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!
Thanks for this – it’s a thoughtful reminder that “work” and “meaning” don’t have to be mutually exclusive. As an occupational health epidemiologist, I often think about how much of our lives are spent at work, and how both the content of that work and the conditions we work under shape well-being, identity, and long-term health. I agree that time with loved ones matters enormously – but I also think there’s something life-affirming about doing work that contributes to systemic change, whether that’s protecting people’s health today or reducing the risk of catastrophic harms to humanity in the future.