Positive deviance: an innovative approach to
improve malaria outcomes in Myanmar
Muhammad Shafique, Celine Zegers de Beyl,...
Background
► Collaboration with Myanmar Medical Association (MMA):
• The pilot project is being implemented in collaborati...
Positive deviance
► Positive deviance is an asset based behaviour change approach which
highlights and appreciates the pos...
PD programme experience
Objectives
• To describe the practical application of positive deviance
informed pilot project on high risk community memb...
PD pilot villages
PD is being piloted in 6 villages of
Kyun Su Island, Myanmar
► Population: 7000
► April 2013 – March 201...
Phase 1: PD Process
(8-10 Days)
Postive deviance process
1. Community orientation
2. Situation analysis
3. Positive deviance inquiry
4. Participatory anal...
1. Community orientation
• Invite 40-50 community members
from each village
• Explain PD concept with games
and stories
• ...
2. Situation analysis
• Conduct focus group discussions
(FGDs) with:
• Community members
• Rubber tappers
• Fishermen
• Es...
3. Positive deviance inquiry
• Enables community to discover
uncommon successful
behaviours and strategies of
the PD role ...
4. Participatory analysis
• Write all the identified PD behaviours on flips charts
• Invite key stakeholders to vet the PD...
Example of PD role model behaviours
A female rubber tapper who works
in rubber farm for 15 years but
never gets malaria:
•...
5. Feedback session
Conduct at the end of PD process (after
10 days as promised) to share the
identified PD role model beh...
Phase 2: PD implementation
(6-10 months)
Two-days training in:
• Community based
• Communication and health
education skills
• Identified PD behaviours
(build on t...
• PD volunteers conduct
monthly/fortnightly sessions
to share PD behaviours
• Conduct sessions on their
convenience
• Soci...
Monthly meetings are
conducted to:
• Strengthen linkages
• Provide on-job training
• Share monthly progress
report through...
Community seminar
A large community event conducted at the end of project to:
• Officially end intervention (handing over ...
Participatory monitoring
• Develop village maps
• Mark the houses with
fever/malaria cases
• Mark the houses covered
with ...
Evaluation methods
► Baseline and end line surveys
► Quantitative
• Household survey conducted in April 2013
• Number inte...
Community mobilisation aspects
► Emergence of new leadership
• How successful was the project in developing and retaining ...
Lessons learned
• PD is an effective interpersonal communication (IPC) tool to better
understand and reach out to at risk ...
Acknowledgements
► National Malaria Control Programme, Myanmar
• Dr. Thar Tun Kyaw
► Myanmar Medical Association (MMA)
• D...
www.malariaconsortium.org
Thank you
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Positive deviance: an innovative approach to improve malaria outcomes in Myanmar

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This presentation is one of a series prepared for the Malaria Consortium symposium Taking the resistance out of elimination at the Joint International Tropical Medicine Meeting (JITMM) in Bangkok on 11 December 2013. It presents a pilot positive deviance project in a remote island, Kyun Su Township in Myanmar, and describes the positive deviance process being implemented in two phases.

A video of this presentation is available to watch here: http://www.malariaconsortium.org/pages/joint_international_tropical_medicine_meeting_bangkok_december_2013.htm

Published in: Health & Medicine
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Positive deviance: an innovative approach to improve malaria outcomes in Myanmar

  1. 1. Positive deviance: an innovative approach to improve malaria outcomes in Myanmar Muhammad Shafique, Celine Zegers de Beyl, Sylvia Meek, Ernest Smith JITMM, 11-13 December, 2013, Bangkok, Thailand
  2. 2. Background ► Collaboration with Myanmar Medical Association (MMA): • The pilot project is being implemented in collaboration with MMA in a remote island, Kyun Su Township, Myanmar • Funded by Department for International Development/Ukaid ► Myanmar Artemisinin Containment Resistance (MARC): • Positive deviance (PD) is being implemented in the MARC project area • At risk populations i.e. mobile and migrants, rubber tappers, forest workers etc. are key target audiences of the MARC project • Lack of understanding about their context, knowledge and behaviours are main challenges to develop effective strategies • Focus and innovative approaches are required to better reach out to these populations • PD is an approach that can fill in this gap
  3. 3. Positive deviance ► Positive deviance is an asset based behaviour change approach which highlights and appreciates the positive behaviours of the community Concept: ► In every community there are certain individuals whose uncommon positive behaviours enable them to find better solutions to problems than their neighbours who have access to the same resources
  4. 4. PD programme experience
  5. 5. Objectives • To describe the practical application of positive deviance informed pilot project on high risk community members, rubber tappers and fishermen • To orient the National Malaria Control Programme, Myanmar and key partners on the PD approach • To conduct evaluation of positive deviance approach using both quantitative and qualitative methods • To document the process and lessons learned to share with national malaria programmes and key stakeholders/partners
  6. 6. PD pilot villages PD is being piloted in 6 villages of Kyun Su Island, Myanmar ► Population: 7000 ► April 2013 – March 2014 ► Selection criteria: • High risk MARC area • Presence of high risk population rubber tappers/fisher men • Presence of village volunteers
  7. 7. Phase 1: PD Process (8-10 Days)
  8. 8. Postive deviance process 1. Community orientation 2. Situation analysis 3. Positive deviance inquiry 4. Participatory analysis of PD findings 5. Feedback session
  9. 9. 1. Community orientation • Invite 40-50 community members from each village • Explain PD concept with games and stories • Identify key community partners • Plan for situation analysis i.e. focus group discussions, in-depth interviews • Promise to assemble again in 10 days with solution
  10. 10. 2. Situation analysis • Conduct focus group discussions (FGDs) with: • Community members • Rubber tappers • Fishermen • Establish normative behaviours of community around malaria prevention and control • Identify potential positive deviants individual through FGDs or mapping Conducted 18 FGDs in Kyunsu
  11. 11. 3. Positive deviance inquiry • Enables community to discover uncommon successful behaviours and strategies of the PD role models • In-depth interviews with potential PD role models (male/female) • Identify successful PD behaviours and strategies
  12. 12. 4. Participatory analysis • Write all the identified PD behaviours on flips charts • Invite key stakeholders to vet the PD findings • Select only those behaviours that are accessible to all
  13. 13. Example of PD role model behaviours A female rubber tapper who works in rubber farm for 15 years but never gets malaria: • She always wear long sleeved shirt, long trouser and rubber boots when she works in rubber farm • Covers her head and face with a cloth during rubber tapping to avoid mosquito bites • When she is at home, she always sleeps under the LLIN • Burns coil when cooking/TV • Whenever gets sick, she always contact the volunteer for blood test
  14. 14. 5. Feedback session Conduct at the end of PD process (after 10 days as promised) to share the identified PD role model behaviours: • Invite community members (70-80) from all villages • Share PD findings through interactive role plays and actual role models • Identify volunteers • Prepare plan of action
  15. 15. Phase 2: PD implementation (6-10 months)
  16. 16. Two-days training in: • Community based • Communication and health education skills • Identified PD behaviours (build on the positive behaviours) • Plan of action for sharing these behaviours with other community members Training of volunteers
  17. 17. • PD volunteers conduct monthly/fortnightly sessions to share PD behaviours • Conduct sessions on their convenience • Social places i.e. schools, monasteries, village chief house, community events Positive deviance sessions
  18. 18. Monthly meetings are conducted to: • Strengthen linkages • Provide on-job training • Share monthly progress report through maps • Plan for the next month activities Monthly meetings
  19. 19. Community seminar A large community event conducted at the end of project to: • Officially end intervention (handing over to the community) • Acknowledge volunteers • Provide platform for advocates • Reinforce messages through innovative ways (i.e. role plays, poster competitions, games and success stories)
  20. 20. Participatory monitoring • Develop village maps • Mark the houses with fever/malaria cases • Mark the houses covered with PD sessions/health education activities • Update these maps on monthly basis
  21. 21. Evaluation methods ► Baseline and end line surveys ► Quantitative • Household survey conducted in April 2013 • Number interviewed (n=504)  Data entry is completed, analysis is in progress  End line survey will be conducted in March 2014 ► Qualitative • Focus Group Discussions • In-depth interviews
  22. 22. Community mobilisation aspects ► Emergence of new leadership • How successful was the project in developing and retaining all the volunteers ► Degree and equity of participation • How community members were engaged in the project • Timing of sessions, accessibility of venues for sessions to maximise participation ► Information Equity • How the outreach was ensured to each part of village (mapping) ► Sense of ownership • How the community was engaged in the project?
  23. 23. Lessons learned • PD is an effective interpersonal communication (IPC) tool to better understand and reach out to at risk communities • PD process helps understand context, normative behaviours which enables us to develop tailored communication strategy for target groups • PD engages community at each step which develops ownership • As PD behaviours and strategies are local hence easily accepted which expedite the process of behaviour change • PD approach provides on-job training opportunities to volunteers which boost their confidence, increase motivation and ensure their retention(no volunnteer has left yet) • PD can be replicated through volunteers and health staff • PD is a human and time intensive approach, requires skilled facilitators
  24. 24. Acknowledgements ► National Malaria Control Programme, Myanmar • Dr. Thar Tun Kyaw ► Myanmar Medical Association (MMA) • Dr. Myo Min ► Positive Deviance Initiative, Tufts University • Monique Sternin ► Health centre staff and communities of Kyun Su ► Department for International Development/UKaid
  25. 25. www.malariaconsortium.org Thank you
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