David C. Hall, DVM, PhD

Faculty of Veterinary Medicine, University of Calgary, CanadaVeterinarians without Borders/Vétérinaires sans Frontières-Canada

E-mail: dchall@ucalgary.ca

Iwan WILLYANTO: Animal Health Consultant, Surabaya, IndonesiaAnak Agung GDE PUTRA: Disease Investigation Center, Denpasar, Indonesia

Edi BASUNO: Indonesian Center for Agricultural, Socioeconomic, and Policy StudiesJeff DAVIDSON: Atlantic Veterinary College, Canada

Controlling Rabies in Bali, IndonesiaIdentifying Complexity

Rabies Control in Bali, Indonesia

OUTLINE

1. Bali and rabies• More than just a pretty beach• Rabies free until 2008• First death from rabies Nov 2009

2. The nature of the problem• Dogs• Culture (people)• Environment

3. Identifying complexity• Cynefin framework approach

3. Conclusions• Policy influence Thanks to FAO, OIE, WSPA, and VWB/VSF-Canada

Rabies Control in Bali, Indonesia

Rabies Control in Bali, Indonesia

Population• 3.9M in 2010; (3.1M in 2005)

Hindu culture• Implications for rabies control

Rural livelihoods• Agrarian society• Poultry, rice, tourism

Acceptance of dogs• Guard dogs, pets• Strays: beaches, villages, temples

Devolution of authority• Funding and control are your problem

now!

Outbreaks• began November 2008

Cases• Humans: > 100 deaths• Dogs: > 85,000 vaccinated

Initial response• Strychnine, shooting• Culled > 100,000 dogs

Results

• No appreciable impact

• Popln control, vaccination

• Bali Animal Welfare Association (BAWA) – vaccinate and neuter

Rabies Control in Bali, Indonesia

Rabies Control in Bali, Indonesia

Contributing factors

Humans Cultural issues

• Food offerings at temples

• Tolerance of strays

• Dog markets, other markets

Animals Dogs are not sterilized

Pack, live around food source

Environment Agrarian society & periurban areas

Temples & markets

Beaches & fields

Climate

Rabies Control in Bali, Indonesia

www.idrc.ca

Ecosystem Health Framework

Adapted from Mergler, 2001

Biophysical environment

Economicenvironment

Socio-culturalenvironment Time

www.idrc.ca

6 Methodological Pillars (revis. Hall)

Recognize complexity of systems

Transdisciplinary research

Participatory approach/ Communities

Gender and social equity research

Sustainability

Knowledge to Action

Building Ecohealth Capacity in Asia (BECA)• Cambodia, PR China, Indonesia, Lao PDR, Thailand, Vietnam

• How to build capacity in ecohealth?• Workshops, research activities, policy input

• Promote networking of ecohealth research community• Websites, meetings, document sharing

• Foster monitoring and evaluation of ecohealth research• M&E tools

• Implemented by VWB/VSF-Canada

• Funded by IDRC & AusAID

Rabies Control in Bali, Indonesia

The Cynefin Framework (David Snowden)

From complexity theory to action

Matches situation with response Distinguishes between:

• Simple

• Complicated

• Complex

• Chaos

Essential elements Systems thinking

Recognize adaptive systems

Willingness to probe and analyze

Knowledge guides action Guided response Leads to informed policy making

Kurtz and Snowden, IBM Systems Journal; 2003

Cynefin Framework applied

From complexity theory to action

4)how is the situation framed

• simple, complicated, complex, and chaotic

6)implications of this framing

• relative to situational response

8)appropriate ways to manage

• What does framing tell us

• Options for policy change

Rabies control, Bali, Indonesia• M&E

– Epidemiologic analysis, ecological assessment, policy change– Examine agricultural community practices and wildlife interaction– Cynefin Framework approach to disease management

• Evidence– Epidemiology – prelim. evidence reduction in canine cases– Ecology: dog behaviour, village & cultural factors examined– Policy

– chaos (no plan) – simple (kill the dogs)– complicated (count and vaccinate the dogs) – acceptance of complexity (interaction and thus

response changes over time)

Cynefin Framework applied

Cynefin Framework – results

Broader solutions & examples• One Health/ ecohealth & integrated agriculture

Rabies in Bali, Indonesia – Response• Understand dog ecology & Bali culture• Respect and work with community wishes, communication• Role of NGOs, government • Recommendation: One Health approach, preventing EIDs

Photos: OIE/FAO and WSPA

Rabies in Bali – Current approach to control

1. Population control with vaccination• can and does work in conjunction with

vaccination (VWB/VSF-Canada)

• Bali Animal Welfare Association (BAWA) – vaccinate and neuter (with WSPA and AusAID)

• Target is vaccinate 70% of dogs (>1M)

• Pilot areas - > 87% vaccinated

• Eradication by 2015?

2. Education & Behaviour change• Cause & prevention of rabies• Modifying environmental factors• Dog ownership/ identification

3. Reduce risk factors• As noted plus …• Offshore immigrant dogs?• Wildlife reservoirs (monkeys)? • Capacity to sustain vaccination

Conclusions

3. Complexity and systems thinking matters

5. Policy can be influenced by communities

7. Business management tools can shed light on approaches to health challenges

Rabies in Bali – Complexity matters!

Dogs first, monkeys next?!

Cynefin Framework to Rabies in Bali, Indonesia

•Iwan WILLYANTO: Animal Health Consultant, Surabaya, Indonesia

•Anak Agung GDE PUTRA: Disease Investigation Center, Denpasar, Indonesia

•Edi BASUNO: Indonesian Center for Agricultural, Socioeconomic, and Policy Studies

•Jeff DAVIDSON: Atlantic Veterinary College, Canada

BECA Project•VWB/VSF-Canada, International Development Research Institute, AusAID

Partners