Children are assessed for immunization status at designated voucher pick-up time and are referred to immunization providers if they were not appropriately vaccinated for their age. So far WIC has shown mixed results, the incentives have resulted in improvement in age-appropriate immunization coverage in some studies while it has shown no improvement in another study [6], [20], [35] and [36]. No documentation is available regarding

testing of economic incentives intervention in any developing country. The Rucaparib chemical structure results presented in this report and other studies [6], [19], [25], [37], [38] and [39] demonstrate that economic selleck inhibitor incentives are associated with increased immunization coverage, at least in the short term. However, there are no published data on the sustainability of such incentive-based

programs. National immunization programs could justify incentive-based strategies in view of the total cost incurred in terms of disease treatment resulting from lack of proper vaccinations. Further, higher socio-economic groups may not be equally influenced by such food/medicine coupon incentives. Therefore, an incentive-based strategy may only yield desired results in geographically targeted areas with high poverty. The generalizability of results may be limited to low socio-economic populations in developing countries with

low immunization coverage rates. Although, in our study the food/medicine coupon improved the timely completion of DTP series, up-to-date coverage achieved in the intervention arm was far below the 90% immunization coverage by 12 months of age recommended by Millennium Development Goals. Incentives can improve coverage, but this intervention on its own may not be sufficient. Moreover, the relevant ethical issues need to be studied and the impact of incentives in various settings needs to be assessed. Immunization coverage is a function of multiple factors including parental behavior, awareness, access to care, provider behavior, laws and regulations, national policies unless [6]. Interventions are required at all these levels to make an impact in improving immunization coverage. Ethical aspects of incentives in research and health programs have not received much attention. The appropriateness of incentives in healthcare still remains controversial and requires further research and discussion to answer all the questions. Grant [40] concludes that incentives become unethical when incentives involve dependency, risk is high, actions are degrading, incentive is significantly large to overcome the aversion to participate, or there is principled aversion.