Department of Community Health and Behavioral Sciences, Makerere University School of Public Health, Kampala, Uganda.
Department of Disease Control and Environmental Health, School of Public Health, Makerere University, Kampala, Uganda.
Glob Health Action. 2024 Dec 31;17(1):2375867. doi: 10.1080/16549716.2024.2375867. Epub 2024 Aug 23.
There is inadequate evidence about the influence of digital and cash payment modalities on the performance of Community Health Workers (CHWs) in underserved communities, such as refugee settlements.
To compare the performance of CHWs when paid in cash or digitally in Kyaka II refugee settlement, Uganda.
A comparative cross-sectional mixed methods design was used. Secondary data comprising 247 CHW reports during a six-month period of cash and digital payments were analyzed using Stata v14. Eleven focus group discussions, four in-depth interviews, and ten key informant interviews were conducted among the settlement stakeholders to explore perceptions of the payment methods. Qualitative data were analyzed thematically using Atlas.ti v9.
CHWs performed better when paid cash than digital payments ( = 5.28; df = 246; < 0.001). During the cash payment period, at least secondary education (APR 1.71 CI: 1.14-2.58) and having a side occupation (APR 1.58; CI: 1.13-2.21) were positively associated with performance. For digital payments, being male (APR 0.58; CI: 0.34-0.98), serving longer than 9 years (APR 0.87; CI: 0.82-0.93), and being allocated more than 60 households per month (APR 0.31; CI: 0.19-0.52) were negatively associated with CHW performance. Qualitative data revealed that most stakeholders preferred cash due to inconsistent and delayed digital payments.
CHWs preferred and performed better with cash payments because digital payments were associated with delays and payment shortfalls that demotivated them. Implementers should invest towards averting digital payment shortfalls in remote settings to enhance CHW motivation and performance.
关于数字支付和现金支付模式对服务不足社区（如难民营）中的社区卫生工作者（CHW）绩效的影响，证据不足。
比较在乌干达 Kyaka II 难民营中以现金或数字方式支付薪酬时 CHW 的表现。
采用了对比性的横断面混合方法设计。使用 Stata v14 分析了在六个月的现金和数字支付期间收集的 247 份 CHW 报告。在难民营利益相关者中进行了 11 次焦点小组讨论、4 次深入访谈和 10 次关键知情人访谈，以探讨对支付方式的看法。使用 Atlas.ti v9 对定性数据进行了主题分析。
与数字支付相比，现金支付时 CHW 的表现更好（ = 5.28；df = 246； < 0.001）。在现金支付期间，至少接受过中等教育（APR 1.71 CI：1.14-2.58）和有兼职工作（APR 1.58；CI：1.13-2.21）与绩效呈正相关。对于数字支付，男性（APR 0.58；CI：0.34-0.98）、服务年限超过 9 年（APR 0.87；CI：0.82-0.93）和每月分配超过 60 个家庭（APR 0.31；CI：0.19-0.52）与 CHW 绩效呈负相关。定性数据显示，由于数字支付不一致且延迟，大多数利益相关者更喜欢现金。
CHW 更喜欢现金支付且表现更好，因为数字支付与延迟和付款不足有关，这会使他们失去动力。在偏远地区实施者应投资避免数字支付短缺，以提高 CHW 的积极性和绩效。
