Mismatches between program components and the community components in the implementation of rabies control programme in an urban context in Kerala: a complaints-based qualitative study

Abstract

The National Rabies Control Program (NRCP) reported 6,644 clinically suspected Human rabies cases and deaths between 2012 and 2022. The increasing rabies cases and growing stray dog population indicates a potential gap exists in the NRCP implementation that requires immediate attention. In this context, the present study aims to assess the key strengths, weaknesses and constraints in the NRCP implementation at the municipality and veterinary hospital level; document community experiences and perceptions; Identify gaps between program components and community needs; and recommend context specific improvements. This qualitative cross-sectional study was conducted in Varkala municipality and includes purposively selected 16 program staffs and 18 community participants identified through complaints received in the municipality. One focus group discussion with 10 participants was also conducted. Data were analysed using thematic analysis as per the JBI critical appraisal checklist for qualitative study. The study highlights successes and gaps crucial for the ultimate goal of rabies elimination by 2030.While general understanding of rabies transmission and treatment exists, awareness of post-exposure prophylaxis remains limited. Inadequate facilities and stringent rules have hindered the ABC program, fuelling rise in the stray dog population and human-dog conflicts. Additionally, lack of community responsibilities further worsens the situation. The challenges can be tackled through a multi-pronged approach to strengthen community awareness and involvement, infrastructures, and coordination among municipality, veterinary department, health sectors, and the public.