Time to embrace digital payments for immunization health workers

World Immunization Week, which takes place every last week of April, is urging urgent collective action to protect individuals against vaccine-preventable diseases, particularly children, under the theme of ‘The Big Catch-Up.’

The goal is to restore essential immunization coverage to pre-pandemic levels and to reach millions of children who have missed out on vaccines.

During the immunization week, it is critical for society to pay attention to health workers who dedicate their time to providing immunization services. They are committed to their work but untimely payments are making it hard for them to do their job well, leaving many children unvaccinated and exposed to life-threatening diseases.

These health workers often have to use their own money for transport and food, and wait for long periods for reimbursement. Therefore, ensuring timely payments for these health workers is crucial if we want to ensure that children get their vaccines on time.

There is growing interest in the potential of digital payments to help solve the problem of delayed payment of health workers.

Existing findings from research on digital payments show that digital payment of health workers, for example during immunization campaigns, could result in several benefits including timely payment, safety of payment since people do not have to move around with cash as well as complete payment since leakage of funds from having to pay the people handling the money is reduced.

This is even more important because a large number of health workers are recruited during national mass immunization campaigns and paying them with cash is not cost-effective. Some institutions, for example, were able to clear a large backlog of payments through mobile money and bank transfers.

Based upon this backdrop, with funding from the Bill and Melinda Gates Foundation, Makerere University School of Public Health established the Digital Health Payment Initiatives and Research (DHPI-R).

Through rigorous research, this initiative aims to identify how, and under what circumstances, digital health worker payments can support effective campaign delivery. The project has already commissioned 25 studies across eight countries in Sub- Saharan Africa.

Although digital payments can provide all these benefits, we acknowledge that it is not easy to set up a digital payment system that can enable timely effective payment of health workers.

During the recent polio campaigns that were held in the country, we followed the payment process and I would like to share two of the challenges that could be fixed by stakeholders in the digital payment ecosystem.

One of the activities that were very resource-intensive was the generation of a health worker database that contained identification information about health workers in the district and their phone numbers.

Secondly, each district had to generate a list of the health workers who actually worked during the campaign and send it to the district finance officer to initiate payment. Because all these processes were manual, they took a significant amount of time and caused delays in the payment of health workers.

Fortunately, a list of health workers and their phone numbers already developed by the ministry of Health in collaboration with the World Health Organization came in handy. But it also needs regular updates because some health workers leave the district or change their phone numbers.

The linkage between national systems that have identification particulars and phone numbers of health workers could help speed up this verification process whenever a digital payment is undertaken.

Additionally, automation of the process of confirming that a health worker actually showed up and participated in the immunization exercise could easily be done using mobile phone digital applications. This would allow for immediate verification and payment of the persons who worked or used money from their own pockets.

We, therefore, recommend that the different stakeholders involved in the digital payment ecosystem devise interoperable systems that can allow personal identification information such as National IDs and phone numbers to be confirmed seamlessly.

Secondly, digital tools that can allow immediate verification of work done should also be developed. Such initiatives can allow the country to harness the full benefits of digital payment not just for immunization campaigns but also for other programs that have to pay workers digitally.

The writer is a senior lecturer, Makerere University School of Public Health and Anglophone hub principal investigator, Digital Health Payment Initiative and Research in Africa Project.