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

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.