THE HDI GUINEA WORM REWARD

THE HDI GUINEA WORM REWARD

System for

Cash Rewards

in the

Global Eradication Program

for

Guinea Worm Disease

As of

October 8, 1993

Dr. Anders R. Seim

Health & Development International

(HDI)

INTRODUCTION

A cash-reward system is being offered to the global GuineaWorm Eradication Program, for use in countries which have onlya few cases of guinea worm disease within their boundaries, andcountries with a history of endemic dracunculiasis.

This document describes the principles of the reward system,general selection criteria for nations and individuals etc. Asthe National Guinea Worm Eradication Programs vary from countryto country, details are expected to be worked out individuallywith each eligible nation.

It is of course up to the National Guinea Worm Eradication Programin each nation to decide, whether they wish to use the rewardsystem. Countries choosing to use the system would decide whetherthey will pay rewards just to patients or also to village volunteersor others, as described below.

The idea is to budget $1,000or $2,000 / eligible country / year in local currency, dependingon whether rewards are offered only to the patients, or also tovillage volunteers. The reward system, including selection criteriafor eligibility of nations and of patients within nations, wasdeveloped in close collaboration with endemic countries and withthe WHO Collaborating Center.

As the number of cases is reduced, and in nations which introducethe HDI-guinea worm reward at lower levels of endemicity, thereward per case can be increased within the total budgeted foreach country.

HDI will offer the reward to each of the eligible nationson a year-by-year basis. Our donors have committed themselvesto finance The HDI Guinea Worm Reward for the durationof the eradication effort, so the year-by-year commitment willdepend only on proper application of funds provided, and the continuedfulfillment of selection criteria.

OBJECTIVES

* To reduce the time and expenserequired to successfully complete the eradi- cationof guinea worm disease, in nations which have only a few casesleft.

* To increase the sensitivity of active surveillance.

* To help guard against concealment of cases.

Proposed Criteria

Selecting Nations for introducing HDI GuineaWorm Rewards

NUMBER OF CASES

There should be about 500 cases of guinea worm or less in thecountry, ascertained by adequate, nationwide, active surveillance.In Nigeria, the figure may be 500 in a single zone.

In situations where only very few or no cases are expected toexist in a country, the reward system may be introduced as partof the surveillance system from the very start. For example,one may offer $100 for the first 10 cases in the nation, limitedto one patient /village.

FUNCTIONING CASE CONTAINMENT SYSTEM

The country must have a system for case-containment, whichis already established and well functioning. The case-containmentsystem must be such that reports of cases are rapidly transmittedto trained health workers in the guinea worm program (nationally,or at a central sub-national level); these health workers mustbe able to personally confirm each reported case; the arrangementsfor case-containment must provide for measures which will ensurethat no further transmission occurs from each case which has beenidentified.

In countries using HDI Guinea Worm Rewards as partof their original national case search, case containment mustnevertheless be provided for.

WIDE PUBLICITY

The country must agree to publicize the rewards widely, sincethe reward will not be effective unless most people in endemicareas know about it. Pictures of guinea worm can be shown inprinted media, TV, and on posters, with broad coverage also givenvia radio broadcasts.

We hope the government itself, the media, UNICEF and other UNagencies, bilateral assistance agencies, and other supportersof guinea worm eradication can help in the task of making theguinea worm reward widely known. We expect broad publicity willbe easier to achieve, the larger the reward being offered. Webelieve that guinea worm rewards of some size will be consideredhighly newsworthy by the media themselves.

ADEQUATE FINANCIAL CONTROL

There must be an agreement between the national guinea wormeradication program and the WHO Representative (or some otherexternal collaborating agency), which assures the donors thatadequate financial control is being exercised and to guaranteethat rewards are only paid upon the fulfillment of the relevantcriteria for the selection of individuals. Paid rewards mustbe accounted for in detail, also for the purpose of assuring optimalcase surveillance.

Each recipient of The HDI Guinea Worm Reward mustin some way sign a receipt for the money. The national guineaworm eradication program must forward these receipts to HDI, viathe WHO Representative or whichever collaborating agency may beacting in lieu of WHO for this purpose.

Along with the receipts for each year, the program manager mustsend a note listing the names of those who got the reward, whatvillage each of them lives in, where each is believed to havebeen infected, and other particulars of each case including whichcase containment measures were taken.

These receipts and such a note from the national program managerare a prerequisite for releasing funding for the next year.

LOW RISK OF IMPORTED CASES

In some situations, nearby areas in neighboring countriesmay have a substantially higher number of cases than the countrywhich is to start implementing the reward system.

The reward system will only work well if it is widely publicized and known. It is important to guard against situationswhere people might cross from a neighboring country with a muchhigher number of guinea worm cases, to collect a reward in thecountry with few cases.

Selecting Individuals for HDI GuineaWorm Rewards

THE PATIENT:

He or She Must Have Guinea Worm

The patient must have one or more confirmed guinea worms. Insome areas, larger rewards could be offered for patients reportedbefore the worm begins to emerge.

Verification

The case must be verified by one or more adequately trainedhealth workers from the national guinea worm eradication program,at the national or a central sub-national level.

Help Determine Place of Infection

The patient must cooperate in assisting the guinea worm eradicationprogram to reconstruct his/her travel during the previous year,so that one may try to determine where the patient might havebeen infected.

Case Containment

The patient must submit to adequate containment measures,e.g. surgical extraction or alternatively, controlled immersionand/or occlusive bandaging followed by adequate control untilall the patient's worms are completely out, in accordance withthe nation's plan of action, to assure that further transmissiondoes not occur.

Payment of the Reward

Payment of the reward should be made promptly when allof the above criteria have been met.

THE VILLAGE WORKERS (AND OTHERS):

In countries wishing to do so, the reward system provides forcash rewards or "incentives" to the village volunteer or any otherindividual who brings the case to the attention of the guineaworm eradication program.

The total amount available for payment to anyone other than thepatient, will be no more than the reward to the relevant case.

Timely Reporting

To be eligible for a reward/incentive, the village workermust report the case promptly, for example within 24 hours offinding the case or some other time-limit chosen at the nationallevel.

Countries may decide to offer larger rewards when the case isreported before worm emergence than after the worm has begun topenetrate through the skin.

Ensure Case Containment Until the Case is Verified

The village worker must ensure that the patient is available forcase-verification without contaminating any new water sources,until the case can be confirmed and adequate containment measuresare taken.

This can be done by bringing the patient directly to the verifying-person,or by otherwise ensuring that the patient does not contaminateany water source until the verifying-person can reach the village(within a very few days of receiving the report).

Timing of the Reward/Incentive

The reward/incentive to the village worker is eligible to be paidwhen the patient has received his/her reward and where the abovecriteria are fulfilled. When possible, this should be paid atthe same time as the patient is paid; if not, the patient shallhave first priority.

GENERAL COMMENTS

Presently, we only expect to be able to offer rewards up to atotal of $1,000 for patients, and $1,000 for village workers andothers, for any country in any given year. This means that thateach reward would only be equivalent to about $2.00 in countrieshaving about 500 cases.

It has been suggested that $2.00 may be too small an amount toserve as an incentive under any circumstances. Unfortunately,we currently expect to be constrained by the limit of $1,000/eligiblenation/year for patients, and a similar amount for village volunteersor others.

Costs for getting the patient to the verifying-person and containmentmeasures must come from the ordinary program budget or some othersorce. Such case-containment interventions in this mopping-upphase of the program would presumably be instead of other interventionspreviously offered to the population by the National Guinea WormEradication Program.

HDI will transfer the budgeted amount for one year at a time,to the WHO Representative (or other collaborating agency) in eligiblenations wishing to implement HDI Guinea Worm Rewards.