Returning to a healthier community in Mozambique

By Steven Dunham, World Vision Australia Program Manager, Mozambique

“What happens after we leave?” It’s a question often asked by our supporters when we talk to them about our work coming to completion in a community.

I recently visited the Inteta Area Development Program (ADP) in Mozambique. We completed our work here around seven months ago and I wanted to find out if community members continued to experience the benefits of World Vision Australia-funded programs and initiatives. I was thrilled to discover quite a bit was still happening. 

Many of the groups and individuals we had trained continue to provide services to the community or participate in groups for their own benefit, particularly the "Positive Deviance" or PD/Hearth groups, which help promote child nutrition.

Bonifacio Georges is one of the original 50 male and female PD/Hearth volunteers who gained the experience to then train others in the community. He is 27 years old and is married to Benjamina. They have three children.  

“World Vision came to the community to ask for volunteers. A local leader selected me to be a PD/Hearth volunteer. They selected me because I was trusted and they had confidence in me. I was trained by World Vision health staff to prepare enriched porridge. We were also trained about good hygiene – to wash hands before preparing a meal and all the food you cook, and also how to construct and use latrines,” Bonifacio said.

The PD/Hearth groups help to address high rates of child malnutrition in the community. Children experience rapid growth and development from birth to three years of age. Children who are malnourished during this stage of life will not develop to their full potential. Early malnutrition affects a child’s physical, mental and emotional capacity throughout their entire life. Half of all child deaths are due to underlying malnutrition.

World Vision Mozambique responded by introducing a model based on the premise that solutions to community problems (like underweight, undernourished children) already exist in the community. The PD/Hearth model rehabilitates malnourished children in their own communities and homes. The model targets moderately and severely underweight children aged between six and 36 months.  

"Positive deviance", means "different in a positive way from what is usual practice". "Hearth" refers to the place within a house where food is cooked and served. Despite limited resources, some parents in our program communities find ways to raise well-nourished children. The success of the model partly relies on identifying and understanding what these ‘positive deviance families’ are doing differently in their feeding, hygiene, caring, and/or health-seeking practices from the parents of malnourished children in the same community. 

PD/Hearth volunteers trained by World Vision then share this knowledge and teach these positive practices to caregivers with malnourished children in practical lessons called "Hearth sessions".

“When the mothers have a question or need help, they call me and I assist them. A group of women had a question about how to use fruit in cooking, because the usual fruits they use weren’t available at that time. So I recommended some different local fruits which were in season then. They fed these fruits to their children before the children had their porridge,” said Bonifacio.

Hearth sessions usually involve two menus composed of locally available, accessible and affordable foods that are nutrient dense. All the ingredients are brought to the Hearth session by participant caregivers, who practise cooking the foods at the Hearth session. 

Hearth lasts 12 days, followed by a two-week follow-up period conducted by the PD/Hearth facilitators or volunteers through home visits. The purpose of these home visits is to encourage caregivers to continue positive feeding practices at home, but also to help overcome barriers caregivers often face when trying to implement at home what they learned at Hearth sessions. 

Children who fail to gain weight are re-enrolled for another 12 days or referred to their local health clinic for further assessments and treatment. To further improve the model, World Vision now trains volunteers to monitor children for three months, during which time they assess weight gain and nutritional status.  

“Here in this community we work in pairs, and each one of us is assigned to five children to follow up at home to see how they are doing after they finish with the cooking groups. Even after children and their mothers finish the cooking group, we follow them up to see if the mothers are doing what they learned. 

"I just visited a child this past Sunday and the child looked well. We also visit other children at home if we’ve identified they are struggling to grow, and we recommend the mothers take them to a cooking group,” he said. 

“Because I’m a man, I send a message first that I will be coming, so the women can prepare themselves. (It is not appropriate for men to visit married women at home while they are alone).

"I like it that people trust me. World Vision opened my mind and I’ve seen things change. For example, nowadays I can see more latrines in the villages. It’s hard to find a house without a latrine. Now, it’s also hard to find a malnourished child or a person with cholera, because people now know what to do.

"I have children myself – five, four and one year old – and I’ve used what I’ve learned at home. Me and my wife feed them nutritious foods. We give them fruits, porridge (we add peanuts and beans, cassava leaves and a little bit of sugar sometimes). And sometimes dried fish, eggs or meat. They’re strong; they deserve to be seen! The five-year-old plays football. I feel so proud!

I’m confident to continue spreading nutrition information in the communities.”