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Govt. Asked to Scale up Successes in Buikwe, Mukono CVDs Interventions to the Rest of the Country

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Africa continues to record the highest prevalence of hypertension globally. Studies show that Uganda’s hypertension prevalence stands at 26.4% and public health experts are worried that rising prevalence of noncommunicable diseases (NCDs) should be curbed lest it contributes to the disease burden.

In Africa, just like other low- and middle-income countries, the burden of disease is transitioning from infectious diseases to NCDs and the World Health Organisation predicts that they are likely to become a major health system challenge in Africa as they are predicted to become the leading cause of death in the region by 2030.

Studies estimate Uganda’s NCDs prevalence at 33 in every 100 people die of cardiovascular diseases (CVDs). The prevalence of hypertension for instance among adults stands at 26.4% with the highest prevalence in central Uganda (28.5%) which hosts Mukono and Buikwe districts.

In Mukono and Buikwe districts, among persons aged 15 years and above, the age standardized prevalence of hypertension is 27.2%.

Makerere University School of Public Health has for close to three (03) years now been impacting the communities in Mukono and Buikwe districts through its project; Cardiovascular Disease prevention program -Scaling -up Packages for Interventions for Cardiovascular diseases prevention in selected sites in Europe and sub-Saharan Africa (SPICES) Uganda.

The SPICES project focuses on prevention of diseases of the heart and blood vessels. The project has conducted a comprehensive study  at both health facility level and community level where a number of community workers and health workers from randomly selected villages and health facilities in Mukono and Buikwe have been trained in cardiovascular disease prevention and control.  

So far, a total of 366 health workers and 80 community health workers (CHWs/VHTs) received training. In addition, the project provided the health centers with equipment to support screening and management of cardiovascular diseases. The project team has, with support of health facilities been involved in screening CVD risk, care and management as well as health promotion and profiling at community level.

As a result of this intervention, there are higher volumes of hypertension and diabetes patients being received as a result of sensitization by the community health workers. There are also reports of changes in behavior in lifestyles especially diet and physical activity as well as improved patient health seeking behaviors for chronic services.

For instance, while presenting results at a dissemination workshop held on December 8th 2021 at Colline Hotel in Mukono district, Dr. Geofrey Musinguzi, the Principal Investigator of the SPICES Project expressed that the project has had significant impact in terms of knowledge changes, and in terms of profiles.

SPICES project Principal Investigator Dr. Geofrey Musinguzi in an interview with journalists immediately after the dissemination in Mukono on Wednesday.
SPICES project Principal Investigator Dr. Geofrey Musinguzi in an interview with journalists immediately after the dissemination in Mukono on Wednesday. 

“Much as the prevalence of smoking didn’t seem to change, there was a change in frequency of smoking. For example, those who were smoking daily, we saw a reduction from 2018/19 to 2021,” says Dr. Musinguzi.

He adds that there was a significant difference in passive smoking. “Passive smoking is as dangerous as active smoking. At the baseline, people were smoking and exposing their love ones to tobacco but when they were trained from the health facilities and from the community on the dangers of smoking and passive smoking. So, we have seen an attitude of people in families where people are smoking, of if they can’t avoid smoking, doing it away from their families.”

Arising out of the successes of the project so far, Dr. Rhoda Wanyenze, Professor and Dean of Makerere University School of Public Health (MakSPH) has asked government and the Ministry of Health in particular to support noncommunicable diseases care in the districts of Mukono and Buikwe.

Prof. Wanyenze who is also co-principal investigator of the project SPICES project intervention in Mukono and Buikwe could be used as a yardstick to pick lessons for the Ministry of Health to extend the services to other parts of the country.

Dr. Rhoda Wanyenze, Professor and Dean of Makerere University School of Public Health (MakSPH) and SPICES project Co-Principal Investigator
Dr. Rhoda Wanyenze, Professor and Dean of Makerere University School of Public Health (MakSPH) and SPICES project Co-Principal Investigator.

“We can use this as a learning hub so that we can also get the other regions that do not have the standard for NCD care at the level that we have in these districts. Let us maintain it because it is an opportunity for us to show that it is doable, that we can do something about NCDs and that others can learn something from these districts and facilities and we can do better across the country,” Professor Wanyenze said.

Tereza Ssenjova, a resident of Busabala Mukono said; “I used to be diagnosed with fever, yet I did not have it. Not until recently through SPICES screening that I was told I have high blood pressure and diabetes.”

Prof. Wanyenze urged for the Ministry of Health to rally Ugandans, the leadership at all levels to aggressively advocate for a safer population by preventing and reducing cardiovascular diseases.

“Please do speak about NCDs like the way we speak about COVID-19 lately and the way we have been speaking about other diseases. Encourage people to screen. If there is an opportunity, why not have a machine around you in your place so that you can encourage people to screen periodically. Think of how you can creatively encourage the communities to screen, so that we can discover these diseases early and be able to do something,” says Prof. Wanyenze.

Dr. Gerald Mutungi, assistant Commissioner Health Services- Non-Communicable Diseases (NCDs) department at the Ministry of Health admits that cardiovascular diseases are on a rise but hastens to add that they can be prevented.

“What we have found out is that the communities, once educated, sensitized can come for screening, but also can follow some of the guidelines given to prevent cardiovascular diseases. This has been shown and we have the data now,” Dr. Mutungi says.

Dr. Gerald Mutungi, the Assistant Commissioner, Non-Communicable Diseases Department, Ministry of Health
Dr. Gerald Mutungi, the Assistant Commissioner, Non-Communicable Diseases Department, Ministry of Health

Dr. Mutungi welcomes the results and noted that government will scale-up the interventions.

“We are in evidence-based policy and decision making. This is going to influence our policy. We had already started sensitizing VHTs but we were not sure that actually they can play a big role in prevention of cardiovascular diseases. Now this study is showing that yes, they can. We thought they could only support in distributing bed nets, simple things but they have shown us that they can do a lot in prevention and control of diseases,” he said.

Dr. Musinguzi said the project has had a multi-component intervention including health promotion, screening, training among others.

“We think that this intervention can reach many people. I gave an example of the talking T-Shirt. It has the modifiable risk factors. ‘don’t smoke’, ‘do more exercise’, ‘reduce/avoid alcohol,’ ‘maintain a healthy weight’, ‘go for checkup’ ‘control stress’, ‘eat healthy diet’ among others. In fact, we got reports from VHTs that the messages were received by the population. So, we think all ways of delivering messages must be explored to be able to enhance awareness about CVDs and other NCDs,” Dr. Musinguzi contends.

Hajat Fatuma Ndisaba Nabitaka, the Resident District Commissioner for Mukono district
Hajat Fatuma Ndisaba Nabitaka, the Resident District Commissioner for Mukono district.

hailed the SPICES project team for the “wonderful research” and requested the project to include Buvuma and Kayunga districts on the study scope.

“I thank you so much for training the VHTs and our health workers around Mukono and Buikwe districts. This is very good,” said Hajat Nabitaka.

She underscores the need for continued sensitization of the population with a view of changing mindsets to be able to fully realise the benefits.

“Some people think these are diseases of the rich people. Not knowing that even a child in primary school can get diabetes. Not knowing that even an ordinary person in community can get pressure due to the various stress factors. Let us utilize the VHTs to solve many problems including social societal problems such as stress,” Hajat Nabitaka.

Dr. Rawlance Ndejjo, the SPICES Project coordinator said the project has been able to enroll 23 health facilities where it has greatly impacted lives.

He adds that the dissemination is; “a great opportunity to share what we have been doing in field with the rest of the world.”

Dr. Rawlance Ndejjo, the SPICES Project coordinator
Dr. Rawlance Ndejjo, the SPICES Project coordinator

Some health facilities have have adopted strategies to acquire hypertension and diabetes drugs, and all enrolled facilities are now able to identify and manage Type 1 diabetes, unlike in the past.

SPICES project is currently implemented in Uganda, South Africa, France, Belgium and the United Kingdom. It is an implementation science project funded by the European Commission through the Horizon2020 research and innovation.

Mukono and Buikwe district Health workers and community health workers (CHWs/VHTs) in a group photo with SPICES project Principal Investigator Dr. Geofrey Musinguzi and Dr. Gerald Mutungi, the Assistant Commissioner, Non-Communicable Diseases Department, Ministry of Health.
Mukono and Buikwe district Health workers and community health workers (CHWs/VHTs) in a group photo with SPICES project Principal Investigator Dr. Geofrey Musinguzi and Dr. Gerald Mutungi, the Assistant Commissioner, Non-Communicable Diseases Department, Ministry of Health at a Dissemination workshop on December 8th 2021 at Colline Hotel, Mukono.

Article originally published on MakSPH website.

Davidson Ndyabahika

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Professor Nakimuli awarded at FIGO Congress for outstanding contribution to Women and Child Health

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Dr. Annettee Nakimuli, Associate Professor of Obstetrics and Gynaecology and Dean, School of Medicine, Makerere University College of Health Sciences. Kampala Uganda, East Africa.

Dr. Annettee Nakimuli, an Associate Professor of Obstetrics & Gynaecology and Dean – School of Medicine at Makerere University College of Health Sciences was awarded by the International Federation of Gynaecology and Obstetrics (FIGO) for her outstanding contribution to improving the health of Women and children as a researcher and practitioner.

She received the award on the 6th Oct 2025 at the FIGO General Assembly/FIGO Congress that is ongoing in Cape Town, South Africa.

Professor Nakimuli is a leading maternal health researcher focused primarily on investigating the aetiology, treatment, prevention and long term outcomes of pregnancy complications among women in Sub-Saharan Africa. She is committed to building maternal and new-born research capacity in Africa and her aim is, with East African and International colleagues, to establish a multidisciplinary centre for African maternal and neonatal health research located at Makerere University in Uganda.

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Zaam Ssali

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MakSPH, TalTech Partner to Shape the Future of Digital Health in Uganda

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At the centre, MakSPH Dean, Prof. Rhoda Wanyenze and H.E. Girisch M. Nair, Honorary Consul of Estonia to Uganda with stakeholders at the project launch. September 9, 2025. Makerere University School of Public Health (MakSPH) and Estonia’s Tallinn University of Technology (TalTech) kick-off meeting for two-year collaborative project to transform health informatics education and practice in Uganda, supported by the Estonian Centre for International Development (ESTDEV), 9th September 2025, MakSPH Auditorium, Kampala Uganda, East Africa.

Kampala, UgandaMakerere University School of Public Health (MakSPH) and Estonia’s Tallinn University of Technology (TalTech) have launched a two-year collaborative project to transform health informatics education and practice in Uganda, positioning the country as a regional leader in digital health. Unveiled earlier this month at MakSPH and supported by the Estonian Centre for International Development (ESTDEV), the initiative aims to build a skilled digital health workforce and accelerate Uganda’s transition to a data-driven health system, while aligning the country’s digital agenda with global best practices through partnership.

This strategic collaboration builds on the success of MakSPH’s Master of Health Informatics (MHI) programme. The MHI is one of the eight master’s degrees hosted at the School and was first introduced in 2016, jointly delivered with Makerere University College of Computing and Information Sciences (Mak-CoCIS). The two-year graduate training equips students with skills in health information systems design, data analytics, and digital health leadership through a hybrid model of face-to-face, online, and self-paced learning. So far, since its inception, nearly 50 graduates have completed the programme, many of whom have now gone on to lead national and regional health data initiatives. In August last month, the School received 26 new entrants for the MHI 2025/2026 cohort, reflecting its rising demand.

Now, the new project, launched on September 9, 2025, links TalTech’s MSc in Digital Health, one of Europe’s pioneering programmes introduced in 2009, with MakSPH’s Master of Health Informatics to strengthen curricula, mentor faculty, and give students exposure to global best practices. The goal is to create a skilled workforce capable of leading Uganda’s digital health transformation. The initiative is co-led by Prof. Peeter Ross, Professor of e-Health at TalTech, and Prof. Nazarius M. Tumwesigye, Professor of Epidemiology and Biostatistics at MakSPH. They are joined by Doris Kaljuste, Programme Director of the MSc in Digital Health, and Mr. Michael Anywar, Doctoral Student at TalTech and the initiator of the collaboration, as well as Ms. Irene Wanyana, MHI Programme Coordinator and PhD Candidate at Karolinska Institute, Sweden, and Mr. Chris A. Balwanaki, the Coordinator for the project at MakSPH.

At the centre, MakSPH Dean, Prof. Rhoda Wanyenze, receiving H.E. Girisch M. Nair, Honorary Consul of Estonia to Uganda, at the project launch. September 9, 2025. Makerere University School of Public Health (MakSPH) and Estonia’s Tallinn University of Technology (TalTech) kick-off meeting for two-year collaborative project to transform health informatics education and practice in Uganda, supported by the Estonian Centre for International Development (ESTDEV), 9th September 2025, MakSPH Auditorium, Kampala Uganda, East Africa.
At the centre, MakSPH Dean, Prof. Rhoda Wanyenze, receiving H.E. Girisch M. Nair, Honorary Consul of Estonia to Uganda, at the project launch. September 9, 2025.

Prof. Ross, a leading global authority on e-health and head of the Digital Health Research Unit at Tallinn University of Technology, commenting on the project and the link between health and technology, stressed that while health itself is not technology, the intelligent integration of digital tools is indispensable for making healthcare more efficient, affordable, and accessible. He underscored that this collaboration marks a key step in that direction, with capacity development and academic exchange key to sustainable digital transformation.

“Capacity building is critical. In Estonia, when the nationwide health information system was being launched, about a third of the budget went into training healthcare professionals. This required training trainers first, underscoring the strategic role of academia. Estonia has a master’s programme in digital health, while Makerere University offers a blended Master of Health Informatics. Together, these programmes can expand training across Uganda and beyond,” Prof. Ross explained, adding that the collaboration also gives Estonia the chance to test digital health solutions in a large, English-speaking population, while Uganda benefits from Estonia’s decades of experience and avoids common pitfalls.

Prof. Peeter Ross, Professor of e-Health at TalTech and Co-lead for the project, underscored that this collaboration marks a key step in the right direction, with capacity development and academic exchange key to sustainable digital transformation. September 9, 2025. Makerere University School of Public Health (MakSPH) and Estonia’s Tallinn University of Technology (TalTech) kick-off meeting for two-year collaborative project to transform health informatics education and practice in Uganda, supported by the Estonian Centre for International Development (ESTDEV), 9th September 2025, MakSPH Auditorium, Kampala Uganda, East Africa.
Prof. Peeter Ross, Professor of e-Health at TalTech and Co-lead for the project, underscored that this collaboration marks a key step in the right direction, with capacity development and academic exchange key to sustainable digital transformation. September 9, 2025.

Estonia, a Northern European country currently with about 1.37 million people and covering a total area of 45,339 km², is seen as one of Europe’s leaders in digital innovation. About 99 per cent of its public services are reportedly delivered online, and its health information system records nearly every citizen’s medical history from birth to death. The X-Road platform in the country enables secure, encrypted data exchange, while e-prescriptions cover almost all prescriptions nationwide. Meanwhile, the Digilugu.ee patient portal allows citizens to access their health records, track activity logs, and even generate certificates, a system widely trusted by users. The Estonian team revealed that the integrated digital health ecosystem shows how technology, governance, and policy work together to provide efficient, patient-centred care.

Conversely, Uganda’s growing digital ecosystem makes the timing of the collaboration strategic. The country currently has more than 43 million mobile subscriptions, over 26 million internet users, and more than 33 million mobile money accounts, creating fertile ground for scaling digital health solutions. With this, strengthening health informatics will build a skilled workforce needed to design, implement, and manage these solutions effectively.

The MakSPH Project Co-lead, Prof. Tumwesigye, hailed the partnership as a turning point for the MHI programme, noting that modules such as Health Analytics are being upgraded to give students hands-on experience in developing tools to digitise public and private health systems. He said Estonia’s model, where digital innovations are widely adopted and lead to measurable improvements, offers a blueprint Uganda can adapt to move beyond paper-based systems, improve data quality, and train graduates to design solutions that strengthen health outcomes.

MakSPH Project Co-lead, Prof. Nazarius M. Tumwesigye, speaking during the project launch. September 9, 2025. Makerere University School of Public Health (MakSPH) and Estonia’s Tallinn University of Technology (TalTech) kick-off meeting for two-year collaborative project to transform health informatics education and practice in Uganda, supported by the Estonian Centre for International Development (ESTDEV), 9th September 2025, MakSPH Auditorium, Kampala Uganda, East Africa.
MakSPH Project Co-lead, Prof. Nazarius M. Tumwesigye, speaking during the project launch. September 9, 2025.

“Uganda is still behind in digital health use. We rely heavily on paper-based systems, experience long delays in transmitting data from primary health facilities to the national level, and face issues with data quality, including missing or inaccurate figures. Strengthening our programme will help address these challenges and produce graduates who can design solutions that lead to better health outcomes. Learning from TalTech University and Estonia’s digital health success will help us put Uganda on a better footing for the future,” Prof. Tumwesigye observed, noting that Estonia’s model stands out for ensuring digital innovations are widely adopted and deliver measurable improvements in health system performance.

The Programme Coordinator, Ms. Irene Wanyana, noted that since its launch in 2016, the Health Informatics training at Makerere University has made a strong impact, earning a reputation as one of the leading graduate programmes of its kind in the region. She observed that faculty members and students have been instrumental in designing, developing, and supporting national health information systems critical to Uganda’s health sector. These include UgandaEMR, an advanced electronic medical record system now deployed in more than 1,700 health facilities; the Weekly Stock Status System, which enables real-time tracking of essential medical commodities; and the Early Infant Diagnosis Laboratory Information Management System (LIMS), which improves the management of HIV testing data for infants.

Still, the programme has contributed to the development of PrEP and DREAMS/OVC tracking systems, supporting HIV prevention and care for vulnerable populations such as adolescent girls, young women, and children. The graduate training has also strengthened national HIV surveillance through the Centralised Blood Screening (CBS) dashboard, advanced the Uganda Health Information Exchange Platform to improve interoperability, and facilitated the migration of critical health data systems into the Ministry of Health’s national data centres, continuing to ensure that health information is secure, reliable, and accessible nationwide.

MakSPH Health Informatics students at the 2024 Open Group India Awards in New Delhi, where they were recognised for Innovation & Excellence for their project on enterprise architecture. September, 2024. Makerere University School of Public Health (MakSPH) and Estonia’s Tallinn University of Technology (TalTech) kick-off meeting for two-year collaborative project to transform health informatics education and practice in Uganda, supported by the Estonian Centre for International Development (ESTDEV), 9th September 2025, MakSPH Auditorium, Kampala Uganda, East Africa.
MakSPH Health Informatics students at the 2024 Open Group India Awards in New Delhi, where they were recognised for Innovation & Excellence for their project on enterprise architecture. September, 2024.

Ms. Wanyana is optimistic that with the new collaboration with TalTech University in Estonia, MakSPH’s Health Informatics programme is poised to deliver even greater innovations and impact to transform Uganda’s digital health system. In September 2024, four of our MHI students, Mr. Edwin Ayebare, Mr. Brian Twesigye, Mr. Enock Mwesigwa, and Mr. Iving Mumbere, won a global Award of Distinction at the Open Group India Awards for Innovation & Excellence in New Delhi. Competing against 22 university teams worldwide, they were recognised for their innovative application of enterprise architecture to address real-world health system challenges, attesting to Makerere University’s global competitiveness.

Speaking at the launch event, H.E. Girisch M. Nair, Honorary Consul of Estonia to Uganda, emphasised that Estonia’s experience offers Uganda a practical blueprint for building interoperable systems, standardising health data, and strengthening national health information infrastructure. “This collaboration is a platform for us to aspire more. Imagine a patient in Bundibugyo with a secure digital ID linked to their electronic health record. Wherever they go, authorised health workers can access their records, prescriptions are issued electronically, and medicines are dispensed at registered pharmacies. This generates rich, actionable data that helps plan better, reduce waste, and improve health outcomes.”

H.E. Girisch M. Nair, Honorary Consul of Estonia to Uganda, speaking during the project launch. September 9, 2025. Makerere University School of Public Health (MakSPH) and Estonia’s Tallinn University of Technology (TalTech) kick-off meeting for two-year collaborative project to transform health informatics education and practice in Uganda, supported by the Estonian Centre for International Development (ESTDEV), 9th September 2025, MakSPH Auditorium, Kampala Uganda, East Africa.
H.E. Girisch M. Nair, Honorary Consul of Estonia to Uganda, speaking during the project launch. September 9, 2025.

There is evidence of the Estonian Consul’s remarks. A new study conducted in 2023 by a team from Makerere University School of Public Health, led by Assoc. Prof. Peter Waiswa, published this September in BMJ Global Health, confirmed that supporting Ugandan districts to adopt digital payments significantly improved the efficiency of mass vaccination campaigns in the country, reducing delays, cutting administrative bottlenecks, and enhancing transparency. The findings from this and similar multi-country studies by the same team show that with targeted support, cashless systems are both feasible and practical for strengthening public health.

For Mr. Jamiru Mpiima, an alumnus of MakSPH and graduate of the Health Informatics programme, these developments underscore the critical need for a skilled workforce to design, implement, and manage digital health systems effectively. Speaking on behalf of Mr. Paul Mbaka, Head of the Division of Health Information at Uganda’s Ministry of Health, Mr. Mpiima shared the Ministry’s progress in digitising health information systems, from electronic medical records to the electronic community health information system, and the lessons learned along the way. He urged stronger collaboration between MakSPH and the Ministry, particularly in training future health informatics professionals and building institutional capacity to manage change in Uganda’s digital health sector transformation.

During the launch, MakSPH Dean, Prof. Rhoda Wanyenze, commended the remarkable speed of the Estonia–Makerere collaboration, noting that within a year, early conversations had already matured into a funded joint project. She emphasised that this milestone marks not just the start of a promising partnership, but also a unique opportunity to embed it more firmly within Uganda’s health system. Prof. Wanyenze called on all partners, the Ministry of Health, Makerere University, and the Estonian counterparts, to pursue a strategic tripartite arrangement, stressing that such collaboration could greatly strengthen Uganda’s digital health systems, accelerate technological innovation, and deliver measurable improvements in national health outcomes.

MakSPH Dean, Prof. Rhoda Wanyenze, together with the project team. September, 2025. Makerere University School of Public Health (MakSPH) and Estonia’s Tallinn University of Technology (TalTech) kick-off meeting for two-year collaborative project to transform health informatics education and practice in Uganda, supported by the Estonian Centre for International Development (ESTDEV), September 2025, MakSPH, Kampala Uganda, East Africa.
MakSPH Dean, Prof. Rhoda Wanyenze, together with the project team. September, 2025.

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John Okeya

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What works, what doesn’t work? Researchers uncover the effect of supporting districts to operationalise digital payments for vaccination campaign workers

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A nurse scrolls through her smartphone. Photo: DHPI-R, MakSPH, CHS, Makerere University, Kampala Uganda, East Africa.

By Joseph Odoi

A motivated and satisfied health workforce is critical for the success of mass vaccination campaigns against diseases like polio. High-quality vaccination campaigns can interrupt disease transmission, especially during and after periods of disrupted health services, such as those caused by the COVID-19 pandemic.

In sub-Saharan Africa, most vaccination campaign healthcare workers (VCHWs) have historically been paid in cash. Cash payments are often plagued by delays in funds disbursement, leakages, theft risks, and limited financial transparency. These challenges can negatively affect vaccination coverage and worker satisfaction.

To address these challenges, many countries are transitioning to digital payment systems, which are perceived as faster, more convenient, traceable, reliable, and easy to implement. Digital financial systems are already being rolled out in countries including Côte d’Ivoire, Ghana, Mali, Congo, and the Democratic Republic of the Congo. Uganda, with a projected population of nearly 41.6 million, had over 30 million registered mobile money customers using e-cash in 2019.

While early rollouts of digital payments have been largely successful, their full impact on vaccination campaign workers had not been systematically evaluated.

 From 2021 to 2024, Makerere University (Uganda) and the University of Dakar (Senegal), with support from the Gates Foundation and technical partners including the Solina Group, WHO AFRO, and the Ministries of Health and Finance in both embarked on an important journey of research  under the Digital Health Payment Initiatives and Research (DHPI-R) Project in  28 countries in Sub Saharan Africa

To explore the experiences and lessons of polio vaccination campaign healthcare workers (VCHWs), both male and female, during the 2022 oral poliovirus vaccination campaign in Uganda, researchers led by Prof. Peter Waiswa (principal investigator), together with Margaret McConnell, Juliet Aweko, Daniel Donald Mukuye, Charles Opio, Maggie Ssekitto Ashaba, Andrew Bakainaga, and Elizabeth Ekirapa-Kiracho, with support from the Gates Foundation, conducted a study titled “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.”

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.

The  mixed method study  now  published in BMJ Global Health, September 2025  was conducted in 54 districts in Uganda that had set up the government e-cash payment platform by May 2022. It involved healthcare workers supporting the polio vaccination campaign, regardless of direct vaccine contact. This included nurses, clinicians (vaccinators), mobilisers, community health workers (village health team members), recorders, local council representatives, and supervisors. The unit of randomisation was the district, while the unit of enrolment and data collection was the individual worker.

Method and Setting

As part of this study , In November 2022, a total of 54 districts and 2,665 vaccination campaign healthcare workers (VCHWs) were enrolled in the study and randomly assigned to two groups. Intervention districts received training on using the government e-cash platform, including managing user roles, uploading beneficiary data, and generating payment reports.

The control districts received the standard support given to districts during mass vaccination campaigns from the MoH, MoFPED, WHO and other development partners. This support included group training on implementation of payments, provision of vaccination materials and financial aid.

The study collected data on how VCHWs were paid, their motivation, and their satisfaction with the payment method. Overall, 765 VCHWs in intervention districts and 589 in control districts received e-cash payments.

Findings

Mode of payment for the vaccination campaign healthcare workers

Overall, approximately half of the campaign workers, 50.8% (1354/2665) were paid digitally (e- cash), either using mobile money or via the bank (online supple mental table 2). Payment by e- cash was higher among females, 53.9% (656/1215) compared with males, 48.1% (698/1450) and was lowest among campaign workers aged 30–39 years, 48.7% (368/765). E- cash payment was higher in the intervention arm at 57.5% (765/1,330) in comparison to the control arm at 44.1% (589/1,335).

Satisfaction with payment received during the campaign

 Only 36.5% (705/1930) of the VCHWs were satisfied with the payment received during the campaign, with satisfaction being slightly higher in the intervention arm, 37.9% (353/931) compared with the control arm 35.2% (352/999) and among females 37.9% (351/925) compared with males 35.2% (354/1005). Satisfaction was lowest among the married workers, 35.7% (575/1611) compared with the other categories.

Timing and completeness of payments

Nearly, all VCHWs were paid after the campaign, 97.6% (1884/1930), with no significant difference between the intervention (98.1%, 913/931) and the control (97.2%, 971/999) arms

Delayed/non- payment was highest among those with no formal education, 34% (17/50) and among community mobilisers, 30.7% (392/1071). The majority (70.6%, 1362/1930) of the VCHWs stated that the payment received met or even exceeded their payment expectation.

Participants also stated that e-cash was convenient, transparent, time-saving, and cost-saving, as it reduced travel and waiting times and minimized informal deductions.

Despite these benefits and support to districts to operationalize digital payments , there was no significant difference in workers’ motivation or satisfaction between the intervention and control groups. The researchers attributed this  partly due to challenges associated with both cash and digital payment modes.

Challenges experienced in effecting payments at the district level

Also a number of challenges were uncovered in this study . Challenges with e-cash payments included unanticipated withdrawal charges, unreliable internet networks, and lengthy processes for validating mobile telephone numbers. For example, payments were delayed or not processed when VCHWs’ names did not match the registration details held by telecommunication companies, or when workers did not have phones registered in their names.

One key informant had this to say on challenges around e-cash payments

‘’ There was a general complaint of charges. Remember when they are dispersing funds, they stick to the budget exactly. They are not looking at the charges. And when you are also paying you have to allocate minus the charges. You get the point. So the people would be expecting let’s take an example of 150 000/= and then they get 149 something. So, they would ask, ‘Why are we getting less money?’ So we labored to explain to them that the bank is charging a certain fee to facilitate the e- cash. (KII_West_EPI FP) There were also challenges associated with an unreliable internet network that was necessary to facilitate log ins for approval of payments

On Challenges experienced in effecting payments at the district level ,Key informant interviews with district leaders involved in the payment process identified several bottlenecks  during the payment process of the campaign healthcare workers. One of the major e- cash payment challenges was a lengthy process of validating mobile telephone numbers. ensuring that the VCHW’s names matched the registered mobile account names attached to the telephone number provided by the VCHW for receipt of funds.

‘’Unsuccessful validation occurred when the VCHW’s names did not match the registration details held by the telecommunication companies. Payments for such individuals were delayed or not effected at all. Because some of them do not even have the phones, but they are very good at doing the work…Or if they have, then the phone is not registered in their names. We were supposed to bring that database of the community as well and feed them into the system. That became a problem’’. (KII_North_ADHO)

Suggestions to improve use of e-cash payment system

To increase the use of e- cash, the majority of key informants identified continued training of key staff as a critical intervention with subsequent follow- up to ensure payments are well implemented.

‘’We are not yet ready; our capacity hasn’t been built. We have a big knowledge gap regarding the e- cash system here in this district. (KII East CFO) We request for more training to be conversant [with the system], and to discuss the challenges together during that training, as we share the experiences. Where we have challenges, we sit together and see how they can be addressed’’.  (KII_Central_CFO)

The participants also expressed the need for feedback mechanisms to allow them to dialogue with the payers in case there was a delay in payment. Additionally, the participants also acknowledged that there was a need to gradually expand adoption of digital payments considering contextual barriers. A hybrid approach would be an alternative, especially in the remote and hard-to-reach districts.

Other suggested solutions include early preparation of campaign health worker databases to allow for the lengthy telephone validation processes, improvement of the internet infrastructure, consistent use of e- cash payments across programmes and inclusion of withdrawal charges when making payments.

Moving forward policy, the researchers recommend the need to support e- payment systems, in order to minimize challenges in the pay ment processes.

‘’Suggestions to improve the e- cash experience include training of personnel in charge of e- cash payments, timely creation of VCHWs databases, expanding e- cash payments across programmes for efficiency and inclusion of withdrawal charges for the digital payments. To ensure the institutionalisation of digital payment interventions across Uganda, several key enablers are essential. These include formal policy integration by the Ministry of Health and Ministry of Finance into operational guide lines and budget frameworks, as well as ongoing capacity strengthening at the district level to enhance digital planning, payroll management and troubleshooting. Reliable infrastructure such as mobile connectivity and access to digital financial services like mobile money must also be prioritised, especially in rural areas. Implementing routine monitoring and feedback systems will be vital for tracking payment timeliness, worker satisfaction and system performance, allowing for continuous improvement. Furthermore, fostering public–private partner ships with telecom providers and payment platforms is critical for cost- effective scaling. With strong political commitment, aligned funding and active community engagement, this model holds the potential for broader national and regional adoption, leading to more efficient and equitable health service delivery’’. The paper concludes on the way forward

To read the paper; click; https://gh.bmj.com/content/10/Suppl_4/e016666

About The DHPI-R project

The DHPI-R project was commissioned by the Bill and Melinda Gates Foundation (BMGF) to generate evidence on digital payments in Africa. Although inception, conceptualization of the proposal, and grant award were conducted earlier in 2021, the DHPIR project officially started implementing activities in November 2021, up to March 2025. DHPIR is hosted at the School of Public Health, College of Health Sciences at Makerere University and is implemented in Anglophone and Francophone hubs (countries) in Africa. The Anglophone hub is hosted at MAKSPH, while the Francophone Hub is hosted by the University of Dakar (UCAD) in Senegal.

DHP-IR was rooted in the End Polio Game Campaign, championed by WHO-Afro and partners in 28 countries in Sub Saharan Africa, where digital payments was a key strategy for timely and complete payments to campaign workers.

Mak Editor

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