Assessing the feasibility of partner-implemented digital payment systems for health workers: stakeholder perspectives from Uganda's yellow fever mass vaccination campaign - a qualitative study.

Abstract

Background: The heightening of efforts to eradicate vaccine-preventable diseases through mass vaccination campaigns has contributed to a growing demand for effective and efficient payment mechanisms for frontline vaccination workers in large-scale campaigns. Subsequently, the Uganda Ministry of Health (MoH) adopted digital payments for campaign workers, which were either implemented by the government or partners. We specifically explored stakeholder perspectives on the feasibility of partner-implemented digital payment to front-line health workers in phase one of the yellow fever mass vaccination campaign in Uganda.

Methods: We employed a cross-sectional qualitative study. The study area comprised four districts (Amuru, Lira, Hoima and Kikuuba) purposively selected from 51 phase one yellow fever vaccination campaign districts. We collected data through 37 qualitative interviews (25 key informant interviews (KIIs) and 12 in-depth interviews (IDIs)). IDI participants included vaccination health workers (n=12). KII interview participants included district technical officials (n=14), representatives of digital payment implementing partners at district and national levels (n=7) and MoH staff (n=4). All interviews were audio-recorded and later transcribed and analysed using thematic analysis.

Results: The partner-implemented payment system was linked with perceived improvements in timeliness and the increased likelihood of beneficiaries receiving complete payment. Despite these benefits, some payment delays were reported. These delays were mainly attributed to incomplete and inaccurate participant payment information. Health workers said they were more motivated because they felt assured of being paid and receiving the full amount.

Conclusions: Despite drawbacks, partner-led digital payment of health workers was perceived as a feasible strategy promoting timely, complete payments. Relevant stakeholders should ensure accurate, complete and timely capture and verification of health workers' payment details to counter payment delays. We recommend more rigorous evaluations to determine whether a partner-implementation of digital payment is more effective than government-led payment in different settings.