Reducing the risk of rabies in Bali

April 28, 2016

Tourism is an important driver of economic growth throughout Southeast Asia. However, a booming tourism industry has caused dramatic changes to populations and ecosystems through rapid urbanization, extensive land development, and the exploitation of natural resources. Overburdened health systems and weak disease surveillance capacity also often make tourist sites hotspots for infectious diseases. An IDRC-supported research project is working with local stakeholders in Bali, Indonesia, to reduce the risk of infectious disease outbreaks.

Tourist boom connected to infectious disease outbreaks

With more than 3.2 million visitors in 2013 alone, Bali is the leading tourism destination in Indonesia. This has fueled rapid urban development and put strain on local health and sanitation infrastructure. This situation is further exacerbated because medical, veterinary, and disease control sectors operate independently. As a result, infectious diseases such as dengue, bird flu, and rabies have often fallen through the cracks of disease monitoring and control systems. As the province’s tourism continues to grow, government officials are increasingly concerned about disease outbreaks.

Rabies, a disease transmitted to humans through the bite of an infected animal, is of particular concern. Until recently, Bali had been free of rabies. However, a first case of a rabies-infected dog was reported in 2008. The disease then spread rapidly across the island: thousands of dogs have been infected and human cases have risen every year. By working with municipal and provincial government officials, IDRC-supported researchers are tackling the spread of rabies and other emerging infectious diseases. 

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Communication between health workers is key

Over the last three years, researchers have been working to reduce the gaps in disease surveillance and control in Bali. They reviewed and analyzed the reporting mechanisms, as well as the data from rabies monitoring in three villages in the city of Denpasar. The team found that there was a lack of communication between rabies workers, veterinary officials, and local health centres. Rabies control workers were recording high numbers of cases of animals biting people, but were not sharing these numbers with veterinary workers or healthcare professionals. Poor communication between these sectors was hampering efforts to break the rabies transmission cycle and delaying effective management and treatment of bites. 

Simple solution, multiple benefits

Working in tandem with the municipal and provincial governments, the research team has developed an integrated monitoring program that requires medical, veterinary, and public health officials to work together to monitor and control diseases. Community health workers now look for animal bites and bird deaths in addition to identifying cases of suspected dengue fever in the homes and compounds they visit. 

Community health workers have also engaged in a public health campaign to raise awareness about the risks of infectious diseases in the city, and have been trained to encourage residents to access health facilities as part of an early warning and response program for dengue, rabies, and bird flu. This simple intervention has been so successful that it is now being expanded to all of Denpasar.

The project in Bali is one of six projects supported by IDRC studying the causes of infectious diseases emergence and transmission in tourist sites in Cambodia, Indonesia, Laos, Philippines, Thailand, and Vietnam. The projects fall under IDRC’s Ecohealth Emerging Disease Research Initiative (EcoEID).

Watch the animated public service announcement produced by the research team about the spread of infectious disease in Bali

Watch the research team’s public service announcement about the integrated monitoring of disease

Photo (right): Center for Health Policy and Social Change
Rabies workers, veterinary officials, and local health centres are working together to break the rabies transmission cycle.