How we developed a systems change lab to prevent acute malnutrition

What do you do when you are faced with a big and complex problem like acute malnutrition prevention?

We published a report which details how we developed and ran phase one of our Acute Malnutrition Prevention Lab, a new kind of systems and partnership lab that we have developed with our partners Vihara Innovation Network. The lab has been developed to tackle the big and complex problem of acute malnutrition prevention. The report outlines what we wanted to achieve, what we did, what happened, and describes our design for the future.

Certainly, when faced with a big and complex challenge, it is important to focus on the upfront need straight away. For example, with malnutrition, providing food to those 20+ million children in India suffering from acute malnutrition today. There is plenty of room for innovation in this solutions space - for new products and services to deal with the current challenge and need.

But it starts to become obvious that the more one does, the more needs become apparent. It can start to feel like running in a hamster's wheel to catch up with the size, scale and complexity of the issue. Anyone who has worked in social change will understand this feeling and frustration. When it comes to acute malnutrition, the challenge is not simply about getting food to children but also the right kind of food, at the right time, with the best hygiene practices in place. The attitudes and behaviours of the children and their families, and communities all play a role in how food is prepared, cooked and eaten, and often our blunt program tools don't really provide for this.

All of this is hard and challenging even before one starts to think about prevention of acute malnutrition. All the things that need to happen before a child becomes malnourished to prevent this occurrence. It feels obvious to us in the social impact sector that the ‘answer’ to this challenge isn't going to be one answer - that elusive silver bullet. It's going to be a portfolio of answers. It also feels obvious that we are not necessarily going to know what that portfolio of answers is straight away; we need to trial, test and experiment to try and find incremental improvements as well as exponential improvements to the situation. This is particularly true for an issue like the prevention of acute malnutrition in urban India where there is no current or agreed 'what works' that could simply be scaled. We have to find a different way to solve this problem.

We know that systems change starts with an individual but we needed the individuals to somehow be working together and to be testing, learning, iterating and building evidence of what works.

Our response to this knowledge was to develop a unique systems change lab, adding to the work of many others in this space. This Acute Malnutrition Prevention Lab was designed with our partners the Children's Investment Fund Foundation (CIFF) and Indian based Innovation agency, Vihara Innovation Network.

We have blogged about the problem and the development of the lab already (we outlined how we designed the lab, and how we are reimagining the tool of the innovation lab), but we wanted to share the outcomes of the lab for you all to see, share and question more fully our new report.

What did we do?

We developed a short, intensive, multi-stakeholder, collaborative lab process. This was with innovators from the public, private and charity sector. Some with deep knowledge and experience of preventing acute malnutrition ,and others with new ideas and technologies that could be deployed to tackle this issue. Our lab was effectively two workshops where teams worked together to develop an idealised future, and worked out what the key components of getting there would be. The multi-sector teams worked intensively for a month in between the workshops to develop their concepts to answer the challenge question: What is the best combination of actors for a specific location to prevent acute malnutrition?

What was the outcome?

The idealised future we co-designed was a 'baby-ready family' which not only included support for mother and child but also interventions with newly married couples and adolescents. It also included the whole family in the thinking about prevention. We organised the group into three teams who came up with the following solutions, which are provided in more detail in the report. Importantly they developed these solutions based on their current knowledge of what works in their field.

The nutrition team identified several challenges, which included the lack of access to nutritious food, the lack of diversity of nutritious food in the identified communities (urban slums), and the lack of context-specific nutritious food, as different communities prefer to eat various hot and cold foods at different times. Through phase one of the lab, the team developed the concept of ‘Food Webs’. These are a network of producers, processors, sellers, role models and end users, working collectively on market and non-market based sustainable models to ensure access to the right food at the right time.

The change-makers team focused on the problem that current communication on nutrition is to target ‘everyone’ with messages heavily loaded with information on nutritious consumption patterns. Their idea is to flip the communication to help the ‘user’ understand what nutrition means and advocate for it within their households. The communication visualised is not just ‘user-centric’ but also conveyed in a language that the ‘user’ speaks and empowers community champions.

The data team identified as a key issue, the lack of data-driven evidence for users, community, policymakers and funders. Their goal is to create a system that enables real-time feedback to stakeholders at all levels to make the right decisions and iterate or change as required. The technology and methodology is already used for the development of water and sanitation in slums.

These solutions were presented at a demo day on the final day of the lab; you can download the slides from the day and find further information in the report.

Overwhelmingly, our phase one evaluation showed an appreciation of a new way of tackling problems, a new way of working together across sectors. It also showed promising new solutions to the challenge that are able to be tested and invested in.

What were the biggest challenges for this method?

The three biggest challenges we identified from our phase one evaluation were time, purpose and mindset change. We had a very short amount of time to build trust between team members. The desire was for this process to be multi-sector and collaborative, but with this approach time must be taken to support people to work together. We struggled to get the teams to the right place where they could perform together in the short timeframe we had. In saying this, they did a great job of rising to the task but were left with a feeling of frustration of just getting to the 'performing' phase of team development by the end of phase one.

Although the purpose of the lab was clear from the challenge question, 'what good looked like' wasn't clear for participants or for the funders. Although this was a necessary part of the process (we don't know what works!), it's a very uncomfortable feeling and with the time limitations the teams were not able to do as much work as they wanted to, to really go deep into their ideas and knit them together as a portfolio for future funding. There is a real tension between delivery of outputs and really innovating and seeing what emerges; this wasn't a comfortable place for participants. It was agreed that a portfolio approach is the most logical, as we appreciated that many 'answers', not just one, would be ideal, however the practicalities of this and the development of how this would work on the ground challenged the teams. A clearer 'what good looks like' from the design team from the outset would have helped the teams along.

Relating to our second challenge, ultimately to do this work required a mindset change not just for the participants in the lab but also for CIFF, Vihara and Nesta. We didn't spend enough time on how important it is to have an experimental mindset, how that would feel and what it might look like. These tensions are normal in any innovation process, the not knowing can feel too uncomfortable for some people. In future, we would recommend more time being spent on mindset change for all parties not just on solution development.

What would the next steps look like?

We have chosen two preliminary geographies (detailed in the report) to test this portfolio approach in urban India and have developed a programme cycle as seen in the model below. Effectively, what we are trying to do is change the current linear and 'non-learning' programme cycle of design, development, delivery and evaluation, and test a new way of learning and experimenting to find the most effective portfolio of interventions. Phase two of the lab would be starting from 'Activating the new system' in the diagram below. The model shown below is version one and we will be working to articulate the process of developing this kind of systems lab more clearly over the next month to help you and us.

Partnership lab approach

Partnership lab approach

This model has been adapted from Collaborate CIC’s human learning systems model by Dawn Plimmer and Toby Lowe's report you can find here.

Phase one was funded by the Children’s Investment Fund Foundation and we are actively looking for new complementary partners to support the second phase. We would also love to speak to anyone who would like to implement something similar to tackle any big and complex social problem. You can email me [email protected]


Kate Sutton

Kate Sutton

Kate Sutton

Head of Corporate Social Innovation

Kate was responsible for managing Nesta's Corporate Social Innovation and Inclusive Growth work

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