Health-facility readiness and provider-perceived barriers and facilitators to animal-bite management in Mangalore, India: a mixed-methods study

Abstract Rabies remains a global fatal disease yet fully preventable zoonotic disease, with India accounting for a substantial share of global deaths. Timely and full post exposure prophylaxis following animal bites is crucial, but its effective delivery depends mainly on the readiness of primary healthcare systems. However, evidence exploring healthcare provider’s perspectives alongside facility preparedness remains limited. We conducted a convergent mixed-methods study in six urban primary health centres (PHCs) and one district-hospital animal-bite clinic. Facility readiness was assessed using a checklist adapted from NAPRE 2030 and IPHS 2022, and nine providers (five medical officers and four staff nurses) were interviewed purposively. Quantitative and qualitative data were analysed separately and integrated through a joint display and narrative triangulation. Anti Rabies Vaccine (ARV) was physically available in all 6/6 PHCs (100%) and at the district-hospital clinic on the assessment date. However, stock-register review showed at least one ARV stock-out during the preceding six months in 2/6 PHCs (33.3%); the district hospital reported none. Human Rabies Immunoglobulin (HRIG) and a designated wound-washing station were unavailable in all 6/6 PHCs (0%) but available at the district-hospital clinic. Nursing staffing met the applicable norm in 2/6 PHCs (33.3%) and at the district hospital. Interviews explained referral burden, intermittent vaccine supply, competing staff responsibilities, wage-related non-adherence and local adaptive practices. In the sampled urban facilities, point-in-time vaccine and cold-chain readiness coexisted with important gaps in HRIG access, wound-washing infrastructure, staffing, documentation and continuity of supply. Facility-level strengthening and coordinated referral pathways are required to improve delivery of complete rabies post-exposure care.