FINAL MTP RABIES (Nov 28) 2 - 0 - Ed
FINAL MTP RABIES (Nov 28) 2 - 0 - Ed
FINAL MTP RABIES (Nov 28) 2 - 0 - Ed
2020- 2025
Table of Contents
Page No.
Table of Contents I
List of Tables and Figures Iii
Acknowledgments Iv
Acronyms and Abbreviations V
Executive Summary Vi
CHAPTER I: THE BURDEN OF RABIES IN THE PHILIPPINES
I. Introduction 1
II. Human Rabies 2
III. Rabies Exposures 3
IV. Canine Rabies 7
I. Introduction 13
II. The Program Vision and Goal 15
III. Legal Mandates of the National Rabies Prevention and Control 15
Program
IV. National Rabies Prevention and Control Program 15
1. Program Components
2. Support Services
3. Budget
I. Introduction 29
II. Guiding Principles 29
III. Key Components Description 30
IV. The Strategic Framework Plan of NRPCP 31
V. Goal of NRPCP 32
2. Animal Health 48
- Oplan RED
Annexes
1. Anti-Rabies Act of 2007
2. Implementing Rules and Regulations of the Anti-Rabies Act of
2007
3. Health Promotion Plan
4. Monitoring and Evaluation Indicators
5. Success Indicators 2016
6. Key Activities at the National, Regional and Local Levels in the
Prevention and Control of Human and Canine Rabies
7. Department Circular No. -2019-057: Adoption of the National
rabies Prevention and Control Program (NRPCP) Strategic Plan
Figure 6 Top Provinces and Cities with Animal Rabies Cases for 2018
The Strategic Plan of the National Rabies Prevention and Control Program is a product of
the collective efforts of implementing agencies and partners who contribute to the
prevention, control and eventual elimination of rabies in the Philippines.
• Infectious Disease Office of the Disease Prevention and Control Bureau of the
Department of Health for providing technical guidance, mobilizing resources and
overseeing the development of the NRPCP Strategic Plan
• Centers for Health Development of the Department of Health for providing
comments and inputs on the strategies and objectives related to the prevention
and control of human rabies
• San Lazaro Hospital and Research Institute of Tropical Medicine for their valuable
technical inputs
• Bureau of Animal Industry of the Department of Agriculture for providing technical
guidance in the development of the NRPCP Strategic Plan
• Department of Education for providing relevant inputs
• Department of Interior Local Government for their valuable inputs
• Department of Agriculture Regional Field Units for providing comments and inputs
on the strategies and objectives related to the prevention and control of animal
rabies
• Local Government Units for participating in the consultative process and providing
their field-level perspectives on the prevention and control of rabies
• Partner government agencies for providing guidance and support and sharing
their insights on their roles and functions in the prevention, control and elimination
of rabies
• World Health Organization for providing logistical support and technical
assistance in the development of this plan.
AO Administrative Order
DA Department of Agriculture
Rabies is a zoonotic disease that cause 59,000 deaths every year worldwide with 56% of
the cases occurring in Asia. In the Philippines, there are 250-300 deaths every year mostly
among children below 15 years of age and those who are poor. Even though such
deaths are preventable, there is no treatment or cure for rabies once the clinical
manifestations of rabies set in. The high cost of anti-rabies vaccine and immunoglobulin,
expenditure for medical consultations and the loss of income are an additional burden
to a regular Filipino family confronted with a potential rabies exposure. In addition, victims
of potentially rabid bites suffer anxiety resulting from the uncertainty on the consequence
of a rabies exposure.
The enactment of the Anti-Rabies Act of 2007 (Republic Act 9482), government
guidelines and local ordinances has provided full mandate for the creation and
implementation of the National Rabies Prevention and Control Program (NRPCP) from
the national to the local level. The program is further backed by a coordinating and
implementation structure from the national to the local level, inter-agency and multi-
sectoral support, organized rabies implementation structure at the local level, funding
support from funding agencies and available resources and opportunities for public
awareness campaigns. Establishment of 613 Animal Bite Treatment Centers (ABTCs)
under the Department of Health (DOH) and Local Government Units (LGUs) all over the
country has resulted to increased access to rabies Post Exposure Prophylaxis (PEP).
With the NRPCP’s overall and ultimate goal of declaring the Philippines rabies-free by
year 2030, the program has the following key focus areas namely: Governance, Service
Delivery, Financing, Regulation, Information and Human Resource.
The key focus areas were reviewed and analyzed by National, Regional and Local
Coordinators in consultation with partner agencies in order to determine the gaps in the
program implementation. To address issues and concerns, Strategic Plan to end rabies
by 2030 was developed for the NRPCP.
This Strategic Plan was able to identify immediate concerns to achieve the goal of zero
incidence of canine-mediated human rabies by 2030.
Rabies remains to be the most acutely fatal infectious disease claiming 250-300 lives of
Filipinos every year. At least one-third of human rabies deaths are among children less
than15 years of age and two thirds of the total cases are males. The high cost of anti-
rabies vaccine and immunoglobulin, expenditure for medical consultations and the loss
of income are an additional burden to a regular Filipino family confronted with a
potential rabies exposure.
To reduce incidence of rabies, Animal Bite Treatment Centers (ABTCs), where patients
are able to access human anti-rabies vaccines and immunoglobulin for Post Exposure
Prophylaxis (PEP) have been established in strategic areas all over the Philippines.
Consequently, the number of reported potentially rabies exposures, mostly dog bites, has
been increasing for the past three years.
Dogs are the principal reservoir of rabies in the country. Of the animal rabies cases
reported in 2018, 85.7% were dogs, 12.5% were cats and the spillover represents other
domestic animals. Rabies in domestic animals like cattles, carabaos, pigs, goats and
horses has been reported since 1930s but were all traced to bite of rabid dogs.
Rabies prevention and control may not be seen by some Local Chief Executives (LCE’s)
as a priority thus there is inadequate enforcement of laws and policies by Local
Government Units (LGUs) and agencies. Many of the LGUs do not allocate funds to
provide human and dog anti-rabies vaccine for their constituents. Moreover, Rabies
Immunoglobulin (RIG) for high-risk cases is costly and not easily available in some
localities. Availability of these immunizing agents against rabies is highly dependent on
the funds from the national government agencies, particularly of the Department of
Health (DOH) and Department of Agriculture (DA).
Access and compliance to PEP is hampered in some areas due to the far distance of the
Animal Bite Treatment Center (ABTC), lack of financial means for transportation and for
the continuation of the regimen, lack of information or job-related time constraints. Many
of the dog bite victims seek “tandok” and “tawak” (traditional healer) that may be a
cause for delay in seeking appropriate management of the rabies exposure, thus face
the risk of rabies infection.
The number of human rabies cases in the past twelve years has been fluctuating.
Statistics showed that human rabies cases fluctuate from 2007 to 2018 as shown in
Figure 1.
200
Cases
Year
Source: Infectious Disease Office, Disease Prevention and Control Bureau, DOH, Philippines
In 2018, the top 5 regions for human rabies cases were Region 3 (Central Luzon) with 58
cases, followed by Region 4-A (CALABARZON) with 30 cases, Region 7 (Central Visayas)
with 25 cases, Region 12 (SOCCSKSARGEN) with 21 cases and Region 1 (Ilocos) with 20
cases. Table 1 shows distribution of human rabies cases in different regions.
A total of 1,156,377 animal bite cases were reported in 2018. This is 247% increase from
330,077 cases in 2011. The incidence of cases of rabies exposures, mostly dog bite cases,
has been on an increasing trend.
Category of Exposure
Region
Cat I Cat II Cat III Total %Contribution to Total
1 524 62960 11845 75329 6.51%
2 291 74652 17936 92879 8.03%
3 596 102746 25363 128705 11.13%
4A 1635 69894 20945 92474 8.00%
4B 982 24465 8341 33788 2.92%
5 868 32830 9403 43101 3.73%
6 131 50905 42476 93512 8.09%
7 1651 65578 34936 102165 8.83%
8 29 15861 11551 27441 2.37%
9 1107 49928 24336 75371 6.52%
10 0 47218 11166 58384 5.05%
11 96 37896 6678 44670 3.86%
12 572 34840 12589 48001 4.15%
CARAGA 309 17549 4722 22580 1.95%
CAR 656 20360 7814 28830 2.49%
NCR 1154 128125 58443 187722 16.23%
ARMM 156 809 460 1425 0.12%
Total 10,757 836,616 309,004 1,156,377 100.00%
Source: Infectious Diseases Office, Disease Prevention and Control Bureau, Department of Health
In 2018 there were 1,156,377 animal bites, 99%of exposure, mostly through bites, 69 %
were from dogs, 28,98 % from cats and 1.3% from other animals. 9.3% were of Category I
exposures which do not require PEP, while 74,68% were Category II and 26.72% were
Category III exposures.
Animal bite per Sex Animal bite per Sex Biting Animal
Sex* Sex*
Dog Cat Others Total
Male Female Total <15 >15 Total
577,272
588,550
1,165,822 492,427 667,284 1,159,711 815,902 339,394 15,525 1,170,821
*Discrepancy in the total is due to incomplete entries in the Rabies Exposure Registry)
Source: Infectious Diseases Office, Disease Prevention and Control Bureau, Department of Health
1000000
783663
800000 683302
600000 522420
410811
400000 328733
176501 190095 216569
200000
Source: Infectious Disease Office, Disease Prevention and Control Bureau, DOH, Philippines
For the past five years from 2005 to 2018, the number and incidence of canine rabies
has been fluctuating from 1,415 confined cases in 2005 to 1,227 cases in 2018. However,
the number of samples sent for examination has significantly declined in the past five
years from 4879 samples in 2005 to 3997 in 2018. Thus it could not be claimed with
certainty that the reduction in the number of animal rabies is brought about by
prevention and control efforts against rabies but it can also be because of the declining
numbers of samples sent for examination.
Among the possible reasons for the reduction of the number of samples submitted are
difficulties in preparing, storing and transport of the specimens, and pet owners have to
shoulder laboratory related expenses such as laboratory fees and transportation cost.
5000
Pos
4500
1415 Neg
4000
3500 1113 1133 1227
3000 998
971
2500 779
Samples Tested
Region 3, 4A, 5 and 1 have been consistently in the top five regions with the highest cases of animal rabies
for the period 2017 and 2018. Highest reported number of animal rabies cases in 2017 and 2018 is in Region
3 and Region 8 with 241 and 252 cases respectively.
In the late 1980s, the Department of Agriculture through the Bureau of Animal Industry
and the Department of Health through the then Communicable Disease Control Service
initiated efforts to prevent and control rabies in the country.
In May 1991, a Memorandum of Agreement was signed among the Secretaries of Health
(DOH), Agriculture (DA), Local Government (DILG) and Education, Culture and Sports
(DECS) now Department of Education (DepEd) with representatives from the LGUs
committing their agencies to exert concerted efforts in eliminating rabies in the country.
This also led to the creation of the Rabies Control Consultative Committee (RCCC)
composed of top level officials from these four Departments and representatives from
NGOs. The function of the RCCC was to provide guidance in the implementation of the
program. At the same time a National Rabies Committee (NRC) composed of the
technical experts from DA and DOH served as the implementing body.
A program to control and eliminate rabies in the country by year 2020 was drafted by
the NRC. Activities were laid down which emphasized the creation of multi-sectoral
rabies committees at the regional, provincial, city and municipal levels on dog
immunization, anti-rabies human immunization and rabies awareness.
There were attempts to eliminate rabies in various parts of the country focusing on mass
dog vaccination such as the Mindanao Anti-Rabies Day (MAD) in the 1990’s and the
Rabies Action Program in Visayas (RAP-V) in 2000. However, all these initiatives failed to
eliminate rabies because of inadequate funds. The logistic support depended so much
on the regular funding of the implementing agencies since no special budget was
appropriated for its execution at the national and local levels.
In 1992, the WHO Expert Committee on Rabies recommended to replace the Nerve Tissue
Vaccine (NTV) with the modern tissue culture vaccine since NTV are less immunogenic
and caused more severe adverse reactions. They also recommended the use of the
intradermal (ID) regimen of anti-rabies vaccination especially for developing countries
where vaccines are costly and the supply is usually inadequate. The ID regimen had
significantly reduced cost but its efficacy was not compromised.
In 1997, the Philippines stopped using the old nerve-tissue vaccines and was replaced
with tissue culture vaccines. Purified Verocell Rabies Vaccine (PVRV), Purified Duck
Embryo Vaccine (PDEV) and Purified Chick Embryo Vaccine (PCEC) were introduced in
the Philippine market. In order to mitigate the cost of shifting from NTV to TCV, the DOH
adopted the intradermal regimen of anti-rabies vaccination.
On March 13, 1999, President Joseph E. Estrada signed Executive Order No. 84 declaring
March as Rabies Awareness Month creating the National Rabies Prevention Committee
composed of representatives from the DOH, DA-BAI, DILG, DECS (DepEd) and NGOs to
formulate policies and coordination implementation of the National Rabies Prevention
Control Program and to conduct massive information drive on rabies prevention
complemented by mass dog vaccination.
In 2006, Rabies Prevention Program through curriculum integration and instruction was
developed by CHD and DepEd in Region 5 (Bicol) and pilot tested in Cabusao,
Camarines Sur.
1. Anti-Rabies Act of 2007 (Republic Act 9482) : An Act Providing for the Control and
Elimination of Human and Animal Rabies, Prescribing penalties for Violation
Thereof and Appropriating Funds Thereof.
2. Batas Pambansa Bilang 97: An Act Providing for the Compulsory Immunization of
Livestock, Poultry and other Animals against Dangerous Communicable Diseases.
The Act required the Secretary of Agriculture to make compulsory the vaccination
of susceptible animals and poultry should there be a threat or existence of a highly
communicable animal or avian disease in a certain locality.
3. Executive Order No. 84: Declaring March as the Rabies Awareness Month,
Rationalizing the Control Measures for the Prevention and Eradication of Rabies
and Appropriating Funds.
1. Program Components:
NRPCP is a multi-agency effort to control and eliminate rabies in the country lead
by the Department of Agriculture (DA) and Department of Health (DOH),
Department of Interior and Local Government (DILG), Department of Education
(DepEd) in coordination with other Government Organizations (GOs), Non-
Governmental Organizations (NGOs) and People's Organizations (POs).
b. Health Promotion
The following are the significant activities in the conduct of information and
education campaign on the prevention and control of rabies:
This is the most effective measure to control canine rabies. The Department of
Agriculture – Bureau of Animal Industry takes the lead in mass dog vaccination
campaigns and provision of animal rabies vaccine.
This includes stray dog management through impounding, field control and
disposal, surgical and non-surgical sterilization and habitat control.
a. Capability -Building
3. Budget
The Department of Health budget for the program has increased from 25M in 2007
to 900m in 2019. The rabies program has its own line budget item starting in 2008.
However, despite the increase in the budget, the program can only augment full
8 doses of intradermal anti-rabies vaccine and one vial of ERIG to 40% of the total
rabies exposures requiring rabies immunoglobulin. The remaining ID doses and
ERIG are either provided by the Local Government Unit or by the patients
themselves. Unfortunately, most LGUs cannot procure enough vaccines and ERIG
to complete the PEP requirement for the animal bite victims. Most bite victims
cannot afford to purchase the remaining ID doses and ERIG. Because of this, there
is still a need for LGUs’ budget allocation for vaccines and ERIG especially when
the number of animal bite cases increases,
The Department of Agriculture has a budget of at least PhP10 Million yearly from
2005 to 2008 and it increased to PhP40 Million in 2009. However, in 2018, it only has
PhP8M budget for the procurement of animal vaccine. The funds are mainly used
for the procurement of dog rabies vaccine. Some local government units allocate
budget from their own funds to procure dog rabies vaccines and tissue culture
vaccines including rabies immunoglobulin for post-exposure prophylaxis.
While dog vaccination is the cornerstone for the prevention and elimination of
rabies, lack of funds for the procurement of dog vaccines against rabies is the
greatest hindrance in the attainment of the goal of reducing the incidence of
canine rabies, albeit of eliminating rabies in the country.
The Department of Health has funds for the NRPCP, amounting to PhP900 Million
for 2019. With the funding constraints for dog vaccination against rabies, the
Department of Health needs to ensure that cases of rabies exposure will be given
protection through post-exposure prophylaxis and pre-exposure prophylaxis.
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CHAPTER III: ASSESSMENT OF THE NATIONAL RABIES
PREVENTION AND CONTROL PROGRAM
I. ASSESSMENT OF THE PROGRAM BASED ON THE MEDIUM TERM PLAN 2011-2016
The National Rabies Prevention and Control Program has improved through the years
with several milestones and strengthened by legal mandates that support the program
and its implementation. The following set of goals based on the National Objectives for
Health have helped to focus efforts on rabies elimination:
Objective 1: To reduce the incidence of rabies to 1.5 cases per million population by the
end of 2016.
The program has moved towards the attainment of the set goals based on the Medium
Term Plan 2011-2016 for Rabies for the year 2011 to 2016 with the following
accomplishments:
Objective 1: At the end of 2016 incidence of human rabies decreased from 2.73/million
population in 2010 to 2.57 in 2018. This represents -- decrease in the incidence of human
rabies. However, the decrease is not enough to meet the objective to decrease the
incidence of human rabies to 1.5/million population
Objective 2: At the end of 2016 the program was able to declare 3 areas as rabies free
areas.
Objective 3: The dog vaccination coverage in 2018 is 53.30% which is below the target
of at least 70%.
21
II. STRENGTHS, OPPORTUNITIES, WEAKNESSES AND THREATS IN THE IMPLEMENTATION OF
THE PROGRAM
The Department of Health and Department of Agriculture in consultation with the LGUs
and other partner agencies, conducted an assessment of the program through the study
of strengths, weaknesses, opportunities and threats in the area of Governance, Service
Delivery, Financing, Regulation Health Information and Human Resources.
Governance: The presence of strong legal framework in the prevention and control of
rabies is considered as one of the strength of the program. Because of the legal support,
policy direction and technical guidance provided by the law it facilitated in the
implementation of the rabies program towards the reduction of mortality rate from
rabies. However, there is inadequacy in the implementation of the laws and policies by
local government units and related agencies
Service Delivery: The availability of logistics, personnel and existence of facilities such as
Animal Bite Treatment Centers contributed to the increase in PEP completion rate among
animal bite victims. But limitations in LGU support, budget and logistics were contributory
in the non-attainment of the set objectives.
Financing: Both DOH and DA have funds in the provision of vaccines under the General
Appropriation Act. However, DA-BAI does not have sufficient funds to procure vaccine.
Significant milestone of the program is the inclusion of health package for animal bite
victims for human rabies post-exposure prophylaxis under Philippine Health Insurance
Corporation (Philhealth). However, not all animal bite victims are Philhealth members.
Allotted national and local budget is not sufficient to cover related activities. LGU support
to the program varies upon the priorities and resources of local chief executive.
Regulation: The availability of guidelines for vaccine use and guidelines for ABTCs/ABC
ensure standard and acceptable services are provided to animal bite victims. Though,
not all are aware of the guidelines which lead to non-compliance to set standards and
guidelines.
Health Information: Both the DOH and DA have trained staff from the National to the
local to oversee implementation of the program in order to achieve rabies free areas,
yet because of the fast turn-over of staff/personnel this hinders efficient and continuous
flow of services thus affecting the attainment of national objectives for Rabies.
The following is the detailed matrix that includes the strengths and opportunities that are
contributory and facilitative to the implementation as well as the weaknesses and threats
and hindering issues in achieving the objectives of the Program. These are mapped
under six focus areas: Governance, Service Delivery, Policy, Regulation, Information and
Human Resource.
National Rabies Prevention and Control Program Strategic Plan 2020-2025
22
1. HUMAN HEALTH
a. Governance
• Strengths: Strong legal framework: The Anti Rabies Act of 2007 (R.A. 9482),
R.A.8485, Department Orders and local ordinances provide strong
mandate for the prevention and control of rabies from the national to the
local level.
b. Service delivery
23
Multi-tasking of Rabies Coordinators: Rabies coordinators are handling
other programs together with rabies.
Many of the LGUs have allocated funds spent mostly for dog and human
anti-rabies vaccines International organizations and funding agencies
support national and local initiatives against rabies (Bill and Melinda Gates
Foundation and JICA)
c. Financing
Rabies program has its own budget line item in the General Appropriation
Act since 2008 ensuring annual funds for the rabies program.
24
Philippine Health Insurance Corporation has included a health package for
animal bite victims for human rabies post-exposure prophylaxis.
Political Intervention: Because some of the budget comes from the LGU,
LCEs sometimes interfere in the guidelines of vaccine provision.
d. Regulation
Guidelines for vaccine. The program has a policy on the use of WHO pre-
qualified Cell Culture Vaccine and approved for intradermal
administration.
e. Health Information
25
Presence of Regional Epidemiology and Surveillance Unit to investigate
cases. Immediate validation of cases is done by the RESU for timeliness of
data.
26
f. Human Resource
27
CHAPTER IV:
STRATEGIC PLAN (2020-2025)
28
CHAPTER IV: STRATEGIC PLAN (2020-2025)
I. INRODUCTION
Both the DOH and DA have their own respective budget for the implementation of the
rabies program, however both agencies have no existing guide that could assist in
project identification and prioritization. As such the strategic aims to addressed
immediate needs and concerns by setting concrete plan of actions for synchronized
implementation towards rabies prevention and control.
Rabies is a public health problem with both, socio-cultural and economic implications
that which need to be addressed through a multi-sectoral approach. Through
integrated efforts of both the government and the private sectors, activities on the
prevention and control of animal and human rabies are coordinated and synchronized.
Sources of funding and support will be explored from national and local funding,
government health insurance and international organizations.
The implementation of the National Rabies Prevention and Control Program is a shared
responsibility of the Department of Health (DOH), Department of Agriculture (DA),
Department of Education (DepEd), and Department of Interior and Local Government
(DILG) and Local Government Units (LGUs).
29
III. Key Components Description:
1. Governance (Political)
This covers the program’s policy, implementation and coordinating structure from
the national to the local level. Implementation of the program will be guided by
policies, guidelines and procedures developed based on international standards.
This also includes high political support for the elimination of rabies at the national
level, among the key national government agencies and among local
government units, with multi-sectoral actions coordinated and in line with the
program direction.
This focus area will include the services (to include preventive and management,
clinical management of human rabies and laboratory diagnosis of human rabies)
that are made readily available aimed to achieve the key objectives of the
program.
3. Regulation (Political)
This focus area includes measures to ensure quality of products and resources
provided for rabies prevention and control, such as; quality Anti Rabies Vaccine
against rabies both for humans and animals, appropriate management of human
rabies exposures, cross-border quarantine procedures, Philhealth and other health
insurance accreditation and ABTCs/ABCs certification and registration.
4. Financing (Resources)
This focus area addresses the issue of funding for anti-rabies vaccines, both for
humans and dogs, resource requirements for vaccination campaigns, control of
dog population and movement and information, education and communication
campaigns for the promotion of Responsible Pet Ownership. This focus area also
identifies mechanisms for funding support such as national and local funding,
Philhealth and other health insurance coverage of rabies exposures.
30
5. Health Information (Socio-Cultrural)
This focus area includes the surveillance system which covers identification of
cases, notification and reporting with corresponding key appropriate actions.
Surveillance is anchored into the Philippine Integrated Disease Surveillance and
Response (PIDSR) & a Rabies web-based information system (NaRIS). This focus
area also includes the information, education and communication (IEC) of the
Program, encompassing development and implementation of communication
plan, information materials, public awareness programs and rabies integration into
school curricula.
IV. THE FRAMEWORK OF THE STRATEGIC PLAN OF FOR THE NATIONAL RABIES PREVENTION
AND CONTROL PROGRAM
To eliminate human rabies in the Philippines and to declare the country rabies- free
by 2030
31
VI. STRATEGIC OBJECTIVES
1. To ensure adherence to DOH AO's of all Animal Bite Treatment Centers (ABTCs)
The target of full PEP coverage of at least 90% of rabies exposures will be
reached if there is an appropriate decision-making on who should receive the
PEP full course. ABTCs will be obliged to adhere to the DOH guidelines on
management of rabies exposures. Updated Administrative Orders and Manuals
shall be distributed to the Animal Bite Treatment Centers for their compliance. A
monitoring system shall be in place to monitor the compliance of ABTCs.
The Program shall take into consideration the lead time for the procurement of
rabies vaccine and immunoglobulin and shall ensure timely delivery of the said
immunizing agents at all levels. The DOH shall allocate funds for the procurement
of cell culture vaccine and advocacy will be done to local chief executives for
fund allocation for CCV in their respective LGUs. Quality data management shall
be carried out at all levels for tracking/follow-up and complete documentation
of patients receiving PEP.
The coverage of Rabies Immunoglobulin is low at 40% due to the high price and
inadequate supply of RIG at the Animal Bite Treatment Centers. RIG is
indiscriminately given due to wrong categorization of exposures and poor
decision-making in management of rabies exposures. ABTC staff will be regularly
updated/ oriented on appropriate management of rabies exposures. The DOH
shall allocate funds for procurement of RIG and advocacy will be done to local
chief executives for fund allocation for RIG in their respective LGUs.
32
5. To provide Pre-exposure Prophylaxis to children in high-risk areas by the end of
2025
33
9. To train/update 100 % of ABTC/ABC staff by end of 2025
To address the problem of rapid turn-over of trained ABTC personnel, training will
be provided to new staff of the ABTCs. Health center personnel who are the front
liners in receiving/ referring rabies exposure cases shall be provided
orientation/updates for appropriate decision-making and proper guidance to the
animal bite victim.
34
Figure 8: Strategic Framework of the National Rabies Prevention and Control Program
To reduce the incidence of human rabies from 2.57 to To reduce the incidence of canine rabies from 6/100,000 dogs to
1.5/million population by 2025 (Baseline: 2.57/million pop in 3/100,000 dogs by 2025 (Baseline: 6/100,000 in 2010)
2018)
Institutionalize NaRIS
Information Validate all Human Rabies cases
Standardized recording & reporting
35
A. HUMAN SECTOR
36
IV: REGULATION
Strategic Objective 1: 90% ABTCs/ABCs Certification & % ABTCs/ABCs certified &
Availability of quality certified & accreditation accredited
vaccines accredited
Strategic Objective 2: All vaccines are Random % of ABTCs/ABCs using
Availability of quality FDA & WHO checking of FDA & WHO approved
vaccines approved vaccines vaccine
V. HEALTH INFORMATION
Strategic Objective 1: All ABTCs/ABCs Monitoring & % of ABTCs/ABCs utilizing
Institutionalized NaRIS utilize NaRIS evaluation NaRIS
Validate all Human All reported Surveillance % of ABTCs/ABCs
Rabies cases Human Rabies Recording & monitored & evaluated %
cases are reporting of ABTCs/ABCs submitting
investigated validated reports on time
using standardized
reporting forms
% of HR cases reported &
investigated
Strategic Objective 2: All AEFI Monitoring & % of AEFIs reported &
Adverse Event Following investigated & evaluation investigated
Immunization reported Surveillance
Standardized recording &
reporting
VI: HUMAN RESOURCE
Strategic Objective 1: All ABTCs/ABCs Capability % of ABTCs/ABCs manned
Capacitate ABTCs / ABCs manned by building by a trained Physician &
& other health staff on trained DOH nurse
management of animal accredited
bite victims. training facility
70% other health Capability % of physicians and nurses
workers oriented building oriented
37
2. Activities, Performance Indicator and Timeline
a. Governance
Targets:
All LGUs & other stakeholders implement the program based on approved
policies & guidelines
Strategy:
Localized program implementation
Activities:
1. Orientation on RA 9482
2. Organize/re-activate Rabies Coordinating Committee
3. Passage of ordinance
Performance Indicator 2020 2021 2022 2023 2024 2025
% of LGUs w/ functional Rabies 30% 40% 50% 60% 70% 80%
Committee
% of LGUs with implemented 30% 40% 50% 60% 70% 80%
ordinance
b. Service Delivery
Targets:
90% PEP Completion Rate by end 2025 (Baseline: 50%)
40%RIG coverage by end of 2025 (Baseline: 25%)
1 ABTC/ABC per 100,000 population or as needed (Baseline: 613 ABTC)
156 ABCs established
Strategy:
Health promotion
Logistics management/control
Engage private health care provider
38
Activities:
1. Conduct ACSM
2. Provision of anti-rabies vaccines, RIG & other supplies
3. Mapping of potential ABTCs/ABCs
4. Setting up of ABTCs/ABCs
Performance Indicator 2020 2021 2022 2023 2024 2025
% of CAT 2 & 3 provided w/ 80% 80% 85% 90% 90% 90%
complete dose
% of Category 3 provided 40% 50 % 60 % 70% 75% 80%
with RIG
Number of of ABTCs/ABCs 31 31 94 126 156 200
established (baseline:1
ABTC/ABC established for
every 150,000 population)
c. Financing
Targets:
80% Category 3 Animal Bite victims w/ PhilHealth card availing of Rabies
Philhealth Package
100% LGUs with NRPCP sub-plan in the CIPH/PIPH
Yearly inclusion as line item in the GAA
Strategy:
Availment of Animal Bite OPB Package
Secure adequate funding & utilization
Activities:
1. Identification of PhilHealth card holders among Cat 3 bite victims
2. Provide information on PhilHealth benefits
3. Timely filing of PhilHealth Re-imbursement
4. Conduct/participate in consultative planning workshops
5. Inclusion of the Rabies plan in the CIPH/PIPH
6. Lobby for program budget from LGU
39
d. Regulation
Targets:
90% ABTCs/ABCs certified & accredited
All vaccines are FDA & WHO approved
Strategy:
Certification & accreditation
Random checking of vaccines
Activities:
1. Develop master list of ABTCs/ABCs
2. Conduct self-assessment
3. Request for technical assistance based on Quality Improvement Plan
4. Comply to certification standards
5. Apply for certification & accreditation
6. Conduct random sampling of ARV for FDA analysis
e. Health Information
Targets:
All ABTCs/ABCs utilize NaRIS
All reported Human Rabies cases are investigated
All AEFI investigated & reported
All ABTCs/ABCs utilize standard recording & reporting forms
Strategy:
Monitoring & evaluation
Surveillance
Recording & reporting
Activities:
1. Conduct orientation on NaRIS
2. Conduct monitoring & evaluation of ABTCs/ABCs
3. Conduct PIR
4. Conduct investigation of HR & AEFI reported cases
5. Submit Quarterly report thru channels
40
Performance Indicator 2020 2021 2022 2023 2024 2025
% of ABTCs/ABCs utilizing NaRIS 50% 70% 80% 90% 100% 100%
% of ABTCs/ABCs monitored & 50% 70% 80% 90% 100% 100%
evaluated
% of ABTCs/ABCs submitting 50% 70% 80% 90% 100% 100%
validated reports on time using
standardized reporting forms
% of HR cases reported & 50% 70% 80% 90% 100% 100%
investigated
% of AEFIs reported & investigated 100% 100% 100% 100% 100% 100%
f. Human Resource
Targets:
100% of ABTCs/ABCs manned by doctor and nurse trained by DOH
accredited training facility
70% other health workers oriented
Strategy:
Capability building
Activities:
1. Conduct training needs assessment
2. Conduct training on Rabies & Animal Bite Management
3. Conduct orientation on NRPCP
41
3. National Rabies Prevention and Control Program Projected Budget 2020-2025
GOVERNANCE
Localize Orientation on P470,000 P517,000 P568,700 P625,570 P688,127 P688,127
program RA 9482
Implementation
Organize/Mobil P150,000 P165,000 P181,500 P199,650 P219,615 P219,615
ize functional
rabies
Coordinating
Committee
Ordinance
SERVICE DELIVERY
Health Conduct P150,000 P165,000 P181,500 P199,650 P219,615 P214,576
Promotion Advocacy,
Communicatio
Logistics ns and Social
Management Mobilization
Engage private Provision of P945,221,020 1.2 1.3 billion 1.3 billion 1.2 billion P945,221,020
health care Anti-rabies billion
provider vaccines, RIG
and other
supplies
potential ABTCs
and ABCs
Rabies
Elimination
campaign
(Dog
vaccination)
42
REGULATION
43
HEALTH INFORMATION
Monitoring and Orientation on P50,000 P2,034,000 P2,185,000 P1,49 P1,500,000 P1,506,000
Evaluation NaRIS 0,000
HUMAN RESOURCE
Capability Conduct of 50,000 55,000 60,500 66,550 73,205 80,525
44
IX. IMPLEMENTATION ARRANGEMENTS
The management and implementation structure of the National Rabies Prevention and
Control Program is composed of the National Rabies Prevention and Control Committee
(NRPCC) at the national level, the Regional Rabies Committee, the Provincial Rabies
Committee, City/Municipal Rabies Committee and the Barangay Rabies Committee.
The NRPCC is responsible for the formulation and harmonization of policies, guidelines,
courses of action and public health messages on rabies prevention and control.
The Regional Rabies Coordinators from the Centers for Health Development and
from the Department of Agriculture Regional Field Units will conduct visits to the
Local Government Units to monitor, provide technical assistance as well as
advocate to local government units to ensure that local efforts are geared for
rabies prevention and eventually, for elimination by 2020.
45
2. Evaluation of the Program
Consequently, as part of the PIR areas for possible declaration as Rabies free
zone will be identified and evaluated to attain the set goal of Rabies Free
Philippines.
Monthly, quarterly and annual reports from the Rabies Exposure Registry are
submitted by Provincial Coordinators to the Regional Coordinators, who are in turn
responsible for consolidation into a regional report for human animal rabies and
animal human rabies. The regional reports are submitted to the Bureau of Animal
Industry and to Department of Health through the National Center for Disease
Prevention and Control and , National Epidemiology Center and Bureau of Animal
Industry respectively.
46
PHILAHIS is an information system established by the Department of Agriculture for
animal health priority diseases. Future actions within the next six years are geared
toward integration and enabling all LGUS to make available all relevant and
needed data and information through PHILAHIS.
The NRPCP shall utilize the Rabies Exposure Registry and PEP Card as its official
recording forms. Quarterly reports on animal bite cases, cohort analysis and
Summary of Human Rabies shall be submitted by all levels to the DOH through
channels. Recording and reporting shall be implemented at all ABTCs/ DOH
recognized ABCs in the country. Recording and reporting shall include all animal
bite cases categorized according to NRPCP guidelines. The NRPCP shall adopt the
official DOH recording and reporting system. Records and reports shall verify the
accomplishment of the program
47
2. ANIMAL HEALTH
OPLAN RED
OPERATIONAL PLAN FOR RABIES ELIMINATION IN DOGS IN THE PHILIPPINES
48
TABLE OF CONTENTS
Contents
III.1 Background on the development of the Rabies Medium Term Plan
(2017-2022) of the animal health sector
49
III. I BACKGROUND ON THE DEVELOPMENT OF THE STRATEGIC PLAN (2020-2025) OF THE
ANIMAL HEALTH SECTOR
The Rabies Medium Term Plan (2011-2016) of the Philippines identified six focus areas
relevant to the National Rabies Prevention and Control Program (NRPCP): (1)
Governance, (2) Service Delivery, (3) Financing, (4) Regulation, (5) Information, and (6)
Human Resource. This has been the standing framework of the NRPCP from which key
result areas, strategies, activities and key performance indicators were based upon for
both the human and animal health components of the program. In the recent years
however, new cohesive regional and global approaches were introduced for a
coordinated approach and vision for the rabies elimination.
50
The ARES was later used during the Rabies Global conference held in Geneva
Switzerland on 10-11 December 2015. In accordance with the consensus of the
conference, the World Organisation for Animal Health (OIE) and the World Health
Organization (WHO) released the global framework for the elimination of dog-mediated
human rabies, in collaboration with the Food and Agriculture Organization of the United
Nations (FAO) and with the support of the Global Alliance for Rabies Control (GARC). This
framework provides a coordinated approach and vision for the global elimination of
dog-mediated human rabies following the STOP Strategy, with addition of Resources as
the fifth pillar. It is intended to harmonize actions and provide adaptable, achievable
guidance for country and regional strategies. This Global Framework was later endorsed
by resolution 26 during the 2016 General Session of OIE Delegates.
C.
Figure 9. The Global Framework for the elimination of dog-mediated human rabies. Building upon the ASEAN
Rabies Elimination Strategy and released at the Rabies Global Conference (Geneva, 10-11 December 2015), this
framework provides a coordinated approach and vision for the global elimination of dog-mediated human
rabies.
51
Aligning the 2017-2022 Rabies Medium Term Plan with the Regional Strategy and the
Global Framework
The OIE STANDZ Rabies Project in the Philippines provided assistance to align the 2017-
2022 Rabies Medium Term Plan with the regional strategy and global framework, while
maintaining consistency with the original visions of the National Rabies Program of the
country. With reference to the original 2011-2016 version, shown in Table c.1 is the
alignment of the focus areas, key result areas, strategies and sample activities as well as
key performance indicators for the 2017-2022 MTP for the animal health sector, named
as the Philippine OPLAN RED (Operational Plan for Rabies Elimination in Dogs).
Following the STOP-R Framework and integrating the lessons, experiences, tools and other
materials generated from the previous cycle of implementation, OPLAN RED will
aggressively target dog rabies elimination. While efforts will focus on educating and
engaging the public for reinforcing actions (Socio-Cultural Component), central to
OPLAN RED will be the efforts to address virus at source through intercepting the cycle of
infection at its entry and exit points (Technical Component) which will also include
strengthening of internal and external coordination and partnerships (Organizational
component). To ensure sustainability, political support and policy reinforcements will also
be secured (policy and legislative component), and efforts to create sustainable human
and funding resources for the National Rabies Program (resources component) will be
targeted. To review progress and quality at implementation, a monitoring and evaluation
framework will also be integrated in the plan, with annual findings released as one of the
highlights of the Rabies Awareness Month in March of every year.
The OPLAN RED will leverage on available progress at the regional and global levels,
improved understanding of the dynamics of the problem, stronger cross-sectoral and
public-private partnerships, and accessible resources such as the vaccine bank.
52
III.2 KEY COMPONENTS DESCRIPTION
A. Socio-cultural component.
This was previously in part under the Health Information focus area in the 2011-2016 plan
which includes the information, education and communication (IEC) of the Program,
encompassing development and implementation of communication plan, information
materials, public awareness programs and rabies integration into school curricula.
Building on the success, experiences, and lessons from the work on public awareness during
the previous implementation, OPLAN RED will continue to pursue engaging the public and
relevant stakeholders in the national fight against rabies. It will also leverage on the
available relevant tools generated for this purpose, as well as the partnerships established
in the course of implementation. OPLAN RED includes strategies to (1) refine and
operationalize the national rabies communication strategy; (2) intensify rabies education
and communication campaign; (3) and promote responsible pet ownership. These are
discussed in more detail under Section III.3.
53
B. Technical component
The technical component of OPLAN RED was largely drawn from two focus areas from MTP
2011-2016: Service delivery and health information which respectively underscore the need
to access necessary technical services and enhancing surveillance systems.
The technical component of OPLAN RED, which will aggressively focus on arresting and
eliminating rabies virus circulation, outlines work to achieve two key result areas: (1) Rabies
transmission is prevented by protecting susceptible dogs and (2) preventing spread of the
rabies virus from infected source. While the previous plan targeted 70% vaccination
coverage, OPLAN RED will emphasize a risk-based approach to mass dog vaccination
which will aim to urgently neutralize circulating infection of known high-risk areas, expanding
towards areas of lower risk, depending on available resources (see Annex 2). These
targeted interventions shall also be accordingly monitored post-implementation (see Annex
3). Both efforts to protect susceptible dogs will be complemented by management of stray
dog population and dog movement control that will build on existing regulations (see Annex
4) and tap on established partnerships.
In pursuit of containing infection where present, OPLAN RED also underscores early case
detection, tracking of infected dogs, and identifying potential pathways of transmission,
and will be operationalized through animal rabies case investigation and management
(see Annex 5). Participatory approaches to this enhanced surveillance (see Annex 6) will
also be pursued to reinforce this area of work. These strategies and accompanying tools are
further discussed under Section III. 3.
54
C. Organizational component
The organizational component of OPLAN RED is drawn from some areas of work under the
Governance focus area of the previous MTP which included strategies on strengthening
collaboration between involved agencies.
OPLAN RED focuses on (1) strengthening the rabies chain of command and communication
within the animal health sector; (2) strengthening of the National and Local Rabies
Prevention and Control Committee; (3) implementation of the practical inter-sectoral linking
using the relevant tool developed for One Health coordination at the grassroots level (see
Annex 7); and (4) strengthening of the public-private partnerships. Details on these
strategies can be found in Section III. 3.
55
D. Policy and legislative component
The sustainability of a national program against a neglected disease like rabies will in part
depend on capturing the attention and support of policy makers, securing political support
and establishing the necessary legal instruments for reinforcement.
This Policy and Legislative component was largely drawn from the Governance focus area
of MTP 2011-2016 which primarily centered on the adhesion to RA 9482 or the Anti-Rabies
Act of the Philippines, as well as Regulation focus area which emphasized the need for strict
implementation of regulations regarding dog movement and registration of dog rabies
vaccines.
The Policy and legislative component of the 2017-2022 MTP OPLAN RED outlines the need
to: (1) Engage adoption of RA 9482 through local ordinance at the Barangay level; (2)
Advocate to national leaders/legislators for commitment on rabies elimination; (3) enforce
appropriate legal instruments where in place (eg., quarantine, vaccine importation, etc.).
These are discussed in more detail under Section III.3.
E. Resources component
One of the more pressing concerns in the implementation of the national rabies program is
the availability of manpower and financial resources to sustain this. Part of the OPLAN RED
therefore places strong emphasis on the intention to create sustainable human and funding
resources for the national rabies program.
56
III. 3 THE RABIES MEDIUM TERM PLAN (2020-2025) OF THE ANIMAL HEALTH SECTOR:
OPLAN RED (OPERATIONAL PLAN FOR RABIES ELIMINATION IN DOGS IN THE PHILIPPINES)
As previously highlighted, OPLAN RED exerts efforts to align the overarching focus areas of
the national plan of the Philippines with the recent developments in the coordinated efforts
to address rabies in the region and globally as a whole following the STOP-R Strategy.
Furthermore, OPLAN RED builds on the achievements and draws lessons learned from the
previous cycle of the national plan implementation.
The overarching goal of the National Rabies Prevention and Control Program is to eliminate
dog-mediated human rabies by 2030.
The Medium-Term goal of OPLAN RED for 2017-2022 is to progressively reduce the risk of
dog rabies in areas where present and maintain freedom where this has been achieved.
This will include initial evidence-based classification of key compartments (Provinces and
Cities) as (1) high, (2) medium, (3) low risk, (4) candidate free zone, or (5) officially free zone.
A classification tool has been prepared and is included as Step Zero under Annex 2 (Risk-
Based Approach to Mass Dog Vaccination).
57
C. Strategy for rabies risk reduction
As introduced in III.1 and described in further detail under III.2, OPLAN RED will adapt the
ASEAN Rabies Elimination Strategy and the Global Framework for the Elimination of dog-
mediated human rabies (STOP-R Strategy), while maintaining consistency with the focus
areas of the National Rabies Program of the Philippines.
Comprehensively shown in Figure 3 below, the overarching STOP-R strategy to reduce rabies
risk will be centered on the dynamics and natural history of the disease. The relevant
strategies for each of the five components (socio-cultural, technical organizational, policy
and legislation, and resources) are also outlined relevant to the progressive elimination of
rabies in the dog population. Emphasis on actions to intercept the virus circulation will vary
depending on the level of risk and prevailing rabies situation in the area. For example, high-
risk areas might opt to heavily place investments in risk-based MDV, medium-risk areas might
choose to focus on case finding through case investigations, while low-risk and free areas
might emphasis on controlling dog movements to prevent intrusion. OPLAN RED calls for
evidence-based actions and continued improvements on capacity of Veterinary Services
to integrate existing rabies situation and designing and implementing the best fit
interventions. Details on the key result areas, strategies, and sample activities are further
described in the section that followed.
58
Figure 3. The STOP-R Framework in the OPLAN RED of the Philippines. While efforts will focus on educating and engaging the public for
reinforcing actions (Socio-Cultural Component), central to OPLAN RED will be the efforts to address virus at source through intercepting infection
at its entry and exit points (Technical Component) which will also include strengthening of internal and external coordination and partnerships
(Organizational component). To ensure sustainability, political support and policy reinforcements will also be secured (policy and legislative
component), and efforts to create sustainable human and funding resources for the National Rabies Program (resources component) will be
targeted. To review progress and quality at implementation, monitoring and evaluation will also be integrated in the plan, with annual findings
released as one of the highlights of the Rabies Awareness Month in March.
59
D. Available and accessible tools and mechanisms for OPLAN RED Implementation 2020-
2025
60
Annex 4. Policies on dog movement control. In
1999, an Administrative Order (43) was released by
the Department of Agriculture (DA) regarding the
Rules and Regulations on Animal Air Transport.
Subsequently, an AO (2) was released in 2002 for
Animals that are transported by sea. Finally, an AO
(10) was released in 2005 requiring permits for
transport of dogs and cats. All these issuances were
released Pursuant to Section 4 of Republic Act 8485,
otherwise known as Animal Welfare Act of 1998.
61
Annex 7. Practical Inter-Sectoral Linking. The
practical inter-sectoral linking was developed and
piloted in the Bicol Region. It provides guideline on
linking key players in the event of rabies event – the
local government unit, the animal health sector
and the human health sector in the locality where
the event arises. Closely tied with the case
investigation protocol (Annex 6), this guidance
document provides mechanisms on how data are
shared, who to share it to, and what actions need
to be taken by both sectors following the
investigation findings.
62
E. OPLAN RED and the STOP-R Strategy
OCIO-CULTURAL COMPONENT
Key Result Area: Inform and engage the community with the national rabies program
Current Challenges
Lessons Learned
1. Target audience for IEC dissemination should not stop to dog owners only, but also
to identify other target audience important to the proper implementation of the
program (veterinarians, physicians, community)
2. Yearly retooling of veterinarians, frontline personnel and partners from other
agencies in the rabies prevention and control program implementation
3. Regular innovation of the IEC materials available to the public
4. Consistent and unified message regarding rabies is a must
5. Preparation of the IEC materials in the local dialect
63
Key Strategies
1.1 Refine and operationalize the National Rabies Communication Strategy. A National Rabies
Communication Plan (Annex 1) has been jointly developed by DA and DoH in 2015-
2016, and can now be operationalized after further refinement, and used as a
reference to harmonize efforts when communicating about rabies.
1.2 Intensify rabies education and communication campaign. The Philippines has a long-standing
work on rabies education and communication. Many of these however, are ad hoc and
episodic (eg., during World Rabies Day celebration only). To establish a mechanism by which
quality and harmonized rabies education and communication are put in place, OPLAN RED will
capitalize on existing partnerships who can provide support on reaching the most critical
segment of the Philippines, particularly the poor and the marginalized.
Sample activities:
Tap DepEd, Veterinary Schools, PVMA Chapters, relevant NGOs to roll out the dog
rabies education and communication campaign
1.3 Promote responsible pet ownership. With a substantial proportion of rabies cases classified as
unvaccinated and/or stray - engaging the public to be responsible pet owners will play a
critical role in achieving rabies elimination and in pursuing sustainability of rabies control and
prevention efforts in the country. Efforts on this important area of work will thus be emphasized,
and the support of all relevant groups will be sought.
Sample activities:
Integration of RPO in the regular celebration of rabies awareness month and world
rabies day
Tap Animal Welfare Groups and DA-CAW to promote responsible pet ownership
64
ARES/
Example
Global
Activities (to Key
Rabies
Strategy be assessed Performance
Frame Key
(2017- and updated Indicators
work Result 2020 2021 2022 2023 2024 2025
2022 in annual (To be
(STOP- Area
MTP) planning) determined
R)
(2017-2022 every year)
Equiva
MTP)
lent
No. of
provinces and
cities are
reached by
1.1.1 Develop
the produced
and produce
IEC materials
IEC materials
in
Favourable
accordance 1,00 1,20 1,00 1,20 1,00
1.1 behavior, 1,200
to the 0,00 0,00 0,00 0,00 0,00
Refine knowledge, 0 0 0 0 0
,000
National
(1) and attitudes and
Rabies
Inform operati practices are
Communicati
and onalize documented
on Strategy
engag the through post-
e the Nationa testing
Socio- comm l Rabies evaluation
Cultur unity Commu every 2 years
al in the nication
nation Strateg 1.1.2 Roll out
al y NRPCP
rabies Medium Term
No. of
progra Plan (2017-
provinces and
m 2022) "OPLAN
cities are 500, 500,
RED" through 000 000
reached by
workshops,
OPLAN RED.
fora,
meetings,
etc.
65
commu Chapters, extended by
nication relevant identified
campai NGOs to roll partners
gn out the dog
rabies
education
and
communicati
on campaign
1.3.1
Integration of
RPO in the No. of
regular provinces and
celebration cities hold
500, 500, 500, 500, 500, 500,0
of rabies Rabies 000 000 000 000 000 00
awareness awareness
1.3
month and month and
Promot
world rabies WRD
e
day celebrations
responsi
ble pet
1.3.2 Tap No. of
owners
Animal reported
hip
Welfare activities and
Groups and outputs (eg.,
DA-CAW to video, leaflet)
promote on RPO
responsible promotion
pet conducted or
ownership produced
66
ECHNICAL COMPONENT
Key Result Areas: (1) Rabies transmission is prevented by protecting susceptible dogs and
(2) preventing spread of the rabies virus from infected source.
Current Challenges
67
Lessons Learned
1. A need for an illustrated and simple field manual for rabies (concise version of
the Rabies Manual of Operations)
2. Creation of a partnership with major couriers and transport companies in the
handling and shipment of rabies and other animal disease samples
3. Educate field personnel in the proper collection, handling and submission (filling-
up of forms and transport) of rabies samples
4. Trained vaccinators and animal catchers should be authorized and supervised
by a licensed veterinarian, with proper identification signed by the
corresponding licensed veterinarian
5. Provision of formal training of vaccinators/humane animal catching is needed,
including provision of pre-exposure prophylaxis
6. Provision of rabies hotline for quick response
Key Strategies
Sample Activities:
Sample Activities:
68
2.3 Stray dog population management.
Sample Activities:
Sample Activities:
Develop and implement strict policies/legal instruments for transporting dogs within the
country
Sample Activities:
Popularize and provide training in conducting animal rabies case investigation and
utilizing the available tool
Sample Activities:
Example
ARES/Glo
Activities (to Key
bal
be assessed
Rabies Performanc
Key Strategy and
Framewor e Indicators 202 202 202 202 202 202
Result (2020- updated in
k (STOP- (To be 0 1 2 3 4 5
Area 2025) annual
R) determined
planning)
Equivalen every year)
(2017-2022
t
MTP)
69
protectin 2.1.2 recommend
g Conduct a ed.
suscepti joint rapid
ble dogs. risk
assessment
to identify
hotspots to
prioritize.
2.1.3
Implement
recommend No. of areas
ed actions who
in
achieved
accordanc
reduction in
e to the
prioritization
risk
based on classification
risk over time
assessment
findings.
2.2.1 Plan
2.2 Post- and
No. of areas
vaccinatio conduct
where PVM
n PVM where
was
Monitoring risk-based
(PVM) MDVs are conducted
conducted
Reduction
of stray dog
2.3.1 Strict
implementa population,
tion of RA especially in
9482 high-risk
regarding areas (info
stray dog from
2.3 Stray
population assessment
dog
manageme
population for MDV can
nt
managem be used as
ent baseline)
2.3.2
No. of
Organize
organization
coordinated
spay and
s that
castration organize
campaigns spay and
with support castration
National Rabies Prevention and Control Program Strategic Plan 2020-2025
70
from NGOs, campaigns
volunteer and total
veterinarians no. of spay
, and others.
and
castration
campaigns
conducted.
2.4.1
Develop
and No. of
implement apprehensio
strict
2.4 Control ns, warnings,
policies/leg
of dog and cases
al
movement raised (and
instruments
for issues
transporting resolved)
dogs within
the country
2.5.1 No. of
Popularize animal case
2.5
and provide investigation
Regularly
training in s
conduct
conducting
animal conducted
animal
rabies
rabies case
case No. of
investigation
investigati human and
and utilizing
(2B) on (See
the animal
Rabies Annex 5)
available rabies cases
transmissi
tool intercepted.
on is
prevente
2.6.1
d by
Popularize
containin
the
g 2.6 No. of
participator
infection Enhance suspect,
y rabies
rabies
surveillance probable,
surveillanc
and and
e and
engage confirmed
reporting
stakeholders cases
(See
to be
Annex 6) reported
involved
and
contribute
71
RGANIZATIONAL COMPONENT
Key Result Area: Strengthen internal and external coordination and partnerships
Current Challenges
Lessons Learned
1. Involve and promote good partnership with private and other socio-civic
organizations for rabies related activities
2. Orientation of the new coordinators and partner agencies of the rabies program
Key Strategies
3.1 Strengthen rabies chain of command and communication within the animal health sector
Sample Activities:
3.2 Strengthen National and Local Rabies Prevention and Control Committee
Sample Activities:
Provide support and guidance to the committees and encourage consistency of regular
meetings
72
3.3 Implement practical inter-sectoral linking
Sample Activities:
Sample Activities:
3.1
Strengthen
rabies
chain of
command
and 3.1.1
(3)
Strength
communica Condu
tion within ct an
en No. of
the animal
internal annual
health implement
Organizati and fora on
sector3.1 ation issues 500,0 500,0 500,0 500,0 500,0 500,0
onal external OPLAN
Strengthen raised and 00 00 00 00 00 00
coordinat
rabies RED for
ion and resolved
chain of regular
partners
command updat
hips
and es
communica
tion within
the animal
health
sector
73
No. of
3.2.1
meetings
3.2 Provide
conducted
Strength support
and
en and
recommenda
National guidance
tions
and to the
accomplished
Local committee
(National);
Rabies s and 50,000 50,000 50,000 50,000 50,000 50,000
No. of LGUs
Preventi encourag
that have an
on and e
established
Control consistenc
MRCC/BRCC
Committ y of
that meet
ee regular
regularly
meetings
(Local).
3.4.1
Finalize
LGU-
academe
No. of BAI-
MOU and
3.4 LGU-
operation
Strength academe
alize the
en MOUs signed
partnershi
public- and no. of 150,00 150,00 150,00 150,00 150,00 150,00
ps;
private coordinated 0 0 0 0 0 0
Convene
partners activities
annual
hip operationalize
meetings
d.
for
updates
on
progress
74
OLICY AND ADVOCACY
Key Result Area: Secure political support and reinforcements to the national rabies
program
Current Challenges
1. Lack of political will to support the rabies program by some Local Chief
Executives and law makers
2. Dedicated personnel to focus on the program (e.g government veterinarians,
vaccinators)
3. Improving yearly budgetary releases for the rabies program
4. Enhancing annual dog registration and regular vaccination
5. Implementation of local rabies ordinances and enforcing penalties by Local
Governments
Lessons Learned
Key Strategies
4.1 Engage adoption of RA 9482 through local ordinance at the Barangay level.
Sample Activities:
75
4.2 Advocate to national leaders/legislators for commitment on rabies elimination
Sample Activities:
4.3 Enforce appropriate legal instruments where in place (eg., quarantine, vaccine importation,
etc.)
Sample Activities:
Example
Activitie
Key
ARES/Gl s (to be
Perform
obal assesse
ance
Rabies d and
Indicat
Framew Key Strategy updated
ors
ork Result (2017-2022 in 2020 2021 2022 2023 2024 2025
(To be
(STOP- Area MTP) annual
determi
R) plannin
ned
Equival g)
every
ent (2017-
year)
2022
MTP)
76
ments to at the Associati ces as
the Barangay on of adapte
national level. Baranga d from
rabies y RA 9482
program Captain
s (ABC)
to
advocat
e for
rabies
ordinan
ce
develop
ment
4.2.1
Particip
ate in
Increas
the
ed
meeting
investm
s of
ents
League
4.2 made
of
Advocate by LCEs
Province
to national to their
s and
leaders/leg local
Municip
islators for rabies
alities to
commitme progra
advocat
nt on ms
e and
rabies (Baselin
seek
elimination e:
funding
survey
support
data
for the
from
rabies
2015)
program
in their
locality
77
4.2.1
Aggressively Amount
lobby to high invested by
level policy- high-level
makers for policy makers
support to to OPLAN RED
OPLAN RED
4.3.1
Inspection, No. of
apprehension apprehensions
and and
confiscation confiscations
of animals No. of
4.3 Enforce shipped properly
appropriate without documented
(4B) Secure
legal proper transactions
political
instruments documents
support and
where in
reinforcements
place (eg., 4.3.2 Develop
to the national
quarantine, accessible
rabies
vaccine instructions
program No. of end-
importation, and tools to
users that
etc.) facilitate
utilised the site
compliance
and complied
(eg., vaccine
with
registration
requirements
site, online
processing
algorithms)
78
ESOURCES
Key Result Area: Creating sustainable human resources and funding resources for the
national rabies program
Current Challenges
1. Limited human and funding resources are available to the rabies program.
2. At the national level, funds allotted as per approval of the Department of
Budgetary Management are not sufficient to cover the needs of the program.
3. Budgetary support at the local level depends on the priority and advocacy of
the local government unit.
4. A need for a centralized and organized monitoring, and report submission of
available resources.
5. Reaching out far-flung areas to conduct vaccination activities
6. Availability of funds for provision of Pre-exposure prophylaxis to volunteer
vaccinators
Lessons Learned
1. Prioritizing the focus areas to maximize the limited human and funding resources
2. Lobbying to increase budgetary support from the lawmakers
3. Tapping volunteer vaccinators from academe and people’s organization
Key Strategies
5.1 Plan and secure vaccine procurement and budget for MDV implementation for 2020-2025
Sample Activities:
Map out vaccine demands for 2020-2025, lobby for necessary funding support and
coordinate with OIE Vaccine Bank for procurement.
79
5.2 Strategically procure and secure budget for the implementation of OPLAN RED
Sample Activities:
5.3 Build the capacity of staff involved in MDV, rabies diagnosis, surveillance, MDV, and other
relevant control activities
Sample Activities:
Develop specific modules for training on essential technical methods for rabies elimination
(eg., dog catching, MDV, sample collection, etc.)
Tap the BAI-LGU-Academe partnership and other institutions as channels for these essential
trainings
Example
ARES/Glo Activities Key
bal (to be Performan
Rabies assessed ce
Key Strategy
Framewor and Indicators 202 202 202 202 202 202
Result (2020-2025
k (STOP- updated in (To be 0 1 2 3 4 5
Area MTP)
R) annual determine
Equivalen planning) d every
t (2017-2022 year)
MTP)
5.1.1 Map
out Mapped
(5A) 5.1 Plan and vaccine vaccinatio
Creating secure demands n
sustaina vaccine for 2017- demands
ble procuremen 2022, for 2017-
funding t and lobby for 2022
Resources necessary establishe
resource budget for
s for the MDV funding d.
national implementat support
rabies ion for 2020- and 100%
program 2025 coordinat procurem
e with OIE ent of
Vaccine mapped
Bank for demands
80
procurem for each
ent. year
Total
amount
secured
5.2.1
from the
Lobby to
governme
secure
nt for each
funds from
year
the
(should be
governme
at least
nt as
100% of
stipulated
5.2 the
in RA9482
Strategically amount
procure and indicated
secure in RA9482)
budget for
the 5.2.2 Seek Total
implementat funding amount
ion of support secured
OPLAN RED from from the
internation internation
al and al and
national national
developm developm
ent ent
partners, partners,
private private
sector, sector,
and other and other
sources. sources.
5.3.1
(5B) 5.3 Build the Develop No. of
Creating capacity of specific modules
sustaina staff modules develope
ble involved in for training d on
Resources human MDV, rabies on essential
and diagnosis, essential technical
funding surveillance, technical methods
resource MDV, and methods for rabies
s for the other for rabies elimination
national relevant elimination
(eg., dog
National Rabies Prevention and Control Program Strategic Plan 2020-2025
81
rabies control catching,
program activities MDV,
sample
collection,
etc.)
5.3.2. Tap
the BAI-
LGU-
Academe No. of
partnershi trainings
p and conducte
other d and
institutions number of
as trainers
channels and
for these trained
essential staff
trainings produced
82
III.4 IMPLEMENTATION ARRANGEMENTS: ROLES AND RESPONSIBILITIES OF OPLAN RED
STAKEHOLDERS
ARES/
Global
Example Key
Rabies
Activities (to Performance
Frame Key Strategy
be assessed Indicators Roles and
work Result (2020- Agencies
and updated (To be Responsibilities
(STOP- Area 20250
in annual determined
R)
planning) every year)
Equiva
lent
83
DA Tap DepEd and other
sectors to provide
training for Academe,
LGUs and NGOs
1.2.1 Tap
DepEd,
Ensure LGU
Veterinary
1.2 implementation
Schools, No. of
Intensify DILG
PVMA registered Conduct community
rabies
Chapters, education/co awareness
educati
relevant mmunication
on and
NGOs to roll activities
commu LGU
out the dog extended by
nication Assist the LGUs in the
rabies identified
campai conduct awareness
education partners
gn activities
and
communicati
Academe Provide training for
on campaign
teachers on the basics
NGOs, PVMA of Rabies Education
84
Example
ARES/Global Key Performance
Activities (to be
Rabies Indicators
Key Result Strategy (2020- assessed and Roles and
Framework (To be Agency
Area 20250 updated in Responsibilities
(STOP-R) determined
annual
Equivalent every year)
planning)
2.1.1
Characterize
the rabies risk in Evaluate areas
the area of to be declared
No. of areas
interest. priorities or
assessed and risk- NRPCC
based MDV hotspots
2.1.2 Conduct
conducted as -DA (BAI
a joint rapid risk Recommend
recommended. and RFO)
assessment to actions to be
identify -DOH done
hotspots to
prioritize.
DILG
DA Plan and
conduct PVM
2.2.1 Plan and
2.2 Post- (laboratory)
conduct PVM No. of areas
vaccination
where risk- where PVM was Conduct PVM
Monitoring
based MDVs conducted with DA
(PVM Academe
are conducted
85
LGU Assist the DA in
the conduct of
PVM
LGU Implement
impounding
activities
86
Monitor inter-
provincial/inter-
island dog
movements
LGUs
Example
Activities (to be
ARES/Global Key Performance
assessed and
Rabies Strategy Indicators
Key Result updated in Roles and
Framework (2017-2022 (To be Agencies
Area annual Responsibilities
(STOP-R) MTP) determined
planning)
Equivalent every year)
(2017-2022
MTP)
87
and conducting for a,
partnership meetings
DA Provide guidance
to LGU
No. of meetings
Establish a local
conducted and
3.2.1 Provide rabies control
3.2 Strengthen recommendations
support and committee and
National and accomplished LGU
guidance to the regularly meet to
Local Rabies (National); No. of
committees and plan out and
Prevention and LGUs that have an
encourage update activities
Control established
consistency of
Committee MRCC/BRCC that
regular meetings
meet regularly
(Local).
DA Conduct trainings
and provide
assistance to LGUs
on the inter-
sectoral linking
protocol
Conduct case
investigation
No. of case
3.3.1 Roll out the Inform LGU of the
3.3 Implement investigations
practical inter- cases reported
practical inter- conducted; no. of
sectoral linking
sectoral linking dog and human
protocol LGU Assist the conduct
cases intercepted
of case
investigation and
conduct study on
DOH-RHU bite cases
Academe
88
ARES/Global Example Activities
Key Performance
Rabies (to be assessed and Roles and
Indicators
Framework Key Result Area Strategy (2020-2025) updated in annual Agencies Responsibilitie
(To be determined
(STOP-R) planning) (2020- s
every year)
Equivalent 2025)
DA Encourage LCEs
to support
DILG Rabies Program
4.1.1 Participate in and ensure
the meetings of adoption of RA
No. of Barangays
4.1 Engage adoption of the Association of 9482.
that has rabies
RA 9482 through local Barangay Captains
ordinances as
ordinance at the (ABC) to advocate
adapted from RA
Barangay level. for rabies
9482 Adoption of RA
ordinance
development 9482
89
4.3.2 Develop DA Provide
accessible guidelines on
instructions and vaccine
No. of end-users
tools to facilitate utilization
that utilised the site
compliance (eg., reporting
and complied with
vaccine
requirements
registration site,
online processing
algorithms)
Example Key
ARES/Global
Activities (to Performance
Rabies
Key Result Strategy (2020- be assessed Indicators Roles and
Framework Agencies
Area 2025) and updated (To be Responsibilities
(STOP-R)
in annual determined
Equivalent
planning) every year)
90
development development
partners, partners,
private private
sector, and sector, and
other other
sources. sources.
91
Annexes
National Rabies Prevention and Control Program Medium Term Plan 2012-2016
National Rabies Prevention and Control Program Medium Term Plan 2012-2016
Annex1: Anti Rabies Act of 2007
Sources Information
1.Governance
2.Service delivery
2.1To increase PEP % of Rabies exposures Review of annual Quarterly and annual
completion rate with PEP completed report on PEP reports from CHDs
among registered up to day 28 dose Annual Report of DOH
rabies exposed cases on NRPCP
to 90 % by end of implementation
2025
2.2 To increase RIG % of Rabies exposure Review of annual Quarterly and annual
coverage to 80% by cases with RIG report on RIG reports from CHDs
end of 2025 coverage coverage of rabies Annual Report of DOH
exposures on NRPCP
implementation
2.3 To validate 100% % of reported human Review of report on Report on the Rabies
of reported human rabies cases are the Rabies Death Death Review at the
rabies cases by end of validated Review at the national national level
2025 level
% of children 5 to 14
years old living in high-
risk areas given
booster dose of PrEP
% of schools in high
risk areas covered
3. Financing
3.1 To reduce out of % of rabies exposures Annual Review of Philhealth records
pocket expenditures receiving PEP report /records of
for PEP of 80 % of reimbursed by Philhealth from 2013
rabies exposures by PhilHealth onwards
end of 2025
4. Regulation
4.1 To certify/accredit % of certified Review of Program’s Updated list of
100 % of ABTCs and ABTCs/ABCs records on the list of accredited ABTCs/ABCs
ABCs by end of 2025 accredited
ABTCs/ABCs
5. Health information
5.1 Integration of anti- % of public elementary Joint review with Report on training of
rabies program into schools adopting DepED on rabies DepEd implementers
the curriculum and rabies integration into integration into and on the number of
curriculum curriculum schools adopting rabies
instruction from
information into the
Grades I-VI in all public curriculum
elementary schools by
end of 2025.
5.2To create public % households aware KAP survey done every Record of KAP survey
awareness on rabies of rabies and its three years results
prevention in all prevention and
regions by end of 2025 control
6. Human Resource
1. Governance
1.1 To ensure 100% % of LGUs (80 Review of report Report by CHDs
compliance to provinces, 122 by CHDs and and DIRFUs on
Anti-Rabies Law cities, 1512 DIRFUs compliance to Ant-
and legal municipalities) Rabies Act of 2007
issuances enforce Anti-
Rabies Act of 2007
2. Service
Delivery
2.1 To cover 70% of % of LGUs with 70% Review of report Report by DIRFUs
dog population for vaccination by DIRFUs Central database
anti-rabies coverage Review of PHILAHIS (PHILAHIS)
vaccination by data
LGUs
5. Information
5.1 To intensify % of Provinces / Review of PHILAHIS PHILAHIS data
nationwide Cities/ data system
surveillance system Municipalities
integrate NRPCP
data into PhilAHIS
6. Human
Resource
6.1 To strengthen % of LGUs have Review of reports/ Reports/ records of
personnel appointed records training
complement in veterinarians
the regions and
NGA working on
rabies program
2.Service delivery
2.1To increase PEP % of Rabies exposures 80% 90%
completion rate among with PEP completed
registered rabies exposed up to day 28 dose
cases to 90 % by end of
2025
3. Financing
3.1 To reduce out of % of rabies exposures 50% 80%
pocket expenditures for receiving PEP
PEP of 50 % of rabies reimbursed by
exposures by end of 2025 PhilHealth
5. Health information
5.1 To integrate of anti- % of public 50% 100%
rabies program into the elementary schools
curriculum and instruction adopting rabies
integration into
from Grades I-VI in all
curriculum
public elementary
schools by end of 2025.
6. Human Resource
6.1 To train/update 100 % % of trained 80% 100%
of ABTC/ABC staff by end ABTC/ABC staff
of 2025
1. Governance
1.1 To ensure 100% % of LGUs (80 provinces, 122 50% 100%
compliance to Anti-Rabies cities, 1512 municipalities)
Law and legal issuances enforce Anti-Rabies Act of
2007
2. Service Delivery
2.1 To cover 70% of dog % of LGUs 54% 70 % of LGUs all
population for anti-rabies with 70% vaccination over the
vaccination by LGUs coverage Philippines
2.2 To reduce total dog % of LGUs with reduction of 100% of LGUs all
population to manageable dog population to over the
levels manageable levels Philippines
2.4 To enhance quick % of LGUs with organized and 100% of provinces 100% of
response to reported human trained QRT and cities Municipalities
and canine rabies cases
3.Financing
3.1To secure/ensure funding Budget for rabies prevention 8million P100 Million
for implementation of the and control provided to DA provided Annually
program and to DOH to DA
6. Human Resource
6.1 To strengthen personnel % of LGUs have appointed 100% of 100% of 2nd to 4th
complement in the regions veterinarians provinces, cities class
and NGA working on rabies and first class municipalities to
program municipalities have
have appointed veterinarians
veterinarians
6.2 To build capacities of LGU % of provincial and city 50% 100%
veterinarians and personnel veterinarians trained in
Veterinary Epidemiology
Training
% of Local Vets (87 50% 100%
Provinces) trained on
Quick Response
Creation of 'expert
panel' at national
level
Laboratory
confirmation of
selected cases
2.4 To provide Pre- Identify high-risk Provide PrEP to
exposure Prophylaxis areas for PrEP for Identify high-risk children 5-14
to children in high- children areas for PrEP for years old in high
risk areas of 2025 children risk areas
6. Human Resource
6.1 To train/update Organize Training of ABTC staff
100 % of ABTC/ABC ABTC/ABC staff attend the
staff by end of 2025 training
Develop materials Regular Representatives
for Regular update/Refresher from Local
update/Refresher courses on semi- health units
courses on semi- annual basis attend the
annual basis refresher courses
Issue Conduct
memorandum/ advocacy
Circulate meetings with
communication leagues of local
reiterating Anti- government
Rabies Act of 2007 officials
Advocacy
meetings with
leagues of local
government
officials
2. Service delivery
3. Financing
4. Regulation
4.1 To prevent Orientation of Inspection,
introduction and quarantine officers apprehension
reintroduction of and related and confiscation
canine rabies agencies of animals
shipped without
proper
documents
4.2 To ensure all dog Random checks of Random checks of Random checks
rabies vaccines dog rabies dog rabies of dog rabies
used in the country vaccines used in vaccines used in vaccines used in
are registered the country the country the country
5. Information
Conduct of KAP
survey
6. Human
Resource
6.1 To strengthen Encourage Encourage Create positions
personnel remaining remaining for veterinarians
complement in the provinces without provinces without in LGUs without
regions and NGA veterinarian and veterinarian and all veterinarians
working on rabies all LCEs of 2nd to 4th LCEs of 2nd to 4th
program class municipalities class municipalities
to create positions to create positions
for veterinarians for veterinarians
The Department of Health of Health would like to recognize the contributions and assistance of the
following, without their commitment and expertise, this 2020-2025 NRPCP Strategic Plan would not have
come into fruition:
World Health Organization
Dr Aya Yajima
Dr Maria Nerissa Dominguez
Ms Concepcion Dumawat
Department of Health
- Undersecretary of Health Myrna C. Cabotaje
- Dr. Napoleon Arevalo
- Dr. Mario Baquilod
- Dr. Leda Hernandez
- Dr. Ronaldo Quintana
- Dr. Ernesto Eusebio Villalon III
- Dr. Vito Roque III
- Mr. Jay Dulay
- Mr. Hipolito Berano
- Ms. Rosemarie Aquirre
- Ms. Evelyn Perez
- Mr. Rhoderic Domingo
- Mr. Rizalito Santiango
- Ms. Eunice De Guzman
- Ms. Marissa Ortega
- Ms. Anastacia Ador