Waiswa Peter, McConnell Margaret, Aweko Juliet, Mukuye Daniel Donald, Opio Charles, Ashaba Maggie Ssekitto, Bakainaga Andrew, Ekirapa-Kiracho Elizabeth
School of Public Health, Makerere University, Kampala, Uganda.
Karolinska Institutet, Stockholm, Stockholm County, Sweden.
BMJ Glob Health. 2025 Sep 10;10(Suppl 4):e016666. doi: 10.1136/bmjgh-2024-016666.
A motivated and satisfied health workforce is critical for the success of mass vaccination campaigns targeting diseases like polio. This study examined whether supporting districts to implement electronic cash (e-cash) payments, instead of cash, increased e-cash usage and improved vaccine campaign healthcare workers' (VCHWs) motivation and satisfaction during an oral poliovirus vaccination campaign in 2022 in Uganda.
In November 2022, 54 districts and 2665 VCHWs were enrolled and randomised. Intervention districts received training on navigating the government e-cash platform, user roles, beneficiary data upload and payment report generation. Control districts received standard support. Data collected included mode of payment (cash or e-cash), VCHW motivation (primary outcome) and satisfaction with the payment method. Primary analysis was on an intention-to-treat basis, with 589 (44.1%) VCHWs in control and 765 (57.5%) in intervention districts receiving e-cash.
E-cash payments were more common in intervention districts (765/1330, 57.5%) compared with controls (589/1335, 44.1%). VCHWs in intervention districts were more likely to be paid via e-cash (adjusted OR (AOR) 3.15; 95% CI: 0.40 to 10.70; p=0.079). Nearly all VCHWs (97.6%) received payments after campaign completion. There was no significant difference in motivation (AOR=0.82; 95% CI: 0.47 to 1.44; p=0.498) or satisfaction (AOR=1.01; 95% CI: 0.77 to 1.55; p=0.641) between groups. Participants reported e-cash as convenient, transparent, time-saving and cost-saving.
Supporting districts to operationalise digital payments increased e-cash usage among vaccination workers, despite delays. However, it did not significantly impact motivation or satisfaction.
NCT05684081.
积极主动且满意的卫生人力对于脊髓灰质炎等疾病大规模疫苗接种运动的成功至关重要。本研究探讨了在2022年乌干达口服脊髓灰质炎疫苗接种运动期间，支持各地区实施电子现金支付而非现金支付是否能增加电子现金的使用，并提高疫苗接种运动医护人员（VCHWs）的积极性和满意度。
2022年11月，招募了54个地区和2665名VCHWs并进行随机分组。干预地区接受了关于政府电子现金平台操作、用户角色、受益人数据上传和支付报告生成的培训。对照地区接受标准支持。收集的数据包括支付方式（现金或电子现金）、VCHWs的积极性（主要结果）以及对支付方式的满意度。主要分析基于意向性分析，对照地区有589名（44.1%）VCHWs收到电子现金支付，干预地区有765名（57.5%）收到电子现金支付。
与对照地区（589/1335，44.1%）相比，干预地区电子现金支付更为常见（765/1330，57.5%）。干预地区的VCHWs更有可能通过电子现金获得支付（调整后比值比（AOR）3.15；95%置信区间：0.40至10.70；p=0.079）。几乎所有VCHWs（97.6%）在运动结束后收到了款项。两组之间在积极性（AOR=0.82；95%置信区间：0.47至1.44；p=0.498）或满意度（AOR=1.01；95%置信区间：0.77至1.55；p=0.641）方面没有显著差异。参与者报告电子现金方便、透明、省时且省钱。
尽管有延迟，但支持各地区实施数字支付增加了疫苗接种工作人员对电子现金的使用。然而，这并未对积极性或满意度产生显著影响。
NCT05684081。
