The flaw with the simplicity/complexity is that it gives the impression that it about making a binary choice – but simplicity and complexity are not polar opposites. In fact, making something “simpler” is often a case of relocating complexity, rather than eliminating it. For example, from the driver’s perspective, a manual-shift transmission is more complex than an automatic transmission. But from an overall systems perspective, the automatic transmission is equally or even more complex.
The following is an example of the complexity of the problem situation in public health – what comes first – prevention of disease through clean water supply or treatment of disease – what comes first? There are no easy solutions to these situations.
Just to enact one part of the plan, just to extend Zanmi Lasante’s program for preventing of HIV from mothers to babies, looked as difficult as the nationwide MDR project in Peru, and that project ranked among the most complex health interventions ever undertaken in a poor country. Only 20 percent of women in rural Haiti received any medical care. An estimated 5 percent had HIV. To find them, a group of PIH and Zanmi Lasante doctors and health workers and Haitian government employees, would have to undertake AIDS education among about half a million peasants who were scattered throughout a mountainous region of about four hundred square miles. They’d have to establish labs and testing centers in a place where the principal roads were nearly impassable even in good weather. They’d have to train lab technicians to run those centers, in places that had only intermittent electricity or none, and hire and train many additional community health workers to deliver prophylactic drugs twice a day for nine months to each infected pregnant woman and for a week to each newborn baby. Because breast milk can transmit the virus, each mother would have to be provided with infant formula for at least nine months, and because the formula would have to be mixed with local water, team would have to clean up the water supplies in dozens of places.
“What problem are you trying to solve?” is the question usually asked when the problem situation gets complex. The intent of the person asking the question is to simplify and to get to the crux of the problem, and then move forward to putting together the actions to resolve the problem – and in most cases time and resources. But remember, “Resources are always limited”, for any organization. And decisions and indecisions made during the problem solving exercise drive the anticipated future.