How prepared is Nigeria digital payment for health workers? A landscape analysis.

Introduction: Stakeholders in the health sector have advocated for the optimization of digital payment channels in low-and-middle-income countries in order to improve program outcomes. We conducted a landscape analysis of the local context, challenges, and opportunities for digitized health worker payments in Nigeria.

Methods: This study was an exploratory qualitative case study with mixed-methods approach to data collection including; i) desk review, ii) interview of key informants and iii) engagement of stakeholders. In the desk review, the databases searched were MEDLINE (PubMed), Google Scholar and Google. For the qualitative interviews, 17 stakeholders were interviewed between May and July 2022. Audio recordings of interviews were transcribed and analyzed using thematic approach with the Nvivo software. At the stakeholders' (n = 15) engagement, findings from the desk review and interviews were discussed and additional data collected.

Results: Digital payment systems for health personnel described in the reviewed documents included the direct disbursement mechanisms, direct bank transfers and mobile money. Among these-payment methods, direct bank transfer was the most prominent digital payment method. Also, there is a high level of acceptability of digitized means of payment of health workers among stakeholders in the Nigerian health sector. From the regulatory point of view, the Nigerian government has initiated a number of digital payment policies including the cashless policy. Other incentives for digitization of payments were: availability of credible financial institutions, improved financial accountability and transparency, previous experience of under-payment or non-payment of end beneficiaries, to avoid delays in payment and ensure timely retirement of funds. Challenges of digital payments included: delayed resolution of problems associated with digital payment such as failed transactions, cyber security, double payments, and unfriendly bank policies.

Conclusion: Digital payment system is being utilized, accepted and would be beneficial for payments for the Nigerian healthcare system. Harnessing its benefits of improved health workers' performance and program outcomes by enacting appropriate policies is recommended.