Tulane University.
American University.
J Health Polit Policy Law. 2021 Dec 1;46(6):989-1017. doi: 10.1215/03616878-9349128.
This article aims to highlight challenges and adaptations made by local health officials in Tanzania in working to contain and manage COVID-19.
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.
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.
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.
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 方面所面临的挑战和做出的调整。
本研究采用归纳法，借鉴了 2020 年 7 月在四个有针对性选择的地区的不同政府级别 40 名官员的报告经验。受访者被问及他们收到的关于控制 COVID-19 的指导意见、这些指导意见的来源、他们在执行这些指导意见时的挑战和成功之处，以及他们是否以及如何根据特定的情况对指导意见进行调整。
这些采访描绘了相当大的挑战，包括缺乏实施感染控制、监测和缓解措施的用品和资源，以及应对恐惧和耻辱感的问题。与此同时，它们也提供了基层官僚创新和适应的证据。受访者普遍赞扬总统，他们认为总统的有限国家反应有助于减少恐惧和耻辱感。
其他学者强调了如果地方官员以违背其机构既定目标的方式“制定政策”，那么基层官员的自由裁量权可能带来的潜在危险。相比之下，我们的研究表明基层自治的好处——特别是在中央政府相对较弱和/或违背公众利益的情况下。
