Digital payments of health workers within vaccination campaigns: a mixed-methods study in Chad

Health workers frequently experience inconsistent and inefficient payment processes of their allowances, with potential implications for their motivation, performance and retention and consequently the effective delivery of essential immunisation services. Digitisation of payments has been proposed as a potential improvement to the payment process. This study assesses health workers' experiences following the digitisation of payments.

A mixed-methods study was conducted, combining quantitative and qualitative approaches. Quantitative data were collected via a survey of 1510 health workers across 12 provinces (seven intervention, five comparison) between August and October 2023. Additionally, thematic analysis was applied to qualitative data from 57 in-depth interviews with officials and health workers.

Health workers in provinces implementing mobile payments reported higher work motivation (50.7%) and job satisfaction (7.9%) compared with those in comparison provinces (38.67% and 2.7%, respectively). Positive payment experiences were also more frequent in mobile money provinces (14.50% vs 1.36%). Qualitative insights highlighted that timely payments reduced financial stress and enhanced focus on core responsibilities. However, challenges such as technological barriers and the need for tailored training were noted, particularly for workers in remote areas or with lower digital literacy.

Digital payments were linked to higher health worker motivation and satisfaction and perceptions of reliability and reducing administrative burdens. Future research should incorporate longitudinal data and randomised controlled trials to better assess the causal impact of digital payments. Expanding qualitative research to include a broader range of stakeholders will provide deeper insights into the contextual factors influencing the effectiveness of digital payment systems. Addressing these gaps is crucial for refining and scaling digital payment interventions in diverse healthcare settings.