In a bid to optimise the rabies eradication programme in Bali, national and local stakeholders have agreed on the Standard Operating Procedure (SOP) for the implementation of the Integrated Bite Case Management (IBCM) protocol using the One Health approach.

The SOP was formulated during a workshop on IBCM conducted by the FAO Emergency Centre for Transboundary Animal Diseases (ECTAD) Indonesia on 25 July 2016 in Kuta, Bali. The workshop gathered national and local Bali stakeholders, including representatives from Bali Provincial Livestock and Animal Health Services, along with agencies overseeing animal health at the district/city level; the Provincial Health Agency and district/city health agencies; Denpasar Disease Investigation Centre; Denpasar Class-1 Agricultural Quarantine Office; district and city Governance Departments; Ministry of Agriculture; Ministry of Health; and Ministry of Environment and Forestry.

Serving as a guideline for human health and animal health workforces in Bali to carry out IBCM activities correctly and in a coordinated manner, the SOP defines several action points. One of them is the categorisation of the status of bite injury and the risk status of the biting animal, classified as either “high” or “low” risk for rabies. The agency overseeing animal health will have the responsibility to decide on the animal risk status. The risk assessment will be then used as the basis for providing post exposure prophylactic vaccination (anti-rabies vaccine) and anti-rabies serum. The SOP also instructs hospitals, health centres and rabies centres to report all recorded bite cases to the Livestock and Animal Health Services for further action.

In addition to the SOP, participants at the workshop also endorsed the issuance of either a Gubernatorial Decree or a Joint Operations Regulation that will serve as the legal basis for the implementation of IBCM in Bali. The draft Decree will be jointly initiated by the Provincial Livestock and Animal Health Service and the Bali Provincial Health Agency. Once the Gubernatorial Decree is issued, another decree on IBCM will follow at the District/City level throughout the island.

The IBCM programme was designed to improve the communication between Disease Surveillance officers at the Health Agency and the Rapid Response teams/Veterinary Service officers of the Animal Health Agency at provincial and district levels.

“This is expected to lead to better surveillance information on rabies in dogs, and improved treatment of human bite cases by the human health services,” said Dr. James McGrane, Team Leader of FAO ECTAD Indonesia.

In the coming weeks, FAO will conduct a series of trainings for the One Health-Rabies workforce in Bali. The Training of Master Trainers (ToMT) in the IBCM protocol will be conducted first, and will be followed by IBCM training for 170 officers from rabies centres and animal health centres across Bali.