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 ApproachPD/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. Feeding 2. Caring 3. Hygiene 4. Health-seeking

Steps 1. Decide if PD/Hearth is feasible 2. Mobilize the community 3. Prepare for a Positive Deviance Inquiry 4. Conduct a Positive Deviance Inquiry 5. Design & conduct Hearth Sessions 6. Support new behaviors through follow-up visits 7. Repeat Hearth as needed 8. 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 group 1. Conduct nutrition baseline assessment 2. Conduct situational analysis 3. Agree with community on the nutrition strategy 4. Conduct wealth ranking survey 5. Identify Positive Deviants 6. 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