Community Health Workers as Street-level Quasi-Bureaucrats in the COVID-19 Pandemic: The Cases of Kenya and Thailand

Abstract

This article uses cross-country comparative analysis to explore how community health workers (CHWs) deal with the COVID-19 pandemic. It combines insights from the street-level bureaucracy literature and an interpretive approach with original data from semi-structured interviews with CHWs in Kenya and Thailand. Findings show that how a public health system is organized (decentralization versus centralization) affects CHWs’ initial responses to the outbreak. While CHWs in Thailand’s centralized system conform to the “state agent” tradition by referring to the hierarchical chain of command, those in Kenya’s decentralized system follow the “citizen agent” tradition by prioritizing community safety.