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Pd hearth overview presentation final

PD hearth -Complementary feeding -Nutrition Model

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Pd hearth overview presentation final

  1. 1. The Positive DevianceThe Positive Deviance Hearth NutritionHearth Nutrition ModelModel Mercy Laker,Mercy Laker, Nutrition Specialist WVUNutrition Specialist WVU
  2. 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. 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. 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. 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. 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. 7. Steps in a Positive Deviance/ Hearth Model
  8. 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. 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. 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. 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. 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. 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. 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. 15. Context considerations for PD/Hearth
  16. 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. 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. 18. Staffing
  19. 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. 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. 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. 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. 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