Whose Resilience Counts? Recentring African Epistemologies in Community Health Worker and Health-System Resilience Scholarship: An Integrative Critical Review

Health-system resilience has become a central organising concept in global health, particularly following epidemics, pandemics, climate-related emergencies, conflict and other disruptions. Existing frameworks have expanded understanding of the capacities through which health systems anticipate, absorb, adapt to, recover from and transform following shocks. However, these frameworks do more than describe resilience: through their definitions, categories and indicators, they also determine which actors, capabilities and forms of knowledge are recognised as constituting resilience. Community Health Workers (CHWs) are frequently recognised as operational assets during emergencies, but their experiential knowledge, relational authority, community intelligence and interpretive agency may remain insufficiently represented. This review will examine whether prevailing health-system resilience scholarship is epistemologically equipped to recognise how CHWs and communities contribute to resilience in African settings. Anticipated contribution The review will assess three sensitising propositions: that resilience is relationally produced but institutionally attributed; that CHWs are operationally visible but epistemically marginal; and that unsupported adaptation can be misrecognised as health-system resilience. These propositions will be retained, revised or rejected in response to the evidence. By bringing African Indigenous Knowledge Systems into dialogue with health-systems and Complex Adaptive Systems scholarship, the review seeks to advance an epistemically plural account of resilience that recognises CHWs and communities not only as recipients or implementers of health interventions, but as legitimate producers and interpreters of health-system knowledge.