Positive Deviance Approach to Improve Maternal/Newborn Health in Zambia

This project seeks to empower patients and communities in the Mumbwa district of Zambia to address the high rates of newborn and maternal mortality and morbidity that exist there. Positive Deviance (PD) is an innovative approach that emphasizes the importance of community empowerment to define the problem and discover existing solutions.

About You

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Section 1: You

First Name

Alexis

Last Name

Felder

Organization

Positive Deviance Initiative

Country

United States, MA, Suffolk County

Section 2: Your Organization

Organization Name

Positive Deviance Initiative

Organization Website

Organization Phone

617-636-2195

Organization Address

150 Harrison Ave, Boston MA, 02111

Is your organization a

Non‐profit/NGO/citizen sector organization

Organization Country

United States, MA, Suffolk County

Your idea

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Name Your Project

Positive Deviance Approach to Improve Maternal/Newborn Health in Zambia

Country and state your work focuses on

Zambia, CE

Describe Your Idea

This project seeks to empower patients and communities in the Mumbwa district of Zambia to address the high rates of newborn and maternal mortality and morbidity that exist there. Positive Deviance (PD) is an innovative approach that emphasizes the importance of community empowerment to define the problem and discover existing solutions.

Innovation

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What makes your idea unique?

Positive Deviance (PD) is an innovative approach which is based on the observation that in every community there are certain individuals or groups (positive deviants) whose special practices or strategies enable them to find better solutions to prevalent, seemingly intractable problems than their peers who have access to the same resources and face the same challenges.

PD differs from traditional top-down approaches to behavior change by focusing on the identification and amplification of existing successful and internally generated strategies rather than on deficits or externally imposed best practices. PD acts as a catalyst for uncovering previously unidentified solutions that are consistent with a community cultural context. Because the solutions are, by definition, based on resources (human and material) already present in the community, they are easily adopted, effective, culturally appropriate, and result in sustainable improvement. All stakeholders in the community, including patients, clinic staff, and families, identify and disseminate those special behaviors and strategies. The PD approach relies on local wisdom and existing resources rather than on external experts and resources.

Existing antenatal and healthcare services offered by clinics remain widely underutilized in the Mumbwa district of Zambia, with many women continuing to deliver at home. Using the PD approach to address this issue will allow patients, community members, and clinic staff to better understand existing barriers and solutions, and will empower those stakeholders to define and design their own strategies for overcoming the problem.

Do you have a patent for this idea?

Impact

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What impact have you had?

The PD approach is gaining recognition in solving a variety of problems including neo-natal mortality and morbidity, educational performance, teen violence, female genital cutting, MRSA eradication, and child trafficking. The PD approach has directly altered the lives and practices of more than 3.5 million people.

The most widespread application of the approach is with childhood malnutrition, the efficacy of which has been documented in over 41 countries. In Vietnam, the PD approach reached a population of 2.2 million people and resulted in a sustained 65-80% reduction in childhood malnutrition.

The PD approach in maternal health has been piloted successfully in Pakistan, Egypt, and Guinea. In Pakistan’s Pashtun communities the PD maternal health pilot resulted in no newborn deaths over an 18 month period and the adoption of life saving behaviors, as well as evidence of social change, especially regarding gender issues. In Egypt, the PD approach has resulted in the documented aversion of thousands of female circumcisions and the formation of 12 “FGM free” communities. PD has also led to a documented reduction in girl trafficking in impoverished communities in East Java, Indonesia. Six U.S. hospitals that piloted the PD approach between 2006 and 2008 had an average decline of 37% in MRSA (hospital-acquired) infection rates, while some pilot hospitals experienced a decline in MRSA of up to 73%.

Problem

An integral part of the PD process is allowing the community, in this case the patients, to define the problem. Since the pilot phase of this project has not yet been implemented, the patients and community members have not yet had the opportunity to define the primary problem.

From the point of view of the PDI, World Vision, and the CORE Group, the primary problem is that the Mumbwa district of Zambia has very high maternal and newborn mortality rates and patients under-utilize clinics and the services offered by clinics. For every 1000 births in the Mumbwa district, 93 result in newborn mortality. One in every 27 pregnancies in Zambia ends in maternal death.

We are piloting the PD approach in the Mumbwa district to help patients and clinic staff better understand prevailing practices and the disconnect between patient needs and available services.

Actions

The first step towards making this innovation a success is to pilot the application of PD to maternal and newborn health in several community sites in the Mumbwa district. In order to support the community intervention, the PDI and CORE group staff will conduct a ten-day training workshop with World Vision staff, patients, and key stakeholders to guide the process and develop the skills of staff and patients to solve their own problems. We will also provide on-going technical assistance and coaching.

The second step will be to conduct monitoring and evaluation of the project and to facilitate in-country networking and the development of a community of practice to facilitate peer and cross organizational learning related to PD and maternal/newborn health.

The third step involves expanding the application of PD to address maternal and newborn health in other districts of Zambia, as well as other countries.

Results

The primary expected result of these actions is the significantly improved health outcome and survival rate of pregnant women and their newborns in the Mumbwa district of Zambia.

Another expected result is that patients and communities in this district will have raised their own awareness around issues impacting maternal and newborn health and will have gained new skills and developed culturally appropriate tools to effectively monitor the progress of their communities in addressing this serious issue.

Additionally, patients and community members in the Mumbwa district will be empowered to use their own strengths and existing solutions to tackle other intractable problems impacting their communities.

As the template developed in the Zambia is disseminated, the expected result is that patients in a wide variety of locations will be positively impacted by the PD approach and will be empowered use their voices to address an array of intractable problems.

What will it take for your project to be successful over the next three years? Please address each year separately, if possible.

An initial ten-day training workshop with patients, World Vision staff and community members, and a follow-up visit after six months are essential to the success of the project during the first year. The PD process often requires a shift in mindset and initially requires a significant amount of time, coaching, mentoring, and encouragement to the community facilitation groups to create the foundation for the project to grow and succeed. Ongoing technical assistance and coaching to address implementation questions as they arise will be key to the success of the project. Meeting the funding needs for coaching and travel expenses are essential for the project to begin and grow over the next three years.

In the second year, it will be essential to facilitate of in-country networking as well as peer and cross organizational learning related to PD and maternal/newborn health. A program evaluation will be carried out to ascertain the impact that the PD approach has had on improving maternal and newborn health in the pilot communities and their health delivery partners. The second year will involve the expansion and improvement of the pilot into other districts in Zambia with rigorous monitoring and evaluation. This phase of the project will help to develop the template that will be used to expand the project to other parts of Zambia, as well as to other countries.

Finally, during the third year, experiences gleaned from the implementation in Zambia will be used to develop a template that will be tested in additional regions of Zambia and at least four additional countries. In order to disseminate the application of PD to maternal and newborn health, a manual will need to be developed and translated into various languages.

What would prevent your project from being a success?

The largest impediments to the success of this project would be a lack of resources (funding) to provide basic coaching and follow-up visits or the unexpected withdrawal of one of the key partners.

How many people will your project serve annually?

More than 10,000

What is the average monthly household income in your target community, in US Dollars?

Less than $50

Does your project seek to have an impact on public policy?

Sustainability

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What stage is your project in?

Operating for less than a year

In what country?

Zambia, CE

Is your initiative connected to an established organization?

Yes

If yes, provide organization name.

Tufts University, Positive Deviance Initiative, World Vision International, and the CORE Group

How long has this organization been operating?

1‐5 years

Does your organization have a Board of Directors or an Advisory Board?

Yes

Does your organization have any non-monetary partnerships with NGOs?

Yes

Does your organization have any non-monetary partnerships with businesses?

No

Does your organization have any non-monetary partnerships with government?

Yes

Please tell us more about how these partnerships are critical to the success of your innovation.

A large part of the PDI’s role in disseminating information about the PD approach involves partnering with individuals and organizations that are passionate about our work and who have the resources to support and spread knowledge about the approach. As a network organization, the partnerships that we are able to establish with NGOs and governments are the foundation upon which the PD approach will have the opportunity to be scaled-up.

The PDI’s Advisory Group members have a wide variety of backgrounds and expertise in fields such as business, health care, education, and communications. These Advisors have played an integral role in the development of the organization, from helping to construct the business plan, to advising about media relations. Each Advisory Group member serves as a strong advocate for the PDI which enables to the PDI to thrive.

What are the three most important actions needed to grow your initiative or organization?

1. Dissemination

One of the most important actions needed to grow the Positive Deviance Initiative is dissemination of the approach through multiple outlets. A large part of dissemination involves the development of networks, both in particular geographical or topical areas, and globally. One of our current objectives is to facilitate a global community of practice so that PD practitioners, communities, NGOs, businesses, and governments may connect, learn, support each other and scale up field applications. Dissemination will also occur via the continued improvement and development of the PDI website, online newsletter, and training workshops

2. Fundraising

A second important action, which will support all other actions, is fundraising. The PDI will need to dedicate a significant amount of effort to fundraising so that we may continue our work. We currently have a matching grant which will allow us to double the effectiveness of any award we receive. We are actively applying for funding both for specific interventions, such as this crucial work on maternal and infant health in Zambia, and for general funds to a) increase the knowledge base to uphold our strong commitment to evidence-based development, and b) continue to provide access to this knowledge for anyone seeking to work on intractable problems using PD.

3. Scaling Up

A third important action is to engage a variety of critical institutions and NGOs in order to leverage the PD approach as a vital innovative tool in the development world. By creating partnerships and joint projects with large scale organizations, such as this project with World Vision and CORE Group, the PDI contributes to their future capacity to promote development work that is locally owned and sustainable.

The Story

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What was the defining moment that led you to this innovation?

In 1991, Jerry and Monique Sternin were faced with what seemed like an insurmountable challenge in Vietnam. As new Director of Save the Children in Vietnam, Jerry was asked by government officials to create an effective, large-scale program to combat child malnutrition and to show results within six months. More than 65 percent of all children living in Vietnamese villages were malnourished at the time. The Vietnamese government realized that the results achieved by traditional supplemental feeding programs were rarely maintained after the programs ended. The Sternins were mandated by the government to come up with an approach that would enable the community to improve and sustain their young children’s health status…and quickly!

Building on Marian Zeitlin’s ideas of positive deviance, working with four communities and a population of 2,000 children under the age of three, the Sternins invited the community to identify poor families who had managed to avoid malnutrition despite all odds, facing the same challenges and obstacles as their neighbors and without access to any special resources. These families were the positive deviants. They were “positive” because they were doing things right, and “deviants” because they engaged in behaviors that most others did not. The Sternins and the community discovered together that caregivers in the PD families collected tiny shrimps and crabs from paddy fields, and added those, along with sweet potato greens, to their children’s meals. These foods were accessible to everyone, but most community members believed they were inappropriate for young children. The PD families were also feeding their children three to four times a day, rather than twice a day, which was customary.

The communities developed an activity which enabled all of the families with malnourished children to rehabilitate their children and to learn how to sustain their children at home on their own, by inviting them to practice the demonstrably successful but uncommon behaviors which they had discovered in their communities. The pilot project resulted in the sustained rehabilitation of several hundred malnourished children and the promotion of social change in their communities.

After that first use of the positive deviance approach to address malnutrition in Vietnam, Jerry and Monique Sternin continued to use the approach, resulting in the successful application of the PD approach in more than 41 countries in nutrition and a variety of other sectors from public health to education to business.

Tell us about the social innovator behind this idea.

Monique Sternin
Co-founder, Positive Deviance Initiative

Monique and her husband Jerry developed the Positive Deviance approach over the last two decades. In addition to using the PD approach to fight childhood malnutrition in the developing world, Monique has promoted the use of the PD approach in various sectors such as advocacy against female genital mutilation (FGM) in Egypt, condom usage for commercial sex workers in Myanmar, and maternal & newborn care in Pakistan. Monique’s passion for the PD approach stems from its successful impact in improving lives of thousands of women and children throughout the world and providing a powerful tool for communities to solve seemingly intractable problems.

Jerry Sternin
Late co-founder, Positive Deviance Initiative

Jerry Sternin was a development practitioner, with 24 years overseas experience in developing countries including 8 years as a Peace Corps Director and Volunteer in the Philippines, Nepal, Mauritania and Rwanda, and 16 years as a Save the Children Director in Viet Nam, Bangladesh, Egypt, Philippines and Myanmar.

Jerry was a pioneer in translating the concept of “Positive Deviance” into an action-oriented community development approach. The Positive Deviance model developed by the Sternins to address the problems of malnutrition in Viet Nam has now been replicated in 41 countries. The Sternins have championed the application of the Positive Deviance approach in other public health issues abroad such as HIV/Aids risk-reduction, advocacy against female genital cutting, advocacy against girl trafficking, and in the US in education and on patient safety and MRSA elimination.

How did you first hear about Changemakers?

Email from Changemakers

If through another, please provide the name of the organization or company

50 words or fewer

186 weeks ago Alexis Felder updated this Competition Entry.
186 weeks ago Alexis Felder updated this Competition Entry.
186 weeks ago Alexis Felder updated this Competition Entry.
186 weeks ago Alexis Felder updated this Competition Entry.
186 weeks ago Alexis Felder updated this Competition Entry.
186 weeks ago Alexis Felder updated this Competition Entry.
186 weeks ago Alexis Felder updated this Competition Entry.
186 weeks ago Alexis Felder updated this Competition Entry.
187 weeks ago Alexis Felder submitted this idea.