LOOK: For Positive Deviants

Poor-country development usually works like this: Outsiders come into a community where there is a problem. They bring in “best practice” ideas that have worked elsewhere, and design ways to teach the community to change its culture and adopt these new ideas. And then they leave.

Here’s how the positive deviance approach is different

By Tina Rosenberg - New York Times Blog

Jerry and Monique Sternin and their son were among the very first Americans to move to Hanoi when they arrived in Vietnam in 1990. They had come from the Philippines, where Jerry had been director of Save the Children’s program there.

At the time, Vietnam was losing its imports of subsidized rice from ideological backers and shifting from collectivized to private agriculture. The dislocation was deadly — “a near-famine situation,” Monique Sternin said in an interview from Addis Ababa this weekend. About two-thirds of children were malnourished. International feeding programs had helped, but when the programs ended, villages fell back into hunger. The government had asked Save the Children to try to find a lasting solution. Some officials didn’t like having Westerners brought in. You have six months to show results, the government warned. If you don’t, you’re out.

The Sternins had seen in their previous work how big programs run by outsiders created dependency. “The essence of development is to help people build capacity to do things themselves,” said Monique (Jerry died in 2008). “We were struggling to find something.”

They had just read a book, however, by Marian Zeitlin, a professor of nutrition at Tufts University, called “Positive Deviance in Nutrition.” The word deviant usually has negative connotations, but Zeitlin wrote about children who thrived even as those around them were poorly nourished. Zeitlin suggested that nutrition could be improved if a village looked at what these children’s families were doing right.

The Sternins were not experts in fighting malnutrition. But they thought they knew where to find some.They went into villages and asked for volunteers to weigh all children under 3, and to characterize each family’s level of income. The volunteers concluded the obvious: the poorer the family, the more likely the children would be malnourished. Then the Sternins asked if any of the families characterized as “very, very poor” had well-nourished children.

The volunteers checked the list and excitedly reported that there were some.

“So it’s possible for a very, very poor child in the village to be well nourished?” asked the Sternins.

“Let’s go see what their families are doing differently,” the volunteers said.

The volunteers fanned out to interview these “positive deviant” families — in each village there were a few, perhaps 5 or 6. They found several practices in common. Children in the village were fed twice a day, mostly rice. Local custom held that an adult diet was harmful for young children. But the positive deviant parents were collecting tiny crabs or shrimps from rice paddies and giving them to the children along with the greens from sweet potatoes. While village wisdom held that you don’t feed a child who has diarrhea, the positive deviant families did. They also fed their children often throughout the day, and washed their children’s hands before they ate.

The Sternins knew that helping villagers to learn about these deviant behaviors would not be enough. “Knowledge doesn’t change behavior,” said Monique. “Practice changes behavior.” They convened meetings of villagers to discuss how best to spread the behaviors. The villagers decided that parents of malnourished children would gather with their children daily at a neighbor’s house for two weeks. Each family had to collect a handful of shrimps, crabs or greens and bring it to the gathering. With a trained health volunteer, the families cooked meals using the nutritious foods and tried out the new practices. If they didn’t become habit and the children were still malnourished, the families could do another two-week cycle the next month. “Trying something new always makes you a little scared. People got confidence through their peers,” said Monique.

Five and a half months after the Sternins had arrived in Vietnam, authorities weighed the children in the district who had participated in the program. More than 40 percent were now well nourished, and another 20 percent had moved from severe to moderate malnutrition. The Sternins got their visa extended. Vietnam eventually replicated the program in 250 communities.

Poor-country development usually works like this: Outsiders come into a community where there is a problem. They bring in “best practice” ideas that have worked elsewhere, and design ways to teach the community to change its culture and adopt these new ideas.

And then they leave.

If they come back later, however, they might find that not much has changed: a few people adopted the new idea, but not many. And since that was not the way the community did things, even those adventurous few might abandon their new practices.

Here’s how the positive deviance approach is different. READ MORE

Image: powerofpositivedeviance.com


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