Mind the Gap:

Why Filling the “Missing Middle” is Critical to Changing Systems

There’s a theory that middle children often get the least attention from parents—they neither get the focus of the “firsts” that come with being the eldest sibling nor the coddling that can accompany the baby of the family.

I’ve noticed another middle that often gets easily ignored: it’s what I call the “missing middle.” It occurs when the big-picture efforts of those creating new resources, proposing new policies, and championing new partnerships to address an issue don’t mesh with the ground-level work being done by those dealing with the day-to-day realities of life facing those affected.

The more complex, entrenched, and multi-faceted a social problem is, the greater the need to change the underlying systems contributing to the problem. I’ve seen a lot of separate top-down or bottom-up efforts, but often those approaches and efforts aren’t coordinated or connected, leading to this missing middle. And what inevitably happens is that the solutions never take hold; they apply a temporary solution to the problem rather than solving it for good.

The Missing Middle

This is where systems entrepreneurs—those organizations and individuals who make systems change possible by bringing together disparate disciplines, interests, and stakeholders—play probably their most important role.

Helping ensure all the relevant partners—from government and media to investors and practitioners—are invited to the systems change table is the essential first step. As independent brokers, if you will, systems entrepreneurs make that possible. But then it is crucial that those around the table really understand each other, if their potential synergy is to be realized. The systems entrepreneur plays the role of bridging those gaps.


The Need to Illuminate Blind Spots

It’s not uncommon that we focus on the top-down components. As important, highly-visible levers—such as advocacy campaigns, policy changes, or new business models—we tend to think these aspects collectively make up the system and will be enough to solve a complicated problem.

Except that it underestimates the complexity of behavioral change.

I’ve seen funders, entrepreneurs, and organizations who have been part of creative responses to needs puzzled and then frustrated when their initiatives do not get embraced as well as they had imagined. They couldn’t understand why their product or program was not more gratefully received.

Sometimes it was because of differing values: what they perceived to be the most important issues were not shared by the communities they were seeking to help.

Oftentimes it was because they did not understand that the subjects of their concern acknowledged the importance of the same issue, but saw it in a different way. For example, passing laws in a capital may not translate into much practical difference in a remote part of the country where suspicious community members see legislators as distant, faceless bureaucrats who don’t understand what real life is like out there.

Each party brings to the table their own worldviews and blind spots.

This issue of differing perspectives sounds like it should be simple enough to solve if all those involved have a common end goal. But it’s important to recognize that while people may share a desire to be part of bringing about great change, that doesn’t mean they are perfect. They can misunderstand and miscommunicate, and be territorial and tetchy.

That’s where the role of a systems entrepreneur becomes vital. As an independent voice who can understand the context behind divergent viewpoints, they are in a position to illuminate everyone’s blind spots and be a bridge between disparate people and opinions.

They become the translator, the coordinator, the mediator, and the matchmaker.  This allows for better, more contextualized ideas and solutions that all sides can work towards.

Putting it in Practice: How We Learned to Close the Gap

One example of the way we connected programs to the grassroots level comes from our work in an area of Zambia’s Luapula province. This area was for more than fifty years known as the Valley of the Blind because of a blindness rate three times the national average.

Northern Zambia's Luapula Valley

Visiting our partners in Northern Zambia’s Luapula Valley


In bringing a holistic, systems change-type approach to the challenge, it became clear to us that part of the problem lay with the traditional faith healers. They were where most people first turned with impaired vision, but the help they got only made things worse.

The healers used herbal treatments that just exacerbated eye problems, and by the time people turned to the area’s actual hospitals for help, it was often too late to avoid or repair lasting damage.

The obvious top-down answer was to just stop the healers and have people go for qualified help, but that clinical answer failed to take into account a major cultural factor—their primary place of influence in the community.

Knowing this, we were able to help develop a program in which rather than being disparaged, the healers were conscripted as first-line helpers, trained in simple diagnostics and given basic medicines to prescribe. We were able to convince them to change their practices and it still preserved their livelihood and their role within the community.

Understanding the context meant that we also knew that many people chose not to go to proper clinics or hospital because they couldn’t get there easily, they were not staffed adequately, or did not have the medicines needed when they did.

So, the systems change project also needed to change people’s perceptions of formal health services by improving access and resources.

In another program we ran for a client in neighboring Namibia, our goal was to improve community health standards. The Chief Medical Officer of the district had been frustrated that by the time people came to the hospital, often it was too late to save them. That not only led to unnecessary deaths but also reinforced the narrative that the hospital and its staff was ineffective. We needed to change how a whole district—about 300,000 people—thought about and managed its health.

We helped build a stakeholder group made up of community members, six regional government entities (such as the ministry of health, ministry of education, etc.), grassroots NGOs and large international nonprofits, and the business community—anyone who had a vested interest or touched some aspect of the community’s health.

Playing the role of the bridge builder, we created a safe space to bring these different organizations and individuals together to figure out how they could collaborate to solve the community’s health issues. Knowing they were working towards the same goal, different local government agencies were able to reallocate their budget to collectively fund the health campaign and efforts to raise awareness and improve health practices. The key here was the ability to get the top-down influencers—government entities, businesses, and other groups—to mesh their agenda and activities with the bottom-up realities on the ground.

Why Patience and Flexibility is Key

Given the critical part bridging the “missing middle” in systems change plays, why is it so often overlooked? In large part because it is less appealing, and certainly less rewarding in the short-term.

The top-down part of systems change is exciting; it’s out-of-the-box thinking and passion for change. The bottom-up part of systems change is inspiring: it’s on-the-ground action and passion for change.

The missing middle is less “sexy.” It can be painstakingly slow and frustrating, but it is where true systems change is actually facilitated by those who can bring the two necessary levels or sides together most effectively.

It requires patience, persistence, and an understanding of the different spoken and cultural languages of the different players. It recognizes, for example, that text and email may make for instant communication in the West, but in parts of the world that are still largely oral cultures you can’t just send someone a document; you have to go and speak with them directly.

All of this requires not just a long-term view and commitment, but a high degree of humility—in trying to bring different stakeholders together, there is always going to be someone who doesn’t like you!—and a good measure of graciousness.

It also necessitates considerable flexibility, and an ability to adapt and change and encourage others to do so even as the systems change initiative is in process.

That’s because the big targets we are aiming at are not fixed. Diseases don’t stay the same; they develop new strains and become drug-resistant. Human traffickers don’t keep operating the same way; they develop new systems and routes to keep ahead of the law.

As a result, bringing top-down and bottom-up actors together in pursuit of systems change can feel a bit like building an aircraft as you are flying it.

The return on all that investment is results that could not be realized any other way, when the sum of the whole truly is greater than the individual parts.

It’s why at Geneva Global we are glad to have the opportunity to bring our many years of experience and insight to filling that “missing middle,” in our role as systems entrepreneurs.