Testing the Positive Deviance Approach for Maternal and Neonatal Health

Rationale: A lack of staff and equipment, travel, and traditional practices cause 46% of Cambodian women to deliver at home. Addressing these issues will take many decades, so in the meantime a new approach is needed that can be implemented with existing resources.

Approach: This project will test the "positive deviance" approach for demand creation and service delivery. Despite the severe lack of resources in Cambodia, there are still some health centers that have lower neonatal mortality than others with the same equipment. There are also some low-income parents who have never lost a baby despite having several complicated pregnancies. This project aims to find these individuals ("positive deviants") and discover which unique behaviors allow them to achieve such positive outcomes. The positive deviants will then teach their behvaiors to others.

Objective and Impact: The objective is to conduct a randomized controlled trial of the positive deviance approach in three districts in Cambodia. If the trial is successful the number of parents and health center staff practicing the positive deviant behaviors should increase in the intervention areas, which should lead to a reduction in maternal and neonatal mortality.

Innovation: The positive deviance approach is radical because it turns the problem of maternal and neonatal mortality "on its head" by looking for parents and health staff who have found their own creative solutions to problems. This would be the first trial of the positive deviance approach for both demand creation and service delivery simultaneously.