Street-Level Bureaucrats in Homa Bay County, Kenya – A bottom-up implementation analysis of the policies on malaria and gender inequalities

The fight against malaria in Kenya is tightly connected to gender inequalities. The traditional gender roles in some households create exposure patterns that affect the most vulnerable groups: pregnant women and children. Current political strategies to prevent malaria in pregnancy rely on community health volunteers (CHVs), who fulfil a crucial role as implementers of malaria policies on community level. This bottom-up study identifies barriers for CHVs to implement the policies that focus on gender aspects of malaria in pregnancy. A participant observation of CHVs was done for one month in Homa Bay County, one of the most malaria burdened regions of Kenya, followed up by qualitative interviews with five CHVs. Empirical data is categorised based on the findings of barriers in previous research and analysed by using two policy implementation theories regarding a bottom-up approach to policy analysis and street-level bureaucrats. The study concludes that CHVs face a lack of accurate training and supervision and are restricted by heavy workload due to time limit and insufficient financial support provided by public authorities and NGOs. This increases the relevance of discretion that CHVs exercise in their role as street-level bureaucrats. Consequently, CHVs’ discretion is important in determining the policy outcome