Interdependence
– Relationships that are symbiotic in that when one person makes a decision it directly affects another or the larger system
– An example from malnutrition is while we were in country we were partnering with the bettah bakery. We worked with them to improve their business model but when they decided to not show up or there was huge miscommunication, it directly impacted our efficiency and work for the muffins

Holism
– The individual parts by themselves cannot operate a complex function– this requires all the parts to work together to form a system to perform that function.
– When it comes to distributing our documentary we are going to be unable to do it without the help of other components of the system. For example, we want to distribute our doc through Marie Stopes and they want to help spread the word about maternal health and mortality throughout their system. We each cannot easily do this by ourselves, we each need the other component to reach our desired outcomes and joint outcome of eliminating maternal mortality.

Multifinality
– The same or similar inputs lead to different outputs. Or a win-win situation for all
– Sickle cell diagnostic devices can be used to provide different outputs depending on the context. For example, in Nigeria, sickle cell diagnostics were successful because of their use in family planning, whereas in Sierra Leone programs are more focused on newborn screening efforts.

Equifinality
– The idea that any given output can be reached by a variety of potential means or combination of inputs.
– An example for malnutrition is how we originally created a lot of products that essentially all did the same things but through different “means”. We had different products but ultimately the outcome would have been the same – healthier children

Differentiation
– Each part in the system plays a crucial role and the system would not be whole without each individual part
– An example from the Safe Motherhood team would be when we compiled a list of our stakeholders we wanted to interview, we wanted to include as many people as possible. We needed to get the perspectives of the local community members, the PHU, and the hospitals. Each doctor, nurse, midwife-to-be and mother were essential to understanding the problem of maternal mortality in Sierra Leone to help prevent us from jumping to conclusions.

Regulation
– A process using checks and feedback to make sure goals are being accomplished & taking corrective action
– In the future, the sickle cell team will rely heavily on regulation concepts. For example, during clinical trials, we will need to confirm our test results by comparing our results to the gold standard (either collecting dried blood spot samples or using in-country IEF), and will adjust accordingly.

Abstraction
– “Zooming out” to look at a problem from multiple angles or “zooming in” to see underlying concepts
– For the Safe Motherhood team, we had a point in our fieldwork when we were coming up with all these theories of how Sierra Leoneans are trying to hide the problem of maternal mortality and how we needed to focus our documentary on exposing the truth. But we had to zoom out to look at the problem from different angles to realize that there could be multiple reasons why people were telling us that maternal mortality wasn’t a problem in their clinic. They could be telling the truth that maternal death didn’t happen in their clinic because any deaths occurred after they had referred them to the hospital and therefore they did not count as patients of the clinic.

Leverage Points
– Places within a complex system where a small shift in one thing can produce big changes in anything
– For example, while in Sierra Leone, the malnutrition team had trouble forming connections with the local bakery. Once Khanjan spoke to the owner, they had no further problems. In this case, Khanjan (and his network/power in the community) was the leverage point.

Emergence
– The concept that the value of a system as a whole is greater than the value of the individual parts
– For example, the sickle cell project will represent an emergent system in the future. A sickle cell screening device has very little value without a program (individuals are diagnosed, but nothing is done to address their diagnosis). Similarly, a sickle cell program has very little value without a low-cost screening device (you can’t treat individuals if you don’t know their diagnosis). However, when both parts come together, our project can be very valuable: individuals with sickle cell anemia are diagnosed and then access low-cost treatments to make their lives better and healthier.

Hyacinth Problem:
– In order to solve the problem of allowing the entrepreneur to have access to the hyacinth in the lake, while making the community happy because she is not the only one being paid, our team came up with a solution utilizing the Multifinality principle.
– Solution: The entrepreneur can pay the local community members (or fisherman who are hurt by the high hyacinth levels) to collect hyacinth from the lake. The entrepreneur can then process and sell the hyacinth products for a profit without the community saying she is the only one who is benefitting financially.
– Multifinality: This solution encompasses the Multifinality principles because it is a “win-win,” where one input has multiple beneficial outputs. Specifically, by allowing any community member to collect and sell their hyacinth to the entrepreneur, the entrepreneur “wins” because they have access to the hyacinth without getting push back from the community, and the community “wins” because they can make money by selling the hyacinth.