Disobedient distributors: street-level bureaucrats and would-be patrons in community-based family planning programs in rural Kenya

Stud Fam Plann. 2001 Sep;32(3):254-69. doi: 10.1111/j.1728-4465.2001.00254.x.


The implementation of social welfare programs, including family planning programs, is strongly conditioned by the needs, desires, and agendas of those who carry them out, known as "street-level bureaucrats." In this study, the strategies of CBD agents in western Kenya are examined in order to understand how they use their job as a means to achieve their own personal goals. The concept of clientelism, borrowed from the field of political science, can help to explain what the CBD agents are trying to achieve for themselves in their communities, at the same time as they promote the use of contraceptive pills and injections. CBD agents are concerned with building up their own stocks of prestige and respect from their community members, while avoiding blame for any possible negative outcomes of family planning.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Community Health Services*
  • Community Health Workers
  • Delivery of Health Care*
  • Health Planning*
  • Humans
  • Interpersonal Relations
  • Kenya
  • Patients / psychology*
  • Public Policy
  • Rural Population