The Beginnings

The term “Positive Deviance” initially appeared in the nutrition research literature in the 1960s.  The concept of Positive Deviance in nutrition was further refined in the book ”Positive Deviance in Child Nutrition” by Tufts University professor, Marian Zeitlin, her colleagues Hossein Ghassemi and Mohamed Mansour, published by the United Nations University Press in 1990. Based on solid research, the book documented the existence of healthy children or “Positive Deviant” children in very poor families living in communities with high level of childhood malnutrition. In this book, Zeitlin and her colleagues advocated for the use of this concept to address childhood malnutrition issues at the community level by identifying what was going right in the community in order to amplify it, as opposed to focusing on what was going wrong in the community and fixing it.

In the early 1990’s in Vietnam, Jerry Sternin, , and his wife, Monique, working for the US NGO Save the Children , supported by Save the Children Health Advisor Dr. Gretchen Berggren, experimented with Zeitlin’s PD concept  and operationalized it  to eradicate childhood malnutrition  in a sustainable way as mandated by the Vietnamese government. Thanks to the dedicated work of the local organizations working together for the first time (Women’s Union, People’s committee and health services) the community based and owned pilot project was successful in rehabilitating 93% of children and was subsequently scaled up to reach 5 million families in Viet Nam. 

Developing the PD Approach: 1997-2001

Based on these early successes, the approach was scaled-up both locally and internationally with the development of a community-based nutrition rehabilitation model called PD/Hearth promoted by USAID and PD/NERP promoted by international organizations such as UNICEF & WFP. The PD approach to eliminate childhood malnutrition in a sustainable way has been used in hundreds of communities in more than 45 countries.

In 1997, the Sternins moved to Egypt where the PD approach was first applied to another seemingly intractable problem: Female Genital Mutilation (FGM). During the next two years the PD approach methodology was developed to address the failure to advocate against this near universal practice. With the active participation of Egyptians NGOs dedicated to eradicate this practice, “Positive Deviant” individuals such as mothers or grandmothers who refused to circumcise their daughters & granddaughters, priests and sheiks who advocated against the practice and many others who said “NO” to excision were identified and interviewed and shared their stories. With their input into developing an advocacy program, they became the frontline community based advocates who worked side by side with the local NGOs’ staff, resulting in thousands of girls’ circumcision being adverted. The pilot project was scaled up in 2002 to be included as a behavior change communication strategy , in a government initiative called “the abandonment of Female Genital Mutilation” (FGMAP) run  by the National Council for Motherhood and Childhood (NCCM) supported by UNICEF . By 2005 The FGMAP has been implemented by 4 PNGOs working with 20 LNGOs in 40 communities. Concurrently the use of the PD approach was applied to Maternal & Newborn health in Northern Pakistan with SCF US with resounding success. Beside eliminating neonatal deaths, the project was successful in doing away with the entrenched practice of gutti (prelactate) and in promoting the near universal use of a clean razor blade to cut the umbilical cord. There is also an acknowledged change in gender based decision-making patterns where issues relating to pregnancy, delivery and care-seeking are now discussed openly between the husband, the wife and the mother-in-law.

Expansion 2002-2014

in 2001  with a grant from the Ford Foundation, the Positive Deviance Initiative was established at Tufts University Friedman School of Nutrition with the mandate to expend the use of the PD approach to different sectors. With a trained group of PD facilitators he PD Initiative was instrumental in putting PD on the map with many new successful PD informed projects in Public health, health care, education and child protection. A particularly successful pilot PD informed project on the prevention and eradication in half a dozen US hospitals resulted in expending this program in many US hospital and in particular the VAHS system. In addition PD collaborative networks were created such as the PD Indonesia Initiative under the leadership of USAID and the MRSA prevention and eradication collaborative that brought together dozens of health care systems.

PDI also collaborated with a variety of partners to expand the use of the PD approach. Such collaborators include ministries of health in different countries, foundations and INGOs, UNICEF, Peace Corps, USAID, and the World Bank.

Within the US, PDI has also collaborated with the CDC, the Veterans’ Administration, Plexus Institute, Delmarva Foundation, New York City of Public Housing, Children’s Aid Society, National Alliance on Mental Illness (NAMI).

With a grant from the Rockefeller Foundation (2008-2012), the PD Initiative focused on diversification and training. Despite the tragic loss of its founder Jerry Sternin in December 2008, the PD Initiative was instrumental in getting the PD approach piloted in new sectors such as governance (corruption in Ecuador, security in Afghanistan), the Judiciary (Penal system in Denmark) The first book, dedicated to the Positive Deviance Approach was published in 2010: “The Power of Positive Deviance; How Unlikely Innovators Solve the World’s Toughest Problems” by Richard Pascale, Jerry Sternin and Monique Sternin. The first international PD Forum took place in Bali, Indonesia with 145 participants from the region, and training in the academia was begun. Emergence of new PD networks, either sectorial or regional were identified and supported.


In mid 2014, the Positive Deviance Initiative was dissolved and a new international PD Collaborative was launched towards the end of 2017. 

This platform intends to be a common place for many different PD networks: from sectors to country based networks to research. The resources developed and available on the website will continue to be accessible.

For those interested in applying the Positive Deviance approach for a project, please see our How to Get Started page.