When and where do social innovations emerge? We address this question using comparative and historical analyses of organizing for palliative care in India. Although palliative care made inroads into different parts of India in the 1980s, it evolved as a vibrant sector only in the state of Kerala, through a novel community-based approach. By examining historical and social conditions, we reveal how poisedness, and particularly political poisedness, of time and place manifests in the genesis and propagation of a social innovation. We contribute to the literature on macro-foundations of social innovations by illustrating how an array of organizations and individuals create the very conditions of poisedness that are thereafter leveraged by institutional actors for the construction of novelty and propagation. Moreover, we specify the conditions of poisedness that are conducive to propagation, thereby contributing to conversations on distinct phases of emergence.

Background: The community form of palliative care first constructed in Kerala, India has gained recognition worldwide. Although it is the subject of important claims about its replicability elsewhere, little effort has gone into studying how this might occur. Drawing on translation studies, we attend to under-examined aspects of the transfer of a community palliative care intervention into a new geographic and institutional context. Methods: Over a period of 29 months, we conducted an in-depth case study of Sanjeevani, a community-based palliative care organization in Nadia district, West Bengal (India), that is modelled on the Kerala approach. We draw upon primary (semi-structured interviews and field notes) and secondary data sources. Results: We identify the translator’s symbolic power and how it counteracts the organizational challenges relating to socio-economic conditions and weak histories of civil society organizing. We find that unlike the Kerala form, which is typified by horizontal linkages and consensus-oriented decision-making, the translated organizational form in Nadia is a hybrid of horizontal and vertical solidarities. We show how translation is an ongoing, dynamic process, where community participation is infused with values of occupational prestige and camaraderie and shaped by emergent vertical solidarities among members. Conclusions: Our findings have implications for how we understand the relationship between locations, institutional histories, and healthcare interventions. We contribute to translation studies in healthcare, and particularly to conversations about the transfer or ‘roll out’ of palliative care interventions from one geography to another.

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