Health
What works, what doesn’t work? Researchers uncover the effect of supporting districts to operationalise digital payments for vaccination campaign workers
Published
9 months agoon
By
Mak Editor
By Joseph Odoi
A motivated and satisfied health workforce is critical for the success of mass vaccination campaigns against diseases like polio. High-quality vaccination campaigns can interrupt disease transmission, especially during and after periods of disrupted health services, such as those caused by the COVID-19 pandemic.
In sub-Saharan Africa, most vaccination campaign healthcare workers (VCHWs) have historically been paid in cash. Cash payments are often plagued by delays in funds disbursement, leakages, theft risks, and limited financial transparency. These challenges can negatively affect vaccination coverage and worker satisfaction.
To address these challenges, many countries are transitioning to digital payment systems, which are perceived as faster, more convenient, traceable, reliable, and easy to implement. Digital financial systems are already being rolled out in countries including Côte d’Ivoire, Ghana, Mali, Congo, and the Democratic Republic of the Congo. Uganda, with a projected population of nearly 41.6 million, had over 30 million registered mobile money customers using e-cash in 2019.
While early rollouts of digital payments have been largely successful, their full impact on vaccination campaign workers had not been systematically evaluated.
From 2021 to 2024, Makerere University (Uganda) and the University of Dakar (Senegal), with support from the Gates Foundation and technical partners including the Solina Group, WHO AFRO, and the Ministries of Health and Finance in both embarked on an important journey of research under the Digital Health Payment Initiatives and Research (DHPI-R) Project in 28 countries in Sub Saharan Africa
To explore the experiences and lessons of polio vaccination campaign healthcare workers (VCHWs), both male and female, during the 2022 oral poliovirus vaccination campaign in Uganda, researchers led by Prof. Peter Waiswa (principal investigator), together with Margaret McConnell, Juliet Aweko, Daniel Donald Mukuye, Charles Opio, Maggie Ssekitto Ashaba, Andrew Bakainaga, and Elizabeth Ekirapa-Kiracho, with support from the Gates Foundation, conducted a study titled “The Effect of Supporting Districts to Operationalise Digital Payments for Vaccination Campaign Workers: A Cluster Randomised Controlled Trial During the 2022 Polio Vaccination Campaign in Uganda.”
This study examined whether supporting districts to implement electronic cash (e-cash) payments, instead of cash, increased e-cash usage and improved vaccine campaign healthcare workers’ (VCHWs) motivation and satisfaction during an oral poliovirus vaccination campaign in 2022 in Uganda.
The mixed method study now published in BMJ Global Health, September 2025 was conducted in 54 districts in Uganda that had set up the government e-cash payment platform by May 2022. It involved healthcare workers supporting the polio vaccination campaign, regardless of direct vaccine contact. This included nurses, clinicians (vaccinators), mobilisers, community health workers (village health team members), recorders, local council representatives, and supervisors. The unit of randomisation was the district, while the unit of enrolment and data collection was the individual worker.
Method and Setting
As part of this study , In November 2022, a total of 54 districts and 2,665 vaccination campaign healthcare workers (VCHWs) were enrolled in the study and randomly assigned to two groups. Intervention districts received training on using the government e-cash platform, including managing user roles, uploading beneficiary data, and generating payment reports.
The control districts received the standard support given to districts during mass vaccination campaigns from the MoH, MoFPED, WHO and other development partners. This support included group training on implementation of payments, provision of vaccination materials and financial aid.
The study collected data on how VCHWs were paid, their motivation, and their satisfaction with the payment method. Overall, 765 VCHWs in intervention districts and 589 in control districts received e-cash payments.
Findings
Mode of payment for the vaccination campaign healthcare workers
Overall, approximately half of the campaign workers, 50.8% (1354/2665) were paid digitally (e- cash), either using mobile money or via the bank (online supple mental table 2). Payment by e- cash was higher among females, 53.9% (656/1215) compared with males, 48.1% (698/1450) and was lowest among campaign workers aged 30–39 years, 48.7% (368/765). E- cash payment was higher in the intervention arm at 57.5% (765/1,330) in comparison to the control arm at 44.1% (589/1,335).
Satisfaction with payment received during the campaign
Only 36.5% (705/1930) of the VCHWs were satisfied with the payment received during the campaign, with satisfaction being slightly higher in the intervention arm, 37.9% (353/931) compared with the control arm 35.2% (352/999) and among females 37.9% (351/925) compared with males 35.2% (354/1005). Satisfaction was lowest among the married workers, 35.7% (575/1611) compared with the other categories.
Timing and completeness of payments
Nearly, all VCHWs were paid after the campaign, 97.6% (1884/1930), with no significant difference between the intervention (98.1%, 913/931) and the control (97.2%, 971/999) arms
Delayed/non- payment was highest among those with no formal education, 34% (17/50) and among community mobilisers, 30.7% (392/1071). The majority (70.6%, 1362/1930) of the VCHWs stated that the payment received met or even exceeded their payment expectation.
Participants also stated that e-cash was convenient, transparent, time-saving, and cost-saving, as it reduced travel and waiting times and minimized informal deductions.
Despite these benefits and support to districts to operationalize digital payments , there was no significant difference in workers’ motivation or satisfaction between the intervention and control groups. The researchers attributed this partly due to challenges associated with both cash and digital payment modes.
Challenges experienced in effecting payments at the district level
Also a number of challenges were uncovered in this study . Challenges with e-cash payments included unanticipated withdrawal charges, unreliable internet networks, and lengthy processes for validating mobile telephone numbers. For example, payments were delayed or not processed when VCHWs’ names did not match the registration details held by telecommunication companies, or when workers did not have phones registered in their names.
One key informant had this to say on challenges around e-cash payments
‘’ There was a general complaint of charges. Remember when they are dispersing funds, they stick to the budget exactly. They are not looking at the charges. And when you are also paying you have to allocate minus the charges. You get the point. So the people would be expecting let’s take an example of 150 000/= and then they get 149 something. So, they would ask, ‘Why are we getting less money?’ So we labored to explain to them that the bank is charging a certain fee to facilitate the e- cash. (KII_West_EPI FP) There were also challenges associated with an unreliable internet network that was necessary to facilitate log ins for approval of payments
On Challenges experienced in effecting payments at the district level ,Key informant interviews with district leaders involved in the payment process identified several bottlenecks during the payment process of the campaign healthcare workers. One of the major e- cash payment challenges was a lengthy process of validating mobile telephone numbers. ensuring that the VCHW’s names matched the registered mobile account names attached to the telephone number provided by the VCHW for receipt of funds.
‘’Unsuccessful validation occurred when the VCHW’s names did not match the registration details held by the telecommunication companies. Payments for such individuals were delayed or not effected at all. Because some of them do not even have the phones, but they are very good at doing the work…Or if they have, then the phone is not registered in their names. We were supposed to bring that database of the community as well and feed them into the system. That became a problem’’. (KII_North_ADHO)
Suggestions to improve use of e-cash payment system
To increase the use of e- cash, the majority of key informants identified continued training of key staff as a critical intervention with subsequent follow- up to ensure payments are well implemented.
‘’We are not yet ready; our capacity hasn’t been built. We have a big knowledge gap regarding the e- cash system here in this district. (KII East CFO) We request for more training to be conversant [with the system], and to discuss the challenges together during that training, as we share the experiences. Where we have challenges, we sit together and see how they can be addressed’’. (KII_Central_CFO)
The participants also expressed the need for feedback mechanisms to allow them to dialogue with the payers in case there was a delay in payment. Additionally, the participants also acknowledged that there was a need to gradually expand adoption of digital payments considering contextual barriers. A hybrid approach would be an alternative, especially in the remote and hard-to-reach districts.
Other suggested solutions include early preparation of campaign health worker databases to allow for the lengthy telephone validation processes, improvement of the internet infrastructure, consistent use of e- cash payments across programmes and inclusion of withdrawal charges when making payments.
Moving forward policy, the researchers recommend the need to support e- payment systems, in order to minimize challenges in the pay ment processes.
‘’Suggestions to improve the e- cash experience include training of personnel in charge of e- cash payments, timely creation of VCHWs databases, expanding e- cash payments across programmes for efficiency and inclusion of withdrawal charges for the digital payments. To ensure the institutionalisation of digital payment interventions across Uganda, several key enablers are essential. These include formal policy integration by the Ministry of Health and Ministry of Finance into operational guide lines and budget frameworks, as well as ongoing capacity strengthening at the district level to enhance digital planning, payroll management and troubleshooting. Reliable infrastructure such as mobile connectivity and access to digital financial services like mobile money must also be prioritised, especially in rural areas. Implementing routine monitoring and feedback systems will be vital for tracking payment timeliness, worker satisfaction and system performance, allowing for continuous improvement. Furthermore, fostering public–private partner ships with telecom providers and payment platforms is critical for cost- effective scaling. With strong political commitment, aligned funding and active community engagement, this model holds the potential for broader national and regional adoption, leading to more efficient and equitable health service delivery’’. The paper concludes on the way forward
To read the paper; click; https://gh.bmj.com/content/10/Suppl_4/e016666
About The DHPI-R project
The DHPI-R project was commissioned by the Bill and Melinda Gates Foundation (BMGF) to generate evidence on digital payments in Africa. Although inception, conceptualization of the proposal, and grant award were conducted earlier in 2021, the DHPIR project officially started implementing activities in November 2021, up to March 2025. DHPIR is hosted at the School of Public Health, College of Health Sciences at Makerere University and is implemented in Anglophone and Francophone hubs (countries) in Africa. The Anglophone hub is hosted at MAKSPH, while the Francophone Hub is hosted by the University of Dakar (UCAD) in Senegal.
DHP-IR was rooted in the End Polio Game Campaign, championed by WHO-Afro and partners in 28 countries in Sub Saharan Africa, where digital payments was a key strategy for timely and complete payments to campaign workers.
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Health
The silent teachers: why body donation matters
Published
3 days agoon
June 5, 2026By
Mak Editor
By Assoc. Prof. Erisa Mwaka and Joyce Nabukalu-Kiwanuka
In every hospital, there is a moment when knowledge becomes a matter of life and death. A doctor must know where to place an incision, how to avoid damaging major organs, how to identify a nerve, how to deliver a baby safely, how to interpret a scan, or how to explain disease to a worried family. That knowledge does not begin in the operating theatre, it begins much earlier, in the anatomy laboratory.
For generations, the study of the human body has been the foundation of medical education. The regular use of human bodies for medical training purposes began in the late Middle Ages and spread during the 18th and 19th centuries. Initially, anatomists depended on gallows, poor houses, mental asylums, or jails as sources of bodies. However, the 1960s and 1970s saw the emergence of wilful body donation. Before students become doctors, surgeons, dentists, nurses, physiotherapists, radiographers, and other health professionals, they must first understand the human body in its real form. They must learn not only from books and diagrams, but from the body itself. This is why cadavers, though silent, remain the most important teachers in medical education. In simple terms, a cadaver is a dead human body used by health professions students to study anatomy; and Anatomy is the study of the physical structure and organization of the human body, both at macroscopic and microscopic levels.
As the Department of Anatomy at Makerere University College of Health Sciences prepares to commemorate the “silent teachers” whose bodies are used for medical education on June 11, 2026, Uganda is invited to reflect on a subject that is rarely discussed in the public domain, willed body donation. Body donation simply means a person willfully donates their body for educational purposes after death, and consent to it in life. This is a sensitive topic, but it is also a deeply human one. It touches our beliefs, families, culture, understanding of death, and responsibility to future generations.This commemoration ceremony is not symbolic but, it is a public statement that the contribution of silent teachers is sacred, educational, and deeply appreciated.
To donate one’s body after death is not an ordinary decision; it is an altruistic act of extraordinary generosity. It is a final gift to society. It allows health professions students to learn and appreciate the human body before they treat living patients. Cadavers are therefore not “specimens”, they are silent teachers and partners in medical education who continue to serve humanity even after death. Learning anatomy using a cadaver helps students to understand and appreciate the complexity of the human body, appreciate its natural variations, and develop the confidence and competence needed to serve the public. Students are also taught laboratory etiquette that emphasises dignity, empathy, and utmost respect for the cadavers, which attributes they carry into the clinical years when they interface with hospital patients.
In Uganda, where the demand for health workers continues to grow, medical education must be strengthened at every level. Our country needs well-trained doctors and health professionals who can serve in hospitals, health centres, universities, research institutions, and communities. But good training requires good teaching resources. One of these resources are the silent teachers who never complain, but impart immeasurable knowledge to future health professionals. Modern technology has introduced many useful tools into medical education. Students can now learn from videos, computer applications, digital images, plastic models, three-dimensional models, and virtual platforms. These tools are important and should be embraced, however, they cannot completely replace learning from the real human body. A cadaver teaches what a diagram cannot fully show; the true position of organs, the texture of tissues, the relationship between structures, and the natural differences that exist from one person to another. More importantly, cadaver-based learning teaches respect. It reminds students that medicine is not simply a technical profession, it is a calling rooted in human dignity. The first lesson students learn in the anatomy laboratory is that the body before them belonged to a person who had a name, a family, a story, and a life. That lesson shapes how they later treat patients.
Currently, most, if not all universities in Uganda, and similar settings in Africa use unclaimed bodies for learning Anatomy. The use of cadavers in Uganda is governed by the Penal Code (Anatomy Rules) of 1957 that permits public hospitals to transfer bodies unclaimed for at least 14 days to a medical training institution like Makerere University. Unfortunately, these cadavers are used without the consent of the deceased because most of them are unknown and with no known relatives to claim them. Many opponents to the use of unclaimed bodies opine that the practice is unethical. There is a global push toward ethical use of cadavers in medical education, where a person consents and bequeathes his/her body for medical education when still alive. For this practice to be sustainable, there is a need for a well regulated body donation program. Unfortunately, the concept of willful body donation is still not well understood by many people, and neither has it been a topic of public debate. Further, there are lots of myths surrounding death and dying in Africa, including Uganda that have hindered the establishment of successful body donation programs. Willingness to donate bodies for medical education is however, influenced by several factors including cultural and religious beliefs, respect for the dead and the need to fulfil burial rites, fear for mutilation and disrespect, to mention a few. These concerns are real and should not be dismissed. But they should be addressed with accurate information, openness, and utmost respect.
It is important to understand that body donation does not mean that a person is forgotten. On the contrary, it creates a legacy. A body donor may teach hundreds of future health professionals, in that way, one person’s final act of generosity can touch and save countless lives. This is kind of patriotism is largely unkown in Uganda and we do not speak about enough. We often talk about serving our country through leadership, business, farming, teaching, parenting, or community service. But there is also service beyond life. Body donation is one way of saying: “Even when I am gone, let me contribute to the health of my people.”
Currently, Uganda now has more than 15 universities training medical students and the demand for cadavers for learning anatomy is on the rise. Actually, the supply of cadavers cannot fulfil the demand, and medical educationists need to find alternative source of cadavers. Wilful body donation is the answer.
Uganda needs a national conversation on body donation. There is a need for deliberative public engagement involving various stakeholder including the public, religious and cultural leaders, civic leaders, the media, educationists, health professionals, medical training institutions, etc.
This commemoration ceremony will involve inter-denominational prayers for the silent teachers, and a reflection of their contribution to healthcare in Uganda. We hope this ceremony will provoke public debate on a subject that is hitherto considered a taboo by many. We talked about some of these issues last year, in the first ever such ceremony in Uganda, and have received several requests for more information on the procedure for donating one’s body for teaching purposes upon death. Like President Obama’s said, “yes we can”, an the dialogue starts from you and me. You are all invited for the commemoration ceremony at 9.00 am on June 11, 2026, at the Makerere University School of Public Health auditorium on main campus.
To donate one’s body is to give a final lesson, a final service, and a lasting gift to the nation.
Health
Makerere Health Services Guidance on Ebola Virus Disease (EVD)
Published
1 week agoon
June 1, 2026By
Mak Editor
The Democratic Republic of Congo (DRC) and Uganda recently reported an outbreak of Ebola Virus Disease (EVD), which is a serious and often deadly disease caused by a person being infected by the Ebola virus.
The virus spreads through direct contact with body fluids such as blood, saliva, faeces, vomit, urine, sweat or genital fluids from a person who is infected with EVD.
The symptoms of EVD usually develop after 8 – 10 days from contact with an infected person and may include fatigue, high fever, headache, sore throat, muscle and joint pains, vomiting and diarrhea and in severe cases, bleeding.
What should we do as the Makerere University community?
The Chief, Makerere Health Services, Prof. J.K. Byamugisha advises as follows:
- Avoid unnecessary contact such as shaking hands, hugging etc.
- Place alcohol disinfectants or hand washing equipment at all entry points within the University and ensure everyone is using them.
- Students should sit in single-person chairs while in class, avoiding contact with their neighbours.
- Do not sit too close to one another especially in frequently crowded places such as classrooms, library or any other waiting area.
- While at the University Hospital, wash hands a the gate, use alcohol disinfectant at the reception.
- All patients should have a maximum of one caretaker – others can check on them by calling.
- Avoid bringing luggage to the University Hospital.
- Target to do as instructed by the health worker.
- For further information and guidance on Ebola, please call Dr. Charles Basigara on Tel: 0702 966652 and Sr. Eunice Namubiru on Tel: 0779 950978 (Contact persons for the University Health Services)
Additionally, always look out for and ensure full compliance with Ministry of Health (MoH) Infection Prevention and Control measures such as the one below.


Please find attached detailed communications from Prof. Byamugisha and
the Permanent Secretary Ministry of Health.
Health
Call for Applications: Masters Support in Self-Management Intervention for Reducing Epilepsy Burden
Published
2 weeks agoon
May 25, 2026By
Mak Editor
The Makerere University College of Health Sciences and Case Western Reserve University, partnering with Mbarara University of Science and Technology, are implementing a five-year project titled “Self-management Intervention for Reducing Epilepsy Burden Among Adult Ugandans with Epilepsy.”
The program is funded by the National Institute of Health (NIH) and the National Institute of Neurological Disorders and Stroke (NINDS). One aspect of the program is to provide advanced degree training to qualified candidates interested in pursuing clinical and research careers in Epilepsy. We aim to grow epilepsy research capacity, including self-management approaches, in SSA.
The Project is soliciting applications for Master’s Research thesis support focusing on epilepsy-related research at Makerere University and Mbarara University, cohort 3, 2026/2027.
Selection criteria
- Should be a Master’s student of the following courses: MMED in Internal Medicine, Paediatrics, Surgery and Neurosurgery, Psychiatry, Family Medicine, Public Health, Master of Health Services Research, MSc. Clinical Epidemiology and Biostatistics, Nursing, or a Master’s in the Basic Sciences (Physiology, Anatomy, Biochemistry, or any other related field).
- Should have completed at least one year of their Master’s training in the courses listed above.
- Demonstrated interest in Epilepsy and Neurological diseases, care and prevention, and commitment to develop and maintain a productive career, and devoted to Epilepsy, Clinical Practice, and Prevention.
Research Programs:
The following are the broad Epilepsy research priority areas (THEMES), and applicants are encouraged to develop research concepts in the areas of: Applicants are not limited to these themes; they can propose other areas.
- The epidemiology of Epilepsy and associated risk factors.
- Determining the factors affecting the quality of life, risk factors, and outcomes (mortality, morbidity) for Epilepsy, epilepsy genetics, and preventive measures among adults.
- Epilepsy in childhood and its associated factors, preventative measures etc.
- Epilepsy epidemiology and other Epilepsy related topics.
- Epilepsy interventions and rehabilitation
In addition to a formal master’s program, trainees will receive training in bio-ethics, Good Clinical Practice, behavioral sciences research, data and statistical analysis, and research management.
The review criteria for applicants will be as follows:
· Relevance to program objectives
- Quality of research and research project approach
- Feasibility of study
- Mentors and mentoring plan; in your mentoring plan, please include who the mentors are, what training they will provide, and how often they propose to meet with the candidate.
- Ethics and human subjects’ protection.
Application Process
Applicants should submit an application letter accompanied by a detailed curriculum vitae, two recommendation letters from Professional referees or mentors, and a 2-page concept or an approved full proposal describing your project and addressing Self-Management Intervention for Reducing Epilepsy Burden Among Adults or an epilepsy-related problem.
For more information, inquiries, and additional advice on developing concepts, don’t hesitate to get in touch with the following:
Makerere University College of Health Sciences
Prof. Mark Kaddumukasa: kaddumark@yahoo.co.uk
Mbarara University
Ms. Josephine N Najjuma: najjumajosephine@yahoo.co.uk
Only short-listed candidates will be contacted for Interviews.
A soft copy should be submitted to the Administrator of the Epilepsy Project. Email: smireb2@gmail.com; Closing date for the Receipt of applications is 5th July 2026.
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