Do cash or digital payment modalities affect community health worker performance? – a case study of a remote refugee settlement in Western Uganda
Background There is inadequate evidence about the influence of digital and cash payment modalities on the performance of Community Health Workers (CHWs) in underserved communities, such as refugee settlements. Objective To compare the performance of CHWs when paid in cash or digitally in Kyaka II re...
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2024-12-01
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| Series: | Global Health Action |
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| Online Access: | http://dx.doi.org/10.1080/16549716.2024.2375867 |
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| author | Michael T Wagaba David Musoke Charles Opio Arthur Bagonza Juliet Aweko Hajarah Nakitende Alex Mulyowa Michael Ediau Peter Waiswa Elizabeth Ekirapa-Kiracho |
| author_facet | Michael T Wagaba David Musoke Charles Opio Arthur Bagonza Juliet Aweko Hajarah Nakitende Alex Mulyowa Michael Ediau Peter Waiswa Elizabeth Ekirapa-Kiracho |
| author_sort | Michael T Wagaba |
| collection | DOAJ |
| description | Background There is inadequate evidence about the influence of digital and cash payment modalities on the performance of Community Health Workers (CHWs) in underserved communities, such as refugee settlements. Objective To compare the performance of CHWs when paid in cash or digitally in Kyaka II refugee settlement, Uganda. Methods A comparative cross-sectional mixed methods design was used. Secondary data comprising 247 CHW reports during a six-month period of cash and digital payments were analyzed using Stata v14. Eleven focus group discussions, four in-depth interviews, and ten key informant interviews were conducted among the settlement stakeholders to explore perceptions of the payment methods. Qualitative data were analyzed thematically using Atlas.ti v9. Results CHWs performed better when paid cash than digital payments (t = 5.28; df = 246; p < 0.001). During the cash payment period, at least secondary education (APR 1.71 CI: 1.14–2.58) and having a side occupation (APR 1.58; CI: 1.13–2.21) were positively associated with performance. For digital payments, being male (APR 0.58; CI: 0.34–0.98), serving longer than 9 years (APR 0.87; CI: 0.82–0.93), and being allocated more than 60 households per month (APR 0.31; CI: 0.19–0.52) were negatively associated with CHW performance. Qualitative data revealed that most stakeholders preferred cash due to inconsistent and delayed digital payments. Conclusion CHWs preferred and performed better with cash payments because digital payments were associated with delays and payment shortfalls that demotivated them. Implementers should invest towards averting digital payment shortfalls in remote settings to enhance CHW motivation and performance. |
| format | Article |
| id | doaj-art-b299a385698f4d49aab8419332d118d8 |
| institution | Kabale University |
| issn | 1654-9880 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Global Health Action |
| spelling | doaj-art-b299a385698f4d49aab8419332d118d82025-02-05T12:46:14ZengTaylor & Francis GroupGlobal Health Action1654-98802024-12-0117110.1080/16549716.2024.23758672375867Do cash or digital payment modalities affect community health worker performance? – a case study of a remote refugee settlement in Western UgandaMichael T Wagaba0David Musoke1Charles Opio2Arthur Bagonza3Juliet Aweko4Hajarah Nakitende5Alex Mulyowa6Michael Ediau7Peter Waiswa8Elizabeth Ekirapa-Kiracho9Makerere University School of Public HealthMakerere UniversityMakerere UniversityMakerere University School of Public HealthMakerere UniversityMakerere University School of Public HealthMakerere UniversityMakerere UniversityMakerere UniversityMakerere UniversityBackground There is inadequate evidence about the influence of digital and cash payment modalities on the performance of Community Health Workers (CHWs) in underserved communities, such as refugee settlements. Objective To compare the performance of CHWs when paid in cash or digitally in Kyaka II refugee settlement, Uganda. Methods A comparative cross-sectional mixed methods design was used. Secondary data comprising 247 CHW reports during a six-month period of cash and digital payments were analyzed using Stata v14. Eleven focus group discussions, four in-depth interviews, and ten key informant interviews were conducted among the settlement stakeholders to explore perceptions of the payment methods. Qualitative data were analyzed thematically using Atlas.ti v9. Results CHWs performed better when paid cash than digital payments (t = 5.28; df = 246; p < 0.001). During the cash payment period, at least secondary education (APR 1.71 CI: 1.14–2.58) and having a side occupation (APR 1.58; CI: 1.13–2.21) were positively associated with performance. For digital payments, being male (APR 0.58; CI: 0.34–0.98), serving longer than 9 years (APR 0.87; CI: 0.82–0.93), and being allocated more than 60 households per month (APR 0.31; CI: 0.19–0.52) were negatively associated with CHW performance. Qualitative data revealed that most stakeholders preferred cash due to inconsistent and delayed digital payments. Conclusion CHWs preferred and performed better with cash payments because digital payments were associated with delays and payment shortfalls that demotivated them. Implementers should invest towards averting digital payment shortfalls in remote settings to enhance CHW motivation and performance.http://dx.doi.org/10.1080/16549716.2024.2375867healthcare deliveryperformance-motivationdigital and cash paymentsvulnerable communitiescommunity health workers |
| spellingShingle | Michael T Wagaba David Musoke Charles Opio Arthur Bagonza Juliet Aweko Hajarah Nakitende Alex Mulyowa Michael Ediau Peter Waiswa Elizabeth Ekirapa-Kiracho Do cash or digital payment modalities affect community health worker performance? – a case study of a remote refugee settlement in Western Uganda Global Health Action healthcare delivery performance-motivation digital and cash payments vulnerable communities community health workers |
| title | Do cash or digital payment modalities affect community health worker performance? – a case study of a remote refugee settlement in Western Uganda |
| title_full | Do cash or digital payment modalities affect community health worker performance? – a case study of a remote refugee settlement in Western Uganda |
| title_fullStr | Do cash or digital payment modalities affect community health worker performance? – a case study of a remote refugee settlement in Western Uganda |
| title_full_unstemmed | Do cash or digital payment modalities affect community health worker performance? – a case study of a remote refugee settlement in Western Uganda |
| title_short | Do cash or digital payment modalities affect community health worker performance? – a case study of a remote refugee settlement in Western Uganda |
| title_sort | do cash or digital payment modalities affect community health worker performance a case study of a remote refugee settlement in western uganda |
| topic | healthcare delivery performance-motivation digital and cash payments vulnerable communities community health workers |
| url | http://dx.doi.org/10.1080/16549716.2024.2375867 |
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