Diningforwomen(D4W)InterimReport

1. Informationa. OrganizationName:SustainableHealthEnterprises(SHE)b. ProjectName:SHE28c. GrantAmount:$46,947d. ContactPerson:MelissaDriverBearde. Address:175VarickStreet,NewYork,NY10014

2. Outcomestheprogramwasdesignedtoachieve

Theprogramwasdesignedtoincreaseaccesstopadsandknowledgearoundmenstruation.Throughtheprogram,503,000go!padswillbedistributedtotenpublicschools,tenkiosks,andotherschoolsandinstitutionsthatserveyouthsuchasyouthvillages,orphanages,andNGOsimpactingover3,000girls’abilitytoaccessaffordablepads.Theschoolswherewedistributepadswillbeabletoprovidedoubletheamountofpadstheycanprovidetogirlsbecauseofourpads’affordability.Attheschoolswherewedistributepads,50targetedteachers/personnelhavebeentrainedinpubertyeducationandmenstrualhygienemanagement(MHM)inordertodeliverMHMafter-schoolprogrammodulestogirlsandboyswithconfidence.Girls,boys,parentsandteacherswillreceiveMHMeducationresourcematerials.

3. ChangesinFundingforthisProgram

Therewerenosignificantorunexpectedchangesinfundingforthisprogram.

4. ChangesinOrganizationorProgram

NadiaHitimana,ourHealthandHygieneManageratthetimeoftheapplication,hasleftSHEtopursueherMastersinPublicHealthattheLondonSchoolofHygieneandTropicalMedicine.

TherehavebeentwoadditionstotheSHEteam.MelissaDriverBeardhasjoinedtheorganizationasExecutiveDirectorandJeanetteMurekatetebeganworkinNovember2015asourHealthandHygieneManager.JeanettehasanMPHand14yearsofworkexperienceintheWASHSector.Shehasconductedtrainingsofbothtrainersandyouth,includingMHMeducationforgirlsinrefugeecamps.

5. Challenges

Ourfirstchallengewasovercomingteachers’perceptionsonMHM.SomeoftheparticipantsstronglybelievedthemythsaroundMHM.Afteranalyzingthefactsbehindmenstruationandcomparingthosefactswithmythsandbeliefsattachedtomenstruation,theteacherscametorealizethatthemythsandtaboosaroundmenstruationwererestrictionsonwomenandgirlsthatwererootedintheculturalcontextratherthangroundedinscientificfact.Evenwithascienceteacherinthecohort,thegroupattimesdidnotfullygrasptheanatomyandphysiologyofthefemalereproductivesystem.However,apersonalexchangeofinformationandexperiencescreatedanatmosphereinwhichalltheteacherswerehighlyengagedandhelpedsomeofthenewteachersbetterunderstandtheinformationpresented.Moretimethanplannedwasrequiredforthetrainerstoresolvemisconceptions.Thisresultedinlesstimebeingavailableforothersubjectsplannedbythetrainer,suchasthemenstrualcycleandchoosingfemininecareproducts.Wehavefacedanotherobstacleinconductingourmonitoring&evaluation.Wehadplannedtoconductourstudentknowledgeandbehaviorchangepost-teststowardstheendofthe2015schoolyearandbelievedthattheschoolyearendedinmid-tolateNovember2015.However,welearnedonshort

noticethattheschoolyearendedinmid-October2015,withtheremainingtimeservingasareadingandexaminationperiod.Conveningthestudentsduringreadingandexamperiodprovedtobeimpossible.Tothatend,wewillneedtoconductthepost-testsinJanuary2016andwillrequestanextension,tobediscussedinSection8belowThischangeinschedulewillenableustoaskmorerigorousquestionsinthepost-test,aswelearnedinthepre-testthatsomeofourquestionswerenotdetailedenough.Ontheproductionside,inordertoincreaseourthroughputandreach250,000ormoregirlsbytheendof2017,wehavekickedoffapartnershipwithamultinationalhealthcompany,whichisdesigningmachineryforusthatwillincreaseourthroughputbytenfold.Wehavealreadyimplementedproductimprovementssuggestedbythispartner,andwillcontinuetodoso.6. Revisionofobjectives

Inourproposal,westatedthatSHEwouldprovide180,000padsto3,000girlsin10schools.In2015-16,wewillactuallymanufactureatotalofover2milliongo!pads.40,000ofthesepads,ratherthantheestimated180,000,willbeprovidedfor3,000Rwandangirlsthroughthe10schoolsmentionedinourproposal.Given2015budgetallocations,thisisboththemaximumthatschoolscanbuyanddoubletheamountofcompetitors’padsthatschoolsbuyforgirlsatcurrentprices.Thisprovisionwillensurethatgirls’roomsarestockedwithpadsforgirlstouseincaseofemergencies.Becausewearecommittedtoincreasinggirls’accesstopads,another50,000padswillbesoldatkiosksnearthe10schools.Finally,413,000willbesoldtootherschoolsandinstitutionsthatserveyouthsuchasyouthvillages,orphanages,andNGOs,whichhavetheresourcestosupplygirlswithpadsforregularuseratherthanonlyforemergencies.Takenasawhole,throughthesechannels,wewillincreaseaccessfor6,803girlsthroughschoolgirls’roomsandbulkpurchasers.Wethinkthismakesforamoresustainablebusinessmodelinthelongtermandultimatelyincreasesgirls’accesstopads.

WecommunicatedthischangetoDiningforWomeninFebruary2015,andthischangewasapproved.Ourobjectiveshavenotchangedotherwise.

7. Progresstowardsachievingobjectives

SHEhasusedtheD4Wgrantforthreemainactivities;teachertraining(November2014)andrefreshertraining(March2015),M&Ewithstudents(March2015)andtocollectteachers’feedbackontheMHMimplementationwithstudents(August2015).Asafollowupstep,SHEwillconductfeedbacksessionswithstudentstolearnhowtheirteachersandSHEcouldservethembetter.

a.SHEMenstrualHygieneManagement(MHM)teachertraining,November2014

Thetrainingwasconductedfor51academicians(24malesand27females),from10schoolsintheEasternprovinceofRwanda,Kayonzadistrict.Amongtheteamwere3headteachers,2headmasters,1headmistressand3directorsofstudies.TheseteachersnowconductMHMtrainingsforstudents.ThegovernmentofRwandahasallocatedabudgetlineof$35,000forhygieneimprovementinschools,includingfor$267perschoolperyearthepurchaseofsanitarypads.Participantswereselectedbasedontheirinfluenceonmakingthegovernmentafterschoolprogramadvanceintheirrespectiveschools.ScienceteacherswillbecatalystsinhelpingunderstandthephysiologyandanatomyrelatedtoMHM.

Thetrainingswereconductedfrom10-13November2014attheMidlandHotelinKayonzadistrict.The51teachersweresplitintotwogroups.Eachgroupwasallocatedatotalof2daysforthewholetrainingsession,withapproximately13hoursofinstructionforeachgroup.

Thepurposeofthetrainingwastoincreaseteachers’knowledgeandskillsonmenstrualhygienemanagement(MHM)and,consequently,theirconfidenceintrainingtheirstudents.OurmaingoalistoprovidereliableinformationonMHMtoteachers,students,andtheRwandancommunity.Furtherdiscussionwillbreakthesilencearoundthetopic,thuskeepinggirlsinschoolsandempoweringwomentoparticipateandcontributetosustainabledevelopment.ThelanguageofinstructionwasKinyarwanda,thelocallanguage.

i. Generaloverviewoftheteachertraining.

Trainingsessionswentaccordingtoplan.Teachersappreciatedthegoalofthisinitiativebecausetheywereunfamiliarwithhowtoaddressthiscriticaltopic.AmongthesubjectstaughtwereMenstrualCycle,ChoosingFeminineCareProducts,andBeliefs,Norms,Myths,andTaboos.Onemaleteacheramongtheparticipants,afterhavingattendedthesessiononthemenstrualcycle,said,“Inowunderstandwhymywifebehavesthisandthatotherway.Iamsoshamefulforblaminghertonotbe

abletocontrolourbirths,butknowIseehowcriticalthisis.Icanonlyimaginehowconfusingandstressfulforayounggirlduringhermenstruation.” Anotherteacherexpressedabeliefinthemyththatmenstruatingwomencouldlowertheyieldofherfamily’scropsbywalkingthroughthefieldwheretheygrow.Thispersistenceofmisinformation,evenamongteachers,showshowfarwestillhavetogoindispellingmythsonmenstruation.

• Teacherslikedthemanuallayoutandteachingmethodologies.TheteachersagreedtogothroughtheSHEMHMmanualafterthetrainingandcomebacktothetrainersformoreclarificationsandimprovementsuggestionswhereneeded.

• Teachersdemonstratedsomeknowledgeofthephysiologyofmenstruation,butmanyonlyhadbasicinsightaboutthetopic.Ingeneral,thefacultyhadnottackledthetopicofMHMbecausetheybelievedthatitwasasubjectbestleftbetweengirlsandtheirmothersorotherfemalefamilymembers.However,manywomenthemselvesdonotknoworaresilentaboutMHMevenwithintheirfamilies,andmalesoftenneverlearnaboutMHM.

ii. Immediateimpactofthetraining

Basedonthepre-andpost-testsadministered,MHMknowledgeamongteachershasincreased.Pre-testgradesrangedfrom48%to84%.Post-testgradesrangedfrom61%-96%.Theaveragescoreinthepretestwas62.9%,increasingto74.1%inthepost-test.Additionally,thepretestmedianwasat66%andthepost-testmedianat78.5%.SHE’sobjectiveofincreasingteachers’knowledgeofMHMwasachieved.Femaleacademiciansscoredhigherthantheirmalecounterparts.Fromournon-scoredpartofthetest,morethan80%ofparticipantssaidtheywerenowconfidentaboutMHMasasubject.

iii. Recommendations

• Teachersindicatedthattwodaysoftrainingwerenotsufficienttocoverallthematerial

• TeacherssuggestedwehighlightthemodulesonMenstrualCycle,ChoosingFeminineCareProducts,andBeliefs,Norms,Myths&TaboosandspendlesstimeonthePuberty&Adolescence,Care&DisposalofMenstrualProducts,andHealthPracticesmodules.

• Teacherssuggestedthatmodulesbeadjustedfortheageofthestudents• Teachersproposedthatwehavevideoinstructionalmaterials

iv. StepsForward

• Bothparticipantsandtrainersagreedthatschoolvisitswillbecarriedouttofollowupontheimplementationplanforthestudents’trainingsandforWASHassessments.

• TheBusinessdevelopmentandproductionteamsneedtopayattentiontothegovernmentschoolpadsbudgetforitwasreportedfromvariousteachersthatthisamountisnotconsistent.

b.TheTeacherrefreshertrainingsoverview

Thetrainingshappenedfrom30January-5February2015.SHEstaffre-trainedtheteachersonlessonstheyhadmisunderstoodorforgotten,elaboratedanimplementationplanforstudents’trainingsandassessedtheschools’WASHfacilities.Onlyoneschoolfailedtoelaborateanimplementationplan.

i.RepeatedLessons

AllofthesmallgroupswantedtorepeatthelessonsonMenstruationandMenstrualCycle,andChoosingFeminineCareProducts.

ii.FeedbackandRecommendations

• Condensethemanualcontentandrearrangethemodules• Coupleourfinalmanualswithinstructionalmaterialsforstudents.Trainerssuggestedpelvicmodels

ordrawingsonpiecesoffabric,menstrualcups,andreusablepads.• Thefinalsoftcopyofthetranslatedmanualshouldbeproofreadbyoneoftheteacherstoensure

thatthecontentandlanguageappropriatetobothstudentsandteachers• DevelopbookletsorotherIECmaterialsforstudents• TrainerswillgenerateadataanalysisofWASHfacilitiesinthe10schools

c.TeacherTrainingEvaluationIn-Service

Thefinalteachertrainingin-servicetookplacefrom10-14AugustattheMidlandHotelinKayonzaDistrict.52teachersandheadmastersfrom10schoolsinKayonzaDistrict–thesameteacherswhoattendedthefirsttwotrainingsessionsandconductedstudentMHMtrainings–attended.Thepurposeofthisevaluationin-servicewasfortheteacherstoevaluatetheteachertrainingmanualandtheeffectivenessofthestudenttrainings.Keyfindingsinclude:

• Teachersfounditeasytoteachstudentsaboutpuberty,asstudentsarealreadyexperiencing,andcuriousabout,puberty-relatedchangesintheirownbodies.Teachersfounditdifficulttoteachstudentsaboutthemenstrualcycle,especiallythephysiologyaroundreleasingoftheegg,variablecyclelengths,andirregularcycles

• Teachersbelievetheyareopeningupasafespacetotalkaboutsensitivetopicsthatintereststudents.

• Toeffectivelydeliverstudenttrainings,teachersneedmorecolorpicturesinthemanualandmorevisualmaterialssuchaschartsandcalendarsforexplainingandtrackingmenstrualcycles,exercisesandcasestudies,samplesofmenstrualproducts,andvideos.AbiologyteacherwhohashadMHMtrainingshouldgiveinputonthedevelopmentofstudentIECmaterials.

• Teachersalsosuggestedusingparticipatory,student-centeredpedagogicalmethods,e.g.presentations,skits,roleplaysthatstudentsdothemselves

• TeachersaremorecomfortableteachingstudentsaboutMHMthantheywerebeforethetraining• Teachersneedtobepreparedtounderstandthemenstrualcycle,answerquestionsfromstudents,

talkopenlyaboutwhathadpreviouslybeenconsideredasensitivetopic,helpstudentsbreakdowntaboos,andadjustcontenttobeage-appropriateforstudents

• Teachersrankedthemostimportantmodulesas:1)Puberty;2)menstruationandmenstrualcycle;3)menstrualhygiene;4)challengesfacedbygirlsandwomen;and5)myths,beliefs,&taboosaroundmenstruation

• Teacherssuggestedthatallothermodulesbesummarizedandcondensed• Studentsneedabooklettofollowalongwiththetrainings• Studentshadagoodunderstandingofpubertybutlittleunderstandingofthemenstrualcycleand

howtousedifferenttypesofmenstrualproducts

• Bothboysandgirlsshowedinterestinandexpressedcuriosityaboutthetopic,thoughgirlsweremorecomfortableaskingquestionsingender-segregatedgroups

• Boysaremoresupportiveofmenstruatinggirlsaftertheygothroughthetrainings

• TeachersareeagertoteachMHMinnationallymandatedafter-schoolhealthclubsoncethoseclubsareimplemented.

• MHMteachertrainingneedstobereplicatedatthenationallevelasuntrainedteachersdon’tunderstandtheimportanceofMHM

• SchooladministratorsshouldrecognizetheimportanceofMHMandencourageteacherstotraintheiruntrainedcolleagues

• Itiscriticaltoconveyaccurateknowledgearoundpuberty,menstruation,andMHMtoparents,andstresstheimportanceofbreakingthesilencearoundthesetopics.

d.BaselinedatareportonstudentsM&E

SHEconductedapre-knowledgeandpre-behaviorchangebaselineassessmentamongmaleandfemalestudentsinthe10schools.Thegoalofthisassessmentwastodeterminethestudents’knowledge,attitudesandskillsaswellastheirbehavioraroundMHMpriortothestartoftheMHMclubs.Theassessmentscombinedbothqualitativeandquantitativemethodsandwereconductedfromthe9thtothe20thMarch2015.Thetotalnumberofstudentsreachedwas657usingavarietyofdatacollectionmethodologiestoinclude:surveys,focusgroupsanddiaries.

Keyfindingsinclude:• Acrossallschools,students(primaryandsecondarystudentswithapproximateagesof10to15

years)werecorrectintheirMHMknowledge74%ofthetime,incorrect18%ofthetimeandnotsure8%ofthetime.

• Secondaryschoolstudentsweremorelikelytogivecorrectanswersthanwereprimaryschoolstudents(77%versus71%ofthetimeforprimary)

• GirlswerecorrectintheirMHMknowledge76%ofthetimeversusboys69%ofthetime.• While34%ofboysadmittedtheywereembarrassedtotalkaboutmenstruation,86%ofbothboys

andgirlsthinkthatboysshouldbeincludedinconversationsaboutmenstruation.• 15%ofgirlsand21%ofboysconsideredmenstruatinggirlsunclean.• 42%ofgirlsand24%ofboysbelievedthatgirlscouldparticipateinsportsduringtheirperiod.• 12.6%ofgirlsreportedthattheyhadmissedapartialorfulldayofschoolduringtheirmostrecent

menstrualperiod.• Ofthosegirlswhomissedallorpartofadayofschool,menstrualpainwasthereasonformissing

school79%ofthetime;lackofproductwasthecause8%ofthetime.• 72%ofgirlsreportedusingthepitlatrineforpaddisposal.

• 81.6%ofgirlswhocompletedthebehaviorsurveyuseddisposablepadsastheirprimarymenstrualproductduringtheirmostrecentperiod.

• Tenofthe191respondents(5.2%)reportedusingmorethanoneproductduringtheirmostrecentmenstrualcycle.8ofthosewereacombinationofdisposablepadandcloth.1wasacombinationofclothandcottonwooland1wasacombinationofnothingandclothing.

• Everytime47%andSupa44%werethemostpopulardisposablepadbrands.• Themajorityofgirls(48%)went2-4hoursbetweenchangingproducts.Girlsweremorelikelyto

stretchthatto4-6hoursandlongerifwearingapadthaniftheywereusingcloth.• Thevastmajorityofgirlsacquiredthepadsfromthestore(49%)orhome(44%).Only3%saidthey

gotthemfromschool.• 34%ofgirlshadrequestedpadsfromschoolinthepastandreportedthattheywereavailable97%

ofthetime.• Whenchangingtheirmenstrualproductatschool45%changetheirproductinthelatrine,37%

changedtheirproductinthegirlsroom• 14%ofgirlssaidtheyhadfeltashamedatsomepointduringtheirlastperiodand2%reportedthat

theyhadbeenteasedduringtheirlastperiod.

e.TeacherfeedbackonMHMimplementationinschools.

FeedbackfromourfirstcohortofteacherswillhelpusdeliverMHMteachertraininginthemosteffectivemannerpossible.Thisinformationwillhelpustomodifythemanual,andtobetteradvocateforotherteacherstobetrainedinthissubjectandconsequentlysupportandtrainstudentseffectively.

8. Pictures

Seeattached

9. Messagefordonors&community

Thankstoyoursupport,SHEtrainedover50teachersin10schoolsinKayonzaDistrict,whothenwentontotrain657studentsinMHM.WehopethatyoucontinuetosupportSHE28andourworktokeepgirlsinschool,period.

10. Listofexpensesincurred

Seeattached