Time to embrace digital payments for immunisation 

World Immunisation Week, which takes place in the last week of April every year, was for urgent collective action to protect individuals against vaccine-preventable diseases, particularly children, under the theme of ‘The Big Catch-Up.’ The goal is to restore essential immunisation coverage to pre-pandemic levels and to reach millions of children who have missed out on vaccines.

I would like to draw your attention to the health workers who dedicate their time to providing immunisation services. They are committed to their work but untimely payments are making it hard for them to do their job well, leaving many children unvaccinated and exposed to life-threatening diseases. These health workers often have to use their own money for transport and food and wait for long periods for reimbursement.  Therefore, ensuring timely payments for these health workers is crucial if we want to ensure that children get their vaccines on time.     

There is growing interest in the potential of digital payments to help solve the problem of delayed payment of health workers.     

Existing findings from research on digital payments show that digital payment of health workers, for example during immunisation campaigns could result in several benefits including timely payment, safety of payment since people do not have to move around with cash as well as complete payment since leakage of funds from having to pay the people handling the money is reduced.

This is even more important because a large number of health workers are recruited during national mass immunisation campaigns and paying them with cash is not cost-effective. Some institutions, for example, were able to clear a large backlog of payments through mobile money and bank transfers. 

Although digital payments can provide all these benefits, we acknowledge that it is not easy to set up a digital payment system that can enable timely effective payment of health workers. During the recent polio campaigns that were held in the country, we followed the payment process and I would like to share two of the challenges that could be fixed by stakeholders in the digital payment ecosystem. One of the activities that were very resource intensive was the generation of a health worker database that contained identification information about health workers in the district and their phone numbers. Secondly, each district had to generate a list of the health workers who actually worked during the campaign and send it to the district finance officer to initiate payment.  Because all these processes were manual, they took a significant amount of time and caused delays in the payment of health workers.

Fortunately, a list of health workers and their phone numbers already developed by the Ministry of Health in collaboration with the World Health Organisation came in handy. But it also needs regular updates because some health workers leave the district or change their phone numbers.

The linkage between national systems that have identification particulars and phone numbers of health workers could help speed up this verification process whenever a digital payment is undertaken. Additionally, automation of the process of confirming that a health worker actually showed up and participated in the immunisation exercise could easily be done using mobile phone digital applications. This would allow for immediate verification and payment of the persons who worked or used money from their own pockets.

We, therefore, recommend that the different stakeholders involved in the digital payment ecosystem devise interoperable systems that can allow personal identification information such as national IDs and phone numbers to be confirmed seamlessly.

Secondly, digital tools that can allow immediate verification of work done should also be developed. Such initiatives can allow the country to harness the full benefits of digital payment not just for immunisation campaigns but also for other programmes that have to pay workers digitally.

Dr Elizabeth Ekirapa Kiracho, Senior Lecturer Makerere University School of Public Health.