POSITIVE DEVIANCE / HEARTH

Overview of the Strategy

Positive Deviants are everywhere

In every community, there are individuals or groups whose uncommon behaviors or strategies enable them to find better solutions to a problem than their peers, while facing similar challenges and constraints and having access to the same resources.

What are we talking about?

Positive Deviance Inquiry Using tools to help a community find existing local

solutions to a common problem… By understanding the behaviors of positive deviants

within the community. Hearth

The way that the community can apply what was learned from the PDI, for nutrition education and feeding sessions.

Comparing approaches

Traditional Approach PD/Hearth Approach

What are your needs? What are your strengths?

What is wrong? What is working here?

What can we provide? What are your resources?

What is lacking in the community?

What is good in your community?

What is missing here? What can we build on?

What kind of “Household Practices” do we want to learn about?

1. Feeding2. Caring3. Hygiene4. Health-seeking

Steps

1. Decide if PD/Hearth is feasible2. Mobilize the community3. Prepare for a Positive Deviance Inquiry4. Conduct a Positive Deviance Inquiry5. Design & conduct Hearth Sessions6. Support new behaviors through follow-

up visits7. Repeat Hearth as needed8. Expand to additional communities

1. Is PD / Hearth feasible?

General Global malnutrition prevalence (> 30%) Availability of affordable local foods Close geographic proximity of homes Rural settings Landless populations/squatter communities Existence of broader public health/development

programs that complement PD Hearth activities Systems in place for identifying and tracking

malnourished children

PD / Hearth feasibility (cont’d)Community Commitment Presence of committed community leadership Presence of committed village health leaders Availability of potential volunteers

Implementing Agency Commitment Hearth Project Manager Supervisors/Trainers Supporting resources

Staffing Considerations

2. Mobilize the Community

PD/Hearth requires self-discovery and action – impossible without community support

Village Health leaders are key Eg, Breastfeeding Initiative committees

Community strengthening

The goal is to build up community health leaders to: Supervise Hearth volunteers Manage Hearth sessions Plan and evaluate results Monitor vital events Share the measurable impact of Hearth

with community members and leaders Manage growth monitoring and promotion

3. Prepare for a PD Inquiry

Determine the target age group1. Conduct nutrition baseline assessment2. Conduct situational analysis3. Agree with community on the nutrition

strategy4. Conduct wealth ranking survey5. Identify Positive Deviants6. Prepare the PDI team

4. Conduct a PDI

Home visits for interviews and to observe practices: At least 4 poor families with well-nourished

children (positive deviants) At least 2 families, not poor, under-

nourished children (negative deviants) Or poor families with malnourished children

(non-positive deviants)] Compile information; create messages

and meals

Model BEHAVIORS

Never tell people they are positive or negative deviants: the aim of PDI is to not to find “role models,” but to find “model behaviors.”

5. Design & Conduct Hearth Sessions

Logistics 12 days (6 per week) 1-2 hours 10 malnourished children and caregivers Each brings food to contribute Child weighed on days 1 and 12

Learning Preparing food with caregivers Feeding Integration of health, nutrition, caring practices Key messages for each day

6. Conduct Home Visits

Hearth volunteers visit households Check on child’s weight Is the family using the new meals? Do they remember the key messages?

Frequency depends on community needs Often during the first 2 weeks after the end

of the Hearth session Less often for 1-2 months

7 & 8: Repeat and Expand

Repeat Hearth sessions until all children who are malnourished have completed treatment

Share the success with other communities

Take-home messages

Positive Deviance: The people are the experts Community ownership at all stages Discovery of existing uncommon but

successful behaviors & strategies Emphasis on PRACTICE and action Community created monitoring &

evaluation to further promote change