The Six Ds of Positive Deviance Approach

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The Positive DevianceHearth Nutrition Model

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

• Extreme poverty
• Complexity offactors
• Immediacy ofneeds
• malnourished children at risk TODAY

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Goal of the Hearth Nutrition Program (HNP)
To enable poor communities to sustainably address
the problems of malnutrition TODAY
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What Development Approachcan alleviate current
childhood malnutrition quickly, affordably
sustainably in a culturally acceptable manner?
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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 peoplePositive Deviants
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Positive Deviance Approach
We must discover what PDs are doing differently
from their neighbors
The PD Inquiry is the tool that provides clues
to PDspecial practices
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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)
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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 Problem
Explore current feeding, caring, hygiene and
health -seeking practices with the community
through
Focus Group DiscussionPLA
Target groups caretakers, stakeholders and
decision makers
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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)
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Step 3 Discover PD Practices

• Demonstrably successful uncommon
• - Feeding
• Caring
• Hygienic
• - Health Seeking Practices

PD Inquiry via Home Visits
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Example of PD Caring Practices (step 3)

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

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Example of PD Feeding Practices (step 3)

• Frequency of feeding, minimum 3 times a day
  Variety of food in the childs diet 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 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
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Analyze PD Findings
Food
Care
Health
Hygiene
And select only PD practices ACCESSIBLE TO
ALLVet PDI results with the community
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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 Learnin
g by doing Interactive Learning