PolioNCT05684081
Effect of Digital Payment to Campaign Health Workers on Vaccination Coverage
A study testing Digital payment in people with Polio, run by Makerere University at 1 site in Uganda.
Trial summary
Introduction: Good quality OPV campaigns can interrupt and possibly prevent transmission of the polio virus. Health care worker performance and motivation are prerequisites for the success of such campaigns. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Polio
- What is being tested?
- Digital payment
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 2,700 participants
- Where
- 1 siteUganda
- Study dates
- 1 Jul 2022to 30 Dec 2023
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Adults aged 18 and above
- History of participation in the most recent polio vaccination campaign in Uganda
- Member of the district leadership team
Who cannot join
- 1) Non-consenting adults
Trial locations and contacts
1 site in 1 country.
Uganda1 site
Ministry of Health Facilities in 54 districts/municipalities in Uganda
Kampala, 256
About this study
Official title: Effectiveness of Mobile Money Payments to Vaccination Campaign Health Care Workers on Polio Vaccination Campaign Coverage and Quality: a Cluster Randomized Controlled Trial
Introduction:
Good quality OPV campaigns can interrupt and possibly prevent transmission of the polio virus. Health care worker performance and motivation are prerequisites for the success of such campaigns. Complete, transparent and timely payments are, in turn, prerequisites for the sustenance of health care worker motivation and thereby efforts. To date, most such health care workers have been paid in cash, with chronic payment issues that have negatively affected campaign quality and vaccination coverage. Cash-based payments are often plagued with multiple delays in funds disbursements, cash leakages, and a lack of accountability and financial transparency. These difficulties have prompted a transition to digitized payments that are perceived to be faster, more convenient, traceable, reliable, easier and more reasonable to set up. The roll-out phase of these digital payment interventions has not been quantitatively evaluated and the effect of digital payments on the motivation, satisfaction and performance of health workers is not known. Therefore, this study will compare digitized payment of polio vaccination campaign health care workers with cash-based payment with regards to health care worker motivation, satisfaction and performance. Findings from this study may inform the operationalization of digital financial systems, and the transition towards cross-campaign digital payments.
Read more
Primary Objectives:
- To compare the motivation, satisfaction and performance of vaccination health care workers in areas where they are paid using mobile money versus in cash,
- To explore how gender norms and relations influence health workers' response to payment systems (mobile money versus cash payments) and how these affect the health workers' performance and motivation in polio vaccination campaigns and
Secondary objectives:
- To compare vaccination campaign quality in areas where health care workers are paid using mobile money versus in cash
- To compare vaccination coverage in areas where campaign health care workers are paid using mobile money versus in cash.
- To estimate the incremental cost of the intervention.
Methods:
This will be a mixed methods study including a cluster-randomized controlled implementation trial and a qualitative study. A total of 60 districts be randomized to implement either a digital payment system for polio campaign vaccinators during the polio campaign or the traditional cash-based payment system.
Read the detailed description
Problem statement and justification
A motivated health workforce is essential for the success of critical health campaigns and programmes such as the recently concluded and upcoming polio campaigns. This is even more critical particularly in periods during and following disruptions in health services such as the Covid-19 pandemic and the resultant restrictions. Remuneration, which has been traditionally cash based is a key factor for health care worker motivation, satisfaction and performance. However, traditional cash-based modes of payment are fraught with numerous problems like delays in funds requisitions and disbursements, cash leakages, exposure to risk of theft while in transit, and a lack of accountability data and financial transparency. These chronic problems associated with cash-based payments have led to a gradual transition to digital (mobile money) payments in several countries including Uganda. While digital payments are seen as fast, convenient, traceable, reliable, and easy to set up, they are not themselves free of challenges. Also, their effect on health outcomes has not been evaluated with robust scientific methods.
Few studies have particularly paid attention to the role of digital payments in influencing gender relations (power relations, access to resources and gender roles) and also how gender relations affect the adoption and use of digital payments particularly in relation to health worker's motivation and performance that is essential for increasing coverage and quality of vaccination campaigns. Furthermore, the investigators are cognizant of the intersections between gender and other social identities of both female and male health workers such as gender, age, education, cadre of health worker, income bracket, location, disability, ethnicity) that could have a bearing on how they interact and respond to digital payments-and their implications on the motivation and performance of health workers.
This study therefore, will evaluate an intervention that seeks solutions to the current challenges faced by payment systems by providing a verified national database of health care workers and processing payments directly to those health care workers digitally, through mobile money platforms. Set within the context of the upcoming polio vaccination campaign, this study will examine the effect of this intervention on health outcomes such as polio vaccination coverage as well as health worker related outcomes like motivation, satisfaction and performance. This study will also examine the effect of gender norms/gender relations on health workers' response to payment systems employed during polio vaccination. While maintaining Uganda free of polio is in itself a very important goal, lessons learned from this cluster randomized implementation trial can be extended to other health campaigns and programmes.
- Conditions
- Polio
- Being tested
- Digital payment
- Medical subject headings
- Poliomyelitis
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Digital paymentBehavioural
The proposed intervention is designed to support the implementation of polio campaigns through digital payments
| Study group | Role | What they receive |
|---|---|---|
| INTERVENTION | Experimental | Refers to the intervention arm i.e. ECASH payment of health workers Receives: Behavioral: Digital payment |
| CONTROL | No intervention | Refers to status Quo or no intervention i.e. payment using cash |
What is being measured
The primary outcome is the main question the study is designed to answer.
Vaccination campaign health care worker motivation, performance and satisfaction based on self reports on a scale of 1-5
Assessing the health workers motivation, performance and satisfaction based on self report on a scale of 1-5.
Measured: At least one week post payment of immunization health workers
Secondary outcomes (1)
Vaccination coverage
Proportion of children 0-59 vaccinated against polio during the campaign
Measured: At least one week post payment of immunization health workers
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted13 Jan 2023
- Study start1 Jul 2022
- Primary completion30 Oct 2023 (estimated)
- Study completion30 Dec 2023 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (1)Papers the sponsor has linked to this study.
- Other trials for PolioStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Health services research
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- The intervention consists of direct cash payment to vaccination campaign health workers using government of Uganda Ecash platform on IFMIS
- Masking
- None (open label)
- Enrolment
- 2,700 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Makerere University
- Sponsor type
- University, hospital or other
- Collaborators
- Bill and Melinda Gates Foundation
- Responsible party
- Sponsor
- Investigators
- Victoria Nankabirwa, PhD, Principal investigator, Makerere University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT05684081
- Sponsor's protocol ID
- MaKSPH_BMGF_INV03047_2022
- Status last verified
- Feb 2023
- First submitted
- 17 Nov 2022
- Last updated
- 8 Feb 2023
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Waiswa P, McConnell M, Aweko J, Mukuye DD, Opio C, Ashaba MS, Bakainaga A, Ekirapa-Kiracho E. 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. BMJ Glob Health. 2025 Sep 10;10(Suppl 4):e016666. doi: 10.1136/bmjgh-2024-016666.
PubMed 40935396
Study at a glance
From the registry record, last updated by the sponsor on 8 Feb 2023. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Effectiveness of Mobile Money Payments to Vaccination Campaign Health Care Workers on Polio Vaccination Campaign Coverage and Quality: a Cluster Randomized Controlled Trial
- ClinicalTrials.gov ID
- NCT05684081
- Acronym / sponsor ID
- MaKSPH_BMGF_INV03047_2022
- Conditions
- Polio
- Study type
- Interventional
- Recruitment status
- Unknown status
- Enrolment
- 2,700 participants (estimated)
- Lead sponsor
- Makerere UniversityUniversity, hospital or other
- Collaborators
- Bill and Melinda Gates Foundation
- Study start
- 1 Jul 2022 (actual)
- Primary completion
- 30 Oct 2023 (estimated)
- Study completion
- 30 Dec 2023 (estimated)
- First posted
- 13 Jan 2023 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Introduction:
Good quality OPV campaigns can interrupt and possibly prevent transmission of the polio virus. Health care worker performance and motivation are prerequisites for the success of such campaigns. Complete, transparent and timely payments are, in turn, prerequisites for the sustenance of health care worker motivation and thereby efforts. To date, most such health care workers have been paid in cash, with chronic payment issues that have negatively affected campaign quality and vaccination coverage. Cash-based payments are often plagued with multiple delays in funds disbursements, cash leakages, and a lack of accountability and financial transparency. These difficulties have prompted a transition to digitized payments that are perceived to be faster, more convenient, traceable, reliable, easier and more reasonable to set up. The roll-out phase of these digital payment interventions has not been quantitatively evaluated and the effect of digital payments on the motivation, satisfaction and performance of health workers is not known. Therefore, this study will compare digitized payment of polio vaccination campaign health care workers with cash-based payment with regards to health care worker motivation, satisfaction and performance. Findings from this study may inform the operationalization of digital financial systems, and the transition towards cross-campaign digital payments.
Primary Objectives:
- To compare the motivation, satisfaction and performance of vaccination health care workers in areas where they are paid using mobile money versus in cash,
- To explore how gender norms and relations influence health workers' response to payment systems (mobile money versus cash payments) and how these affect the health workers' performance and motivation in polio vaccination campaigns and
Secondary objectives:
- To compare vaccination campaign quality in areas where health care workers are paid using mobile money versus in cash
- To compare vaccination coverage in areas where campaign health care workers are paid using mobile money versus in cash.
- To estimate the incremental cost of the intervention.
Methods:
This will be a mixed methods study including a cluster-randomized controlled implementation trial and a qualitative study. A total of 60 districts be randomized to implement either a digital payment system for polio campaign vaccinators during the polio campaign or the traditional cash-based payment system.
Detailed description
Problem statement and justification
A motivated health workforce is essential for the success of critical health campaigns and programmes such as the recently concluded and upcoming polio campaigns. This is even more critical particularly in periods during and following disruptions in health services such as the Covid-19 pandemic and the resultant restrictions. Remuneration, which has been traditionally cash based is a key factor for health care worker motivation, satisfaction and performance. However, traditional cash-based modes of payment are fraught with numerous problems like delays in funds requisitions and disbursements, cash leakages, exposure to risk of theft while in transit, and a lack of accountability data and financial transparency. These chronic problems associated with cash-based payments have led to a gradual transition to digital (mobile money) payments in several countries including Uganda. While digital payments are seen as fast, convenient, traceable, reliable, and easy to set up, they are not themselves free of challenges. Also, their effect on health outcomes has not been evaluated with robust scientific methods.
Few studies have particularly paid attention to the role of digital payments in influencing gender relations (power relations, access to resources and gender roles) and also how gender relations affect the adoption and use of digital payments particularly in relation to health worker's motivation and performance that is essential for increasing coverage and quality of vaccination campaigns. Furthermore, the investigators are cognizant of the intersections between gender and other social identities of both female and male health workers such as gender, age, education, cadre of health worker, income bracket, location, disability, ethnicity) that could have a bearing on how they interact and respond to digital payments-and their implications on the motivation and performance of health workers.
This study therefore, will evaluate an intervention that seeks solutions to the current challenges faced by payment systems by providing a verified national database of health care workers and processing payments directly to those health care workers digitally, through mobile money platforms. Set within the context of the upcoming polio vaccination campaign, this study will examine the effect of this intervention on health outcomes such as polio vaccination coverage as well as health worker related outcomes like motivation, satisfaction and performance. This study will also examine the effect of gender norms/gender relations on health workers' response to payment systems employed during polio vaccination. While maintaining Uganda free of polio is in itself a very important goal, lessons learned from this cluster randomized implementation trial can be extended to other health campaigns and programmes.
Study design
- Primary purpose
- Health services research
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
- Model description
- The intervention consists of direct cash payment to vaccination campaign health workers using government of Uganda Ecash platform on IFMIS
| Arm | Type | Receives |
|---|---|---|
| INTERVENTION | Experimental | Behavioral: Digital paymentRefers to the intervention arm i.e. ECASH payment of health workers |
| CONTROL | No intervention | –Refers to status Quo or no intervention i.e. payment using cash |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (3 listed)
- Adults aged 18 and above
- History of participation in the most recent polio vaccination campaign in Uganda
- Member of the district leadership team
Key exclusion criteria (1 listed)
- 1) Non-consenting adults
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Digital paymentThe proposed intervention is designed to support the implementation of polio campaigns through digital payments | Behavioural | INTERVENTION |
Primary outcome
Vaccination campaign health care worker motivation, performance and satisfaction based on self reports on a scale of 1-5
Time frame: At least one week post payment of immunization health workers
Assessing the health workers motivation, performance and satisfaction based on self report on a scale of 1-5.
1 secondary outcome
Vaccination coverage
Time frame: At least one week post payment of immunization health workers
Results and safety
Results are not available in the source record.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 8 Feb 2023.
- Derived from this study: PubMed 40935396Waiswa P, McConnell M, Aweko J, Mukuye DD, Opio C, Ashaba MS, Bakainaga A, Ekirapa-Kiracho E. 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. BMJ Glob Health. 2025 Sep 10;10(Suppl 4):e016666. doi: 10.1136/bmjgh-2024-016666.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Victoria Nankabirwa, PhD principal investigator
Makerere University
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Digital payment in people with Polio, run by Makerere University at 1 site in Uganda.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 3 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: status not confirmed, as of the sponsor's last update on 8 Feb 2023. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Uganda. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
Results are not available in the source record.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Vaccination campaign health care worker motivation, performance and satisfaction based on self reports on a scale of 1-5 (time frame: At least one week post payment of immunization health workers). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT05684081, which also lists 1 linked publication.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 8 Feb 2023.