Relationships between Levels of Bureaucracy and their Effects on the Co-production of Public Health Services




Research objective: This research analyzes how relationships between different levels of local bureaucracy (top, mid, and street-level) – and the context of rules and values in which they operate – affect the practices of co-production of public health services.

Theoretical Framework: The study is based on two distinct theoretical concepts rarely associated in the literature: the co-production of public services and levels of bureaucracy.

Methodology: It is a qualitative research examining the family health strategy in three medium-sized Brazilian municipalities.

Results: The six co-production arrangements identified showed that co-production practices materialize in different ways, sharing more or less power with users, depending on the different patterns of relationship between levels of bureaucracy and the bureaucracy and citizens.

Originality: Few studies analyze co-production from the state’s point of view. Therefore, this research explores a gap in the literature, focusing on the relationships between levels of bureaucracy and their influence on public service co-production practices.

Theoretical and practical contributions: The results raised four points to be theoretically developed, points that also deserve the attention of practitioners operating in co-production: (1) Any level of bureaucracy can offer resistance or openness to co-production, and this is not hierarchically determined; (2) A structure of support and incentive for co-production by the top and mid-level bureaucracy does not guaranteethe engagement of street-level bureaucracy; (3) The collaboration of top and mid-level bureaucracy is essential to expand co-production results; (4) Different relationship patterns between levels of bureaucracy and between the bureaucracy and citizens.


Keywords:Co-production, Levels of bureaucracy, Co-production arrangements, Co-production of public health services.


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Como Citar

Faria Zimmer Santos, G., & Chies Schommer, P. (2023). Relationships between Levels of Bureaucracy and their Effects on the Co-production of Public Health Services. Administração Pública E Gestão Social, 15(3).