The Positive Deviance Hearth Nutrition Model

2 Basic Causes -Resources and control (human, economic and organizational) -Resources and control (human, economic and organizational) The Context Underlying Causes Underlying Causes -Inadequate maternal and child care -Insufficient household food security - Insufficient health services and unhealthy environment Causes of malnutrition among young children are complex, interrelated and can take years to overcome Direct Causes Direct Causes -Inadequate intake of food -Disease

3 The Challenges Extreme povertyExtreme poverty Complexity of factorsComplexity of factors Immediacy of needsImmediacy of needs malnourished children at risk TODAY

4 Goal of the Hearth Nutrition Program (HNP) To enable poor communities to sustainably address the problems of malnutrition TODAY

What Development Approach… can alleviate current childhood malnutrition quickly, affordably & sustainably in a culturally acceptable manner?

6 Positive Deviance (PD) Approach Identifying Solutions to Community Problems Within the Community Today What enables some poor members of the community to have well nourished children when their neighbors do not?… We call these people Positive Deviants

7 Positive Deviance Approach Positive Deviance Approach We must discover what PDs are doing differently from their neighbors The PD Inquiry is the tool that provides clues to PD special practices

8 PD PROCESS 1. Define the problem, issues & community norms affecting the nutritional status of children 2. Determine the presence of well nourished children from poor families in community (Positive Deviant Children/Families)

9 PD PROCESS 3. Discover what they are doing differently by conducting home visits. (PD Inquiry) 4. Design activities based on demonstrably successful practices and strategies

10 Step 1 – Define the Problem Explore current feeding, caring, hygiene and health -seeking practices with the community through Target groups: caretakers, stakeholders and decision makers Focus Group Discussion PLA

11 Step 2 – Determine Presence of PD Children and PD Families With members of the community: 1: Weigh all children in target group & plot them on giant growth chart 2: List all well-nourished children 3: Select well-nourished children from poor families (wealth ranking)

12 Step 3 – Discover PD Practices Step 3 – Discover PD Practices Demonstrably successful uncommon - Feeding - Caring - Hygienic - Health Seeking Practices PD Inquiry via Home Visits PD Inquiry via Home Visits

13 Example of PD Caring Practices (step 3) - Experienced secondary caretaker (older siblings) Supervision during feeding (active feeding) Gender equity in child care

14 Example of PD Feeding Practices (step 3) - Frequency of feeding, minimum 3 times a day Variety of food in the child’s diet Amount of food and consistency

15 Example of PD Hygiene Practices (Step 3) Washing Hands Before & After Eating Environmental Cleanliness Keeping Food Covered

16 Example PD Health-Seeking Practices (Step 3) -Timely seeking qualified help when child is sick - Appropriate child feeding during & after illness - Identification of danger signs - Home management of minor illnesses -Timely seeking qualified help when child is sick - Appropriate child feeding during & after illness - Identification of danger signs - Home management of minor illnesses

17 Analyze PD Findings Analyze PD Findings And select only PD practices ACCESSIBLE TO ALL Vet PDI results with the community Food CareHealthHygiene

18 Step 4 - Design a PD informed activity or HEARTH Involvement of community in the design Inclusion of PD concepts & PDI findings Multi channels Multi target: including all stakeholders Learning by doing: Interactive Learning