Pyne-Mercier Lee, Jafa Krishna, Maigua Susan, Muli Jennifer, Gichinga Elijah, Khaemba Antony, Kataraia Nitusima, Mohammed Aisha, Kamangadazi Tembo Frank, Esmail Imran, V R Besana Giulia, Hornung Heiko, Makame Zubeir Ali
University of Washington, 3980 15th Ave NE, Seattle, WA, 98105, United States, 1 206-696-8855.
Medic, San Francisco, CA, United States.
JMIR Med Inform. 2025 May 28;13:e65325. doi: 10.2196/65325.
Community health workers (CHWs) are essential for achieving universal health coverage and reaching the Sustainable Development Goals. Paying CHWs for their work increases their motivation and effectiveness, and is recommended by the World Health Organization and advocacy organizations such as the Community Health Impact Coalition. Many implementing organizations currently pay CHWs using mobile money or other digital means. However, most payment systems are designed without the involvement of CHWs.
In this implementation report, we describe efforts to improve efficiency, accuracy, and user experience of the CHW payment process of the Jamii ni Afya project in Zanzibar.
We applied Medic's design process to develop new functionality for the open-source Community Health Toolkit. We reviewed documentation and engaged with users to understand their needs and experiences with the current payment system. This information formed the basis of technical specifications, which were developed into a revised workflow. The workflow was iteratively tested and refined. Several steps that were managed offline, such as resolving payment discrepancies, were formalized and incorporated into the workflow. We conducted user acceptance testing to assess functionality and user experience.
The workflow was able to accurately translate programmatic data into payment information for each CHW and securely transmitted this information to a payment service provider. User acceptance testing revealed that CHWs felt the revised payment system provided them with more information and gave them a greater sense of control. Program staff felt the workflow would increase the efficiency and accuracy of the payment process, while simplifying the resolution of payment discrepancies.
Engaging users in the design and optimization of digital payment systems has the potential to improve the efficiency and accuracy of digital payment systems while enhancing satisfaction among all users, contributing to improved sustainability and impact of CHW programs. Definitive conclusions will depend on evaluation of the system after implementation.
社区卫生工作者对于实现全民健康覆盖和达成可持续发展目标至关重要。为社区卫生工作者的工作支付报酬能提高他们的积极性和工作成效，这是世界卫生组织以及社区卫生影响联盟等倡导组织所推荐的。目前许多实施机构使用移动货币或其他数字方式向社区卫生工作者支付报酬。然而，大多数支付系统在设计时并未让社区卫生工作者参与。
在本实施报告中，我们描述了为提高桑给巴尔Jamii ni Afya项目社区卫生工作者支付流程的效率、准确性和用户体验所做的努力。
我们应用Medic的设计流程为开源社区卫生工具包开发新功能。我们查阅文档并与用户交流，以了解他们对当前支付系统的需求和体验。这些信息构成了技术规范的基础，进而形成了修订后的工作流程。该工作流程经过反复测试和完善。一些离线管理的步骤，如解决支付差异问题，被规范化并纳入工作流程。我们进行了用户接受度测试以评估功能和用户体验。
该工作流程能够准确地将项目数据转化为每位社区卫生工作者的支付信息，并将此信息安全地传输给支付服务提供商。用户接受度测试表明，社区卫生工作者认为修订后的支付系统为他们提供了更多信息，让他们更有掌控感。项目工作人员认为该工作流程将提高支付流程的效率和准确性，同时简化支付差异的解决。
让用户参与数字支付系统的设计和优化，有可能提高数字支付系统的效率和准确性，同时提升所有用户的满意度，有助于提高社区卫生工作者项目的可持续性和影响力。最终结论将取决于实施后对该系统的评估。
