How social networks affect policy implementation: An analysis of street-level bureaucrats' performance regarding a health policy

Policy implementation is an interactive process between citizens and street-level bureaucrats. Although the literature has already addressed different factors that influence discretion, there is still a gap in understanding if and how bureaucrats' relational profiles affect policy implementation. This article analyses bureaucrats' interactions and the relational environments in which they exercise their discretion. The hypothesis is that bureaucrats' different relational profiles specify policy implementation at the street level. We study bureaucrats in a Brazilian health care programme involving community workers that requires regular visits to beneficiary families' homes. The research departs from ethnography and network analyses with workers from three very different contexts. We analyse bureaucrats' practices, the discursive styles mobilized in their interactions, and their personal networks. The results show that organizational factors are central to explain variations in practices, and their relational profiles highly influence the discursive styles used by bureaucrats in their interactions with citizens. The article concludes that relational elements can affect the exercise of discretion and influence interactions at the street level and should be incorporated more systematically in the implementation literature.