System and Social Mechanisms of Rabies Prevention under a One Health Framework: A Multiple-Case Qualitative Study in Si Sa Ket Province

Abstract

Rabies remains a major public health challenge requiring coordinated multisectoral action and effective social mechanisms across the public health, veterinary, local government, and community sectors within the One Health framework. This study aimed to examine the systems and social mechanisms associated with rabies prevention within a One Health framework and to compare how these mechanisms operated across three community settings in Si Sa Ket Province, Thailand. A multiple-case qualitative design was employed. Study sites were purposively selected using epidemiological and rabies surveillance data from 2021 to 2025 and represented three community settings: rabies-free, rabies-controlled, and areas undergoing rabies control. Data were collected through in-depth interviews with 15 administrators and key actors involved in rabies prevention and control and through focus group discussions with 50 community stakeholders. Data were analyzed using inductive and deductive thematic approaches at both within-case and cross-case levels. The findings indicated that rabies-free communities were characterized by effective animal data systems, vaccine quality assurance and cold-chain management, systematic follow-up of unvaccinated animals, and community regulations that were implemented in practice. Rabies-controlled communities had operational systems and community networks but still experienced limitations in data continuity and the follow-up of certain animal populations. Communities undergoing rabies control continued to face constraints related to service accessibility, stray dog management, risk communication, and the management of environmental risk points. Cross-case analysis revealed that community-based rabies prevention was associated with the interaction among service systems, vaccine quality, information systems, animal management, environmental management, community regulations, and public trust in government services. The findings suggest that strengthening integrated information systems, vaccine quality assurance, comprehensive dog population management, and enforceable community regulations could support rabies prevention under a One Health framework and enhance the sustainability of community-based rabies prevention and control.