Central Asia AIDS Control Project

The Central Asia AIDS Control Project (CAAP) funded by the World Bank and DFID, is being implemented in four Central Asian Countries (Kazakhstan, Kyrgyzstan, Tajikistan and Uzbekistan). The recipient of the grant for the CAAP is the Eurasian Economic Community (EAEC). The CAAP project has been implemented since 2005 by the Regional Project Management Unit (RPMU) based in Almaty. Recognizing the value of regional cooperation and the need to address multiple determinants of health outcomes, the CAAP Steering Committee is establishing a Central Asia (CA) Regional Health Platform.
Establishment of a regional public health platform under CAAP was undertaken within the scope of the regional strategy on prevention of an HIV-infection epidemic and based on the trends of epidemiological situation in Central Asian countries, as well as lessons learned from coordination and harmonization efforts of many partners at the national and regional levels. Experience in the prevention of infectious and zoonotic infection worldwide as well as in Central Asia shows the effectiveness of regional initiatives that harmonize national programs.
EAEC has received funding in the amount of 3 mln USD from the World Bank Avian and Human Influenza Trust Fund for regional initiatives under the Central Asia Regional “One Health” Project (CAR/OH). This project will target zoonotic and infectious disease control activities with public health and veterinary services in project countries and also consider related food safety risks.
Activities of the Central Asian Regional Project on “One Health” (CAR/OH) will be directed to implementation of main objectives and priorities of the regional public health platform related to zoonotic disease control and food safety.

The proposed project activities are based on the concept of “Health In All Policies,“ which argues that health outcomes are essentially outside of the health care sector, and that effective control of health status and outcomes should include other sectors such as agriculture, transport, education, justice etc. The project activities are also based on the “One Health” approach, which represents a systems approach to contribute to control of health outcomes through the involvement of Veterinary and Agriculture sectors (zoonoses and vector control). Regional cooperation in the public health sector provides opportunities to address systemic issues in the control of communicable diseases in general and advance the reform agenda in the region. The project will mainly support analytical work that would examine key deficiencies in the animal and public health systems that contribute to the weak control of communicable diseases among the people and provide economic analysis and rationale to inform future policies and serve to prioritize reform actions.

The objective of the Project is to assist the Benefiting Countries to manage infectious disease risks, focusing at the human, animal and environmental interface, through strengthening control of infectious diseases, including HIV/AIDS and other infectious diseases from systems perspective and advancing development of the intra-regional cooperation arrangements established under the Central Asia AIDS Control Project.

The following activities, planned to be completed by September 30, 2011, are designed to identify gaps and opportunities that can be supported by future investments to strengthen the control of infectious diseases in the region.

Gap Analysis and Action Plans for Veterinary and Public Health Services
Since the key health determinants outside the health sector are related to agriculture and agri-food systems, the project will fund technical assistance that will focus on identifying gaps in both public health services and in the agriculture sector, focusing primarily on veterinary services.

This component will support completion of the Performance of Veterinary Services (PVS) exercise with the World Organization for Animal Health (OIE) and the follow-up steps, i.e., a gap analysis and development of a detailed strategic plan including legislative review for the Ministries of Agriculture that have not already done so. The strategic plan would set the stage for specific activities to be supported based on availability of Government budgetary resources and donor priorities. The emphasis will be primarily on systemic action rather than response to a specific disease emergency. Emphasis would be placed on the regional aspects of animal disease control, trans-boundary movement of animals in trade and system harmonization including legislation and regulations, information systems, laboratory services, etc.

Similarly, it is proposed to carry out a quantitative and qualitative assessment of public health systems in each country with respect to infectious diseases control, including identifying gaps in health care and public health delivery system, financing, performance incentives, food safety, sanitary systems, outreach services, health promotion and education etc. The assessment would address the alignment with and capacity to implement International Health Regulations (IHRs) relating to infectious disease. The assessment would form the basis for the development of specific national strategic plans with detailed budget and schedules. The project will pilot an assessment tool developed for the One Health program to address ten core public health functions.

Economic Assessment of the Impact of Zoonotic Diseases
Joint actions by the Ministers of Health, Agriculture, Environment and Economy (Finance, etc.) are needed to understand and address the full economic and social impact of emerging, re-emerging infectious diseases, including zoonotic diseases. This should go beyond the calculation of the burden of disease on human health side and include impact on trade, GDP, poverty reduction, gender inequities, nutritional security, etc.

A tool for the economic assessment has been developed by World Bank (ECA region) in cooperation with IFPRI and the Swiss Tropical Institute, and will be available for application in CA under the proposed project. This assessment is an essential work for advocacy and for promoting multisectoral efforts among Government agencies, parliamentarians, the public, and to mobilize donor support.

This component will apply the economic assessment tool in each of the four countries with teams of international and national specialists. The methodological tool is intended to be used in combination with the OIE Performance of Veterinary Services (PVS) and WHO International Health Regulations (IHR) assessment (Component 1) to attract investments for One Health Project.

The methodology will use primary and secondary data and robust analytical tools to:

Estimate the cost of zoonotic diseases on livelihoods outcomes (income, health, trade) and national economies (agriculture sector productivity, public health, food safety, trade, tourism, etc), including environmental impacts;
Assess the cost-effectiveness of control strategies currently used to reduce the risk of human and animal exposure to zoonotic diseases;
Identify the factors preventing the adoption of cost-effective strategies by poor households, commercial sector and government bodies;
Estimate the cost and benefits of applying zoonotic disease risk reduction programs;
Organize a series of high level national workshops to present the findings and develop recommendations for their implementation. Brief Parliamentarians in each country, or jointly at the regular semi-annual Parliamentarian meeting organized under the CAAP; and
Disseminate the results of the assessments through ECA regional forum and global audiences through the International Conferences. The proposed project will present the first opportunity to pilot this methodology, and therefore offer the occasion to share important lessons with other countries and regions.

Food Borne Diseases and Food Safety
This component will review the current situation with respect to food safety, focusing on food borne diseases, domestic, trans-boundary and international trade aspects, and nutrition related illness especially in women and children, and will identify gaps in enhancing food safety in the region. Particular emphasis will be placed on some of the current food safety priorities including, for example, mycotoxin/aflatoxin contamination in grains and food.

Support the initiation of a regional food safety body to facilitate trade and coordinate regulatory measures. Convene a regional workshop to agree on the steps needed to develop a regional food safety action plan, including outputs, schedule, roles and responsibilities, and sources of funding.
Support clarification of roles of public and private agencies in food safety to avoid duplication and gaps.
Begin a comprehensive review of the structure and organization of the agri-food sector (focusing on the selected sub-sectors – milk, meat and fish) looking in detail at the characteristics and structure of supply chains with analysis of the strengths and weaknesses with an outline of appropriate solutions to the latter.
Disseminate the findings of the AAA recently completed on KG, KZ and UZ on food safety and under-nutrition in women and children through production and distribution of video and printed materials and organization of a series of national workshops to present the findings.

Project Management
This component will support the CAAP Regional Project Management Unit (RPMU) for implementation, monitoring and evaluation, procurement, financial management, safeguards and reporting functions of the project.