Digital payments revolutionize health worker compensation in Africa

Campaigns in Africa to stop 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 in cash.

Over 80 percent of workers are saying they prefer the digital payments."

Ahmed Hamani Djibo, Head of WHO's Digital Finance Team

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

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

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

"A really big difference in speed"

Workers surveyed in Côte d'Ivoire, Liberia and Tanzania said they appreciated the security of not carrying cash, the convenience of no longer having to travel to a disbursement site to receive their wages, and above all, the speed of payment – as short as half an hour after finishing work compared to waits of weeks or even months.

The surveys, funded by the Bill & Melinda Gates Foundation, linked timely compensation to better morale and worker retention.

"There is really a big difference in speed," said Jean-Luc, a health worker interviewed in the Democratic Republic of Congo (DRC) at the end of a polio immunization campaign. "We finished the campaign mop-up yesterday and received a text notification the next evening. I'm going to pay my child's school fees. Now we can relax."

Digital payments also save time and money for health campaign organizers, including the burden and expense of transporting large sums of cash and completing documentation.

"When you have 300 to 500 volunteers to pay, doing accounts and signing receipts takes a lot of time," said Saïdi, a polio team leader in DRC.

WHO first used the new digital payments in polio immunization campaigns in Côte d'Ivoire. Although outbreaks of vaccine-derived polio were on the rise, vaccination campaigns were having trouble getting off the ground. In the first quarter of 2020, almost half the polio campaigns in WHO's African Region were postponed, saw workers drop out, or suffered other detrimental effects stemming from delays in cash disbursements.

As WHO and partners worked to develop the nuts-and-bolts aspects of a digital payment ecosystem (registering workers into a database, verifying their profiles with the mobile network operator and more) the benefits of a cashless approach became more apparent.

There is substantial evidence that digitizing payments can support people, especially women, to gain access to financial services and increase control over their earnings. Over the past four years, the World Health Organization has utilized the growing presence of mobile money across Africa to ensure that the courageous frontline vaccinators in polio outbreak campaigns are paid completely, quickly, and securely."

Maria May, Senior Program Officer, Inclusive Financial Systems, at the Gates Foundation

Alain Labrique, director of WHO's Department of Digital Health and Innovation, said that "digital payments are one of the key pillars of Digital Health Public Infrastructure currently strongly encouraged within WHO's guidance to member-states on Digital Transformation." WHO views digital payments as a foundation for many more digital development activities, together 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 WHO's joining the Better Than Cash Alliance".