Street-Level Bureaucrats Decision Making

Abstract
This paper examines how street-level bureaucrats behaviour influenced the implementation of the Tanzanian Community Health Fund (CHF) and proposes several managerial strategies to improve the success of the CHF. The CHF is a voluntary pre-payment scheme which operates at the district level and was created by the central government with a top-down approach.1 Due to the nature of the policy making (i.e. top-down approach with a political agenda) the CHF was imposed upon district managers who were pressured to implement the pre-payment scheme immediately. The ambiguity of the policy and lack of funding coupled with the exclusion of district managers in the making of the policy caused a general bitterness and dislike for the CHF among

SLBs, as defined by Lipsky (1980), are public servants who directly interact with citizens on the behalf of the government (i.e. those who work on the frontlines) and use their discretion in the implementation of policy, which in turn effects how the public experiences and understands a political act. Although SLBs may not always be involved in the formal creation of public policy, they are integral in how the policy is implemented, shaped, modified, and experienced.5,6 SLBs are often faced with serious restrictions, such as limited resources and high volume of clients, which directly influence their ability to provide proper services.7 Consequently, the flawed circumstances under which SLBs must work cause them to develop coping mechanisms. Coping mechanisms are behaviours or practices that help SLBs manage the limitations and stress they

The CHF policy was created using a top-down approach, in which the Central Ministry of Health and the World Bank wrote the act with the assumption that the District Managers would comply with the guidelines of the policy. In this traditional managerial approach, the central government had more power than the District Managers, who had limited input on the creation of the policy, despite their position on the frontlines. Thus, District Managers felt that the policy was imposed upon them without proper discussion of key issues.11 This left the District Managers feeling powerless over how the CHF should be implemented, and in turn, caused a bitterness and resistance to the CHF. The negative attitude towards the policy influenced District Managers actions, or lack thereof, to support the success of the CHF in their