Healthcare workers are street-level bureaucrats (H-SLBs) who are expected to perform according to specific roles. The COVID-19 pandemic has strained healthcare systems to unprecedented levels. The acute scarcity of medical resources has left H-SLBs exposed to a higher risk of personal harm and has them making an increased number of decisions in the apportionment of scarce life-saving treatment. The article studies the case of H-SLBs in Mexico to understand the impact of the crisis on their roles. The pandemic provides an opportunity to observe role changes during crisis. Their roles, derived from two policy guidelines, and from the de facto roles that H-SLBs shared in the storytelling interviews, are coded, analyzed, and compared. Findings suggest two main roles, client-processing and resource-rationing, guide the set of sub-roles H-SLBs perform to cope with the challenges brought by the COVID-19 pandemic.Note: In the interests of space, street-level theory and the pandemic context underpinning the articles for this Special Issue are discussed in detail in the Introduction to the Issue.

The study of street-level bureaucracy has been dominated by research from the Global North. Mainstream conceptualizations are, therefore, based on observations from institutional contexts that may vary significantly from the working conditions of frontline workers elsewhere. This article takes stock of the growing body of literature on street-level bureaucracy in weak institutional contexts and brings together relevant insights from comparative political science and public administration into a coherent analytical framework. We identify four institutional factors that shape frontline working conditions and three behavioral patterns in frontline worker agency. These patterns in frontline agency – ranging from policy improvisation to informal privatization – can be understood as an institutional waterbed effect caused by institutional deficiencies, such as resource scarcity and accountability gaps: if the complexity of public service provision is not tackled at the institutional level, it is pushed towards the street-level where frontline workers cope with it in highly diverse ways. Points for practitioners Frontline workers in weak state institutions are commonly faced with highly precarious working conditions. If the structural preconditions for policy implementation and rule enforcement are unresolved, these complexities are pushed towards frontline workers that cope with them through informal privatization, policy improvisation, or alienative commitment focused on mere job survival. Frontline agency is an indispensable factor for understanding the selective and often distributive nature of service delivery and rule enforcement in the Global South.

Despite taking the citizen experience of policy implementation as starting point for analysis, the literature on administrative burdens has mostly portrayed citizens as passive victims of burdens. Based on a literature review, three hypotheses are formulated regarding citizens' capacity to ease the impact of administrative burdens through behavioral adjustment, use of social and human capital, and strategic behavior. Evidence for these strategies is found in a case study of beneficiaries' behavior in a Mexican social program, where even the most vulnerable citizens have resources to reduce the impact of administrative burdens, even if the actual causes of those burdens remain out of reach. The findings contribute to understanding (a) variance in people's experience of administrative burdens, (b) the impact of prolonged street‐level interactions on people's ability to ease administrative burdens, (c) the importance of studying informal street‐level interactions, and (d) the relevance of studying state‐citizen interactions in developmental contexts.

How do frontline workers behave when they are, from one day to the other, left without clients because the policy that organized their street-level interactions has been terminated? This is what happened in early 2019 to the staff of medical centers across Mexico after the sudden transformation of the longstanding social program Prospera. Interviews with frontline workers show that they respond to this "policy void" by developing strategies of informal talks, community outreach, and the investment of personal resources to recover their clients. The findings presented here are relevant for understanding how frontline workers cope with public service gaps in developing countries. The notion of "policy improvisation" as a coping mechanism-frontline workers developing informal policy activities when being left without proper implementation instructions and capacity-is used here to signal the broader phenomenon of human resource neglect and implementation gaps in Latin American public administration.

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