Digital Governance at the Street Level: A Mixed-Methods Study of Systemic Resilience and ‘Human-in-the-Loop’ Telemedicine in Rural Thailand

> 0.05), highlighting a 'Low-Tech, High-Touch' paradox. Qualitative analysis elucidated this through the "Human-in-the-Loop" mechanism, where Village Health Volunteers (VHVs) and healthcare providers bridge the digital divide. However, the study identifies an "invisible workload"-non-formalized discretionary effort-that sustains this resilience. Findings suggest that rural digital health governance should prioritize human intermediaries and pragmatic utility over purely technical upgrades. The study concludes that long-term sustainability requires institutionalizing human support networks while mitigating the exploitation of healthcare personnel's goodwill.