First, successful application of the Positive Deviance/Hearth approach in rural Cameroon Intro comments Following on from previous speaker – “Professor of World Affairs” is a daunting prospect I am SM Project manager for the CPME system based in the programmedepartment of Plan international HQ down in Woking: what follows is a personal view – not that of PLAN international At the end of Ravis’ paper he called for debates to move forward and centre more on case studies. The aim of my presentation is to begin to do this – exploring how the quantitative/qualitative debates are actually played out within an international NGO My presentation will illustrating two things: That on the one hand the qualitative/quantitative dichotomy is a very real one: The debates surrounding qualitative/quant have played a key role in shaping our organisation….and, undoubtedly, the progress made with attempts to clarify the complementarities and tensions between the two approaches such as workshops such as the Q2 workshop finding presented by Ravi will continue to shape the future of our organisation On the other hand, the way the organisation operates and the realities of and complexities of an organisation such as PLAN (the power relationships the stakeholders, the politics, the workloads etc) will always mean that debates such as the quantitative/qualitative issue will serve to highlight issues which may not have been dominant in researchers minds – and may serve to in turn shape these debate Ephraim Toh, MD, SPH; Esther Tallah, MD DrPed; Christopher Mfornyam, MD MPH; Joseph Shu Atanga, MD MPH; Health Department, Plan Cameroon, Yaounde, Cameroon, © Plan International 1

CAMEROUN CAMEROON

THE PROBLEM: 32% of under-five children in Cameroon (Central Africa) suffer from chronic malnutrition. 13% of under-fives have acute malnutrition. Plan Cameroon, an international, humanitarian NGO, has partnered with the Ministry of Health, UNICEF and other local agencies to address child malnutrition, both at policy and at program implementation.

THE PROBLEM, cnt’d: Some traditional approaches such as growth monitoring and follow-up have proven not effective in significantly reducing child malnutrition. Consequently Plan Cameroon piloted the first Positive Deviance/Hearth Approach project in the country during 2004.

OF THE PD/HEARTH PROJECT Project Area CHARACTERISTICS OF THE PD/HEARTH PROJECT Project Area 4 pilot rural villages in East Cameroon Target Population 6- 60months old children Goals and Objectives To empower U-5 caregivers to conduct community-based nutrition rehabilitation through hearth within 12days Use locally available foods to constitute balanced meals for malnourished children Provide feeding and health education talks to caregivers during hearth sessions East Cameroon

PROJECT STRATEGIES Selection of malnourished children ( WAZ-score <= -2SD) during routine monthly growth monitoring by Community-based Organizations (CBOs) Hearth sessions using model mothers (“Maman lumiere”) for 12 days

RESULTS (1): In the four pilot, rural villages, 34 children were identified with mild (29 = 85%) and severe malnutrition (5 = 15%) All malnourished children (except one) took part in at least 8 of the 12 days of nutrition rehabilitation.

RESULTS (2): Of the 34 children, all except one had adequate weight gain of at least 300g. Weight gain ranged from 300 – 2500g with an average of 1082g per child. One child lost 400g in spite of 12 day participation at the hearth session being ill health. After treatment, he participated at the next hearth and gained from 4.6 to 6.3 kg.

RESULTS (3) In three children, reasons for discontinuation included traveling out of the village, continuation of rehabilitation at home and simply abandoning the activities for the third case. Even though this happened, their weight gains were ranged between 300 and 1300 grs for the 8 and 9 days participation respectively.

RESULTS (4) Community members were amazed to see that malnutrition, which they considered as due to witchcraft (and therefore cannot be cured), got cured just after a few sessions at the villages using locally available food items. The excitement solicited extensive community support for the hearths including the village chiefs, men, women and children.

CONSEQUENCES PD/Hearth was an effective to rehabilitate malnutrition especially in communities with high prevalence. Plan Cameroon is scaling up the PD/Hearth approach in 11 health districts of the country. The MOH has approved this approach and is considering the development of a policy for scaling up PD/H to eligible communities