by the system) Implementation Performance Indicators QAG Assessments (if any) Rating Potential Prob. Project at any time(Yes/No): Yes Quality at Entry (QEA): S Problem Project at any time(Yes/No): No Quality of Supervision (QSA): S DO[GEO] rating before Closing/Inactive status: MS D. Sector and Theme Codes3 Original Actual Sector Code (as % of total Bank financing) 1. Agriculture Extension & Research 80% 80% 2.Health 20% 20% Original Priority Actual Priority Theme Code (Primary/Secondary) 1.Other Rural development 80% 80% 2.Other Communicable Disease 20% 20% E. Bank Staff (some fields are entered by the system) Positions At ICR At Approval Vice President: Philippe H. Le Houerou Isabel M. Guerrero Country Director: Johannes C. M. Zutt Ellen A. Goldstein Sector Manager: Simeon Kacou Ehui Simeon Kacou Ehui Project Team Leader: Purna B. Chhetri Norman B. Piccioni ICR Team Leader: Purna B. Chhetri ICR Team Member: Dikshya Dawadi ICR Primary Author: Jan Hinrichs 3 There can be a maximum of five Sector Codes (that has more than zero percent) and five Theme Codes (of which at least one must be “Primary”). ii F. Results Framework Analysis Project Development Objective (from Project Appraisal Document): The Project development objective of the proposed project was to enhance the country capacity for the prevention and control of infectious diseases that transmit between animals and humans (zoonoses) under a One Health approach4. This is a necessary first-step in reduction in the incidence of infectious diseases from animals to humans which will also lead to increase livestock productivity and strengthen the livelihoods base for food insecure communities. This objective would be achieved through two types of interventions: planning and preparedness; and prevention.5 If successful, the proposed project would contribute to reduce the burden of disease in animals, the consequent economic losses, the risk of human infection, and the loss of productivity attributable to animal and human infections in Nepal. (a) PDO Indicators Indicator Baseline Value Original Target Values Actual Values Achieved (from approval documents) at Completion Indicator 1: Priority zoonoses identified and prevention and control plan developed for animals and humans Value (Number) 1 of 6 (17%) 5 of 6 (83%) 6 of 6 (100%) Date achieved 31/07/2011 05/07/2012 31/03/2014 Comments (% achievement) The PAD results framework reflects yearly targets instead of cumulative targets. The current TTL has confirmed this with the appraisal TTL. Results reflected in this ICR reflect achievement against cumulative targets, which were calculated from the PAD. The objective was 100% achieved based on project developed surveillance plans for 6 ZDs (3 per year with 2 years of implementation). The project contained 216 Outbreaks in poultry during the project period. There was no transmission to humans. Indicator 2: Mechanisms developed to share information on priority zoonoses (mitigation and outbreak) among DOLS, DOHS, and NARC Value (Yes/No) Partial (mechanism between Yes (data and information Yes DOLS and DOHS for HPAI) shared among three agencies for three priority diseases) Date Achieved 31/07/2011 05/07/2012 31/03/2014 100% achievement. The National Avian Flu Influenza Information Committee now includes Comments (including % NARC, FAO, DOLS, and DOHS. It has been redefined to cover all zoonotic diseases. District achievement) Avian Influenza Technical Committees have been formed to survey and report avian flu and zoonotic diseases. Beneficiaries Indicator Project beneficiaries (training and communication outreach) 4 The One Health (OH) targets to reduce the risk of infectious diseases at the animal-human ecosystem interface nationally, regionally and internationally. The approach propose an interdisciplinary, cross-sectoral, integrated multi-partner approach to surveillance, monitoring, response, control, mitigation and prevention of emerging and infectious diseases, as well as to ecosystems health. 5 While earlier GPAI projects typically included response as one of the interventions, this project focused on a more systemic approach based on prevention and preparedness and planning. This is because the AICP developed and tested rapid response mechanisms by successfully containing several avian influenza outbreaks in Nepal and should containment be required these mechanisms would be used for zoonotic disease outbreaks. iii Indicator Baseline Value Original Target Values Actual Values Achieved (from approval documents) at Completion Value (Number) 217,0826 24,000 54,129 Date Achieved 31/07/2011 05/07/2012 31/03/2014 Comments (incl. % The baseline value reflects those trained on avian influenza prevention and control under the achievement) preceding AICP project. It is 50 percent of population in 26 AI high-risk districts reached by communication campaign. The PAD results framework reflects yearly targets instead of cumulative targets. The current TTL has confirmed this with the appraisal TTL. Results reflected in this ICR reflect achievement against cumulative targets, which were calculated from the PAD. The original target value agreed at the time of project signing was that additional 24,000 people would be trained by project closure. Project achieved 225% of this target. Indicator Of which 50 per cent were female [of the Project beneficiaries (training and communication outreach)] Value (Percentage) 40% Y1: 45%; Y2: 50% 40% Date Achieved 31/07/2011 05/07/2012 31/03/2014 Comments (incl. % Out of 54,129 trained, 9717 were women (40% of targeted 24,000). achievement) (b) Intermediate Outcome Indicator(s) Baseline Value Original Target Values Actual Values Achieved (from approval documents) at Completion or Target Years Component 1: Animal Health IO Indicator 1.1: Number of livestock inspected at model service centers and quarantine offices Value (Number) 0 Y1: 3000 + Y2: 4000=7000 14,506 Date achieved 31/07/2011 05/07/2012 31/03/2014 Comments (incl. % The PAD results framework reflects yearly targets instead of cumulative targets. The current achievement) TTL has confirmed this with the appraisal TTL. Results reflected in this ICR reflect achievement against cumulative targets, which were calculated from the PAD. The inspections took place in the high and medium risk and border districts based on information from DOLSO and Quarantine offices. Achievement 207% IO Indicator 1.2: Number of farmers in PAF groups trained on bio-security Value (number) 0 Y1: 500 + Y2: 500=1000 1,243 Date achieved 31/07/2011 05/07/2012 31/03/2014 Comments (incl. % The PAD results framework reflects yearly targets instead of cumulative targets. The current achievement) TTL has confirmed this with the appraisal TTL. Results reflected in this ICR reflect achievement against cumulative targets, which were calculated from the PAD. The project’s aim was to reach out for the poorest communities who did not have chance for training in the past. Achievement 124% IO Indicator 1.3: Incidence of priority Zoonotic diseases in animals 6 The previous project, AICP, trained a total of 217,082 persons on AI prevention and control in 26 AI high-risk districts. This includes: (a) 8,715 farmers, traders, and other local stakeholders on AI prevention, control, and bio-security; (b) 18,805 farmers and veterinarians on participatory disease intelligence; (c) 362 veterinarians and surveyors on surveillance and diagnosis; (d) 150 veterinary rapid response team (RRT) members on outbreak control; (e) 423 medical RRT members on human surveillance; (f) 75 medical doctors on diagnosis; (g) 377 health care workers on case management; (h) 750 media spokespersons on risk communication; (k) 1,425 security personnel on AI prevention and control; and (m) 3,000 teachers, 3,000 peer educators, and 180,000 school children (UNICEF school education program). iv Value (Percent) Priority diseases: Avian Influenza (64%);  Influenza; Brucellosis (0.56%);  Brucellosis; Leptospirosis (9.51%);  Leptospirosis; Toxoplasmosis (24.31%);  Toxoplasmosis; Cysticercosis (5.2%);  Cysticercosis; Hydatidosis (0.0%)  Hydatidosis Rabies (57.4%) Date achieved 31/07/2011 05/07/2012 31/03/2014 Comments (incl. % Monitoring incidence of priority ZDs exceeded the target of 6 ZDs by one (Rabies). achievement) Achievement 116% IO Indicator 1.4: Project implementation monitored and coordinated among DOLS, NARC, and DOHS Value (% completion 0 Y1: 80% + Y2: 100% = 535 75% (151 meetings) against work plan) targeted visits Date achieved 31/07/2011 05/07/2012 31/03/2014 Comments (incl. % M&E activities include visits workshops meetings as well as capacity development and achievement) advice. By project closure in March 31, 2014 , a total of 151 meetings and M&E activities were conducted (75% achievement) Component 2: Climate Sensitive Disease risk mitigation IO Indicator 2.1: Priority climate sensitive diseases identified, and action plans developed Y1: Yes (disease identified Value (Yes/No) No Y2: Yes (action/surveillance Yes plan developed) Date achieved 31/07/2011 05/07/2012 31/03/2014 Comments (incl. % Out of the 10 planned HPEDs seven were identified as Climate Sensitive (CS): Four ZDs, achievement) (Leptospirosis Toxoplasmosis , Cysticercosis, and Japanese Encephalitis), and 3 non ZDs (Blue Tongue , and two parasitic: Liver flukes and Gastroenteritis). In addition, NARC reported the following incidence rates: Avian Influenza (H9) only (2.3 %); Brucellosis (2.97 %); Leptospirosis (3.15 %); Toxoplasmosis (25.97 %); Cysticercosis (3.3 %); Blue Tongue (25.51-73.36); Laboratory test results completed Component 3: Human Health Indicator 3.1 Percent of surveillance sites that regularly report to Epidemiology and Disease Control Division (EDCD)/DOHS (immediate, weekly, or monthly) Value (%) 86 90 100 Date achieved 31/07/2011 05/07/2012 31/03/2014 Comments (incl. % This was achieved from information gathered by the 40 sentinel sites. Target was exceeded achievement) by 10% Component 4: Communication Indicator 4.1 Increased awareness of prevention and control of priority zoonotic diseases among human health workers and general public Baseline and KAP survey Average 48% (first year Value (%) 20% Average 35% (Y1: 30 and 47% and year 49% ) Y2: 40) Date achieved 31/07/2011 05/07/2012 31/03/2014 Comments (incl. % The degree of awareness measured through KAP survey indicated, in spite of short period , achievement) that the awareness campaigns have achieved higher KAP percentage than what was planned G. Ratings of Project Performance in ISRs No. Date ISR Archived DO IP Actual Disbursements (US$ mil.) 1 Dec 01, 2012 S S 0 2 Jun 07, 2013 S S 1.5 v No. Date ISR Archived DO IP Actual Disbursements (US$ mil.) 3 Sep 29, 2013 S MS 1.5 4 March 31, 2014 MS MS 8.46 H. Restructuring (if any) (some fields are entered by the system) Restructuring Board ISR Ratings at Amount Reason for Restructuring & Date(s) Approved PDO Restructuring Disbursed at Key Changes Made [or GEO] Restructuring Change DO IP in US$ in [check box] [GEO] Millions Sept 13, 2013 No S MS 1.5 Category Reallocation I. Disbursement Profile (system generated graph) vi 1. Project Context, Development Objectives [or Global Environment Objectives] and Design 1.1 Context at Appraisal 1. Nepal is a landlocked Himalayan country of 27 million people, bordering India and China. The GDP growth rate has increased to more than 4.3% over the last three years. Nepal is one of the least developed countries with an annual income per capita of USD 700. There is a strong trend towards rapid urbanization at an annual growth rate of 3.8% and this together with rising incomes has led to increased demand for meat. 2. The livestock sub-sector contributes about 26% of agriculture GDP, with an estimate of 24.5 million poultry, 11.8 million cattle and buffalos, and 9.3 million goats and sheep. There is a high incidence of infectious diseases which constrain productivity and cause severe losses. Many of these diseases are zoonotic and therefore pose a threat to human health which could reduce income and even cause loss of lives. Climate change with rise in temperature and extreme weather events has also been associated with increased disease risk. 3. In 2012, Nepal was at high risk of avian influenza outbreaks in poultry because of reported outbreaks in wild birds and domestic poultry in India. The border controls were limited both for animals and humans. Avian Influenza detection and control capacity, both in animals and humans, had been significantly strengthened with funding from the Bank and other development partners. The Bank supported the Department of Livestock Services (DOLS) and the Department of Health Services (DOHS) through the Avian Influenza Control Project (AICP – P100342) between 2007 and 2011. Pandemic preparedness had improved and gains in collaborative zoonotic disease control and preparedness were made but they had not been fully institutionalized and were at risk to decline over time with ceasing funding. The Bank intended to continue its support to address these issues through the One Health approach. This approach aims to address zoonotic diseases by linking animal health, human health, and ecological factors. 4. The project supported Pillar II of the Nepal Interim Strategy Note for FY12-13, reducing vulnerabilities and improving resilience, by building GON capacity in preventing and controlling zoonotic diseases. It would reduce the likelihood of incidence of such diseases and complement the proposed Agriculture and Food Security Project (to be financed by GAFSP) by improving animal and human health, rural livelihoods, and food and nutritional security. The project would also support ISN's second cross cutting theme, fostering gender equality and social inclusion, given that about 50 percent of rural households keep poultry and other livestock in their backyard. Approximately, 30 percent rural households with backyard poultry belong to Dalits and Janajati, which are the most disadvantaged social groups. The proposed project would have inclusive outreach in animal and human health service delivery by complementing the IDA-financed Poverty Alleviation Fund (PAF). It would engage PAF’s Village Organization (VOs) in livestock husbandry into prevention activities. 1.2 Original Project Development Objectives (PDO) 5. The objective of the project was to enhance Nepal’s capacity for the prevention and control of infectious diseases that transmit between animals and humans (zoonosis) under a One Health approach. Revised PDO: 6. The PDO and Key Indicators remained unchanged throughout the project period. 1.3 Main Beneficiaries 7. The project was intended to directly benefit the farmers and the rural population whose livestock is threatened by zoonotic diseases (ZD) and who depend on livestock for their livelihoods, food security and nutrition. In addition, the project aimed to strengthen the key government agencies involved in prevention and 1 control of zoonotic diseases, protect consumers of livestock products and the public at large from infection, and contribute to the wider global public good of mitigating the risk of pandemics. 1.4 Original Components 8. The project consisted of four components: (a) animal health, (b) climate sensitive disease risk mitigation, (c) human health, and (d) communication. The total project cost was US$10 million. 9. Component A. Animal Health (US$5.4 million) to further enhance capacity to control AI and broaden the scope to control a wider set of ZD. This component was implemented by DOLS and comprised 4 sub- components: (1) institutional capacity, (2) capacity building in surveillance and diagnostics, (3) strengthening live animal markets, and (4) project management unit:  Sub-component A.1: Institutional capacity to support development of veterinary legislation for prevention and control of animal diseases; to develop a “One Health” strategy and action plan; to identify key infectious diseases in relation to climate change (component B) and their impact on animal and human health.  Sub-component A.2: Surveillance and diagnosis to refurbish laboratories, provision of equipment and to train staff.  Sub-component A.3: Strengthening live animal markets via response and control capacity building: Modernization of live bird markets, biosecurity awareness raising and upgrading of quarantine facilities.  Sub-component A.3: Project management unit to support overall project implementation. Project management was the responsibility of DOLS, which hired consultants to assist in financial management, procurement and monitoring. 10. Component B. Climate Sensitive Disease Risk Mitigation (US$2 million) to support building livestock climate resilience by benchmarking priority climate sensitive infectious diseases. This component was implemented by NARC, which introduced the innovative climate change mitigation instruments under the ‘One Health’ approach such as improving climate impact assessment on diseases and concrete interventions to mitigate climate risk. 11. Component C. Human Health (US$2 million) to support enhanced surveillance, diagnostics, and case management of priority zoonotic diseases in humans. More specifically the component was to strengthen sentinel sites7 by equipping them with adequate diagnostic facilities, training public health workers on zoonotic disease prevention and control and to assess the prevalence of zoonotic diseases in humans. The component was to complement an on-going IDA-financed project (National Health Sector Program (P117417) by strengthening collaboration with DOLS. This included linking of an Animal Health Information System (AHIS) in DOLS (component A) with the Early Warning Alert and Response System (EWARS) of DOHS. The component was implemented by DOHS. 12. Component D. Communication (US$0.6 million). This cross-cutting component, which was managed by DOLS, was to support communication activities for zoonotic disease control. This included the provision of technical assistance to support DOLS and DOHS to revise their AI communication strategy to encompass priority zoonotic diseases and implement awareness raising campaigns. 2. Key Factors Affecting Implementation and Outcomes 2.1 Project Preparation, Design and Quality at Entry 13. The rationale for the project and for Bank involvement was strong, and the PAD provided solid analysis of the background issues to justify Bank involvement. The PAD underscored the relevance by stressing that the 7 The target was 40 Sentinel survey sites of which 36 were identified and developed by AICP. Sentinel sites are hospital based. 2 project would enhance the capacity of Nepal for the coordination, preparedness, and prevention of the zoonotic diseases. Further to enhanced inter-sectoral coordination, the project was envisaged as an instrument to promote awareness and to develop early warning mechanisms to mitigate climate change induced livestock disease risks. 14. The design benefited from the lessons learned during the design and implementation of the national (AICP) and regional (capacity development, surveillance and creation of the OH Hub) projects. For example, several activities to be supported by NZCP (e.g. the 36 out of the existing 40 sentinel district surveillance sites) were developed by AICP. The appraisal team was cognizant of the significant risk facing implementation and designed NZCP to mitigate those risks as much as possible. NZCP built on the achievements, organization, and management structure of AICP. Those government officials who had been deputed to AICP, were continued for NZCP. This proved prescient when GON funds were delayed in the first year because non-procurement-related activities could continue with staff familiar with the program’s goals and Bank processes. Similarly, by building on existing institutional arrangements for inter-ministerial coordination (Steering and Technical committees), NZCP increased the likelihood of achieving the expanded agenda of surveillance and response to key zoonoses. The capacity of the implementing agency was assuaged by designing in a technical assistance team for procurement, financial management, and other critical functions. 15. The project used sector investment lending (SIL) instrument and was financed by a grant from the Avian Human Influenza Facility (AHIF). The AHIF was administered by the World Bank and was established with contributions from various bilateral and multilateral donors, including European Commission. Since the AHIF Trust Fund was scheduled to close on June 30, 2014 (without any possibility for extension), the Government of Nepal had to prepare the project in a very short time (2 months) to take advantage of the AHIF before its closing. 2.2 Implementation 16. The project was approved in July 2012, but release of the budget from GoN was delayed during the first year of the project. Actual disbursements began in January 2013, and the resultant completion of civil works and delivery of goods were completed during the grace period. However, project activities that did not require procurement—such as, planning project implementation, Technical Committee and Steering Committee meetings8 of which there were 30 and 9 respectively. This was made possible because the national staff that managed AICP was transferred to the new project while they remained on their respective government payrolls. Disbursement was accelerated by reallocating funds from international level training to a compensation cost category for GON’s culling and compensation policy and completion of civil works towards the end of the project. Implementation progressed rapidly in the last few months before project closing in March 2014. However, US$1.54 million had to be cancelled at project closing in May 2014. This was a result of a substantial US$ appreciation against the NRS.9 17. In addition to the national project staff released to the project from their respective departments (DOLS, NARC and DOHS) the project was supported by a number of subject matter specialists (consultants) for: procurement, finance management, training and curriculum development, engineering, environmental screening and M&E. This team of experts provided technical backstopping and facilitation. 18. By the time of the ICR mission in May 2014, most of the project activities were completed. During implementation, the project was subject to three implementation reviews (October 2011; June 2013 and January 2013) and a WB commissioned independent assessment through the FAO Investment Centre. The assessment revealed that significiant technical capacity to control zoonotic diseases has been built by the WB and other development partners. Economic analysis showed significant returns on the investment in AI control capacity. However, the need to reduce GON’s dependency on development partners for funds to sustain the operational costs of its veterinary services for zoonosis disease control was highlighted along with the recommendation for 8 The TC is chaired by DG of DOLS and the SC is chaired by SG of the MOAD. 9 The exchange rate at the time of project formulation and signing was NPR 80.33 to 1 USD. Since then there has been substantial appreciation of one USD to NPR 95-97, which led to a savings of nearly USD 1.5 million. If the original exchange rate was to be used the disbursement would have been very close to hundred percent. 3 revision of compensation for culled birds to reflect market value. The assessment also advised on continued support to a One Health approach within the framework of a larger livestock development initiative. 19. Despite the late start, the project achieved and exceeded all of its key targets, namely: understanding the prevalence of zoonotic diseases10 and climate sensitive zoonotic diseases (ZDs), using data collected from 12 research sites,11 and identification of eight ZDs.12 These activities related to sharing information of priority ZDs; training in biosecurity of zoonoses through awareness building, AI prevention and control, inspection of livestock at a number of quarantine posts; construction of additional space for laboratories; collection of epidemiological data on enlisted ZDs; human health diagnostic test results; laboratory tests results on climate sensitive animal diseases; construction of drug warehouse and administration facilities or upgrading in addition to the creation and support of networks—e.g., national AI surveillance networks; training and prevision of compensation to encourage reporting and culling. The benefits of reallocating funds from training to provision of cash compensation to encourage poultry producers to report and cull suspected stock was discussed, but the magnitude of benefits need to assessed. The provision of USD 886,000 for culling and compensation operations also led to earmarking of compensation funds within the GON budget (NR 110.0 million in 2013). A policy supportive of compensation has been initiated but leaves room for improvement to reduce farmers’ reporting disincentives. In spite of the tight and very short implementation period (2 years according to PAD; but actually 15 months from disbursement of funds to project closing) and the short grace period of only one month for disbursement,13 the project accomplished all of its planned activities except for few activities such as reporting of test results, functioning of upgraded laboratories, and closed without pending audit or financial reports. Contributing factors to this success include the dedication of the Project Manager and his close collaboration with the country based WB’s TTL and specialized administrative support staff; continuity of the AICP project management and staff; commitment of the GoN and its provision of advance resources to allow for project startup and planning; and the recruitment of capable subject matter consultants, in particular the M&E senior consultant. 2.3 Monitoring and Evaluation (M&E) Design Implementation and Utilization 20. The M&E system, which was developed during AICP, was located at the DOLS. The M&E and Planning Unit provided technical support, capacity development and training in the use of the standard reporting templates to the M&E staff in each of the three implementation agencies (DOLS, NARC and DOHS). Each implementing partner monitored the outcomes and outputs of its component and reported the progress to the M&E Unit. In addition the Unit was instrumental in identifying bottlenecks in disbursement and implementation, and supported the Project Steering Committee (SC) and the Project Technical Committee (TC) through sharing information, technical support and administrative advice. Overall, all planned targets of the visits, inspections, observations, meetings, data collection and timely reporting were satisfactorily achieved and exceeded the targets (e.g. total of 725 monitoring activities were completed compared to 535 planned). 2.4 Safeguards and Fiduciary Compliance Safeguards and Outbreak Containment Management 21. The Project was category Type B on environmental safeguards.14 This, as with the assessment for its 10 Brucellosis, Leptospirosis, Toxoplasmosis, Cysticercosis, LPAI and Japanese Encephalitis 11 Based on the “ aide `memoire WB Implementation review and support mission January 2014” and the “ Draft National ZCP Implementation Report 2014. 12 Information based on discussion with Project Management and national staff. The nine criteria used by the national team for identifying the priority ZDs were selected from 52 used collectively by a number of countries. The nine criteria used are: Food Safety, morbidity, fertility rates, zero prevalence, risk of emergence, neglected zoonotic, enzootic, global importance and finance resources nationally available for control. The identification process followed included selection by a technical committee, presentation at a multi-sectoral technical and other stakeholder workshop. Based on the outcome of the workshop the 6 ZDs and two (brucellosis and TB) were identified as the priority ZDs. 13 This was a condition from the Trust Fund. 14 WB: PID Appraisal Stage PIDA308; integrated safeguards data sheet Appraisal stage ISDSA595’; 4 predecessor AICP, was based on the updated Environmental Management Plan (EMP)15 prepared by the DOLS in 200616 The EMP (2012/3- 2013/4)17 was developed to identify the potential impacts and establish the mitigation measures associated with the nine construction works (construction and renovation sites). These included severe potential impacts (such as air pollution, contaminated sewage water, and exposure to chemicals) as well as minor impacts (such as noise and dust). The EMP also proposed and the project implemented the construction of livestock markets with provisions for lined pits for biological waste, fencing, toilets, and drainage. The other implementation partner (DOHS) applied the health care waste management plan developed in June 2006 for the Nepal Health Sector Program (a SWAp supported by IDA and other partners). Overall application of the mitigation and safety measures as well as contaminant management on all of the construction sites was found moderately satisfactory. 22. The response of NZCP to the 216 HPAI outbreaks in 2013 was within the framework of the outbreak containment procedures organized for each affected district through the District Avian Influenza Technical Committee (DAITEC).18 The containment focused mainly on culling and disposal of 1.7 million birds in twelve sites (disposal pits). Safety measures included groundwater quality testing for presence of AI virus near the disposal pits. No water contamination with AI virus was reported. Financial management (FM) 23. Although there was a gap of 12 months19 between the closing of AICP and the start of disbursements under NZCP (July 2011 – June 2012), the dedicated project personnel who are regular GoN employees -continued working in the planning and preparation of the NZCP. Some units also advanced GoN financial resources. Limiting the disbursement grace period to only one month, which was a condition from the Trust Fund, was a further challenge. The FM capacity was strengthened over time with the recruitment of Procurement, Finance and M &E consultants. Among the three implementing agencies, DOLS and NARC performed better, while DOHS was not as proactive and slow in implementation for most part of the project period. However, having only one well-coordinated FM system for the whole project contributed to timely resolution of any delays caused by DOHS. At the time of project closure (including the one month grace period) disbursement was USD 8.46 million (85%) of the grant (table 1). Table 1 Allocated and spent budgets by components in US$ millions % Components Allocated budget Spent Budget Expenditure C1. Animal Health 5.4 4.80 89.0 C2. Climate Sensitive diseases risk mitigation 2.0 1.70 85.0 C3. Human Health 2.0 1.45 72.5 C4. Communication 0.6 0.50 83.0 TOTAL 10.00 8.45 84.5 Procurement 24. The NZCP was a procurement intensive project. However, the limited implementation period (only 15 months available for bidding and executing procurement contracts) and the very short grace period for disbursements (only one month) were major challenges. A further challenge was quality control. However, both issues were resolved effectively by hiring the procurement and quality control consultants, and the close follow- up and consultation between the World Bank Team and the project staff. As a result the procurement capacity 15 Environmental safeguards have been mainstreamed in the Bird Flu Investigation, Prevention and Control Guidelines/Standard Operating Procedures used by the Government (and formerly used for AICP) so that should any plans, studies or other project activities suggest or propose activities with environmental implications, there will be consideration for environmental implications in the study or plan itself. 16 AICP’s ICR report -January 30, 2012 17 WB-EMP 2012-2014 18 DAITEC is composed of a Chief District Officer, municipalities, District Development Committee (DDC), District DOLS, and District DOHS. 19 AICP closed in July 2011. Even with 6 month grace period, GoN had to bridge about 12 month without funding support. 5 was strengthened and improved, leading to successful planning, preparation of procurement documents and implementing procurement activities on time. All procurements (the construction works, training and capacity development and laboratory tests on collected samples) were completed by or before March 14, 2014, and a detailed procurement status was available for the ICR Team for review upon their arrival. 2.5 Post Completion Operation 25. NZCP implementation was internalized within the existing government structure. The NZCP Steering Committee (SC) and Technical Committee (TC) evolved to permanent governance and advisory bodies that function through regular meetings (the SC meets three times each year; whereas the TC meets on a weekly basis and also responds to emergencies). In addition, the Project Manager and selected staff members were transferred to a permanent coordination body (The AI Control Program) under direct supervision of the DG of DOLS. NRS 200 million have already been allocated for this function in 2013-2014 (including 50 percent for culling compensation) and an additional NRS 100 million earmarked for 2014-2015. 26. One of the indicators of achievement of the PDO is the current coordination activity between DOLS and DOHS aiming to establish a One Health (OH) Hub. Actions to establish the OH Hub culminated, less than two months after the closure of NZCP, in the formation of an OH Hub Committee (OHHC) comprising the relevant staff from DOLS and DOHS (25 members). Based on the recommendations of the OHHC two OH Secretariats (OHS) were established, one in each of the two departments under the direct management of the OHHC Focal points (Focal point for DOLS Dr. Vijay Kant Jha Programme Manager Directorate of Animal Health, and Focal Point for DOHS, Dr. Baburam Marasini, Director Epidemiology and Disease Control Division (ECDC)). The meeting held on 16 May 2014 designated a six-people OH Guideline Drafting Committee (OHGDC) with specific responsibility to draft the guidelines in three months for submission to the review and ratification by the Council of Ministers. The Committee (3 from each department) will have an office at DOLS and be chaired by a Senior Zoonosis Officer at DOHS. Five out of the six OHGC were directly involved in NZCP as trainees and as operators/ managers of the restored laboratories and other facilities. 27. Furthermore, capitalizing on the PDO outcome, and with the objective to scale up the project interventions, a NZCP facilitated the development of a Concept Note for a larger livestock project. The leadership for the preparation of the concept note was undertaken by the Ministry of Agriculture Development. The concept note aims mainly at filling the gaps identified by the OIE PVS, aligns with the Agriculture Development Strategy (ADS) and will directly benefit from the significant institutional and infrastructural capacities20 developed through NZCP. For example, the construction of the Quarantine station at the border21 of India and Nepal will facilitate and speed up inspection and vaccination of livestock imported from India and will provide the District Veterinary Office staff with a safe and efficient working environment. 3. Assessment of Outcome 3.1 Relevance of Objectives, Design and Implementation 28. The relevance of NZCP’s objectives, design and implementation were high. The objective remained relevant to the Nepal Interim Strategy Note (ISN 63381) for FY 2012-13 which supported three pillars: (i) enhancing productivity for growth, (ii) reducing vulnerabilities and improving resilience (iii) promoting access to better quality services. NZCP supported pillar (ii) by building capacity in prevention and control of zoonotic diseases. NZCP also reduced the likelihood and prevalence of zoonotic diseases which enables increased productivity of livestock and thereby contributes to the ongoing WB supported initiatives such as the Agriculture and Food Security Project, currently being implemented in 19 districts in West Nepal. The ISN cross cutting theme of ‘fostering gender equality and social inclusion’ was attended by providing livestock health services to 20 Construction, renovation and equipping of the HQ and field laboratories; Training and awareness building of a large number of professionals, field technicians and farmers 21 At the animal quarantine check-post, Belahiya in Rupandehi. 6 rural households in which mainly women are keeping poultry. The World Bank’s draft Country Assistance Strategy (CAS) for Nepal identifies agricultural sector development, including livestock, as a priority. At the global policy level, the World Bank has developed strategy documents related to One Health with the objective to operationalize this approach. NZCP has implemented ZD prevention and control capacity building activities under a One Health approach, which has led to a policy process of institutionalizing the approach in the GON public and veterinary health service agencies. 29. The project design remained relevant in building ZD prevention and control capacity as well as supporting emergency operations. NZCP played a key role in containing 216 outbreaks of Highly Pathogenic Avian Influenza H5N1. The World Bank’s implementation assistance was responsive to changing needs and that the operation remained important. Three budget revisions were approved by the World Bank to adjust procurement plans to changing requirements and to reallocate funding from training to a compensation cost category. GON’s culling and compensation policy required substantial funding during the AI in 2013. 3.2 Achievement of Project Development Objectives 30. Project achievement rating: The PDO was substantially achieved. 31. The Project achieved its PDO to enhance Nepal’s capacity to prevent and control ZDs under the OH approach. This was achieved in a record short time (15 months of practical implementation period) by building upon the institutional and organization structure of AICP and the commitment and expertise of the project staff. The project was successful in coordinating the planned activities of three components (Animal Health, Climate Sensitive Disease Risk Mitigation, Human Health) implemented by three sectoral partners, as well as the cross cutting component dedicated to supporting communication and information sharing through raising awareness on preventive practices, risk communication, Knowledge Attitude and Practice (KAP) surveys and institutional capacity building. 32. The targeted values for the two measurable indicators were reached as follows: a) Confirming the six ZDs identified during project preparation (HPAI, Brucellosis, Leptospirosis, Toxoplasmosis, Cysticercosis, Hydatidosis (or Echinococcosis). through participatory multi-stakeholder assessment as described in section 2.2 Implementation. Also two additional priority ZDs (TB and Rabies) as well as Blue Tongue and GI Nematodes were identified. Surveillance control plans were formulated for the eight ZDs. b) Mechanisms for communication and information sharing at the national level and in the 75 districts developed and data collection has begun at national and district levels. The National AI Information Committee (NAIC) was redefined to include all ZDs.22 In addition to DOLS and DOHS the committee includes representatives of NARC and FAO (ECTAD-RSU). c) Enhanced coordination activity between DOLS and DOHS and confirmed measures to establish a One Health Hub (as detailed in section 2.5 Project Completion Operation) 33. Capacity enhancement: The capacity enhancement targets for prevention and control of infectious diseases were achieved building on the infrastructure developed by AICP. Indicators include:  training, communication outreach, and awareness building of 54,139 (28,549 and 25,593, respectively) farmers in 75 districts of whom 9,717 were female participants (40% of the targeted number), which 22 The newly emerged National Zoonoses Information Committee (NZIC) continued functioning after closing of NZCP with the same organization as during project implementation (membership of DOLS, DOHS, NARC and ECTAD-RSU). NZIC is currently chaired by Dr. Gita Shakya Director of the National Public Health Laboratory and membership of Manager of NZCP, AH Director of NARC, Director of AH at DOLS, Director of Veterinary Public Health Coordinator. NZIC holds periodic meetings to share information. Although both DOHS and DOLS have or are in the process of planning Computerized Information Management Structures (HHIS and AHIS, located at the directorate of Public Health and Veterinary Epidemiology Center -VEC, respectively), information sharing of NZIC is still managed through emails, messages and verbal communication. 7 exceeded the targeted 24,000 people;23  improved capacity for prevention and control of zoonoses and effective coordination among the three implementing agencies was evident in the successful containment of 216 HPAI H5N1 outbreaks;  inter-sectoral consultative ranking procedures and criteria used in the identification of priority zoonoses (as detailed in Section 2.2. Implementation above);  benefits from capacity/ institutional enhancement were reflected in the inspection of 14,506 animals (more than double appraisal goal of inspecting 7000 livestock) at the model service centers;  inspection of 14,506 livestock at model service centers and quarantine offices by project closing;  In direct response to the poverty alleviation strategy 1243 PAF 24 Group farmers received training in biosecurity (exceeding the target of 1,000);  establishment of 6 ZD surveillance plans;  development of a system for collection/ monitoring incidence / case prevalence of priority ZDs;25  identification of climate sensitive HPEDs by NARC;  implementation of surveillance from 40 sentinel surveillance sites in the districts;26  implementation of the poultry culling compensation plans and the possibilities that the approach will be sustained and improved; and  increased awareness of prevention and control of priority ZDs among human health workers and general public as indicated by comparing pre and post KAP survey. Although the difference was very minor considering the very short time (two months) between the two surveys, there was a change in knowledge, attitude and practices (pre: 44.31 percent, 56.31 percent and 40.61 percent, versus post: 42.16 percent, 58.78 percent and 45.27 percent for K, A and P respectively). 3.3 Efficiency 34. The project’s efficiency was high. The economic analysis (detailed in Annex 3) related the total disbursed project costs of USD 8.46 million to the benefits derived from the economic value stream of HPAI losses, which were avoided from project activities in the poultry industry. This was expressed as the expected value of the economic loss avoided from HPAI outbreaks during the two year period of project implementation (2013-14). The actually occurred HPAI losses were assessed under the ‘with project’ scenario. Under the ‘without project’ scenario, widespread HPAI in poultry and some transmission to humans with doubling of HPAI losses was assumed. A NPV of USD 98 million was calculated for the NZCP investment. 35. Strong veterinary and public health service capacity is a public good and a crucially important factor in controlling ZD such as HPAI. NZCP funding was certainly effective in strengthening the ZD control capacity and benefits to this investment can be derived from the control of a wide array of animal diseases with knock-on effect beyond the agricultural sector. Attributing the benefits of controlling a single disease to the costs of building and maintaining effective veterinary and public health infrastructure would significantly underestimate the benefits of veterinary and public health capacity development. The economic analysis in Annex 3 focuses on the assessment of HPAI losses during NZCP. Assessed HPAI losses illustrate the economic return of strong veterinary and public health service capacity. 23 This number also adds on to the number of 217,082 achieved by AICP 24 Poverty Alleviation Fund 25 The system was developed and the first results of the sero/fecal /case surveillance were produced. 26 20 of the sentinel surveillance sites were already functioning before the initiation of the AICP. NZCP established 16 additional sites. Further 5 sites have already been planned nest year from the GoN fiscal budget 8 3.4 Justification of Overall Outcome Rating 36. Overall rating: Satisfactory 37. Overall the project has been rated as Satisfactory with PDO substantially achieved. This classification rating is justified because the PDO and project design were and remain relevant. Both PDO indicators were achieved or exceeded, as was the number of project beneficiaries targeted for outreach. In addition, 6 of the 7 intermediate outcome indicators were met or exceeded. The PDO was substantially achieved, with the One Health approach established within government systems, and an operational protocol for inter-agency cooperation is operable. The government response to the 2013 HPAI outbreak exemplifies the efficacy of the system. These outcomes were delivered despite a delay in release of the funds by GON, which shortened the implementation period from two years to 15 months. Sustainability of the project interventions are likely as the interventions are integrated into government systems, even the culling compensation plan, which is now financed by GON. 3.5 Overarching Themes, Other Outcomes and Impacts i) Poverty Impact, Gender Aspects and Social development 38. The project was developed within the context of supporting the FY12-13 Nepal Interim Strategy Note (ISN)’s second pillar “reducing vulnerabilities and improving resilience” and its second cross cutting theme, "fostering gender equality and social inclusion". These targets were achieved because preventing or reducing disease afflicted losses of poultry and other livestock have directly benefited the smallholders and poor backyard poultry and livestock producers who represent 50% of the rural households, among whom approximately 30% of the households belong to Dalits and Janajati disadvantaged ethnic groups who live below the poverty line. The project had an outreach in animal and human health service delivery by complementing the IDA-financed Poverty Alleviation Fund (PAF). The outreach was through engaging PAF’s farmers in training on biosecurity. This activity was achieved through training 1,240 (240 above the 1,000 target). In addition most of the trained farmers or those who benefited from awareness building (total 54,139 farmers) or the rapid deployment in the 216 outbreak sites in the high-risk districts were poor backyard poultry producers. Female participants in training were relatively significant (9,717 or about 40% of the target estimated during appraisal). (ii) Institutional Change/Strengthening 39. The NZCP contributed to further enhancement of the capacities of DOLS and DOHS in preventing and controlling zoonotic diseases. The project embarked successfully in the implementation of a very extensive training program. This was supported by a wide communication and awareness building campaign in all of the 75 districts. In addition the project strengthened further the surveillance, disease detection, diagnosis and response (containment or case management) capabilities of DOLS and DOHS, and improved the border quarantine and biosecurity through the establishment of efficient and safe livestock inspection and handling capabilities. The coordination and rapid response system developed by the project and its predecessor AICP that was instrumental in the containments of HPAI outbreaks of 2011 and 2013 have been maintained and supported as a regular GoN program under the direct supervision of the DG of the DOLS. Also NZCP contributed significantly to the focused plan that was initiated by DOLS and DOHS to establish an OH Hub. A Secretariat representing both departments was tasked with the responsibility of generating, in less than six month, a formal GoN guideline for the nationwide implementation of the OH approach. 3.6 Summary of Findings of Beneficiary Survey and/or Stakeholder Workshops 40. Beneficiary Survey. A Knowledge Attitude and Practice (KAP) survey was undertaken by a consultant company in 6 districts where NZCP was implemented to assess awareness of prevention and control of priority zoonotic diseases among human health workers and general public. KAP data was collected twice: baseline data and a post-training or post-awareness campaign KAP data which would enable evaluating the impact of NZCP trainings and awareness campaigns. The survey revealed there is an increased awareness of prevention and control 9 of priority zoonotic diseases among human health workers and general public and measures taken to practice preventions. Time of data collection January 2014 March 2014 Knowledge (% of all respondents) 44.31 42.16 Attitude (% of all respondents) 56.31 58.78 Practice (% of all respondents) 40.52 45.27 41. The project organized an end of project workshop on March 30-31, 2014 which was attended by high ranking officials from many organizations including the Government of Nepal (GoN) and World Bank. GoN appreciated the NZCP for successfully containing 216 Avian Influenza outbreaks, constructing the model quarantine facility in Belahapur, Bhairahawa that has helped quarantine animals at the Indian border, and completing of the first diagnostic facility at BLS2 at the Department of Health (outstanding activity from the AICP). Moreover, the convergence of Health and Livestock Services under the One Health approach has facilitated the survey, assessment, response to contain zoonotic diseases. The forum was encouraged to note that district Level Avian Flu Control Committees chaired by CDOs are now functional. GoN has consolidated its support for zoonotic diseases by allocation of NPR 200 million for the FY 2014/15. NZCP was noted as the most successful project implemented at the DOLS in the last decade and the collaboration between World Bank and Project teams in implementation of NZCP despite a two year time constrained project was appreciated. In this regard, the contribution Nepal Agriculture Research Council, Department of Livestock Services, Department of Health, and consultants that provided NZCP with managerial, financial, technical and procurement support/expertise was duly recognized. 4. Assessment of Risk to Development Outcome Rating: Moderate 42. The project was considered substantial at appraisal, as acknowledged in the PAD.27 The risk was mainly because of the AHIF Trust Fund requirement that limited the project implementation to only two years and a grace period for disbursements of only one month. The actual disbursement period was only 15 months. Another challenge was the multi-sectoral characteristic of the project that required full collaboration between two Ministries (MOAD and MOHP) and two departments (DOLS, DOHS) and the Nepal Agriculture Research Council (NARC), an autonomous organization within the MOAD. The risk mitigating factors estimated during appraisal, however, have proven to be effective. These are: (i) the substantial experience already acquired under the previous AICP project, (ii) the continuity of the existing implementation structure established under the previous project, and (iii) the establishment of a facilitating unit for FM, procurement and planning/monitoring activities. 43. In addition, the DOLS commitment and the advance financing (FY12/13 and FY13/14) provided by the government allowed timely development implementation plan and hiring project consultants. Moreover, recruitment of competent M&E consultant and the strong leadership of the project Manager and his close collaboration and consultation with the WB TTL, procurement, financial and safeguard officers turned many risk factors into opportunities. Overall the project was able to address major risks such as the 216 HPAI outbreaks in 2013 by providing timely support to diagnosis, reporting, culling of suspected animals and compensation to effected producers. Other risk mitigation facts expected during appraisal such as the development of the two complementary projects AFSP through GAFSP funding and the ongoing projects/ pipeline PPCR, PAF, were still in early phase and therefore not effective in providing any mitigation support. 27 WB PAD Zoonoses Control Project Report No 66838 -NP 10 44. The strategy taken by the project to build on the gains made by the Avian Influenza Control Project and the proactive actions taken by the project to draw up the implementation in the early phase when the project did not receive the funds, contributed to minimizing the risk to achieving the PDO. Further, contributions made by AICP and NZCP in the formulation of Bird Flu Act have secured continued support from the government of Nepal to continue to address Avian Flu in particular and Zoonotic diseases in general. Finally, the One Health Approach initiated and fostered by NZCP has already resulted in joint collection and sharing of information and data related to zoonotic diseases. 5. Assessment of Bank and Borrower Performance 5.1 Bank (a) Bank Performance in Ensuring Quality at Entry: Rating: Satisfactory 45. Lessons learned from the completed HPAI project AICP with similar activities and project development objectives were incorporated in the project design. In particular the institutional and implementation arrangements which maintained project management units, and core staff namely the Project Director, Senior Veterinary Officer, and technical focal points from AICP were a crucial factor for successful execution of planned activities and achieving the development objectives. Based on the lessons from AICP, implementation capacity was strengthened by early recruitment of management support team which comprised consultants supporting monitoring and evaluation, procurement, financial management, training and civil works. The establishment of a cross-cutting planning and monitoring unit responsible for project implementation via three different government agencies in two different ministries further supported one health approach to implementing zoonosis control initiatives. This was further enhanced by establishment of a high-level steering committee and a working- level committee. The World Bank’s South Asia Region (SAR) was implementing a Regional Training Program in Epidemiology and Bio-security. Although the regional project was referenced in the PAD it was not fully integrated in the operation and opportunities for synergies were lost. Massey University was the recipient and implementing agency of the regional project. Massey University was funded to implement collaborative investigation projects for Zoonoses. Full integration of these activities into NZCP would have required the development of a grant fund flow mechanism by WB SAR and MoF. This grant flow mechanism through NZCP was not achieved and the activities therefore implemented in parallel. Quality of Supervision Rating: Satisfactory 46. The Kathmandu-based TTL provided valuable support to the project management unit and regularly facilitated assistance in FM, procurement, and safeguards by the Bank team throughout implementation. The Bank team maintained a cross-sectoral technical team, including a Kathmandu-based Public Health Specialist and animal health specialists based in Washington DC and Delhi who regularly monitored implementation. The FAO regional office also supported implementation, and the project engaged the FAO investment center to carry out an economic assessment of the avian flu outbreak in early 2014, which recommended the need to support culling operations and formulate a policy to support zoonotic disease control. Budget revisions were conducted on a timely basis in view of changing needs. The Bank was responsive to the emergency Avian Influenza outbreak situation and reallocated funds to support GON’s culling and compensation policy. Justification of Rating for Overall Bank Performance Rating: Satisfactory 11 47. The overall Bank performance was satisfactory. Lessons learned from AICP with regard to institutional and implementation arrangements were reflected in the PAD. The Kathmandu-based TTL provided regular support and the Bank responded to swiftly to changing conditions with budget revisions. 5.2 Borrower Performance (a) Government Performance: Rating: Moderately Satisfactory 48. Implementation was seriously delayed by late fund disbursement. MOF disbursed funds 6 months after the project became effective. However, preparatory planning by the project management unit was enabled by maintaining AICP management staff within MOAD. GON set up a steering and technical committee to effectively coordinate the project. GON maintained a high level of ownership and commitment in ZD prevention and control, which was demonstrated by the specific budget allocation for DOLS for the current and the next fiscal year. An institutionalization of the One Health approach to prevention and control of ZDs, as stated in the development objective, has been initiated by the GON via a joint One Health guideline drafting committee. Implementing Agency or Agencies Performance Rating: Moderately Satisfactory 49. DOLS had a high level of ownership in NZCP. The project manager remained the same throughout the project and after completion. NZCP’s project management structure is maintained by DOLS to manage MOAD’s Avian Influenza program. DOLS built capacities in project management, FM, procurement, and M&E, and submitted all required reports to the Bank. DOLS lost the opportunity to enhance the technical quality and impact of project outputs via involvement of FAO’s technical expertise in ZD control capacity building.28 NARC was proactive in project implementation. NARC started planning and implementation in the absence of implementing funds during the first 6 months of the project. Information sharing and coordination between NARC and DOLS was effective. Project activities in DOHS mainly focused on procurement of diagnostic equipment and upgrading the central veterinary laboratory to a higher biosecurity standard. This was delayed throughout the project and only completed during the last weeks before project closing. However, by project closing, DOHS was fully engaged in the institutionalization of the One Health Approach. Justification of Rating for Overall Borrower Performance Rating: Moderately Satisfactory 50. NZCP built the capacity for surveillance mechanism, prevention and control of zoonotic diseases, demonstrated by successfully contained 216 AI outbreaks, and the institutional mechanisms for an effective One Health Approach are being developed. DOLS and DOHS have assured commitment and are maintaining coordination mechanisms that enable an effective and coordinated response to ZD threats. 6. Lessons Learned 6.1 The following are the Key lessons learnt from NZCP 51. Government commitment to the continuation of the investment made through other HPAI projects was a crucial factor in achieving NZCP’s PDOs in spite of the very short implementation period (2 years according to PAD; but actually 15 months from disbursement of funds to project closing). The project accomplished all of its planned activities and closed without pending audit or financial reports, because the GoN 28 FAO was implementing a HPAI control project through DOLS but was not involved in NZCP, although this was suggested in the PAD. 12 advances financial resources for startup and planning and sustain AICP project management and staff. However, considering Nepal’s status of political transition, short duration projects with limited grace period poses a serious challenge, especially for procurement heavy projects. 52. Dedication of the Project Management and staff and close collaboration with the WB. The Contributing factors to this success is the dedication of the Project Manager and his close collaboration with the WB’s Team and continuity of the AICP project management and staff; commitment of the GoN and its provision of advance resources to allow for project startup and planning; and the recruitment of capable subject matter consultants specially the M & E senior consultant. The close collaboration and interaction between the Kathmandu-based TTL and the NZCP management and staff contributed greatly to successful implementation of the project under its tight and very short period. The TTL was able to provide regular facilitation between the National Team and the WB Country Team (cross cutting technical and administrative support staff) 53. Centralized and strong M & E and Planning Unit is crucial for effective technical support. The M&E system, which was developed during AICP, was located at DOLS. The M&E and Planning Unit provided technical support, capacity development and training in the use of the standard reporting templates to the M&E staff in each of the three implementation agents (DOLS, NARC and DOHS), and information and technical advice to the Project Steering and Technical Committee. This strengthened coordination and collaboration among the three implementing agencies. 54. Centralized project financing, procurement and budget management system. The centralized system at the PMU level in Kathmandu provided two benefits; reduction of transaction cost and enhancement of inter- sectoral collaboration; both being crucial for the development of a cost effective OH approach. 55. The KAP survey could be a strategic M&E tool. Knowledge Attitude and Practice (KAP) survey was undertaken to evaluate impact of NZCP training and awareness building. However, KAP data was collected twice over a very short time span; and therefore the opportunity to use this important survey as a tool for assessing project feedback from the project stakeholders was missed. 56. Inter-sectoral collaboration and high level GoN commitment are crucial for the development and installation of the One Health Approach. The GoN has diligently supported the establishment of the inter- ministerial OH Hub Network, supported by two OH Secretariats one in each of the DOLS and DOHS. A Joint Committee was assigned the responsibility to draft the OH Guideline with deadline to submit its report to the Council of Ministers within 3- 6 months from now. However, the benefits would have been higher, if there was collaboration between the regional projects which advocated the One Health Approach and NZCP. The inclusion of the Nepal Agriculture Research Council both as implementation agency and their subsequent inclusion in the Avian Influenza Surveillance Committee has institutionalized a system based approach to disease research and monitoring. 57. Keeping just one agency as the primary implementing partner, which is responsible for streamlining, consolidating and submitting the budgets requests, procurement plans, and audit reports have mitigated many coordination issues and delays. The implementation modality of AICP included two separate independent implementing partners (DOHS and DOLS). This arrangement lead to coordination challenges and role confusions, which often lead to delays. The final audit report for AICP from the MOHP is still outstanding. But with NZCP, the project adopted a different approach. DOLS was the key implementing partner for the project (as the majority of the project grant was managed by DOLS), and DOHS the co-implementing agency. The DOLS was responsible to collect the audit reports, progress reports and procurement plans from DOHS and submit one consolidated report to the Bank. Also, the fund flow arrangement was designed the same way i.e. the funds were issued to DOLS, which in turn, transmitted the necessary share to the DOHS. This overall arrangement streamlined the project activities to a great extent and was able to avoid many implementation delays. 58. The concluding workshop organized by Massey University in Bhutan played an instrumental role in bringing the key regional stakeholders together and raising high level awareness on OH approach. Similar events 13 are necessary in order to reinforce the need to form and institutionalize the OH approach to address zoonotic diseases. 7. Comments on Issues Raised by Borrower/Implementing Agencies/Partners (a) Borrower/implementing agencies: The Bank distributed the ICR to the Government of Nepal and the implementing partners. The comments received indicated that the report was well accepted and there were no specific comments. The overall contribution of the project was well appreciated by the clients demonstrated by the following positive comments received from them “We appreciate and thank the World Bank for making funds available for this short but high impact Project that has produced tangible results. The NZCP is one of the projects that has performed so well with clear and tangible results the Ministry of Agriculture as implemented in the last few years. We are pleased to inform you that the Government of Nepal has made available NPR 95,551,000 Crores to Bird Flu Control Project for FY 2014/15 in order to support and internalize the gains made by AICP and NZCP. While we are committed continue this support on long term basis, we would also like to highlight the importance of donor support for livestock sub sector in Nepal. With the conclusion of the NZCP there is practically no donor support in this sector. Livestock s an integral part of the Nepalese farming system and is well built into the local culture and is a source of livelihood over 60 per cent of its people, particularly in the rural area. We look forward to another opportunity to collaborate with the World Bank in this important sub sector to help the rural poor and contribute towards the goal of Government of Nepal to alleviate poverty”. For details see Annex 8. (b) Co-financiers: [NA] (c) Other partners and stakeholders (e.g. NGOs/private sector/civil society): [NA] 14 Annex 1. Project Costs and Financing (a) Project Cost by Component (in US$ million equivalent) Appraisal Estimate Actual /Latest Estimate Percentage of Appraisal Components (US$ million) (US$ million) 1.Animal Health 5.4 4.80 89.0 2. Climate Sensitive Disease Risk 85.0 2.0 1.70 Mitigation 3.Human Health 2.0 1.45 72.5 4.Communication 0.6 0.50 83.0 Total Baseline Cost 10.0 8.46 84.5 Physical Contingencies Price Contingencies Total Project Costs 10.0 Project Preparation Facility (PPF) Front-end fee (IBRD only) Total Financing Required 10.0 **US$ 1.54 million was cancelled at project closure in May 2014. (b) Financing Appraisal Actual/Latest Percentage of Source of Funds Type of Financing Estimate Estimate Appraisal (US$ million) (US$ million) Government of Nepal 0 0 0 EU AHIF 10 10 100% 15 Annex 2. Outputs by Component 59. The below table summarizes the project’s outputs by component. These outputs were linked to measuring intermediate outcome indicators and monitored by both DLS and DOHS. Project Indicators Outputs indicated in the PAD Actual Achievements Component 1: Animal Health Number of livestock inspected at 7000 livestock inspected at model A total of 14,506 livestock inspected model service centers and service centers and quarantine office (Sample physical examination and 514 quarantine office suspected cases sample collection) at UOM: Number various quarantine check posts. Number of farmers in PAF groups 1000 farmers in PAF groups trained on 1243 farmers in PAF groups trained on bio- trained on bio-security bio-security security UOM: Number Incidence of priority zoonotic Priority diseases; Avian Influenza; Priority diseases: Avian Influenza (43%); diseases in animals Brucelosis; Leptospirosis; Brucellosis (0.56 %); Leptospirosis (under UOM: Percent Toxoplasmosis; Cysticercosis; and analysis); Toxoplasmosis (9.04 %); Hydatidosis Cysticercosis (92 sample tested are negative so far); Hydatidosis (under analysis). Project implementation monitored 100 Percent of project implementation A total of 24 District Coordination and coordinated among DLS, activities monitored and coordinated Meetings, 6 regional level meetings, NARC, and DOHS among DOLS, NARC, and DOHS. Steering Committee Meeting (3) and UOM: Percent completion against The target was 200 meetings over a Technical Committee (22) meeting and 31 workplan period of two years. times Construction site monitoring have been held. In addition to this, various coordination meetings (13) and site monitoring (52) in NARC are completed during this period. A total of 151 times (75.5 % progress against 200 planned.) Component 2: Climate sensitive disease risk mitigation Priority climate sensitive diseases Yes Priority climate sensitive diseases identified, and action plans identified, and but formulation of developed Surveillance Action Plan is nearing UOM: Yes/No completion. Component 3: Human Health Percent of surveillance sites that 90 Percent of surveillance sites 100 Percent of surveillance sites (all 42 regularly report to Epidemiology regularly report to Epidemiology and Sentinel sites) regularly report to and Disease Control Division Disease Control Division Epidemiology and Disease Control (EDCD)/DOHS (immediate, Division. weekly, or monthly) UOM: Percent Component 4: Communication Increased awareness of prevention 40 Percent of increased awareness of Year one 47% and year two 49% (average and control of priority zoonotic prevention and control of priority 48%) increased awareness of prevention diseases among human health zoonotic diseases among human health and control of priority zoonotic diseases workers and general public. workers and general public by year 2 among human health workers and general UOM: Percent public. Component A 60. In collaboration with the Department of Health and Nepal Agriculture Research Council, zoonotic 16 diseases in the context of Nepal were identified and prioritized. The Avian Influenza Surveillance Committee (AISC), chaired by the Chief of National Public Health Laboratory under the Department of Health, now includes the Nepal Agriculture Research Council (NARC). The AISC is responsible for collecting, analyzing and sharing information on zoonotic diseases under the umbrella of the One Health approach. These two activities have directly contributed to meeting the project objectives. 61. One major outcome of this project is the institutionalization of the One Health Approach in Nepal. Today, the Department of Health and Livestock Services have adopted the One Health approach. The project also contributed to the development of Animal Health Policy and Surveillance Plans for prioritized zoonotic diseases. 62. As part of institutional capacity development, a Veterinary Standard and Drug Administration Laboratory has been constructed at Budanilkantha; one regional laboratory constructed in Biratnagar, a new model quarantine facility has been built at the border point between India and Nepal at Bhairahawa and District Livestock Service Office in Kathmandu has been constructed and it is in full operation. Staff capacity, from professionals, researchers to laboratory assistants have been enhanced through provision of training courses based on needs assessment covering a wide range of topics from zoonosis, quarantine management, biosecurity, meat hygiene, disease surveillance etc. Nearly 10,261staff were trained over a period of two years. 63. The Avian Influenza Control Coordination Committee continues to meet regularly at both district and regional levels. Component B 64. Implemented under the initiative of the Nepal Agriculture Research Council, research related to climate sensitive diseases and zoonotic diseases were carried out. Findings revealed high occurrences of diseases such as Toxoplasmosis, Brucellosis, Cysticercosis and Leptospirosis, warranting caution and further investigation on the epidemiology of these diseases under Nepalese conditions. A total of six research grants were provided to students for Masters Research to carry out studies on Leptospirosis, Brucellosis, H9N2, Liver fluke, Neoascaris viulorum and Blue Tongue disease. 65. As part of upgrading, Nepal Agriculture Research Council’s laboratories were equipped with equipment such as microscope, incubator, PCR-1, Elisa Plate Reader, computers and generator. In addition to this, veterinary laboratories at Tarhara, Parwanipur, Nepalgunj, Bandipur and Jumla were refurbished. A total of 1500 farmers and 2500 students were trained on zoonotic diseases. Technical trainings were organized for 12 officers and 14 mid-level technicians. Four regional workshops were organized and attended by 302 participants. Overseas training courses were organized for veterinary epidemiology for 16 scientists, diagnostic on emerging and reemerging zoonotic diseases for 10 scientists, GIS and disease modelling for 4 scientists, and procurement management training for 11 management staff were organized. Publications on zoonotic diseases, climate trend analysis, GIS mapping of diseases were produced in addition to a TV documentary on zoonotic diseases. Component C 66. Monitoring of priority zoonotic diseases is being carried out on a monthly basis. Refurbishment of BSL 2 Plus laboratory has been completed. This was an activity that was supposed to have been completed under the AICP but due to financial constraints it remained outstanding, also noted by the IEG. Today, the laboratory has been completed and is now in operation. 67. Guideline on animal bite management and brochures and manuals on prevention and control of Zoonotic diseases have been developed for circulation. A Draft Act for prevention and control of infectious diseases has been developed. 68. Procurement of hospital equipment (ventilator, mobile X-ray, suction pump, syringe pump, and blood gas analyzer) and laboratory equipment (nucleic acid sequencer, RT-PCR machine, freezers, microscope, auto-pipette, and centrifuges) has been completed. 69. Training courses have been implemented as planned, covering a wide range of topics such as prevention and control of zoonotic diseases, nucleic acid sequencing, animal bites management etc. 17 Component D 70. All communication materials (leaflets, posters and pamphlets) and training toolkits were developed and finalized with the approval authority and are in process of printing and distribution. There were 120 packages (benefitting 12,000 people) delivered under this category. A total of 77 packages (benefitting 4560 people) were completed in the last (2013) and first (2014) quarter period and the remaining packages were completed in the last quarter of the project period. The overall physical progress under this category was recorded to be 87 %. The printing and distribution of zoonotic leaflet, posters and brochures is expected to be completed as per projects Target. 71. There were 50 packages of deliverables (material preparation for printing) under this category. A total 49 packages were completed and handed over to ZCP. All materials of Animal Health and NARC component were printed and are under distribution except for the Human Health component. The overall physical progress under this category was recorded to be 87%. The details of deliverable packages are presented in the Table below. Progress status - Communication up to March 2014 SN Activities Status Progress level 1 Preparation of Project Brochure. 5000 copies of Brochure Completed Printed and in distribution is going on 2 Preparation of IEC material/ Brochure in Nepali Draft prepared and approved Completed language for following 6 zoonotic diseases by Communication working a. Avian Flu group. Now awaiting consent b. Brucellosis of NHEICC for publication c. Leptospirosis and distribution. d. Hydatidosis e. Cysticercosis f. Toxoplasmosis 3 Draft materials for Other awareness materials Draft prepared and submitted Completed (messages) in Nepali language to Directorate of Livestock a. Avian Influenza leaflet Training and Extension for b. H7N9 leaflet approval and other necessary c. Leptospirosis poster action d. Toxoplasmosis poster 4 Drafting of document on PDIC formation and Both Drafts prepared and 60% mobilization submitted to Project Office Program a. Composition and responsibilities in Nepali and Directorate of Livestock dropped in language. Training and Extension for second review b. Detailed concept and procedure in English necessary action mission Source: Final progress report, NZCP, May 2014. 18 Annex 3. Economic and Financial Analysis (including assumptions in the analysis) 1. This assessment is based on an economic impact assessment which was commissioned by the WB office Nepal through FAO-TCI in January 2014. It was focused on HPAI, which is one of the 6 priority ZDs targeted by the project because of the history and the large number of HPAI outbreaks and containment efforts that took place during the project implementation. This was a unique opportunity to assess the effectiveness and relevance of the project. 2. The Nepal Zoonosis Control Project (NZCP) is a follow-on project to AICP in terms of building veterinary service capacity to prevent and control HPAI and other livestock diseases. The GON and other development partners have been providing their support in strengthening veterinary and public health service capacity which has been beneficial in controlling HPAI H5N1 and other diseases. Strong veterinary and public health service capacity is a public good and crucially important factor in controlling ZD such as HPAI. NZCP funding was certainly effective in strengthening the ZD control capacity and benefits to this investment can be derived from the control of a wide array of animal diseases with knock-on effect beyond the agricultural sector. Attributing the benefits of controlling a single disease to the costs of building and maintaining effective veterinary and public health infrastructure would significantly underestimate the benefits of veterinary and public health capacity development. This economic analysis is focusing on the assessment of HPAI losses during NZCP. Assessed HPAI losses illustrate the economic importance of strong veterinary service capacity. Project Costs 3. At project closure, NZCP costs were about USD 8.46 million financed by the Avian Human Influenza Facility (AHIF) grant. Project Benefits 4. Benefits are driven by avoided losses of poultry breeding stock and subsequent production declines. For quantifying these benefits two scenarios were considered (with and without project) in order to measure, from the difference between scenarios, the loss avoidance. Poultry Sector Project Benefits 5. The analysis assesses the economic impact of occurred losses in the poultry sub-sector during the implementation of the project. Nepal has a highly specialized commercial poultry production sector which depends on day-old parent stock imports. Lost parent stock would result in reduced production for an extended time period after the containment of HPAI due to the required growth period until birds are productive again and produce production stock. A value chain model is developed to estimate the economic knock-on effects of lost commercial poultry breeding stock. HPAI outbreaks had limited impact on native poultry production and therefore the following analysis is focused on commercial poultry production. Before the onset of the H5N1 epidemic in 2013 the commercial poultry sector had an output of 25.4 million eggs and 1.9 million broilers. A total production value of USD 7.4 million per week is equivalent to 2.04% of Nepal’s GDP. The main inputs in terms of costs were feed, breeding stock, and staff. After payment of the aforementioned main inputs an approximate gross margin of USD 1.9 million was generated per week by commercial poultry farms. 6. More than 1.7 million poultry were culled or died during the HPAI outbreaks in 2013 (Table 2). The lost poultry had a domestic market value of about USD 9 million. Control efforts prevented a much larger spread. About 60% of the high value broiler breeding stock and about 85% of the layer breeding stock was saved. This has prevented severe supply shortages of replacement breeds for poultry meat and egg production and the poultry subsector has commenced importing breeding stock which will result in full production recovery within 6 – 9 months. Culling upon confirmation of HPAI suspicions combined with low compensation rates are proving to be a disincentive for farmers to report signs of HPAI in poultry. NZCP provided USD 886,000 for culling and compensation operations on a one-time basis. This has also led to earmarking of compensation funds within the 19 GON budget (NR 110.0 million in 2013). A policy supportive of compensation has been initiated but leaves room for improvement to reduce farmers’ reporting disincentives. Culling and compensation operations could not be sustained from GoN budget allocations if HPAI were to re-occur at a similar magnitude as in 2013. A revision of the compensation rate to reflect higher market values of poultry would worsen this situation. Table 2: Poultry losses from culling and mortality in 2013 Market Compensation Compensation Birds, value rate % of market Eggs, kg (USD/unit) (USD/unit) value Total loss (USD) Broiler PS PS growers 83,30829 11.95 5.15 43% 995,398 PS productive birds 167,71229 20.62 5.15 25% 3,457,970 Layer PS PS growers 4,84329 11.95 5.15 43% 57,868 PS productive birds 13,00029 25.77 5.15 20% 335,052 Total PS 268,862 - 4,846,288 Broiler < 4 weeks 442,980 0.77 0.52 67% 342,510 Broiler > 4 weeks 675,902 2.58 1.34 52% 1,742,015 Layer > 4 weeks 253,761 6.19 1.34 22% 1,569,656 Backyard > 6 weeks 18,781 15.46 1.34 9% 290,428 Backyard < 6 weeks 19,131 3.09 0.52 17% 59,168 Eggs 2,122,414 0.08 171,398 Feed kg 116,132 0.36 41,903 Meat kg 497 2.16 1,076 Total birds lost 1,679,417 - 9,064,442 7. Source: FAO-TCI mission report, January 2014Commercial poultry production declined from an output value of USD 7.4 million to USD 5 million per week from June 2013 for about 9 months (Table 3). This is due to the loss of 40% of broiler and 15% of layer parent stock. A minimum time period of about 42 to 56 weeks is required to resume full production of commercial poultry meat and eggs after parent stock is culled due to HPAI infection. A period of 49 weeks is assumed with reduced output of poultry meat and eggs due to lost breeding stock (40% broiler and 15% layer breeding stock). The poultry production value decline for a time period of about 49 weeks accumulates to a declined output value of USD 119 million which is equivalent to 0.63% of Nepal’s annual GDP. The gross margin decline accumulated to USD 38.8 million for a 49 week period of declined output after the HPAI outbreak in 2013. Domestic poultry farmers’ losses were limited to the gross margin loss from declined production. The outbreaks did, however, slow down the recent dynamic growth in commercial poultry production and therefore have likely resulted in lost value addition opportunities. The national economy was faced with the entire declined output value. The declined domestic poultry production value was, to some extent, likely replaced with formal and informal imports from other countries. Nepal is a net importer of livestock and therefore also the replacement of poultry meat with other meat substitutes has likely occurred. Table 3 Production value and gross margin decline post HPAI in 2013 Total output pre HPAI in USD per week 7,435,084 Total output post HPAI in USD per week 5,003,735 29 From July to August 2013 DLSO staff culled 211,813 broiler parent stock and 8,601 layer parent stock. Additional private culling and mortality has occurred. The presented numbers in the table are adjusted for this and derived from a value chain model based on industry estimates of broiler DOC production subsequent to HPAI outbreaks. 20 Declined production output in USD per week 2,431,349 Decline production time period in weeks (average for layer & broiler) 49 Accumulated decline of production output over 49 weeks post HPAI in USD 119,136,092 Accumulated gross margin decline over 49 weeks post HPAI 38,751,545 Source: FAO-TCI mission report, January 2014 8. Poultry inventory losses of USD 9.0 million and accumulated decline of production output over 49 weeks post HPAI of USD 119.1 million resulted in a total HPAI H5N1 related economic impact of USD128.2 million for the commercial poultry sector during and subsequent to outbreaks in 2013. 9. Human Health Project Benefits were not quantified although the project has had significant impact by preventing the spread of HPAI from poultry to humans. The control of HPAI in Nepal represents a global public good. The risk of an emergence of a human influenza pandemic is increasing with uncontrolled multiplication of HPAI viruses in poultry and subsequent infections of humans. HPAI control measures supported by the project are therefore reducing the global pandemic risk. Even though the risk level of the emergence of a human pandemic influenza virus from HPAI viruses in poultry is unquantifiable and the timing of such an event is not predictable. The costs of such an event, if it were to occur, are so high that actions to control HPAI can be justified on this basis alone. The cost estimates for the emergence of a human pandemic strain of HPAI vary considerably but losses to the global economy in the order of hundreds of billions of dollars have been proposed. Therefore the project’s benefits resulting from the contribution to the global good of HPAI pandemic prevention are not quantified within the economic analysis. This is not meant to underplay the benefits associated with reducing the risk of a global pandemic. It prevents basing the analysis on highly speculative assumptions while facilitating an analysis of the profitability of HPAI control within the agricultural sector. Animal to human transmissions of HPAI has not been reported in Nepal. This shows the success in reducing the risk of human exposure to HPAI virus. A without-project scenario would have led to wider spread of HPAI and resulted in human cases with fatalities. The value of human life is not quantifiable and therefore not accounted for in this analysis for the without project scenario. 10. Other Possible Non-quantified Benefits are substitution effects between livestock subsectors. Short time demand declines occurred due to consumers’ health risk with subsequent surplus production of poultry meat. Demand for poultry meat substitutes such as goat, beef and pork increased. Supply of poultry meat substitutes such as goat and pork is inelastic in the short term and therefore market prices increase which leads to increased expenditures for urban households. Substitution effects with other livestock subsectors are not accounted for due to a lack of available market data on price fluctuations for poultry and other meat products as well as their cross- price elasticity. Scenarios 11. The ‘with project scenario’ represents an HPAI impact analysis of actually occurred losses in the poultry sub-sector during NZCP implementation.30 This includes losses from 1.7 million dead or culled poultry which includes the loss of 40% the broiler breeding stock losses and 30% of the layer breeding stock. 12. Under the ‘without project scenario’ wide spread HPAI in poultry is assumed. This would lead to a doubling of poultry losses compared to with-project scenario (Table 4). A prediction of the quantity of lost poultry in the absence of project support is speculative. Assuming a doubling of losses in all commercial poultry production systems appears, however, a reasonable and conservative estimate. A limited number of human cases are assumed for the without-project scenario. Table 4 with and without project scenario With-project Without-project Parent layer breeding stock loss 15% loss of total parent layers with 30% loss of total parent layers with 30 TCI-FAO mission report, January 2014 21 With-project Without-project subsequently declined poultry subsequently declined poultry production output value production output value Parent broiler breeding stock loss 40% loss of total parent layers with 80% loss of total parent layers with subsequently declined poultry subsequently declined poultry production output value production output value Total poultry mortality 1.7 million birds 3.4 million birds Human cases of HPAI H5N1 None Few mild cases Economic Rate of Return 13. The analysis shown in Table 5 relates HPAI control and prevention costs to the benefits in the poultry sub-sector in 2013/14 for two year period of NZCP. Benefits are attributed to NZCP based on the NZCP share in providing HPAI control funding to the GON. NZCP project costs contributed about 97% of all HPAI control and prevention funds from development partners. A NPV of USD 98 million was calculated for the NZCP investment. The market prices used for poultry products are considered to be economic prices, because the markets, for the most part, operate freely without production quotas and subsidies for poultry or poultry inputs. Wages and other market prices used in the analysis are also assumed to be economic prices. NZCP was also aimed at building capacity to respond to other priority zoonotic diseases. The potential benefits of controlling other priority zoonotic diseases are not included and therefore potentially underestimate the benefits. Table 5: Nepal: Economic Analysis of the Nepal Zoonosis Control Project Total 2013 2014 With project WB NZCP costs 8,455 5,060 3,395 FAO HPAI control costs 290 130 160 Total HPAI control and prevention costs 8,745 5,190 3,555 Lost poultry stock 9,064 9,064 - Loss due to declined poultry production 119,136 59,568 59,568 Costs due to HPAI with project 136,946 73,822 63,123 Without project FAO HPAI control costs 290 130 160 Total HPAI control and prevention costs 290 130 160 Lost poultry stock 18,129 18,129 - Loss due to declined poultry production 238,272 119,136 119,136 HPAI H5N1 costs without project 256,981 137,525 119,456 Net benefits 120,036 63,702 56,333 Net benefits attributed to NZCP 31 116,055 61,590 54,465 Net Present Value = USD 98 million Return on Investment (ROI) = 1,362% 14. A sensitivity analysis concerning the mortality by HPAI in the poultry sector in the “with project” situation during the 2013 outbreaks was undertaken and the results are shown below (Table 6). The economic returns to the NZCP are highly robust, even under highly conservative parameters (mortality “with project” increased by 1.44 million poultry compared to base case “without project”) that severely restrict the benefit estimation. The results show a return to the project for the two year implementation period. Expanding the analysis to future benefits from avoided mortality in poultry and also incorporating human health benefits would further increase the returns to the project. 31 Attribution of benefits according to NZCP share in total funding. NZCP share was 96.68%. 22 Table 6: Nepal: Economic Returns and Sensitivity Analysis Mortality by HPAI (million birds) NZCP Returns With Project Without Project ROI NPV (USD million) Base Case 1.70 3.39 1,362 98.41 Scenario 1 1.87 3.39 1,280 92.49 Scenario 2 2.29 3.39 1,157 83.60 Scenario 3 2.72 3.39 952 68.79 Scenario 4 3.14 3.39 747 53.98 23 Annex 4. Bank Lending and Implementation Support/Supervision Processes (a) Task Team members Names Title Responsibility/ Specialty Unit Lending (The system pulls from Task Team in PAD Data Sheet, if any .) Norman Bentley Piccioni Sr. Rural Development Rural development GAGDR Spec. Bigyan B. Pradhan Sr. Operations Officer Finance management SACNP Rohan G. Selvaratnam Operations Analyst GPSOS Tara Shrestha Program Assistant Program Assistant SACNP Bigyan B. Pradhan Sr. Operations Officer Finance management SACNP Shambhu Prasad Uprety Procurement Specialist Procurement Specialist GGODR Supervision (The system pulls from Task Team Members in all archived ISRs.) Name Title Specialization Unit Manav Bhattarai Health Specialist Health Specialist GHNDR Purna Bahadur Chhetri Sr. Rural Development Spec. GAGDR Dikshya Dawadi Consultant Consultant GAGDR Drona Raj Ghimire Environmental Specialist Environment GENDR Parthapriya Ghosh Sr. Social Development Spec. Senior Social Development Spec. GURDR Yogesh Bom Malla Financial Management Spec. Financial Management Specialist GGODR Mohinder S. Mudahar Consultant GAGDR Norman Bentley Piccioni Sr. Rural Development Spec. Rural development GAGDR Bigyan B. Pradhan Sr. Operations Officer Finance management SACNP Rohan G. Selvaratnam Operations Analyst GPSOS Tara Shrestha Program Assistant Program Assistant SACNP Timila Shrestha Financial Management Spec. Financial Management Spec. GGODR Shambhu Prasad Uprety Procurement Specialist Procurement Specialist GGODR Hiramani Ghimire Political economy and governance (b) Staff Time and Cost (from SAP) 24 (The system pulls data available for all fields) Staff Time and Cost (Bank Budget Only) US$ Thousands Stage of Project Cycle No. of Staff Weeks (including travel and consultant costs) Lending FY12 6.16 48,082.77 TOTAL: 6.16 48,082.77 Supervision/ICR FY13 26.26 113,021.33 FY14 14.19 78,994.54 TOTAL 40.45 192.015.87 25 Annex 5. Beneficiary Survey Results 1. No beneficiary survey per se was conducted. However, information generated through Knowledge Attitude and Practice (KAP) survey by Development Vision Nepal (DVN) in 6 districts where NZCP was implemented to assess awareness of prevention and control of priority zoonotic diseases among human health workers and general public has been utilized as a proxy for beneficiary perception. KAP data was collected twice: baseline data and a post-training or post-awareness campaign KAP data which would enable evaluating the impact of NZCP trainings and awareness campaigns. Due to the short project duration and delays in receiving funding from MOF the time lag between baseline and post-exposure data collection was only two months and therefore too short to evaluate the effectiveness of NZCP activities on KAP among human health workers and the general public. However, the results of the KAP survey are: KAP survey results Time of data collection January 2014 March 2014 Knowledge (% of all respondents) 44.31 42.16 Attitude (% of all respondents) 56.31 58.78 Practice (% of all respondents) 40.52 45.27 2. Indicator 4.1 ‘Increased awareness of prevention and control of priority zoonotic diseases among human health workers and general public’ of the PAD set the target value for the second year of the project at 40% awareness of all respondents. While there was no baseline set at the beginning of the project, the target set during implementation was achieved. Avian influenza awareness was 82 percent in early 2011 at the end of AICP.32 3. Stakeholder workshops. Poultry sector associations33 and market development committees with private sector members were consulted in the establishment of public private partnerships for the upgrading the biosecurity and waste management of five livestock markets. 32 KAP survey results from AICP ICR report. 33 Nepal Poultry Association, Nepal Hatchery Association, Nepal Feed Association 26 Annex 6. Stakeholder Workshop Report and Results  The Nepal Zoonosis Control Project organized back to back workshop on the 30 and the 31st of March 2014. The workshop was being attended by high officials from various organizations. Day one was chaired by the Director General of the Department of Livestock Services and day 2 by the Secretary and Joint Secretary of the Ministry of Agriculture Development (MoAD). From World Bank, Senior Operations Specialist and Task Team Leader attended the workshop. The second day of the workshop also marked the official closure of the project. Each component presented the progress. Summary of the two day back to back workshops are summarized below:Six zoonotic diseases were prioritized as the diseases of national interest and importance from among the list of pre-identified zoonotic diseases. The diseases identified as priority are: HPAI, Brucellosis, Leptospirosis, Tozoplasmosis, Cysticercosis, and Hydatidosis  The Secretary and Joint Secretary both praised the NZCP for successfully containing the spread of Avian Flu outbreaks, 216 in total.  The construction of model quarantine facility in Belahapur, Bhairahawa was appreciated as it has made quarantine of animals from India into Nepal.  The completion of the Biosecurity Laboratory Plus 2 at the Department of Health, an activity that remained outstanding from the AICP was taken as a big success as it now allows diagnosis of emerging zoonotic diseases in the country itself.  Over the last four years, with the initiation of AICP and further support of the NZCP there is now a One Health approach in operation where both Health and Livestock come together in order to survey, assess, respond to contain zoonotic diseases.  The formation of district level Avian Flu Control Committee is now functional and is chaired by the Chief District Officer.  The Government of Nepal’s commitment to continue to support the capacity built by the NZCP has been demonstrated by allocation of NPR 20 Crores for the FY 2014/15.  The fact that the project was able to disburse 84 per cent of US$ 10 million, despite a very slow start due to late release of money to the project, was applauded.  The support and continued support of the World Bank team in implementing this two year time constrained project was appreciated. World Bank team thanked the Project Director, Dr Indra Kant Jha, without whose hard work, dedication, approach and interpersonal skills, the project would not have been able to achieve the success it has seen today. In fact the participants recognized NZCP as one of the most successful projects the DoLS has seen in the last 10 years.  Finally, the Secretary closed the workshop thanking all those involved in making Nepal Zoonosis Control Project a great success. They included the Nepal Agriculture Research Council, Department of Livestock Services, Department of Health, and consultants that provided NZCP with managerial, financial, technical and procurement support/expertise. 27 Annex 7. Summary of Borrower’s ICR and/or Comments on Draft ICR) Introduction 1. The Nepal Zoonosis Control Project (NZCP) is a two year project which became effective on May 1, 2012. This was a two year project with a budget of US$10 million. The project started one year after the conclusion of Avian Flu Influenza Control Project, also funded by the same Facility. Thus, NZCP in essence can be seen as a follow on project of AICP which ended on July 31, 2011. 2. The main objective of the project is to enhance the country capacity for the prevention and control of infectious diseases that transmit between animals and humans (zoonosis) under a One Health approach. This was to be achieved through the following four key project components: 1) Animal Health (US$ 5.4 million); 2) Climate Sensitive Disease Risk Mitigation (US$ 2 million), 3) Human Health (US$2 million) and 4) Communication (US$0.6 million). Implementation 3. Key implementing institution is DOLS of the Ministry of Agriculture Development, the Nepal Agriculture Research Council (component 2); and the Department of Health (Component 3). The project was managed by the DLS and all funds were managed by DLS itself. Procurement of goods and services for the project as well as for the health component was carried out by DLS and therefore DLS was financially accountable. 4. Although the project was approved in July 2012, disbursement of funds started only in January 2013. During this funding lag, the project worked on preparatory activities such as preparation of procurement plan, drafting of terms of reference for required consultants (financial, procurement, monitoring and evaluation), and in organizing Technical Committee and the Steering Committee which did not require substantial funding. This was possible as the national staff that managed the AICP was transferred to NZCP while they remained in the government payrolls. With funds made available the progress picked up rapidly. 5. While the NZCP could be seen as an extension of the AICP, the focus of NZCP was placed on enhancing capacities for developing surveillance, diagnosis, and laboratory testing and reporting of 6 identified zoonotic diseases selected during the project design. Achievement of Project Development Objective 6. The project achieved its PDO to enhance Nepal’s capacity to pr event and control Zoonotic diseases under the One Health approach. This was achieved in a record of short time period of 15 months of practical implementation. The project was successful in securing coordination between the NARC, DoHS and DLS to survey, plan and control Avian Flu in particular and zoonotic diseases in general. 7. The result indicators for the project were: 1) priority zoonosis identified and prevention and control plans developed for animal and human; 2) mechanism developed to share information on priority zoonotic diseases. The achievements are as follows:  Prioritization of six zoonotic diseases namely HPAI, Brucellosis, Leptospirosis, Tozoplasmosis, Cysticercosis, and Hydatidosis through participatory multistakeholder assessment and consultation. Also two additional priority zoonotic diseases namely Blue Tongue and GI Nematodes were identified. Surveillance plans have been formulated for all the eight priority diseases.  Mechanism for communication and information sharing at the national and in the 75 districts have been developed and data collection has begun at the national and district levels. The National Avian Influenza Information Committee has been redefined to include all zoonotic diseases. In addition to DoLS and DoHS, the committee also includes representatives of NARC and FAO. 28  In addition to above, the project made notable contributions in: i) completion of Biosecurity Laboratory level 2 plus at the Department of Health; ii) development of Animal Health Policy, iii) development of surveillance plans for key zoonotic diseases, iv) construction of veterinary standard and drug administration laboratory at Budanilkantha, Kathmandu; v) regional laboratory in Biratnagar; vi) one new model quarantine facility in Belahiya, Bharahawa; vii) construction of district livestock office in Kathmandu.  The capacity enhancement targets for prevention and control of infectious diseases was achieved building on the infrastructure developed by AICP. Indicators include: 1) training and communication outreach and awareness building of 54,139 (28,549 and 25,593) respectively) farmers in all the 75 districts of which 9,717 were female, exceeding the target of reaching 24,000 farmers; 2) the improved capacity of prevention and control of zoonosis and effective coordination among the three implementing partners was evident in the successful containment of 216 HPAI H5N1 outbreaks; 3) the inter-sectoral consultative ranking procedures and criteria used in the identification and prioritization of zoonotic diseases; 4) development of zoonotic disease control plan and guideline, 5) the number of livestock inspected at model and improved service centers and quarantine offices, 6) identification of climate sensitive diseases, and 7) completion of BSL 2 plus laboratory at the Department of Health Services.  The economic analysis showed a total disbursement of US$8.455 million against US$ 10 million. The disbursement was calculated on the basis of NPR 95 to a dollar. If the exchange rate of NPR 80.33 at the time of project agreement was to be used the disbursement would have been close to a hundred percent. Economic analysis of possible loss to poultry, employment and impact on tourism showed a net present value of USD 98 million.  Independent survey of knowledge attitude and practice (KAP) in 6 districts where NZCP was implemented showed nearly 50 per cent of the people surveyed were found to be aware of Avian Flu in particular and Zoonotic disease in general. Lesson learned 8. The following summarizes the lessons from the NZCP  Government commitment to the continuation of the investment made through other HPAI projects was a crucial factor in achieving NZCP’s PDO inspite of the tight and very short implementation period.  Dedication of project management and staff and close collaboration with the WB’s TTL and specialized administrative support and the continuation of AICP project management and staff and commitment of GoN and its provision of advance resources to allow for project start up and planning and support of management consultants made it possible achieve the project objectives and targets  Effective day to day supervision and support from TTL is both crucial and required.  Centralized and strong M and E and Planning Unit is crucial for effective technical support. The M and E system which was developed during the AICP, led by capable consultant(s), located at DoLS contributed substantially to the project success.  The centralized system of project financing, procurement and budget management provided two benefits: reduction of transaction cost and enhancement of inter-sectoral collaboration for the development of cost effective One Health approach.  KAP is a strategic M&E tool which could help evaluate the impact of initiatives such as the ones taken up by NZCP. But, they need to be administered at appropriate times to get reliable results that can be used for the future. The NZCP project being a very short duration project, suffered from the lack of spacing between the two surveys. 29 Annex 8. Comments on Implementing Completion Report by the Implementing Agency and Partners The Bank distributed the ICR to the Government of Nepal and the implementing partners. The comments received indicated that the report was well accepted and there were no specific comments. The overall contribution of the project was well appreciated by the clients demonstrated by the following positive comments received from them. We appreciate and thank the World Bank for making funds available for this short but high impact Project that has produced tangible results. The NZCP is one of the projects that has performed so well with clear and tangible results the Ministry of Agriculture as implemented in the last few years. We take this opportunity to highlight the following key achievements: 1. Despite a slow start initially due to internal problems related to release of funds from the Government side, the project made substantial physical and financial progress. 2. Thanks to the Nepal Zoonosis Control Project, the Government of Nepal was able to control and contain the spread of Avian Flu in the last two years. A total of 216 outbreaks were contained successfully. This would not be possible if not for the capacity built in surveying and responding to HPAI. 3. The funding support made available by the NZCP to complete the construction of Biosecurity Laboratory 2 plus at the Department of Health Services at Teku, an activity that remained outstanding from the Avian Flu Influenza Project, is much appreciated. The laboratory is functional today and has built the capacity to diagnose. 4. One major achievement of the NZCP is the initiation of the much needed One Health approach in Nepal to address zoonotic diseases. This has been demonstrated by consorted effort by the DOLS and DOHS in addressing avian flu outbreaks in the last 2 years. 5. We are pleased to inform you that the Government of Nepal has made available NPR 95,551,000 Crores to Bird Flu Control Project for FY 2014/15 in order to support and internalize the gains made by AICP and NZCP. While we are committed continue this support on long term basis, we would also like to highlight the importance of donor support for livestock sub sector in Nepal. With the conclusion of the NZCP there is practically no donor support in this sector. Livestock s an integral part of the Nepalese farming system and is well built into the local culture and is a source of livelihood over 60 per cent of its people, particularly in the rural area. We look forward to another opportunity to collaborate with the World Bank in this important sub sector to help the rural poor and contribute towards the goal of Government of Nepal to alleviate poverty. 30 Annex: List of Supporting Documents Additional references are cited as footnotes in the report. 1. Project Appraisal Document, April, 2012 2. Nepal - Interim strategy note for the period, FY2012-2013, August 2011 3. Aide-Mémoire Implémentation Support mission Consultation October, 2012 4. Aide Memoire Implementation Review and Support Mission June, 2013 5. Aide Memoire Implementation Review and Support Mission January, 2014 6. Draft WB Country Assistance Strategy (CAS) 7. NZCP Implementation Progress Report, May 2014 8. OIE, “Evaluation: Performance of Veterinary Services (PVS) in Nepal”, June 2011 9. NZCP Operational Plan, July 2012 10. Project Information Document (PID) Appraisal Stage, March 2012 11. NZCP Environmental Management Plan, March 2012 12. Integrated Safeguards Data Sheet Appraisal Stage, April 2012 13. Regional Training in Animal and Human Health Epidemiology in South Asia – Strategic Overview, Phase 2 December 2011 – December 2013 14. NZCP KAP survey report, March 2014 15. Implementation Completion Report (ICR) Review - Avian Influenza Control Project, December 212 16. European Commission – AFRICA Evaluation of the Support Program for Integrated National Action Plans on Avian and Human Influenza (SPINAP–AHI), January 2012 17. Agriculture and Food Security Project (AFSP) - Project Information Document (Appraisal Stage), October 2012 18. Pilot Program for Climate Resilience (PPCR) PAD, December 2012 19. NZCP Surveillance Plan for priority Zoonosis, 20 NZCP Economic impact assessment for priority Zoonosis 21. Economic impact of the NZCP in containing the spread of Avian Influenza – TCI-FAO mission report, March 2014 22. PPAR Nepal AI Control 23. ASR NEP ZCP -Modahar May 2012 24. ASR NEPAL NZCP Report Hinrichs Jan14 25. PPAR Nigeria AI control and human pandemic preparedness and response project 26. ASR Nepal AICP Kennard November 2009 27. EMP ZCP 2012-2014 28. OH IEG Global Evaluation 29. Development Vision AICP Impact Study March 2014 30. WB Safeguard Data Sheets for ZCP Appraisal Stage 31. WB PID ZCP Appraisal Stage 32. WB Implementation Status Report 29-Sep-2013 31 Map of locations covered by the Nepal Zoonosis Control Project -- IBRD 33455 32