HEALTH:
Quality and coverage of immunization campaigns in SSA, what is the gap?
Countries in Sub-Sharan Africa (SSA) have for a long time invested in immunization campaigns to ensure population immunity against VPDs. However, implementation of these immunization campaigns is a complex and challenging process that requires continued investment. Several challenges remain in reaching immunization targets across Africa. These include; limited access to immunization services, inaccurate and untimely compensation of immunization frontline workers, and the most recent challenge of sustaining routine immunization as part of essential health services during the COVID-19 pandemic and the Ebola outbreak in Uganda. When frontline polio health campaign workers are not compensated in a timely manner or completely, there are serious negative effects. Campaign worker retention becomes diffcult due to unmotivation to work without pay and eventually affects the success of campaigns. More innovative ways are needed to strengthen health systems and improve immunization quality and coverage. Digitalizing payments for campaign health workers is one of such initiatives that should be further explored to bridge this gap.
The future of digital payments research: new and upcoming studies in SSA
In response to these challenges, SSA countries with support from World Health Organisation (WHO) Afro and funded by the Bill and Melinda Gates Foundation embarked on digitalizing the payment of healthcare workers in an effort to improve the quality and coverage of polio campaigns under the Digital Health Payments Initiative and Research project (DHPI-R). So far, 16 countries including; Cote de d’Ivoire, Conazzaville, DRC, Gambia, Ghana, Liberia, Malawi, Mali, Kenya, Tanzania, Uganda, Nigeria, Sierra Leon, South Sudan, Cameroon, and Algeria have been supported through the WHO digital payment system since 2020.
The system involves working with local mobile money operators or banks, based on the preferences of the countries. They also work with partners and the Ministry of Health, a key stakeholder in this, to design country-appropriate intervention strategies. (SCIDaR Research Brief 2023).Since the program started, over 200,000 frontline campaign health workers have been paid through digital payments platforms such as mobile money. Recent studies in Mali, Nigeria, Cote de d’Ivoire, and our landscape analysis provide evidence that digitizing payments for health care workers is an opportunity to further strengthen healthcare systems in SSA and has increasingly become the preferred mode of the payment for health care workers due to its added advantage of curtailing leakage of health system funds and enhancing health worker motivation. Frontline health workers often lack bank accounts making digital payments through mobile money, a more convenient and accessible way to receive payment on time with minimal physical cash handling. Furthermore, digital payments can improve the efficiency and transparency of payment processes, by providing a digital record of transactions that can be audited and tracked and in the long run, this can help to reduce administrative costs and ensure that campaign health workers are paid accurately and on time.
As quoted by Barbara Jordan, “for all its uncertainty, we cannot flee the future”. Digital payments are the future. As shared above, there are registered successes in using digital payments for frontline health workers but there is still a need to understand the dynamics surrounding these payments better to inform policies and scale-up of the digital payments systems in SSA. The Digital Health Payments Initiative and Research project (DHPI-R) has therefore funded several studies to collect more rigorous and empirical evidence on the effectiveness and cost-benefit of digitizing payments for healthcare workers, specifically, those involved in vaccination campaigns in the previously mentioned countries. The project will advance knowledge, build capacity and enhance reciprocal learning in the field of digital payments for immunization campaign health workers.As part of the project, up to 24 studies (including an RCT) are being conducted in both Anglophone and Francophone countries. The studies offered grants include; Six student-led studies as part of capacity building in the Anglo and Francophone hub, and 18 expert-led studies.
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