FIGHTING HUNGER AND OTHER COMPLEX PROBLEMS WITH SMART SIMPLICITY
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FIGHTING HUNGER AND
OTHER COMPLEX PROBLEMS
WITH SMART SIMPLICITY
By Yves Morieux, Charmian Caines, Heino Meerkatt, Obey N. Assery, and Michael Dunford
F or a child, stunting is a cruel fate.
Caused by chronic hunger, stunting
leads to serious and permanent damage of
edness—we focused on the context, the
ways people interact within that context,
and what drives their behavior. We also
a child’s brain and body and lowers used analytical tools and insights from so-
resistance to disease. In the 50 countries cial sciences to create strategies that pro-
with the highest levels of chronic hunger, mote new behaviors and ways of working.
more than 30% of the children are affected In the process, we found that Smart Sim-
by stunting, creating problems not only for plicity can help countries make progress on
individual people but also for economies complex problems—such as a lack of ac-
and societies. cess to quality education and health ser-
vices—even in highly challenging social
But although the challenge of stunting has and environmental contexts.
marshaled the resources of organizations,
including government agencies and nongov-
ernmental organizations (NGOs), individual Individual and System
and system complexities make it hard for Complexities
countries to find solutions for chronic child The first step in applying Smart Simplicity
hunger. To develop a new solution, and to is to analyze the individual and system
explore how it might help nations to ad- complexities that hamper solutions despite
dress other severe problems such as a lack the existence of well-recognized interven-
of access to health care, BCG worked with tions. (See the exhibit.)
the government of Tanzania and the World
Food Programme (WFP) to implement When it comes to the individual complexi-
BCG’s Smart Simplicity approach. ties driving stunting, the causes might
seem surprising: mothers fail to provide
Rather than create new structures, process- children with adequate nutritious food,
es, or systems—which often add complicat- they neglect to use hygiene practices thatWell-Recognized Interventions That Address Malnutrition and Stunting
Before Up to
pregnancy Pregnancy Birth 6 months 12 months 18 months 24 months five years
1 Iron and folic acid supplements
2 Iron fortification of staple foods1
3 Vitamin A supplements
4 Salt iodization1
5 Multiple micronutrient supplements
6 Promotion of breastfeeding
7 Promotion of complementary feeding
8 Promotion of hand washing with soap
9 Management and prevention of acute malnutrition
10 Zinc supplements
11 Deworming
Interventions for adolescent girls and women to improve maternal nutritional status
Interventions to improve the nutritional status of children under five
Universal interventions to improve the nutritional status of the entire target population
Source: The Power of Nutrition.
Note: Time frames are approximate.
1For up to six months, children are exclusively breastfed, so these interventions are not targeted.
prevent diarrhea, or they don’t take mal- mothers from eating certain types of food,
nourished children to the health clinic. such as eggs or meat. And as women are gen-
However, when analyzing the constraints erally held responsible for household duties
mothers face in countries where chronic and childcare, as well as working, little time
child hunger is prevalent, such behaviors is left to focus on good nutritional practices.
can be understood, enabling those behav-
iors to be modified. Knowing what to do, when, and how is es-
sential to success. But because of a lack of
Mothers may not act because they do not measurement tools, as well as the absence
recognize stunting. Malnourished children of a single data set and key indicators—
often appear happy and healthy, whereas such as the prevalence of stunting—local
those suffering from malaria clearly de- health workers are unable to tell where
mand immediate medical attention. Com- chronic hunger is occurring most regularly
munity health workers often record cases and where best to focus their efforts. With-
of malaria, HIV and AIDS, and tuberculo- out feedback loops between mothers and
sis, but they rarely track stunting. Local health workers, little is known about
health clinics chart the weight of children whether interventions—such as those that
but not their height. provide food, vitamins, and breastfeeding
training—are being deployed and having
Even if mothers understand malnutrition an impact. Meanwhile, with various groups
and the need for exclusive breastfeeding delivering interventions, it is hard to assess
(feeding an infant only breast milk) for the their relative impact and to develop a ho-
first six months, deworming, and proper listic approach.
hygiene, putting these solutions into prac-
tice is difficult. Often mothers are juggling System complexities compound these diffi-
childcare with other demands, such as culties. Certainly, the resources that govern-
working on the land, fetching water, or col- ment agencies, donors, NGOs, advocacy
lecting firewood. Visiting the health clinic groups, and others devote to stunting help.
may mean missing a day’s work. But the way their efforts are organized has
created complexities that prevent their in-
Cultural norms erect obstacles, too. For ex- dividual interventions from having a trans-
ample, some traditional practices prohibit formative impact.
Boston Consulting Group | Fighting Hunger and Other Complex Problems with Smart Simplicity 2For example, insufficient interaction be- Finding out what is working in Tanzania
tween various government agencies—such offers insights for stakeholders that are try-
as ministries of health, nutrition, educa- ing to find solutions to chronic hunger and
tion, water and sanitation, and agricul- other similarly complex and seemingly in-
ture—can slow progress in the battle tractable problems.
against stunting. It requires changes in ar-
eas such as education, the food supply, and
the quality of sanitation services, demand- Factors for Success
ing coordinated action rather than isolated Despite the obstacles and complexities,
efforts. chronic child hunger has been successfully
reduced in several countries: Brazil, India,
A lack of collaboration can have knock-on Malawi, Mauritania, Peru, Senegal, and
effects: Governments and development Vietnam. Strong parallels exist between
partners do not work with a single data the efforts of these countries and the
source or shared objectives. Additionally, Smart Simplicity approach to managing
each organization develops its own proc- complexity.
esses, procedures, committees, and working
groups. The outcome is often splintered Although progress on nutrition could in
and duplicated efforts. This means that some cases be linked to a nation’s econom-
simply increasing the volume of inputs— ic growth, our analysis found that a num-
whether time, money, or resources such as ber of other factors were responsible for
nutritious food supplies—does not neces- the success of these countries’ efforts.
sarily produce better results. These factors included the availability of
good data, a central team focused on re-
In facing these obstacles, those fighting ducing hunger that had access to decision
stunting are not alone. The people and or- makers, strong links and feedback loops
ganizations working to address other glob- among national and local actors, and stake-
al challenges encounter many of the same holders that were empowered to act at ev-
issues, including the following: ery level.
•• Disappointing results, despite many In looking to apply Smart Simplicity to
attempts to solve the problem with chronic hunger and stunting in Tanzania,
substantial resources and goodwill BCG’s analysis revealed that a number of
the key elements of Smart Simplicity were
•• The lack of an overarching authority already in place. These included clear gov-
with the legitimacy and power needed ernment sponsorship, a committed nation-
to influence the many stakeholders al integrator, and government-approved
targets (such as the country’s goal to re-
•• Many stakeholders (including house- duce stunting from 34% to 28% by 2021).
holds, NGO teams, and government However, the analysis also revealed gaps—
officials) making microdecisions that such as the lack of a single source of nutri-
are rational in the context of their tion data and weak district-level stunting
individual goals, resources, and con- data—limiting the insights that could guide
straints but that work against each decisions.
other in the aggregate, preventing an
overall solution from being found On the basis of this analysis, BCG chose to
work in Tanzania in partnership with the
There is something else that global prob- WFP. Together, we adapted Smart Simplici-
lems share: when they are successfully ty to support specific government agencies
solved, they improve individual lives and and NGOs that were implementing pro-
benefit the common good. For example, grams to address chronic hunger. The first
better-fed, healthier children have better step was to conduct a thorough analysis of
lives and support a country’s human capi- the ecosystem addressing malnutrition, its
tal and economic development. strengths and weaknesses, as well as the
Boston Consulting Group | Fighting Hunger and Other Complex Problems with Smart Simplicity 3context in which people and organizations This team spurs the implementation of in-
were operating. terventions by coordinating stakeholders,
overseeing pilots, monitoring and reporting
The next step was to work with existing progress, and alerting decision makers to
stakeholders to identify potential changes potential roadblocks. This team needs to
that could be made to this ecosystem and be sufficiently close to implementation op-
context to enable the new individual be- erations to assess the impact of collabora-
haviors and collaborative efforts that could tive efforts and to encourage further coop-
improve overall outcomes. In doing this, we eration.
focused on four key areas:
In Tanzania, the catalyst team—embedded
Working with Government. Applying Smart within the Tanzania Food and Nutrition
Simplicity to challenges such as stunting Centre, under the Ministry of Health—be-
means understanding the context in which came the glue at the central and district
leaders operate and how that shapes their levels, guiding the efforts of all those work-
behaviors. Since local authorities are ing to improve nutrition.
highly motivated to have a local impact,
rather than introducing new structures, Using Data as a Key Tool. Robust data
much progress can be made working collection and analysis, as well as the
within existing hierarchies, roles, and dissemination of findings, are essential to
responsibilities. combating complex problems. In Tanzania,
data collection efforts started with mothers,
In Tanzania, for example, district officers since knowing a child’s height as well as
report to district executive directors. DEDs weight helps them understand stunting.
follow the lead of the President’s Office of Health facilities, therefore, needed to
Regional Administration and Local Govern- include height boards among their anthro-
ment and are accountable to this office for pometric (body measurement) tools.
district-level performance on nutrition.
Gaining the commitment of the DEDs, At the community level, data collection is
therefore, helped to secure local budgets critical to planning interventions and as-
and execute plans. sessing progress. In Tanzania, the BCG-
WFP team helped strengthen data systems,
It can prove to be important for a national increase access to nutritional information,
government to assign regional and local re- and train village health officials in how to
sponsibilities for action on child nutrition use this information to educate families. A
and enshrine them in policy documents. database of anthropometric tools—the
This provides transparency and gives legiti- types and their locations in health facilities
macy to nutritional strategies. nationwide—was established to improve
intervention targeting.
Creating Catalyst Teams. One of the
biggest obstacles to solving complex The catalyst team also plays a key role in
problems is the existence of funding making data an important tool. In Tanza-
models that require NGOs to demonstrate nia, the team developed a nutrition cockpit,
their efficiency to donors—something that an online hub for the prevention and con-
becomes difficult when their efforts are trol of malnutrition. By creating a single
combined with those of other organiza- website and giving all stakeholders access
tions. Because the funding model hinders to information relevant to nutrition—in-
collaboration, it was necessary to change cluding training programs, official policies,
their ways of working so that staff in guidelines, bottleneck analysis, and an
government agencies and NGOs could events calendar—the team advanced data
together act as an independent catalyst collection and analysis and facilitated col-
team, creating an approach to allocating laboration and data-driven decision mak-
funds that was better coordinated and, ing. In addition, as the single source of nu-
therefore, more effective. trition data, the nutrition cockpit helped
Boston Consulting Group | Fighting Hunger and Other Complex Problems with Smart Simplicity 4meet the transparency demands of the gov- sure that the government accomplishes its
ernment, donors, and implementation goal, the Smart Simplicity steering commit-
partners. tee—which includes government and WFP
representatives—has set out the next steps
Training Stakeholders. Key to addressing to be taken.
chronic hunger is training. In Tanzania, this
started in the home. Weekly radio broad- Some steps are focused on data. For exam-
casts focused on nutrition and signs of ple, the steering committee is seeking to
stunting, which created awareness among provide anthropometric tools to all health
mothers of the dangers of stunting, facilities, train the health staff, and ensure
prompted them to have their children that data systems enable wide access to nu-
measured, and encouraged them to seek tritional information. To understand what
solutions, if needed. Training religious stakeholders value, the committee is foster-
leaders to discuss stunting with families, as ing the creation of feedback loops at all lev-
well as with couples before they married, els—national, regional, district, and village.
also built awareness.
Encouraging greater collaboration is a key
Meanwhile, training stakeholders to collab- goal. The committee recommends uniting
orate is essential. In Tanzania, the catalyst cross-sector stakeholders—including gov-
team developed and delivered a training ernment agencies, NGOs, and businesses—
program in nutrition collaboration. Using on a common goal and holding them jointly
video, demonstrations, and other forms of accountable. Expanding the catalyst team
instruction, team members helped stake- model is also critical, and the committee’s
holders adopt collaboration practices, such recommendations include establishing a
as participating in feedback loops, celebrat- catalyst team to implement initiatives local-
ing what is working, and acknowledging ly, without disrupting existing structures,
what isn’t. Rather than simply providing systems, and hierarchies. The central cata-
additional technical skills, the training pro- lyst team will continue to drive forward ini-
gram empowered people to work in com- tiatives on behalf of the government, agen-
pletely different ways. cies, and others, and to act as the central
coordinating team for the implementation
To ensure that a catalyst team’s training of all national nutrition efforts.
programs lead to material change, inten-
sive support and follow up is essential. In
Tanzania, at the end of each training pro- Lessons from Tackling Child
gram, the team asked participants—wheth- Hunger
er from the health, education, or agricul- The application of Smart Simplicity to
ture sectors—to make commitments, such chronic child hunger in Tanzania showed
as to communicate more frequently with how this analytical approach is relevant for
their ministry counterparts. After the train- any organization or group of stakeholders
ing has been completed, the team should trying to address a long-term, complex
check in monthly on these commitments. problem, such as poverty or poor access to
education and health services. Specific les-
sons include the following:
The Next Steps for Tanzania
In Tanzania, the Smart Simplicity ap- •• Successful interventions are not based
proach has the potential for significant im- on persuasion or nudging but on social
pact. Although the development of data sciences, which can guide data collec-
collection systems requires more work, ma- tion, problem analysis, and solution
jor advances have been made on improv- design.
ing collaboration, particularly at the dis-
trict level, and the Tanzanian government, •• Instead of judging the efforts of individ-
supported by the WFP, is moving toward ual people as failures or mistakes, those
achieving a reduction in stunting. To en- trying to address complex problems
Boston Consulting Group | Fighting Hunger and Other Complex Problems with Smart Simplicity 5should identify the context that leads communicate with all stakeholders
people toward certain behaviors. Chang- involved.
ing that context prompts shifts in behav-
iors, both individually and in the aggre- This approach is particularly helpful at a
gate, allowing governments, NGOs, and time when development resources are
other organizations to be informed by stretched and competition for donor fund-
facts before implementing interventions. ing is intensifying. Although accessing new
sources of funding and resources will al-
•• Rather than applying a preexisting ways be important, Smart Simplicity can
package of solutions, using analytical enable governments to address a problem
tools makes it possible to find a way for using current resources.
all stakeholders to work effectively
together to develop solutions that are Rather than adding new pieces to the puz-
more likely to succeed in the local zle, Smart Simplicity enables the existing
context. pieces to fit better together, amplifying the
impact made by everyone involved and
•• Working with existing stakeholders and greatly increasing the chances of solving
within an existing context—however even the most complex challenges.
complex—makes it possible to harness
existing skills and resources. This article summarizes “Using Smart Sim-
plicity to Tackle Complex Global Challeng-
•• An integrator that is close to implemen- es: Chronic Child Hunger in Tanzania,”
tation operations—in this case, the which was published in Social Business, a
catalyst team—fosters collaboration by journal that focuses on the elimination of
observing and assessing collective poverty and the enhancement of human wel-
efforts and the results. fare and that aims to provide a forum for the
exchange of ideas and experiences among ac-
•• The integrator should manage feedback ademics and practitioners working toward
at the implementation level and this goal.
About the Authors
Yves Morieux is a managing director and senior partner in the Middle East office of Boston Consulting
Group and a fellow at the BCG Henderson Institute, where he focuses on people and organizations. He is
an expert in corporate transformation, and he has pioneered new ways of organizational thinking through
the development of Smart Simplicity. You may contact him by email at morieux.yves@bcg.com.
Charmian Caines is a managing director and senior partner in the firm’s London office. She is a core
member of the Consumer practice, focusing on major retailers and consumer goods companies. She is
also part of the leadership team that works with the World Food Programme. You may contact her by
email at caines.charmian@bcg.com.
Heino Meerkatt is a senior advisor in BCG’s Boston office and a core member of the Social Impact prac-
tice. He is also part of the leadership team that works with the World Food Programme. Previously, he was
a senior partner, focusing on social impact, health care, and private equity. You may contact him by email
at meerkatt.heino@advisor.bcg.com.
Obey N. Assery is an economist and the director of Policy and Planning in Tanzania’s Ministry of Agricul-
ture. He coordinates food security and nutrition initiatives for Scaling up Nutrition, and he chairs the Part-
nership Accountability Committee, which coordinates G8 initiatives on food security and nutrition. You
may contact him by email at asseryn@yahoo.com.
Michael Dunford is the representative to Tanzania for the World Food Programme. Previously, he was
WFP’s deputy country director in Uganda, Bangladesh, and the Democratic People’s Republic of Korea.
You may contact him by email at michael.dunford@wfp.org.
Boston Consulting Group | Fighting Hunger and Other Complex Problems with Smart Simplicity 6Boston Consulting Group partners with leaders in business and society to tackle their most important
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