Frontline governance: a street-level bureaucracy perspective on brucellosis control in Western Iran.

BACKGROUND: Brucellosis remains a major endemic zoonotic disease in Iran, particularly in western provinces where traditional livestock farming and nomadic pastoralism sustain persistent transmission. Despite longstanding national control programs, important gaps persist between policy intentions and frontline implementation. This study applied a Street-Level Bureaucracy (SLB) perspective to examine how frontline actors shape the governance and delivery of brucellosis control in practice. METHODS: A qualitative interpretive study was conducted in Lorestan Province, Western Iran, between February 2025 and January 2026. Data were collected through semi-structured, in-depth interviews with 39 frontline and managerial actors involved in brucellosis control, including physicians, public health managers, veterinarians, laboratory personnel, and environmental health officers. Participants were selected using purposive and snowball sampling. Interviews were analyzed using Braun and Clarke's thematic analysis with a hybrid deductive-inductive coding approach informed by the SLB framework. Trustworthiness was enhanced through prolonged engagement, triangulation across professional sectors, member checking, peer debriefing, reflexive memoing, and maintenance of an audit trail. RESULTS: Three overarching themes emerged: (1) frontline discretion in adapting national protocols to local realities; (2) coping mechanisms under structural scarcity, including rationing of services and informal resource-sharing practices; and (3) informal governance of intersectoral collaboration characterized by person-dependent coordination and fragmented accountability. The inductive analysis also identified context-specific patterns extending beyond the SLB framework, including the critical role of interpersonal trust in sustaining collaboration and the normalization of personal resource use as an embedded governance practice. Findings suggest that brucellosis control is sustained through continuous frontline adaptation, whereby informal practices compensate for institutional fragmentation, operational rigidity, and limited resources. CONCLUSIONS: Brucellosis control in Western Iran operates through a dynamic interplay between formal policy and informal frontline governance. While discretionary practices enhance system responsiveness and continuity, overreliance on informal coordination may reinforce institutional fragility and implementation inequities. Strengthening integrated One Health governance, interoperable information systems, and formalized intersectoral accountability mechanisms may contribute to bridging the policy-practice gap in endemic settings.