Positive Deviance - reaching out to undernourished children
By Sreenath Cheruvari
It seemed as though the Community Child Development Centre (anganwadi centre) at Bharu Ramkrishnapur, a sleepy village in South 24 Parganas District of West Bengal was hosting a ‘picnic’. The community kitchen, teeming with activity; toddlers happily banging their spoons on the steel plates filled with food while their mothers were coaxing their young ones to have another morsel. Amidst all the noise and laughter, Kavita Naskar the energetic anganwadi worker was busy supervising the feeding session:. ‘bachcha thake aarek tu dao’ (give the child a little more) she called out to one mother.
This “picnic” was actually a collective feeding session for underweight and malnourished infants under the Positive Deviance (PD) approach, an intervention aimed at reducing malnutrition among children less than three years of age in West Bengal. Under this initiative, behavioural change is emphasized through participatory learning and community mobilization to bring about the desired results. Explains Malathi Das, a health worker under the Integrated Child Development Services (ICDS), "the idea behind this exercise is to share the best feeding practices that exist within the community".
The guardians of the children bring food including vegetables, fish and eggs to the anganwadi centre. The ICDS programme provides the centre with rice and pulses. All this is cooked together and a nutritious meal is fed to the children once in a day. For twelve days in a month, mothers with undernourished children follow this regime. This is followed up by an 18-day break wherein care givers monitor the feeding practices in the respective child’s homes and record progress. Every month the malnourished child is weighed and in most cases, mothers find their children gaining weight between 100 and 600 gm. A pleasant surprise and a great moral booster for them.
Statistics show that malnutrion has been a major problem in West Bengal. Every second child under the age of three is under-weight; 4 out of 10 children are stunted.With this scenario in mind, UNICEF with the Department of Women and Child Development and Department of Social Welfare launched the Positive Deviance Programme known as ‘Keano parbo na’ (why can’t we do it?) in the year 2001. Today the programme is being implemented in four districts of West Bengal, mainly Murshidabad, South 24 Parganas, Dakshin Dinajpur and Purulia covering over a thousand villages, reaching out to over 1,22,000 children.
The whole programme is based on an integrated strategy consisting of convergence and partnership through capacity building of childcare functionaries and leaders of the community. This is done through Information Education and Communication activities and dissemination of information about improved methods of child care like breast feeding, immunization and hand washing, community based management of malnutrition through counselling and hands-on child care sessions. The unique feature about the Positive Deviance approach is that it focuses on the inherent strengths of the community and draws from the untapped resources available within the community
Mangala Karmakar, one of the workers associated with the PD approach in Bishnupur block where Bharu Ramkrishnapur is situated, explains that PD has made a major impact in tackling malnutrition in the villages. The whole village is mapped and charts are drawn indicating the status of each child under different grades as per its nutritional status in the village. The charts stating the health status of each child are prominently displayed at the anganwadi centres creating a sort of psychological impact on the mothers to improve the status of their children.
UNICEF has provided technical assistance as well as partly funded the programme wherever necessary. Progress is monitored right up the chain from the village level to the state level and corrective steps are taken to plug loopholes. Rudolf Schwenk, UNICEF State Representative for West Bengal points out that the programme has been well received by all stakeholders: “The turning point has been the acceptance of Positive Deviance by the district officials. This has given it the much needed institutional backing and the results are there for all to see. More children are healthy”
The women who used to meet at the Anganwadi Centres have formed self-help groups and in some cases even run income generation programmes. A recent survey conducted in 168 villages in 8 blocks of Dakshin Dinajpur district shows that malnutrition has come down from 59% to 48%There has also been considerable improvement in social indicators like immunization, hand washing and even child marriage.
Encouraged by the positive results of this intervention, more and more districts are coming forward to introduce the PD approach in their villages and government departments like Health and Family Welfare are getting involved in the process. J Sundara Shekhar, former Director of Social Welfare, Government of West Bengal sums up the success of the PD programme aptly “instead of the slogan Kano Parbo Na, the new slogan for Positive Deviance in West Bengal should be “Ami nischay parbo” (We can certainly do it.)