Coping with Denialism: How Street-Level Bureaucrats Adapted and Responded to COVID-19 in Tanzania.

IF 3.3 3区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Journal of Health Politics Policy and Law Pub Date : 2021-12-01 DOI:10.1215/03616878-9349128
Ruth Carlitz, Thespina Yamanis, Henry Mollel
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引用次数: 8

Abstract

Context: This article aims to highlight challenges and adaptations made by local health officials in Tanzania in working to contain and manage COVID-19.

Methods: The study takes an inductive approach, drawing on the reported experiences of 40 officials at different levels of government across four purposefully selected regions in July 2020. Interviewees were asked about the guidance they received to contain COVID-19, the source of that guidance, their challenges and successes in implementing the guidance, and if and how they adapted the guidance to their particular setting.

Findings: The interviews depict considerable challenges, including a lack of supplies and resources for implementing infection control, surveillance, and mitigation practices and dealing with fear and stigma. At the same time, they also provide evidence of innovation and adaptation among street-level bureaucrats. Respondents overwhelmingly praised the president, whose limited national response is seen as helpful for reducing fear and stigma.

Conclusions: Other scholars have highlighted the potential dangers of street-level discretion if local officials "make policy" in ways that contradict their agencies' stated goals. In contrast, our study suggests benefits of autonomy at the street level-particularly in contexts where the central state was relatively weak and/or acting against the public interest.

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应对否认主义:坦桑尼亚街头官僚如何适应和应对COVID-19。
背景:本文旨在强调坦桑尼亚地方卫生官员在努力控制和管理COVID-19方面面临的挑战和作出的调整。方法:本研究采用归纳法,借鉴了2020年7月有目的地选择的四个地区40名各级政府官员的经验报告。受访者被问及他们在控制COVID-19方面获得的指导、指导的来源、他们在实施指导方面面临的挑战和取得的成功,以及他们是否以及如何使指导适应其特定环境。调查结果:访谈描述了相当大的挑战,包括缺乏用于实施感染控制、监测和缓解做法以及处理恐惧和污名的供应和资源。与此同时,它们也提供了基层官僚创新和适应的证据。受访者压倒性地赞扬了总统,他有限的国家反应被视为有助于减少恐惧和耻辱。结论:其他学者强调,如果地方官员“制定政策”的方式与他们机构的既定目标相矛盾,那么街头自由裁量权的潜在危险。相比之下,我们的研究表明,在街头自治的好处——特别是在中央政府相对薄弱和/或违背公共利益的情况下。
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来源期刊
CiteScore
7.30
自引率
7.10%
发文量
46
审稿时长
>12 weeks
期刊介绍: A leading journal in its field, and the primary source of communication across the many disciplines it serves, the Journal of Health Politics, Policy and Law focuses on the initiation, formulation, and implementation of health policy and analyzes the relations between government and health—past, present, and future.
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