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Participants are usually reimbursed for the transport they have used when travelling for a clinic visit. The usually can travel on foot, use a bicycle or motorcycle, and at times they use public transport (where they pay fares). Questions have arisen such as transport reimbursement to which destination? Is it possible that we talk about transport payment? At times the traffic police carry out a crackdown of public transport vehicles causing the fares to double or triple. When such a participant arrives, it is the obligation of the study to pay back money spent - in this case, it stretches the written rates in the consent form. What happens? Do we ask the participant to call the clinic first, when there is a crackdown by traffic police so that we re-schedule the visit or do they just come and tell them we will reimburse what we have reimbursing you in the past when there is no crackdown!! That would be in-sensitive. Over time, semantics have developed within the research field but I would like to hear other thoughts whether we say reimburse or pay??
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Francis Akor
25 Aug 2010
I actually find it strange that the protocol has a fixed amount/range for reimbursement of transport fares.This does not take into account thenfact that cost of transport could increase at any time ranging from increase in price of fuel to the example you gave of police crackdown.I think the protocol should not fix the fares but rather make a statement that transport fares would be reimbursed.
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ALI Innocent
20 Aug 2010
This issue of participant reimbursement is quite interesting. I agree that in some instances, reimbursement is not perceived as reimbursement per se. some participant stay very close to study clinics while others are far away. it is the responsibility of PIs to find a consensus way of taking care of follow up compliance. Applying a fixed way of doing so may not be the solution. A good dose of common sense documented on a case by case basis can help solve many otherwise embarrassing situations arising from our very different ways of approaching this issue.
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amorutdenis
28 Jul 2010
Transport reimbursement is such a pretty idea as most participants travel from far places to study sites. The fact that participants spend a good number of hours during a follow up visit means that they have nothing to eat that day, so lunch should also be provided as cash as most participants would prefer cash to food.
Transport & lunch refund play a vital role in follow up compliance other wise many will default resulting to a much expensive tracing mechanism -
Daveline Nyakundi
12 Jul 2010
Thanks Steve,this is quite interesting a topic. indeed the situations can be quite complex. The flexibility we are referring to need to be discussed with the IRB and the scenarios that demand such will need to be documented clearly during approval and when they actually happen. The limits of such maneuver should as well be defined/established by the IRB in view of the prevailing challenges. The study should equally have quality systems in place to ensure that there is compliance in all aspects at all times. Such scenario of staff-participant connivance to 'blow' funds should be minimized by such systems. I believe in documentation. Whatever situation, good or bad, let the trial be gracious enough to put it down in a memo or note to file.Alternatively, each country can set a standard figure for reimbursement enough to cater for such instances, but this becomes tricky in developing countries where situations are never predicable and the reimbursement not perceived as reimbursement.This is why this matter need to b e dealt with using a 'blow-by-blow account' method(according to the situation,locality and IRB)
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Steve Wandiga
8 Jul 2010
Moses brings in a component that is s catch twenty two by saying that not paying will result in family skipping a meal thus implying that transport reimbursement or payment is actually a source of income, so why don't we just pay enrolled participants instead? Does common sense have boundaries? Can it be subject to abuse? I mean, study staff and participants colluding to fraudulenty obtain money from the study??? Again how flexible can we possibly be given that protocols stipulate a fixed amount or range but at times we go beyond, isn't this a deviation?
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Moses
6 Jul 2010
I fully agree with Phaik Yeong and Daveline. We work in situations where this is life and these sums of money make so much difference. Really should we withhold money when not paying could result in that family not eating that day - this is more that possible and quite likely in the communities where we all work. So yes please let us have the ability to apply common sense and flexibility to do what is right. If the nurse or whoever is looking after the participant is convinced by the situation they should be able to act - and then document as necessary. In my view as long as they document why the money given was over what was stated in the protocol then this is fine. Common sense and fairness is my comment!
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Daveline Nyakundi
6 Jul 2010
Hello, it indeed can be tricky! my take would be to ask the participant to ask for receipts for the transport provider to be a guide on this matter. If according to the receipt the amount is beyond the approved, then the difference can be given to them. But how do you verify that the receipts and amounts presented are authentic? i guess the study should take the participant by their word.it is clear that for those participants whose participation in the study is of altruism nature, then such reimbursements in general would be a disincentive. in a nutshell, my take would be, to employ flexibility to accommodate the unique circumstances that emerge in our varied settings.
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phaikyeong
5 Jul 2010
Hello! You certainly have a tricky situation! I would suggest sticking to the term "reimbursement" if that is what you are doing. "Compensation" is also quite commonly use. Good luck.