A research agenda for digital payments of health workers in large-scale health campaigns in sub-Saharan Africa

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INTRODUCTION: Digital payments are increasingly favoured over cash for remunerating healthcare workers in large-scale health campaigns due to perceived advantages in efficiency and security. However, evidence to guide their scaling and optimisation is limited. This study aimed to identify and prioritise a global research agenda for digital payments in health campaigns in sub-Saharan Africa (SSA). METHODS: We employed the Child Health and Nutrition Research Initiative methodology. In stage 1, we defined the context and criteria (answerability, feasibility, sustainability/equity, impact). In stage 2, 420 stakeholders were engaged via an online survey, generating 450 research questions, which were refined to a final pool of 35. In stage 3, these 35 questions were scored by 63 experts against the predefined criteria. Research Priority Scores (RPS) and Average Expert Agreement (AEA) were computed for ranking in stage 4. RESULTS: The overall RPS for the 35 questions ranged from 38.6% to 6.0% (mean 28.2%, SD 6.4%). The AEA ranged from 67.2% to 82.7% (mean 77%, SD 3.4%), indicating strong consensus. RPS and AEA showed a strong positive correlation (r=0.989, p<0.01). The top-ranked research questions were: (1) Minimum requirements for health systems to digitise payments responsibly (RPS 38.6%); (2) Optimisation of digital payments to enhance campaign effectiveness in SSA (RPS 36.8%); (3) Incentives for digital payment adoption in the healthcare sector (RPS 36.1%); (4) Cost-benefit analysis of digital payments vs cash (RPS 36.3%) and (5) Coverage of mobile money agents and its impact on uptake and satisfaction (RPS 34.0%). CONCLUSIONS: This study provides an expert-consensus roadmap for research on digital payments in health campaigns. Addressing these priorities will generate critical evidence to develop robust, equitable and effective digital payment systems, ultimately strengthening health systems and improving health outcomes in SSA.

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