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Street-Level Bureaucrats: From Obedience to Participation
Abstract
This chapter presents the first piece of empirical evidence on the nature of officer–recipient relationships in Oportunidades-Prospera by scrutinizing the perspectives of physicians and nurses implementing the program in two localities of the state of Puebla. It presents the health officers’ experiences and attitudes toward program delivery, their work, and especially recipients. It complements interviews with observations of interactions at the waiting room and during the delivery of the health workshops. The findings indicate that officer–recipient interactions are unavoidably infused with authority and power as a result of three distinguishing factors. First, the discourse of conditionality of Oportunidades-Prospera; second, the contrasting professional and socioeconomic identities of officers and recipients; and third, the job position of temporary and permanent officers. Temporary and permanent officers clearly fostered different interactions with recipients. The former—mostly managing the clinic in Cualcan—promoted a relationship of empathy, reciprocity, and communication, whereas the latter—mostly in Nexpan—promoted a hierarchical relationship driven by obedience and compliance. This chapter ends exploring how relationships at different levels –between staff, within the localities, and between staff and the National Ministry of Health—are additional relational layers explaining officer–recipient interactions.
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Este documento presenta un análisis de la Encuesta Nacional
sobre Discriminación en México con el objetivo de valorar la
importancia de las prácticas y actitudes de discriminación en la vida
cotidiana de la población. Los resultados revelan a una sociedad con
intensas prácticas de exclusión, desprecio, y discriminación hacia
ciertos grupos, y tal vez más preocupante aún, revelan que la
discriminación está fuertemente enraizada y asumida en la cultura
social y que se reproduce por medio de valores culturales en el seno de
la familia. Esta realidad, de presentarse de manera generalizada en
América Latina, podría representar una restricción considerable para
el fortalecimiento y la ampliación de la cohesión social. Más aún, hace
más difícil construir consensos alrededor de la idea de un contrato
social integrador. Dada esta posibilidad, se vuelve aún más relevante
la discusión e identificación de las estrategias y de las políticas
públicas más adecuadas para hacerles frente, y el análisis que aquí se
presenta busca precisamente contribuir en este sentido
Authoritarian medical habitus in Mexico begins during the years of medical school training, residency and specialization. Elements of this process include the hierarchies of the profession, gender inequality and punish-ment as a teaching resource. This article describes the functioning of the medical habitus on the basis of observations in delivery rooms in public hospitals. The solution to the problem of human rights violations of women in health services would involve a restructuring of the medical field and the development of users' citizenship.
This article builds on the work of Michael Lipsky and develops an argument about the significance of interprofessional working for street-level bureaucracy. It presents an ethnographic analysis of criminal justice social workers writing presentence reports for the Scottish courts. Social workers' report writing for judges brought into relief issues of relative professional status. Social workers were uncertain of their place within the legal domain and concerned about their credibility as criminal justice professionals. Reports were written, in part at least, as a way of seeking esteem and credibility in the eyes of judges—a motivation that undermined the policy objectives of social enquiry in sentencing. Applying the conceptual tools of Bourdieu to our findings, we argue that street-level bureaucrats who have to work across bureaucratic “fields” may find, or fear, that the cultural and symbolic “capital” they retained within their own field is undervalued in the symbolic economy of new fields, putting them in a position of relative inferiority. This issue of relative professional status, and how officials respond to it, is significant for our understanding of street-level bureaucracy.
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 long‐standing 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.
This article explores interactions between the front-line officers and recipients of Oportunidades-Prospera, a conditional cash transfer (CCT) in Mexico. Like other CCTs, Oportunidades-Prospera provided monetary transfers to families with the requirement of following certain conditions, including receiving preventive healthcare and workshops. This produced constant and compulsory physician-recipient interactions. This article examines these through observations of programme delivery and interviews with physicians at health centres of two localities of Puebla. The results show that officers’ strategies of implementation and attitudes towards recipients were influenced by the programme’s use of health services as conditionalities, promoting a relationship of authority and obedience. This, however, was exacerbated by the officer’s job position. Those with a permanent contract systematically fostered authoritarian interactions compared to officers with temporary contracts. Ultimately, this study reveals factors that influence officer-recipient relationships in CCTs and their centrality for programme delivery and for the success of social policies more broadly.
Background:
In England, public health nursing has been subject to major policy reform. The Health Visitor Implementation Plan (2011) set out a plan to recruit increasing numbers of nurses and midwives to the profession to deliver an expanded and refocussed health visiting service. Exploring this policy change from the viewpoint of those new to health visiting offers a unique perspective into how a specific policy vision is translated into nursing practice.
Methods:
A descriptive qualitative study in which participants were enrolled on a one-year post-graduate health visiting course at a University in South West of England. Qualitative data were collected pre- and post-qualification. A total of 16 interviews and a focus group were conducted with nine participants between September 2012 and March 2013. Findings Descriptive data were interpreted using Lipsky's theoretical framework of street-level bureaucracy. Three themes emerged which relate to this 'bottom-up' perspective on policy implementation; readiness to operationalise policy, challenges in delivering the service vision; and using discretion in delivering the vision. Community public health nurses operate as street-level bureaucrats in negotiating the demands of policy and practice, and by this means, attempt to reconcile professional values with institutional constraints. Barriers to policy implementation at a local level mediate the effects of policy reform, ultimately impacting upon outcomes for children and families.
What is the role of culture in street-level bureaucrats' bending the rules and accepting informal payments for health care? The literature on street-level bureaucrats stresses the importance of both individual and organizational factors in understanding how they use their discretion, but usually neglects the importance of the culture in determining how far they are willing to go in exercising this discretion. Using data from 102 in-depth interviews with doctors and nurses in Israel, and by linking the literature about street-level bureaucrats to that of the research on informal payments for healthcare, we demonstrate that the culture plays a key role in decisions about accepting such payments. According to our findings, such payments are a phenomenon rooted in the culture and range from the extreme case of bribery to the fuzzier area of making exceptions for favored and sympathetic clients.
Social workers are classic street-level bureaucrats. This article provides a critical examination of Michael Lipsky's account of discretion within street-level bureaucracies. While concurring with the main thrust of Lipsky's critique of management control of discretion, I argue that he gives insufficient attention to the role of professionalism in his analysis and the impact this has on the relationship between front line managers and workers and the nature of discretion. I employ a qualitative case study of adult social work within a local authority to illustrate and develop this argument. The study, which draws primarily on interviews with local managers and practitioners, suggests that the professional status of social workers influences both the nature of their discretion and the way in which this is managed. I conclude that Lipksy's work needs to be augmented by an understanding of the role of other perspectives, such as professionalism, in examining manager-worker relations and discretion in the street-level bureaucracies within which social workers practise.
This reassessment of the continuing significance of Lipsky's (1980) work on ‘street-level bureaucracy’ for frontline decision making is based on a retrospective review of the author's research on assessment practice in adult social care in England. The studies span the past two decades during which time successive governments have restructured and modernized social services departments. When these were established in 1970, they represented the high watermark of bureau-professionalism – a mode of administration which dominated social welfare at the time Lipsky was writing. The subsequent dismantling of bureau-professionalism calls into question the validity of his findings, and the author draws on her own research to assess conflicting views about the impact of social care reforms on the discretion which social workers exercise as street-level bureaucrats. She concludes that the distinct types of discretion to emerge from her findings, represented in a taxonomy, are shaped by the differing micro environments of frontline practice which, in turn, affect the relative force of managerialism, professionalism and user empowerment in countering the defensive exercise of discretion described by Lipsky. Whilst her analysis affirms the continuing significance of Lipsky's analysis, it also points to the need for some revision to accommodate major shifts in welfare administration since the publication of his work. She highlights the potential relevance of these insights for investigating the next planned transformation of adult social care, personalization, as well as for the implementation literature more widely.
An operations evaluation of PROGRESA from the perspective of beneficiaries, promotoras, school directors, and health staff
- M Adato
- D Coady
- M Ruel