The Positive DevianceThe Positive DevianceHearth Nutrition ModelHearth Nutrition Model

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Basic CausesBasic Causes

-Resources and -Resources and controlcontrol ( (human, economic human, economic and and organizational organizational))

The ContextThe Context

Underlying CausesUnderlying Causes

--Inadequate Inadequate maternal and child care maternal and child care

-Insufficient household-Insufficient household food security food security

- Insufficient health - Insufficient health servicesservices and unhealthy and unhealthy environmentenvironment

Causes of malnutrition among young children are Causes of malnutrition among young children are complex, interrelated and can take complex, interrelated and can take yearsyears to overcome to overcome

Direct CausesDirect Causes

--Inadequate intake of Inadequate intake of foodfood

-Disease-Disease

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The ChallengesThe Challenges

• Extreme povertyExtreme poverty• Complexity ofComplexity of

factorsfactors• Immediacy ofImmediacy of

needsneeds malnourished children at risk malnourished children at risk

TODAYTODAY

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Goal of the Hearth Nutrition Program Goal of the Hearth Nutrition Program (HNP)(HNP)

To enable poorTo enable poor

communities tocommunities to

sustainablysustainably

address the address the problemsproblems

of malnutritionof malnutrition

TODAYTODAY

What Development Approach…What Development Approach…can alleviate current childhood can alleviate current childhood

malnutrition quickly, affordably & malnutrition quickly, affordably & sustainably in a culturally acceptable sustainably in a culturally acceptable

manner?manner?

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Positive Deviance (PD) Positive Deviance (PD) ApproachApproach

Identifying Solutions to Community Problems Identifying Solutions to Community Problems WithinWithin the Community Today the Community Today

What enables some poor What enables some poor members of the members of the

community to have well community to have well nourished children when nourished children when their neighbors do not?their neighbors do not?

…… We call these peopleWe call these peoplePositive DeviantsPositive Deviants

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Positive Deviance ApproachPositive Deviance Approach

We must discover what PDs are doing We must discover what PDs are doing differently from their neighborsdifferently from their neighbors

The PD InquiryThe PD Inquiry is the tool that is the tool that

provides clues to PDprovides clues to PDspecial practicesspecial practices

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PD PROCESSPD 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)

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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

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Step 1 – Define the Step 1 – Define the ProblemProblem

Explore current feeding, caring, hygiene and health Explore current feeding, caring, hygiene and health -seeking practices with the community through-seeking practices with the community through

Target groups: caretakers, stakeholders and Target groups: caretakers, stakeholders and decision makersdecision makers

Focus Group Focus Group DiscussionDiscussionPLA PLA

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Step 2 – Determine Presence of Step 2 – Determine Presence of PD Children and PD FamiliesPD 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)

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Step 3 – DiscoverStep 3 – Discover PD PD Practices Practices Demonstrably successful uncommonDemonstrably successful uncommon

- Feeding- Feeding- CaringCaring- Hygienic Hygienic

- Health Seeking Practices- Health Seeking Practices

PD Inquiry via Home PD Inquiry via Home VisitsVisits

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Example of PD Caring Example of PD Caring Practices Practices (step 3)(step 3)

- Experienced secondary caretaker (older Experienced secondary caretaker (older siblings)siblings) Supervision during feeding (active feeding) Supervision during feeding (active feeding) Gender equity in child care Gender equity in child care

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Example of PD Feeding Example of PD Feeding Practices Practices (step 3)(step 3)

- Frequency of feeding, minimum 3 times a Frequency of feeding, minimum 3 times a dayday Variety of food in the child’s diet Variety of food in the child’s diet Amount of food and consistency Amount of food and consistency

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Example of PD Hygiene Practices (Step 3)

• Washing Hands Before & After Eating

Environmental Cleanliness

Keeping Food Covered

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Example PD Health-Seeking Example PD Health-Seeking Practices Practices (Step 3) (Step 3)

-Timely seeking qualified help when child -Timely seeking qualified help when child is sickis sick - Appropriate child feeding during & after - Appropriate child feeding during & after illness illness - Identification of danger signs - Identification of danger signs - Home management of minor illnesses- Home management of minor illnesses

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Analyze PD FindingsAnalyze PD Findings

And select only PD practices And select only PD practices ACCESSIBLE TO ALLACCESSIBLE TO ALL

Vet PDI results with the communityVet PDI results with the community

Food Care HealthHygiene

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Step 4- Design a PD informed activity or HEARTH

Involvement of community in the Involvement of community in the designdesign

Inclusion of PD concepts & PDI Inclusion of PD concepts & PDI findingsfindings

Multi channels Multi channels

Multi target: including all Multi target: including all stakeholdersstakeholders

Learning by doing: Interactive Learning by doing: Interactive Learning Learning