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Uganda’s Ministry of Health Embraces Family Planning Data, PMA Data to Influence Policy

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Kampala, Uganda, Feb. 16, 2022 (MakSPH) – Commissioners at Ministry of Health in Uganda have applauded the Performance Monitory for Action -PMA Uganda project for its robust research in family planning.

Dr. Olaro Charles, the Director Health Services- Curative Services at the Ministry of Health says the Ministry is grateful for the work that PMA does, citing that it would cost government a lot of money since such work would require a consultant to do it.

“The data collected in this PMA survey inform monitoring and assessment, assessing the progress of the targets as we set in the Family Planning 2030 commitments and the costed implementation plan. I am happy that all of you were involved during the formulation and official launch of these commitments,” Dr. Olaro said at a recent dissemination of panel survey results for phase 2 at Golden Tulip Hotel in Kampala.  

Dr. Olaro Charles, the Director Health Services- Curative Services at the Ministry of Health
Dr. Olaro Charles, the Director Health Services- Curative Services at the Ministry of Health

PMA Uganda, a Bill and Melinda Gates Foundation funded project at Makerere University School of Public Health (MakSPH), a leading public health institution in Uganda and within the East and Central Africa region uses innovative mobile technology to support low-cost, rapid-turnaround surveys monitoring key health and development indicators.

Between September and November last year, MakSPH-PMA project led by Principal Investigator Dr. Fredrick Makumbi and Co-Principal Investigator Dr. Simon Peter Kibira conducted a survey from 4,399 households where 4,346 females of ages 15-49 were interviewed. Also, data was collected in 384 health facilities and 2,370 client-exit interviews conducted.

According to the results, the trends in use of Contraception among all women of age 15-49 increased from 35% in 2020 to 40% in 2021 in all methods. On further analysis, those using modern methods of contraception increased from 29.5% to 34% while those using traditional methods of birth control rose slightly from 5.5% in 2021 to 5.9%.

“I am also happy to mention that I sit in the FP20 global committee, and as you know this is great not only for our country but as well as the region. From the first PMA survey, we were seeing the country making progress, however slow it is towards increasing modern contraceptive usage. As you all know the FP2030 objectives were launched and we need to be able to work. I will soon share with you the considerable plan, which is also a precursor for us to be able to achieve our Family Planning 2020,” said Dr. Olaro.

The Government of Uganda set an ambitious goal to increase the modern contraceptive prevalence rate to 50% by 2020. This however was not achieved. In acknowledging this, Dr. Olaro notes that there are still unsolved challenges with the quality of family planning services especially the counselling of users.

“If you go to back to our commitments, one of them is purposed to address this challenge. To address family planning misconceptions, government committed to improve counselling and in it, we provide what options are available, possible side effects and how we manage them, and how the users pick on a different component. So, with implementation and measurements, we shall be able to overcome the challenge,” says Dr. Olaro.

Hons. Catherine Namuddu, Sylivia Bahireira, Joel Ssebikaali, Charles Ayume, Hope Nakazibwe, Ronald Bagaga and Bayiga Rulume, all Members of the Health Committee of Parliament attended the dissemination. 

Professor of Disease Control, Researcher, Public Health Expert and Dean, MakSPH, Dr. Rhoda Wanyenze says a lot of the work that done at MakSPH is geared towards ensuring equity and through evidence. According to Prof. Wanyenze, PMA program is one of the projects at MakSPH where researchers generate evidence and continue facilitating policy formulation.

“This program shows this because on the data we have generated, has to be used by all these stake holders here with us today. For example, we have just used the PMA data to inform Uganda’s FP2030 commitments and before that we were also looking at this data while implementing the costed development plan,” she said.

Professor of Disease Control, Researcher, Public Health Expert and Dean, MakSPH, Dr. Rhoda Wanyenze
Professor of Disease Control, Researcher, Public Health Expert and Dean, MakSPH, Dr. Rhoda Wanyenze

Speaking to an audience that had legislators under the umbrella of the Health Committee of Parliament, Professor Wanyenze said improving health requires holistic approach that includes several other sectors of development including education. She also appealed to the legislators and the sector planners to re-orient health by investing more in promotion of health and prevention of disease than focus only at treating people.

“We can also generate more evidence. You can tell us where it is that you need more evidence that you do not have so that we can work together to generate evidence. We are available and ready to work with you so you can make more evidence-based interventions,” she said.

 In light of the Makerere University centenary celebrations, Dean Rhoda pledged continued generation of evidence that adds value.

Dr. Olaro paid emphasis on need for concerted efforts of Ministry of Health an its partners required to solve family planning challenges.

“We need to develop and adopt the use of innovative strategies to inform programming in an effort to address some, if not most of these challenges and I want to implore you to implement what works based on the findings,” Dr. Olaro said.

Further adding that; “These statistics that guide in programming should be progressively pursued and we are looking forward to continue good working relationships as we strive for better health of our communities in which we serve and live.”

Dr. Richard Mugahi Adyeeri, the Assistant Commissioner in charge of Reproductive and Infant Health said MoH appreciates Dean Rhoda’s comments especially the call for evidenced based Interventions and the ability of the ivory tower, to keep producing this evidence whenever it is needed.

“We also appreciate your comment about the partnership with education, given the fact that the determinants of health, some of them fall in education, others are housed in agriculture, and we need a total rethink of our post pandemic public health interventions,” Dr. Mugahi observes.

Dr. Richard Mugahi Adyeeri, the Assistant Commissioner in charge of Reproductive and Infant Health shares with the PMA PI and Deputy Dean MakSPH Dr. Frederick Makumbi
Dr. Richard Mugahi Adyeeri, the Assistant Commissioner in charge of Reproductive and Infant Health shares with the PMA PI and Deputy Dean MakSPH Dr. Frederick Makumbi

The Head of surveys at Uganda Bureau of Statistics (UBOS) Mr James Muwonge, while representing the Executive Director Dr. Chris Ndatira Mukiza congratulated MakSPH for pulling off this national survey and for having consistent data.

He encouraged research entities to continuously share information and best practices, as well as coordinate research efforts across different agencies. He also committed on behalf of UBOS to continue working together with MakSPH.

“The Dean has talked about the need to utilise information. There is a lot of information that is collected, but probably not much is being used but looking at the audience in here, I am encouraged and feel contented that the information is getting as far as the parliament because it influences policy and the fact that within the audience we have the policy makers, to me it is a testimony and really important,” said Muwonge.

The Head of surveys at Uganda Bureau of Statistics (UBOS) Mr James Muwonge
The Head of surveys at Uganda Bureau of Statistics (UBOS) Mr James Muwonge

National Population Council (NPC) Director General, Dr. Jotham Musinguzi said they advised Parliament on the need to invest in the population, reduce fertility in this country, and investments in education as a means to reduction of fertility.

NPC was established by the National Population Council, Act 485, 1994, to advise Government on all population matters. Dr. Musinguzi observes that if we do not reduce fertility fast enough, we will not be able to benefit from the demographic dividend.

“We have an opportunity now that Fredrick (Makumbi) and Simon (Kibira) have shown us that we can impact on contraceptive work, we can push it firmly, we need to make sure that education, health are working together so that the population moves from a pyramid that is very heavy at the bottom, to a pyramid that has a lot of people in the middle and these people get education, health and have skills,” he said.

National Population Council (NPC) Director General, Dr. Jotham Musinguzi
National Population Council (NPC) Director General, Dr. Jotham Musinguzi

In the last decade, Dr. Musinguzi says Uganda has been reducing on mortality and fertility rates citing that that’s when the country enters the realm of opportunity.

“I want say that this is something very important and we need to continue leaning to reproductive health and family planning especially use of contraceptives and through working with the Ministry of Health and other development partners. That is the only way we are going to achieve big impact on health, education of the population,” he said.

Dr Betty Kyadondo, the head of Family Health Department at NPC
Dr Betty Kyadondo, the head of Family Health Department at NPC

Dr. Betty Kyadondo, the head of Family Health Department at NPC noted that while there was an increase in the uptake of family planning services and that modern contraceptives, the country still needed to do more.  

She says great attention to the issues of use of contraceptive by certain groups such as adolescents and men, that are largely under looked and misrepresented is important.

“They don’t get adequate counselling in times they need the service but we are seeing an increasing number of teenage pregnancy rates and if we don’t work with these young people, its risky and sensitive issue and many people are shy to talk about it but its high time we faced it and addressed sexually active adolescents about the use of family planning methods,” Dr. Kyadondo says.

She advances the need to leverage on the existing efforts in improving family planning service delivery such as human capital development program, community mobilisation and mindset change to reduce negativity and misconceptions about family planning, utilization of the parish development model through its pillars as well as integration of integrate technology into our family planning agenda.

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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