Challenge
In 2005 outbreaks of the Highly Pathogenic Avian Influenza (HPAI) surged in several Asian countries and spread to Europe. Significantly for Moldova, outbreaks in neighboring Romania and Ukraine obliged those governments to cull poultry. Moldova was at risk of the infection spreading from contact between domestic birds and migrating waterfowl and the growing cross-border trade. The impact on the country, whose poultry division represents 80 percent of the livestock sector and for which poultry is a nutrition staple, could have been disastrous.
At the end of 2005, the World Health Organization (WHO) reported that 186 people worldwide contracted HPAI and 105 died. The infection rate increase led to concerns that the virus could mutate to favor human-to-human transmission, producing devastating effects on human health and livelihoods. As one of the poorest countries in the region, Moldova lacked the necessary financial resources to respond adequately to a highly probable outbreak, putting at risk human health and the country’s economy.
Approach
The project was part of the “Global Program for Avian Influenza Control and Human Pandemic Preparedness and Response,” which supported several countries through an Adaptable Program Loan. Since Moldova was a country at risk, the Bank assisted the Government in preparing this project in response to a potential crisis. The project combined short-term investments in basic capacity-building activities to ensure adequate public awareness, proper equipment for emergency response teams, sufficient stocks of vaccines, and the creation of a compensation mechanism to encourage farmers to report possible outbreaks to limit contagion. It also included long-term capacity building measures aimed at the rehabilitation and modernization of laboratory and hospital facilities, as well as enhanced preparedness—involving sample collection, transport, and testing—to deal with infected patients.
Results
Key outcomes from September 2006 to May 2011:
- An IT surveillance system was developed and installed, which strengthened the epidemiological surveillance and monitoring capacity in Moldova, providing real-time information at more than 250 locations, and establishing six rapid response teams for outbreak investigations. During the 2009 H1N1 pandemic, the system allowed public health officials to better understand the magnitude and location of infection flare-ups, and apply focused response measures.
- Laboratory infrastructure was renovated, the necessary equipment and consumables for risk-based sampling and testing obtained and training to laboratory staff provided, thereby improving Moldova’s capacity for diagnosing viral diseases in humans and animals, both nationally (at a central virology laboratory in Chisinau) and locally (at new regional laboratories in Cahul and Drochia). During the 2009 pandemic, a near 100 percent testing accuracy within 48 hours of sample collection was confirmed by WHO-accredited laboratories.
- The capacity to transport and treat infected patients was enhanced by providing three modern ambulances, reconstructing and equipping an intensive care unit in Dr. Toma Ciorba Hospital in Chisinau, equipping 40 hospitals with intubation and respiratory equipment and medication, and training medical practitioners in the application of modern intensive care techniques. As a result, during the 2009 H1N1 pandemic more than 2,000 patients were hospitalized and treated.
- The improved general public awareness of the risks of HPAI and other influenza types led to behavioral and attitudinal changes. Assessments in 2010 indicated that 90 percent of people could identify the main influenza symptoms. Seventy percent of those reached by project-supported media interventions reported behavior and attitude changes for at least some key prevention practices.
Bank Contribution
The project was supported by International Development Association (IDA) funds of US$9 million, allocated to four components: animal health (US$4 million); human health (US$4 million); awareness and communications (US$1.5 million); and project management (US$1.0 million). IDA was the largest source of funding, amounting to 86 percent off the total project cost.
Partners
IDA's involvement engendered partnerships which helped bring the country into the international arena, with improved disease information exchange and the assurance of the longer-term sustainability of project investments within the framework of overall reforms. The Government of Japan and the European Union (EU) were partners in cofinancing the project, contributing Policy and Human Resources Development (PHRD) grants of US$0.5 million and US$1 million, respectively. WHO deployed three specialists who led in the identification of the human health component, and the United Nations Children’s Fund (UNICEF) supported the public awareness and information campaigns.
Moving Forward
The project-supported improvements in capacity and equipment/facilities can be adapted for use in non-epidemic/pandemic settings for current public health needs, including testing, intensive care, and ambulatory treatment of various infectious conditions. As they are not expensive items to be safeguarded and set aside for emergencies, they are useful assets that constantly generate public benefits. Laboratories focusing on animal health are playing an important role in supporting the country’s food safety system and in the facilitation of Moldovan animal exports to EU markets.
Beneficiaries
Magdalena Spanu, a 10-year-old, comes from a large household that rears chickens, ducks, geese, rabbits, and pigs. She is proud to help her mother with household chores. She and her older brother used to feed the poultry and collect the eggs. Sometimes her father would allow her to help him clean the chicken pen. “I liked playing with little chicken, but since we learned about avian flu I am not allowed to touch birds. I miss playing with chicken but I understand this is for my own safety.”
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