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. 2025 May 28:13:e65325.
doi: 10.2196/65325.

Enhancing Efficiency and User Experience of Digital Community Health Worker Payments in Zanzibar: Implementation Report

Lee Pyne-Mercier  1   2 , Krishna Jafa  2 , Susan Maigua  2 , Jennifer Muli  2 , Elijah Gichinga  2 , Antony Khaemba  2 , Nitusima Kataraia  3 , Aisha Mohammed  3 , Frank Kamangadazi Tembo  3 , Imran Esmail  3 , Giulia V R Besana  3 , Heiko Hornung  3 , Ali Makame Zubeir  4
Affiliations

Enhancing Efficiency and User Experience of Digital Community Health Worker Payments in Zanzibar: Implementation Report

Lee Pyne-Mercier et al. JMIR Med Inform. .

Abstract

Background: Community health workers (CHWs) are essential for achieving universal health coverage and reaching the Sustainable Development Goals. Paying CHWs for their work increases their motivation and effectiveness, and is recommended by the World Health Organization and advocacy organizations such as the Community Health Impact Coalition. Many implementing organizations currently pay CHWs using mobile money or other digital means. However, most payment systems are designed without the involvement of CHWs.

Objective: In this implementation report, we describe efforts to improve efficiency, accuracy, and user experience of the CHW payment process of the Jamii ni Afya project in Zanzibar.

Methods: We applied Medic's design process to develop new functionality for the open-source Community Health Toolkit. We reviewed documentation and engaged with users to understand their needs and experiences with the current payment system. This information formed the basis of technical specifications, which were developed into a revised workflow. The workflow was iteratively tested and refined. Several steps that were managed offline, such as resolving payment discrepancies, were formalized and incorporated into the workflow. We conducted user acceptance testing to assess functionality and user experience.

The workflow was able to accurately translate programmatic data into payment information for each CHW and securely transmitted this information to a payment service provider. User acceptance testing revealed that CHWs felt the revised payment system provided them with more information and gave them a greater sense of control. Program staff felt the workflow would increase the efficiency and accuracy of the payment process, while simplifying the resolution of payment discrepancies.

Conclusions: Engaging users in the design and optimization of digital payment systems has the potential to improve the efficiency and accuracy of digital payment systems while enhancing satisfaction among all users, contributing to improved sustainability and impact of CHW programs. Definitive conclusions will depend on evaluation of the system after implementation.

Keywords: Africa; Zanzibar; community health worker; digital health; digital payment; implementation report; mobile health; mobile money; mobile payments; user experience.

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Conflict of interest statement

Conflicts of Interest: The authors are employed by the Ministry of Health Zanzibar, D-tree, and Medic, and have no financial interests apart from the receipt of salaries. Authors have a stake in the success of Jamii ni Afya and the Community Health Toolkit and are thus not impartial due to our institutional affiliation.

Figures

Figure 1.
Figure 1.. Existing payment process map. CHW: community health worker.
Figure 2.
Figure 2.. User acceptance testing conducted in Zanzibar.
Figure 3.
Figure 3.. Screenshots of 2 example forms in the CHT (Community Health Toolkit) digital payments workflow. CHW: community health worker.
Figure 4.
Figure 4.. Screenshot of an example digital payments summary. CHV: community health volunteer.
Figure 5.
Figure 5.. Simplified monthly workflow with perceived benefits at each step. CHW: community health worker.
See this image and copyright information in PMC

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