PD hearth -Complementary feeding -Nutrition Model

1. The Positive DevianceThe Positive Deviance
Hearth NutritionHearth Nutrition
ModelModel
Mercy Laker,Mercy Laker,
Nutrition Specialist WVUNutrition Specialist WVU

2. 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.

3. Positive Deviance/Hearth - principle
The Million $ Question:
Why do well nourished children exist beside
malnourished children despite living in the same
conditions of poverty?

4. 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.

5. To reduce the
prevalence of
malnutrition
among children
under 5
Three (3)
Dimensional
Approach of
Positive
Deviance/Hearth
Three (3)
Dimensional
Approach of
Positive
Deviance/Hearth
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

6. 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)

7. Steps in a Positive Deviance/
Hearth Model

8. 8
Step 1 – Determining feasibility andStep 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. 9
Step 2 – Conducting a PDI (LearningStep 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. 10
PD Inquiry is an “Ends” as well as “Means”PD Inquiry is an “Ends” as well as “Means”
andand MUSTMUST be repeated in each Communitybe repeated in each Community
ToTo discoverdiscover successful,successful,
replicablereplicable PD behaviorsPD behaviorsMeansMeans
EndsEnds
To empower communityTo empower community
toto discoverdiscover andand “own”“own”
theirtheir own solution,own solution,
based on theirbased on their ownown
resourcesresources

11. 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
Care
Health

12. 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

13. 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

14. INTEGRATED POSITIVE DEVIANCE/HEARTH MODEL
Key Entry PointsKey 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

15. Context considerations
for PD/Hearth

16. 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

17. 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?
What do you want to
do about this high
level of malnutrition?

18. Staffing

19. 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

20. 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

21. Costs of Hearth Sessions
The direct costs include:
The average cost of the
meals per child for the 12
days 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

22. 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

23. 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

24. MANYTHANKSMANYTHANKS
FORFOR
YOUR ATTENTIONYOUR ATTENTION