SARE workshop steers Sri Lanka towards rabies elimination

Sri Lanka, an island nation in South Asia, remains a rabies-endemic country to this day, in spite of having one of the earliest national policies to combat the disease, a rabies ordinance that was drafted in 1893. By investing in large-scale dog vaccination programs and making post-exposure prophylaxis (PEP) for rabies widely available, Sri Lanka was able to decrease dog-mediated human rabies from 300 cases in 1974 to 19 cases in 2014. However, for the last 5 years, human rabies cases have plateaued to 20-25 confirmed cases annually, and the government is now facing a new challenge – how to reach zero human rabies cases by 2030.

SARE participants discuss ongoing efforts to control rabies in Sri Lanka. (Photo: GARC)
SARE participants discuss ongoing efforts to control rabies in Sri Lanka. (Photo: GARC)

To help drive rabies control efforts towards disease elimination, an in-country Stepwise Approach Towards Rabies Elimination (SARE) workshop was conducted in Sri Lanka with GARC facilitating and providing technical support. The SARE is a multi-stage planning, monitoring and evaluation tool that provides practical, measurable steps for rabies control programmes, and presents these steps as a logical flow of activities, from Stage 0 to Stage 5. Participation in a SARE workshop was recommended to Sri Lanka by the World Health Organization (WHO), the Food and Agriculture Organization of the United Nations (FAO), and the World Organisation for Animal Health (OIE), not only to develop a plan for elimination, but also to prepare for the South Asia Association for Regional Cooperation (SAARC) rabies meeting that was held in Nepal in June 2019.

The SARE workshop, held on 19-21 June 2019 in Colombo, was organized by the Public Health Veterinary Services (PHVS), a division of the Ministry of Health, Nutrition and Indigenous Medicine. With funding support provided by the WHO country office of Sri Lanka, more than 40 participants from PHVS, the Medical Research Institute, academia, the WHO country office, animal welfare representatives, and public health investigators were able to participate in the workshop and contribute towards its success.

When asked about the importance of the workshop, one of the participants,  Dr. L. D. Kitsiri, the Director of the PHVS, remarked, “The multi-sectoral national workshop was important to achieve the target of Sri Lanka of rabies elimination by 2025. The workshop highlights the need to streamline the strategies through a multi-sectoral approach.”

Photo Credit: Public Health Veterinary Services (PHVS) of the Ministry of Health, Nutrition and Indigenous Medicine Sri Lanka
Sri Lanka's SARE participants. (Photo: Public Health Veterinary Services (PHVS) of the Ministry of Health, Nutrition and Indigenous Medicine Sri Lanka)

As the three-day SARE workshop concluded, participants realized that Sri Lanka had made great progress in rabies control in the past, but now the country needed to step up efforts and eliminate the disease. Sri Lanka earned a SARE score of 1.5 on a scale of 1 to 5, where 5 indicates full rabies control has been reached, and 1 indicates that no rabies control activities are in place. With a score in this zone, activities for rabies control were identified using the SARE tool and included the following:

i) there is a need to improve animal vaccination coverage;

ii) inter-sectoral collaboration between animal health and medical sectors at different levels needs to be enhanced;

iii) One Health surveillance needs to be strengthened;

iv) rabies awareness plans targeting identified high-risk groups need to be developed;

v) the existing legislation needs to be reviewed and updated; and

vi) a technical working group for rabies elimination needs to be established.

By focusing on the activities identified during the in-country SARE assessment – and maintaining their existing rabies control efforts – Sri Lanka is well placed to eliminate dog-mediated human rabies before the global target of 2030. Through the use of the SARE assessment and unique workplan (based on the SARE outputs), however, the government can progress towards this goal in a considered manner, which in turn will ensure that their efforts are sustainable and effective.

More information about the SARE can be found on the Canine Rabies Blueprint website here.The Zero by 30 campaign is explained further on the GARC website here.

Contributed by Dr. Sarah Jayme, GARC Asia Representative