Mandate of the Centre for One Health (CoH): CoH is working in coordination with all stakeholders to promote health and quality of life by undertaking activities necessary for prevention and control of Zoonotic Diseases with “One Health” approach. One Health approach takes into consideration that humans, animals, plants and broader ecosystems coexist in a delicate interdependent manner.

Introduction

The Centre for One Health implements four National Health Programs, these are: –

1. National Rabies Control Program (NRCP)
2. National One Health Programme for Prevention and Control of Zoonoses (NOHP-PCZ)
3. Program for Prevention and Control of Leptospirosis (PPCL)
4. National Programme for Prevention and Control of Snakebite Envenoming (NPSE)

Apart from these programs, the division is also undertaking following activities –

• Outbreak Investigations in collaboration
• Teaching for Epidemic Intelligent Service (EIS) and Regional Field Epidemiology Training Programme (FETP) in collaboration with other divisions of NCDC
• Trainings
• Research

1.National Rabies Control Program (NRCP)

Background:

During the 11th Five Year Plan, the National Rabies Control Program (NRCP) was initiated by the National Centre for Disease Control (NCDC) in five cities: Delhi, Ahmedabad, Pune, Bangalore, and Madurai. This project commenced in January 2008 and continued until 2012. Building upon the insights garnered from this pilot phase, the NRCP was expanded nationwide during the 12th Five Year Plan. Additionally, from 2014 to 2017, a small-scale pilot was conducted to evaluate the animal health component strategies in Haryana and Chennai under the auspices of the Animal Welfare Board of India (AWBI), facilitated by the Ministry of Environment, Forest and Climate Change (MoEF&CC), Government of India.

Presently, the NRCP focuses only on the human health component across all States and Union Territories. State-level initiatives are managed through the National Health Mission since the fiscal year 2019-20. Furthermore, the program has received approval under the Standing Finance Committee (SFC) for the fiscal years 2021-2026, under Scheme E of the NCDC’s umbrella program.

Objective of the Programme:

To prevent and control deaths due to Rabies in Humans and progressively achieving the Global target for “Rabies- Zero by 2030”.

Components of the Programme:

1. Capacity Building of States and district level manpower for prevention and control of Rabies
2. Promote of cost effective Intra-dermal Rabies vaccines for Rabies Post Exposure Prophylaxis.
3. Strengthen Rabies diagnostics
4. Strengthening Surveillance of animal bites and Rabies cases
5. Information, Education & Communication
6. Intersectional coordination
7. Operational Research

Deliverables under the programme

1. Capacity of States and district level manpower for prevention and control of rabies
2. Strengthening Rabies Diagnostic Services
3. Strengthening of Infectious Disease hospitals/ Rabies In- patient’s management facilities
4. Operationalization of the National Action Plan for dog mediated Rabies Elimination (NAPRE)
5. Advocacy of joint Rabies control activities for Operationalization of SAPRE
6. Advocacy for utilization of National Free Drug Initiative under NHM for procurement of Anti-Rabies Vaccine (ARV)
7. Improving of awareness regarding Rabies

Major Activities and Achievements

1. Joint launch – On the occasion of World Rabies Day 28th September 2021, Hon’ble Union Minister for Health and Family Welfare, Shri Mansukh Mandaviya and Hon’ble Union Minister of Fisheries, Animal Husbandry and Dairying, Shri Parshottam Rupala unveiled the National Action Plan for dog mediated Rabies Elimination by 2030 (NAPRE) in the presence of Dr. Bharati Pravin Pawar, Minister of State for Health and Family Welfare and Shri Sanjeev Kumar Balyan, Minister of State of Fisheries, Animal Husbandry and Dairying. The Ministers urged all the States and UTs to make Rabies a notifiable Disease. Hon’ble Mansukh Mandaviya and Hon’ble Parshottam Rupala also launched “Joint Inter-Ministerial Declaration Support Statement” for Elimination of Dog mediated Rabies from India by 2030 through One Health Approach.

2. Stakeholder engagement for policy – While framing the NAPRE all stakeholders for Rabies control in India i.e., Animal Husbandry dept, Wildlife dept, State and district level health and veterinary departments, representatives of Urban local bodies/Panchayat bodies (rural health bodies) have been sensitized and advocated for the need of strategic action plan for achieving elimination of rabies in India. Good practices adopted by States i.e., Sikkim and Goa were shared with other states.

• Regional Workshops for North-East, Southern and Delhi Region (14 States) has been conducted for developing a State Action Plan for Elimination of Dog Mediated Rabies by 2030 (SAPRE) in collaboration with State officials from both human and animal health sector along with representatives from municipal corporations, and local civic bodies.
  

3. Surveillance

• To strengthen Human Rabies Surveillance efforts are ongoing to make Rabies a notifiable disease in Humans. For this, communications have been sent to all the states by the NRCP, MoHFW, GoI to make Human Rabies as a Notifiable Disease under the ‘Clinical Establishment Registration and Regulation Act 2010 or Nursing Home Act or respective State Public health Act’.
• To improve surveillance and reporting of animal bites, Suspected / Probable/ Confirmed Rabies Cases/ Deaths, Status of ARV and ARS, schedule of vaccination etc., a web-based portal is under development. The portal will have with linkages with different Divisions of MoHFW, Subordinate Offices, and Ministries / Departments / Organizations is required to have live updates of data available on portals / websites of respective data source agencies.

4. Laboratory Strengthening- 11 Laboratories have been strengthened for diagnosis and management of Rabies.

5. Institutional mechanism for Rabies- Under the NRCP, to provide guidance for policy level, a National Technical Advisory Committee on Rabies (N-TAC) has been formed to provide continuous guidance to the program division for implementation.

• In addition to these, the NAPRE has recommended constituting of multidisciplinary Joint Steering Committee at the State and district level for monitoring of the State Action Plan for Dog Mediated Rabies Elimination from India.
• States have been advised to constitute a State Level Zoonotic Committees consisting of stakeholders from Health, Veterinary, wildlife dept. which will guide the implementation of Rabies control through the “One Health “approach.
• Rabies free cities initiative has been started in phase wise manner. In Tier 17 Cities of 6 States has been targeted and in Tier II 103 cities in 25 states has been targeted for Rabies and preparation of action plan under process.

6. Advocacy – Continuous advocacy to the animal husbandry sector has been done to increase fund allocation for the Rabies control program.

• The NAPRE was launched jointly by the policymakers from MoFAHD and MoHFW.
• As part of advocacy undertaken under the NRCP program, the Department of Animal Husbandry had communicated to all the states to take Rabies as a priority issue and develop a plan for dog vaccination.
• DAHD had also being the administrative procedures to include dogs and cats in their mandate & work allocation of the ministry.
• The states have been advised for framing and monitoring the implementation of the state-level action plan on rabies elimination.

7. IEC Activities-

• Every year, on 28th September, World Rabies Day is being observed throughout the country in collaboration with animal health stakeholders at the National, state, and below levels.
• Division had also published and disseminated a booklet on Rabies and a Banner for behavioural change communication campaigns- Information Regarding IEC is available on NCDC website- https://ncdc.gov.in/index1.php?lang=1&level=2&sublinkid=502&lid=428

8. Capacity Building – For training of health care professionals, three National Level trainings have been organized for animal bite management and PEP. Master training has also been organised in all States and UTs. NPMU Participated in trainings conducted on Rabies management at State level.

9. Research – Rabies burden estimation study, pre-exposure prophylaxis in children and new treatment therapies for Animal bite are under process.

10. Human Rabies surveillance – Case definitions for Suspected, probable, and Confirmed Rabies cases have been adopted in IDSP (Integrated Disease Surveillance Program). Under NRCP, monthly data on clinically suspected and lab confirmed cases of Rabies is being monitored for all the states. Good practices adopted by States i.e., Sikkim and Goa in terms of dog vaccination were shared with other States. Rabies case investigations are conducted in the program, in coordination with the State nodal officers and would be further increased in the future.

11. Model Anti rabies clinic – under the program, it has been envisaged that facilities will be identified for specifically for animal bites victims for evaluation and clinical management. The identified District Hospitals/Medical Colleges/Tertiary Hospitals will act a Model ARC, wherein Doctor/S and Nurse/s are trained in Animal Bite management, Rabies Pre and Post exposure prophylaxis and All the NRCP recordings and reporting formats would be maintained. In order to provide the quality assured services for Animal bite victim’s 294 Model Anti-Rabies Clinics (25 States) are being established across country .

12. Implementation of Rabies Helpline number in the 4 States

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