What does changing complex systems look like in practice?

Comprehensive Logic Model Cartoon by Chris LysyI have different motivations for writing blogs. Often, it’s anger at the way the development business functions (or doesn’t.) Sometimes it’s to share something funny or interesting. Today, it’s because I need help.

I’m evaluating a nutrition project which aims to build the ability of the health system to better provide nutritional services to the community. The project team are smart and dedicated, but schooled in traditional ways of delivering aid. They aim for sustainability; but think of this in terms of a continuing benefit from an intervention, rather than a change in the way the system works.

For example, the project provides equipment to nutrition centres and training on how to use and maintain this equipment. They hope that this will be sustainable; the equipment will continue to be used, at least until it falls apart completely. The team don’t, however, think about who in the current system of nutritional services should be providing this equipment and training, nor why it isn’t happening, nor how they can work with the current system to try and get it to happen.

I’m hoping to bring some insights from systems thinking into this evaluation, although I’m no specialist in the area. Keen to avoid a report smelling of horseshit, I thought I would bring some of the challenges that I’ve faced to the infinite wisdom of the blogosphere.

The basic problem is how to work within a dysfunctional system which is broken far beyond the ability of your project to fix it. To pick a simple example, the NGO supports “nutrition coordinators”, government staff who monitor local health facilities to check that they are fully stocked and the nurses are doing their jobs. Nutrition coordinators are a vital part of the healthcare system, but their ability to do their roles is compromised by the fact that they don’t have any fuel, and so can’t visit the health facilities.

In response, the NGO gives fuel to the coordinators. My initial reaction was that this is a superficial solution, but doesn’t fix the cause of the problem. It’s unsustainable and arguably perpetuates the problem by discouraging the state from properly funding their nutrition coordinators. The NGO responded – a bit irritably – that if they don’t do it, then there would be no supervision of the health facilities.

The actions of other donors and NGOs compound these challenges. For example, it would make sense for the local nutrition authority to take on the funding of the training programme after the NGO left. This would make it a real solution – the NGO would have succeeded in changing nutrition services so that training is now provided on a permanent basis. All the trainers come from the local authority, so you would have thought that it would be reasonably cheap for the government to provide training; it would just require their own staff to do their work correctly.

The trouble is, the trainers require a large supplement to their normal salary in return for conducting training, euphemistically termed a per diem. The local nutrition authority can’t afford to pay this. The payment of per diems by the NGO significantly reduces the chances that the training is taken up by local actors, since nobody has the money to pay. But if the NGO hadn’t paid the per diems in the first place, then the training would never have taken place.

Perhaps this reflects the fact that poverty and incompetence are at the root of a large number of problems here. The nutrition centres are falling apart and money to fix them trickles in slowly, if at all. This is partly due to corruption and mismanagement, no doubt, but also to a lack of money. The NGO has very little influence on higher level corruption and mismanagement. Consequently, my critique of their focus on the symptoms of problems (rather than underlying causes) has a bit of a hollow ring to it; the real problems are just too big for them to address.

The ultimate question, perhaps, is to what extent is it acceptable for this NGO to provide unsustainable solutions which enable the project to continue (and benefit people), but which address the superficial problem rather than the underlying causes? And what can an evaluation report do to help them – beyond clever-sounding but impractical truisms?

Answers on a postcard– or even better, in the comments section of this blog.

There have been some really useful comments on the blog. If you’re reading this on the homepage, then click here to see them; otherwise scroll down.