Street-Level Bureaucrats: From Obedience to Participation

This chapter presents the first piece of empirical evidence on the nature of officer–recipient relationships in Oportunidades-Prospera by scrutinizing the perspectives of physicians and nurses implementing the program in two localities of the state of Puebla. It presents the health officers’ experiences and attitudes toward program delivery, their work, and especially recipients. It complements interviews with observations of interactions at the waiting room and during the delivery of the health workshops. The findings indicate that officer–recipient interactions are unavoidably infused with authority and power as a result of three distinguishing factors. First, the discourse of conditionality of Oportunidades-Prospera; second, the contrasting professional and socioeconomic identities of officers and recipients; and third, the job position of temporary and permanent officers. Temporary and permanent officers clearly fostered different interactions with recipients. The former—mostly managing the clinic in Cualcan—promoted a relationship of empathy, reciprocity, and communication, whereas the latter—mostly in Nexpan—promoted a hierarchical relationship driven by obedience and compliance. This chapter ends exploring how relationships at different levels –between staff, within the localities, and between staff and the National Ministry of Health—are additional relational layers explaining officer–recipient interactions.