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Use Positive Deviance to Increase Acceptance of Vaccination

Develop a scalable network of “positive deviants” who can influence the behavior of peers.

Photo of Tom Short
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Describe what you intend to do and how you'll do it in one sentence (required 250 Characters)

Use the PD process to understand existing behaviors, identify PD individuals and their uncommon behaviors, and implement a program to share their PD behaviors with the rest of the community to influence their behaviors.

Explain the idea (less than 2,000 characters)

Changing behavioral norms is never an easy task. One proven approach is positive deviance, whereby members of the target community who are acting in the desired way are identified and promoted among their peers as role models who are doing something different that is having a positive effect. The idea surfaced in Vietnam in the 1990s when researchers were looking for ways to address malnutrition among infants there, and found some women were picking up brine shrimp in the rice paddies and feeding them to their children. The approach involves finding these “positive deviants” and promoting them among their peers, thereby leveraging the deviant’s inherent trust and social capital, which supports adoption of the desired behavior. In addition to the resources that the Gates Foundation and Positive Deviance might be able to provide for this effort, third party agencies such as the Peace Corps may also be enlisted to help identify and promote individuals in local communities who can help change norms around accepting vaccination as an important community health initiative.

Which part(s) of the world does this idea target?

  • North Africa
  • Eastern Africa
  • Middle Africa
  • Southern Africa
  • Western Africa
  • Caribbean
  • Central America
  • South America
  • Northern America
  • Central Asia
  • Eastern Asia
  • South-eastern Asia
  • Southern Asia
  • Western Asia
  • Eastern Europe
  • Northern Europe
  • Southern Europe
  • Western Europe
  • Oceania

Geographic Focus (less than 250 Characters)

A country with low immunization rates, and identified barriers to immunization are behavior-based and related to lack of knowledge, misperceptions/fears, social barriers to immunizing children, access issues, behaviours of the health care providers.

Who are your end users and how well do you know them? (750 characters)

We still need to identify a suitable community with low immunization rates to pilot our approach. The community members, especially parents of immunization-aged children, would be the end users of the PD-informed immunization intervention. The PD process or qualitative assessment will help to understand their norms, values, perceptions, beliefs and practices regarding the immunization. The PD process will help identify the PD role models and their local, accessible and replicable strategies which would be shared with the wider populations to improve their immunization related behaviours.

How is the idea unique? (750 Characters)

The successful application of the PD approach has been documented in more than 41 countries in nutrition and other issues. Some examples of PD-informed from the 15 years: • Sustained 65 to 80% reduction in childhood malnutrition in Vietnamese communities, reaching a population of 2.2 million people. • Reduction in neo-natal mortality & morbidity in Pashtun communities in Pakistan and minority communities in Vietnam with near universal adoption of protective behaviors and social change. • Estimated 50% increase in primary school student retention in 10 participating schools in Missiones, Argentina. • Thousands of documented female circumcisions averted in Egypt and the formation of 12 “FGM free” communities.

Idea Proposal Stage (Select 1)

  • Blueprint: We are exploring the idea and gathering the inspiration and information we need to test it with real users.

How many months are required for the project idea? (140 characters)

2-3 months to conduct PD process; about a year to show positive results.

Organization Name (less than 140 characters)

The Positive Deviance Initiative

Type of Submitter

  • We are a registered NGO or Non-Profit Organization

Organizational Characteristics

  • International/global organization (implementing in multiple countries)

Organization Location (less than 140 Characters)

I'm in San Francisco; my PD partner is based in Bangkok.

What is the current scale of your organization’s work?

  • Global (within 2 or more global regions)

Website URL

Tell us more about your organization/company (1-2 sentences)

The mission of the Positive Deviance Initiative is to promote social change from the inside out, leveraging local wisdom for global impact. We provide resources for those seeking to use the PD approach for both programmatic and research purposes, with access to PD practitioners, and periodic update on PD materials and guides, current projects, and publications.

Who will work alongside your organization in the project idea? (750 characters)

TBD. Our usual approach is to partner with members of the targeted local community. The first step is to identify the community to pilot our approach with, and then it can be expanded to others anywhere in the world.

How many people are on your team?


Tell us more about you and your team

Mohammed Shafique is a PD Faciliator based in Bangkok. He is a specialist in communication and behaviour change with areas of expertise in malaria and dengue prevention and control, maternal and newborn health, and polio eradication. He has worked with Malaria Consortium, Save the Children, and Merlin organzations and in many countries, including Thailand, Myanmar, Cambodia, and Pakistan. Tom Short is a management consultant, with a focus on culture change, strategic messaging, and process improvement.


Join the conversation:

Photo of Isaac Jumba

Hi Tom Short , great to have your idea on the platform. I like that your idea draws inspiration from a proven model that has worked in different contexts.
It might be helpful in the coming days before the idea stage closes to think about:
1. What specific target area you might want to focus on, and the context
2. Who might be involved in helping prove the idea (e.g in identifying the PDs) and making the whole idea work and what resources you might need.
3. As you explore the idea further and gather insights, it will be exciting to share them as the idea progresses. The Design Kit: and the Demand For Health Services ( are quite resourceful in your approach.

Manisha Laroia  Anne-Laure Fayard  might you have any insights & experiences to share with regards to the positive deviants approach in healthcare or any other industries?

Photo of Anne-Laure Fayard

Hi @Tom Short like @Isaac Jumba I really like the idea of using positive deviance to change behaviors among care givers. I agree with Isaac that it might be good at this point to possibly focus on a country. For example, I found this interesting article on Ghana: Whether through your contact with, you could see if they have already done projects on immunization. Ideally, you would want to decide at what level you want to start (community vs. country) to find examples and then tell the stories (finding the best media depending on the context). I found this article quite useful and providing a lot of clear steps about the approach: Looking forward to hearing about your next steps.