MID-TERM REVIEWTERM REVIEW OF THE...

MID-TERM REVIEWMID TERM REVIEW OF THE CONTRIBUTION BY THE EUROPEAN COMMISSION

TO THE AVIAN AND HUMAN INFLUENZA FACILITY (AHIF)

IN EAST AND SOUTHEAST ASIA

P t ti t thPresentation to the AHIF Advisory Board

October 15, 2009

This project was financed

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This project was financed by the European Union

This project was implemented by IBF International Consulting

Evaluation Mission Parameters• Field Mission: March 8 – April 16, 2009• Mission Contacts:

Br ssels Mission briefings and debriefings E ropeanBrussels Mission briefings and debriefings, European Commission and IBF International consulting

World Bank Interviews and data collectionThailand Regional offices EC, WHO, FAOLao PDR Project evaluationVietnam Project evaluationCambodia Project evaluationIndonesia Project evaluationHome Base Report writingHome Base Report writing

• Mission members Brian Brandenburg, Team Leader and Animal Health Specialist

Roberto Esposito Public Health Specialist

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Roberto Esposito, Public Health Specialist

Frans van Andel, Health Economist

Evaluation DesignA logical framework was prepared from which 5 evaluation questions emerged:

Question 1: How well does the World Bank manage the European Commission’s contribution and comply with AHIF Advisory Board procedural and operating p y y p p gmodalities?

Question 2: What is the status of grant implementation, and what are the actions to date and expected results at both the general and country-specific levels?

Question 3: What are the efficiency, effectiveness and sustainability of supported actions being implemented, and what is their relevance with respect to the program’s main objectives?

Question 4: To what extent have AHIF-supported projects, in a sustainable manner, contributed to the strengthening and coordination of veterinary and human health services, and fostered human and animal health services collaboration at the national and sub-regional levels?

Question 5: What improvements, if any, can be made in the AHIF and what future actions which the Commission’s grant financing might foster to promote cross-border cooperation in animal and human health in East and South Asia can be considered

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Question 1: How well does the World Bank manage the European

Commission’s contribution and comply with AHIF Advisory Board p y yprocedural and operating modalities?

Conclusions:Based on a review of technical and financial documentation provided by Bank p y

Headquarters and Country offices,

• The Bank’s management procedures of the AHIF (and thereby the European Community) grant are being conducted in full compliance with p y) g g pAHIF Advisory Board regulations.

• Donor visibility leaves room for improvement by both the Bank and the Commission

Recommendations:• Donor visibility can be improved by adopting some or all of the

recommendations maderecommendations made

• Subcontracting issues Bank partners have often been problematic. The agreed upon waiver with WHO should provide a remedy.

4• The Bank should ensure that the WHO waiver is indeed being complied with

at the operational level

Promoting Donor VisibilityThere is room for the Bank and the Commission to further strengthen their efforts to

promote donor visibility. The following recommendations should be considered:

TTL h ld th t d i ibilit d t b k d t th ti l j t• TTLs should ensure that donor visibility does not break down at the national project management level

• Adopt a Best Practices approach by identifying AHI projects that respond well to the Donor Visibility GuidelinesDonor Visibility Guidelines

• Insert a page of the Donor Visibility Guidelines in the Project Implementation Manual (PIM) to ensure that local project staff is aware of and implement this requirement

• European Commission Country Delegation staff should be more responsive in attending Bank or project functions related to AHI projects in their countries

• European Commission staff should be invited by Bank staff to join supervision wrap-ti k h t k t i AHI j t i i i iup meetings, workshops, or take part in AHI project supervision missions

• Bank staff and staff European Commission Delegation staff should improve timely and adequate information exchanges related to their AHI projects and thereby improve information sharing

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improve information sharing

Question 2 What is the status of grant implementation, and what are the actions to date and expected results at both the general and

country-specific levels?

Status of grant financing by source of funds (at 31 March 2009)

AHI Country IDA Credit /a IDA Grant /a PHRD Grant AHIF Grant GOVTotal

FundingAfghanistan 5.4 5.00 10.4Bangladesh 18.0 2.00 20.0gBhutan-1 1.30 1.2 1.3Bhutan-2 1.20 1.2Cambodia 6.0 6.0Cambodia 3.0 2.00 5.0Indonesia 5.0 10.00 15.0Lao PDR 4.0 2.0 2.52 8.5Mongolia 4.656 4.7Sri Lanka 1.43 1.43Vietnam 20.0 5.0 10.00 3.0 38.0Total financing (USD mln) 20 0 33 4 15 0 40 106 4 2 112 71mln) 20.0 33.4 15.0 40.106 4.2 112.71Total financing (Euro mln) 15.2 25.3 11.4 30.4 3.2 85.4% Financing 17.7% 29.6% 13.3% 35.6% 3.7% 100.0%/a IDA credits and grants are disbursed simultaneously

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Question 2 What is the status of grant implementation, and what are the actions to date and expected results at both the general and p g


Disbursement of AHIF at Country level from Bank and Project Accounts at 31 March 2009

Disbursement from Bank to Project level reached 15 9%Disbursement from Bank to Project level reached 15.9% Disbursement from Project to Beneficiary level reached 10.8%

Total Bank Project % Bank % ProjectAHIF Budget Disbursement Disbursement disbursement Disbursement

Country Allocation of AHIF /a of AHIF /b of AHIF of AHIFVietnam 10,000,000 1,278,425 957,631 12.8% 9.6%L PDR 2 520 000 1 078 820 672 864 42 8% 26 7%Lao PDR 2,520,000 1,078,820 672,864 42.8% 26.7%Bhutan 2,500,000 795,026 376,244 31.8% 15.0%Cambodia 2,000,000 230,648 325,648 11.5% 16.3%Afghanistan 5,000,000 500,000 42,762 10.0% 0.9%Bangladesh 2,000,000 295,135 288,455 14.8% 14.4%Mongolia 4,656,000 500,000 442,335 10.7% 9.5%Sri Lanka 1,430,000 705,064 314,359 49.3% 22.0%Indonesia 10,000,000 1,000,000 925,169 10.0% 9.3%Totals, USD 40,106,000 6,383,118 4,345,467 15.9% 10.8%Totals, Euro 30,400,348 4,838,403 3,293,864

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/a From AHIF Quartely Report January 1 - March 31, 2009/b From AHI project disursement records

Question 2 What is the status of grant implementation, and what are the actions to date and expected results at both the general and p g


Comparative AHIF Disbursement at regional levelWith the exception of the Africa region the Asia Region (EAP) under which the Commission’s EWith the exception of the Africa region, the Asia Region (EAP) under which the Commission s E

and SE Asia portfolio falls shows disbursement rates similar to the other regions. According to Bank trust fund managers, the rates of AHIF trust fund disbursement, although slow, are similar to those experienced with the disbursement of other trust funds

8From: 11th Quarterly AHIF Report, World Bank, 31 March 2009

Question 2 What is the status of grant implementation, and what are the actions to date and expected results at both the general andactions to date and expected results at both the general and


Processing time of Bank approvals and Government effectiveness (in days)

Party Responsible Bank Government Bank + Government

AHI Project Countries Appraisal to ApprovalApproval to

EffectivenessAppraisal to

Effectiveness

Lao PDR 58 223 281Lao PDR 58 223 281

Vietnam 81 244 325

Afghanistan 91 230 321

Indonesia /a n/a n/a 180

Lao PDR 58 223 281Lao PDR 58 223 281

Bhutan /a n/a n/a 75

Bangladesh 219 118 337

Cambodia n/a n/a 430

Sri Lanka /a n/a n/a 135Sri Lanka /a n/a n/a 135

Average Time Lag (Days) 101 208 263

Processing Time Share 39% 79% 100%

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Bank and Government processing times occupy 39% and 79%, respectively. Government processing time takes almost twice as long as Bank processing

Question 2 What is the status of grant implementation, and what are the actions to date and expected results at both the general and

country-specific levels?Evaluation: The slow disbursement rates do not reflect the substantial on-the-ground

progress madeprogress made

Recommendations:• A time-bound processing period (i.e. 8 weeks) for emergency projects would p g p ( ) g y p j

shorten processing time and speed up grant effectiveness• Seven of the nine AHI projects implemented in the E and SE Asia regions

have a good chance of meeting their development objectives. • Indonesia (weak government commitment) and Afghanistan (a country at ( g ) g ( y

war) are the exceptions • The INAPs and pandemic preparedness plans developed will significantly

improve country capacity to address existing (HPAI) and emerging transboundary and zoonotic disease threats (e.g. swine flu)

• More capacity building is needed in veterinary and medical epidemiology and public health management

• Procurement and monitoring and evaluation capacities are generally weak and hamper project management quality

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• More project outreach is needed to civil society groups at the grassroots level, especially in biosecurity, minority and migrant groups advocacy, and grassroots surveillance

Question 3What are the efficiency, effectiveness and sustainability of

supported actions being implemented, and what is their relevance pp g p ,with respect to the program’s main objectives?

1. Grant Efficiency• Risk assessment Project TTLs should improve key risks when• Risk assessment. Project TTLs should improve key risks when

preparing their AHIF grant applications so that more proactive risk mitigation can be instituted during project preparation, thereby avoiding potential bottlenecks that hamper effective implementation

• Compensation comprises 13.3% of total AHIF commitment ($5.3 million or €4 million) to E and SE Asia, but little has been disbursed

th lt f k ti li i l tias the result of weak compensation policies, long compensation times, inadequate compensation processing logistics, and financial management issues

• A Best Practices effort: Lao PDR disburses compensation within 3 weeks of claims presented, by having district governments pay up front, using the compensation fund as collateral for subsequent

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, g p qreimbursement



2. Grant Effectiveness• Grant-financed AHI projects are monitored by the Bank through

Grant Reporting and Monitoring (GRM) reports• IDA-financed AHI projects are monitored by Implementation Status p j y p

Reports (ISR)

The GRM evaluation parameters are twofold:The GRM evaluation parameters are twofold: • Success toward achieving grant objectives, and • Evaluation parameters related to project implementation: project

component implementation financial management procurementcomponent implementation, financial management, procurement, fiduciary matters, monitoring and evaluation, counterpart funding, compensation and disbursement

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supported actions being implemented and what is their relevancesupported actions being implemented, and what is their relevance with respect to the program’s main objectives?

Based on these parameters, the 9 projects in the E and SE Asia f li i d h f ll i iportfolio were assigned the following ratings:

Percentage of ratings across the 9 portfolio projects:– 0% Highly Unsuccessful (HU)– 9% Unsuccessful (U)– 9% each Moderately Unsuccessful (MU)– 24% Moderately Satisfactory (MS)– 57% Satisfactory (S)– 0% Highly Satisfactory (HS)

• Most of the HU, U and MU ratings related to , gprocurement, monitoring and evaluation, and to a lesser extent to financial management and component implementation

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p



Grant Reporting and monitoring (GRM) ReportsNumber of recorded ratings assigned to

Country Risk Factor HU U MU MS S HS Total

Success in Achieving

Grant Objectives

Number of recorded ratings assigned to implementation progress criteria

Afghanistan High U 5 1 6Bangladesh Substantial NR 3 1 4Mongolia Modest S 10 10Cambodia Low S 5 5Lao PDR Substantial S 11 11Bhutan Modest S 1 4 4 9Sri Lanka Modest SMongolia Low SVietnam Substantial MS 9 9

Totals by Rating 0 5 5 13 31 0 54y g% Total by Rating 0% 9% 9% 24% 57% 0% 100%

HU - Highly Unsatisfactory /a Implementation Progess includes: project ocmponent performance, counterpart funding, U - Unsatisfactory financial management, feduciary issues, procurement, monitoring and evaluatioMU - Moderately UnsatisfactoryMS - Moderately Satisfactory

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MS Moderately SatisfactoryS - SatisfactoryHS - highly SatisfactoryNR - Not recorded


supported actions being implemented and what is their relevancesupported actions being implemented, and what is their relevance with respect to the program’s main objectives?

Th l i fl h i i l i• The lowest ratings reflect the most critical issues :• Weak project management (Afghanistan, Bhutan, Indonesia,

Mongolia); • Procurement (Afghanistan Vietnam Bangladesh);Procurement (Afghanistan, Vietnam, Bangladesh); • Implementation of the Animal Health Component (Afghanistan,

Bangladesh); • Implementation of the Human Health Component (Afghanistan,

Bh t Vi t )Bhutan, Vietnam);• Slow or delayed recruitment/capacity of project staff and consultants

(Afghanistan, Lao PDR, Cambodia, Indonesia, Bangladesh);• Contract signing delays with FAO and WHO (AfghanistanContract signing delays with FAO and WHO (Afghanistan,

Cambodia) and,• Disbursement delays (Bangladesh, Bhutan, Cambodia, Lao PDR,

Vietnam).



Recommendations to improve implementation quality and timeliness:

• GRM reports should be rated more objectively by persons/units rather than be the TTLs themselves

• The OP8 00 Bank guidelines for emergency operations were designed to ensure• The OP8.00 Bank guidelines for emergency operations were designed to ensure maximum grant efficiency through rapid proposal approval procedures, simplified disbursement, project financing and procurement.

• These guidelines are being hampered by overly slow recipient government g g p y y p gprocedures to reach grant effectiveness and facilitate rapid implementation. This constraint is the result of governments’ inability to shift existing infrastructure from a routine to an emergency mode

• More proactive risk assessment and risk mitigation prior to Negotiations coupled to a• More proactive risk assessment and risk mitigation prior to Negotiations, coupled to a time-bound schedule for government completion of steps to effectiveness, might alleviate some of the delays encountered

• The Commission’s contribution earmarked for compensation is not being efficiently

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p g yused. A more effective compensation payout system needs to be devised that allows better access by claimants and simpler reimbursement procedures . Even though the Bank, FAO and other donors have conducted such studies, more work is needed



3. Sustainability• The sustainability of inter-ministerial coordinating mechanisms is not• The sustainability of inter-ministerial coordinating mechanisms is not

ensured where these entities were established to implement the AHI projects outside existing emergency management structures and therefore have a limited mandate period

• Projects linked to a National Disaster Management Agency have better sustainability prospects, as is the case in Cambodia and Bangladesh—and partly so in Vietnam—which are integral institutions embedded in, and financed by, the governmenty g

Sustained impact will require:• Strong, sustained government commitment by including the incremental

costs of upgraded infrastructures into national budgets pg g• Introduction of cost recovery mechanisms such as fees-for-services

schemes, especially targeted at private sector service users who can afford to pay

• Restructuring of veterinary/human health services commensurate with

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Restructuring of veterinary/human health services commensurate with the roles of public and private services, thereby making government services more cost effective and sustainable

Question 4:To what extent have AHIF-supported projects, in a sustainable manner, contributed to the strengthening and coordination of

veterinary and human health services and fostered human andveterinary and human health services, and fostered human and animal health services collaboration at the national and sub-

regional levels?Th t i bilit f th C i i ’ t ib ti t f t ti l d b i l• The sustainability of the Commission’s contribution to foster national and sub-regional collaboration is, at this stage of project implementation, not assured and will end with AHI project closure, after which many inter-ministerial steering entities will be disbanded

• At the regional and sub-regional levels national and sub-regional strengthening and coordination is mostly undertaken through the efforts of UN partners and the internationalcoordination is mostly undertaken through the efforts of UN partners and the international development agencies

• Coordination between veterinary and public health services at the national and regional levels will not be assured unless sustainable collaboration infrastructures are developed by the recipient governments themselvesrecipient governments themselves

• Commission support to the regional associations of SAARC and ASEAN would help to strengthen these organizations to develop sustainable coordination infrastructures

• The lack of support to SAARC and ASEAN was also quoted in the August 2009 issue of FAOAIDE News, which mentions this as a constraint to improving regional collaboration

• The Integrated National Avian Influenza Plans (INAP) and the National Emergency Management Agencies that exist in some countries are important entry platforms from which

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Management Agencies that exist in some countries are important entry platforms from which sustained, integrated animal and public health service collaboration can be launched

Question 4:To what extent have AHIF-supported projects, in a sustainable manner, contributed to the strengthening and coordination of

veterinary and human health services, and fostered human and animal health services collaboration at the national and sub-

regional levels?

• The Commission’s 2007-2013 program for Asia can contribute significantly to sustaining sub-regional and regional cooperation, but should reach beyond the public sector to private sector stakeholder groups that are directly involved in avian flu and/or HPED controland/or HPED control

• AHI countries with existing disaster management entities have a better change at sustainability by incorporating part or all of their HPAI infrastructures into these entities

• The Inter-ministerial creation of country INAPs, linked to stakeholder lt ti h f d b d d hi th t h th t ti l f l tconsultations, have formed bonds and ownership that have the potential for long-term

viability• Close collaboration between human and animal health services at the AHI

project level has been successful in six of the nine countries that are part of the East and South Asia portfoliop

• Much of the sustained sub-regional inter-service collaboration is driven by the international organizations rather than by the sub-regional countries themselves

• Financial sustainability of the gains made with AHIF-support depend to a large extent on the recipient government’s commitment to include into their national budgets the necessary line items to cover incremental operating costs incurred

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budgets the necessary line items to cover incremental operating costs incurred. • Cost recovery mechanisms toward sustainability should be addressed by AHI

project TTLs and project management, and ways and means found to ensure the financial sustainability of project gains made

Question 5 What improvements, if any, can be made in the AHIF and what future actions which the Commission’s grant financing might

foster to promote cross-border cooperation in animal and human health in East and South Asia can be considered

The following interventions are proposed as The Way Forward beyondThe following interventions are proposed as The Way Forward beyond HPAI:

1. Cross-border collaboration in countering Highly Pathogenic Emerging Diseases (HPED), along the Middle East Consortium on g g ( ) gInfectious Disease Surveillance (MECIDS) which brings together public health leaders, academic institutions and private health care facilities in Jordan, Israel and the Palestinian Authority to improve the ability of nations to detect and respond to infectious disease threatsnations to detect and respond to infectious disease threats(Reference: http://www.mecids.org/docs/MECIDS%20meeting%20report%20January%20200712.doc)

2. Support to the regional organizations of SAARC and ASEAN, to coordination regional responses to HPED and emerging zoonotic diseases

3 St th i b i l di i f ti t b

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3. Strengthening sub-regional disease information systems, by providing support to OiE to organize more workshops on avian influenza information systems in East and Southeast Asia

Question 5 What improvements, if any, can be made in the AHIF and what future actions which the Commission’s grant financing might

foster to promote cross border cooperation in animal and humanfoster to promote cross-border cooperation in animal and human health in East and South Asia can be considered

4. Regional capacity building in risk-based epidemiology, by medium term postgraduate (i.e. M.Sc. level) training of veterinary and public health professionals in each of the Commission’s AHIF portfolio countries

5. Advanced capacity building in pandemic preparedness, utilizing the INAPs prepared by each AHI country to plan for newly emerging disease events, supported by further expansion of patient care infrastructures

6. More grassroots health worker capacity building, by training para-medical and para-veterinary health workers

7. More emphasis on biosecurity and food safety on livestock and poultry farms, live-bird markets, village slaughter facilities and meat markets, including behavior change training of meat market chain

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workers

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