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

## TL;DR

This paper outlines a research agenda to improve digital payments for health workers in sub-Saharan Africa, focusing on efficiency and equity.

## Contribution

The paper presents a prioritized global research agenda for digital payments in health campaigns, developed through stakeholder and expert input.

## Key findings

- Top research priorities include minimum health system requirements for responsible digital payment digitization.
- Strong consensus exists among experts on the prioritization of digital payment research questions.
- Digital payment optimization and cost-benefit analysis are highlighted as key areas for future study.

## Abstract

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).

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.

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%).

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.