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

Abstract

Community Health Workers (CHW) 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 (WHO) 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 input from CHWs. In this implementation report, we describe efforts to improve efficiency, reliability, and user experience of the CHW payment process of the Jamii ni Afya project in Zanzibar. We followed 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. 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. Implementation (Results): The workflow was able to accurately translate programmatic data into payment information, and securely transmitted this information to a payment service provider. CHWs felt that 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. Engaging users in the design and optimization of digital payment systems has the potential to improve efficiency, accuracy, and satisfaction of all users, leading to improved quality, sustainability, and impact of CHW programs.