The island province of Bohol is the 10th largest island in the Philippines (). The total human population is 1,139,130 living in 152,324 households 
. The economic drivers are eco-cultural tourism and agro-industrialization. The annual average family income is 77,291 Philippine Pesos (PHP) (1,770 US$) and the annual average family expenditure is 66,907 PHP (1,534 US$). Annual per capita income is 16,478 PHP (378 US$) and annual per capita expenditure is 14,364 PHP (329 US$).
Map of the province of Bohol Philippines.
At the provincial level, the BRPEP was managed by the Bohol Rabies Prevention and Eradication Council (BRPEC) under the jurisdiction of the Governor. Canine rabies prevention and elimination was coordinated by the Provincial Veterinarian while human rabies prevention and elimination was managed by the Provincial Health Officer. The BRPEC administered overall implementation, formulated proposals, measures and strategies that would ensure the implementation and sustainability of the BRPEP. This body also recommended the enactment of support legislation, policies and directives to strengthen the program and provided timely reports to program partners and the general public.
Parallel organizations to the BRPEP were created at the municipal and barangay (villages) local government units (LGU) namely the Municipal Rabies Prevention and Elimination Council (MRPEC) and the Bantay Rabies sa Barangay (BRB) or the “Rabies Watchers”. The MRPEC assumed the same roles and functions at their areas of jurisdiction in accordance with the BRPEP. The BRB ensured implementation of the program at the community level, arranged mass vaccination campaigns in their areas and compiled a master list of dogs and dog owners.
Legal Framework for the Program
The legal framework for implementing a rabies prevention and control program in the Philippines was already in place at the inauguration of the BRPEP and included several national regulations: Republic Act No. 8485 known as the Animal Welfare Act was enacted in 1998; Philippine Republic Act No. 9482 was enacted on 25 May 2007 and is identified as the Anti-Rabies Act of 2007 
. The Philippine Republic Act was approved by the national government to be implemented at the LGUs. At the local level, the provincial Governor promulgated the Provincial Ordinance No. 2007-012 “Strengthening the Bohol Rabies Prevention and Eradication Program” that was approved on 10 July 2007 by the Sangguniang Panlalawigan or the local legislative body. This ordinance stipulated the establishment of the implementing bodies (BRPEC, MRPEC and BRB) at the provincial, municipal and barangay level. Membership of the municipal councils was designated by the Mayors and brought together representatives of the national offices (Departments of Agriculture, Health, Education, Interior and Local Government, Philippine National Police, Agricultural Training Institute and the Philippine Information Agency), the provincial offices (provincial veterinarian, health , tourism, legal, social welfare and agriculture), as well as representatives of several NGOs, league of elected and appointed officials and the local media group. BRB membership was designated by the barangay captains.
The local legislation defined the roles and responsibilities of the councils including: The organization of dog and dog owner registration; collection of registration fees; elimination of stray dogs (defined in the national law as any dog leaving its owner's place or premise and that is no longer in the effective control of the owner); dog vaccination; surveillance of human and animal rabies and dog bite incidents; settlement of disputes/agreements between bite victims and dog owners; and promotion of responsible dog ownership. To ensure dissemination of information and understanding of the supporting legislation and to promote program advocacy throughout the entire province, orientation and paralegal training sessions were conducted for 7,763 BRB volunteers.
All communications regarding the BRPEP were managed in a coordinated manner to ensure integration of all components of the program as it progressed through the development, initiation, implementation, maintenance and sustainability phases. It was deemed critically important from the beginning of the BRPEP to facilitate understanding, cooperation, and support among stakeholders including the citizens living on Bohol, medical professionals, volunteers and paid employees implementing the program as well as government officials and funding agencies. Information was therefore delivered to the beneficiaries at the grass roots level as well as to government agencies overseeing the project and funding agencies supporting the project. The Provincial as well as the Municipal/City Rabies Task Forces designated key spokespersons authorized to dispense information and answer questions relevant to their areas of jurisdiction.
As part of the communications strategy, a BRPEP handbook was developed, published and distributed to every municipal rabies council to serve as a reference for all field units working within the program 
. The handbook was designed to provide a logical web of operational activities among inter-agency stakeholders and a common approach in controlling rabies within the province. Moreover this document provided clear and distinct roles and responsibilities at various management levels from the national level down to the barangays and individual households. It also included vital information regarding the disease and its epidemiology. It outlined the goals and objectives of the BRPEP, strategies of implementation, program management, and information on legislation and issuances as well as contact phone numbers in case of questions about the program. Additionally, the BRPEP handbook included an example of an annual operational plan including the report forms and the monitoring format. A Barangay Handbook with simplified standard operating procedures written in the local dialect was also distributed to each of the 1,109 BRBs.
Information and Educational Campaign (IEC)
A two-pronged social mobilization plan, including a ‘Community-focused program’ and a ‘School-based education program’, was launched as a first step to increase awareness and enhance community participation and support. Components of the IEC included discussions on rabies as a disease, its epidemiology, and its prevention and control, the Bohol Program in general and related national and municipal rabies ordinances as they supported the program implementation and responsible pet ownership.
The community program concentrated on campaigns using tri-media (television, radio, newspapers), display of posters and banners in strategic areas, distribution of flyers and other materials, public hearings of local ordinances and hosting of municipal and barangay symposia, meetings and seminars. Educational campaigns were also conducted at various government offices and in churches. Philippine National Rabies Awareness Month in March, and World Rabies Day, held annually on September 28 were both observed to remind people of the continual threat of rabies and the importance of the program to eliminate rabies on Bohol.
The School-based educational program, designed to improve awareness about rabies prevention, was developed and implemented in close supervision with the Department of Education and in coordination with the Department of Health and other member agencies of the BRPEC. The integration of rabies education into the school curriculum was initially developed by the Department of Health's National Rabies Control Program in 2006. In 2008, this program was piloted in Bohol beginning with round table discussions with teachers, followed by intensive planning, a workshop to develop lesson plans, orientation/training of teachers, and testing of the developed lesson plans for 6 months in the municipality of Corella during the 2008–2009 school year. In 2009, they were integrated into the curriculum of all 962 public elementary schools in Bohol. Educational activities for the children included: Incorporation of rabies modules into various subjects in the public elementary school curriculum; creation of “Rabies Scouters” (boy and girl scouts who have successfully completed a rabies and responsible pet ownership training program); creation of a campaign slogan to encourage responsible pet ownership; conducting fun educational events to celebrate the bond between children and pets. Other forms of campaigns promoting responsible pet ownership were also adopted in the city/municipalities.
Census of the Dog Population and Dog Vaccination
Dog population data on Bohol was first estimated from the 2006 census published by the Bureau of Agriculture Statistics (BAS). To secure data on the number and location of dogs throughout Bohol, the BRB initially conducted a house-to-house inquiry using a master list of households. The collected data reflected dog owner's name, number of dogs owned, whether they were confined, leashed or free-roaming, sex of each dog and total number of households. Dog population data was updated annually. To further regulate the possession of dogs, establish dog ownership, and facilitate the traceability of dogs involved in bite cases, the mandatory registration of dogs, with a corresponding fee collection, was implemented at the barangay level in accordance with the Provincial Ordinance. Dogs from households that were not able to afford the fees were also registered and the dog owners were given a promissory note and allowed a staggered payment. The collected registration fees were shared in a manner specified in the Provincial Ordinance as follows: 50% was retained in the barangay and 50% divided between the municipal and provincial treasury to support the sustainability of the entire rabies control program.
A parenteral mass dog vaccination program was initiated in August of 2007 with the Governor of Bohol proclaiming August 2007 as the synchronized rabies vaccination month. Vaccination teams were organized at the provincial and municipal levels. Provincial teams were assigned to oversee the vaccination activities and to ensure the presence and usage of cold chain equipment in every municipality. The Municipal Agricultural Officers (MAO) led the municipal vaccination teams composed of livestock technicians, Barangay Livestock Aides and other personnel duly designated by the MRPEC trained as dog vaccinators. Vaccination activities were supervised by the provincial and district veterinarians. The majority of the members of the vaccination team, (including those who administered the vaccine, or assisted in handling and tagging animals), received pre-exposure rabies vaccination. Team members who handled registration and collection of fees, or prepared reports did not come in contact with animals, and were not given pre-exposure rabies vaccination. All team members were briefed on proper rabies vaccination activities, provided vaccination supplies and paraphernalia, registration/health certificates and dog tags, recording forms and education campaign materials.
Mop-up dog vaccination campaigns targeting low coverage areas were conducted within six months following the initial mass vaccination campaign. Dogs not vaccinated during the scheduled synchronized mass rabies vaccination campaigns were accommodated upon special arrangement with the municipal vaccination teams.
A uniform dog tag, indicating vaccination, was securely fastened on a dog collar with the help of the assistant dog vaccinator. The tag was valid for one year from the date of vaccination and was replaced annually upon renewal of registration at which time a booster rabies vaccination was administered. Standardized dog vaccination report forms were consolidated and submitted to the BRB, the MAO and the BRPEP. The community was also encouraged to bring their cats for vaccination during the mass vaccination campaign.
Dog Population Management and Movement Control
Dog population and movement control was implemented as part of the BRPEP and in compliance with the PNRA and the Animal Welfare Act. The dog population was managed by selective elimination of captured stray dogs, impounded dogs unclaimed within 3 days, and unmanageable dogs voluntarily submitted by owners 
Municipal rabies ordinances in the Philippines include a section on dog population management and designated a task force to perform this function. At the barangay level, socially acceptable procedures were discussed and widely disseminated throughout the community. Euthanasia procedures were initially conducted in accordance with Administrative Order No. 21 of the Department of Agriculture on the Code of Conduct in the Euthanasia for Pets/Companion Animals. During the third year of the project (2010), the purchase of a mobile veterinary clinic was funded by one of the partners and provided the opportunity to improve neutering, spaying, and euthanasia procedures. Additionally, partnerships were established with animal welfare organizations to improve dog population management practices to comply with recommended international standards.
Clinical Management of Human Rabies Exposures
In 2007, prior to the launch of the BRPEP, two government-operated Animal Bite Treatment Centers (ABTC) were located on Bohol. As part of the BRPEP, four additional ABTCs, all privately operated, were established on the island to increase accessibility of timely post-exposure prophylaxis (PEP). Medical personnel were trained to administer rabies vaccines intradermally (ID) in order to provide effective PEP as economically as possible. Rabies biologicals were acquired either through the support of the DOH National Rabies Program, the investment of the private ABTCs, or direct procurement by the provincial government. Additionally, the government subsidized the purchase of PEP for indigents without sufficient financial resources, and for persons bitten by the dogs of responsible pet owners (those that had kept their animals registered and vaccinated) and responsible pet owners exposed to suspect rabid dogs. All exposed patients received PEP according to the WHO standard ID regimen and all adverse events were reported and managed accordingly 
. Training on bite management and PEP for all district hospital doctors & nurses of the primary health care units was conducted in collaboration with the Research Institute for Tropical Medicine (RITM), the national rabies referral center of the Department of Health.
Laboratory Diagnosis of Animals
When possible, animals involved in biting incidents were observed for 14 days. If the animal demonstrated clinical signs of rabies during the observation period, including behavioral change or illness, it was euthanized and submitted for testing at the Regional Animal Disease Diagnostic Laboratory (RADDL) located in the city of Cebu on the adjacent island province. Submitted specimens were analyzed using the direct fluorescent antibody test. Laboratory results usually available within 1–2 days were relayed to the OPV and the MRPEC who releases this to the victim or the immediate relatives. The sample testing was free of charge but the cost of transporting specimens was assumed by the BRPEP.
Surveillance systems for both human and canine rabies cases were established in order to ensure immediate and reliable transfer of information and follow-up in the case of human or animal exposure to a confirmed rabid animal. The protocol for investigation and follow-up of all bite cases was established, and continues presently as follows: The reporting of bite cases is initiated at the BRB level when the bite victim presents at the Rural Health Center for consultation, first aid treatment and assessment; if referred, the patient attends the closest ABTC for PEP. In cases where multiple biting incidents have occurred or when the involved animal is suspected to be rabid, the MAO and the OPV are informed in order to monitor the status of the biting animal(s). In highly suspicious cases involving the death of a bite victim, the attending physician immediately reports the case to the Provincial Rabies Coordinator who in turn contacts the Quick Response Team (QRT) and the Provincial Surveillance Unit to initiate a field investigation. Contact tracing is conducted in coordination with the MRPEC, all human and animal contacts of the biting animal are assessed and, if deemed necessary, immediately given PEP (human patients) or a booster vaccination (animals). Movement of all animals involved in biting incidents is strictly monitored, the dog vaccination record at the barangay level is reviewed and mop-up vaccination is conducted.
Monitoring and Evaluation
For planning purposes, estimating dog vaccination coverage, and evaluating the outcome of the project, a household survey was conducted to collect data on the owned dog population, knowledge, attitudes and practices (KAP), and data regarding the dog-human relationship. The survey was designed using questionnaires and cluster sampling procedures and collected data among 300 households 
Sustainability was ensured through the BRPEP activities on advocacy, general public awareness, child education, legislation, dog registration with fees, 100% of which was re-invested back into the BRPEP to establish a self-sustaining funding stream for the program. Sustainability was strategically built into the program through an integrated program interface with LGU officials, community leaders and other stakeholders to ensure community participation; establishment of a rabies diagnostic laboratory on the island for increasing further disease surveillance; creation of volunteer quarantine aides in coastal barangays to continually monitor the entry of new dogs from other provinces; and provision of annual award system to motivate excellence in program execution.