Interview schedule

This paper examines how street-level bureaucrats (SLBs) interpret and exercise discretion when implementing healthcare and immigration policies for migrants in the City of Johannesburg (CoJ), Gauteng, South Africa. Using interviews with thirty frontline workers and guided by Street-Level Bureaucracy theory and the 7-C policy implementation model, the study identifies a persistent gap between progressive legal provisions and actual practice. While most SLBs understood core health policies, limited knowledge of migration legislation, conflicting prescripts, and resource shortages shaped highly variable decision-making. Discretion produced mixed outcomes: some staff used flexibility to ensure access for vulnerable migrants, whereas others engaged in discriminatory behaviours, including overcharging, delays, and refusal of care. Analysis across the 7-C model shows that context, capacity, communication, and coordination exert the strongest influence on discretionary choices. Implementation gaps stem from policy ambiguity, inadequate oversight, socio-political pressures, and uneven institutional support, underscoring the need for clearer guidance, training, and intergovernmental collaboration.