Introduction to Financial Incentives in One Health

Financial incentives are increasingly used to promote pro-social, pro-environmental, and health-promoting behaviors globally. A comprehensive review published in Science in One Health examined over two decades of research on these incentives within One Health contexts, which involve human, animal, and ecosystem health. The review explores both the potential and limitations of these powerful tools.

Effectiveness and Challenges Identified

Research indicates that conditional financial incentives effectively promote health-related behaviors in the short term. However, evidence for long-term sustainability beyond 18 months remains limited. Payment for ecosystem services programs have shown success, though benefits are often modest and depend on crucial factors such as governance, property rights, and monitoring.

While effective for short-term behavioral change, the long-term sustainability of financial incentives in One Health contexts remains largely unproven, and their success is highly dependent on specific design and contextual factors.

Several persistent challenges hinder the widespread effectiveness of these programs:

• Additionality: It is difficult to determine if incentives lead to behavior change that would not otherwise occur.
• Monitoring: Complex, repeated behaviors are challenging to monitor, unlike simple actions such as disease reporting.
• Collective vs. Individual Behaviors: Designing effective group incentives is more complex than individual ones, relying heavily on internal group governance and shared understanding.
• Social Equity: Programs can disproportionately benefit influential residents or disrupt existing livelihoods without providing adequate alternatives.
• Moral Hazard: Payment structures can inadvertently encourage undesired behaviors; for example, quantity-based rewards might lead to overfishing.
• Income Effects: In low-income countries, payments as significant income sources can lead recipients to support disease persistence if they fear the discontinuation of incentives.

Critical Knowledge Gaps

Six major unknowns were identified by the review, highlighting areas where further research is crucially needed to optimize financial incentive programs:

1. The interaction between incentives and communication campaigns.
2. The inconsistent understanding of motivation crowding effects (crowding-out vs. crowding-in).
3. The relative effectiveness of cash versus non-cash incentives.
4. The precise role of conditionality (requiring behavior verification for payment).
5. Long-term effects after incentives cease, regarding behavior persistence or decline.
6. Effective design of collective incentives, as participation has led to both stronger governance and conflict.

Guinea Worm Disease: A Case Study

The Guinea worm disease eradication effort serves as a compelling example of financial incentives at play within a One Health framework. The disease has declined by an astonishing 99.9% to just 15 human cases by 2024 since 1986. However, animal infections, particularly in dogs, have become a significant challenge, with animal cases surpassing human cases since 2014.

National Guinea Worm Eradication Programs (GWEPs) have utilized three main financial incentive strategies:

• Reporting Human Cases: Cash rewards for reporting human cases have increased over time (from US$10 to several hundred dollars). This strategy aligns with effective principles due to the individual nature of the action, its verifiability, and clear individual benefits.
• Reporting Infected Animals: Initial per-animal rewards in Chad led to increased dog ownership and community disputes. Consequently, the program restructured incentives to a household basis, combined with community awareness campaigns, to mitigate these unintended consequences.
• Proactive Dog Tethering: Incentives are provided for confining animals to prevent their access to water sources. Monitoring is supported by local surveillance, and communities themselves decide on reward distribution, sometimes pooling funds for public goods. Chad's program, for instance, provides approximately US$5 monthly per household, specifically designed not to be perceived as an expected income source.

Design Principles for One Health Contexts

Successful incentive design principles align closely with the practices observed in the Guinea worm eradication efforts:

• Targeted behaviors should be easily monitorable and not already market-incentivized.
• Reward amounts should be sufficient to motivate but not perceived as a regular income.
• Incentives must integrate effectively with community participation and communication to build understanding and ownership.
• Local decision-making processes should be empowered, allowing communities to tailor approaches.
• Programs should proactively anticipate and design against perverse incentive effects through rigorous research and continuous monitoring.

Conclusion

Financial incentives can undeniably promote behavior change in One Health contexts, but they are not universally appropriate solutions. Meta-analyses indicate only modest effects, high dependence on context, and largely unknown long-term impacts.

When programs cannot align with research-based design principles—especially concerning additionality, monitoring, collective action, equity, and long-term effects—alternative approaches emphasizing community engagement, communication, and infrastructure development may be more suitable.

Effective One Health initiatives demand a deep contextual understanding, robust monitoring, adaptive management, and genuine community partnership. Carefully implemented incentives, alongside comprehensive communication strategies and an understanding of social norms, can contribute significantly to One Health objectives within broader behavior change programs.