Street-Level Discretion in the Implementation of Healthcare and Immigration Policies for Migrants in Johannesburg, South Africa

The paper examined how street-level bureaucrats (SLBs) interpreted and exercised discretion when implementing healthcare and immigration policies affecting migrants in the City of Johannesburg (CoJ), Gauteng, South Africa. Drawing on interviews with 30 frontline workers and guided by Street-Level Bureaucracy theory and the 7-C policy implementation model, the paper identified a persistent disconnect between progressive legal provisions and frontline practice. While most SLBs understood core health policies, limited knowledge of migration legislation, conflicting policy prescripts, and resource constraints shaped highly variable decision-making. Discretion produced mixed outcomes: some frontline workers used flexibility to facilitate access for vulnerable migrants, while others engaged in discriminatory practices, including overcharging, delayed treatment, and refusal of care. Analysis through the 7-C framework showed that context, capacity, communication, and coordination most consistently shaped discretionary decision-making. Implementation challenges stemmed from policy ambiguity, weak oversight, socio-political pressures, and uneven institutional support, pointing to the need for clearer policy guidance, targeted training, and stronger intergovernmental coordination.