Date post: | 18-Jan-2017 |
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The Positive DevianceThe Positive DevianceHearth Nutrition Hearth Nutrition
ModelModelMercy Laker,Mercy Laker,
Nutrition Specialist WVUNutrition Specialist WVU
The concept of PD Hearth• Positive Deviance: It is a departure, a difference, or
deviation from the norm that results in a positive outcome. It is a departure from the conventional wisdom,
• “Positive”? Looks for what is working, what people are doing right. Utilizing what resources are available, not what is needed and missing. It is asset-based, rather than needs based.
• A positive deviant is a poor member of the community who has a well-nourished child while most of their neighbors do not.
• A Hearth? It is a home kitchen, community volunteers volunteering their homes
• A Positive Deviance Inquiry (PDI) is a process of discovery that occurs before a Hearth directly informing the content to be shared during the Hearths.
Positive Deviance/Hearth - principle
The Million $ Question:Why do well nourished children exist beside malnourished children despite
living in the same conditions of poverty?
What is PD/Hearth programming model?
• in every community there are certain individuals or groups (the positive deviant) whose special practices or behaviors enable them to find a better solution to a prevalent problem than their neighbors who have access to the same resources.
• Presumes that the knowledge about ‘what works’ is available in existing individuals or entities (Solutions from within!)
• The goal of PD Hearth is to treat, sustain and prevent malnutrition
• Provides timely catch up growth for children showing growth faltering– Target: moderately malnourished children and
children at risk of malnutrition.
To reduce the prevalence of malnutrition
among children under 5
Three (3) Dimensional Approach of
Positive Deviance/Heart
h
Reduce
To build local capacity to sustain the
rehabilitation of children
To prevent future malnutrition
among all children in the communities
Process in PD Implementation
:
Social Mobilization
Information Gathering
Behavior Change
Build
Prevent
Stages in PD Hearth
• Implementation of the PD/HEARTH model progresses in five stages:
• Determining feasibility• Conducting the Positive Deviance Inquiry
(Learning from the positive deviants)• Implementing the NERS(treating malnutrition)
• Follow up and monitoring (sustaining)• Nutrition education (prevention)
Steps in a Positive Deviance/Hearth Model
8
Step 1 – Determining feasibility and Step 1 – Determining feasibility and normingnorming
• Malnutrition Prevalence in the Community
• Availability of Affordable Local Foods
• Availability of complimentary services
• Geographic Proximity of Homes• Existence of Food Aid• Emergency nutritional situation• Landless Populations or Squatter
Communities Committed leaders, village chiefs
9
Step 2 – Conducting a PDI (Learning Step 2 – Conducting a PDI (Learning from the positive deviants) from the positive deviants)
What works???
• Feeding PracticesFeeding Practices• -Caring & Hygiene Practices-Caring & Hygiene Practices- Health Care PracticesHealth Care Practices• (home management & health-seeking)(home management & health-seeking)
10
PD Inquiry is an “Ends” as well as “Means”PD Inquiry is an “Ends” as well as “Means”and and MUSTMUST be repeated in each Community be repeated in each Community
ToTo discover discover successful, successful, replicablereplicable PD behaviors PD behaviorsMeansMeans
EndsEnds
To empower community To empower community toto discover discover andand “own” “own”theirtheir own solution, own solution, based on theirbased on their own own resourcesresources
Step 3. Nut. Education Rehabilitation Sessions (NERS)
• Behavior ‘promotion and empowerment’ Learning by Doing
• Nutrition Rehabilitation + Education over 12 days + home visits
• Promotion of behaviors and practices related to Feeding, Caring, Hygiene and Health Seeking Food
CareHealth
Step 4: Follow up
Observe sustained application of PD behavior with Hearth child and siblings (qualitative).
Measure for sustained weight gain at 2 mos, at 6 mos, 12 months, etc.;
Follow the cohort over time to assure that the graduates stay onthe Road to Health and do not falter
Nutrition Education
Home visits are conducted to the Hearth participants at least once every two weeks to support the new behaviors at home.
Create community support systems (Nutrition care groups)
Support food production
Continue home visits and outreaches as usual
INTEGRATED POSITIVE DEVIANCE/HEARTH MODEL
Key Entry Points
Improved water, sanitation, gender &other interventions addressing the underlying causes of malnutrition
Improved access and availability of
nutritious foods
Increased family economy especially for food and health care
Families with currently
malnourished children
Target Groups
Context considerations for PD/Hearth
Stakeholders • Stakeholders are the
individuals, groups and institutions that stand to GAIN or LOSE from project activities
– Key actors for change (central role)
– support actors for change– Final Beneficiaries– Influential players (cultural,
religious leaders)– Information holders
Important considerations in identifying stakeholders
• Power and status• Degree of
organization• Control of resources• Decision-making
process• Power relations• Importance to the
success of the project
I’ll call urgent health
committee meeting
tomorrow!
What do you want to do about this high level of malnutrition?
Staffing
Combination of technical, critical thinking
&community mobilization skills• A Nutrition Advisor (NO level or regional level):
– PD Hearth approach: anthropometry, PD Inquiry, Energy calculation, Adult education
– Follow up, monitoring & evaluation
• Project staff (nut / health facilitator / coord) in ADP:– Anthropometry, Training, Referral of malnutrition, Training & working with
volunteers and health staff
• Community volunteers: as the backbone
PROCESS - How to Develop Competencies to implement PD/H
National Office – identifies malnutrition (>30% children in the
ADP community)
NO contacts the Regional Office (Regional Nutrition
Coordinators/Advisors)
Nutrition Center of Expertise (Nutrition Technical Advisor –
Diane Baik)
Interim process
SO
Costs of Hearth Sessions
The direct costs include:The average cost of themeals per child for the 12days is approximately 1 USD
The indirect costs include:the estimation of time spent by the mothers, community health agents, cooking equipments etc.
The total cost of Hearth is not substantial
Range $1.85 to $12.00 per recovered child
Cost per child with neighborhood level Nutrition education/rehabilitation is
less than half of cost per hospitalization for malnutrition
Advantages of using the PD Model!• Quick solutions addressing moderate malnutrition• Affordable
– Vietnam (USD2 per child)– Mongolia (USD8 per child)– Uganda (USD 1.2 PER child)
• Participatory – Community participation
• Sustainable– Communities gaining skills (cooking, feeding, hygiene
caring)• Indigenous (solutions from within!)• Based on behavior change
PDH Inversions• Trainee vs. Trainer (in a PDI the community becomes the
trainer of ours) • Best practices vs. working practices • Needs based vs. assets based (glass half empty/half full) • KAP vs. PAK • Hearth-based vs. Center-based • Poverty leads to malnutrition vs. Malnutrition leads to
poverty • Acting into new thinking vs. Thinking into new acting • Food Aid vs. food contributions from community • PDI vs. nutritional survey (KPC style) Listening vs. Speaking
Solutions from the inside vs. solutions from the outside • Outside experts knowledge vs. PD mothers knowledge
MANY THANKS MANY THANKS FOR FOR
YOUR ATTENTIONYOUR ATTENTION