Abstract
The Indonesian island province of Bali experienced its first rabies incursion in 2008. Mass vaccination of the dog population has proven effective and rabies cases in dogs and people have decreased, however the virus is still circulating among the dog population. Vaccination coverage must be maintained until rabies elimination. Increasing efficiency and effectiveness of vaccination campaigns is therefore desired. Community engagement leading to preventative health actions by community members can reduce disease incidence and costs of control. Here we evaluate 2 years of a novel community-based dog welfare and rabies control project (Program Dharma) in the Sanur sub-district. The project engaged the services of people living in the project area with an interest or experience in dogs or community health services. These people spoke with owners within their own community about dog welfare and health, monitored owned and unowned dogs and increased owner and carer efforts to access vaccination and further veterinary services. The evaluation focused on a sample of dogs whose owners had been regularly engaged with project. Vaccination coverage was increased and there were no dog or human rabies cases reported in the project area; the percentage of the dogs that had never been vaccinated was reduced by an average 28.3% (baseline unvaccinated 41–49%, post-project unvaccinated 11–19%). The welfare of dogs improved from an average of 20.7% of dogs with visible welfare problems at baseline to 2.7% after project implementation. Roaming dog density observed on street surveys also decreased in all project areas (24–47% reduction dependent on desa). A participatory evaluation event with a sample of Program Dharma community-based agents highlighted several additional successes, including that the community appeared to welcome and value their services and were beginning to support the cost of project activities. Conversely, challenges included identifying dogs in the database during revisits, sustaining the costs of community member time spent working on Program Dharma activities and the costs of veterinary care, whilst avoiding dependency of owners on free veterinary services. The benefits revealed by the evaluation were judged to be sufficient to extend Program Dharma to new areas, whilst evolving activities to resolve challenges.
Highlights
Rabies has spread throughout Indonesia and is maintained in the domestic dog population in the majority of the 33 Indonesian provinces [1]
The 2,098 dogs were comprised of 22.6% “Bali dogs,” a recognized breed native to Bali, 44.8% were identifiable as other breeds and 32.6% were mixed-breed dogs
This population composition was not significantly different to the population reported at the baseline census, the proportion of unowned dogs was higher at baseline (3.3%) [10]
Summary
Rabies has spread throughout Indonesia and is maintained in the domestic dog population in the majority of the 33 Indonesian provinces [1]. The Indonesian island province of Bali was historically rabies-free until an incursion in 2008 [2]. A combination of culling unconfined dogs with strychnine and vaccination of dogs at central point locations using locally manufactured vaccine failed to contain the outbreak; by 2010, rabies cases had been confirmed in all nine regencies in Bali [2, 3]. Following concerted efforts by local, national and international agencies, the first island-wide mass dog vaccination campaign was launched in October 2010 [2]. Several mass dog rabies vaccination drives were run in subsequent years, with resulting decreases in the number of both dog and human rabies cases of the disease [4]; based on government records, 476,459 dogs were vaccinated in 2018 [5]. In 2017, 15,630 people received post-exposure prophylaxis following dog bites, there were 93 laboratory confirmed dog rabies cases and two people are confirmed to have died of rabies [5, 6]
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