One of the most enduring questions in health policy analysis is why policies are often implemented in unintended ways; why implementation “on the ground” looks different to the intentions of top-level policy makers or the objectives of official policy documents.
Part of the answer lies in the working environments and mind-sets of street-level bureaucrats: front-line workers or policy implementers such as nurses, teachers and police officers.
This guidance note, courtesy of the Health Policy and Systems Division of the University of Cape Town, summarises the theory of street-level bureaucracy. It is intended to be used as a teaching resource, with the aim of introducing students to street-level bureaucracy theory and stimulating them to read further. It can work well with CHEPSAA’s module Health Policy Analysis or any other discussion of the behaviour of front-line health policy implementers.
This summary was developed in the context of work that synthesised the literature on street-level bureaucracy, as well as other aspects of the health policy analysis literature in low- and middle-income countries. This open access work can be accessed here.