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Positive Deviance for Better Newborn Care in Haripur, Pakistan: 

Positive Deviance for Better Newborn Care in Haripur, Pakistan Save the Children USA Monique Sternin, Rolla Khadduri, Tariq Ihsan, Raheel Nazir, Abdul Bari, Karin Lapping, David Marsh April 2001

Household Practices: Central to Newborn Health: 

Household Practices: Central to Newborn Health Most births and newborn deaths occur in the home. Many suspected behavioral risk-factors: Poor antenatal care (diet, iron, tetanus vaccination) Unskilled delivery attendant and unhygienic delivery (hands, surface, cord) Poor response to non-breathing newborn. Poor routine newborn care: temperature control, immediate and exclusive breast-feeding Poor recognition and response to newborn illness

Positive Deviance: 

Positive Deviance Rests on the observation that: The uncommon behaviors of a few enterprising individuals enable them to cope more successfully than their neighbors with the same, or worse, resources. Therefore, “the community cures itself … today” because there are already sustainable, immediate, culturally appropriate behaviors within the community.

Positive Deviance Inquiry: 

Positive Deviance Inquiry Process of identifying these uncommon beneficial behaviors. Rapidly, at low cost With the community PDI mobilizes the community for behavior change (which may, in fact, start during the PDI).

Setting: Pakistan: 

Setting: Pakistan Haripur District (700,000), Northwest Frontier Province, Jan 2001 SC’s Reproductive Health Program Bagra, Dobandi, Kholian villages (6000)

Positive Deviance: Initial Steps: 

Positive Deviance: Initial Steps Community Orientation Situation Analysis Positive Deviance Inquiry Community Feedback & Planning Follow-up

1. Community Orientation: 

1. Community Orientation Met 20-50 males and females separately. Introduced PD concept (pucca & kutcha houses). Identified community partners. Planned.

2. Situation Analysis: 

2. Situation Analysis Normative behaviors around newborn care, i.e., pregnancy, delivery, routine, and special care. Individual and group interviews with various care-givers “Norms” established through triangulation, i.e., mothers, fathers, mothers-in-law, birth attendants. Results? Confirmed sub-optimal behaviors!

3. Positive Deviance Inquiry: 

3. Positive Deviance Inquiry Who are they?

Slide10: 

Postpartum Care for Newborn & Mother Maternal & Neonatal Behaviors Labor & Delivery Care Antenatal Care Immediate Newborn Care Special Care Special Care Special Care Birth Asphyxia LBW Danger Signs Special Care Danger Signs

3. Positive Deviance Inquiry: 

3. Positive Deviance Inquiry Who are they? Thriving newborn (age 7-40 days). Surviving newborn or infant who had had danger signs (age 10 days-6 months). Thriving infant who had been a low birth weight newborn (age 40+ days). Surviving infant who had been a non-breathing newborn (age 2 days-1 year).

Selected PD findings: 

Selected PD findings Birth preparedness: Unemployed husband saved 10,000 Rupees in case of emergency. Clean delivery: Husband gave traditional birth attendant a clean blade. Thermoregulation: Family hand-stitched a small mattress (gadeila), a clean, warm surface on which to place the baby immediately after delivery.

Selected PD findings: 

Selected PD findings Breast-feeding: A sick, premature baby was exclusively fed. Danger signs: Family recognized danger signs of possible pneumonia and sought appropriate care.

4. Community Feedback & Planning : 

4. Community Feedback & Planning Community received information with great interest: behaviors recognized and validated as uncommon. Community members committed to spread information and change some behaviors 4-5 community members “energized.” No request for outside assistance.

5. Follow-up: 

5. Follow-up Continued interest: 2 young infant deaths in Bagra village highlighted the need for action on NB health. Sharing of information: Mohalla-level meetings to share PD behaviors, conducted by activists and SC/US staff. Behavior change: “Maqsooda” insisted on clean blade and an un-dressed cord for her grandchild.

Mohalla Meeting: 

Mohalla Meeting

PD “Worked” for Newborn Care: 

PD “Worked” for Newborn Care Mobilized communities for newborn health. Identified valid behavioral norms in the community. Identified immediate, sustainable, culturally appropriate model newborn behaviors. Informs behavior change strategies to help spread these behaviors widely. Mobilized SC staff.