Sukimin (Head of Sendang Village) share his experience in responding to suspect cases of rabies in 2017

“One Health” is a collaborative effort of health practitioners (veterinarians, MDs, public health officers, epidemiologists, ecologists, toxicologists, environmentalists and others), and their related agencies to achieve optimal health levels for the community, agriculture and livestock, wildlife and the environment. One Health works on local, national and global scales.

Boyolali District has proven the success of the One Health approach at the local level when it coped with suspect cases of rabies in the region in January-October 2017.

“The first suspect case occurred in March 2017. One of the residents was bitten by a monkey which was hanging around the village,” explained Sukimin (50) Head of Sendang Village, Karanggede Sub-district, Boyolali.

Over the next six months, the victims of dog and long-tailed monkey (Macaca Fascicularis) bites continued to increase. A joint team of the Livestock and Fisheries Office, Boyolali District Health Office and Central Java Natural Resources Conservation Agency (BKSDA) recorded 22 people bitten by potential rabies-carrying animals (GHPR).

“The interaction of the Boyolali community with wild animals is quite high because the region is located between the Mount Merapi and Merbabu National Parks,” explained Slamet Sukeri from BKSDA.

Local Government Response

The Boyolali District local government assembled an integrated surveillance team of Livestock and Fishery Officers, Health Office staff and BKSDA personnel.

“This team was in charge of conducting investigations, case monitoring, controlling rabies susceptible animals and risk mapping together with village officers, police and the community,” explained Afiany Rifdania, Animal Health Head, Boyolali Livestock and Fisheries Office.

Cross-sectoral coordination and communication was able to cope with suspected rabies cases in the district. The surveillance team managed to capture two rabies-suspect long tailed monkeys and when they showed no signs of rabies following 14 days of observation, they were handed over to Central Java BKSDA.

“We referred bite case patients to the health centre to get anti-rabies vaccine if considered necessary," said Subandono from Andong Community Health Centre (Puskesmas).

Impact of EPT2 Program

The successful application of the One Health approach by the Boyolali District Government in handling the suspect rabies cases in its region was one of the tangible impacts of the Emerging Pandemic Threats (EPT2) program.

EPT2 is a collaborative program consisting of international institutions, universities and research centres such as: the UN Food and Agriculture Organization (FAO), World Health Organization (WHO), PREDICT-2 (managed by Bogor Institute of Agriculture and Eijkman Institute), the Preparedness and Response project or P&R, One Health Workforce (led by INDOHUN), Indonesian Red Cross (PMI) and the International Federation of Red Cross and Red Crescent Societies (IFRC).

FAO ECTAD (Emergency Centre for Transboundary Animal Diseases) and other EPT2 partners facilitated a series of workshops to prepare technical materials and developed the expertise of frontline officers of the human, animal and environmental health sectors in the pilot areas.

EPT2 has One Health pilot areas in Bengkalis, Ketapang, Boyolali and Minahasa districts.

"The focus of FAO’s One Health activities under the EPT2 program is to improve capacity in early disease detection, reporting and response," explained Andri Jatikusumah, national technical advisor of FAO ECTAD Indonesia.

Andri added that the key to building cross-sectoral coordination lies in capacity building of the officers, communication and development of communication strategies and media for information sharing.

To date, the FAO EPT2 programme has produced 23 One Health training modules, and trained 25 Master Trainers and 210 surveillance and response personnel across the three sectors.

"Through the development of modules and collaborative training, we understand the duties and responsibilities of each sector in dealing with emerging infectious diseases and zoonoses," said Bashori from the Animal Health Centre (Puskeswan), Karanggede.

Challenges Ahead

Indonesia is considered one of the emerging infectious disease (EID) hotspots in Asia. Indonesia has the second richest biodiversity in the world, which makes the country vulnerable to zoonotic threats. Law 24/2007 on Disaster Mitigation determines disease outbreaks as non-natural disasters that require special management because of their potentially disastrous consequences, both nationally and globally.

"This has encouraged the Government of Indonesia to develop One Health Coordination Guidelines as a key policy document. The Guidelines support integrated, effective and efficient cross-sectoral coordination in the management of zoonoses and emerging infectious diseases," explained Gafur Akbar Dharma Putra, Sustainable Development Goals expert of the Coordinating Ministry for Human Development and Culture during a public seminar on the One Health Approach at Gadjah Mada University Yogyakarta, on February 13, 2018.

Proponents of the One Health approach, especially EPT2 program partners, have responsibility to continue applying the One Health approach to detect and respond to influenza and EID in other pilot areas. Partners will use the One Health Coordination Guidelines as a legal umbrella as well as a policy reference in addressing emerging infectious diseases and zoonoses in the future.