Health
Digital Payments Boost Vaccination Campaign Efficiency in Uganda
Published
4 months agoon

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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Holistic Retirement Planning includes Psychological, Emotional & Social well-being across all Career Stages
Published
1 week agoon
January 12, 2026By
Mak Editor
The Makerere University Retirement Benefits Scheme (MURBS) on Thursday, 8 January 2026 organised a Member Sensitisation Session on “Understanding Identity Shifts; Developing Routines; Sustaining Motivation and Purpose”. The session focused on holistic retirement planning, emphasising that readiness for life after work goes beyond finances to include psychological, emotional, and social well-being across all career stages—from early career to post-retirement.
The session featured a keynote presentation by Professor Seggane Musisi, who highlighted how work-related titles and roles often shape personal identity, and how retirement can trigger a sense of loss if individuals are unprepared to redefine themselves. Members were encouraged to consciously design a post-work identity grounded in values, purpose, and community contribution.
Participants learned practical strategies for:
- Preparing early for retirement at different career stages;
- Developing healthy, meaningful routines that support mental stability and productivity;
- Sustaining motivation and purpose beyond formal employment;
- Managing stress, maintaining physical and mental health, and nurturing social connections; and
- Balancing family responsibilities with personal well-being.
The discussion also addressed cultural realities of retirement in Uganda, including family expectations, social obligations, and financial pressures. Special attention was given to age-related challenges such as dementia, depression, and chronic illness, underscoring the importance of preventive health care, emotional resilience, and timely professional support.
Overall, the session reinforced the message that retirement is a lifelong transition, not a one-time event. Members were encouraged to plan early, adapt continuously, and intentionally design a fulfilling, purposeful life beyond work—psychologically, socially, and financially.
To view the session, please click the embedded video below. Further below is the presentation.
Health
Kampala at a Crossroads: What New Research Reveals About Mobility, Governance, and the City’s Public Health Risks
Published
2 weeks agoon
January 8, 2026
Every day in Kampala, millions of people inch through gridlock, dodge swarming boda-bodas threading through narrow gaps in traffic, inhale dangerously polluted air, and walk along streets rarely designed for pedestrians. These conditions, and more, are often dismissed as ordinary transport frustrations. Yet researchers at Makerere University School of Public Health (MakSPH) are examining how such everyday realities translate into public health outcomes, shaped not simply by congestion, but by governance, policy, and power. Their work forms part of a multi-country project investigating the political economy of urban mobility in three African cities.

Co-led by Dr. Aloysius Ssennyonjo, the Principal Investigator and health systems and governance researcher at MakSPH, together with Uganda’s Country Principal Investigator, Dr. Esther Bayiga-Zziwa, a road safety and injury epidemiologist, and Co-Principal Investigator Dr. Jimmy Osuret, an injury prevention researcher, the project titled The Political Economy of Urban Mobility Policies and Their Health Implications in African Cities (PUMA) applies a political economy lens to understand how political interests, institutional arrangements, and power dynamics shape mobility systems and their consequences for public health in Kampala, Kigali, and Lilongwe.
To note, political economy analysis examines how public decisions are shaped by the interplay of politics, interests, institutions, and resources, in short, who has influence, who controls what, and how money and power circulate within a system. In Kampala, a capital of nearly two million residents whose daytime population swells with commuters, this lens helps explain why some transport options attract funding and enforcement while others are tolerated, neglected, or contested. These choices are not just technical, but reflect competing interests and priorities, with consequences for safety, equity, and the everyday well-being of those moving through the city.

Now, through the NIHR-funded project, the Ugandan team is currently working with colleagues from the University of Rwanda, led by Professor David Tumusiime, and Kamuzu University of Health Sciences in Malawi, led by Dr. Dominic Nkhoma. The research partnership aims to generate evidence that can strengthen mobility governance and improve public health outcomes across the three African cities above, with advisory support for the research consortium from the University of Antwerp in Belgium and Canterbury Christ Church University in the UK.
Explaining the project’s rationale for the Politics of Urban Mobility, or PUMA, during the 2025 Universal Health Coverage Day webinar held on December 12 under the theme “Mobility, Costs, and Politics: How Urban Systems Shape Access and Progress Towards Universal Health Coverage in African Cities,” Principal Investigator Dr. Ssennyonjo said Africa is urbanising at an unprecedented pace. Projections show that by 2050, nearly 60% of the continent’s population will live in cities, a shift that is intensifying transport pressures and increasingly turning everyday mobility into a public health risk.

“Rapid urbanisation has created multiple challenges: transport systems are under strain, risks and vulnerabilities are rising, and opportunities for healthy behaviours such as walking are often limited. Access to livelihoods is also affected, with broad implications for health,” Ssennyonjo noted, adding: “Crucially, these issues are shaped by political and governance dynamics, yet few initiatives explicitly address them. This gap motivated our focus on the politics and governance of urban mobility.”

He mentioned that health outcomes are shaped by social, economic, and environmental factors, with transport costs, risks, and stress often posing greater barriers than medical fees alone to achieving affordable health for all. He noted that the PUMA project brings together multidisciplinary teams to study how governance and political dynamics shape urban mobility, public health, and development, a perspective reflected in Prof. Julius Kiiza’s observation that effective urban development relies on coordinated action by diverse stakeholders across sectors to improve health outcomes, though emphasising the primacy of politics.
“Uganda and Singapore had comparable levels of underdevelopment in the 1960s. Under Lee Kuan Yew, Singapore embarked on a deliberate nation-building project. Today, it is among the smartest cities globally, outperforming many Western cities in clean government, mobility, and liveability. Why are we lagging behind? The answer, I argue, lies largely in the nature of our politics,” Prof. Julius Kiiza cogently argued.
He intimated that the result has been cities that are “unreliable, unsafe, unsmart, and chaotic,” noting that claims of inclusive urban development often ring hollow. “I have argued, and repeat here, that boda bodas as a symbol of inclusivity represent a false model of inclusion. We must interrogate this and invest in better urban transport systems and wider, well-planned highways,” he affirmed.

Prof. Kiiza urged policymakers and practitioners to move beyond piecemeal technical fixes and instead treat urban mobility as a governance challenge requiring coordinated, cross-sector action. He stressed the importance of aligning transport planning with public health, housing, employment, and skills development, arguing that safer, more liveable cities depend on institutions that work together and are accountable to the public. Such reforms, he noted, demand sustained political commitment and inclusive dialogue across government, academia, civil society, and the private sector, precisely the terrain the PUMA project is engaging, by convening stakeholders and shaping a shared research agenda around Uganda and the continent’s urban mobility challenge.

Indeed, on November 21, 2025, the Ugandan team convened a national stakeholder workshop in Kampala, bringing together a wide range of stakeholders. Opening the workshop, Assoc. Prof. Suzanne Kiwanuka, Head of the Department of Health Policy, Planning and Management (HPPM) at MakSPH, commended the team for highlighting what she described as a long-underexplored dimension of Uganda’s urban health landscape: mobility and its governance.
Reflecting on her own experience, she noted how boda-bodas have become increasingly indispensable for millions seeking quick, flexible transport, but also carry complex health, safety, and economic implications that demand multisectoral attention, calling for a balanced, evidence-driven dialogue that recognises their value while also addressing the infrastructural and policy gaps that shape mobility systems in Uganda’s rapidly growing cities.
“I sometimes use boda-bodas,” Assoc. Prof. Suzanne Kiwanuka said. “They are necessary when you need to move quickly during heavy traffic. Yet we all know how unsafe they can be. This PUMA initiative is timely to generate evidence not only on the politics of urban mobility and its health implications, but also its economic consequences.”

Notably, road traffic crashes remain one of Uganda’s most urgent public health threats today. The recent Uganda Police Force Annual Crime Report 2024 recorded 5,144 road deaths, a seven per cent rise from 2023, with motorcyclists accounting for nearly half of all fatalities. In Kampala, pedestrians, cyclists, and motorcycle riders constitute 94 per cent of all fatal crashes, according to the Kampala Capital City Authority. Thousands more suffer life-altering injuries each year.
Still, evidence from MakSPH, through its Centre for Trauma, Injury and Disability Prevention (C-TRIAD) and the Johns Hopkins International Injury Research Unit (JH-IIRU) under the Bloomberg Philanthropies Initiative for Global Road Safety (BIGRS), shows that the design and use of city roads are worsening the risk environment. Between 2021 and 2023, the team conducted more than one million roadside observations across Kampala, finding that while only five per cent of vehicles are officially recorded as speeding, those that do travel at an average of 57 km/h, well above safe limits for dense urban corridors, making city roads increasingly unsafe.

The World Health Organization (WHO) guidelines, cited in the report, recommend speed limits of 30 km/h on community roads and in urban areas where pedestrians, cyclists, and other vulnerable road users share space with motorised traffic, and 50 km/h on major urban roads. Yet the findings show that six in ten vehicles on community roads exceed these limits, heightening risks for those least protected and underscoring the need for lower-speed zones, traffic-calming measures such as speed humps and raised crossings, and consistent enforcement of traffic regulations.
For the PUMA team in Uganda, the writing on the wall shows that these rising injuries coincide with worsening congestion and rapid urbanisation, yet city mobility policies within Kampala remain heavily oriented toward road expansion and vehicular flow, with limited attention to safety, health protection, or non-motorised transport. This policy imbalance, then, explains why daily commuting remains hazardous and why progress on safer streets has been slow.

The study uses a three-tiered approach that combines policy analysis, regional evidence, and local experiences to examine how mobility decisions are made in Kampala, Kigali, and Lilongwe, who holds authority, and how these processes affect public health and equity. This is strengthened by structured co-creation workshops with practitioners, policymakers, and community actors, which reveal how governance functions in practice, often diverging from what is written on paper.
In parallel, the research team is conducting a continent-wide review of academic and grey literature to map regional trends, gaps, and the broader forces shaping African mobility systems. Together, these streams enable the researchers to compare cities, identify shared challenges, and build a grounded analytical framework for improving mobility governance across Africa.
In Kampala, preliminary findings by the MakSPH PUMA research team show a city governed by many mobility policies but marked by weak mobility governance. The team shared that Kampala operates under a dense mix of frameworks, from the National Integrated Transport Master Plan and National Urban Policy to road safety, climate, and KCCA development plans. While these documents acknowledge congestion, urbanisation, and road injury risks, they also reveal overlapping mandates, blurred institutional roles, and limited coordination authority.

Key government Ministries, Departments, and Agencies (MDAs) actors include the Ministry of Works and Transport, KCCA, the Ministry of Lands, the Office of the Prime Minister, and the Ministry of Finance, with the Ministry of Health conspicuously absent despite clear health implications. Policy attention, according to the early findings, remains heavily skewed toward road transport, leaving non-motorised mobility and major health pathways, noise exposure, psychosocial stress, community severance, heat, and mobility independence largely unaddressed.
Governance realities are further shaped by political processes, including electoral cycles, informal negotiations with transport unions, selective regulation of boda-bodas, and heavy reliance on development partners that often influence what is prioritised and implemented. Together, these dynamics help explain stalled master plans, inconsistent enforcement, and resistance to progressive interventions. While the PUMA research remains at a preliminary stage currently, the emerging findings underscore the need for an integrated, multisectoral mobility agenda that places health at the centre of Kampala’s transport policy and practice.

Health
How People Earn a Living is Contributing to Malaria Risk in Uganda, Study Finds
Published
2 weeks agoon
January 5, 2026
Livelihood activities such as farming, livestock keeping, construction, and night-time work significantly increase malaria risk in Uganda, according to new research by Dr Kevin Deane, a development economist at The Open University, UK, and Dr Edwinah Atusingwize and Dr David Musoke, a Research Associate and Associate Professor of Environmental Health at Makerere University School of Public Health, respectively.
The study, Livelihoods as a key social determinant of malaria: Qualitative evidence from Uganda, published on December 2, 2025, in the journal Global Public Health, examines how everyday economic activities shape exposure to malaria, often undermining conventional prevention measures such as insecticide-treated nets and indoor residual spraying. The findings are based on qualitative fieldwork conducted in June 2024 in Busiro County, Wakiso District, a peri-urban area with persistently high malaria transmission in Uganda.
Using a qualitative design, the researchers conducted 14 key informant interviews, 10 focus group discussions, and 11 in-depth interviews with households recently affected by malaria, engaging 100 participants from communities, health services, local government, and civil society across Kajjansi, Kasanje, and Katabi Town Councils, as well as Bussi Sub-County, in Busiro South. Their analysis, guided by the Dahlgren–Whitehead social determinants of health model, enabled the researchers to situate malaria risk within the broader social, economic, and environmental conditions shaping how people live and work.

In their findings, participants linked malaria exposure to agricultural practices, among which is maize cultivation near homes, which was associated with increased mosquito density during the rainy season. “One of the most common crops cultivated in Uganda, which many rely on as staple foods, creates environments in which mosquitoes are attracted to and thrive, often in settings where maize is grown near homes in rural areas and urban areas. This increases mosquito density around homes and contributes to increased outdoor biting and the number of mosquitoes entering houses,” the study argues.
Its authors say this poses a difficult policy challenge because maize is central to household food security, leaving few practical options for reducing exposure. They argue that proposals to keep maize away from homes are often unrealistic for families with limited land or those farming in urban areas, while targeted control during flowering periods may have limited impact given mosquitoes’ ability to travel beyond cultivation sites.

Beyond crop farming, the study reports that livestock rearing, especially zero-grazing cattle kept close to houses, attracts mosquitoes into household compounds. Other livelihood activities, including construction and brick-making, created stagnant water-filled pits that served as breeding sites, while night-time livelihoods, such as street vending, guarding, fishing, bar work, and brick burning, among others, prolonged outdoor exposure during peak mosquito biting hours. Gender further shaped risk, with women’s livelihoods and caregiving responsibilities frequently exposing young children alongside them.
“The evidence we present illustrates the unintended health consequences of development strategies intended to promote key livelihood activities, food security, and poverty reduction. There are no straightforward solutions given the complexity of these relationships and the importance of these livelihoods for many households,” the authors assert.
They conclude that malaria elimination efforts will fall short unless livelihoods and development activities are explicitly integrated into malaria prevention strategies, calling for stronger alignment between public health, agriculture, urban development, and economic policy.
Please see below for the study:
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