Positive Deviance and Hearth in Indonesia

1
Positive Deviance and Hearth in Indonesia
2
PD/Hearth in Indonesia

• PD/Hearth implementation in Indonesia
• Preliminary results of Evaluation

3
THE PREVALENCE OF UNDERWEIGHT PRE-SCHOOL CHILDREN
(1989-2003)
4
Stunting Among Pre-School Children (1990 2001)
5
Wasting Among Pre-School Children (1990 2001)
6
Positive Deviance

• In most settings, a few at risk individuals
  follow uncommon, beneficial practices and
  consequently experience better outcomes than
  their neighbors who share similar risks.
• - Sternin, BMJ (British Medical Journal), 13
  November 2004

7
Positive Deviance

• Processes in PD implementation
• Social Mobilization
• Information Gathering
• Behavior Change

8
Hearth

• Adopting successful strategies identified in the
  positive deviance inquiry.
• 3 Goals
• Rehabilitate malnourished children
• Sustain improved status
• Prevent future malnutrition

9
PD/Hearth in Indonesia

• New PD implementers trained and PD Network born
  in 2002
• Vision Government of Indonesia adopts PD as
  country-wide strategy

10
PD/Hearth in Indonesia
Aceh
Medan (05)
Kalimantan
Papua
West Sumatra
Jakarta Tangerang
Surabaya
Banten
Malang
NTT
Cianjur, Garut, Sukabumi
11
PD Network Indonesia

• Regular meetings to discuss lessons learned and
  share successes attended by INGOs, LNGOs,
  district and national health offices
• Jerry and Monique Sternin attended several
  meetings and gave additional TA
• Cross Visits
• Advocacy, Training, Publications
• Informal network, strengthened DAP consortium

12
PD in Indonesia Network and Replication/Scaling
up Challenges (2004)

• Lack of National standard for PD confusing
  for government partners
• PD is the intervention du jour partners want
  to implement regardless of conditions
• Government budgeting and planning mechanisms make
  planning for PD difficult

13
Suggestions for starting a PD Network

• Start with quality training of all partners
• Create standards for implementation
• Need good consultant or strong local experts
  with PD experience to keep PD on track
• Advocacy at all levels from the beginning
• Clear understanding of roles and responsibilities
  of each partner in network

14
Positive Deviance Resource Center Faculty of
Public Health - UI

• Vision Become a Center of Excellence of the PD
  Approach in Indonesia
• Mission Strengthen1. Education and training
  2. Research 3. Community services
• http//www.pdrc.or.id

15
Second National Workshop on PD

• Five Years of Implementing Nutrition Programs
  Using the Positive Deviance Approach Lessons
  Learned and the Way Forward
• 188 attendees
• Key issues identified
• Evaluating and documenting current PD /Hearth
  programs is crucial for making further decisions
  as to where and how to implement PD.
• A standard training package must be used by all
  implementers to avoid common problems
• It is important to gather people from different
  parts of Indonesia with diverse PD experiences

16
Evaluation

• Partners CARE, CRS, Mercy Corps, Save the
  Children, World Vision
• GOAL Provide guidance to the Ministry of
  Health on using the methodology.

17
Evaluation Preliminary Results

• Number of Communities 168
• Number of Hearths 434
• Number of Children 7,836
• Graduation Rate 36 55

18
Evaluation Preliminary Results

• Overall, 45.6 of children who entered the Hearth
  gained sufficient catch up weight over one
  month.

19
Evaluation Preliminary Results

• Hypothesis Children who are more malnourished
  respond better to this kind of intervention.

20
Evaluation Preliminary Results

• Factors identified with success
• Rural
• Complementary activities
• De-worming
• Frequency of staff support
• Frequency of home visits

21
Evaluation Preliminary Results

• Factors identified with success (cont.)
• Community health workers and health clinics
  understand key PD/H concepts
• Leaders know the causes and consequences of
  malnutrition and support Hearth activities.

22
Evaluation Preliminary Results

• Group Discussion

23
Evaluation Preliminary Results

• Discussion

24
Evaluation Preliminary Results

• Remaining data to explore
• Factors for rural success
• Further analysis on sustained status
• Qualitative findings relevant to MoH
• Sustainability of behavior changes

25
The End

• Thank you!
• If youd like a copy of this presentation, please
  email me at cbergman_at_mercycorps.org.