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.