Globally, annual incidence of human rabies is estimated to be between 30,000- 70,000 with more than 90% of cases reported from developing countries. This contributes to 20,000 deaths attributed to Rabies and 17.4 million cases of animal bite per annum. The highest numbers of human deaths due to rabies are observed in India and Philippines [
1]. India accounts for 36% of the Global and 65% of the Asian rabies related deaths [
2]. In India, a nationwide survey reported that annual incidence of animal bites was 1.7% (2003), more common in rural areas, among children and low income groups [
2]. In spite of this disease burden, rabies is a neglected infectious disease in India. The main biting animals are stray dog followed by cat [
2]. Rabies can be averted only by effective pre- exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP) [
3]. PEP includes anti-rabies vaccine administration, and for severe categories of exposure, infiltration of purified rabies immunoglobulin (RIG) in and around the wound [
4]. In low and middle income countries, RIG is rarely used as it is expensive [
5,
6] and not regularly available [
7,
8]. Hence, only post exposure vaccination is provided to patients with animal bites [
9]. In the year 2007, out of all animal bite cases, 50% received PEP in India. Out of this almost 40% got nerve tissue vaccine (NTV) due to its low cost and free availability [
8]. Government of India (GOI) banned use of NTV in the year 2004, since then patients of animal bite are forced to purchase Tissue Culture Vaccine (TCV). Non-availability or irregular supply in public health system and high cost of TCV contributes to significant out-of-pocket expenditure (OOP) in the range of 1500-1800 Indian Rupees (Rs) for five doses under PEP. High OOP limits health care seeking by most of the animal bite-patients. In 1997, World Health Organization (WHO) recommended intra-dermal (ID) TCV administration in resource-poor setting [
10]. Immunological response and effectiveness of PEP via intra-dermal route has been found to be similar to other intra-muscular regimens [
11]. In the year 2006, GOI recommended use of ID TCV administration under PEP [
12]. Although some Indian states provide TCV at free of cost through few public health facilities, erratic supply reduces its utilization. Loss of wages due to required multiple visits to the health facility has been incriminated in poor compliance to PEP. This has been also identified as a reason for increased rabies deaths especially in rural areas [
12]. Therefore, the possibility of PEP provision for rabies via self-sustaining mechanism at primary care level becomes worth exploring.
As an initiative under National Rural Health Mission (NRHM), a patient welfare society or Rogi/Swasthya Kalyan Samiti (RKS/SKS) has been formed at all Primary Health Centres (PHCs) in India. The SKS is a registered society with the Medical Officer (MO) as the Chairman and selected healthcare provider and civil society representatives as members. Some funds are given to these SKSs by GOI through NRHM [
13]. SKS members are authorized to utilize the funds. These societies can also levy user-fees which can be used for welfare of patients seeking healthcare. Encouraged by this financial flexibility, we planned to offer a comprehensive care package for patients with animal bite. The objective of this study is to document various feasibility issues related with provision of rabies ID-PEP services at a rural Primary Health Centre (PHC) in Haryana state in north India.