The Nepal Multiple Indicator Surveillance (NMIS) began in 1994, with a first cycle in early 1995 on Health and Nutrition that covered a number of indicators necessary to assess progress toward development goals1. The NMIS was designed as an-ongoing monitoring scheme rather than a one-off survey.
The NMIS process comprises repeated cycles of data collection, analysis, interpretation, and communication of results to stimulate action. Each cycle focuses on a set of priority issues for the health, well-being and rights of children also for the whole population of Nepal. A steering group from the National Planning Commission, Central Bureau of Statistics and relevant line ministries agrees the focus of each cycle. The Steering Group nominates a technical group to develop and agree the cycle plan and instruments of data collection for each cycle as well as to play a key role in interpreting NMIS results and ensuring their use.
The five cycles of NMIS that have taken place so far are: Cycle 1 on Health and Nutrition in early 19951; cycle 2 on Primary Education2 in spring/summer 1995; cycle 3 on Diarrhoea, Water and Sanitation3 in the first half of 1996; cycle 4 on early childhood feeding, nutrition and development4 in the autumn of 1996, and cycle 5 on Care during Pregnancy and Delivery in spring 19975. Reports on these first five cycles are available1-5.
The findings of the first five cycles of the NMIS incidentally demonstrate that there are problems with delivery of public services in Nepal. Access to services is very limited in some parts of the country and the quality of services that are available is often poor. For example, access to primary education has been explored in NMIS cycle 22 and found to be poor in some areas, especially for girls, and access to and quality of antenatal and delivery services has been shown to be poor in NMIS cycle 55.
Service Delivery Surveys
Effective provision of key public services is recognised as an
important part of development. The old method of central planning of services, with little
reference to local conditions and no reference at all to the population being
"served",
has clearly not worked. New ideas of partnership with civil society as part of good
governance are gaining wide acceptance as the way forward. Ideally, services should be
responsive to the needs and wishes of the population, who should have a say in the
planning and delivery of services. This new paradigm means asking the population about
their views and experience of present services, and about their suggestions and
preferences for services in the future. Of course, the budget for public services is
always limited, especially in countries such as Nepal. But this is all the more reason for
ensuring that what money there is is spent on services that are acceptable to the intended
users and considered likely to be effective, on the basis of evidence. This implies that
planning of services should be based on evidence of impact, coverage and costs6.
Information about these factors has to come from asking the population for whom the
services are intended. This is the basis for service delivery surveys, asking the
population in a given area about their use, experience and perceptions of services. Such
surveys have been carried out in a number of countries, using the method of Sentinel
Community Surveillance, and focusing on different key public services7,8,9.
NMIS cycle 6
While previous cycles of the NMIS gave information about delivery of
services as part of their findings, this sixth cycle of the NMIS is specifically a Service
Delivery Survey. It focuses particularly on the delivery of government health and
agriculture services. These services were chosen as essential basic services in a country
whose population are mainly subsistence farmers. It is intended to provide information
from the population on their access to, use of, experience of and perceptions of health
and agriculture services. Less detailed information about other public services is also
collected and the survey also provides information about perceptions and functions of
District Administrations and Village Development Committees.
In this sixth report in the NMIS Series the Methods section includes a background to the methodology used in the NMIS, which will be relevant especially for those readers who have not seen the first five reports in the NMIS Series1-5. The methods used in the sixth cycle are described, including the instruments used and the sources of data from households, institutions, key informants and focus groups. The Results section gives an analysis of public use, experiences and perceptions of health and agriculture services and brief information about other services. It also includes an analysis of those factors that seem to be associated with use of or different experiences or perceptions of services. In NMIS cycle 6, information has been collected from 6 groups of key informants (among the public and local service providers and administrators) on their views and perceptions, as well as from focus groups in the community. The analysis includes a comparison of their different viewpoints as a starting point for dialogue and planning of future services. Results disaggregated geographically and by ethnic group are given in Annex 5.
This report and the reports of cycles 1, 2, 3,4 and 5 are only a small part of the process of communicating the results of the NMIS to those who need them for planning and development at national, local, community and household levels. The findings of cycles 1-5 have been discussed with decision-makers and planners in a number of different fora, including with Chairmen of District Development Committees (DDCs). For cycle 6 it will be particularly important to discuss the findings with the health and agriculture departments, local government, DDCs and VDCs. Hopefully the information collected from different groups could help the concerned government departments and bodies to improve their current services, in partnership with civil society.