How social networks affect policy implementation: An analysis of street‐level bureaucrats' performance regarding a health policy

Abstract

Policy implementation is an interactive process between citizens and street-level bureaucrats. Although the literature has already addressed different factors that influence discretion, there is still a gap in understanding if and how bureaucrats' relational profiles affect policy implementation.This article analyses bureaucrats' interactions and the relational environments in which they exercise their discretion.The hypothesis is that bureaucrats' different relational profiles specify policy implementation at the street level. We study bureaucrats in a Brazilian health care programme involving community workers that requires regular visits to beneficiary families' homes. The research departs from ethnography and network analyses with workers from three very different contexts. We analyse bureaucrats' practices, the discursive styles mobilized in their interactions, and their personal networks. The results show that organizational factors are central to explain variations in practices, and their relational profiles highly influence the discursive styles used by bureaucrats in their interactions with citizens. The article concludes that relational elements can affect the exercise of discretion and influence interactions at the street level and should be incorporated more systematically in the implementation literature.

Desafios para a Atenção Primária à Saúde no Brasil: uma análise do trabalho das agentes comunitárias de saúde durante a pandemia de Covid-19

“…Profissionais da APS estão bem posicionados para fazer um diagnóstico precoce, identificar infectados e seus contactantes e fornecer informações de qualidade durante a pandemia (Ang, Rohani e Look, 2010;Deckers et al, 2006;Hogg et al, 2006). Entre esses profissionais, as Agentes Comunitárias de Saúde (ACSs) têm elevado potencial de atuação em crises sanitárias que demandam enfrentamento comunitário pela familiaridade com o contexto local e a relação continuada que estabelecem com a comunidade (Haines et al, 2020;Lotta et al, 2020;Nunes e Lotta, 2019;World Health Organization, 2018;Nogueira et al, 2020aNogueira et al, , 2020bRahman, Ross e Pinto, 2021). Entre as potencialidades das ACSs durante a pandemia estão a capacidade de realizar atividades de disseminação de informações e prevenção; o rastreamento de contatos; o acompanhamento de doentes; a identificação de casos de vulnerabilidade que devem ser acompanhados pela saúde e pela assistência.…”

“…Assim, tendo a análise do trabalho das ACSs como uma referência para reconhecer as fragilidades da APS e entendendo que a situação enfrentada por essas profissionais representa desafios estruturais do sistema de saúde (Lotta et al, 2020), este artigo tem como objetivo apresentar e analisar a situação das ACSs no enfrentamento à pandemia de Covid-19. Analisamos os desafios dessas profissionais observando três dimensões: as mudanças nas práticas de trabalho; as mudanças nas interações entre trabalhadores e usuários e a expectativa do futuro no trabalho pós-pandemia.…”

“…Diferentemente de crises epidêmicas anteriores, durante a pandemia de Covid-19, estas profissionais não têm tido papel central (Lotta et al, 2020;Morosini, Fonseca e Lima, 2020;Costa et al, 2021). Na realidade, o treinamento e direcionamento destas profissionais para combater a Covid-19 não se formalizou como uma política nacional deliberada.…”

Street-Level Bureaucrats at the Forefront of Pandemic Response: A Comparative Perspective

“…Nevertheless, in all countries examined, street-level implementation is characterized by increased policy ambiguity, demand, uncertainty, and insufficient resources to meet citizens' needs. One preliminary insight is therefore an emphasis on applying a comparative perspective, which has rarely been taken in street-level studies, not only with regard to macro-level aspects, but also on meso-level aspects, mainly comparing structural and organizational arrangements of street-level implementation (Brodkin 2021; see also Brodkin 2011Brodkin , 2012Brodkin , 2013 and the social networks and power relationships in which they are embedded (Nunes and Lotta 2019;Lotta and Marques 2020).…”

“…Ever since, rich scholarship has documented the ways through which SLBs exercise their discretionary power and what influences their attitudes, decisions, and behavior during direct-delivery interactions (e.g. Evans and Harris 2004;Hupe and Hill 2007;Tummers et al 2015;Lotta and Marques 2020). Often portrayed as "policy of street-level implementation, such as discretion, ambiguity, and professionalism.…”