Kampala, Uganda – Makerere 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.

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.

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.

“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.

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.”

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.

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_{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.

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.”

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.

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.

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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