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PD/Hearth Alive, Well and Improving
- 1. PD/Hearth: Alive, Well and Getting Better PD/Hearth: Alive, Well and Getting Better CORE Group Nutrition Working Group April 2013 CORE Group Nutrition Working Group April 2013
- 2. PD/H Survey OverviewPD/H Survey Overview Purpose: To assess the state of Positive Deviance/Hearth and make recommendations for its future use. Purpose: To assess the state of Positive Deviance/Hearth and make recommendations for its future use.
- 3. RespondentsRespondents • Responses= 31 • And you?? • Rwanda, Burundi, Zambia, Vietnam, Mali • Range of Donors: USAID offices, private foundations, UN, NGO funding • CORE Group materials (food groups, adult learning activities, ENA and sprinkles) • Alternative target groups (PLHIV, pregnant women) • • • • Responses= 31 • And you?? • Rwanda, Burundi, Zambia, Vietnam, Mali • Range of Donors: USAID offices, private foundations, UN, NGO funding • CORE Group materials (food groups, adult learning activities, ENA and sprinkles) • Alternative target groups (PLHIV, pregnant women) • • •
- 4. Positive Deviance InquiryPositive Deviance Inquiry • Only 55% do a PDI for each new community • Child vs Mother vs Household (41%, 23%, 36%) • 70% - “helps to understand the community better, very informative” • yet 50% - “time consuming” • Only 55% do a PDI for each new community • Child vs Mother vs Household (41%, 23%, 36%) • 70% - “helps to understand the community better, very informative” • yet 50% - “time consuming”
- 5. Incorporation of PD behaviors into BCC Strategy Incorporation of PD behaviors into BCC Strategy • Care Groups • More concrete, “doable” actions (tippy taps, mosquito nets, reserving eggs) • Monitrice developed songs that mention specific ingredients and actions • Include the hearth recipes into MoH community cooking demonstrations • Care Groups • More concrete, “doable” actions (tippy taps, mosquito nets, reserving eggs) • Monitrice developed songs that mention specific ingredients and actions • Include the hearth recipes into MoH community cooking demonstrations
- 6. Elements of PD/Hearth’s SuccessElements of PD/Hearth’s Success • PDI – empowers communities (solutions) • Quality external technical assistance- PDI and menus • Community understanding & commitment, dedicated staff and government collaboration • Including community leaders, fathers and mother-in-laws in activities • • PDI – empowers communities (solutions) • Quality external technical assistance- PDI and menus • Community understanding & commitment, dedicated staff and government collaboration • Including community leaders, fathers and mother-in-laws in activities •
- 7. Elements of PD/Hearth’s SuccessElements of PD/Hearth’s Success • Hearth (learn by doing, social/emotional peer support, immediate corrective action, weight gain/appetite as motivation, child development) • Follow- up visits to support/encourage new behaviors • Having access to better practices despite limited resources • GMP and registration system • • Hearth (learn by doing, social/emotional peer support, immediate corrective action, weight gain/appetite as motivation, child development) • Follow- up visits to support/encourage new behaviors • Having access to better practices despite limited resources • GMP and registration system •
- 8. Challenges to PD/Hearth’s SuccessChallenges to PD/Hearth’s Success • PDI- time • Quality technical support- menus • Dedicated staff and their time, supervision, linkages with MoH • Time constraint for caregivers for 12-day rehabilitation sessions • PDI- time • Quality technical support- menus • Dedicated staff and their time, supervision, linkages with MoH • Time constraint for caregivers for 12-day rehabilitation sessions
- 9. Needs/InterestsNeeds/Interests • Tracking behavior change outcomes not just recuperation rates • Using PD/H as a prevention method- to teach new behaviors to all mothers • Sell the approach (donors) as both recuperative and preventive • Simplify the PDI process • Harmonize entry criteria • Tracking behavior change outcomes not just recuperation rates • Using PD/H as a prevention method- to teach new behaviors to all mothers • Sell the approach (donors) as both recuperative and preventive • Simplify the PDI process • Harmonize entry criteria
- 10. Needs/InterestsNeeds/Interests • Tracking behavior change outcomes not just recuperation rates • Using PD/H as a prevention method- to teach new behaviors to all mothers • Sell the approach (donors) as both recuperative and preventive • Simplify the PDI process • Harmonize entry criteria • Tracking behavior change outcomes not just recuperation rates • Using PD/H as a prevention method- to teach new behaviors to all mothers • Sell the approach (donors) as both recuperative and preventive • Simplify the PDI process • Harmonize entry criteria
Notes de l'éditeur
- The purpose of the survey was to learn from those who have implemented PD/H in the past or are still implementing and hear what has worked and not worked in order to make recommendations on its future use. I’ll provide you with a very brief overview of the survey findings that came out of the PD/H survey sent out to organizations earlier this year. While we heard from the “doers”, what we hope to accomplish next is to learn from those no longer doing PD/H. In identifying what is keeping others from trying PD/Hearth might lead to much more information on improving the materials, providing training or technical support, etc. We will c ombine the survey findings with inputs from the discussion at the end of the concurrent session to decide what steps the NWG can take to support or improve PD/H.
- We had 31 responses many responding about country program experience, both from field and HQ perspectives. How many of you in this room responded? Well for those of you who did- thank you- and those who did not have the opportunity to participate, you can contribute today with feedback on what the next steps should be. Respondents had a range of country experience including these countries The majority of funding for PD/H came from USAID bureaus (Child Survival, FFP, OFDA to name a few) and less so from private foundation, UN organizations and NGO sponsorship funding. The range indicates that there is support and interest for PD/H. It was found that the majority are using the CORE Group materials, with some adding additional information to meet country context (# of food groups, adult learning activities, overview of Essential Nutrition Actions and micronutrient sprinkles) Some groups have used the Hearth model in their HIV-focused programs, or encourage pregnant women to eat the foods introduced in Hearth sessions
- PDI study subjects vary, with only 41% saying the child, 23% the mother and 36% the household Nearly 70% felt that the PDI is both very informative and helps to understand the community better, yet ½ the respondents felt it was too time consuming
- Various strategies used for incorporating pd behaviors into larger BCC strategies. Many incorporate PD behaviors into Care Group trainings. Others said that PD behaviors were already part of the BCC messaging but that more concrete "doable actions" and hands-on practice are added to the broader BCC strategies (training on practical things such as teaching how to make tippy taps for handwashing , dish racks for keeping dishes off the ground, how to properly hang a mosquito net, how to keep a few eggs for the youngest children instead of selling them all, etc) monitrices developed songs that mention specific ingredients/recipes and reinforce behaviors like handwashing identified in PDI's
- a process that empowers communities as they identify solutions; helps in identifying simple actions that families can undertake Having communities understand the degree of undernutrition They are often the decision makers and support activities at home
- caregivers learn by doing such as finding and bringing foods to prepare the meal; the support exchanged between caregivers (i.e. emotional/social, food contributions); close monitoring at Hearths whereby problems are identified and corrected immediately; the powerful motivation for mothers to see improvements in their children through weight gain and increased appetite; community members learn from their neighbors; an opportunity to support child development if toys are made available to entertain the children while mothers cook; having both regular growth monitoring to identify malnourished children and a registration system so it is known which HH have children under 3
- Many of these factors were mentioned as factors contributing to success, perhaps suggesting that while they are difficult, if done properly they are effective Needing dedicated staff for implementation until rates decline and strong linkages with MoH and partners to supervise volunteers; MoH staff are often located too far away and are too busy Supervision, hand-over
- set up a monitoring system that tracked key PDI behaviors that you had promoted to have data that attribute uptake of that behavior directly to the PD/H intervention Overall there is strong support for PD/H to be as a preventive model for children under 2 PDI itself identifies how families with limited resources KEEP their children well-nourished, so in that sense, PDI findings are more appropriate for a preventative approach than recuperation an approach where PDI don’t have to be done in every community Entry criteria mainly depends on WFA, some MUAC, little WFH; in the Indonesia Titlle II evaluation finding that by using only weight for age for entry criteria, too many kids with normal weight for their height were included because there are so many stunted. They had no reason for "catch up" growth and when they didn't gain the 400 g , they were asked to repeat PD/H over and over. Confounded the recuperation data and demoralized their mothers.