Street-level bureaucrats and the (in)effectiveness of malaria control in Punjab

ABSTRACT

This research sheds light on various environmental factors that lead to different decisions regarding the implementation of health policy by street-level bureaucrats (SLBs) in similar districts. The paper explores the factors behind different incidence of malaria in two districts of South Punjab-Pakistan that possessed similar characteristics, focusing on the actions of frontline workers and policymakers. Based on semi-structured interviews with frontend workers, observation of health units from the two districts and review of policy documents on epidemic control programs, we find that SLBs practice lesser discretion when they perceive the policy issue as grave and as policymakers increase surveillance of SLBs, their discretion decreases. We also find that when SLBs have higher room for discretion, they choose convenient behaviors that provide them quicker results.

KEYWORDS:

• Street-level bureaucrats
• Malaria Control Program
• healthcare policy
• digression
• policy implementation

Acknowledgments

The authors would like to thank Marium Ashfaq for helping with the editing and presentation of this paper. We would also like to thank Sarmad Fateh, Maleha Ahmad, Maha Abubakar, Nasir Abbas, and Aeman Husain for helping us with data collection.

Disclosure statement

We declare to Taylor & Francis, as per their policy, there was no funding received for this research or paper.

Additional information

Notes on contributors

Mohsin Bashir

Mohsin Bashir is an Associate Professor at the Suleman Dawood School of Business in the Lahore University of Management Sciences. His research is mainly focused on public administration, nonprofit management and human resource management.

Kainat Shakil

Kainat Shakil is a Research Fellow at the Shahid Javed Burki Institute of Public Policy at NetSol. Her research interests focus on governance, public policy and development.