Integrating HIV and maternal health services: will organizational culture clash sow the seeds of a new and improved implementation practice?

Drawing on an analysis by Pritchett et al of the "techniques of persistent implementation failure" common across many development sectors, this commentary suggests that health systems attempting to integrate maternal health and HIV services may need to contend with a profound clash of organizational cultures. For decades, countries have been pressed to implement global "best practices" in maternal health without attention to the systemic capacity building needed to support complex interventions. The result is often form without function, a kind of "isomorphic mimicry" in which policy documents and program plans that meet global standards ultimately camouflage deep dysfunction in the actual delivery of lifesaving services. As a result, the organizational culture that surrounds maternal health services often stands in stark contrast to the can-do style that has characterized the rapid, well-resourced deployment of HIV services over the last few years. As integration proceeds, the resolution of this clash may hold the seeds of a much-needed transformation of implementation support practices in both fields.