Positive Deviance (PD) approach has been applied to tackling major thematic problems, except adolescent anemia. PD was used to improve compliance to adolescent anemia control programme in Jharkhand State, India, where anemia prevalence in adolescent girls is 70%, and programme compliance is low, despite robust delivery system and political will.
With leadership of state government, the study was designed and implemented by a multi-disciplinary 42 member PD team, in 2014, in Khunti district. Participatory appraisals were undertaken with 434 adolescent girls, 18 frontliners, 15 teachers, and 751 community leaders/ parents were interviewed to identify PDs and PD determinants, across 17 selected villages.
Perceived benefits of Iron and Folic Acid (IFA) tablet and nutritional care during adolescence was low. PDs existed among adolescents (26 of 434), villages (2 of 17) and schools (2 of 17). PD adolescents relied on home-based strategies – eating millet chapattis, leafy greens and fruits sourced from backyard or forest and animal foods. They were more informed of menstrual hygiene and drank less tea. Caregivers of PD adolescent girls (mothers, older sisters, aunts, or fathers) supervised the young girls’ food intake and showed interest about their well-being. From the PD enquiry, new elements were included in behavior change strategy including interactive phone-based educational modules, girls’ football for health promotion, and PD Schools nurtured as âLiving Universities’.
Government-led PD approach uncovered local solutions and provided forum for government functionaries to listen to affected communities, who are missing partners, and accordingly adapted their programme.