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On October 24 at the Global Health Collaborative (GHKC) meeting, I had the pleasure of attending a presentation titled “Beyond Best Practices: How adoption of new strategies really happens” by Lisa Kimball of Group Jazz.
Lisa spoke about using the theory of positive deviance to address problems requiring behavior change. The premise of this approach is that “in every community there are certain individuals whose uncommon practices/behaviors enable them to find better solutions to problems than their neighbors who have access to the same resources”. This approach’s best practice can be summed up as “the process of solving the problem NOT the solution to the problem”.
This process can be implemented in a variety of settings including both clinical and programmatic. For example, one group of community health workers (CHWs) might notice that family planning methods discontinuation is very high in the community that they serve, but another group may experience low rates of discontinuation within their community. By setting up a discussion between CHWs from both communities, the CHWs from the community with high rates of discontinuation might discover that their more successful colleagues make it a point to stock up on their family planning supplies when their inventory runs low. Through this “group discovery”, the CHWs with high rates of discontinuation will be able to use this demonstrably successful strategy to overcome this issue.
Lisa gave an anecdotal account of how this theory had been put into practice in a Vietnam pilot program to combat malnutrition. In this study, villagers found poor peers in their community who through their uncommon but successful strategies (they collected tiny shrimps and crabs from paddy fields and added these to their children’s meals) had well-nourished children. It turned out that these foods were accessible to everyone, but most community members believed they were inappropriate for young children. A nutrition program based on these insights was created and as a result, malnutrition fell drastically.
Regardless of the approach’s best practice, funders and program managers are sometimes left asking the following questions:
- How can we move to a system that holistically seeks out the process and doesn’t focus on the solution only?
- How does this idea play out in the realm of project scale-up or sustainability? Just because a project using this approach was successful in one setting, it doesn’t mean that this could be replicated elsewhere.
In searching for answers to these questions, program managers may be more likely to look to the end result or solution rather than the process by which that result was achieved.
The take home message from this interesting presentation was that behavior change can occur most efficiently by using locally available, sustainable and effective approaches or in the famous words of Lao Tzu “Learn from the people, Plan with the people, Begin with what they have, Build on what they know, Of the best leaders, When the task is accomplished, The people all remark, We have done it ourselves”