Policy Innovations Digital Magazine (2006-2016): Innovations: The Food for the Hungry Story

The word deviance usually brings to mind negative behavior. But positive deviance refers to a deviation from the norm that results in a positive outcome. Food for the Hungry's founder Dr. Larry Ward embraced innovation to battle world poverty and could himself be considered a positive deviant.

Armed with a mission and a credit card, Ward flew to Haiti in 1971 and donated 1,000 dollars to help meet urgent disaster needs. From this action, Food for the Hungry was born. After maxing out his credit card to help suffering people, he returned to the United States with a firm belief in helping people one at a time. As he has said: "They die one at a time. We can help them one at a time."

What started out as one man's compassionate response to a hurting world has now developed into a vibrant ministry of more than 2,000 staff members who walk alongside the poor in more than 45 developing countries. Each carries the same desire that inspired Ward.

Every year, nearly 11 million children die before they reach the age of five. Malnutrition underlies an estimated 60 percent of these deaths. In each community where Food for the Hungry has worked, however, there have been a few poor families with well-nourished children, despite their poverty. Local solutions, which use available resources, can be utilized to combat malnutrition.

Positive deviance (PD) approaches avoid focusing on a community's weaknesses, a traditional practice inherent in questions such as, "What is wrong here?" and "What do you need?" Instead, PD starts from the perspective of asking, "What are your resources? What is going right here? How can you utilize your resources to solve your problems?" At the very core of PD is belief in the wisdom and untapped resources that can be found in the community.

Food for the Hungry and numerous other partners in the child survival community have used PD and the Hearth Nutritional Rehabilitation strategy, which is based on PD, to successfully combat child malnutrition. Positive deviance has demonstrated that good nutrition is not always dependent on wealth. Basic inquiries can determine how some poor individuals are able to adequately nourish and care for their children while their neighbors are not. Those different behaviors—feeding practices, childcare practices, and care seeking practices—are then promoted to all families living in the community.

Many feeding programs are able to improve childhood malnutrition, but unfortunately, the effects are usually temporary. Children gain weight while in the feeding program, but then lose it again once they are not being fed. With positive deviance, it's different. Changes are sustained because they are based on local solutions that individuals in the community were already sustaining.

Using the PD approach in Vietnam, more than 250 communities brought an estimated 50,000 malnourished children out of malnutrition between 1991 and 1999. The younger siblings of these children, many of whom were not yet born at the time that the nutrition program was implemented, are also staying better nourished.

In Vietnam, a PD study by Save the Children Fund found that the mothers or caregivers of the poor children who were well nourished did several key things differently from other mothers: They would collect tiny shrimp and crabs in the rice paddies and add these to their children's diet; they would also add the greens from sweet potato tops (although these foods were readily available and free for the taking, most people felt that it was not appropriate—or even dangerous—to give them to a young child.); and they also fed their children more often each day.

In Mozambique, Food for the Hungry (FH) has been successfully using PD and Hearth Nutritional Rehabilitation in its Title II Food Security program. Through a positive deviance inquiry, it was discovered that some mothers were adding oil to their children's meals. With that knowledge in mind, Food for the Hungry educated all local mothers about the need to add oil to their children's meals. The efficacy of PD Hearth is evident in the case study presented below:

Mulinda Joia lives a few kilometers away from Gorongosa village where FH team member Domingas Manuel works with a group of ten mothers. She is a mother of four and her youngest child Bungo is three years old. From birth, Bungo had serious health problems, which included continuous diarrhea episodes, respiratory problems, malaria, loss of appetite, and sporadic vomiting. These problems led to a loss of weight and body weaknesses. This went on until the time when FH started with the Hearth program in 2004.

According to Mulinda, "Witchdoctors were my last hope for the cure of my child. They even stressed the point that my child was left with a few days to live. A few days later, the FH promoter came and observed the child's state of health. She advised me to take the child to the hospital. I also had no hope that my child would have life. The promoter registered me and my child to participate in the porridge [PD/Hearth] program. He was weighed, and his weight did not correspond to his age. I was advised to breastfeed Bungo, but I had no milk in my breasts. It was decided that I eat the porridge first to induce milk production in my breasts. This was done and after some days, I had enough milk to feed my child. Today, Bungo is healthy. You can see him playing, eating porridge, solid foods and at three, he can run around with others. This program brought life back to my child."

According to Domingas Manuel, Mulinda took the child to the hospital only once. After that, she participated in the PD Hearth program where the child received an enriched porridge based on the foods that the positive deviant mothers were giving to their children. The child was breastfed, as well. At 18 months of age, Bungo was very thin but after he participated in the 12-day Hearth nutritional rehabilitation sessions, and his mother learned what the PD mothers did with their children, his weight started to increase rapidly. With the help of the program, Bungo started crawling, walking, and at times even running. Today he is a healthy boy and continues to breastfeed, eats porridge and mixed meals with solids like sweet potatoes, vegetables and paw-paws. (1)

Food for the Hungry has further adapted the positive deviance inquiry to include previously under-investigated but potentially important factors including maternal depression, intake of specific nutrients (e.g., magnesium, potassium and phosphorus (2)), domestic abuse, and alcoholism among family members. These expanded Local Determinants of Malnutrition studies have thus far been conducted in Kenya and Mozambique. The results of these studies have allowed FH staff to tailor health and nutrition messages to address the significant differences between families of well-nourished children and families of malnourished children.

For more information on PD/Hearth and Positive Deviance Inquiries, please visit CORE's Nutrition Working Group website: http://www.coregroup.org/working_groups/pd_hearth.cfm.

NOTES

1. Mulinda Joia was interviewed by Derrick Kapurura on August 14, 2006.
2. Golden, M.H. "The role of individual nutrient deficiencies in growth retardation of children as exemplified by zinc and protein." Waterlow, J.C., ed. Linear growth retardation in less developed countries (New York: Raven Press, 1988): 143-163.