_{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.

_{By Joseph Odoi}

In a significant step toward revolutionizing mosquito surveillance in Uganda, Dr. Peter Waiswa, Associate Professor of Health Policy Planning and Management at the School of Public Health, Makerere University has revealed that a new AI-driven mosquito surveillance project is set to be rolled out to strengthen vector monitoring efforts across 22 districts in Uganda.

He disclosed this while briefing a multidisciplinary team during a courtesy visit to the Ministry of Health on 7^th August 2025 to engage with officials on the VectorCam Project.

The VectorCam Project is a partnership between the Makerere University School of Public Health, Johns Hopkins University, and the Ministry of Health, with funding from the Gates Foundation. The project seeks to revolutionize mosquito surveillance by shifting from manual, human-led identification to a digital, AI-driven mobile application using computer vision

What is VectorCam?

VectorCam is an innovative project focused on transforming how Uganda monitors malaria-carrying mosquitoes. At its core is a smartphone-based, AI-powered application that uses computer vision to quickly identify mosquitoes by species, sex, and feeding status whether a mosquito has fed recently or not. Traditionally, such analysis requires the expertise of entomologists and takes considerable time.

According to Prof Waiswa, VectorCam will advance ento. surveillance.

‘’We have worked with Johns Hopkins University and the Minister of Health to develop an AI-powered mobile application which can be used to identify mosquitoes. This apps tells you the type of mosquito, the sex of the mosquito, and whether the mosquito has a full abdomen or half abdomen or is empty. That is, if it fed last night or not.

This one is a way to just shift mosquito surveillance from people to an app. The app does it in 20 seconds using computer vision. It does it faster and better than any entomologist. Every district just has one Entomologist. So the entomologist can go and focus on other things as part of his work because nowadays an app can do it.

The good thing with the app is we’ve already done a big trial funded by the Gates Foundation and we have evidence that it works. The app also posts data and makes it accessible through the DHIS to the districts but also at the national level’’ Prof. Waiswa explained.

‘’With support and funding from the Gates Foundation, we are going to be scaling up the Vector Cam Project to 22 districts. In 12 of these, we will conduct research to evaluate how the app actually performs at scale in routine life settings ‘’ Prof Waiswa stated about the next project step.

As part of the project engagement, Prof. Waiswa met with Dr. Daniel Kyabayinze, Director of Public Health at the National Malaria Control Division, Ministry of Health, Uganda, who also serves as the Acting Program Manager for Malaria at the National Malaria Control Program (NMCP) to brief him on the project genesis and its next objectives which will lead to data-driven decision making to tailor vector control interventions.

Also in attendance were also; Professor Soumyadipta Acharya a respected researcher in the field of ento. surveillance from Johns Hopkins University, United States, along with representatives from the Ministry of Health and Makerere University.

More About VectorCam Project

VectorCAM  is an innovative project focused on transforming how Uganda monitors malaria-carrying mosquitoes. At its core is a smartphone-based, AI-powered application that uses computer vision to quickly identify mosquitoes by species, sex, and feeding status.

Between November 2022 and April 2024, Makerere University, in partnership with Johns Hopkins University and Uganda’s National Malaria Control Programme (NMCP), successfully implemented the first phase of the VectorCam Project. Through this, the project piloted the VectorCAM an AI-driven mobile application that uses computer vision to identify mosquitoes by species, sex, and abdominal status providing rapid, cost-effective entomological surveillance in malaria-endemic regions.

Following the successful trial and validation of the technology, the project is now entering a new phase focused on scaling up.

VectorCam will be rolled out across 22 districts in Uganda, with operational research embedded in 12 of those districts to assess its performance.

Welcome to this comprehensive reflection on the remarkable milestones achieved by the Makerere University Research and Innovations Fund (Mak-RIF) throughout the second half of the 2024/2025 financial year. This dynamic period was marked by various achievements, strategic collaborations, and a steadfast commitment to advancing knowledge for national development. From capacity-building initiatives such as equipping PhD students with vital skills in crafting policy and issue briefs to supporting several project dissemination activities, Mak-RIF further demonstrated its dedication to fostering panoramic and impactful research.

The pinnacle of the period was the vibrant Research and Innovations Week, officiated by His Excellency, President Yoweri K. Museveni. During this landmark event, our researchers showcased the tangible impact of Government investment in research through Mak-RIF, and Makerere’s innovative strides and research excellence.

Beyond this event, the period saw meaningful benchmarking visits from the Ministry of Public Service and Lira University, deepening inter-institutional collaboration in research management and knowledge translation. We were also privileged to host Prof. Christine Suniti Bhat from Ohio University, exploring partnerships in mental health, psychosocial support, and capacity building.

In the second half of the financial year, Mak-RIF also launched its 6^th round of grants award and inducted the RIF6 grantees, marking yet another chapter of impactful research ahead.

I extend my heartfelt appreciation to the Government of Uganda and the University Management for their support towards Mak-RIF. I further appreciate researchers, the Mak-RIF Grants Management Committee and the Secretariat whose hard work and dedication continue to elevate Uganda’s research and innovation ecosystem. Together, we continue to position Makerere University as a beacon of research-led national development.

Prof. Fred Masagazi-Masaazi
Chairperson, Mak-RIF Grants Management Committee (GMC)