A study by Purdue University (US) scientists published in January 2024  reviewed the existing literature concerning access to veterinary care, in order to understand how “access to veterinary care” has been defined in the literature, map a broad list of potential barriers that may influence access to veterinary care, and identify how access to care impacts the welfare of animals, both companion as well as livestock species.

In terms of the barriers to accessing veterinary care, ten distinct themes were found and the most frequently reported barriers were financial limitations, geographic location, and limited personnel/equipment. Most of the existing literature did not clearly define the term access to veterinary care or discuss its impacts on animal welfare.

However, one of the studies had shown how improved access to veterinary care among a remote Aboriginal community in Northern Australia increased sterilisation coverage of the dogs by 150% and another study had demonstrated that prevalence of infectious disease in goats significantly reduced within a year of community-based veterinary service program becoming available for goat producers in South Africa. On the other hand, a study from Haiti recorded that over 80% of dog owners were facing difficulties in accessing rabies vaccination for their dogs and this was a major challenge for rabies control efforts. In Nigeria, limited access to veterinary services was seen as the cause of frequent disease outbreaks in cattle.

Though the number of articles that discussed the connection between access to veterinary care and animal welfare was rather small, these examples show that lack of access to veterinary care may have larger implications that can affect the entire community, such as inability to control infectious disease outbreaks. In the US, where most of the studies were from, inability to access veterinary care has been suggested to be one of the most significant animal welfare crises, presenting problems for the health of both livestock as well as companion animals.

None of the reviewed publications established a clear, comprehensive, and consistent definition of the term and therefore the authors of this Purdue university group proposed the following definition: Access to veterinary care means that the economic, physical, social, mental, and emotional resources necessary for people to secure, communicate with, and benefit from the services of a trusted veterinary service provider are available as needed to optimize the health and welfare of animals in their care.

Access to veterinary care also requires that the services be affordable, available, and delivered by adequately trained personnel who are willing and able to educate the client on animal health and welfare, irrespective of their gender, ability, cultural, or socio-economic status.

The Purdue group, Pasteur and colleques, found only one study around this topic from India and that paper focused on the livestock farmers in Uttar Pradesh and their choice of veterinary service providers. However, the evidence of the implications of lack of access to veterinary care on disease control programs, especially in rabies control, and companion animal welfare, are every day in front of us.

According to a recent newspaper article, a 23-year old woman had recently died of rabies in Coimbatore. She had been bitten by her own puppy couple of months before. This is so sad, so unfortunate and so unnecessary. While the human medical sector discusses the reason why she did not receive appropriate Post-Exposure Prevention (PEP) vaccination after the dog bite, veterinarians are wondering why she had not had her dogs vaccinated? Her story, very unfortunately, follows the trend that was shown in another publication by the Tamil Nadu Directorate of Public Health in December 2023. In 2018-2022, totally 121 human rabies deaths were reported in Tamil Nadu. Of these 70.2% happened in rural areas and 42.1% were due to unvaccinated pet dog bites.

This data as well as other articles around this topic have been fuelling my thought process when assessing strategies implemented in India for humane dog population management. The focus on animal welfare organisations (AWO) as the sole implementing agencies, the heavy bureaucracy and lengthy application process involved for any AWO to get all the required permissions to be allowed to operate stray dogs, the insufficiency and irregularity of public funds for stray dog ABC programs, and the initial capital investment required to set up all the facilities and the human resources as per the requirements, mean that effective ABC programs can mainly exist in big cities where NGOs can also access other donations from public to bridge the gaps in government fund release. The factors that have been commonly identified as barriers for access to veterinary care; financial constraints, geographical location, and limited personnel/equipment, are very much found as reasons why NGO-run or municipality run ABC programs are not available for every dog owner in India.

It is therefore from this background that I have begun to see more and more importance in involving private as well as government veterinary clinics in providing affordable spay/neuter surgeries for owned dogs.  This is essential to complement the stray-dog focused, traditional ABC programs (that in any case mainly function in big cities). Another publication;  “High-quality, high-volume spay-neuter: Access to care and the challenge to private practitioners”,  by Philip Bushby (2020), provides an important insight on how and why private clinics should also begin to provide low(er)-cost spay/neuter services. More about this topic and article at another time for sure.

To me, the definition of “access to veterinary care” – especially in the context of India, primarily means that all dogs – regardless of the socio-economic status of their owners, should have access to annual rabies vaccination (this is top priority!) and to affordable spay/neuter surgery. One possible way to do this (taking some wild imaginative liberties here…), could be for ration shops to include a voucher for subsidized spay/neuter surgery at any government or private veterinary clinic or hospital that has had agreed to arrange intensive spay/neuter campaign days. Dog owners could bring their dog on a set day, get it operated and only pay for whatever the government had decided as the owner’s share of the expenses. The remaining money, the vet would receive from the municipality against the voucher that the owner had produced. Obviously, the success of such a system depends on timely release of the funds to make sure that the scheme is financially viable for vet, as well as on strong intersectoral collaboration.

Whichever way we define access to veterinary care, we need to look to it also in the context of the specific animal health and welfare needs of the region/country. With resources being limited there is always need to set priorities as for what are the essential services that should be available for all and at what cost. It is hard to argue, though, that nothing else than annual rabies vaccination and access to affordable spay/neuter surgery, could be more important for companion animals in India.