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Health workers’ experiences with digital and cash payments during health campaigns in Nigeria: a qualitative study

Year: 2026

Type: article

Abstract: Background Digital financial services (DFS) for health worker remuneration have introduced a paradigm shift, addressing many of the challenges associated with cash payments. However, evidence on health workers’ experiences of digital and cash payments in Nigeria remains limited. This study explored health workers’ experiences and perceptions of digital and cash payments, with particular attention to satisfaction, motivation, perceived work performance, and the benefits and challenges associated with each payment modality. Methods This qualitative study was conducted among 171 purposively selected immunization campaign workers from three regions of Nigeria, including the Federal Capital Territory. Participants included both operational and strategic-level workers, such as local and state immunization officers. Data were collected through in-depth interviews ( n = 12), key informant interviews ( n = 12), and focus group discussions ( n = 12; 147 discussants). Data collection was conducted from May to July 2023, and each interview lasted about 35 min. All interviews were audio-recorded, transcribed verbatim, coded inductively, and analyzed thematically. The National Health Research Ethics Committee of Nigeria (NHREC/01/01/2007) approved the study. Results Campaign workers generally perceived digital payments as supporting their satisfaction, motivation, and willingness to perform assigned campaign activities compared with cash payments. Digital payments were valued for their transparency, direct funds transfer, timeliness, reduced intermediary involvement, and lower travel-related costs. Participants also described challenges, including delayed payments due to incorrect account information, difficulty resolving transaction problems, limited access to smartphones or bank accounts, and unstable internet connectivity, particularly in rural areas. Some participants therefore continued to prefer cash because it provided more immediate access to funds and depended less on digital infrastructure. Conclusion Digital payments were beneficial when remuneration was timely, accurate, and transparent, but depended on reliable implementation and infrastructure. Strengthening account verification, providing timely mechanisms for resolving payment problems, improving user training, and ensuring reliable connectivity may improve payment experiences and support health workers’ motivation and perceived work performance.

Source: Frontiers in Digital Health

DOI: 10.3389/fdgth.2026.1780807