Coping with Denialism: How Street-Level Bureaucrats Adapted and Responded to COVID-19 in Tanzania

Abstract

Context: This article aims to highlight challenges and adaptations made by local health officials in Tanzania in working to contain and manage COVID-19. Methods: The study takes an inductive approach, drawing on the reported experiences of 40 officials at different levels of government across four purposefully selected regions in July 2020. Interviewees were asked about the guidance they received to contain COVID-19, the source of that guidance, their challenges and successes in implementing the guidance, and if and how they adapted the guidance to their particular setting. Findings: The interviews depict considerable challenges, including a lack of supplies and resources; enforcing physical distancing, contact tracing and surveillance; and dealing with fear and stigma. At the same time, they also provide evidence of innovation and adaptation among street-level bureaucrats. Respondents overwhelmingly praise the President, whose limited national response is seen as helpful to reduce fear and stigma. Conclusions: Other scholars have highlighted the potential dangers of street-level discretion if local officials may “make policy” in ways that contradict their agencies’ stated goals. In contrast, our study suggests benefits of autonomy at the street level—particularly in contexts where the central state is relatively weak and/or acting against the public interest.

Challenges in Implementing the National Health Response to COVID-19 in Senegal

“…This study shows how the implementation of the national response to the COVID-19 pandemic in Senegal was rapid and intense, as elsewhere in West Africa (Bonnet et al, 2021 ), and sometimes even highly coercive. But at the same time, as in Tanzania at the beginning of the epidemic (Carlitz et al, 2021 ), it was rapidly diluted in national and local contexts that shaped it according to power issues, organizational challenges, and public perceptions of the disease. Some of the facilitating factors confirm this analysis: good preparation, commitment and reactivity of the actors, and capacity building.…”

“…The other explanation may be the fact that decentralization is still not very effective. The delegation of resources poses challenges to local adaptation when possible, as in Tanzania: “Nearly all respondents stated that decentralization of authority should be accompanied by more resources for epidemic management” (Carlitz et al, 2021 ). The few regional differences we observed were mostly related to the encounter of the national response with local contexts, as seems to be the norm in the study of public policy implementation in West Africa (Belaid & Ridde, 2015 ; Kwamie et al, 2016 ; Olivier de Sardan, 2021 ).…”

“…Moreover, the research demonstrates the politicization of implementation, where political and religious leaders sometimes played a prominent role which is often a constraining factor in the implementation. On the other hand, unlike in Tanzania, where the President's downplaying of the pandemic made the process of informing communities complicated (Yamanis et al, 2021 ) but allowed for local adaptations (Carlitz et al, 2021 ), this was not the case in Senegal, where the President seems to have been in charge. The Minister of Health confirmed this perspective, in July 2021, in his speech in which he received a prize for excellence (Cauris d'Or) for his fight against the pandemic.…”

“…The presidentialization of the response, but also its centralization, as in France (Rozenblum, 2021 ) and Tanzania (Carlitz et al, 2021 ), has had an impact on the perception of implementation strategies in the country's regions, particularly in a context where the pandemic was accompanied by social movements challenging the government in power. This may have been a favourable factor in certain regions or in mobilizing certain actors.…”

“…Indeed, the history of public policy studies shows that frontline actors are the actual policymakers (Lipsky, 2010 ). This broad understanding has been demonstrated in Africa (Erasmus, 2014 ) and more recently regarding the measures implemented against the COVID-19 pandemic in Tanzania (Carlitz et al, 2021 ; Yamanis et al, 2021 ). Taking into account the views of these actors (in terms of their understanding, but also their acceptance Hill & Hupe, 2014 ), especially at the local level, is an important element in understanding and planning the pandemic response (Semaanet al, 2020 ).…”