‘We are bitter but we are satisfied’: nurses as street-level bureaucrats in South Africa

Removing the User Fees for the Under-Fives' Simple Malaria Treatment in Cameroon: Effect on the Health Services Utilization

“…Source: Extract of the decision No: 0032/MINSANTE/CAB/, January 24,2011 This study aimed at assessing the main effect of the exemption policy on services utilization fifteen months after its implementation.…”

Nurses’ perceptions of universal health coverage and its implications for the Kenyan health sector

“…Most felt that ordinary Kenyan citizens strongly favor the free maternal health policy as well. This ability to represent a position (that free maternal healthcare is good) despite conflicting interpretations of how it affects themselves (that it is largely bad), suggests that nurses are committed to the communities they serve, a finding shared by the South African study (Walker and Gilson 2004). It also demonstrates that disagreement with the larger political processes associated with health policy notwithstanding, nurses understand that policymakers have to balance political demands of the citizenry.…”

“…Unfortunately, this finding too is supported by work in six African countries that illustrated nurses were never consulted during policy formulation on fee removal policies (Meessen et al 2011). Additional strain placed on an already overloaded and thinly stretched workforce contributes to the widespread belief that nurses are not valued in the health system, as seen in South Africa (Walker and Gilson 2004;Joyner et al 2014). Moreover, there is a concern that patients' needs are not being met.…”

“…Policy theorists argue that at the heart of these policy controversies lie fundamentally conflicting value systems, such as those underlying social health systems and those preferring market-based systems (Schön and Rein 1994). While this presumably occurs in many countries embarking on a path towards UHC, limited evidence exists about how actors on the ground understand the broader movement, how their professional lives are affected, and how this shapes the interplay of competing values (Walker and Gilson 2004). This article investigates how nurses understand concepts related to UHC and make value-based judgement about how to behave.…”

“…This knowledge gap is conspicuous in LMICs, like Kenya, where physician shortages position nurses as central agents in the delivery of primary healthcare (WHO 2006). Nevertheless, nurses have been historically marginalized within health systems (Freidson 1970) and their views are rarely solicited on issues such as national health reform or UHC more generally (Walker and Gilson 2004). Thus, because of their central role in healthcare delivery, and because little is known about how they engage with global policy agendas, there is a need for more research to understand how nurses collectively interpret and influence domestic policy reform measures.…”