Tuesday, February 7, 2012

Malnutrition & Bright Spots

How do you combat malnutrition in a poor country in six months with minimal staff and almost no money to spend? How do you get people to change their habits and beliefs about feeding their own children? What follows is an inspiring and educational story of success.

The Malnutrition Problem

In 1990, Jerry Sternin, who worked for Save the Children, was asked to open a new office in Vietnam. The government had invited Save the Children into the country to fight malnutrition. But, when Sternin arrived, the foreign minister let him know that not everyone appreciated his presence. The minister told him: “You have six months to make a difference.”

Sternin had minimal staff and meager resources, but he had read as much as he could about the malnutrition problem. At the time, experts thought that malnutrition was the result of an intertwined set of problems: poor sanitation, poverty, clean water not readily available, and ignorance about nutrition.

But, millions of kids can't wait for all these factors to be addressed. If addressing malnutrition requires us to end poverty, purifying water, educating mothers and building sanitations systems, then it would take several years and lots of money.

Sternin had a better idea: he began a search for bright spots – successful efforts worth emulating. If some kids were healthy against the odds, it would mean that malnourishment is not inevitable under these conditions. It would provide hope for a practical and lasting solution.

The Bright Spots

So, Sternin traveled to villages and met with groups of mothers. The mothers then went out to weigh and measure every child in their village. They found very poor kids who were healthier than the average child. This meant that it was possible in that village for a very poor family to have a well-nourished child.

If a handful of kids could be healthy despite their disadvantage, then why could not every child? And, so Sternin now had to find out what was different about these bright spot families, so that other families could learn from them.

In order to recognize what the bright-spot families were doing differently, Sternin and his group had to synthesize the prevailing norms and beliefs about feeding kids in the villages. So they talked to people and discovered that the norms were pretty clear: kids ate twice a day along with the rest of their families, and they ate soft, pure foods like the highest-quality rice.

Finding the Solution

With an understanding of the norms and beliefs, they went into the homes of the bright-spot kids and observed the way the homes were run, looking for any deviations. They found several:

1. Bright-spot mothers were feeding their kids four meals a day. The total amount of food was approximately the same. The larger twice a day meals eaten by most kids was a mistake because their stomachs could not process that much food at one time. Thus, it was better to have four smaller meals each day, than two larger ones.

2. The style of eating was different. Most parents believed that their kids understood their own needs and would feed themselves appropriately. But the healthy kids were fed more actively. They were also encouraged to eat when they were sick.

3. The healthy kids were eating different kinds of food. The bright spot mothers mixed shrimp and crabs with rice. Shrimp and crabs were eaten by adults, but generally considered inappropriate food for kids. The mothers also tossed in sweet-potato greens, which were considered a low-class food. These different kinds of foods added sorely needed protein and vitamins to the children's diet.

How to Change Habits

Now, we had the solution to the problem. Since the solution emerged from the village itself, it was both realistic and sustainable. But, knowing the solution is not enough. For anything to change, lots of mothers had to adopt new habits and beliefs about feeding their children.

How should we teach them? Some would just call the village together and give them information and a set of recommendations. But knowledge does not always produce action or change behavior. Just telling mothers about nutrition and give them recipes, will not bring about as much change. A better approach is to also get them to practice it, and make them implement it in their everyday life.

So, Sternin designed a program in which malnourished families meet at a hut each day and prepare food. The families are required to bring shrimp, crabs, and sweet-potato greens. The mothers wash their hands with soap and then cook the meal together.

The cooking-program engages the mothers to act and they soon realize that they themselves can conquer malnutrition, which create a powerful combination of hope and empowerment.

Notice that the mothers got highly specific instructions. Also, the social aspect of the cooking-program created a strong sense of pressure to go along. Another factor that contributed to make change possible was that the solution came from the “inside”, and was not some message “preached” to the locals from an arrogant outsider.

A Success Story

Six months after Sternin had come to the village, 65 percent of the kids were better nourished and stayed that way. There was a change in the culture which had lasting effect. The cooking-program spread, and reached 2.2 million Vietnamese people in 265 villages.


Heath, C. & Heath, D. (2010). Switch: How to Change Things when Change is Hard

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