Effect of Digital Payment to Campaign Health Workers on Vaccination Coverage

Introduction:Good quality OPV campaigns can interrupt and possibly prevent transmission of the polio virus. Health care worker performance and motivation are prerequisites for the success of such campaigns. Complete, transparent and timely payments are, in turn, prerequisites for the sustenance of health care worker motivation and thereby efforts. To date, most such health care workers have been paid in cash, with chronic payment issues that have negatively affected campaign quality and vaccination coverage. Cash-based payments are often plagued with multiple delays in funds disbursements, cash leakages, and a lack of accountability and financial transparency. These difficulties have prompted a transition to digitized payments that are perceived to be faster, more convenient, traceable, reliable, easier and more reasonable to set up. The roll-out phase of these digital payment interventions has not been quantitatively evaluated and the effect of digital payments on the motivation, satisfaction and performance of health workers is not known. Therefore, this study will compare digitized payment of polio vaccination campaign health care workers with cash-based payment with regards to health care worker motivation, satisfaction and performance. Findings from this study may inform the operationalization of digital financial systems, and the transition towards cross-campaign digital payments.Primary Objectives:To compare the motivation, satisfaction and performance of vaccination health care workers in areas where they are paid using mobile money versus in cash,To explore how gender norms and relations influence health workers' response to payment systems (mobile money versus cash payments) and how these affect the health workers' performance and motivation in polio vaccination campaigns andSecondary objectives:To compare vaccination campaign quality in areas where health care workers are paid using mobile money versus in cashTo compare vaccination coverage in areas where campaign health care workers are paid using mobile money versus in cash.To estimate the incremental cost of the intervention.Methods:This will be a mixed methods study including a cluster-randomized controlled implementation trial and a qualitative study. A total of 60 districts be randomized to implement either a digital payment system for polio campaign vaccinators during the polio campaign or the traditional cash-based payment system.

Inclusion Criteria:Adults aged 18 and aboveHistory of participation in the most recent polio vaccination campaign in UgandaMember of the district leadership teamExclusion Criteria:1) Non-consenting adults