Motivating and retaining the health workforce for neglected tropical disease mass campaigns with innovative digital payment solutions

Background Timely and reliable payment of frontline health workers is critical for the implementation of Neglected Tropical Disease (NTD) mass campaigns. However, traditional payment systems can be inefficient and prone to delays, particularly at scale. Digital payment solutions offer a potential pathway to improve efficiency and reliability, yet empirical evidence from large-scale campaign settings remains limited. Methods This study evaluated changes in payment performance following the introduction and subsequent scale-up of a digital payment workflow integrating DHIS2-based data collection with Nigeria’s NUBAN account verification system. Administrative data from NTD campaigns conducted in 2023 and 2024 in Rivers and Oyo States, Nigeria, were analyzed. Descriptive statistics, Mann–Whitney U tests, and multivariate regression were used to assess differences in payment success and failure rates, processing time, and delay components, controlling for batch size, payment amount, and state. Results Payment processing efficiency improved significantly in 2024. Median total processing time decreased from 35 to 12 days, while median operational delay decreased from 33.5 to 10 days. In contrast, median finance-related delays increased from 1 to 3 days, indicating a bottleneck at the financial processing stage. Median payment success remained 100% in both years, while the mean failure rate decreased from 1.14% to 0.54%, and absolute failed transactions declined from 690 to 332 despite increased transaction volume. Regression analysis confirmed a significant reduction in processing time in 2024 after adjustment for batch size, payment amount, and state. Conclusion The integrated digital payment workflow was associated with substantial improvements in payment-processing efficiency while maintaining consistently high payment reliability as operations expanded. However, persistent delays in the financial processing stage highlight the need to strengthen downstream financial workflows and coordination with financial service providers.