Street-level policy co-production and co-designing through informal deliberation during the COVID-19 crisis: Lessons from the Philippines

This paper investigated how nationally formulated but locally implemented policies in a crisis are negotiated by street-level bureaucrats, often referred as frontline workers, to achieve desired policy outcomes. Building on street-level bureaucrat theory, the paper described and uncovered the internal and external pressures experienced by street-level health workers who were tasked to implement pandemic management policies. The paper argues that to cope with pressures associated and linked to a complex crisis, street-level health workers negotiated and modified policy implementation amongst themselves, and subsequently engaged in informal policy deliberation with policy clients (i.e., citizens) to co-design and co-produce policy implementation and desired policy outcomes. I use a case study of COVID-19 pandemic management in the Philippines to demonstrate this. I investigated the "policy-as-practiced" by determining the deviation of pandemic-restriction implementation from national and sub-national guidelines using qualitative data from policy documents across levels of government, interviews with local government officials, a focus group discussion with health emergency response teams, and field notes. This deviation is linked to the pressures and challenges faced by street-level health workers, and the need to innovate to cope with such challenges. These internal and external pressures include workload, lack of resources, fear of infection, perceived characteristics of their clients, legal accountability, political, and organizational, and political pressures from other levels of government. Using informal networks with the citizens and authorities from different levels of government, street-level health workers effectively co-designed and co-produce pandemic management policies with authorities across levels of government and with citizens.