Health
Digital Payments Boost Vaccination Campaign Efficiency in Uganda
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.
A major milestone in Uganda’s efforts to reduce newborn mortality was marked on June 17, 2026, when Makerere University College of Health Sciences graduated the first cohort of fellows from the Perinatal and Neonatal Medicine Fellowship Programme.
The pioneering cohort of five specialists completed the two-year sub-specialty fellowship designed to equip pediatricians with advanced competencies in newborn care, leadership, research, advocacy, and neonatal intensive care. The programme is accredited by the Uganda Medical and Dental Practitioners Council and is implemented through a partnership involving Makerere University, Mulago Specialised Women and Neonatal Hospital, Kawempe National Referral Hospital, St. Francis Hospital Nsambya, Seed Global Health and Elma Philanthropies.
Speaking at the graduation ceremony, the Principal of the College of Health Sciences, Prof. Bruce Kirenga, described the occasion as a significant achievement for Makerere University and Uganda’s health sector.
“Today is a very important occasion for the College of Health Sciences, and indeed the health sector in Uganda,” he said, noting that the fellowship was established to develop highly skilled specialists capable of responding to increasingly complex healthcare needs.
Prof. Kirenga emphasized that Uganda’s changing disease patterns, increasing life expectancy, and growing demand for specialized healthcare services have created an urgent need for super-specialized training programmes. He challenged the graduates to use their newly acquired knowledge and skills to improve newborn health outcomes and save lives.
Addressing Uganda’s Neonatal Health Burden
Presenting an overview of the fellowship programme, the Head of the Department of Paediatrics and Child Health, Prof. Victor Musiime, highlighted the urgent need for specialists in neonatal care.
He noted that neonatal deaths, those occurring within the first 28 days of life, remain one of the leading contributors to child mortality in Uganda. The country continues to face a shortage of professionals with advanced skills in neonatal care, research, leadership, and advocacy.
“The demand for neonatologists remains extremely high,” Prof. Musiime explained, adding that the Ministry of Health envisions deploying neonatologists to regional referral hospitals and other health facilities across the country.
The fellowship programme was established to build a critical mass of neonatologists, strengthen care for high-risk newborns, develop expertise in advanced neonatal procedures, and produce leaders and advocates for newborn health.
A unique feature of the programme is its strong clinical apprenticeship model, complemented by international placements at leading institutions, including Yashoda Hospital in India and Aga Khan University Hospital in Nairobi, Kenya.
Ministry Commits to Expanding Neonatal Services
Representing the Ministry of Health, Commissioner for Maternal and Child Health, Dr. Richard Mugahi, congratulated the graduates and commended Makerere University and its partners for establishing the fellowship programme.
Dr. Mugahi revealed that the five graduates join another five neonatologists already serving in Uganda, bringing the country’s total number of neonatologists to ten. He described the locally trained fellows as a critical addition to Uganda’s healthcare workforce.
“The Ministry’s vision is to have a neonatologist at every Regional Referral Hospital,” he said, adding that Uganda aims to have at least 14 neonatologists by 2030.
He further outlined government plans to strengthen newborn care through the establishment of specialized neonatal care units at different levels of the health system, ranging from Health Centre IVs to Regional Referral Hospitals and super-specialized facilities such as Mulago Specialised Women and Neonatal Hospital.
Dr. Mugahi assured the graduates that the Ministry of Health is investing in equipment and infrastructure to support advanced neonatal services and pledged to advocate for improved career progression pathways for super-specialized health professionals.
Makerere’s Commitment to Advanced Medical Training
Representing the Vice Chancellor, the Deputy Vice Chancellor (Finance and Administration), Prof. Henry Alinaitwe, congratulated the fellows and their families on the achievement.
He praised the College of Health Sciences for its contribution to national development and noted that programmes such as the Perinatal and Neonatal Medicine Fellowship enhance Makerere University‘s position as a leader in knowledge generation and societal transformation.
Prof. Alinaitwe paid tribute to the graduates’ families, particularly their spouses and children, for supporting them through the demanding years of specialist training.
“The work you do is truly priceless,” he told the fellows. “The contribution you make to humanity is immeasurable.”
Graduates Hailed as Future Leaders in Newborn Health
In attendance were the director of Mulago Specialized Women and Neonatal Hospital, Dr. Sam Ononge, Deputy Director Mulago Referral Hospital, Dr. John Sekabira, Dr. Mary Nyanzi from Kawempe Referral Hospital, Sr. Dr. Assumpta Nabawanuka, the Director of St. Francis Hospital Nsambya, Dr. Irene Atuhaire from Seed Global Health Uganda and Ms. Ritah Akankwasa from ELMA Philanthropies Services, who partnered with the college in training the fellows.
The training partners described the graduates as pioneers who had demonstrated exceptional resilience and commitment throughout the rigorous training programme.
They applauded their contributions to patient care, teaching, mentorship, and supportive supervision, noting that their work had already contributed to improvements in maternal and newborn health services in Kampala and other regions of Uganda.
“As Kawempe National Referral Hospital, we have been privileged to witness your growth, not only as clinicians but also as leaders and advocates for newborn health,” Dr. Nyanzi said.
The graduates
- Dr. Tumwebaze Anita Kiiza Muhumuza
- Dr. Ediamu Tom Didimus
- Dr. Kezia Kibedi
- Dr. Hellen Kyokutamba
- Dr. Gerald Ojambo
For most people, the thought of death evokes grief, fear, or loss. But at Makerere University‘s College of Health Sciences, death became a lesson in gratitude, service, and humanity as students, faculty, and health professionals gathered to honour a unique group of teachers, individuals who continued to educate future doctors long after their passing.
At the Second Cadaver Commemoration Ceremony, on June 11, 2026, organized by the Makerere Students’ Anatomy Society, candles flickered softly as students paid tribute to what they fondly call their “silent teachers”, the human bodies that make it possible for medical students to learn anatomy and develop the skills that will one day save lives.
Standing before fellow students and guests, Chairperson of the Makerere Students’ Anatomy Society, Joseph Mwera, reminded the audience that the ceremony was not about mourning the dead.
“Today, we gather not only to remember those whose bodies have contributed to medical education but also to celebrate their lives,” he said. “Their legacy continues to inspire and serve humanity even after death.”
For many medical students, the anatomy laboratory is where they first encounter the reality of the profession they have chosen. Behind every lesson on muscles, nerves, blood vessels, and organs is a person who once lived, loved, worked, and contributed to society.
That reality was brought to life by the keynote speaker, Rev. Prof. Dr. Samuel Luboga, a surgeon, anatomist, and priest who spent nearly four decades teaching anatomy at Makerere University.
Reflecting on his own days as a medical student, Prof. Luboga recalled spending long hours in the anatomy laboratory after his classmates had gone home, studying human anatomy in detail.
Many people wondered whether he was afraid to spend so much time among cadavers.
His answer was simple.
“These men and women had lived productive lives. They had raised families, served their communities, and contributed to Uganda’s development. Even in death, they continued to teach us the science and art of medicine. They had earned my admiration, my respect, and my gratitude.”
His remarks resonated deeply with the students in attendance.
In a society where discussions about death and body donation remain sensitive, Prof. Luboga challenged participants to view the individuals in anatomy laboratories not as lifeless remains but as people who continue to contribute to humanity through education.
“The silent teachers before us today made learning possible,” he said. “The impact of their contribution is reflected in the doctors you have become and those you are yet to become. It is reflected in the countless patients you will treat and the innumerable lives you will save.”
Legal framework to guide body donation
The ceremony also sparked important conversations about the future of anatomical education in Uganda.
Head of the Department of Anatomy, Prof. Elisa Mwaka, highlighted the need for a national legal framework to guide body donation and anatomical research. While anatomy training in Uganda has traditionally relied on unclaimed bodies obtained through hospitals, he noted that many countries are increasingly embracing voluntary body donation programmes.
According to Prof. Mwaka, building public trust will be essential if Uganda is to establish a sustainable body donation programme.
“We must help the public understand how human bodies contribute to medical education, how they are treated with dignity, and how appropriate legal safeguards can protect donors and their families,” he said.
He revealed that discussions are already underway to develop an Anatomy Act that would provide a modern legal and ethical framework for the use of human remains in medical education and research.
Representing the Deputy Vice Chancellor (Academic Affairs), Prof. Julius Kikooma described the ceremony as much more than an academic event.
“Behind every competent healthcare professional stands an invaluable source of learning that often remains unseen and unheard,” he said. “These individuals taught us without speaking a single word. Though they are no longer able to communicate, their contribution continues to educate, inspire, and shape future generations of healthcare professionals.”
He commended the medical students for organizing what remains the only cadaver commemoration ceremony of its kind in Uganda, noting that the initiative reflects the values of compassion, professionalism, and respect for human dignity that are at the heart of medicine.
The event concluded with recognition of past and present leaders of the Department of Anatomy whose contributions have shaped anatomical education at Makerere University over the decades. Students also honoured exceptional educators who have inspired generations of future health professionals.
Yet the most powerful tribute of the day was reserved for those who could not be present to receive awards or applause.
The silent teachers
Individuals whose names may never appear in textbooks, whose stories may never be fully known, but whose gift continues to echo through hospital wards, operating theatres, and communities across Uganda.
Every doctor trained, every surgery performed, and every life saved carries a small part of their legacy.
And for one day at Makerere University, students paused to say the words that are rarely spoken aloud: Thank you.
-
Agriculture & Environment2 weeks agoPolicy Brief: Strengthening Climate Resilience and Livelihoods in Uganda’s Refugee and Host Communities
-
General2 weeks agoCHS Quality Assurance Guide Book
-
Law6 days agoMakerere hosts Chief Justices of Zambia and Uganda
-
Agriculture & Environment1 week agoMaster’s Scholars Engage Lwengo and Rakai Communities to Inform Research Conceptualisation
-
Research2 weeks agoMakerere University Rolls Out Thesis Completion Grants to Accelerate PhD Research and Strengthen National Policy Impact