{
  "abstract": "Introduction 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.Methods 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.Results 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.Conclusion Supporting districts to operationalise digital payments increased e-cash usage among vaccination workers, despite delays. However, it did not significantly impact motivation or satisfaction.Trial registration number NCT05684081.",
  "authors": [
    {
      "affiliations": [
        "School of Public Health, Makerere University, Kampala, Uganda",
        "Karolinska Institutet, Stockholm, Stockholm County, Sweden"
      ],
      "name": "Peter Waiswa"
    },
    {
      "affiliations": [
        "Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA"
      ],
      "name": "Margaret McConnell"
    },
    {
      "affiliations": [
        "Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda",
        "Makerere University Digital Payment Unit, Kampala, Uganda"
      ],
      "name": "Juliet Aweko"
    },
    {
      "affiliations": [
        "Republic of Uganda Ministry of Health, Kampala, Kampala, Uganda"
      ],
      "name": "Daniel Donald Mukuye"
    },
    {
      "affiliations": [
        "Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda",
        "Makerere University Digital Payment Unit, Kampala, Uganda"
      ],
      "name": "Charles Opio"
    },
    {
      "affiliations": [
        "School of Public Health, Makerere University, Kampala, Uganda",
        "Makerere University Digital Payment Unit, Kampala, Uganda"
      ],
      "name": "Maggie Ssekitto Ashaba"
    },
    {
      "affiliations": [
        "World Health Organization Country Office for Uganda, Kampala, Uganda"
      ],
      "name": "Andrew Bakainaga"
    },
    {
      "affiliations": [
        "Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda",
        "Makerere University Digital Payment Unit, Kampala, Uganda"
      ],
      "name": "Elizabeth Ekirapa-Kiracho"
    }
  ],
  "title": "The effect of supporting districts to operationalise digital payments for vaccination campaign workers: a cluster randomised controlled trial during the 2022 polio vaccination campaign in Uganda",
  "uid": "60a6d56a-6c20-5d51-9ac8-6727d5f29c1d"
}