Ediau Michael, Ekirapa Kiracho Elizabeth, Aweko Juliet, Opio Charles, Ashaba Maggie Ssekitto, Waiswa Peter
Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda
Building Research Initiatives Advancing Global Health Equity (BRIDGE), San Diego State University School of Public Health, San Diego, California, USA.
BMJ Glob Health. 2025 Sep 18;10(Suppl 4):e017472. doi: 10.1136/bmjgh-2024-017472.
The heightening of efforts to eradicate vaccine-preventable diseases through mass vaccination campaigns has contributed to a growing demand for effective and efficient payment mechanisms for frontline vaccination workers in large-scale campaigns. Subsequently, the Uganda Ministry of Health (MoH) adopted digital payments for campaign workers, which were either implemented by the government or partners. We specifically explored stakeholder perspectives on the feasibility of partner-implemented digital payment to front-line health workers in phase one of the yellow fever mass vaccination campaign in Uganda.
We employed a cross-sectional qualitative study. The study area comprised four districts (Amuru, Lira, Hoima and Kikuuba) purposively selected from 51 phase one yellow fever vaccination campaign districts. We collected data through 37 qualitative interviews (25 key informant interviews (KIIs) and 12 in-depth interviews (IDIs)). IDI participants included vaccination health workers (n=12). KII interview participants included district technical officials (n=14), representatives of digital payment implementing partners at district and national levels (n=7) and MoH staff (n=4). All interviews were audio-recorded and later transcribed and analysed using thematic analysis.
The partner-implemented payment system was linked with perceived improvements in timeliness and the increased likelihood of beneficiaries receiving complete payment. Despite these benefits, some payment delays were reported. These delays were mainly attributed to incomplete and inaccurate participant payment information. Health workers said they were more motivated because they felt assured of being paid and receiving the full amount.
Despite drawbacks, partner-led digital payment of health workers was perceived as a feasible strategy promoting timely, complete payments. Relevant stakeholders should ensure accurate, complete and timely capture and verification of health workers' payment details to counter payment delays. We recommend more rigorous evaluations to determine whether a partner-implementation of digital payment is more effective than government-led payment in different settings.
通过大规模疫苗接种运动加大根除疫苗可预防疾病的力度，导致对大规模运动中一线疫苗接种工作人员有效且高效的支付机制的需求不断增加。随后，乌干达卫生部采用了由政府或合作伙伴实施的针对运动工作人员的数字支付方式。我们特别探讨了在乌干达黄热病大规模疫苗接种运动第一阶段中，利益相关者对合作伙伴实施的数字支付给一线卫生工作者的可行性的看法。
我们采用了横断面定性研究。研究区域包括从51个黄热病疫苗接种运动第一阶段的地区中特意挑选出的四个地区（阿穆鲁、利拉、霍伊马和基库巴）。我们通过37次定性访谈（25次关键信息访谈和12次深入访谈）收集数据。深入访谈的参与者包括疫苗接种卫生工作者（12人）。关键信息访谈的参与者包括地区技术官员（14人）、地区和国家层面数字支付实施合作伙伴的代表（7人）以及卫生部工作人员（4人）。所有访谈都进行了录音，随后进行转录并使用主题分析进行分析。
合作伙伴实施的支付系统与及时性方面的明显改善以及受益人获得全额支付的可能性增加有关。尽管有这些好处，但仍有一些支付延迟的报告。这些延迟主要归因于参与者支付信息不完整和不准确。卫生工作者表示他们更有动力，因为他们对获得支付和全额支付感到放心。
尽管存在缺点，但由合作伙伴主导的卫生工作者数字支付被视为促进及时、全额支付的可行策略。相关利益相关者应确保准确、完整和及时地获取和核实卫生工作者的支付细节，以应对支付延迟。我们建议进行更严格的评估，以确定在不同环境中合作伙伴实施的数字支付是否比政府主导的支付更有效。
