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Donors increasingly favour complex interventions, but this approach is misguided, says Christopher Charles.
Every year, hundreds of billions of foreign aid dollars are spent on international development and humanitarian assistance. But the return is modest, with relatively little achieved.
Sometimes the metrics (or lack thereof) are to blame. But more often it’s because those interventions weren’t what the target community needed, were too technically complex or costly to maintain, or failed to understand the social and cultural dimensions around implementation and uptake.
As a result, aid organisations must constantly defend their presence and the importance of funding.
The answer is to go back to supporting the simple solutions that we know have worked for years.
The three categories of problems
In philosophical communities, and now more commonly in applied science circles, problems are typically broken down into three categories with corresponding analogies. A ‘simple problem’ is analogous to baking a cake: the task is uni-disciplinary, there is a clear pathway to solving the problem and, once the recipe is mastered, one can repeat the process with similar success.
A ‘complicated problem’ might be compared to sending a rocket ship to the moon: the problem is multidisciplinary and requires expert-level teamwork, as well as following step-by-step algorithms. But, once the process is mastered, they too can be repeated with similar success.
Finally, we have ‘complex problems’, the most challenging of all. These include raising a child: there are an infinite number of ways to raise a child, involving multiple players with varying levels of expertise, independence and skills. Crucially, each child is unique, with different needs and wants — and so repeating the steps has no guarantee of success.
“While a package of interventions targeting each area seems promising at first glance, the financial and human resource costs, along with the time required for implementation, often lead to failure.”
Christopher Charles, Lucky Iron Fish
In development, complex problems reflect the interdependencies within the field. For example, poverty may be a result of poor education, which can be linked to malnutrition, which is a result of poverty. More broadly, complex problems are dynamic and respond to ever-changing political, economic and social environments.
But the answer to this complexity is simplicity. The example of nutrition shows that simple solutions are the way to solve complex problems in development.
The difficulty of improving nutrition
Interventions that aim to improve nutrition are often technically challenging. They require substantial upfront funding, significant behavioural change to have a lasting impact and time — both to get the project off the ground and to sustain it.
Civil society organisations implement projects to increase household food production with varying degrees of success. These projects require: agricultural expertise; buy-in from communities, since they often involve land use changes; time and effort to develop and maintain a household farm; gender training to ensure that both men and women take on the added tasks; and training on how to best sell produce and generate income.
While a package of interventions targeting each area seems promising at first glance, the financial and human resource costs, along with the time required for implementation, often lead to failure.
Studies on such projects consistently demonstrate only modest improvements in nutritional status — and the long-term impact can be even less as NGOs and their expertise depart when the project ends. 
Instead, simple solutions can be more easily adapted to respond to change. Nutrition programming has recently focused on tackling ‘hidden hunger’: malnutrition associated with specific deficiencies in micronutrients, such as iron and vitamin A. Numerous studies have demonstrated the effectiveness and efficacy of micronutrient powders that can be sprinkled on foods to enhance their nutritional value. 
These products can contain few or many micronutrients, and so can be tailored to specific health needs. They can be centrally or regionally produced and are easy to store and use. Importantly, little time and money is needed for implementation — so long as shops or civil society groups make the powders available locally, people can continue to benefit.
The lucky iron fish
My own research group has focused on scaling up a project to reduce the prevalence of iron deficiency and anaemia in Cambodia.
The concept of the Lucky Iron Fish Project is incredibly simple: a specially designed iron ingot added to and left in the cooking pot slowly but steadily releases iron, fortifying each meal. The ingot resembles a fish that symbolises good luck in Cambodia, which encourages people to use it.
Our studies show that the Lucky Iron Fish can reduce the prevalence of both iron deficiency and anaemia. A single ingot releases approximately three-quarters of the average adult’s daily iron requirements in just one use, costs less than US$5 and can be used for upwards of five years by the whole family — that’s just US$1 per family per year. [3,4]
The simplicity is not in the concept and design, which required extensive metallurgical and anthropological investigation, but in the implementation. Simple instructions, a sustainable and long-lasting product without moving parts, and proven efficacy — these qualities drove success.
Complex problems still favoured
There are numerous other examples. But donors continue to favour complex solutions. Why?
Some see failed interventions as an opportunity to endlessly experiment with innovative technologies. Let’s shift our thinking — for example by moving away from expensive agricultural biotechnologies that promise to cure malnutrition if enough time and money are poured into them, and instead look at simple solutions like incorporating ancient grains such as millet, which already have the nutritional benefits the biotechnologists are trying to engineer. 
We must have confidence that, although they might not make the news, they are backed by evidence and will dramatically improve the quality of life for the world’s poorest people.
Christopher Charles is inventor of the Lucky Iron Fish and vice-president of global health at the Canadian Federation of Medical Students. He can be contacted at [email protected]. He tweets regularly about global public health @chrisvcharles
 Edoardo Masset and others Effectiveness of agricultural interventions that aim to improve nutritional status of children: systematic review (BMJ, January 2012)
 Luz De-Regil and others Use of a powder mix of vitamins and minerals to fortify complementary foods immediately before consumption and improve health and nutrition in children under two years of age (Cochrane Summaries, 4 January 2014)
 Christopher Charles and others Iron-deficiency anaemia in rural Cambodia: community trial of a novel iron supplementation technique (The European Journal of Public Health, 28 January 2010)
 Christopher Charles Happy fish: a novel supplementation technique to prevent iron deficiency anemia in women in rural Cambodia (University of Guelph, 15 March 2013)
 Increasing millet production in South Asia (International Development Research Centre, accessed 26 January 2015)