Deadly Liver Mob offers nominal incentives to encourage participants to be educated on hepatitis C then recruit and educate up to three of their peers, returning to the Deadly Liver Mob for consolidation of health messages and an ‘incentive payment’ dependent on the quality of their ‘teaching’. Clients also receive incentives for attending sexual health screening, returning for their results, and if they require additional follow-up care such as hepatitis A or B vaccination or treatment for sexually transmissible infections. The incentive amounts for each engagement with the program differ across sites, based on the local set up of the program. However, all current sites provide clients with a maximum of $110 total for their engagement in the program. For example, some sites offer greater incentive amounts for clients returning to screening or receiving their results, as geographic location acts as a barrier for clients returning to the service. It is up to new sites to decide on the incentive amounts provided for engagement in the program, based on the available budget.

The management of incentives (vouchers) is a key challenge to these types of programs as health services do not typically manage this type of activity, so an accountability system for the vouchers will be required. Each health service may have specific local policies about record keeping, so management of vouchers should comply with any relevant policies.

A secure place to store vouchers on non-program days is required. On program days, staff cannot anticipate the number of vouchers that will be required (as clients attend on a drop-in basis). Each client intake card records the vouchers provided to that client. A separate record should be maintained of vouchers provided each day, which is then tallied at the end of each program day to immediately identify any issues. Other principles for managing the incentive system are to work with procurements systems of the health service to allow timely purchasing of vouchers. Also, senior staff should be responsible for the management and accounting for vouchers.

‘… And yes, incentives obviously make a massive difference and I think they do enable [engagement with clients] to occur … they’re a great benefit and most of the clients really enjoy the engagement, so they might come in to get that voucher to begin with, but at the end they will say “it was really good seeing you, it’s really good talking to you about that and learning about that”, so it becomes so much more than the voucher.’

Staff Member

Figure 3 outlines the ways in which incentives are applied at various stages of engagement with Deadly Liver Mob. Clients are limited in the amount/number of incentives they can earn and this is clearly explained to them (e.g. clients are asked to refer a maximum of three peers to Deadly Liver Mob). This flow chart was used by the Aboriginal workers to explain to clients how the program would work and was displaying in the Needle and Syringe Programs (NSP) on program days.  Note: some Deadly Liver Mob sites varied the schedule for incentives to suit their needs — for more information see troubleshooting.

Incentive Voucher System


All clients receive a voucher for undertaking and participating in hepatitis C education with the Aboriginal Deadly Liver Mob staff member.

Payment is made at the conclusion of an education session.

The Aboriginal Deadly Liver Mob worker manages the voucher payments by checking the Deadly Liver Mob intake card to find out which components of the program have been completed by a client and require payment. All client payments are recorded on a participant tracking sheet. The tracking sheet data is entered into an Excel spread sheet at the end of each program project day by the program staff. These records contain only minimal personal identification (see privacy). All program materials are kept in a locked filing cabinet and all vouchers are locked in a safe on site.

Recruitment and education

All clients who recruit others receive a voucher per recruit — they can also receive an additional voucher, if they have passed key information about Hepatitis C onto their recruits. These vouchers are given to the client at the conclusion of the education session following the assessment of the recruit’s knowledge (see the checklist). However, care is taken to make this assessment a positive and strengths-based exchange. No Deadly Liver Mob client should be penalised (in terms of not being provided vouchers) for the responses of their peers. The Aboriginal Deadly Liver Mob staff member records the education session on a Deadly Liver Mob intake card, which is recorded manually onto the tracking sheet and entered daily into the Excel worksheet.


An additional voucher incentive is offered to encourage program clients to undergo hepatitis testing, hepatitis B vaccinations and sexual health screening. If a client consents to screening, the Aboriginal Deadly Liver Mob worker takes the client through to the sexual health clinic with their Deadly Liver Mob intake card. Following the screening, the sexual health nurse stamps and dates the intake card as a record for the program of the sexual health session. All clients who agree to screening receive an additional voucher incentive to return for their results. This is recorded on their intake card. An additional voucher payment is made for each HBV vaccination to encourage completion of the vaccination schedule. The is recorded on their intake card.

Note that all clients have separate Sexual Health Clinic registration and confidential records are held by Sexual Health. No clinical information is collected on the Deadly Liver Mob intake card and the Deadly Liver Mob worker does not have access to clinical records.

Note: some Deadly Liver Mob sites varied the schedule for incentives to suit their needs — for more information see troubleshooting.