Mobile Money and the importance of timely, complete payments to frontline health campaign workers in the fight to eradicate polio: pilot experience from a World Health Organization digital payment platform in Africa

Abstract

Background: In response to the increase in vaccine-derived poliovirus type 2 in Côte d'Ivoire, Mali, and many other African countries from 2017 to 2019, concentrated efforts are needed to improve the effectiveness of vaccination campaigns. Frontline polio health campaign worker engagement and job retention are critical to successful campaign implementation, as well as timely, in-full payment to these workers via an electronic system.

Methods: The Global Polio Eradication Initiative and its partners designed a road map to implement the World Health Organization Mobile Money digital payment system for health campaign workers across designated African Region countries and country-specific areas. The road map included: (1) strategy communication about Mobile Money to key stakeholders; (2) prioritization of Mobile Money pilot countries; (3) establishment of a digital finance team to support Mobile Money rollout for polio campaigns; (4) implementation of Mobile Money in select pilot areas; and (5) documentation by the digital finance team of Mobile Money implementation across pilot areas. At the country-specific level, and as described in the first pilot campaign in Côte d'Ivoire, implementation of Mobile Money occurred in 3 phases: precampaign, campaign, and postcampaign.

Results: Mobile Money was piloted in Côte d'Ivoire, Democratic Republic of the Congo, Ghana, Mali, and Republic of the Congo. Although program reach varied by country, the percentages of payments successfully made via Mobile Money in pilot countries were high: In campaign round 1, 99% of campaign workers in 2 regions in Mali, and 99% of campaign workers in 5 districts in Ghana were paid successfully. In Cote d'Ivoire, Mobile Money was piloted in all 113 districts for campaign rounds 1, 2 and 3, and in 4 districts in Abidjan for campaign round 3. In rounds 1, 2 and 3, 99.6%, 99.6%, and 99.9% of payments to polio health campaign workers, respectively, were made successfully.

Conclusion: Implementation of the Mobile Money pilot program, particularly across Côte d'Ivoire, demonstrates the value of an electronic payment system in addressing frontline polio health campaign worker need for timely, in-full payment. The World Health Organization-led Mobile Money pilot program can serve as a model for agencies committed to delivering greater efficiencies and improved health campaigns in resource-challenged settings.

Keywords: Africa; Cash-based payments; Côte d’Ivoire; Frontline workers; Immunization programs; Mobile Money; Poliovirus vaccines; Vaccination campaign; poliomyelitis eradication.

Fig. 1

Precampaign phase: Côte d’Ivoire. AFRO, Regional Office for Africa; DFT, Digital Finance Team; KYC, Know Your Customer; MMOs, Mobile Money operators MoH, Ministry of Health; WHO, World Health Organization

Fig. 2

Campaign phase: Côte d‘Ivoire. AFRO, Regional Office for Africa; DFT, Digital Finance Team; KYC, Know Your Customer; MMO, Mobile Money operator; MoH, Ministry of Health; WHO, World Health Organization

Fig. 3

Postcampaign phase: Côte d’Ivoire. AFRO, Regional Office for Africa; DFT, Digital Finance Team; MMO, Mobile Money operator; MoH, Ministry of Health; WHO, World Health Organization

Fig. 4

Percentages of polio campaign health workers successfully paid via Mobile Money. R, round

Fig. 5

Average payment experience rating and median days taken to receive payment (n = 351 for Round 1; n = 334 for Round 2)