Community Mental Health Service Teleconsultation Bandwidth Volatility and Diagnostic Concordance in Rwandan District Clinics: A Difference-in-Differences Estimation of Connectivity Exposure

Teleconsultation has been promoted as a means of extending specialist mental health support to district clinics in Rwanda, yet the diagnostic reliability of remote assessment depends on network conditions that are rarely stable in rural settings. The indicator, which measures the percentage of women who heard family planning messages at a community meeting or event, had a mean of 29.733 and a standard deviation of 17.495 across the fifteen country-surveys, ranging from 6.60 in Mali to 73.40 in Malawi. These values are used to characterise the scale of community-level health communication exposure that teleconsultation programmes must complement, not to estimate diagnostic concordance directly. The paper specifies the exposure contrast, the concordance metric, the parallel-trends assumption and the threats to identification that a district-level evaluation would need to address. It argues that bandwidth volatility is a structural feature of connectivity exposure rather than a nuisance parameter, and that evaluations which treat connectivity as a binary treatment will systematically misstate the effect of teleconsultation on diagnostic agreement. The contribution is a pre-specified estimation strategy and a set of testable propositions for a trial that has not yet been conducted.