Pendekatan Komunitas untuk Pencegahan Rabies di Bali: Sebuah Narrative Review
Keywords
Rabies, Community Empowerment, Customary Village, One Health, BaliAbstract
Background: Rabies was introduced to Bali in November 2008 and continues to cause human deaths despite repeated mass dog vaccination. In 2025, 16 deaths were recorded, almost all among bite victims who were not brought to a health facility, indicating that the main barriers to control now lie largely in community behaviour and participation. Objective: To examine the evidence on the forms, roles, achievements, and challenges of community-based approaches to rabies prevention in Bali. Methods: A narrative review of scientific articles, programme reports, and policy documents published in 2008–2026, identified through PubMed, Google Scholar, DOAJ, Garuda, SINTA, and official government portals, and synthesised thematically with reference to the SANRA criteria. Results: Community contributions were identified in five domains: (1) the socio-cultural capital of banjar and customary villages (desa adat) as vehicles for mobilisation; (2) strengthening knowledge, attitudes, and practices (KAP) on responsible dog ownership and bite-wound management; (3) community-based intervention models, such as Program Dharma in Sanur, which reduced the proportion of dogs with welfare problems from 20.7% to 2.7%; (4) customary regulation through pararem; and (5) community involvement in surveillance and integrated bite case management, Rabies Alert Teams (Tisira), and digital applications. Key challenges include low vaccination coverage of puppies and free-roaming dogs, delayed care-seeking, funding sustainability, and programme fatigue in the elimination end-game. Conclusion: Community approaches are an essential complement to mass dog vaccination and post-exposure prophylaxis. Institutionalising the role of customary villages within a One Health framework, supported by indicator-based monitoring, is needed to achieve a rabies-free Bali by 2030.
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