Hi Nick, I really appreciate the thoughtful and detailed reply. You’re absolutely right that “resilience” is a broad and slippery concept, and I agree that attributing outcomes to specific components like CHWs is tricky, especially in crises with many moving parts.
By resilience, I meant something like maintained or recoverable delivery of essential services under stress – not necessarily stopping viral spread, but preserving routine care, adapting quickly (e.g., home-based care), and using real-time data for coordination. I take your point about the COVID epi curves – and agree that the mortality patterns owe much to demographic structure – but I’d argue that Rwanda’s capacity to maintain service delivery (e.g., immunisations, maternal health) and implement decentralised home-based care was in part enabled by their CHW and data infrastructure. That doesn’t negate the limitations of their COVID containment, but points to other dimensions of system functioning.
And yes, you’re absolutely right that Rwanda saw early gains from its CHW programs in areas like malaria and maternal health – I didn’t mean to suggest otherwise, only that some system-wide or crisis-response benefits can be delayed or harder to isolate. I’ll have a read of your Uganda piece – thanks for sharing!
Great insights there, hope to hear from you more on the forum!
Yes thanks to much I understand better now. I agree that Rwanda’s structure is resilient and enabled them to maintain service delivery during the pandemic. Uganda was terrible in this front, for a number of reasons. During the early lockdowns people died because of poor access—this is an article about a kid dying after we couldn’t refer them from one of our OneDay health centers
I think resilience is important but I’m struggling to see how we can test for it in solid ways. In this case I think we have to really on case studies like Rwanda during covid like you say. As a side note like I mentioned in the article, over a 10 year period almost every development thing in Rwanda seemed to work well and bore fruit, and I consider them a success story more than necessarily a model for other countries. Takes a pretty savage dictator to stay on that tight path!
I would hope that many of the same interventions that bring resilience also bring more immediate benefits that would be measurable, but you’re right that won’t always be the case.
Hi Nick, I really appreciate the thoughtful and detailed reply. You’re absolutely right that “resilience” is a broad and slippery concept, and I agree that attributing outcomes to specific components like CHWs is tricky, especially in crises with many moving parts.
By resilience, I meant something like maintained or recoverable delivery of essential services under stress – not necessarily stopping viral spread, but preserving routine care, adapting quickly (e.g., home-based care), and using real-time data for coordination. I take your point about the COVID epi curves – and agree that the mortality patterns owe much to demographic structure – but I’d argue that Rwanda’s capacity to maintain service delivery (e.g., immunisations, maternal health) and implement decentralised home-based care was in part enabled by their CHW and data infrastructure. That doesn’t negate the limitations of their COVID containment, but points to other dimensions of system functioning.
And yes, you’re absolutely right that Rwanda saw early gains from its CHW programs in areas like malaria and maternal health – I didn’t mean to suggest otherwise, only that some system-wide or crisis-response benefits can be delayed or harder to isolate. I’ll have a read of your Uganda piece – thanks for sharing!
Great insights there, hope to hear from you more on the forum!
Yes thanks to much I understand better now. I agree that Rwanda’s structure is resilient and enabled them to maintain service delivery during the pandemic. Uganda was terrible in this front, for a number of reasons. During the early lockdowns people died because of poor access—this is an article about a kid dying after we couldn’t refer them from one of our OneDay health centers
https://www.google.com/amp/s/www.aljazeera.com/amp/features/2020/4/21/children-women-casualties-of-ugandas-coronavirus-transport-ban
I think resilience is important but I’m struggling to see how we can test for it in solid ways. In this case I think we have to really on case studies like Rwanda during covid like you say. As a side note like I mentioned in the article, over a 10 year period almost every development thing in Rwanda seemed to work well and bore fruit, and I consider them a success story more than necessarily a model for other countries. Takes a pretty savage dictator to stay on that tight path!
I would hope that many of the same interventions that bring resilience also bring more immediate benefits that would be measurable, but you’re right that won’t always be the case.