Myanmar, 1 October - Almost 50 local community volunteers gathered in Hinthada district, in the Ayeyarwady Region, to attend a two-day refresher training on dengue prevention and control organised by Malaria Consortium as part of the positive deviance dengue project, funded by UK aid. These volunteers, some of whom are community selected role models, could be key players in winning the region’s fight against dengue.
Every year, dengue, a mosquito borne disease, kills an average of 100 people in Myanmar. Since the beginning of 2015, the Hinthada hospital alone has registered 2,311 cases of which three people died.
“Positive deviance is a community driven approach that identifies existing and easily replicable behaviours demonstrated by certain community members, who have found better methods to overcome this killer disease than their neighbours, despite having access to the same resources,” explained Muhammed Shafique, Malaria Consortium regional behaviour change and communications specialist. “These community members become known as positive deviant role models, and volunteers then help us to share and amplify these simple behaviours among the rest of their community.”
The positive deviance approach has been successfully applied to a variety of health programmes, such as nutrition, maternal and new born health, hand washing and hygiene, retention of antiretroviral patients, etc. This is the first time this concept is being applied to dengue management and a key part of the project is to evaluate if it is successful in helping fight the disease.
Out of the 12 villages covered by the project, Malaria Consortium selected around 50 volunteers who are helping to pioneer positive deviance as a technique to control dengue.
The training refreshed the volunteers’ communication and facilitation knowledge and skills, provided them with an opportunity to practice positive deviance sessions using locally designed flip charts and booklets, and helped them develop their work plans to share the role model behaviours with their fellow community members. Once back in their villages, all volunteers will conduct household visits, as well as larger positive deviance sessions with up to 20 participants, to reinforce positive deviance behaviours in their community. Sometimes the actual role models also participate in these sessions to share their inspirational stories with other community members.
The training was followed by field visits to the villages of Sit Pin and Tar Gwa to observe how the volunteers work and engage with the community and how the positive deviance practical activities to combat the spread of the disease are carried out.
During the visit, the volunteers used a ‘dengue village map’ as a powerful sensitisation tool as well as a community based dengue information system. The map is developed by the volunteers in consultation with the community and displayed in the village centre or gathering place. It shows all households in the village: marking out the ones with dengue as well as suspected dengue cases and also the ones whose inhabitants attended the discussion sessions. In this way, villagers can assess the progress of the positive deviance activities, ensure their participation in the sessions and appreciate the role of volunteers in carrying out these activities. The map motivates them to be actively engaged in the dengue control activities and even exerts some influence on people with dengue to comply with those activities.
Moe Myint Oo, Malaria Consortium programme coordinator further explained, “To increase ownership and fully embed the project in the villages, the volunteers work together with village leaders, government health staff and others partners such as the Red Cross, teachers and students.” One such partner is the local fire brigade as fire and dengue prevention are linked: fire preventive water bags need to be changed to prevent larvae growth.
Volunteers meet monthly, supported by Malaria Consortium, to discuss progress, to share experiences, issues and challenges, and plan for the next positive deviance activities.
The project will provide information on the extent to which the positive deviance model can contribute to dengue control in the region. If proved effective, the approach will be used to shape further scale-up of this community driven intervention for behaviour change.
Ma Su Lei Yee is a 25-year old farmer who lives in village Sein Pan Kone. She has never had dengue. She knows that dengue is caused by mosquito that bites during the day. To prevent the mosquito bites, she always wears long sleeved clothes and sleeps under a mosquito net, even when taking a nap during the day. She always covers the big water containers, regularly changes the water in the small ones, puts the extra containers upside down and even replaces the water in the Buda vase at her family shrine to prevent larvae from growing. She cleans the household surroundings and fills in the ditches with sand, especially in the rainy season, to avoid larvae breeding. She understands high fever and vomiting are dengue symptoms and considers it very dangerous. “If the patient does not get early diagnosis and treatment from the health facility, he or she may die,” she said.