From October 2021, Makerere University School of Public Health obtained funding from the Bill and Melinda Gates Foundation to establish a Center for Digital Health Payment Initiative & Research in Africa (DHPI-R). The project will establish a center for Digital Health Payment Initiatives whose activities will be anchored at Makerere University, Uganda and University of Dakar, Senegal to catalyze the creation of evidence on digitized payments of health workers of immunization programs/campaigns in selected Anglophone and Francophone countries.

This project aims to enhance and inform national, regional and global efforts to digitize payments for health workers by fostering and supporting evidence-based and evidence-driven decision making in Sub Saharan Africa.

Digital Health
Digital Health Payment Initiative and Research in Africa (DHPI-R)

The first quarter of the DHPI-R (October to December 2021) focused on initiating activities including registration in institutional review boards (IRB) and the respective national councils in the implementing countries; and recruitment of staff - activities were officially launched on 1st December 2021. However, the second quarter (January to March 2022)  managed to:

  1. Set up a Robust technical advisory group (TAG);
  2. Set up agreements with key partner organisations and consultants; providing;  Landscape analysis findings of the local context, challenges and opportunities for digitization of payments in SSA. Additional information on the project is provided in the sections below.

Background of Project

Digital financial systems (DFS) in the health sector are a critical strategy for health system strengthening because of their ability to improve the timeliness of efficiency of health workforce payments. Health workers form one of the largest inputs into an immunization program. Therefore, costs attributed to health workers comprise a significant proportion of immunization campaign costs (Yehualashet et al., 2016). Faster and better-quality health campaigns e.g. OPV campaigns have been shown to interrupt diseases such as polio transmission globally. It is reported that faster and more transparent payment frontline workers for polio campaigns and other health campaigns can improve worker performance as well as the speed and quality of a campaign and health outcomes in general if they are well motivated and payments made in time.  

The Digital Health Payment Initiative & Research in Africa (DHPI-R) project is intended to provide strategic funding for research which will be generated to meet the evidence demands of health partners who are already looking for payment solutions, and encourage greater attention to their value. In order for all these innovations to take root and be scaled up, the engagement and support of key development funders is critical. There is growing acknowledgement of the importance of solutions to integrate mobile payments into their campaign efforts, curated evidence-based guidance on best practices, tools and potential risks is lacking. The WHO AFRO – through its polio Rapid Response Team (RRT) and recently-formed Digital Finance Team (DFT) - is already employing mobile money and other digital tools in paying polio campaign workers who support house-to-house polio outbreak vaccination campaigns in the African region. Facilitating robust research on these existing efforts, for example, will not only improve these campaigns themselves, but will provide insights into general best practices and encourage adoption for digital payment efforts across additional campaign platforms (e.g. immunization, neglected tropical diseases, malaria, etc.).  The proposed center aims to bridge the evidence gaps and also to build a community of practice around digital payments in Sub Saharan Africa. We also aim to learn how these digital payment systems strengthen or disrupt the complex health system. Lessons from pioneer research projects and synthesized research evidence on health worker digital payments will be collated, synthesized and adopted/adapted for different settings with an emphasis of capacity building and harnessing lessons from both English and French speaking countries.

This BMGF funded investment establishes a new research initiative anchored at 2 prominent existing African institutions –Makerere University, Uganda (Anglophone) and University of Dakar, Senegal (Francophone) to catalyze the creation of evidence on digitized payments of health workers of immunization programs/campaigns.  The proposal envisions integrating best practices in qualitative and quantitative research, including demand-side mobile and field surveys, supply-side data analysis, and targeted experiments in close collaboration with key global health and vaccine campaign partners.

The project will balance the value of working in regions with developed financial infrastructure (e.g. ubiquitous mobile money) and the opportunity to work in regions likely to host vaccine campaigns in the near future. We would consider evolving the initial focus on health worker wages and payment digitization, as a steppingstone to establishing a sustainable Africa-based center of excellence for operational research on health campaign effectiveness. More specifically, we would also seek to use an initial focus on mobile payments to campaign workers as an initial step towards a more crosscutting focus on payments for health workers.