Malnutrition in Vietnam
In the 1990s, Jerry Sternin of Save the Children was tasked with reducing childhood malnutrition in Vietnam, and he was only given six months to do it. While this may have seemed an impossible feat, he knew he simply needed to find the right way to influence the decisions impacting nutritional behaviors.
Malnourishment affected nearly half the children in Vietnam due to a convergence of poor sanitation, inadequate educational system, lack of food distribution, poverty, and lack of access to clean water. In just six months, Jerry knew that he was unlikely to impact any of these large roadblocks. He called these True, but useless (TBUs). He couldn’t tackle these insurmountable TBUs and expect any meaningful change – he needed to identify something smaller, something he could impact.
Jerry went straight to the villages and the people who made the most important decisions about children’s health: mothers. He looked for what he called “positive deviance”. If half the population is malnourished, he reasoned that the other half was doing something right.
Sure enough, in every village he found some mothers that had found ways to feed their children more effectively despite having the same constraints everyone else had. Jerry observed how these mothers fed their children.
Themes appeared. The well-nourished children were fed smaller meals but more frequently. Their parents helped them eat instead of simply placing food out. Well-nourished children also ate even while afflicted with diarrhea, contrary to folk knowledge that prescribed fasting for sick children.
However, the greatest difference was that these mothers gathered small shrimps, crabs, and field greens from the rice fields and incorporated them into the rice. These added vital nutrients and protein to the children’s diet – marking the difference between starving and healthy kids.
Jerry called these women who made different choices with positive results within the village community positive deviants (or, as the brothers Heath call them, bright spots).
Jerry and Save the Children developed a mother-to-mother communication program to share these best practices - starting in one village and then quickly spreading to others. The initiative saw incredible results, and continued even after the Vietnamese government forced them to leave.
Over the next two years, the sharing of these simple methods led to a 65-85% drop in malnutrition. Eventually, the program reached 2.2 million Vietnamese people in 265 villages, and Save the Children has improved nutrition rates using similar methods in over 20 countries.