Call for Applications

Notice of Funding Opportunity : RFA NO. – 01.08.2022 

1.0 Overview of the Digital Health Payments Initiative and Research in Africa

Digital financial services (DFS) delivered via mobile phones, the internet, or bank cards have the potential to lower costs, promote more efficient, secure, and transparent transactions, and improve access to formal financial services. The adoption of DFS can facilitate changes in consumers’ financial behaviors that boost economic well-being and reduce poverty. Moreover, DFS have enabled innovation and improvement in service delivery across diverse sectors including social protection, education, utilities, and businesses employing low-wage factory workers. Digital financial payment mechanisms in these sectors have also played a role in increasing transparency of financial flows and reducing leakage of public resources. Despite the potential of DFS to generate innovation, there has not been widespread and sustained adoption and application of DFS innovations in the health sector of low- and middle-income countries (LMICs). To better understand the current use of DFS in the LMIC health sector and the impact of these services on the health system, the Bill and Mellinda Gates Foundation in collaboration with Makerere University School of Public Health (MAKSPH) and the University of Dakar in Senegal has established the Digital Health Payments Initiative and Research in Africa (DHPI-R).

1.1 Key definitions: Digital Financial Services (DFS) and Health workers

What are Digital Financial Services (DFS)?  DFS refer to the use of mobile phones or bank cards to conduct payments, savings, or borrowing activities.  DFS are distinguished from analog financial services in that DFS frequently enables unique identification of senders and receivers of payments, leaves a data trail that improves the traceability of transactions, and requires an intermediary, such as a mobile money or banking agent, to convert electronic currency into analog cash.  DFS may increase the speed and reduce the cost of conducting long distance transactions, help consumers avoid theft associated with storing or transporting cash, and reduce leakage associated with distributing funds such as salaries or program funding from central to peripheral workers and administrative units.  Bank and non-bank institutions may offer DFS but may be regulated by different public agencies.

The canonical DFS use case for this project will be the distribution of payments from a centralized government agency or NGO account to frontline health workers through a telecom managed mobile money network, which may then be converted into cash (“cashed out”) by the health worker at a local mobile money agent or used to send payments to family or friends without cashing out. 

Which health workers are targeted with this work?  The term health worker may be construed to include the full spectrum of individuals that serve the health system from formally educated and certified doctors with permanent salaried jobs in sophisticated fixed hospitals with ample IT systems to modestly trained frontline community engagement agents with temporary jobs supporting the distribution of vaccines in peripheral rural communities and poor telecom connectivity.

For the sake of this work, applicants can think of the canonical health worker as frontline agents that work outside of fixed locations who are often mobile, change communities as they support the distribution of vaccines or other health campaigns and often work in a temporary capacity. This includes formal and non-formal health workers such as community health workers. Among other health campaigns, polio campaigns will be a particular priority focus for this project. 

2.0 Funding Opportunities

DHPI-R anticipates awarding a total of 6 external research grants for this funding cycle.

Type of research studies

To both stimulate creative project development and anchor expectations, we provide the following examples of the research projects and methods within scope of this project. Please refer to the framework paper for more details. These examples are not meant to be exhaustive; they only cover a fraction of potential study designs that would be considered for funding by this project. And, while use of randomization and exploitation of natural experiments to infer causal impact of digitizing payments for health workers would be highly prized by the project, we acknowledge other methods can contribute important evidence to the topic.  For example, assessing whether digital payments increase motivation and or access to financial services of health workers are all topics within scope. Note that both quantitative and qualitative approaches are within scope, and so are mixed methods.  Some examples of quantitative and qualitative research approaches are summarized below.

Quantitative: 

  • Baseline, midline, and endline surveys of health workers and vaccine recipient households before, during, and after a campaign that integrated mobile money payments to health workers either in staggered rollout or in a randomized manner that enables comparison between health workers that do and do not receive payment through DFS.
  • High frequency surveys (potentially via phone or SMS) monitoring the experience of health workers that receive payments via DFS during a health campaign.
  • Descriptive surveys of a sample of health workers collected from an existing health worker database or during a new health worker recruiting process focused on the health workers’ financial lives, preferences for DFS vs. analog payment, access and literacy with technology/mobile phones, possession, or lack of official identification, etc.
  • Analysis of natural experiments in the rollout of DFS for health workers that exploits existing administrative or survey data to estimate the causal impact of the introduction of DFS health worker productivity, campaign effectiveness, and individual health outcomes for the recipient of the health interventions.
  • Analysis of administrative data on payment transfers to health workers via DFS and their subsequent DFS / financial behavior, e.g. if, when, and where they cash out their mobile money delivered salary, whether they transfer funds directly to other contacts without cashing out, whether they deposit additional funds into their accounts or limit their balances to payments for their work as health workers.
  • Cost estimates for the process of introducing DFS into health worker payment systems, including costs to the public agencies/NGOs and to the health workers (e.g. need to upgrade identification, purchase an upgraded phone, pay for transport, etc.).

Qualitative:

  • Qualitative studies could include focus group interviews with health workers before, during, and after the introduction of DFS for payments or observational descriptions from activities to onboard and train health workers for payment via DFS.
  • Case study descriptions of the operations and processes involved in introducing DFS to health worker payment systems, capturing the challenges faced and solutions pursued by public agencies and individual health workers.

Size of research studies - We anticipate that the studies done may vary in terms of scope. Funding and project length will depend on the research questions and methods. Generally, project length, award amount and scope should be as follows:

  • Large studies -12 months - Large studies will involve large surveys, or comprise of multi-country research and will receive up to $200,000.
  • Medium studies -9 months - Medium-sized studies will involve primarily qualitative research, document review approaches and secondary data analysis. Medium-sized projects may also include extensions of ongoing digital health projects and may be done in a single country or more than one country. Such projects will be eligible to receive up to $100,000.
  • Small studies - 6 months - Small studies may involve primarily qualitative research, document review approaches, secondary data analysis, and small quantitative surveys. Small projects may also include extensions of ongoing digital health projects. Such projects will be eligible to receive up to $60,000.

DHPI-R plans to distribute one large, one medium and one small grant to projects based in Anglophone and Francophone countries respectively.

2.1 Priority Research Topics

DHPI-R is seeking applications for studies that address evidence gaps listed below and in the digital health framework paper found here:

The research questions related to the primary outcomes and impact of DFS questions are among the highest priority for the initiative. Therefore, DHPI-R expects project applications that can answer a combination of these research questions. The questions may arise from one theme or several themes. Applicants should note that these questions are not exhaustive, so applicants may add to these questions. Applicants are also encouraged to incorporate gender related issues within their research. It is highly recommended that applicants refer to the digital payments framework paper for more guidance.

Table 1: Priority Research Questions

Themes

Research questions related to the primary outcomes and impact of Digital Financial Services

Campaign effectiveness

  1. To what extent do DFSs impact intended health program outcomes e.g (Vaccine coverage, equity, quality of vaccination campaigns)?
  2. How (through which mechanisms) do digital payments influence intended health program outcomes e.g., (vaccine coverage, equity, quality of vaccination campaigns).
  3. To what extent does digital payment influence the effectiveness of the health system?

DFS effects on financial inclusion, safety, and security of payments

  1. To what extent does digital payment affect financial inclusion and financial behavior among health workers and their household members?
  2. To what extent does digital payment influence the safety and security of payments?

Health worker performance and retention

  1. What is the effect of digital payment on health worker satisfaction, motivation, performance, and retention?
  2. How (through what mechanisms) does digital payment influence health worker satisfaction, motivation, performance and retention?
  3. How could digital payments be leveraged to improve the performance management and the timeliness of feedback for community health workers and other outreach frontline health workers?
  4. What gender relations and roles influence the performance of health workers within the context of digital payments?

 

Payment experience and financial behavior

 

  1. What are the benefits/risks/unintended consequences and challenges associated with the use of digital payments for health workers?    
  2. For those previously without DFS, what constrained their adoption of DFS?
  3. What is the health worker willingness to accept digital payments?

3.0 Scope

The research must be done within Sub Saharan Africa. It may be undertaken in a single country or in several countries.

4.0 Target group and eligibility

  • The Principal Investigator (PI)/Lead researcher should be affiliated with a credible institution. Eligible institutions include institutions of higher learning, research institutes and registered Non-Governmental Organizations (NGOs).
  • The PI’s institution should possess existing in-house capacity to host a grant and to carry out research that materially extends and enhances the national or international research base.
  • The PI should be affiliated with a reputable research organization/University or Institution and should have worked in the University/Institution for at least 6 months by the time of application.
  • The PI/Lead researcher should have the capacity to conduct the proposed research (master’s or Ph.D. and relevant research experience).
  • The PI/Lead Researcher should have the capacity to mentor junior researchers.
  • Each applicant will be eligible for only one award as a Lead.
  • Multi-disciplinary teams are encouraged.

4.1 Funding restrictions and Terms:

The award will be a fixed fee agreement, and the total amount of the award will be stated in the award letter. The funding is intended to support the collection, analysis, and dissemination of research. The allocation of program funds will directly correspond to the monetary figures presented in the final Budget and disbursement of funds will be initiated upon the timely receipt of invoices, financial reports and expected deliverables.

4.2 Submission guidelines and deadline:

  • All applications must be submitted through the project’s website here (English) or here (french). The proposal template is available here.
  • The proposal should demonstrate value for money and should be aligned to the guidelines outlined in the submission template.
  • The proposals should clearly outline the research gap that will be filled with well stated research questions and objectives and a clearly outlined methodology that details the data collection methods, tools and analysis techniques that will be utilized to answer the proposed research questions.
  • The research gaps should address current challenges and issues within the digital health payment landscape as outlined in the above suggested research questions, framework paper and current literature about digital payment.
  • All applications should be written in English or French.
  • Applicants should submit a support letter from the institution where the team lead is based.
  • Completed applications must be submitted by 5:00 pm 30th September 2022 East Africa Standard Time.

4.3 Application requirements 

Only proposals adhering to the required format will be reviewed. All sections of the proposal are limited to 8.5”x11” pages with one-inch margins on all sides, double spaced, in Times New Roman, 12-point font. The application must be submitted as a single PDF and the applicants should follow the guidelines outlined in the application template. Applicants should state on the cover page, the topic of specific interest (as listed above), under which their proposal is being submitted.

4.4 Criteria for evaluating applications

All proposals will go through a three step review process:

  • Initial review: All applications will go through the initial review to ensure that they fulfill the eligibility criteria.
  • Full technical review: Each shortlisted proposal will be examined for soundness of methodology and alignment to other criteria outlined in the scoring template below (see Table 2). The review will be undertaken by a minimum of two reviewers.
  • Final review: Applicants may be asked to respond to a few questions from the reviewers. After they respond to the questions a final decision will be made to select the beneficiaries.

Note: The final decisions will be taken by an independent global Technical Advisory Group

Table 2: Criteria for Assessing Internal and External Grant Applications

 Criteria

Points

Award

  • To what extent does the proposed Research/innovation align with the project goal and the priority research questions for the project?

5

 

  • To what extent is this an original and significant project? (innovation)

10

 

  • To what extent does the proposal include sufficient information about the project and is the information clearly presented and understandable to non-specialists?

8

 

  • To what extent are the activities proposed appropriate to implement the proposed project?

15

 

  • To what extent is the proposed methodology and research design rigorous and appropriate?

20

 

  • To what extent does the project leader/team have the appropriate experience to implement the proposed project?

10

 

  • To what extent does the proposed project clearly and realistically articulate the timeline and outcomes for the project, from planning to implementation and evaluation?

9

 

  • To what extent does the project team commit to wide sharing of results?

5

 

  • Does the project team demonstrate necessary partnerships with policymakers and/or practitioners’ activities (e.g., NDAs, letters of support, MOUs)?

8

 

  • To what extent is the budget – reasonable for the proposed activities and  does it  demonstrate  value for money?

10

 

TOTAL SCORE:

(  /100)

 

(Applicants scoring above 60% will be considered for the second round of assessment)

Note:

  1. Applications should be submitted through our website: Submit applications here.
  2. Application deadline: 30th SEPT 2022
  3. Award decisions: All applicants will be notified of the outcome of their submission by 30th October 2022.