TY - JOUR
T1 - Street-level bureaucrat's coping strategies in health policy implementation
T2 - a comparative case study from Sawla-Tuna-Kalba district of Ghana
AU - Kipo-Sunyehzi, Daniel Dramani
N1 - Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Springer Nature Limited.
PY - 2023/9
Y1 - 2023/9
N2 - 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.
AB - 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.
KW - Coping strategies
KW - Ghana
KW - Sawla-Tuna-Kalba district
KW - Street-level bureaucrats
UR - http://www.scopus.com/inward/record.url?scp=85141433207&partnerID=8YFLogxK
U2 - 10.1057/s41285-022-00190-8
DO - 10.1057/s41285-022-00190-8
M3 - Article
AN - SCOPUS:85141433207
SN - 1477-8211
VL - 21
SP - 267
EP - 285
JO - Social Theory and Health
JF - Social Theory and Health
IS - 3
ER -