TY - JOUR T1 - How are health workers paid and does it matter? Conceptualising the potential implications of digitising health worker payments JF - BMJ Global Health JO - BMJ Global Health DO - 10.1136/bmjgh-2021-007344 VL - 7 IS - 1 SP - e007344 AU - Margaret McConnell AU - Mansha Mahajan AU - Sebastian Bauhoff AU - Kevin Croke AU - Stéphane Verguet AU - Marcia C Castro AU - Kheya Melo Furtado AU - Abha Mehndiratta AU - Misha Farzana AU - Sabina Faiz Rashid AU - Richard Cash Y1 - 2022/01/01 UR - http://gh.bmj.com/content/7/1/e007344.abstract N2 - Summary boxPayment digitisation efforts in the health sector in low/middle-income countries have accelerated due to the COVID-19 pandemic.Research on impacts of worker payment digitisation on health systems is lacking.Our conceptual model details how payment digitisation could improve health systems.Wage digitisation has the potential to improve health system performance and provider well-being and consequently, patient outcomes.Critical gaps in evidence need to be addressed to support implementation and effective innovation.Health systems are striving to improve their effectiveness in response to evidence of significant avertable mortality stemming from challenges in the delivery of high quality healthcare.1 Ensuring that facilities are staffed with well-trained, motivated, fairly compensated health workers is a major challenge, yet paramount to improving health system performance and achieving universal health coverage.2–4 Beyond the health facility, frontline community health workers (CHWs) in many low/middle-income countries (LMICs) are charged with the essential task of communicating key health and programmatic information to communities in a culturally sensitive manner, while in many cases receiving limited formal compensation.Increasing evidence suggests that many health workers lack critical knowledge of key guidelines and procedures,5–7 and do not always adhere to guidelines even when they demonstrate knowledge.5 Absenteeism and turnover of trained providers undermines quality of care and the delivery of life-saving interventions.8 Health workers perform more of the tasks they know how to do when they are working in private facilities,5 suggesting a potential link between payment and performance. Yet the link between motivation, retention, compensation and performance is complex.4 9 The amount and design of supplemental incentives have been a major focus of health sector reforms in LMICs,10 with mixed evidence of impact and effectiveness.11 However, the prevalence of payment system failures, such as inefficiencies in the documentation and verification of work, … ER -