ArticleSocial science & medicine (1982)2019
Discretion, power and the reproduction of inequality in health policy implementation: Practices, discursive styles and classifications of Brazil's community health workers.
Article in Social science & medicine (1982), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
20 citing papers in PubMed.
- Frontline workers in India's tuberculosis (TB) elimination efforts: a street-level bureaucracy perspective.BMC public health · 2025Article
- Experience of Older Adults and Their Family Members in the Kidney Transplant Evaluation.JAMA internal medicine · 2025Article
- Being both a grandmother and a health worker: experiences of community-based health workers in addressing adolescents' sexual and reproductive health needs in rural Zambia.BMC public health · 2024Article
- Racial inequalities in mental healthcare use and mortality: a cross-sectional analysis of 1.2 million low-income individuals in Rio de Janeiro, Brazil 2010-2016.BMJ global health · 2023Article
- Implementation of PM-JAY in India: a qualitative study exploring the role of competency, organizational and leadership drivers shaping early roll-out of publicly funded health insurance in three Indian states.Health research policy and systems · 2023Article
- Article
- The impact of the COVID-19 pandemic in the frontline health workforce: Perceptions of vulnerability of Brazil's community health workers.Health policy OPEN · 2022Article
- The "Corona Warriors"? Community health workers in the governance of India's COVID-19 response.Political geography · 2022Article
- Pandemic-Related Impairment in the Monitoring of Patients With Hypertension and Diabetes and the Development of a Digital Solution for the Community Health Worker: Quasiexperimental and Implementation Study.JMIR medical informatics · 2022Article
- Improving hospital-based processes for effective implementation of Government funded health insurance schemes: evidence from early implementation of PM-JAY in India.BMC health services research · 2022Article
- Commentary on "Promising careers? A critical analysis of a randomised control trial in community health worker recruitment in Zambia," by James Wintrup.Social science & medicine (1982) · 2022Article
- "Provider discretionary power practices to support implementation of patient-centered HIV care in Lusaka, Zambia".Frontiers in health services · 2022Article
- Implementing a "convergent" framework of action against childhood malnutrition in urban informal settlements of Mumbai: Frontline perspectives.Journal of family medicine and primary care · 2021Article
- Community-engaged healthcare model for currently under-served individuals involved in the healthcare system.SSM - population health · 2021Review
- Sometimes Resigned, Sometimes Conflicted, and Mostly Risk Averse: Primary Care Doctors in India as Street Level Bureaucrats.International journal of health policy and management · 2021Article
- The vulnerabilities of the Brazilian health workforce during health emergencies: Analysing personal feelings, access to resources and work dynamics during the COVID-19 pandemic.The International journal of health planning and management · 2021Article
- Power, policy and abortion care in Uganda.Health policy and planning · 2021Article
- Understanding the role of lady health workers in improving access to eye health services in rural Pakistan - findings from a qualitative study.Archives of public health = Archives belges de sante publique · 2021Article
- "The Wheel of My Work": Community Health Worker Perspectives and Experiences with Facilitating Refugee Access to Primary Care Services.Health equity · 2021Article
- Community health workers reveal COVID-19 disaster in Brazil.Lancet (London, England) · 2020Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
2 authors.
Funding
Abstract
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.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.