here - basics

USAID/BASICS GLOBAL Symposium - Essential Nutrition Actions : Prevention First
Hôtel des Almadies, Dakar, Senegal
(April 20 – 23, 2009)
THE HEARTH AND NUTRITIONAL
REHABILITATION APPROACH BASED ON
POSITIVE DEVIANCE TO REINFORCE THE
COMMUNITY-BASED COMPONENT OF ENA
(Integrated Nutrition Program)
Dr Djibril Cissé
Deputy Country Director/ hki senegal
TABLE OF CONTENTS
I. BACKGROUND
II. RATIONALE
III. PD CONCEPT IN NUTRITION
IV. OBJECTIVES OF HEARTHS
V. KEY IMPLEMENTATION STAGES
VI. FUNCTIONING OF HEARTHS
VII. FINDINGS OF THE RAPID QUALITATIVE
ASSESSMENT
VIII.SCALING UP STRATEGY
IX. LESSONS LEARNT
CONCLUSION
I. BACKGROUND
Integrated Nutrition Program adopted in 1998
 Constraint: functioning of CRENs
 An approach proven effective in a certain
number of countries (Egypt, Haiti, Guinea,
India, Vietnam, Mali, Nepal)
 Support from BASICS during its introduction
in Senegal:
 Workshop from 6 to 16 November 2000
 Implementation and assessment of a pilot
phase at the rural test site of Ida Mouride
(District of Koungheul)
 Development of a handbook and a policy paper
 Support to expand the approach in Senegal
II. RATIONALE
 Close relationship between poverty and the
nutritional status of vulnerable groups
 Infant malnutrition control requirements in a
poverty context: rapid, economic, sustainable
and appropriate approaches adapted to our sociocultural realities
 Hearths and Nutritional Rehabilitation using
Positive Deviance (PD):
 Strengthening the community-based approach of the integrated nutrition
program
 Alternative for the nutritional rehabilitation of malnourished children
 Addresses the principle of decentralizing screening and the management
of malnutrition.
III. THE CONCEPT OF POSITIVE DEVIANCE IN NUTRITION
 FINDINGS:
Community 
Nutritionnal Status 
Poor families
Well-nourished young
children
Neighboring
families(rich or poor)
Malnourished children
III. THE CONCEPT OF POSITIVE DEVIANCE IN NUTRITION
Conclusion: definition of MODELS
Community 
A poor individual or family
with a well-nourished child
A less poor individual or
family or considered welloff based on local
standards with a
malnourished child
MODELS 
POSITIVE
NEGATIVE
III. THE CONCEPT OF POSITIVE DEVIANCE IN NUTRITION
 Question?
What do some
poor families do to
keep their
children wellnourished
whereas
neighboring
families with
access to the same
resources have
mal-nourished
children?
III. THE CONCEPT OF POSITIVE DEVIANCE IN NUTRITION
 Suggestion: Survey on positive models
The survey
on PMs is the
instrument
used
Identification of current solutions to
malnutrition problems of young children
within the community.
IV. OBJECTIVES OF
HEARTHS
V. KEY IMPLEMENTATION STAGES
1. Weigh all children
from 0 to 36 months
with the participation
of the entire
community
2. Identify and describe
behavioral practices of
the majority of villagers
that affect the nutritional
status of young children
V. KEY IMPLEMENTATION STAGES
3. Draw up an exhaustive
list of food resources
available to villagers
4. Review and disseminate
survey results to the
community
NB: Findings: there are
“poor” families (according
to local standards) who
have children in good
health: what do they do?
V. KEY IMPLEMENTATION STAGES
Example to illustrate the concept of
positive deviance
 “Xëlu kuy daw moy yee kuy
nelaw”: The runner’s stride awakens he who sleeps

(Ida Mouride, District of Koungheul)
 “CEELAL HEERANI E JOGAL”:
Health is not dependent on means
(Darou Idjiratou, District of Vélingara)
V. KEY IMPLEMENTATION STAGES
5. Investigate positive
models
PM
NB: Negotiations will be
held on the introduction of
hearths and nutritional
rehabilitation activities
within the community
(project based on the survey
results)
be
ha
vi
or
s
6. Disseminate, within the
community, results of
positive model survey
VI. FUNCTIONING OF HEARTHS
• Structuring at the
village level
within the
framework of
implementing ENA
NB: Greater
participation of
grandmothers in
Vélingara “MAMA
BALLO THIELAL”
« FARNE »
VI. FUNCTIONING OF HEARTHS
 Local name of Hearth:

WAAÑALE (WAAÑU ÑIANGUE AK LOPPANTI) – IDA MOURIDE
VILLAGE (Koungheul)
 DIMEBA LEKOBA – KOO SOCE VILLAGE (Koungheul)
 SOUDOU BOBO – DAROU IDJIRATOU VILLAGE (Vélingara)
 Number of children per hearth: 12
 Schedule of activities: 12-day sessions (6
consecutive days – 1 day off – 6 consecutive days).
VII. FINDINGS OF THE RAPID QUALITATIVE ASSESSMENT
 Reinforcement of community dynamics
 Nutritional rehabilitation of children
 Awareness of the existence of malnutrition as a health
problem (rather than treating the head, the feet were
targeted)
 A decrease in cases of diarrhea
 Stimulation of the malnourished child in hearths
 Benefits are immediate and sustainable as well as for
children yet to be born
 More time for the mother to focus on her other tasks
 Affordable cost as the operation is based on the use of local
products
 Awareness of the importance of weighing to monitor the
nutritional and health status of children
 Moral satisfaction of volunteers in improving the nutritional
status of children without any remuneration.
VII. RESULTS OF THE RAPID QUALITATIVE ASSESSMENT
% of malnourished
children in Ida
Mouride between
November 2000
and January 2004
40
35
30
25
20
NB: decline of
acute cases
identified during
the 2001
assessment
15
10
5
nov.
2000
oct.
2001
août-03
Jan.
2004
0
VIII. SCALING UP STRATEGY
• The participation of 13 ICP was identified
as a key element in the strategy to expand
this approach in the District of Koungheul
• Expanding coverage to the districts of
Mekhe and Vélingara in partnership with
World Vision and UNICEF and technical
support from BASICS
VIII. SCALING UP STRATEGY
HEARTH AT DAROU IDIARATOU (VELINGARA), WITH UNICEF AND WORLD
VISION
IX. LESSONS LEARNT
 Greater perception of certain scientific evidence
 the relationship between health and nutrition
 the existence of malnutrition as a health problem and its determining
factors
 the possibility to satisfy nutritional needs by using local products
 the sustainable nature of the operation understood by the populations
 Regarding constraints
 Observing the advocacy stage targeting the elders, grandmothers, fathers
and women
 Hearths should be constantly monitored and supervised during the early
stages to ensure the pursuit of activities and the quality of services
 The literacy training of community-based caregivers is a prerequisite for
activity follow-on.
CONCLUSION
 Positive deviance helps reduce and prevent malnutrition through a
behavior change model entitled “The hearth and nutritional
rehabilitation approach”
 It is presently a solution in response to the new guidelines for
the management of moderate acute malnutrition at the
community level.
 Wedi guiss bokou ca. Wolof Proverb
“What I hear, I forget. What I see, I believe. What I do, I
know”
 Hearths are actually learning facilities
CONCLUSION
The Positive Deviance Approach lays
emphasis on Practice rather than
Knowledge
Positive Deviance
Discern
Develop
Discover
Determine
Define
Disseminate
THANK YOU
BOBO ANDA ALLA
« L’ENFANT NE CONNAIT PAS QU’IL Y A
PAS »
«A Child doesn’t know there is NONE, What he
knows is the satisfaction of his needs in terms
of good nutrition and health care»