Negotiated compliance at the street level: Personalizing immunization in England, Israel and Sweden

Anat Gofen, Paula Blomqvist, Catherine Needham, Kate Warren, Ulrika Winblad

Research output: Contribution to journalArticlepeer-review

10 Citations (Scopus)
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Often portrayed as behaviour that is inconsistent with policy goals, public noncompliance poses a significant challenge for government. To explore what compliance efforts entail on‐ the‐ground, this study focuses on childhood immunization as a paradigmatic case where a failure to ensure compliance poses a public health risk. Analysis draws on 48 semi‐structured interviews with frontline nurses and regional/national public‐health officials in England (N=15), Sweden (N=17) and Israel (N=16), all of which have experienced periodic noncompliance spikes, but differ in direct‐delivery of vaccination provision. Compliance efforts emerged as a joint decision‐making process in which improvisatory practices of personalised appeals are deployed to accommodate parents’ concerns, termed here ‘street‐level negotiation.’ Whereas compliance is suggestive of compelling citizens’ adherence to standardised rules, compliance negotiation draws attention to the limited resources street‐level workers have when encountering noncompliance and to policy‐clients’ influence on delivery arrangements when holding discretionary power over whether or not to comply.
Original languageEnglish
Pages (from-to)195-209
JournalPublic Administration
Issue number1
Early online date28 Sept 2018
Publication statusPublished - Mar 2019


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