Digital payments to healthcare workers drive retention, motivation and performance

^{An immunization worker gets paid to her mobile wallet in the Democratic Republic of Congo. Credit: WHO}

Campaigns in Africa to end polio and other diseases have a more stable, better-motivated workforce thanks to WHO's collaboration with countries and partners to pay frontline health workers through their mobile phones instead of cash.

“More than 80 percent of workers say they prefer digital payments,” said Ahmed Hamani Djibo, head of WHO's digital finance team.

WHO has led the way among international organizations in moving away from the cumbersome, less secure practice of paying salaries in cash. Over the past few years, the Organization has launched its Digital Finance Team and joined the Better Than Cash Alliance, an 80-member United Nations partnership with a mandate to advance the digitization of payments and expand financial inclusion – activities that support the UN's Sustainable Development Goals.

Since it was established in 2020, the WHO Digital Finance Team has designed and implemented digital payment solutions in 24 countries in Africa, including last year Benin, Botswana, Madagascar, Rwanda, Togo and Zimbabwe.

“WHO has successfully digitized payments for more than two million health workers across Africa,” said Tidhar Wald, Acting Director of the Better Than Cash Alliance. “With these inspiring results, WHO is taking a clear leadership role in accelerating the digital transformation in delivering health outcomes globally.”

^{A polio vaccination team at work in the Democratic Republic of the Congo. Credit: WHO}

“Really big difference in speed”

Workers surveyed in Côte d'Ivoire, Liberia and Tanzania said they valued the security of not carrying cash, the convenience of no longer having to travel to pay points to receive their wages, and above all, the speed of payment – ​​less than half an hour after work was completed compared to waiting weeks or even months.

Research, funded by the Bill & Melinda Gates Foundation, links timely compensation to better employee morale and retention.

“There really is a big difference in speed,” said Jean-Luc, a health worker we spoke to in the Democratic Republic of Congo (DRC) at the end of a polio vaccination campaign. “We finished cleaning the campaign yesterday and received a text notification the following evening. I will pay my child's school fees. Now we can relax.”

Digital payments also save health campaigners time and money, including the burden and cost of transporting large amounts of cash and filling out paperwork.

“When you have 300 to 500 volunteers to pay, keeping accounts and signing receipts takes a lot of time,” said Saïdi, DRC's polio team leader.

WHO first used new digital payments in polio vaccination campaigns in Côte d'Ivoire. Although outbreaks of vaccine-induced polio have been on the rise, vaccination campaigns have struggled to get off the ground. In the first quarter of 2020, almost half of the polio campaigns in the WHO African region were delayed, workers walked off the job or suffered other adverse effects resulting from delays in cash payments.

While WHO and partners worked on developing the basic aspects of the digital payment ecosystem (registering workers in the database, checking their profiles with mobile network operators, etc.), the benefits of a cashless approach became more apparent.

“There is significant evidence that digitizing payments can support people, especially women, to gain access to financial services and increase control over their earnings,” said Maria May, Senior Program Officer, Inclusive Financial Systems, at the Gates Foundation. “Over the past four years, the World Health Organization has leveraged the growing presence of mobile money across Africa to ensure that brave vaccinators in polio campaigns are paid in full, quickly and securely.”

Alain Labrique, Director of the WHO's Digital Health and Innovation Department, said that “digital payments are one of the key pillars of the public digital health infrastructure currently strongly encouraged within the WHO's guidance to member states on digital transformation.” WHO sees digital payments as a foundation for many other digital development activities, along with data exchange and digital ID infrastructure. He added “we are delighted to work with partners in the digital space and add our voice to this celebration of joining the WHO Better Than Cash Alliance”.