Positive Deviance/Hearth

World Vision began utilising the Positive Deviance/Hearth (PD/Hearth) approach in nutrition programming as early as 1999. Starting in Latin America, the organisation soon expanded implementation of PD/Hearth to other regions. This approach is one of World Vision’s Nutrition Project Models, and is currently being used in more than 30 countries (including Uganda, profiled in video).

In fiscal year 2016, more than 56,000 underweight children under five years were enrolled into PD/H programmes in seven countries, with 65% gaining adequate weight in three months and 54% fully rehabilitated and graduated from PD/H. These seven countries achieved significant and sustained reductions in underweight status of participating children, from 81% at baseline to 37% at six-month followup. These continued reductions over time indicate both successful rehabilitation of underweight children and sustained behaviour change of primary caregivers to continue improvements and prevent malnutrition from recurring.

Countries implementing PD/Hearth are: Africa: Burundi, Chad, Democratic Republic of Congo (DRC), Ethiopia, Kenya, Malawi, Mali, Mauritania, Mozambique, Niger, Rwanda, Sierra Leone, South Africa, Tanzania, Uganda, Zambia, Zimbabwe; Asia: Bangladesh, Cambodia, India, Indonesia, Laos, Myanmar, Nepal, Philippines, Sri Lanka, Vietnam; Latin America: Ecuador, Guatemala, and Haiti

PD/Hearth is a community-based approach with three interrelated goals:

To reduce the prevalence of malnutrition among children under five years.
To build local capacity to treat malnourished children and sustain the rehabilitation of children.
To prevent future malnutrition among all children in the community.

‘Positive deviance’ means straying from the norm, but in a beneficial way. Despite stark poverty and food scarcity, some parents find ways to raise well-nourished children. Understanding what these ‘positive deviant families’ are doing differently from the parents of malnourished children in the same community is key. This inquiry often identifies positive practices that are unique to that context, such as Vietnamese mothers collecting shrimp for their children while working in rice paddies, Ecuadorian women pre-masticating meat before giving it to their children, and mothers in Democratic Republic of Congo feeding their children dried and powdered caterpillars in their porridge. Families with malnourished children are then supported to adopt these positive practices through hands-on nutrition education and rehabilitation sessions conducted in the home (‘hearth’) of a community volunteer.

During the hearth sessions, the children are fed nutritious meals based on positive deviant foods, which the caregivers prepare together using ingredients they have contributed. As the children respond to the improved nutrition by gaining appetite, energy and weight, their families experience first-hand the value of the positive deviant practices. After the hearth session, volunteers continue to monitor the children’s growth and support the families to apply the new behaviours they have learned.

For PD/Hearth implementation basics and links to downloadable resources, please visit the PD/Hearth Project Model page.

Cost of Programming

Costs for PD/Hearth integrated with food security include significant investment initially in training and start-up costs, and remain high as the activities are scaled up in each fiscal year. Cost analysis from area development programmes in Bangladesh, Honduras, India and Mali show a per capita cost ranging from $0.73 in Mali to $4.86 in India and $9 in Bangladesh. Up to 80 per cent of the overall programme cost in India was for food production activities (animal and garden inputs).

Publications

World Vision offers the following PD/Hearth training resources:

Training of Master Trainers

Training of Facilitators

Volunteer Training

IQA: Implementation Quality Assurance Tool

Articles

Improving Child Nutrition Community by Community in Zambia

PD/Hearth Approach in Bangladesh

PD/Hearth Approach in Guatemala

PD/Hearth Impact Evaluation Report