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Positive Deviance for Better Newborn Care in Haripur, Pakistan

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

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Positive Deviance for Better Newborn Care in Haripur, Pakistan

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

  2. 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

  3. 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.

  4. 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).

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

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

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

  8. 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!

  9. 3. Positive Deviance Inquiry • Who are they?

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

  11. 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).

  12. 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.

  13. 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.

  14. 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.

  15. 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.

  16. Mohalla Meeting

  17. 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.

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