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Key Text Using Key Informant Monitoring in Safe Motherhood Programming in Nepal

Author: N Price and D Pokharel
Date: 2005
Size: 14 pages (96 KB)

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Summary

The Nepal Safer Motherhood Project (NSMP) works to improve maternal health and contribute to programme development at district and national level. This article from Development in Practice discusses the project’s use of Key Informant Monitoring (KIM). KIM is an adapted version of the peer ethnographic research method. Data is collected by community-based Key Informant Researchers (KIRs) and used for monitoring and planning. KIRs have proved useful sources of information and acted as change agents by spreading safer motherhood messages.

Only 13% of births in Nepal are attended by a health professional and the unmet need for obstetric care is estimated at 95%. Using KIM, NSMP aims to understand the socio-cultural, economic and political environment in which pregnancy and childbirth are experienced and monitor progress in improving access. KIM takes as its starting point the idea that this social context is important in shaping health-seeking behaviour and maternal outcomes. Developing and implementing KIM has led to recognition among NGOs of its potential for use in other activities associated with safe-motherhood, HIV and reproductive health.

KIM is an adaptation of the peer ethnographic method, which draws on the participant-observation approach of anthropology, encouraging trust and rapport between the researcher and the researched.

Rural Nepal is highly stratified along lines of ethnicity, gender, kinship and age. These divisions and power relations must be considered when exploring community perceptions.
While there are no clearly defined peer groups in rural Nepal, KIM has sought to train women to interview others of similar age and social background.
There are limits to the amount of information KIRs are able to record. Instead of an interview script, KIRs make use of conversational prompts to collect data on barriers to services, quality of care and women’s decision making.
After gathering data, KIRs attend debriefing workshops with NSMP female local facilitators. Data analysis also involves review and dissemination workshops led by NGOs at Village Development Committee (VDC) headquarters.
Steps taken by VDCs in response to KIM findings are further reviewed and refined by subsequent rounds of KIM data collection. Findings are also shared with the District Reproductive Health Co-ordination Committees.
Responses to KIM findings have included: awareness raising campaigns, training for traditional healers, better privacy in examination rooms, more emergency funds and greater involvement of women in VDCs.

Key lessons and implications relate to local ownership, partnership and methodology:

KIM has facilitated participatory dialogue between NSMP, its key partners and the community. It has fostered community ownership of methods and data and produced credible findings.
Through their interaction with women and their families, KIRs have acted as catalysts for dialogue and behaviour change, for example, by convincing family members to take women with obstetric complications to hospital.
One methodological issue that had to be addressed early on was possible KIR bias. Some KIRs had become over-committed to NSMP objectives and overzealous in the pursuit of evidence of better access and service quality.
The generic peer ethnographic method lends itself to use in urban settings, where there is a sense of anonymity. Its use in rural Nepal required adaptation, but ulitimately demonstrated how the method could be applied in different contexts.

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Source: Price, N., and Pokharel, D., 2005, ‘Using Key Informant Monitoring in Safe Motherhood Programming in Nepal’, Development in Practice, Volume 15, Number 2
Author: Deepa Pokharel , deepa@nsmp.org.np ; Neil Price , n.l.price@swansea.ac.uk
Centre for Development Studies, Swansea (CDS), http://www.swan.ac.uk/cds