| Behavior Change - Tools
and Approaches |
| First Households
(Hearth Model) |
| |
| The concept of positive deviance has
been applied in nutrition programs since the 1960s. The
basic approach is to identify mothers who, while typically
poor, are feeding, caring for, and/or seeking health care
for their children in more effective ways than others
in the community. By studying these mothers or families,
researchers can learn the creative ways in which some
people have managed to do "the impossible",
(found inexpensive ways of feeding their children nutritious
food). (See also Positive Deviance.)
The "model" community members can then be involved
in teaching others these positive practices. |
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| The approach is appropriate in situations
where a majority of families do not require additional
food or income to make small improvements in nutrition
and/or caring practices. NGO and government programs can
use the approach effectively when they are willing to
devolve some control to communities. |
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| The Hearth Model is a community-based
approach to reducing malnutrition. It was developed as
an alternative to nutrition rehabilitation centers that
had some success in rehabilitating malnourished children.
However, the children too often went back to an unchanged
home environment and reverted to malnutrition. The program
links mothers of well nourished children with mothers
of poorly nourished children in their community. For example,
mothers (and/or minimally compensated program workers)
might go to the homes of malnourished children and prepare
meals jointly with the mothers. Over time, women gain
knowledge, skills, and confidence that they too can do
something that makes their children visibly healthier.
These activities are often linked with a community growth
monitoring and promotion program. |
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| In Vietnam,
Save the Children used this model to reduce second
and third degree malnutrition by 80 percent among tens
of thousands of children under three years of age. Caretakers
were able to sustain the enhanced nutritional status of
these children as long as two years beyond their participation
in the program. Younger siblings and other children in
the community born after the program ended enjoyed the
same enhanced nutritional status. |
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| The Hearth Model has been used mostly
by NGOs, starting with Save
the Children in Vietnam and by Save and others in
Haiti, Bangladesh, and elsewhere. The model has been implemented
under safe motherhood, early childhood development, and
water and sanitation programs. Save the Children has recently
produced Designing
a Community-Based Nutrition Program Using the Hearth Model
and the Positive Deviance Approach - A Field Guide. |
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