Using key informant monitoring in safe motherhood programming in Nepal

Abstract

This article discusses the methodology and application of the Key Informant Monitoring (KIM) tool as used by the Nepal Safer Motherhood Project (NSMP). NSMP aims to achieve a sustained increase in the uptake of midwifery and essential obstetric care services by addressing, among other things, constraints on access to such services. Data collected by community-based Key Informant Researchers (KIRs) are synthesised and used by NSMP and key project partners for monitoring and planning purposes. NSMP has used KIM findings to modify its main interventions at the local level. International and Nepali NGOs have adopted KIM in their safe motherhood and other development programmes. Village Development Committees, with support from NGOs and NSMP, have responded to issues raised by KIM by running maternal health awareness-raising campaigns, working with traditional healers, improving the quality of care, and facilitating local emergency transport and funding schemes. KIRs have proved effective as sources of information and as change agents, spreading safe motherhood messages to promote behaviour change.

Acknowledgements

We would like to acknowledge the support of all the people involved in the implementation and documentation of KIM. We thank in particular the KIRs, NSMP's national NGO partner (HICODEF), the NSMP SDOs and Local Facilitators, the local NGOs and CBOs, and NSMP's Social Development Manager for backup support. We are also grateful to Susan Clapham and to an anonymous reviewer for their valuable comments on an earlier draft of this article.

Notes

1. The term ‘peer’ does not refer exclusively to young people, whose peers are often of the same age, but to members of the same social network or social group, such as friends, neighbours, workmates, and kinsfolk, with whom an individual shares relatively equal status.

2. The Social Development Officer (SDO) has overall responsibility for managing the increasing access work in NSMP-supported districts. The Local Facilitators are managed by the SDOs and their role is to work closely with the NGO partners, providing them with technical support. Along with NGO partners, they are responsible for the KIM training, debriefing, and VDC presentation.

3. It was recognised early in the KIM design process that having a female facilitator who was familiar with KIM and well known to the KIRs in a pivotal role in debriefing sessions was crucial to the success of KIM: pregnancy, childbirth, and associated issues concerning sexual behaviour would not be discussed—even by KIRs—in the presence of men.

4. The second round of KIM was undertaken in February/March 2003 in four of the six NSMP districts. Data analysis and presentation were delayed in the fifth (Kailali) because of the security situation during the first phase. Data collection was delayed by eight months in the sixth district (Surkhet) for security reasons as well.