Assessment of Digital Payment for Agents in Mass Chemoprevention Campaigns: The Karangue Fay Project in Senegal

IntroductionThe payment of healthcare agents is a crucial aspect of organizing mass health campaigns. This study aims to examine the effects of digital payments in seasonal malaria chemoprevention (SMC) campaigns in Senegal. MethodsThis quasi-experimental study used a three-arm before-after/here-elsewhere design, including (i) a mandatory digital payment zone in Kounkane (Kolda region), (ii) a voluntary digital payment zone in Koussanar (Tambacounda region), and (iii) a control zone without digital payment in Bantaco (Kedougou region). A mixed-method approach combining both qualitative and quantitative data collection was employed from March to June 2023. Ethical approval was obtained from the Senegalese National Ethics Committee for Health Research (CNERS) before field activities began (approval number: 0209 MSAS/CNERS/SP). ResultsA total of 299 agents participated in the study, with 181 surveyed before the intervention and 118 after. Participants were distributed as follows: Kounkane (Kolda) 48.8%, Koussanar (Tambacounda) 35.8%, and Bantaco (Kedougou) 15.4%. The key stakeholders included community health workers (90.9%) and supervisors (5.4%) responsible for receiving payments. Among them, 33.5% were single, while 65.2% were married. Male agents constituted 50.8% of the sample. The median age of participants was 32 years, with a median tenure of 3 years. All agents had at least one mobile money account. Most SMC agents used Wave and Orange Money accounts (69.89%), with 90% using Orange Money and 96% using Wave. The main criteria for choosing a reliable money transfer operator included security (95%), ease of use (90.3%), and cash availability (79.2%). Users perceived Karangue Fay as a more secure financial transaction system (82.45%), a reliable process (83.10%), enabling faster transactions (78.20%), more transparent (91.25%), and confidential (95.20%). Compared to cash payments, digital payments were preferred for their transaction security (p<0.001), speed, and ease of use (p<0.001). Qualitative interviews highlighted that digital payments were traceable, fast, and secure; however, reliability depended on stable internet coverage. ConclusionSMC agents demonstrated strong acceptability of digital payments, contributing to improved campaign coverage across different implementation phases. Additionally, digital payments enhanced community health workers engagement and optimized their performance.