Street-level bureaucrat's coping strategies in health policy implementation: a comparative case study from Sawla-Tuna-Kalba district of Ghana

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Abstract

The article examines the factors and conditions that affect street-level bureaucrats in health service delivery and how the street-level bureaucrats cope with their working conditions in rural Ghana. It draws insight from Lipsky’s street-level bureaucracy theory. The study argues that street-level bureaucrats coping strategies are not necessarily out of job frustrations but due to motivational factors. It further argues that street-level bureaucrats’ behaviour towards subscribers matters most in healthcare service delivery. The research design is a qualitative comparative case study approach. It compares public and private health facilities' street-level bureaucrats’ behaviour/actions and coping strategies in healthcare service delivery. The data are obtained from in-depth interviews, focus group discussions, document reviews and direct observations and some statistics from census, health insurance claims and health facilities attendance. The sample size is 65 and data are analysed using thematic analysis. The results show that private health facilities exhibit more positive attitudes/behaviour towards health insurance subscribers than their public counterparts. The results imply that the private health facilities coping strategies are ‘moving towards clients’ rather than ‘moving away’ or ‘against clients’. It recommends future research may adopt a quantitative research design with larger samples and with a rural–urban comparative study.

Original languageEnglish
Pages (from-to)267-285
Number of pages19
JournalSocial Theory and Health
Volume21
Issue number3
DOIs
Publication statusPublished - Sep 2023

Keywords

  • Coping strategies
  • Ghana
  • Sawla-Tuna-Kalba district
  • Street-level bureaucrats

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