Effectiveness of Mobile Money Payments to Vaccination Campaign Health Care Workers on Polio Vaccination Campaign Coverage and Quality: a Cluster Randomized Controlled Trial

Problem statement and justification

A motivated health workforce is essential for the success of critical health campaigns and programmes such as the recently concluded and upcoming polio campaigns. This is even more critical particularly in periods during and following disruptions in health services such as the Covid-19 pandemic and the resultant restrictions. Remuneration, which has been traditionally cash based is a key factor for health care worker motivation, satisfaction and performance. However, traditional cash-based modes of payment are fraught with numerous problems like delays in funds requisitions and disbursements, cash leakages, exposure to risk of theft while in transit, and a lack of accountability data and financial transparency. These chronic problems associated with cash-based payments have led to a gradual transition to digital (mobile money) payments in several countries including Uganda. While digital payments are seen as fast, convenient, traceable, reliable, and easy to set up, they are not themselves free of challenges. Also, their effect on health outcomes has not been evaluated with robust scientific methods.

Few studies have particularly paid attention to the role of digital payments in influencing gender relations (power relations, access to resources and gender roles) and also how gender relations affect the adoption and use of digital payments particularly in relation to health worker's motivation and performance that is essential for increasing coverage and quality of vaccination campaigns. Furthermore, the investigators are cognizant of the intersections between gender and other social identities of both female and male health workers such as gender, age, education, cadre of health worker, income bracket, location, disability, ethnicity) that could have a bearing on how they interact and respond to digital payments-and their implications on the motivation and performance of health workers.

This study therefore, will evaluate an intervention that seeks solutions to the current challenges faced by payment systems by providing a verified national database of health care workers and processing payments directly to those health care workers digitally, through mobile money platforms. Set within the context of the upcoming polio vaccination campaign, this study will examine the effect of this intervention on health outcomes such as polio vaccination coverage as well as health worker related outcomes like motivation, satisfaction and performance. This study will also examine the effect of gender norms/gender relations on health workers' response to payment systems employed during polio vaccination. While maintaining Uganda free of polio is in itself a very important goal, lessons learned from this cluster randomized implementation trial can be extended to other health campaigns and programmes.