Background: Ensuring the uninterrupted availability of the anti-rabies vaccine (ARV) and rabies immunoglobulin (RIG) in health facilities is crucial to achieve the global target of zero dog-mediated human rabies deaths by 2030. This study aimed to estimate the availability of ARV and RIG across health facilities in India.
Methods: We conducted a nationwide health facility-based, cross-sectional study across 60 districts selected by multistage probability sampling from 15 Indian states. In each district, we selected nine health facilities. We interviewed staff involved in the rabies control program in each of the selected health facilities, and abstracted and physically validated information on the availability of ARV and RIG.
Findings: Of the 534 health facilities surveyed, 467 (87.5%) were public sector health facilities. ARV was available in 372 (79.7%, 95% CI: 75.7%-83.2%) public sector health facilities, ranging from 60.0% to 93.2% in different geographic regions. Availability of ARV was lowest in Urban Primary Healthcare Centres (UPHCs) (58.9%, 95% CI: 45.0%-71.9%). RIG was available in 95 (20.3%, 95% CI: 16.8%-24.3%) public sector health facilities, with the highest availability in southern states (27/88, 30.7%). The availability of RIG ranged from 1.8% (95% CI: 16.8%-24.3%) in UPHCs to 69.2% (95% CI: 48.2%-85.7%) in medical college hospitals.
Interpretation: Considerable geographic and facility-level variations exist in the availability of ARV and RIG across India. Bridging the gap in the availability of ARV and RIG should be prioritised to achieve the goal of zero-dog-mediated human rabies deaths by 2030.
Funding: Indian Council of Medical Research.
Keywords: Bites and stings; Health facility; Immunoglobulin; Monoclonal antibody; Rabies; Vaccine.
© 2025 The Author(s).