"You're only a receptionist, what do you want to know for?": Street-level bureaucracy on the front line of primary care in the United Kingdom.

Introduction: In care settings across the globe non-clinical staff are involved in filtering patients to the most appropriate source of care. This includes primary care where general practice receptionists are key in facilitating access to individual surgeries and the wider National Health Service. Despite the complexity and significance of their role little is known of how the decision-making behaviors of receptionists impact policy implementation and service delivery. By combining the agent-based implementation theory of street-level bureaucracy with a tri-level analytical framework this work acknowledges the impact of the decisions made by receptionists as street-level bureaucrats and demonstrates the benefits of using the novel framework to provide practical insight of the factors influencing those decisions. Methods: A secondary analysis of qualitative data gathered from a series of semi-structured interviews conducted with 19 receptionists in the United Kingdom in 2019 was used to populate a tri-level framework: the micro-level relates to influences on decision making acting at an individual level, the meso-level influences at group and organizational levels, and the macro-level influences at a societal or policy level. Results: At the micro-level we determined how receptionists are influenced by the level of rapport developed with patients and would use common sense to interpret urgency. At the meso-level, influences included their position at the forefront of premises, the culture of the workplace, and the processes and protocols used by their practice. At the macro-level, participants described the impact of limited health service capacity, the lack of mandatory training, and the growth in the use of digital technologies. Conclusions: Street-level bureaucracy, complemented with a tri-level contextual analysis, is a useful theoretical framework to understand how health workers, such as receptionists, attempt to provide universality without sufficient resource, and could potentially be applied to other kinds of public service workers in this way. This theoretical framework also benefits from being an accessible foundation on which to base practice and policy changes.

Os burocratas de nível de rua: possibilidades para os estudos em implementação de políticas públicas de esporte e lazer / Street-level bureaucracy: possibilities of studies in implementation of public policies for sports and leisure / os burócratas a pie de calle: posibilidades de estudio en la implementación de las políticas públicas de deporte y ocio

Considerando os estudos de implementação de políticas públicas, a teorização sobre os burocratas de nível de rua, de Michael Lipsky, é fundamental para entender os dilemas dos serviços públicos. Porém, essa temática ainda é pouco difundida nos estudos sobre as políticas públicas de esporte e lazer. Nesse ensaio objetivamos apresentar uma possibilidade de leitura da implementação de políticas públicas de esporte e lazer por meio do arcabouço teórico dos burocratas de nível de rua. Desse modo, compreendemos que os estudos em políticas públicas de esporte e lazer aliados à teorização dos burocratas de nível de rua poderão ser um caminho para o melhor entendimento dos fatores que impactam na tomada de decisões dos agentes esportivos que estão em contato com os cidadãos (Au)

Considering public policy implementation studies, Michael Lipsky's theorizing about street-level bureaucracy is critical to understanding public service dilemmas. However, this theme is still not widespread in studies on public sports and leisure policies. In this essay the main objective is introduce a possibility of public sports and leisure policies reading of implementation based on street level bureaucracy studies. Thereby studies on public sports and leisure policies, combined with the theorizing of street-level bureaucracy, may be a way to better understand the major factors that impact the decision-making by sports agents who are in contact with citizens (AU).

Considerando los estudios sobre la implementación de políticas públicas, la teorización sobre los burócratas a pie de calle, de Michael Lipsky, es fundamental para comprender los dilemas de los servicios públicos. Sin embargo, este tema aún está poco difundido en los estudios sobre políticas públicas de deporte y ocio. En este ensayo, pretendemos presentar una posibilidad de lectura de la implementación de las políticas públicas de deporte y ocio a través del marco teórico de los burócratas a pie de calle. Así, entendemos que los estudios sobre políticas públicas de deporte y ocio aliados a la teorización de los burócratas de calle pueden ser una forma de comprender mejor los factores que inciden en la toma de decisiones de los agentes deportivos que están en contacto con los ciudadanos (AU).

Atuação da APS em tempos de crise: uma análise da discricionariedade dos profissionais de saúde na pandemia da COVID-19 / The role of PHC in times of crisis: an analysis of discretion of health workers during the COVID-19 pandemic

Resumo Crises são eventos excepcionais que alteram os arranjos estruturais sob os quais a burocracia de nível de rua (BNR) atua normalmente, gerando insuficiência de recursos, suspensão de regras e de rotinas, e alteração das práticas de trabalho. Essas características ressaltam a importância do espaço de discricionariedade, uma vez que decisões rápidas precisam ser tomadas em um contexto atravessado pela imprevisibilidade. Neste artigo, analisamos o impacto da pandemia de COVID-19 no Brasil na discricionariedade dos profissionais de saúde da atenção primária à saúde (APS). Portanto, o objetivo do artigo é entender quais fatores impactaram a discricionariedade dos BNRs da APS, examinando aspectos organizacionais, emocionais e científicos. Para isso, analisamos os dados de um questionário, com respostas abertas e fechadas, com 1218 profissionais que atuavam na APS em março de 2021. Os resultados mostram que, diferente do esperado, a discricionariedade dos BNRs não se transforma em uma panaceia pela crise. Uma grande parcela dos profissionais seguiu operando dentro das regras, o que demonstrou a tendência dos BNRs de buscar respaldo para sua atuação, seja por melhores condições organizacionais, pela redução de incerteza ou por amparo na ciência.

Abstract Crises are exceptional events that alter the structural arrangements under which street-level bureaucrats (SLBs) normally operate, generating resource shortages, the suspension of rules and routines, and changes in work practices. These characteristics highlight the importance of room for discretion, since quick decisions need to be made in a context pervaded by unpredictability. This study analyzed the impact of the COVID-19 pandemic in Brazil on the discretion of primary health care workers, seeking to understand which factors influence the exercise of discretion, focusing on organizational, emotional and scientific aspects. We used data from an online survey comprising open- and closed-ended questions conducted in March 2021 with 1218 primary care workers. The results show that, unexpectedly, discretion of SLBs does not become a panacea for the crisis. A large portion of professionals continued to operate within the rules, demonstrating a tendency to seek support at work, either through better organizational conditions, the reduction of uncertainty or from science.

Discretion and local health policy implementation: street-level bureaucrats and integrative and complementary therapies in Santos' local health units.

This research discusses contextual factors that influence the development of complementary and/or integrative therapies developed by local health units on street-level bureaucracy in Santos. Through a qualitative approach, the research verifies that street-level bureaucracy is free to suggest and implement the aforementioned therapies, even if they do not have formal support of the municipality; however, they need support from their immediate local supervisors so they can adjust and implement the practice's routine, or the practice might not occur. Additionally, this text also presents guidelines in order to further develop the research.

Integrating Nutrition Actions in Service Delivery: The Practices of Frontline Workers in Uganda.

BACKGROUND: Integrating nutrition actions into service delivery in different policy sectors is an increasing concern. Nutrition literature recognizes the discrepancies existing between policies as adopted and actual service delivery. This study applies a street-level bureaucracy (SLB) perspective to understand frontline workers' practices that enact or impede nutrition integration in services and the conditions galvanizing them. METHODS: This qualitative exploratory study assesses the contextual conditions and practices of 45 frontline workers employed by the agriculture, health and community development departments in two Ugandan districts. RESULTS: Frontline workers incur different demands and resources arising at societal, organizational, and individual level. Hence, they adopt nine co-existing practices that ultimately shape nutrition service delivery. Nutrition integration is accomplished through: (1) ritualizing task performance; (2) bundling with established services; (3) scheduling services on a specific day; and (4) piggybacking on services in other domains. Disintegration results from (5) non-involvement and (6) shifting blame to other entities. Other practices display both integrative and disintegrative effects: (7) creaming off citizens; (8) down prioritization by fixating on a few nutrition actions; and (9) following the bureaucratic 'jobs worth'. Integrative practices are driven mostly by donors. CONCLUSION: Understanding frontline workers' practices is crucial for identifying policy solutions to sustain nutrition improvements. Sustaining services beyond timebound projects necessitates institutionalizing demands and resources within government systems. Interventions to facilitate effective nutrition service delivery should strengthen the integrative capacities of actors across different government levels. This includes investing in integrative leadership, facilitating frontline workers across sectors to provide nutrition services, and adjusting the nutrition monitoring systems to capture cross-sector data and support policy learning.

Giving condoms to school children: educators' views on making condoms available in South African schools.

One of the policy goals of the South African Department of Basic Education's National Policy on HIV, STIs and TB of 2017 is to reduce the incidence of HIV and pregnancy among learners. This is expected to be achieved by improving access to prevention services, including the provision of condoms in schools. This study uses street- level bureaucracy theory to explain how educators can play a more productive role in ensuring that policy goals are achieved. Educators provide their views on their role as condom promotion agents, their perception of demand and utilisation among learners, as well as their insights on suitable distribution mechanisms in the school setting. Trepidation exists among educators about their roles in the promotion and education of condoms. Educator statements suggest that they see the value in their policy-ascribed role to deliver sexual health messages and are also open to performing a role in the distribution of condoms at schools. However, our findings reveal that their role as policy communicators or "street-level bureaucrats" is complicated by inadequate policy guidance. We therefore conclude that to achieve optimal outcomes in terms of safer sexual practices among learners, condom messaging and distribution mechanisms in school settings require evidence-informed implementation strategies.

"Provider discretionary power practices to support implementation of patient-centered HIV care in Lusaka, Zambia".

Introduction: Traditional patient-provider relationships privilege the providers, as they possess the formal authority and clinical knowledge applied to address illness, but providers also have discretion over how they exercise their power to influence patients' services, benefits, and sanctions. In this study, we assessed providers' exercise of discretionary power in implementing patient-centered care (PCC) practices in Lusaka, Zambia. Methods: HIV clinical encounters between patients on antiretroviral therapy (ART) and providers across 24 public health facilities in Lusaka Province were audio recorded and transcribed verbatim. Using qualitative content analysis, we identified practices of discretionary power (DP) employed in the implementation of PCC and instances of withholding DP. A codebook of DP practices was inductively and iteratively developed. We compared outcomes across provider cadres and within sites over time. Results: We captured 194 patient-provider interactions at 24 study sites involving 11 Medical Officers, 58 Clinical Officers and 10 Nurses between August 2019 to May 2021. Median interaction length was 7.5 min. In a hierarchy where providers dominate patients and interactions are rapid, some providers invited patients to ask questions and responded at length with information that could increase patient understanding and agency. Others used inclusive language, welcomed patients, conducted introductions, and apologized for delayed services, narrowing the hierarchical distance between patient and provider, and facilitating recognition of the patient as a partner in care. Although less common, providers shared their decision-making powers, allowing patients to choose appointment dates and influence regimens. They also facilitated resource access, including access to services and providers outside of scheduled appointment times. Application of DP was not universal and missed opportunities were identified. Conclusion: Supporting providers to recognize their power and intentionally share it is both inherent to the practice of PCC (e.g., making a patient a partner), and a way to implement improved patient support. More research is needed to understand the application of DP practices in improving the patient-centeredness of care in non-ART settings.

Specialty Probation Officers as Street-Level Bureaucrats: Exploring How Discretion Is Perceived and Employed on a Mental Health Caseload.

This study explores the perceptions of specialty mental health caseload probation officers and their use of discretion in day-to-day supervision of individuals with mental illness in one large jurisdiction in the United States. Scholars have examined overall effectiveness of specialty probation programs, probation officers' roles as street-level bureaucrats, and the impact of the mental health caseload probation officer and probationer relationship on successful completion. Less attention, however, has been placed on examining how the officers supervising these specialty caseloads perceive their roles as mental health probation officers and how they use discretion in their caseload management. The current study examines the narratives of 24 specialty mental health caseload probation officers and supervisors to understand how discretion is used on a problem-solving caseload and how discretionary decision-making may impact probationer outcomes.

Examining policy intentions and actual implementation practices: How organizational factors influence health management information systems in Uttar Pradesh, India.

This study investigates the implementation of a recent health management information systems (HMIS) policy reform in Uttar Pradesh, India, which aims to improve the quality and use of HMIS data in decision-making. Through in-depth interviews, meeting observations and a policy document review, this study sought to capture the experiences of district-level staff (street-level bureaucrats) who were responsible for HMIS policy implementation. Findings revealed that issues of weak HMIS implementation were partly due to human resources shortages both in number and technical skill. Delays in recruitment and the presence of inactive staff overburdened existing staff and weakened the implementation of HMIS activities at the block- and district-levels. District staff also explained how inadequate computer literacy and limited technical understanding further contributed to low HMIS data quality. The organizational culture was even more constraining: working within a very rigid and hierarchical organization was challenging for district data staff, who were expected to manage day-to-day HMIS activities, but lacked the discretion and authority to do so effectively. Consequently, they had to escalate minor issues to district leadership for action and were expected to follow their supervisors' directives- even if they contradicted HMIS policy guidelines. High performance pressures associated with achieving top district rankings deviated focus away from HMIS data quality issues. Many district-level respondents described their superiors' "fixation" with becoming a top-ranking district often resulted in disregard for the quality of data informing district rankings. Furthermore, the review of district rankings only partially encouraged district-level leadership to investigate reasons for low-performing indicators. Instead, low district rankings often resulted in punitive action. The study recommends the importance of incorporating the perspectives of district staff, and recognizing their discretion, and authority when designing policy implementation processes, and finally concludes with potential strategies for strengthening the current HMIS policy reform.

The Double Bind of School Nurses and Policy Implementation: Intersecting the Street-Level Bureaucracy Framework and Teaching Sexual Health Education.

As described in the Framework for 21st Century School Nursing Practice, school nurses bridge the realities of health and education policy within the school community every day. This role is inclusive of helping teach sexual health education (SHE) to students. We were interested in characterizing how school nurses navigate requirements of health education policy to provide their students with the SHE content that they need. Using data from a larger study, we organized a subset of school nurse data within the street-level bureaucracy framework to better understand the many challenges school nurses face in implementing SHE policy. School nurses' involvement in SHE policy implementation was congruent with characteristics of the framework. This included using their professional discretion to manage dilemmas, working with inadequate resources, unclear policy expectations, lack of support, and ambiguous policy goals. Trusted relationships with teachers and students helped school nurses with their SHE policy implementation responsibilities.

Police Discretion and Restorative Justice in China: Stories from the Street-level Police.

Based on ethnographic data collected from one local police station in China, this article attempts to examine the use of discretion by Chinese police in three different restorative justice (RJ) programs. With reference to Wilson's organizational style of policing, the hybridity of watch-man, legalistic and service style in Chinese policing is identified, which can help conceptualize how police decision over mediation work has been institutionally co-shaped. This article also deploys Lipsky's street-level bureaucracy with specific focuses on how the police select cases and facilitate an agreement between stakeholders. Coping strategies defined by Lipsky are found to be employed by the police to confront their huge workload and complicated cases. Overall, RJ in China is primarily promoted as universal top-down national reforms; meanwhile, police discretion, catalyzed by bureaucratic rationalities and the political imperative of social order and stability, is conducive to both the divergence and convergence between RJ in law-books and in action.

Sometimes Resigned, Sometimes Conflicted, and Mostly Risk Averse: Primary Care Doctors in India as Street Level Bureaucrats.

BACKGROUND: In this study, we use the case of medical doctors in the public health system in rural India to illustrate the nuances of how and why gaps in policy implementation occur at the frontline. Drawing on Lipsky's Street Level Bureaucracy (SLB) theory, we consider doctors not as mechanical implementors of policies, but as having agency to implement modified policies that are better suited to their contexts. METHODS: We collected data from primary care doctors who worked in the public health system in rural Maharashtra, India between April and September 2018 (including 21 facility visits, 29 in depth interviews and several informal discussions). We first sorted the data inductively into themes. Then we used the SLB theoretical framework to categorise and visualise relationships between the extracted themes and deepen the analysis. RESULTS: Doctors reported facing several constraints in the implementation of primary care- including the lack of resources, the top-down imposition of programs that were not meaningful to them, limited support from the organization to improve processes as well as professional disinterest in their assigned roles. In response to these constraints, many doctors 'routinized' care, and became resigned and risk-averse. Most doctors felt a deep loss of professional identity, and accepted this loss as an inevitable part of a public sector job. Such attitudes and behaviours were not conducive to the delivery of good primary care. CONCLUSION: This study adds to empirical literature on doctors as Street Level Bureaucrats in lower and middle income countries. Doctors from these settings have often been blamed for not living up to their professional standards and implementing policies with rigour. This study highlights that doctors' behaviours in these settings are ways through which they 'cope' with their loss of professional identity and organizational constraints; and highlights the need for appropriate interventions to counter their weak motivation.

Supporting patients with female genital mutilation in primary care: a qualitative study exploring the perspectives of GPs' working in England.

BACKGROUND: Female genital mutilation (FGM) includes all procedures that intentionally harm or alter female genitalia for non-medical reasons. In 2015, reporting duties were introduced, applicable to GPs working in England including a mandatory reporting duty and FGM Enhanced Dataset. Our patient and public involvement work identified the exploration of potential impacts of these duties as a research priority. AIM: To explore the perspectives of GPs working in England on potential challenges and resource needs when supporting women and families affected by FGM. DESIGN AND SETTING: Qualitative study with GPs working in English primary care. METHOD: Semi-structured interviews focused around a fictional scenario of managing FGM in primary care. The authors spoke to 17 GPs from five English cities, including those who saw women who have experienced FGM often, rarely, or never. Interviews were audio recorded and transcribed verbatim for thematic analysis. Lipsky's theory of street-level bureaucracy was drawn on to support analysis. RESULTS: Managing women with FGM was experienced as complex. Challenges included knowing how and when to speak about FGM, balancing care of women and their family's potential care and safeguarding needs, and managing the mandated reporting and recording requirements. GPs described strategies to manage these tensions that helped them balance maintaining patient-doctor relationships with reporting requirements. This was facilitated by access to FGM holistic services. CONCLUSION: FGM reporting requirements complicate consultations. The potential consequences on trust between women affected by FGM and their GP are clear. The tensions that GPs experience in supporting women affected by FGM can be understood through the theoretical lens of street-level bureaucracy. This is likely to be relevant to other areas of proposed mandated reporting.

Community Health Care Workers' Experiences on Enacting Policy on Technology with Citizens with Mild Cognitive Impairment and Dementia.

PURPOSE: Assistive technologies and digitalization of services are promoted through health policy as key means to manage community care obligations efficiently, and to enable older community care recipients with mild cognitive impairment (MCI) and dementia (D) to remain at home for longer. The overall aim of this paper is to explore how community health care workers enacted current policy on technology with home-dwelling citizens with MCI/D. PARTICIPANTS AND METHODS: Twenty-four community health care workers participated in one of five focus group discussions that explored their experiences and current practices with technologies for citizens with MCI/D. Five researchers took part in the focus groups, while six researchers collaboratively conducted an inductive, thematic analysis according to Braun & Clarke. RESULTS: Two main themes with sub-themes were identified: 1) Current and future potentials of technology; i) frequently used technology, ii) cost-effectiveness and iii) "be there" for social contact and 2) Barriers to implement technologies; i) unsystematic approaches and contested responsibility, ii) knowledge and training and iii) technology in relation to user-friendliness and citizen capacities. CONCLUSION: This study revealed the complexity of implementing policy aims regarding technology provision for citizens with MCI/D. By use of Lipsky's theory on street-level bureaucracy, we shed light on how community health care workers were situated between policies and the everyday lives of citizens with MCI/D, and how their perceived lack of knowledge and practical experiences influenced their exercise of professional discretion in enacting policy on technology in community health care services. Overall, addressing systematic technology approaches was not part of routine care, which may contribute to inequities in provision of technologies to enhance occupational possibilities and meaningful activities in everyday lives of citizens with MCI/D. TRIAL REGISTRATION: NSD project number 47996.

Bureaucratic encounters "after neoliberalism": Examining the supportive turn in social housing governance.

It is well established that encounters between welfare bureaucracies and their clients have been reconfigured under neoliberalism to address the problem of "welfare dependency." Contemporary bureaucratic encounters therefore entail measures to activate clients' entrepreneurial/self-governing capacities, and conditionality/sanctioning practices to deal with clients who behave "irresponsibly." Despite the dominance of the neoliberal model, recent research has identified a counter-trend in the practices of housing services away from entrepreneurializing and punitive strategies and towards a more supportive approach. This paper examines this counter-trend and its implications for neoliberal welfare governance. To do this, it presents findings from research into social housing governance in Queensland, Australia, where the neoliberal focus on welfare independence, conditionality and sanctioning has been tempered by a new supportive approach focused on assisting vulnerable clients to maintain and benefit from access to welfare/housing support. Following Larner, we argue that this shift signals the emergence of an "after neoliberal" governmental formation, wherein key features of neoliberal governmentality are replaced by, or redeployed in the service of, progressive initiatives that address neoliberalism's failings at the street level, but leave broader neoliberal policy settings undisturbed. We also challenge recent sociological accounts that construe supportive welfare practices as a function of an all-encompassing neoliberal project, arguing instead for appreciation of the contingency of these developments and the progressive political affordances that they entail.

The Federal Justice act in combating corruption in Southern Brazil / La actuación de la Justicia Federal en el combate a crímenes de corrupción en la Región Sul de Brasil / O combate a crimes de corrupção pela Justiça Federal da Região Sul do Brasil

Abstract This article studies the operation of the Federal Regional Court of the 4th Region (TRF4) in the fight against corruption crimes. Judgments produced by the TRF4 criminal courts between 2003 and 2016 underwent text analysis using the dictionary method, seeking to outline the profile of crimes and defendants. Despite the changes in the web accountability institutions, with the outbreak of major federal police operations, technological uses, new legal devices and a high degree of concentration between the agencies, there is a small proportion of grand corruption crime, involving middle and high-ranking bureaucrats and more sophisticated crimes with greater financial value. Crimes involving contraband and petty corruption take up much of the day to day of the judiciary in the south region of the country, at least in the criminal intermediate courts, where the judge appeals decisions coming from specialized and generalist criminal courts.

Resumen Este artículo analiza la actuación del Tribunal Regional Federal de la Cuarta Región, en el combate a crímenes de corrupción. Las sentencias dictadas entre 2003 y 2016 por las salas de justicia criminal del TRF4 se sometieron al análisis de texto con el método de diccionario para esbozar el perfil de los crímenes y de los acusados. A pesar de los cambios en la red de instituciones de accountability, con el desencadenamiento de grandes operaciones de la Policía Federal, usos tecnológicos, nuevos dispositivos jurídicos y el alto grado de concertación entre las agencias, se constató una reducida porción de alta criminalidad involucrando burócratas de medio y alto escalón y crímenes más sofisticados y de mayor valor financiero. Los crímenes como contrabando y corrupción a pequeña escala (petty corruption) predominan en el Poder Judicial en la región sur del país, al menos en las salas de justicia criminales, que juzgan recursos de sentencias de cortes criminales especializadas y generalistas.

Resumo Este artigo analisa a atuação do Tribunal Regional Federal da 4ª Região (TRF4) no combate a crimes de corrupção. Decisões judiciais das turmas criminais entre 2003 e 2016 receberam análise de texto com o método de dicionário, traçando o perfil de crimes e réus. Apesar das mudanças na rede de instituições de accountability, com a deflagração de grandes operações da Polícia Federal (PF), usos tecnológicos, novos dispositivos jurídicos e alto grau de concertação entre agências, constatou-se reduzida parcela de grande criminalidade, envolvendo burocratas de médio e alto escalão e crimes sofisticados e de maior valor financeiro. Crimes de contrabando e descaminho (petty corruption) preponderam no Judiciário Federal do Sul do país, pelo menos nas turmas criminais, que julgam recursos de decisões proferidas por varas criminais especializadas e generalistas.

O Direito à Educação de Alunos com Deficiência: a Gestão da Política de Educação Inclusiva em Escolas Municipais Segundo os Agentes Implementadores / The Right to Education of Students with Disability: the Management of Inclusive Education Policy in Municipal Schools According to the Implementing Agents

RESUMO: Este trabalho investigou a implementação da política de educação inclusiva na Rede Municipal de Corumbá/Mato Grosso do Sul, por meio da atuação e das percepções dos agentes implementadores tanto no âmbito da Secretaria de Educação quanto da escola. Buscamos conhecer como as políticas educacionais voltadas aos alunos com deficiência são implementadas e as condições de atendimento a esses alunos na Rede Municipal. Como referencial teórico, utilizamos os estudos sobre Burocracia de Médio Escalão e Burocracia de Nível de Rua para entender as percepções e as interações entre os agentes. Os Estudos sobre a Deficiência (Disability Studies) ofereceram-nos importantes chaves de interpretação dos fenômenos por meio da perspectiva sociológica da deficiência, sobretudo o conceito de capacitismo. Inicialmente, realizamos um levantamento sobre as matrículas e as escolas a partir do Censo Escolar. Em seguida, foi aplicado um survey às equipes de gestão e aos professores de todas as escolas urbanas da Rede Municipal, sendo escolhidas três escolas para pesquisa qualitativa. Os resultados mostraram que os agentes implementadores, apesar de seus esforços para realização do trabalho, encontram dificuldades que interferem diretamente em sua atuação.

ABSTRACT: This work sought to investigate the implementation of a public policy for inclusive education in the Municipal Education Network of Corumbá/Mato Grosso do Sul, Brazil, through the actions and perceptions of the implementing agents, both within the Secretariat of Education and the school. We sought to learn how education policies aimed at students with disabilities are implemented and the conditions of assistance to these students in the Municipal Network. As theoretical framework, we used the studies on Middle-Level and Street-Level Bureaucracy to understand the perceptions and interactions among agents. Disability Studies provided us with important keys for interpreting phenomena through the sociological perspective of disability, especially the concept of Ableism. Initially, we conducted a survey on enrollment and schools from the School Census. Then, a survey was applied to the management teams and teachers of all urban schools of the Municipal Network, from which three schools were chosen for qualitative research. The results showed that the implementing agents, despite their efforts to carry out the work, found difficulties that interfere directly with their performance.

Discretion, power and the reproduction of inequality in health policy implementation: Practices, discursive styles and classifications of Brazil's community health workers.

This article explores the mobilization of power by health workers during policy implementation, showing how in a context of discretion and resource scarcity they can reproduce inequalities in access to health services. The argument innovates theoretically by supplementing the 'street-level bureaucracy' literature, which emphasizes frontline worker discretion, with a conceptualization of power as domination encompassing the shaping of behavior, the constitution of subjects and the reproduction of inequality. Empirically, the article focuses on Brazilian community health workers (agentes comunitários desaúde, CHWs). CHWs are a neglected but highly important segment of the health workforce that traditionally functions as a link between the health system and disadvantaged groups. The article examines how Brazilian CHWs act as street-level bureaucrats mobilizing power in their interactions with users. They operate within a severely under-resourced public health system, the Sistema Único de Saúde, which places constraints upon their action and forces them to make allocation decisions with little training and support. The article highlights the ways in which inequalities in access to health services are reproduced (inadvertently or not) through the practices, discursive styles and classifications of CHWs. Methodologically, the paper is based on ethnography with 24 CHWs and interviews with 77 other CHWs in Brazil.

Selection Processes in Prison-Based Treatment Referrals: A Street-Level Bureaucracy Perspective.

Studies indicated that detainees are not always allocated to treatment programs based on official guidelines. Street-level bureaucracy theory suggests that this is because government employees do not always perform policies as prescribed. This study aimed to assess whether this also applies to the allocation of offenders to treatment in Dutch penitentiary institutions, and aimed to determine which factors influenced this. The proposed questions were addressed by studying a group of 541 male prisoners who participated in the Dutch prison-based Prevention of Recidivism program. Results showed that official guidelines were, in most cases, not leading when referring detainees to programs. Instead, treatment referrals were influenced by a broad range of risk factors, as well as the length of an offender's sentence.