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Enhancing multisectoral collaboration to combat rabies in One Health approach in Bali

16 July 2023
Highlights
Bali, Indonesia
Rabies is a viral disease that affects the central nervous system and is virtually 100% fatal once clinical symptoms appear. To address this challenge globally, the World Health Organization (WHO), the Food and Agriculture Organization (FAO), the World Organisation for Animal Health (WOAH), and the Global Alliance for Rabies Control (GARC) have developed a global strategic plan to end human deaths from dog-mediated rabies by 2030, known as "Zero by 30". 

Opening remarks at provincial bridging workshop for rabies in Bali, 12-15 April 2023 (Credit: WHO/Endang Wulandari)

 

Endemic in 26 of 38 Indonesian provinces, including Bali, rabies presents a formidable challenge. In response, Bali has founded 103 rabies centres, stockpiled anti-rabies vaccine (VAR) and serum (SAR), empowered communities, and in 2022, convened a Stepwise Approach Rabies Elimination (SARE) workshop. Despite these efforts, gaps remain, from enforcement of provincial government Regulation No. 15, 2009, to the improvement of dog vaccination campaigns and the strengthening of multisectoral collaboration for rabies control.

“To effectively combat human rabies in Bali, we must focus on a reliable estimation of the dog population, provision of rabies vaccine for dogs, funding for operations, provision of VAR and SAR stockpiles for humans, control of the dog population by reducing stray and providing shelters, and the establishment of Rabies Centres and risk communication," said Dr. Imran Pambudi, MPHM, Director of Communicable Diseases Control, Ministry of Health, Republic of Indonesia, during his opening remarks.

Plenary group presentation on session identifies collaborative activities from SARE pending activities assessment

Plenary group presentation on session identifies collaborative activities from SARE pending activities assessment     (Credit : WHO/Endang Wulandari)

The SARE workshop engaged 50 participants from diverse sectors in Bali, along with the Ministry of Health (MoH), the Ministry of Agriculture (MoA), the National Disaster Agency, and the Coordinating Ministry of Human Development and Culture. The workshop aimed to bring among others the human and animal health sectors together in the fight against rabies. At the workshop, participants assessed the situation, identified shortcomings and best practices, and formulated a plan to bolster collaboration. This joint strategy prioritizes coordination, communication, resource sharing, local legislation implementation, and surveillance.


The joint work plan for rabies prevention and control lays out several priority measures: forming a coordination team, securing emergency funding for rabies control, amplifying risk communication via social media and podcasts, designing effective risk communication materials, executing ‘Training of Trainers’ for better risk communication, speeding up the vaccination of animals bitten by rabies-infected creatures, incorporating local regulatory wisdom, and advancing surveillance and case management for rabid animals.

Development of priority collaborative activities during provincial bridging workshop for rabies, 12-15 April 2023, Bali

(Credit: WHO/Endang Wulandari)


I Wayan Pujana, SKM, MPH, from the Bali Provincial Health Office emphasized "In this workshop, we draw upon existing documents and outcomes from prior rabies workshops to augment our current efforts. The output will strengthen our joint endeavour to eradicate dog-mediated human rabies cases by 2030." 

Stakeholders are set to implement the agreed work plan for priority collaborative activities for rabies control, following the provincial bridging workshop on rabies in Bali. Furthermore, community participation and engagement in rabies control remains crucial in combating this issue. The Australian Government, in collaboration with WHO, bolsters these efforts by assisting the Ministry of Health in procuring rabies vaccines and serum for humans in high-risk provinces like Bali. They also advocate for the adoption of intradermal rabies post-exposure prophylaxis, a method promoted by WHO.

 

WHOs work on rabies is supported by DFAT, Friedrich-Loeffler-Institut (FLI), GARC, SEEG and USAID.

Written by Dr Endang Widuri Wulandari, National Professional Officer for Epidemiologist