A qualitative study on gender relations and digital payments: healthcare workers' experiences during polio vaccination campaigns in Uganda and Malawi

Gender is a key factor shaping societal roles and access to resources, with cultural norms often limiting women's abilities to use digital financial services. Despite the rise of digital payments, little is known about how gender relations influence their adoption and experience, especially among health workers involved in vaccination campaigns.

Between January and September 2023, we explored how gender norms and relations influence the uptake and experiences of digital payments among health workers participating in mass polio vaccination campaigns. The qualitative study involved 23 focused group discussions (FGDs; 16 in Uganda and 7 in Malawi) and 82 in-depth interviews (IDIs; 35 in Uganda and 47 in Malawi) with healthcare workers who received digital payments for implementing polio mass vaccination campaigns. IDI participants included village health teams, midwives, nurses, health facility managers, immunisation focal persons and district health officers in Uganda, and community health workers, health facility managers and mobile money operators in Malawi. FGDs were held with midwives, nurses and village health teams in Uganda and community health workers in Malawi. Data were coded using Dedoose software and thematically analysed.

Participants highlighted that digital payments were convenient since they were able to receive funds without travelling long distances or queuing at health facilities. Women reported that it gave them more time to engage in alternative activities, improve their financial autonomy and ability to participate in decision-making around use of household funds. Structural challenges leading to delayed disbursement of funds were reported to reinforce gender norms around financial dependency on men to meet operational campaign costs (eg, transport). Reported limited ownership of mobile money accounts, a prerequisite for digital payments, led to the exclusion of some women.

Our findings suggest that digital payments could help improve financial autonomy and participation in decision-making around use of household funds among women involved in immunisation campaigns. However, our findings show that digital payments are implemented in the context of prevailing harmful gender norms that, if not addressed, have the potential to compromise women's agency. This underscores the importance of integrating gender-transformative programming in planning for digital payments during vaccination campaigns.