ArticleBMJ global health2025
A qualitative study on gender relations and digital payments: healthcare workers' experiences during polio vaccination campaigns in Uganda and Malawi.
Article in BMJ global health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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4 citing papers in PubMed.
- A research agenda for digital payments of health workers in large-scale health campaigns in sub-Saharan Africa.BMJ global health · 2026Article
- Digitising payments for campaign health workers in Africa: the promise and the path to sustainable scale.BMJ global health · 2026Article
- Assessing the feasibility of partner-implemented digital payment systems for health workers: stakeholder perspectives from Uganda's yellow fever mass vaccination campaign - a qualitative study.BMJ global health · 2025Article
- From Peer Support to Program Supervision: Qualitative Insights on WhatsApp as Informal Digital Infrastructure for Community Health Workers and Public Health Officers in an Indian High-Priority Aspirational District.Healthcare (Basel, Switzerland) · 2025Article
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10 authors.
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Abstract
backgroundGender is a key factor shaping societal roles and access to resources, with cultural norms often limiting women's abilities to use digital financial services. Despite the rise of digital payments, little is known about how gender relations influence their adoption and experience, especially among health workers involved in vaccination campaigns.
methodBetween January and September 2023, we explored how gender norms and relations influence the uptake and experiences of digital payments among health workers participating in mass polio vaccination campaigns. The qualitative study involved 23 focused group discussions (FGDs; 16 in Uganda and 7 in Malawi) and 82 in-depth interviews (IDIs; 35 in Uganda and 47 in Malawi) with healthcare workers who received digital payments for implementing polio mass vaccination campaigns. IDI participants included village health teams, midwives, nurses, health facility managers, immunisation focal persons and district health officers in Uganda, and community health workers, health facility managers and mobile money operators in Malawi. FGDs were held with midwives, nurses and village health teams in Uganda and community health workers in Malawi. Data were coded using Dedoose software and thematically analysed.
resultsParticipants highlighted that digital payments were convenient since they were able to receive funds without travelling long distances or queuing at health facilities. Women reported that it gave them more time to engage in alternative activities, improve their financial autonomy and ability to participate in decision-making around use of household funds. Structural challenges leading to delayed disbursement of funds were reported to reinforce gender norms around financial dependency on men to meet operational campaign costs (eg, transport). Reported limited ownership of mobile money accounts, a prerequisite for digital payments, led to the exclusion of some women.
conclusionOur findings suggest that digital payments could help improve financial autonomy and participation in decision-making around use of household funds among women involved in immunisation campaigns. However, our findings show that digital payments are implemented in the context of prevailing harmful gender norms that, if not addressed, have the potential to compromise women's agency. This underscores the importance of integrating gender-transformative programming in planning for digital payments during vaccination campaigns.
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