Administration and evaluation of rural health services. I. A tetanus control program in Haiti

Tetanus has been a public health problem of major importance in rural Haiti. Energetic preventive measures by a rural Haitian hospital were successful in controlling the problem only after immunization services were made easily available to the entire population served by the hospital. This was accomplished by a program which carried the services to the market places and villages of the region. The program developed several new categories of auxiliary personnel who were recruited locally and trained on the job. These personnel were utilized in a program which incorporated preparatory publicity, timing, handling of large crowds in open surroundings, education, record keeping, follow-up and evulation as well as the technical matters concerning the giving of injections. The program sharply reduced the number of admissions to the hospital for the treatment of tetanus. Evaluated on the basis of hospitalizations avverted the program cost only 1/9 the value of the 50,000 hospital days of care for the tetanus cases it prevented.