Travelling models and the challenge of pragmatic contexts and practical norms: the case of maternal health

Olivier de Sardan, Jean-Pierre; Diarra, Aïssa; Moha, Mahaman

doi:10.1186/s12961-017-0213-9

Cited by 167Health Policy Implementation ScienceGlobal Maternal and Child HealthGlobal Health and Surgery

Travelling models and the challenge of pragmatic contexts and practical norms: the case of maternal health

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Olivier de Sardan, Jean-Pierre, Diarra, Aïssa, Moha, Mahaman·2017·Health Research Policy and Systems

DOI 10.1186/s12961-017-0213-9PMC PMC5516842

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Abstract

As in other areas of international development, we are witnessing the proliferation of 'traveling models' developed by international experts and introduced in an almost identical format across numerous countries to improve some aspect of maternal health systems in low- and middle-income countries. These policies and protocols are based on 'miracle mechanisms' that have been taken out of their original context but are believed to be intrinsically effective in light of their operational devices.In reality, standardised interventions are, in Africa and elsewhere, confronted with pragmatic implementation contexts that are always varied and specific, and which lead to drifts, distortions, dismemberments and bypasses. The partogram, focused antenatal care, the prevention of mother-to-child transmission of HIV or performance-based payment all illustrate these implementation gaps, often caused by the routine behaviour of health personnel who follow practical norms (and a professional culture) that are often distinct from official norms - as is the case with midwives.Experiences in maternal and child health in Africa suggest that an alternative approach would be to start with the daily reality of social and practical norms instead of relying on models, and to promote innovations that emerge from within local health systems.

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Interventions based on traveling models may be unsuitable for real-world health facilities.
“However, in-depth field analyses, particularly by anthropologists, have shown that (1) interventions based on these models may be unsuitable for real-world health facilities,”
From The gender factor in meeting the needs of women who use drugs in Senegal (2025) · cites this paper as [17]
Traveling models are often only partly implemented at the field level.
“(2) models are often only partly implemented at the field level,”
From The gender factor in meeting the needs of women who use drugs in Senegal (2025) · cites this paper as [17]
Traveling models are disconnected from the local context.
“(3) they are disconnected from the local context [17].”
From The gender factor in meeting the needs of women who use drugs in Senegal (2025) · cites this paper as [17]
Traveling models are frequently applied by health institutions in different African countries.
“Traveling models are frequently applied by health institutions in different African countries.”
From The gender factor in meeting the needs of women who use drugs in Senegal (2025) · cites this paper as [17]

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Authors: Olivier de Sardan, J.-P., Diarra, A., & Moha, M.
Affiliations: Laboratoire d'Études et de Recherche sur les Dynamiques Sociales et le Développement Local (NE)
ORCID: Diarra, Aïssa
Venue: Health Research Policy and Systems
Publisher: Springer Science and Business Media LLC
Published: 2017-07
Volume: 15
Issue: S1
Pages: 60-60
ISSN: 1478-4505 (ISSN-L)
DOI: 10.1186/s12961-017-0213-9
PMC: PMC5516842
OpenAlex: W2736206036
Cited by: 167
References: 146
Citations by year: 2026: 10 · 2025: 12 · 2024: 18 · 2023: 20 · 2022: 28 · 2021: 18 · 2020: 30 · 2019: 9 · 2018: 16 · 2017: 6
FWCI: 2.94
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
Locations: Health Research Policy and Systems (publishedVersion, cc-by)
Europe PMC (PubMed Central) (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders: International Development Research Centre
Topics: Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Global Health and Surgery
Keywords: policy transfer, maternal health, implementation gap, practical norms, professional culture, midwives, partograph, focused antenatal care, prevention of mother-to-child transmission of HIV, performance-based pay, low- and middle-income countries, Africa
MeSH terms: Maternal Health, Africa, Community Health Workers, Female, Health Services Accessibility, Humans, Maternal Health Services, Midwifery, Pregnancy, Prenatal Care

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Travelling models and the challenge of pragmatic contexts and practical norms: the case of maternal health

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