Brighter Communities Worldwide (formally known as Friends of Londiani – rebranded in January 2017) has been working with communities in Kericho County, Kenya for the past fifteen years. We began working on Menstrual Hygiene Management (MHM) in schools in 2010 when the need was identified by
the community. Approximately 90% of teachers in schools were the programme has been implemented reported an improvement in girl’s school attendance and 77% of the girls involved in the programme have seen a change of attitude and understanding towards menstruation among their families and
communities. Feedback from the programme has enhanced our view that MHM requires a multidimensional approach and that improved MHM will have benefits for all sectors of the community. This paper goes through our experience in the field of running one programme on MHM to mainstreaming MHM across all of Brighter Communities Worldwide’s programmes

Carol Galvin (7223342)

Joan S. Nthusi (7223345)

Maria Kidney (7221164)

English

Loughborough University Institutional Repository

KIDNEY, GALVIN & NTHUSI   1  40th WEDC International Conference, Loughborough, UK, 2017   LOCAL ACTION WITH INTERNATIONAL COOPERATION TO IMPROVE AND SUSTAIN WATER, SANITATION AND HYGIENE SERVICES  The need to have a multifaceted and mainstreamed approach to addressing menstrual hygiene management:  a Kenyan case study  Maria Kidney, Carol Galvin & Joan Syombua Nthusi (Kenya)   PAPER 2648   Brighter Communities Worldwide (formally known as Friends of Londiani – rebranded in January 2017) has been working with communities in Kericho County, Kenya for the past fifteen years. We began working on Menstrual Hygiene Management (MHM) in schools in 2010 when the need was identified by the community. Approximately 90% of teachers in schools were the programme has been implemented reported an improvement in girl’s school attendance and 77% of the girls involved in the programme have seen a change of attitude and understanding towards menstruation among their families and communities. Feedback from the programme has enhanced our view that MHM requires a multidimensional approach and that improved MHM will have benefits for all sectors of the community. This paper goes through our experience in the field of running one programme on MHM to mainstreaming MHM across all of Brighter Communities Worldwide’s programmes.    Introduction Menstrual hygiene management (MHM) is defined by the WHO & UNICEF as being “Women and girls using clean menstrual management material to absorb or collect blood; that can be changed in privacy; as often as necessary for the duration of the menstruation period; using soap and water for washing the body as required, and having access to facilities to dispose of used menstrual management materials” (UNICEF and WHO, 2014). The progress and attention being given to MHM is increasing and it is being given a global platform with initiatives such as Menstrual Hygiene Day. However there is still a lot of work needed in bringing together all the elements required to ensure that quality MHM is available to all. In Brighter Communities Worldwide, we believe that a multi-faceted approach is required to address the issues surrounding MHM; we have learnt this through our experience of working on MHM since 2010. We began our journey by focusing on keeping girls in school through our Girls for Girls programme. The feedback and learning that arose from this programme is now leading us towards mainstreaming MHM across all our health programmes in the community. Results from the schools programme have been very positive, adapting to challenges as they are met and it is early days so far with the Community MHM programme and the mainstreaming of MHM across our other community health programmes.  This paper is about showcasing our journey from starting with one MHM programme to mainstreaming it across all our programmes. The evidence we have gathered through our own learning points us towards the need for a multi-dimensional approach to MHM. This approach needs to integrate across schools and communities, and involve both males and females to truly work. Dispelling cultural taboos around MHM, providing products and infrastructure to support MHM is part of the work we are doing at a local level but we are also working at a national level through technical working groups on MHM. The need for change at policy level is apparent not only in Kenya but many other countries as well.   KIDNEY, GALVIN & NTHUSI   2  MHM programme  Girls for Girls Programme (G4G): history and concept  Brighter Communities Worldwide first contact with schools in Kericho County is through our Healthy Schools programme which utilises the concept underlying the World Health Organisation’s initiative of the Healthy Environments for Children Alliance (HECA). The aim of this programme is to reduce environmental risks to children’s health that arise from the settings where they live, learn and play by providing knowledge, increasing will, mobilizing resources, and catalysing urgent action. This is achieved through a programme that provides training for teachers and increases students’ awareness of environmental health issues through classroom studies. The G4G programme is an additional programme which is layered on top of the Healthy Schools Programme. It was the beginning of Brighter Communities Worldwide’s involvement in MHM. The programme was established in 2010 at the instigation of a local teacher, who was concerned about the impact of girls missing school on a regular basis due to the lack of access to sanitary products. It was apparent from the outset that the programme would need to be multi-faceted as lack of access to sanitary products was only one part of a much bigger picture.  The G4G programme has evolved and been adapted over the last few years but the core remains that the programme views the education of girls and young women as a fundamental human right. We continue to work with stakeholders to enable girls to remain in school so they may graduate, and enable women beyond school to reach their full potential. Stakeholders include various Government Ministries, Teachers, Health Professionals, Community Leaders, girls, and women. New schools are coming on board each year and by the end of 2016, the programme was running in 41 schools across the region and directly reaching approximately 2,011 girls.     Figure 1. Girls for Girls infographic   The essence of the G4G programme is about integrating education, health and economic empowerment initiatives to enable girls to stay in school. It includes: 1. A modularised education programme delivered by trained facilitators  2. Peer learning and mentoring  3. Access to sanitary products (low cost, various options, available each month)  4. Income generation that includes: training; seed funding; mentoring and support; school saving schemes  5. Provision of infrastructure (“girl friendly” latrines & washrooms).     As a result of being involved in the G4G programme, a girl will have regular ongoing access to sanitary products - she can choose what type works for her; she can learn about her body and taking care of it; she can access clean, safe, reliable facilities with water available; she is economically empowered and therefore is prepared for the world. The intergenerational impacts of G4G will be seen through more educated and economically empowered women who in turn will seek the same benefits for their children.  The objectives of the G4G programme and that will be incorporated into our future programmes around MHM are: 1. To enable more girls to stay in school and graduate – resulting in greater life choices. KIDNEY, GALVIN & NTHUSI   3  2. To enable more girls and women to enter the workforce through accessing improved menstrual health, having completed formal education and non-formal business education.  3. To enable more girls and women to have access to independent financial resources through economic empowerment, in order to make choices in their Menstrual Health Management (MHM).  4. To engage all sections of communities in Kenya in the issue of MHM resulting in a change to cultural attitudes and policies. 5. To contribute towards the elimination of violence against women through ensuring that girls remain in school and understand their rights, and have alternatives to early marriage.  The G4G programme is evaluated on a bi-annual basis and results from the 2015 evaluation found that 96.8% of girls surveyed want the G4G programme continued in their school; 90.5% of teachers felt that yes they was an increase in the attendance levels of girls since the introduction of G4G programme in their school; 77.1% of the girls surveyed who have been involved in the G4G programme have seen a change of attitude and understanding towards menstruation among their families and communities since the introduction of the programme; and that 82.6% of girls surveyed who had received a sanitary kit stated that they had not missed any days of since receiving their sanitary kit. Qualitative data gathered from the survey brought to the fore the need for more to be done in the community rather than just the school. The girls surveyed felt that education around MHM was poor among women and that the subject needed to be discussed more openly in order to dispel harmful taboos.     Photograph 1. Participants in the  Girls for Girls programme  Photograph 2. An example of  girl friendly latrines  Community MHM programme The feedback from the 2015 evaluation surveys and requests from women in the community who had heard of the programme led us to start creating a MHM programme designed for women of all ages to be held in a community setting. Meetings took place in early 2016 between a number of advocates for the programme in the community and Brighter Communities Worldwide and it was agreed that a Pilot Community MHM Programme should be put in place.  The process began in 2016 when a pilot village was selected and a sensitization process was planned to assess the wants and needs of participants. A period of sensitization then happened between June and July, during this time 13 churches were visited, information was disseminated and MHM challenges discussed. In July two community MHM workshops took place in Londiani with 67 participants attending over the two days. The objectives of the workshop included: 1. Creating awareness on issues regarding MHM among girls and women in the community. 2. To understand the myths and taboos surrounding MHM in the community. 3. To eradicate the stigmatization of girls and women due to menstrual related cases. 4. To empower all genders with information regarding MHM for the well-being of all. 5. To partner with all stakeholders involved to tackle challenges associated with menstruation. The one day workshop covered topics such as puberty (physical and emotional changes), the concept of re-usable sanitary products and sustainability. There was also learning stations on: • Menstruation and Hygiene. • Menstrual Cycle. • Challenges around Menstruation. • Managing Menstruation. KIDNEY, GALVIN & NTHUSI   4   The workshop received very positive feedback from all participants and an evaluation was also done through a meeting between Brighter Communities Worldwide and the local advocate group. The following were considered to be the next steps of the programme: • Target other communities for the next workshop. • Look for more women who can train the community (Facilitators) - from the workshop. • Integrate Menstrual Hygiene in our other programmes. • Come up with a number of Community Menstrual Health Workshops to be held annually. • Work on modules to be used in the workshops. • To consider a Menstrual Health Workshop for men facilitated by men.    Photograph 3. A learning station at the community MHM workshop Mainstreaming MHM The next step for our organisation came about through meetings with the Ministry of Health and other feedback about the need for MHM to be mainstreamed across all our programmes. Brighter Communities Worldwide is fortunate to have built up a good relationship with key stakeholders in the communities in which we work. We have a strong track record in community mobilization and sensitization and we feel we are in a position to achieve positive outcomes around MHM in communities a whole. The first step we will endeavour to take to mainstream MHM will be to integrate it across the Community Health Strategy programmes. The Community Health Strategy is a bottom up approach aimed at creating healthy communities through empowering Kenyan households and communities to take charge of their own health. By working with a strategy already in place it will allow us to reach more people in a more efficient and less time consuming way. Components of the Community Health Strategy include Community Health Volunteers who work directly with households in communities, Field Days which bring health information to the people and Outreach Clinics which bring health services to people in remote communities. By adding an element of MHM to all of these components we can create awareness, start discussions and provide vital education.  We are currently working with the Ministry of Health in our region to create a module around MHM that can be added to a Community Health Volunteers training schedule. We are also working to adapt materials we have so that they can be used to create information stands at field days and outreach clinics. The idea of all this is to raise the general awareness and increase knowledge and education in the communities. Sensitization of the community is the key to breaking down the barriers of the taboos and stigmas that surround menstruation throughout a lot of this region.  Menstrual Hygiene Day – 28th May 2016  One of the highlights of 2016 for Brighter Communities Worldwide was being invited to host the Kenyan Menstrual Hygiene National Day of celebration in Londiani, the theme for 2016 “Every day can be a good day” was celebrated in style. Menstrual Hygiene Day is about creating a platform to bring together individuals, organisations, social businesses and the media to create a united and strong voice for women KIDNEY, GALVIN & NTHUSI   5  and girls around the world, helping to break the silence and build awareness about the fundamental role that good menstrual hygiene management plays in enabling women and girls to reach their full potential.  The event in Londiani was attended by Menstrual Hygiene Management partners from across the county, representatives of the Ministry of Health at National and County level, and over 2,000 people from 42 schools and 22 community units in the County. The day gave Brighter Communities Worldwide the opportunity to showcase the Girls for Girls programme on a national level. It also gave the students (both male and female) and teachers involved in the programme the opportunity to discuss menstrual health issues and challenges through experiential learning and games. Brighter Communities Worldwide partnered with Eva Wear to design & implement the educational programme component of the day and we found that the use of games with menstrual hygiene messages was an excellent way to dispel taboos surrounding the topic in a fun and non-threatening manner. Eva Wear supplies re-usable sanitary products to girls and women across Africa. Another benefit of being involved in a day like this was the opportunity for networking with those involved in MHM in Kenya. The benefits of this will come to fruition through new partnerships being formed and getting the opportunity to see the positive and innovative solutions being taken to address the challenges around MHM in a country context.     Photograph 4. Girls from a local school partaking in Menstrual Hygiene Day  Photograph 5. Girls from local schools with Maria Kidney from BCW  at MH Day  Learnings and future plans One thing that we as an organisation learned, particularly over the last year or so, is that MHM doesn't just affect girls in schools, but women in the community and beyond that again it has implications across all sectors of society. If woman does not have employment opportunities as a result of poor MHM then a family suffers; if a girl leaves school early all the evidence points to her marrying younger and having more children, this impact is generational. The need to also include males in society across all ages in the process is becoming more apparent, MHM has to become an open topic for discussion if real change is to happen and be sustainable. WASH Infrastructure in schools is essential for a successful MHM programme. Without appropriate washrooms and latrines managing MHM is impossible. The implementation of personal hygiene lessons in a school through our Healthy Schools Programme contributes to the success of G4G. It is becoming more apparent to us as we continue to work in this field that it is not all about the pad or the product, access to products is an issue but MHM is about more than pads. The access to products is evolving rapidly with more options becoming available all the time and becoming more accessible to most but there are still major gaps. We have used a number of different providers of reusable sanitary products; some have had great feedback from the girls and some not so positive. The types of products available are constantly changing and improving so we endeavour to keep up with innovation in this area and constantly review products we use.  The need for sustainability in improving access to products is becoming increasingly important. We are working with schools now to set up saving schemes among the girls as one of the lessons learnt over the last few years was that in some schools students and teachers found the running of an income generation project too difficult to reach scale of money needed. We also hope to work with local savings groups such as merry KIDNEY, GALVIN & NTHUSI   6  go grounds, table banking and village savings schemes to assist women in the community to achieve a sustainable supply of funds for products when they need them so they are self-reliant.  There are many changes occurring in our programmes around the area of MHM, we hope to reach more communities than ever in the year ahead. The need for a multi-dimensional approach is foremost on the agenda and we will be taking all that we have learned in the past few years and incorporating it into future programmes.    Photograph 6. Girls for Girls programme participants examining a reusable sanitary pad package   Acknowledgements The authors would like to extend thanks to the schools participating in the Girls for Girls Programme, the Ministry of Public Health and Sanitation, the Ministry of Education and the communities in which we work with in Kericho County, Kenya.  References WHO/UNICEF 2014 WASH in Schools Empowers Girls’ Education - Proceedings of the Menstrual Hygiene Management in Schools Virtual Conference 2014. UNICEF: New York Friends of Londiani 2015 Girls for Girls Programme School Survey   Contact details Maria Kidney is a Director at Brighter Communities Worldwide, Carol Galvin is a Development Analyst with Brighter Communities Worldwide and Joan Syombua Nthusi is the Field Officer who runs the Girls for Girls Programme. Maria Kidney,  maria@brightercommunities.org www.brightercommunities.org Carol Galvin,  carol@brightercommunities.org  Joan Syombua Nthusi, programme@brightercommunities.org   

The need to have a multifaceted and mainstreamed approach to addressing menstrual hygiene management: a Kenyan case study

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The need to have a multifaceted and mainstreamed approach to addressing menstrual hygiene management: a Kenyan case study

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