Lessons in tetanus elimination revisted [i.e. revisited]

In the mid-1960s, the Albert Schweitzer Hospital (ASH) in Haiti"s Artibonite Valley treated some 500 cases of neonatal tetanus annually. This article describes ASH"s successful efforts to eliminate neonatal tetanus through a series of innovative hospital- and community-based activities. ASH employed many techniques that later became associated with social mobilization, social marketing, rapid assessment, ethnography, community mobilization, and cost analysis. The program provided effective and convenient services for which the public felt a strong need, promoted the services in a sensitive and powerful manner, and utilized community resources both for service promotion and provision. Other important factors contributed to ASH"s success. The fund of goodwill and trust which the hospital had built through years of service greatly facilitated the community health outreach team"s ability to cover the population of women in the hospital"s district of 150,000 persons. In addressing the problem of neonatal tetanus, the hospital leadership followed basic public health principles extremely well and took an incremental, problem-solving approach. The program successfully mobilized community resources and cooperation and over time incorporated complementary strategies. The staff utilized information effectively to (1) garner support for the program; (2) plan an effective program; (3) motivate health staff; (4) guide program adjustments, and (5) monitor program progress. Both staff and community members were highly motivated to act, primarily because of the ubiquity of neonatal tetanus deaths. The folk health system was extremely supportive rather than antagonistic. (Author abstract)