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Experts Gather to Analyze and Strengthen Efforts in Maternal and Reproductive Health

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By Samantha Agasha and Davidson Ndyabahika

Uganda has made notable progress in increasing coverage of Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCAH) services over the past two decades, but overall progress remains uneven due to inadequate investment and funding for health, fragmented and disorganized healthcare systems, gaps in evidence-based policy, and weaknesses in policy implementation.

In an effort to catalyze policy improvement in Africa, the International Development Research Centre (IDRC) of Canada and the Malaysia-based United Nations University International Institute of Global Health (UNU-IIGH) have agreed to co-fund a program of work aimed at promoting Maternal, Newborn, Sexual and Reproductive Health (MNSRH) policy improvement and development in five African countries, including Uganda.

On Wednesday 18th January 2023, a partner engagement meeting was held in Kampala to conduct a situational analysis of the Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCAH) services in Uganda and discuss challenges in policy formulation, implementation, and evaluation.

In his opening remarks, Prof. Charles Ibingira highlighted the challenges in policy formulation, implementation, and evaluation in RMNCAH services.

“Our targeted outputs are; updated/improved versions of existing policies, or new policies, an improved MNSRH research-policy-practice system (including better coordination and communication between commissioners, producers, and users of research), case studies of catalyzing policy improvement in Africa – CPIA model, and two structured courses for a cohort of young professionals in policy analysis and implementation research,” Prof. Ibingira highlighted.

Prof. Charles Ibingira, the team lead on the project takes notes during the RMNCAH partner's engagement.
Prof. Charles Ibingira, the team lead on the project takes notes during the RMNCAH partner’s engagement.

The session was moderated by Professor Elizeus Rutebemberwa, the Deputy Dean, School of Public Health assisted by Dr. Josaphat Byamugisha, of Obstetrics & Gynecology and the Director, Makerere University Health Services with assistance from Professor Lynn Atuyambe.

Professor Elizeus Rutebemberwa, the Deputy Dean, School of Public Health moderates the session.
Professor Elizeus Rutebemberwa, the Deputy Dean, School of Public Health moderates the session.

According to Dr. Sarah Byakika, the Commissioner Health Services Planning, Financing, and Policy at the Ministry of Health, there is a need to evaluate program indicators on a regular basis.

“The challenge is that when it comes to monitoring and evaluation, and following up on why we are not achieving targets, there is a big gap. We produce annual sector performance reports but don’t give time to reviewing this performance. People always just go back home and wait for the next report,” remarked Byakika.

Further adding; “We are good at designing policies but are struggling when it comes to learning from them.”

Dr. Sarah Byakika, the Commissioner Health Services Planning, Financing, and Policy at the Ministry of Health.
Dr. Sarah Byakika, the Commissioner Health Services Planning, Financing, and Policy at the Ministry of Health.

Dr. Moses Walakira, the family planning program specialist at the United Nations Population Fund (UNFPA) decried the absence of a joint multi-sectoral action plan when it comes to addressing RMNCAH issues.

“How do we work collaboratively to address structural barriers? Who are the gatekeepers? And how do we target them together? Harmonization of perspectives and commitments at different levels is so important, otherwise, we shall remain fragmented in our policy implementation,” said Dr. Walakira.

Dr. Moses Walakira, the family planning programme specialist at the United Nations Population Fund (UNFPA).
Dr. Moses Walakira, the family planning programme specialist at the United Nations Population Fund (UNFPA).

Ms. Friday Madinah, a Senior Youth Officer from the Ministry of Gender, Labour and Social Development, advises that when dealing with issues related to young people, women, children, and people with disabilities, the Ministry of Health should involve the Ministry of Gender, Labour, and Social Development, as they also have the necessary linkages and structures to assist in implementing these policies.

Ms. Friday Madinah, a Senior Youth Officer from the Ministry of Gender, Labour, and Social Development speaking at the event.
Ms. Friday Madinah, a Senior Youth Officer from the Ministry of Gender, Labour, and Social Development speaking at the event.

 “When issues of young people, women, children and even those of people with disabilities are being handled, it is mostly the Ministry of Health taking charge yet we at the Ministry of Gender, Labour and Social Development also have the linkages and structures to help in implementing these policies. Please bring us on board, and make use of our competencies in these areas,” says Madinah.

Dr. Olive Sentumbwe, Family Health, and Population Adviser, at the World Health Organization (WHO), also underscores the need for a platform for the RMNCAH team to utilize in discussions with the other key players in regard to the kind of support they can provide.

Dr. Olive Sentumbwe, Family Health and Population Adviser, at the World Health Organization (WHO) speaks at the partners engagement.
Dr. Olive Sentumbwe, Family Health and Population Adviser, at the World Health Organization (WHO) speaks at the partners engagement.

“The platform is crucial when it comes to accountability; following up/asking other sectors, and Ministries whether our policies and action points are being implemented. We also need different platforms at the different levels of government so there is an understanding of policies and their implementation processes by the different beneficiaries,” she said.

According to Dr. Jessica Nsungwa, the Commissioner for Maternal and Child Health at the Ministry of Health of Uganda, accountability ought to be mutual in order for policies to be successful.

“Government should be accountable to its people, but the people also need to be accountable to the government. For example, we bought a bunch of COVID-19 vaccines using government money but people refused to come for them and some of those doses ended up expiring,” Dr. Nsungwa attests.

Dr. Jessica Nsungwa, the Commissioner for Maternal and Child Health at the Ministry of Health of Uganda.
Dr. Jessica Nsungwa, the Commissioner for Maternal and Child Health at the Ministry of Health of Uganda.

The Minister of Health Dr. Jane Ruth Aceng reported in June 2022 that 2.6 million doses of the COVID-19 vaccine expired due to a lack of interest and misinformation. This highlights the need to improve cooperation and coordination between the public, private sectors, and community to improve access to maternal, newborn, sexual, and reproductive health.

Participants holding a discussion at the RMNCAH partners' engagement meeting.
Participants holding a discussion at the RMNCAH partners’ engagement meeting.

Hon. Dr. Bhoka Didi George, a public health specialist, area MP for Obongi County in Obongi District, and a member of the Committee on Health in Parliament reminded the team that the current public health law in Uganda is obsolete, dating back to the 1930s.

“From a legal and regulatory framework point of view, there is a lot of room for improvement. What we have is a national policy, not a law. Therefore, we cannot hold the government accountable in case they fail to deliver on Maternal, Newborn, Sexual, and Reproductive Health for example. We need an enabling legal and regulatory framework,” Hon. Dr. Bhoka.

Hon. Dr. Bhoka Didi George, a public health specialist, area MP for Obongi County in Obongi District, and a member of the Committee on Health in Parliament.
Hon. Dr. Bhoka Didi George, a public health specialist, area MP for Obongi County in Obongi District, and a member of the Committee on Health in Parliament.

Dr. Richard Mugahi Adyeeri, the Assistant Commissioner Ministry of Health in charge of Reproductive Health advises the localization of policies to suit Uganda’s population needs at the implementation of RMNCAH services.

“One district with five million people, but only one DHO [District Health Officer] can’t have the same issues as a district with only 60,000 people for example. Let us have policies that are not only culturally, but also socially sound,” Dr. Mugahi said.

Dr. Richard Mugahi Adyeeri, the Assistant Commissioner Ministry of Health in charge of Reproductive Health.
Dr. Richard Mugahi Adyeeri, the Assistant Commissioner Ministry of Health in charge of Reproductive Health.

Prof. Ibingira stresses that the engagement was quite central to the responsibility of individual stakeholders, which is proper service delivery for the health improvement of Ugandans.  

“You have given us a lot of information on the issues we are tasked with, regarding policy formulation and implementation. We are now going to do the analysis by looking at the different existing policies so we can come up with strategies instrumental to accelerating policy improvement. We hope a lot is going to change, and that other countries will learn from us. Thank you very much,” Prof. Ibingira.

The CPIA partnership operates in five countries and is coordinated by the UNU-IIGH, which leads to the conceptualization and evaluation of the program’s model. Makerere University leads the implementation of the CPIA model and operational plan in Uganda, and the project aims to benefit staff and students through visiting fellowships, internships, and Ph.D. research opportunities.

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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.

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Digital Payments Boost Vaccination Campaign Efficiency in Uganda

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A picture reflecting digital payments for health workers - powering polio vaccination. Makerere University School of Public Health (MakSPH), Kampala Uganda, East Africa.

KAMPALA, Uganda —Supporting districts to adopt digital payments can significantly improve the efficiency of mass vaccination campaigns in Uganda, even if the gains do not directly translate into higher worker motivation, a new study by Makerere University School of Public Health (MakSPH) researchers has found.

Published on September 10, 2025, in BMJ Global Health, the study examined how helping districts in Uganda transition from cash-based to electronic payments affected vaccination campaign workers. Conducted in early 2023, some four months after the nationwide oral poliovirus vaccination campaign of November 2022, the research assessed the impact of digitised payments on efficiency, timeliness, and worker satisfaction.

With generous support from the Bill & Melinda Gates Foundation, the study was led by MakSPH researchers Peter Waiswa, Juliet Aweko, Maggie Ssekitto Ashaba, Elizabeth Ekirapa-Kiracho, and Charles Opio, in collaboration with Margaret McConnell of the Harvard T.H. Chan School of Public Health, Daniel Donald Mukuye from Uganda’s Ministry of Health, and Andrew Bakainaga from the World Health Organisation (WHO)–Uganda Country Office.

The study’s Principal Investigator and lead author, Assoc. Prof. Peter Waiswa, a health systems researcher at Makerere University School of Public Health, said while the research was conducted in Uganda, its implications are global. He pointed out that some African countries, such as Côte d’Ivoire, Zambia, Tanzania, and Kenya, are already ahead in adopting digital payment systems, while others still lag behind. The study’s findings, he said, are relevant across these contexts and have already informed the work of global actors such as Gavi, WHO, and the Global Fund, who are now integrating digital payments into their own processes.

“This paper is part of several studies we are conducting, but perhaps the most significant,” said Dr. Waiswa, clearly enthusiastic about the findings. “Another outlines the research agenda for digital payments, emphasising the need for more evidence on whether they improve the quality of immunisation campaigns, ensure timeliness and efficiency, and identify which groups face barriers to their use.”

Assoc. Prof. Peter Waiswa speaking at the recent MoU signing between Makerere University and UNICEF to advance child health in Uganda. August 14, 2025. Kampala Uganda, East Africa.
Assoc. Prof. Peter Waiswa speaking at the recent MoU signing between Makerere University and UNICEF to advance child health in Uganda. August 14, 2025.

The study was coordinated by MakSPH in collaboration with a network of partners. In Uganda, these included the Ministry of Finance, the Ministry of Health, the World Health Organisation, several implementing organisations, district authorities, as well as telecommunication companies. Importantly, the involvement of Airtel as a non-traditional actor in the study demonstrated the critical role of private sector engagement, often absent in such collaborations, in generating evidence and advancing digital health solutions, particularly in addressing challenges such as timely payments for health campaign workers.

The November 2022 polio campaign, led by the government of Uganda with support from the U.S. CDC and WHO, targeted 8.7 million children under five with the novel oral polio vaccine (nOPV2). Nearly 72,000 teams, including health workers, Village Health Teams, and Local Council representatives, were mobilised nationwide, administering about 10 million doses despite the temporary exclusion of five districts due to the Ebola outbreak at the time.

Building on the campaign, the researchers conducted an exploratory cluster-randomised trial using a mixed-methods approach across 54 districts in Uganda, where they enrolled 2,665 healthcare workers. Intervention districts were trained to use Uganda’s e-cash platform, a government innovation managed by the Ministry of Finance. Introduced in 2017 and formalised in 2019, the cashless system was designed to digitise urgent government payments, enhance efficiency, and improve transparency. It now complements the Integrated Financial Management System, which, though effective for routine payments, was seen as too slow for time-sensitive transactions, including paying campaign health workers, where timely remuneration is critical for maintaining workforce readiness, sustaining campaign momentum, and promptly addressing public health challenges in the communities served.

Intervention studies usually introduce a treatment or program to a group to observe its effects, and the results are compared with a group that does not receive it. The training during the study addressed the delays, leakages, and administrative bottlenecks common in cash-based systems. Intervention districts received instruction on navigating the government e-cash platform, managing user roles, uploading beneficiary data, and generating payment reports, while control districts maintained standard cash payment procedures, serving as a baseline.

Dr. Juliet Aweko, co-author and Research Associate at MakSPH, said the study was timely, observing that health workers are central to successful vaccination campaigns and delayed payments can demotivate them and compromise campaign effectiveness.

 “To make digital payments truly work, campaigns must be planned with the workforce in mind. Government and partners need to ensure funds are disbursed on time, streamline and automate registration and verification, and keep accurate records of health workers and their performance. Making mobile money systems compatible and giving workers real-time updates on their payments would not only build trust but also keep them motivated, ultimately improving turnout and ensuring smoother service delivery,” Dr. Aweko stated.

Dr. Juliet Aweko signing on the board at the launch of the Research Study on the Impact of Digital Health Technologies on Maternal and Child Health Services. March 15, 2024. MakSPH, Kampala Uganda, East Africa
Dr. Juliet Aweko signing on the board at the launch of the Research Study on the Impact of Digital Health Technologies on Maternal and Child Health Services. March 15, 2024.

The study found that electronic cash adoption was significantly higher in intervention districts, where 57.5% of workers were paid digitally compared to 44.1% in control districts. What’s more, digital payments did not delay disbursement, as 97.6% of all workers received payment after campaign completion, regardless of method. Still, workers paid via e-cash consistently described the cashless system as convenient, transparent, and cost-effective, citing reduced travel time, lower personal costs, and fewer security risks.

Today, Uganda’s rapidly expanding digital ecosystem provides ground for scaling up cashless payment systems. The Uganda Communications Commission reports that the country has over 43 million active mobile subscriptions, nearly 88% of the estimated 49 million population. Its latest market report shows 26.1 million active internet users, while mobile money continues to dominate financial transactions with more than 33 million accounts and transaction values growing by over 25% annually, according to reports by the Bank of Uganda as of March 2025. This trend reflects a population increasingly reliant on digital platforms, creating a strong opportunity to embed e-payment systems in health service delivery.

AI-generated image demonstrating a health worker in rural Uganda using mobile technology during a vaccination campaign. Findings from the MakSPH study shows that district-led digital payments improve efficiency in mass immunisation by reducing delays and bottlenecks, even if they do not directly boost worker motivation.
AI-generated image demonstrating a health worker in rural Uganda using mobile technology during a vaccination campaign. Findings from the MakSPH study shows that district-led digital payments improve efficiency in mass immunisation by reducing delays and bottlenecks, even if they do not directly boost worker motivation.

For MakSPH researchers Dr. Waiswa and Dr. Aweko, the study evidence confirms that digital payments are both feasible and practical for strengthening the delivery of mass campaigns in low- and middle-income countries like Uganda. With relatively modest support, districts can adopt e-cash systems, providing a scalable model for the health sector. This approach, they suggest, would streamline compensation, reduce administrative delays, and provide a stronger basis for integrating digital payments into future immunisation drives and other public health interventions in the country, thereby strengthening our health systems.

The researchers further emphasised that digitising campaign payments reduces transaction costs and minimises leakages, enabling more funds to reach frontline workers quickly. E-cash also simplifies logistics, strengthens accountability, and enhances financial tracking in health campaigns. These advantages, they found, directly align with the global effort to advance digital transformation in health systems and ensure reliable, transparent worker compensation. The implications also extend beyond just polio, as Uganda continues to rely on mass campaigns for routine immunisation and other outbreak responses, such as measles and yellow fever, where digital payments could improve the efficiency of scarce health resources.

Still, the study acknowledged barriers that could hinder full adoption of a cashless system. Some districts lacked the technical capacity to operate the government’s e-cash platform, upload beneficiary data, and manage user roles. Connectivity issues, limited digital literacy among staff, and occasional system downtimes further disrupted implementation. Additionally, many campaign workers lacked national identity cards or mobile money accounts, making them ineligible for digital payments. To address these challenges, the researchers, among others, recommend targeted capacity building for district finance and health teams, expanded identity and mobile registration for campaign workers, improved internet connectivity, and integration of e-payment systems into routine health planning.

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Ekyaalo Diagnostics; Johns Hopkins University Partners with Makerere and MUST to Advance AI Innovation for Breast Cancer Diagnosis

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Group photo at Centre for Maternal, Newborn, and Child Health Research at Makerere University School of Public Health led by Associate Professor Peter Waiswa, alongside Graduate biomedical engineers from the Centre for Biomedical Innovation and Design (CBID) at Johns Hopkins University.

By Joseph Odoi

Globally, Breast cancer remains a serious health challenge, with the World Health Organization (2022) reporting over 2.3 million new cases annually and nearly 670,000 deaths. In Uganda, breast cancer is one of the leading cancers among women, yet the majority of patients are diagnosed at late stages due to delays in accessing diagnostic services, most of which are centralized at the Uganda Cancer Institute (UCI) in Kampala. Since 72% of Uganda’s population lives in rural areas, women often face late diagnosis due to long travel distances. Even after accessing care, results can take 1–6 months due to the slow process of transporting samples to central laboratories. This delay directly impacts the timely start of treatment.

To address this gap, Johns Hopkins University in collaboration with Makerere University and Mbarara University of Science and Technology (MUST), is spearheading innovative solutions that leverage artificial intelligence (AI) and low-cost technologies to improve early diagnosis and treatment.

As part of this collaboration, the Centre for Maternal, Newborn, and Child Health Research at Makerere University School of Public Health led by Associate Professor Peter Waiswa in July hosted a team of graduate biomedical engineers from the Center for Bioengineering Innovation and Design (CBID) at John Hopkins University.

The team is developing a low-cost, AI-powered technology called Ekyaalo Diagnostics, aimed at reducing the turnaround time for breast cancer diagnosis, especially in hard-to-reach areas. As part of their work, they undertook a learning tour at the Ministry of Health, Uganda Cancer Institute, and regional cancer referral centres. The purpose was to map stakeholders in the breast cancer space, gather Ekyaalo diagnostic technology usability feedback, and understand the local innovation ecosystem in breast cancer care.

Ekyaalo Diagnostics and Bringing Pathology Closer to Communities

The flagship innovation, Ekyaalo Diagnostics, is a portable AI-powered whole-slide scanner (WSS) designed to digitize cytology samples at Health Centre IVs and General Hospitals. These digitized images are securely transmitted to pathologists at higher-level facilities for timely review, eliminating the need for physically transporting samples to Kampala.

Ekyaalo Diagnostics hardware: A whole slide scanner and a Laptop displaying a scanned Image.
Ekyaalo Diagnostics hardware: A whole slide scanner and a Laptop displaying a scanned Image.

This technology has the potential to reduce diagnosis delays from several months to just a few days, thereby improving survival outcomes for breast cancer patients.

Building Local Solutions to Global Challenges

In addition to Ekyaalo Diagnostics, Makerere researchers at the Department of Biomedical Engineering are also advancing other innovations such as development of artificial breast prototypes to be used in  educating women on breast cancer symptoms while Research at Mbarara University led by Dr. William Waswa, are developing  PapsAI, a low-cost automated tool that support whole slide scanning of slides for cervical cancer screening.

These initiatives are aligned with the National Cancer Control Plan (NCCP) of the Ministry of Health, which emphasizes prevention, early detection, timely diagnosis.

Design Challenges and Considerations

Despite the progress being made, challenges persist, according to the team’s findings from the tour,these technologies hold great promise however their success in Uganda will depend on addressing some critical barriers.

One of the biggest challenges is limited staffing. Many lower-level health facilities lack trained laboratory personnel to prepare slides. For this reason, new technologies must be designed to be simple, user-friendly, and capable of being adopted after short training sessions.

Another major barrier is equipment maintenance. Past medical innovations in Uganda have often struggled with frequent breakdowns and software failures. The team emphasized that new diagnostic tools must be affordable, durable, and resistant to common system crashes if they are to serve rural health facilities effectively.

Finally, high operational costs continue to undermine sustainability. Some innovations fail because their maintenance costs are too high or because they are incompatible with existing health systems. Ensuring cost-effectiveness and system integration will therefore be vital for the long-term success of breast cancer diagnostic technologies in Uganda.

MORE ABOUT THE PROJECT

The project is led by the Johns Hopkins  Center for Bioengineering Innovation and Design (CBID) in collaboration with Makerere’s Department of Biomedical Engineering and MUST researchers. Field learning tours have already been conducted at Mulago National Referral Hospital, Jinja, Mbarara, and Fort Portal Regional Referral Hospitals, with input from clinicians, technologists, and innovators in Uganda’s health ecosystem.

The Johns Hopkins team has conducted usability interviews with clinicians, laboratory technologists, and surgeons at multiple hospitals including Mulago, Jinja, Mbarara, and Fort Portal. They have also engaged with Uganda’s innovation ecosystem, including makerspaces and industry partners. It has been noted that the Ministry of Health together with Partners working on treatment of cancer has drafted the National Cancer Control Plan (NCCP) that is aimed at reducing incidence, morbidity and mortality through prevention and early treatment and palliative care. The Plan will give guide on health education, early detection, and diagnosis among others Special thanks go to the Center for Bioengineering Innovation and Design   (CIBID) Johns Hopkins University for funding this field learning tour, Centre for Maternal Newborn and Child Health Research at School of Public health (Makerere University) for hosting the team, Departments of Bioengineering at Makerere University and Mbarara University of Science and Technology, Mulago pathology department and the Uganda cancer institute, Regional Referral hospitals of Jinja, Mbarara and Fort Portal among other General hospitals and Health center IVs visited for technical input.

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