Related Expertise: Food Systems and Food Security, Global Health, Smart Simplicity
Chronic hunger claims the lives of more than 3 million children under the age of five each year—more than die from malaria, tuberculosis, and HIV/AIDS combined. Those who survive suffer permanently from stunted physical growth, impaired cognitive development, and lowered resistance to disease.
The technical solution to chronic child hunger is well recognized: provide at-risk populations with sufficient amounts of nutritious food (or the means to produce it themselves), supplemented by appropriate health care (for example, deworming treatments) and education (such as emphasizing the importance of breast-feeding to new mothers). Why, then, does the problem still exist?
Although the eradication of chronic child hunger might seem straightforward, the challenge is enormously difficult in practice because of its vast complexity. (See Exhibit 1.) Indeed, significant complicating factors exist at the family, community, and organizational levels:
Lack of Vital Knowledge. The relevant parties may not know about the practices that can fend off chronic child hunger—including breast-feeding, proper hygiene, balanced nutritional intake, and deworming. Receiving the necessary education takes time, and that time may not exist in people’s daily routines. Social Norms. Norms that guide the behaviors of families, communities, and governments can create sizable hurdles. In a village in Peru, for instance, quinoa, a highly nutritious crop, grew in abundance, offering a ready solution to hunger in the region. But local communities believed that the grain was cursed and refused to consume it.
Competing Demands on Mothers’ Time. A mother might be painfully aware of the importance of having her child treated for severe malnutrition. But if traveling to and from the nearest health center means that she’ll miss a day’s work, compromising her ability to earn enough to feed her other children, she is unlikely to make the trip, even if the treatment is available at no cost.
The Large Number, and Often Overlapping Agendas, of Organizations. Progress against chronic child hunger can be hindered by the sheer number of organizations involved. In a single country, multiple government agencies (including ministries of agriculture, education, and health), UN organizations (such as the World Food Programme, the World Health Organization, UNICEF, and the Food and Agriculture Organization), NGOs, donors, coordinating bodies and movements (such as Scaling Up Nutrition), and other aid organizations are typically engaged in the battle against hunger. Because of
Because so many factors are involved both in the problem of chronic child hunger and in potential solutions, complexity is unavoidable. The task, therefore, is not to try to reduce complexity but to find a different way to think about and manage it.
Complexity is also a fundamental challenge for participants in a vastly different realm—the business sector. Businesses across industries routinely face substantial complexity as they strive to pursue multiple valuable, yet competing, performance objectives. Companies want to innovate and be efficient, offer customers low prices and high quality, and customize offerings for specific markets and standardize them to maximize operating returns. Departments and leaders can easily find themselves facing dozens of conflicts, including internal conflicts with other departments or functions such as finance, HR, and IT.
When reconciling those objectives proves challenging, companies tend to respond by creating structures, processes, systems, scorecards, and committees. But such interventions rarely deliver as expected. Instead, they merely add layers, which are ultimately counterproductive. In short, they add what we call complicatedness: a man-made response to complexity.
We have found that the companies that deal successfully with complexity do not focus on structures but on context and on the ways people interact. They de-emphasize traditional management techniques and emphasize instead what people actually do in an organization and why. We call this approach
Smart Simplicity rests on the idea that three critical requirements enable organizations to navigate through fundamental challenges and their related complexity: leadership, cooperation, and engagement. Effective leadership is about understanding what people do and empowering them to use their judgment and intelligence. It is also about setting objectives beyond employees’ direct control, holding people accountable for the consequences of their actions, and rewarding those who cooperate. The second element is genuine cooperation among stakeholders. The third is the engagement of all relevant parties.
Might these requirements—leadership, cooperation, and engagement—hold equally in the fight against chronic child hunger?
Those elements mean specific things, however, in the effort to eradicate chronic child hunger.
Leadership. Someone personally dedicated to the cause must champion and take charge of the effort in a country for a minimum of five years, acting as a national integrator of the activities of key stakeholders. This person must have the commitment and backing of the country’s political leaders at the highest level.
The leader must be supported by a full-time team of 10 to 15 people that operates under the government’s aegis but is not tied to a particular ministry; this team must have secure funding for at least five years. The team’s task is not to implement specific interventions but to act as a catalyst to necessary actions and then to coordinate and drive them forward.
The team supports the formulation of strategies tailored to specific contexts; oversees pilot projects with the aim of producing results quickly and demonstrating proof of concept; and plays a key role in monitoring and reporting progress, and alerting decision makers to potential roadblocks.
Cooperation. Cooperation in this context refers to any activity undertaken by a stakeholder that makes the activities of other stakeholders more effective. The steps to foster such cooperation include establishing easy-to-measure joint targets at the village level and formulating strategies and tactics to reach them. Effort should be made to achieve and promote quick wins in order to motivate participants for the journey ahead.
Engagement. During the critical “last mile” of implementation—the connection to beneficiaries—aid providers must have a thorough understanding of how to promote engagement and, ultimately, responsibility among individuals and their communities. Mothers, fathers, and other family members should be given incentives and rewards for taking the mitigation of chronic child hunger into their own hands and ensuring ongoing progress.
The critical importance of leadership, cooperation, and engagement was evident in the most successful initiatives we observed.
Start with leadership. The success in the Indian state of Maharashtra traces its roots to the chief minister’s decision to address malnutrition in the state and to the subsequent engagement of a senior government official. This official led the Rajmata Jijau Mother-Child Health and Nutrition Mission, a team of 15 people that operated from within the state government, for five years with the support of UNICEF. Senegal’s success, in turn, was spurred by a World Bank official who united relevant parties to rethink the country’s approach to hunger challenges. This official secured political support and long-term funding for the effort from the World Bank. The official also recruited an effective local leader to head the National Commission to Fight Malnutrition and to assemble a team that reported to the country’s prime minister.
Cooperation among stakeholders was also apparent. In Peru, the initiative’s team, which also reported to the prime minister, worked with various stakeholders and experts to develop a strategy informed by several successful small programs that had been established throughout the country. In Maharashtra, the Rajmata Jijau Mother-Child Health and Nutrition Mission fostered stakeholder cooperation by focusing on one joint outcome metric: the percentage of underweight children. The Mission reinforced stakeholders’ accountability by regularly weighing children in the villages and then publicizing each district’s progress using a simple rating of red, yellow, or green. Joint accountability was further strengthened by regular interactions among district offices, the Mission, and state-level secretaries, and by periodic reviews at the highest levels of the Maharashtra government.
The teams we observed fostered engagement in creative ways. In Peru, Juntos, the National Program to Support the Poorest People, gave cash rewards to participating families that verified that pregnant women had prenatal care, newborns had specialized care, and children’s growth was monitored periodically. In Senegal, economic activities (such as the production of clothing and towels using local fabric) were developed that brought together mothers and the community workers who were critical in efforts such as weighing children and counseling and educating mothers.
These are only a few examples of cases in which the elements of Smart Simplicity played a fundamental role in successful initiatives to reduce chronic child hunger. Indeed, the prevalence of the elements suggests that they should be part of the blueprint that guides future efforts. (See Exhibit 3.)
Considerable amounts of time, energy, and resources have been marshaled to combat chronic child hunger, and great advances have been made. But the journey is far from over, and the complexity of the challenge should not be used as an excuse for the distance that remains.
We believe that the elements of Smart Simplicity discussed above can lead to critical improvements in this campaign and that international agencies, governments, charitable organizations, and other parties that have taken up the cause of chronic child hunger would be well served to consider them. The children stand to be the ultimate winners.