Motivation Matters: Lessons for REDD+ Participatory Measurement, Reporting and Verification from Three Decades of Child Health Participatory Monitoring in Indonesia.

Participatory Measurement, Reporting and Verification (PMRV), in the context of reducing emissions from deforestation and forest degradation with its co-benefits (REDD+) requires sustained monitoring and reporting by community members. This requirement appears challenging and has yet to be achieved. Other successful, long established, community self-monitoring and reporting systems may provide valuable lessons. The Indonesian integrated village healthcare program (Posyandu) was initiated in the 1980s and still provides effective and successful participatory measurement and reporting of child health status across the diverse, and often remote, communities of Indonesia. Posyandu activities focus on the growth and development of children under the age of five by recording their height and weight and reporting these monthly to the Ministry of Health. Here we focus on the local Posyandu personnel (kaders) and their motivations and incentives for contributing. While Posyandu and REDD+ measurement and reporting activities differ, there are sufficient commonalities to draw useful lessons. We find that the Posyandu kaders are motivated by their interests in health care, by their belief that it benefits the community, and by encouragement by local leaders. Recognition from the community, status within the system, training opportunities, competition among communities, and small payments provide incentives to sustain participation. We examine these lessons in the context of REDD+.

Getting the Data Flowing: Lessons Learned from Existing Reporting Systems in the Forestry Sector in Indonesia for REDD+ MRV.

In the context of REDD+, Measurement, Reporting and Verification (MRV) is one way to manage forest change information. A national carbon and non-carbon database will be used in REDD+ to negotiate compensation schemes with the international community. Much of this data will be collected at the local level, thus a reporting system that can integrate these locally collected data into the national database is crucial. In this paper we compare and draw lessons from three existing local to national reporting systems that include the participation of local communities: 1) the government extension services, 2) the government owned forestry company, and 3) a private logging company in Indonesia, and provide recommendations for REDD+ reporting systems. The results suggest that the main desired conditions for effective data flow are: benefits to motivate local participation, based on contributions to reporting activities; simple data format and reporting procedures to allow local participation in the reporting process, and to support data aggregation at the national level; a facilitator to mediate data aggregation at the village level to ensure data consistency, completeness and accuracy; and a transparent and clear data flow. Under these conditions, continuous, accountable and consistent data flow from the local level will reach the national level where it can be fully utilized.

Safety, Feasibility, and Acceptability of the PrePex Device for Adult Male Circumcision in Malawi.

INTRODUCTION: Nonsurgical adult male circumcision devices present an alternative to surgery where health resources are limited. This study aimed to assess the safety, feasibility, and acceptability of the PrePex device for adult male circumcision in Malawi. METHODS: A prospective single-arm cohort study was conducted at 3 sites (1 urban static, 1 rural static, 1 rural tent) in Malawi. Adverse event (AE) outcomes were stratified to include/exclude pain, and confidence intervals (CIs) were corrected for clinic-level clustering. RESULTS: Among 935 men screened, 131 (14.0%) were not eligible, 13 (1.4%) withdrew before placement, and 791 (84.6%) received the device. Moderate and severe AEs totaled 7.1% including pain [95% CI: 3.4-14.7] and 4.0% excluding pain (95% CI: 2.6 to 6.4). Severe AEs included pain (n = 3), insufficient skin removal (n = 4), and early removal (n = 4). Among early removals, 1 had immediate surgical circumcision, 1 had surgery after 48 hours of observation, 1 declined surgery, and 1 did not return to our site although presented at a nearby clinic. More than half of men (51.9%) reported odor; however, few (2.2%) stated they would not recommend the device to others because of odor. Median levels of reported pain (scale, 1-10) were 2 (interquartile range, 2-4) during application and removal, and 0 (interquartile range, 0-2) at all other time points. CONCLUSIONS: Severe AEs were rare and similar to other programs. Immediate provision of surgical services after displacement or early removal proved a challenge. Cases of insufficient skin removal were linked to poor technique, suggesting provider training requires reinforcement and supervision.