Implementing mass dog rabies vaccination through a community-based continuous approach: A socio-anthropological process evaluation

Abstract

Introduction: Mass dog vaccination to control rabies usually involves centralized planning and team-led annual campaigns. We evaluated the implementation processes of a decentralized, community-based continuous approach to mass dog vaccination (CBC-MDV), delivered as an arm of a randomized controlled trial (RCT) across the Mara region, Tanzania. We employed the socio-anthropological framework to assess the implementation process of the CBC-MDV approach. Methods: We embedded a mixed method process evaluation into the RCT and conducted in-depth interviews with district and village-level implementers, focus group discussions with ward-level implementers and community leaders and members, non-participant observation of the campaigns, and an audit of the vaccination campaign activities. We analyzed the resulting data following the five domains of the socio-anthropological framework. Findings: Refining the five domains, we report that 1) Environmental context affected CBC-MDV campaigns, which were interrupted by rainy and farming seasons, school schedules, market days and funerals, whilst village size and routes of access reduced their reach. 2) Social difference and pressures, and community involvement influenced delivery; cultural celebrations and social statuses of implementors hindered delivery, while by-laws and perceived rabies risk improved delivery. Community involvement facilitated implementation, but there was a need to strategically select who did what and how. 3) Strategies and incentives affected implementers, who were motivated by training and resources provided, and delivered 88% of components as planned. 4) Socio-materiality and resilience of intervention strategies and tools made it feasible to deploy the required equipment across a wide geographic scale, with adequate vaccination opportunities, but implementers found house-to-house and on-demand strategies demanding and less effective than central point delivery. 5) Governance also affected delivery with closer supervision by veterinary officials and community leaders, and co-reflexive appraisal of implementation with communities constrained by resource limitations. Conclusions: CBC-MDV with local storage of dog vaccine can be deployed across the rural landscape of Tanzania. Deeper involvement of communities in planning when and how campaigns are conducted, and in the appraisal of outcomes can significantly address barriers to dog-owner participation. The socio-anthropological framework provides a useful framing for understanding intervention delivery but not refinement for use cases. Author summary: Mass dog vaccination campaigns in most rabies-endemic countries are planned and delivered by veterinarians annually without involving local communities. An alternative approach that involves communities, storing vaccines locally, and enabling several rounds of campaigns to be carried out within a year, was tested in the Mara region of Tanzania. We used a socio-anthropological framework to explore how the implementation of the strategic components of this community-based approach was affected by environmental and socioeconomic factors; what motivated implementers; the usefulness and resilience of the intervention strategies and tools; and how implementation was coordinated. We collected data through interviews of implementers and community members, observation of campaigns and review of implementation records. We found that rainy and farming seasons, school and market days, cultural celebrations and funerals affected campaign schedules; whilst difficult terrain, by-laws, perceived rabies risk, and community involvement impacted reach of the campaigns. With time, the implementers delivered most components as planned; it was feasible to deploy the tools and strategies in the context; supervision of campaigns by community leaders and veterinary officials was limited. We conclude that the active involvement of communities in planning when and how vaccination campaigns are conducted and evaluated can significantly improve dog-owner participation.