Context: This article aims to highlight challenges and adaptations made by local health officials in Tanzania in working to contain and manage COVID-19.

Methods: The study takes an inductive approach, drawing on the reported experiences of 40 officials at different levels of government across four purposefully selected regions in July 2020. Interviewees were asked about the guidance they received to contain COVID-19, the source of that guidance, their challenges and successes in implementing the guidance, and if and how they adapted the guidance to their particular setting.

Findings: The interviews depict considerable challenges, including a lack of supplies and resources for implementing infection control, surveillance, and mitigation practices and dealing with fear and stigma. At the same time, they also provide evidence of innovation and adaptation among street-level bureaucrats. Respondents overwhelmingly praised the president, whose limited national response is seen as helpful for reducing fear and stigma.

Conclusions: Other scholars have highlighted the potential dangers of street-level discretion if local officials “make policy” in ways that contradict their agencies' stated goals. In contrast, our study suggests benefits of autonomy at the street level—particularly in contexts where the central state was relatively weak and/or acting against the public interest.

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