WHO (HQ/MZCP) Intercountry EXPERT WORKSHOP ON DOG AND WILDLIFE RABIES CONTROL IN JORDAN AND THE MIDDLE EAST 23/25 June, 2008, Amman, Jordan
Good practices in intersectoral rabies prevention and control management Lessons learnt D. Tabbaa
canine rabies is a serious problem in today s rapidly expanding urban sub-urban areas where poorly controlled dog populations are proliferating fast, and wildlife locations and numbers changed continuously.
The slow progress in the control of rabies attributed to: Insufficient financial support of relevant programs and activities The weakness or the lack of collaboration between different sectors involved, including public health and animal health sectors, Inaccurate information of decision makers Low public health education level
This presentation serve as a base for good practices in an effective intersectoral human-animal rabies prevention and control management to facilitate standardization of procedures among different sectors, contributing to an effective comprehensive national or regional rabies-control program
Basic requirements for rabies Intersectoral collaboration Rabies surveillance is still inadequate in many countries and this deficit should be addressed by national authorities, with the support of international agencies. Rabies can only be reliably diagnosed by laboratory tests and it is strongly recommended that, in countries where diagnostic facilities are inadequate or lacking, laboratory capacity be developed to permit effective rabies surveillance.
Dog ecology and dog population management There is no evidence that removal of dogs alone has ever had a significant impact on dog population densities or the spread of rabies. The population turnover of dogs may be so high that even the highest recorded removal rates (about 15% of the dog population) are easily compensated for by increased survival rates.
Intersectoral Collaboration in the management of rabies prevention and control programs: The concept of intersectoral collaboration in public and animal health was introduced at the International Conference on Primary Health Care in Alma-Ata, Kazakhstan in 1978
Horizontal collaboration should occur across sectors (or across sub-sectors within a single sector) PHE PHS VET Vertical collaboration brings together partners with unique characteristics and requirements related to their public sector PHL Univ. Community NGO s Intersectoral Collaboration
Intersectoral collaboration is a strategy used to Deal with complex policy problems that cannot be solved by a single country, region, government, department, or sector. Brought to bear on specific determinants of health, diseases, populations, geographic communities, health behaviours, ecosystems and risk factors.
intersectoral collaboration has been used to bolster community development, disease prevention, economic development, sustainable development, education, health promotion, health protection,. primary care, public health, public security, Social cohesion.
The mean mechanism for collaboration could be achieved through a process of: Identifying the people / organisations involved in rabies control Identifying the priority work areas and the work to be done within these areas Identifying the roles and responsibilities of each sector Evaluating progress and reviewing the plans for collaborative action.
rabies control and prevention management is a multi disciplinary duty!!!! veterinary governmental and private services Public Health authorities universities municipalities ministries of agriculture and environment Please!!! Work together animal welfare local societies national reference laboratory for rabies authorities responsible for solid waste treatment customers and veterinary quarantine Research institutes at the universities ministry of education public and veterinary public health education authorities
enhance capacity on rabies control and prevention in four key areas: surveillance and information sharing coordinated response risk reduction collaborative research
STEPS TO DEVELOP COORDINATING MECHANISM STEP 1: Setting up a sustainable mechanism for intersectoral collaboration STEP 2: Identify areas of work for collaboration STEP 3: Determine roles and responsibilities STEP 4: Evaluate / report progress and revise plan of action
SURVEILLANCE AND INFORMATION SHARING STEP 1: Identify contacts for surveillance and information sharing in all sectors STEP 2: Identify events / incidents where information sharing is required STEP 3: Determine the roles and responsibilities of each sector STEP 4: Evaluate and revise the protocol where necessary
COORDINATED RESPONSE STEP 1: Identify the events / scenarios / locations where a coordinated response is required STEP 2: Identify the activities to be coordinated in the events / scenarios identified STEP 3: Clarify the roles and responsibilities of each sector in the situations identified STEP 4: Evaluate progress and revise the protocol where necessary
RISK REDUCTION STEP 1: Identify high risk areas/ populations at risk / practices and behaviours STEP 2: Identify measures to reduce risks STEP 3: Determine roles and responsibilities for risk reduction measures STEP 4: Evaluate and revise the plan for risk reduction intervention activities where necessary
The need to collaborate is a core driver for Intersectoral collaboration. Additional drivers have included: lobbying and political pressure from the public, non-government organisations, the media, to address a significant policy challenge;
favourable economic conditions supporting intersectoral collaboration to address complex policy challenges. Since this collaboration often costs more in the short-term than simpler, quick-fix responses, strong economies may offer the resources for sustained investment in intersectoral work. In periods of fiscal constraint, innovative approaches to cross-sectoral collaborations may be undertaken as a means of addressing overlapping and intersecting organizational mandates;
the existence of a feedback loop between citizens and government, to drive, define and respond to the issues. Timely information sharing between citizens and government is required; strong central agencies that oversee and guide approaches to ensure that organizational mandates, authorities and reporting are respected. While central agencies do not necessarily lead these approaches, they often play a strong support role in ensuring adequate resources for intersectoral Collaborators; guiding policies through formal decision-making avenues; and, designing and monitoring complex Intersectoral Collaborations with accountability frameworks; and
negative data from reports of commissions and/or task forces, studies, statistics, poll results. Bad news sometimes attracts more public and political attention than success stories. Comparing nations health status and conditions for health can spark interest in intersectoral efforts to address shared problems and promote equitable conditions for health and socio-developement of Intersectoral Collaboration.
Working Local, Regional or Global
Lessons learnt Lack of IC has affects the rabies control strategies through: Rabies is not prioritized in the list of important PH hazards The need for dog rabies vaccination has often been overlooked Health care programs, pay more money by administering post-exposure rabies immunization to save dog bite victims.
Intersectoral collaboration in the rabies control and prevention management in developing countries can be very successful if based on appropriate planning, health education of human populations, 70% vaccine coverage of dog populations, dog population reduction, and epidemiological surveillance
The rabies control teams impounded and euthanized only dogs who appeared to be already rabid, aggressive, or otherwise severely unhealthy
Persistent trapping or poisoning campaigns as a means to rabies control should be abolished. There is no evidence, that these costly and politically attractive programs reduce either wildlife reservoirs or rabies incidence
Policymakers in the developing world often seek for their cities the superficially animalfree appearance of a modern city that they see in Europe and the U.S., equating this with ridding themselves of rabies. But casual outdoor observation of European and U.S. cities by daylight is deeply deceptive. European and American cities support even more dogs, cats, and wild animals per thousand humans than the cities of the developing world. They have merely achieved a transition from hosting outdoor animals, seen in daytime, to hosting mostly indoor pets and nocturnal wildlife
Motor vehicles, rather than any animal control strategies, appear to be the major transitionary agents. Motor vehicle traffic reduces street dog populations by killing dogs, obviously enough, but this is the least of the vehicular impacts, and is no different in effect from animal control killing.
Many sources provide advice on conditions for Intersectoral Collaboration success at local, national, and regional levels, 1. Create a philosophical framework and approach to control rabies that is conducive to Intersectoral Collaboration. 2. Emphasize shared values, interests, and objectives among partners and potent Intersectoral Collaboration partners.
3. Ensure political support; build on positive factors in the policy of rabies control 4. Engage key partners in rabies programs at the very beginning: 5. Ensure appropriate horizontal linking across different sectors involved with rabies prevention and control, as well as vertical linking of levels within these sectors.
6. Invest in the alliance-building process by working toward consensus at the planning stage of the national programs of rabies prevention and control. 7. Focus on concrete objectives and visible results of these programs. 8. Ensure leadership, accountability and rewards are shared among all partners working on rabies programs.
9. Build stable teams of people who work well together, with appropriate support systems. 10. Develop practical models, tools and mechanisms to support the implementation of Intersectoral Collaboration in rabies control programs. 11. Ensure public participation; educate the public and raise awareness about health determinants and intersectoral collaboration in the prevention of rabies.
Thank you for your attention