Preparedness of primary health centres for snakebite management and challenges faced by healthcare providers: a mixed-methods study from a selected district, southern India.

Abstract

Objectives: Primary health centres (PHCs) are the first point-of-care in rural settings for snakebite management and are expected to provide early management, including anti-snake venom (ASV) administration. However, evidence on their functional readiness and operational challenges remains limited. This study assessed PHC preparedness for snakebite management and explored challenges faced by healthcare providers in a district of Tamil Nadu, India.

Methods: A convergent mixed-methods study was conducted across 65 PHCs. Quantitative data on preparedness were collected using a structured checklist. Qualitative data from 12 in-depth interviews with healthcare providers were analysed using descriptive content analysis.

Results: Most PHCs demonstrated high structural preparedness, with availability of ASV (96.9%) and trained healthcare providers (93.8%). Although 44 centres (67.7%) reported at least one snakebite case in the preceding 3 months, only two PHCs (4.5%) managed cases at the PHC level. Qualitative findings revealed a consistent pattern of early referral, driven by provider hesitancy to administer ASV because of a fear of adverse reactions and social pressure, limited hands-on training, inadequate capacity for adverse-event monitoring, and workforce constraints. Community care-seeking behaviour further contributed to underutilisation of PHCs.

Conclusion: Despite high structural preparedness, functional readiness for snakebite management at PHCs remains limited, highlighting a critical implementation gap. Strengthening emergency preparedness, practical training, and addressing systemic and socio-behavioural barriers are essential to improve early management and reduce preventable mortality.