Youth-Led Delivery of the Bfree Duo with Support for Improved SRH Outcomes for Adolescent Girls in Bidi Bidi & Palorinya Refugee Settlements
We aim to implement the novel Bfree Duo to help 5k+ refugee adolescent girls with menstruation and reproduction in Bidi Bidi and Palorinya.
Group photo with the girls who participated in a discussion to get their ideas and feedback on our proposed Bfree Duo.
Segawa Patrick discussing the PHAU Youth-led Edutainment Mission.
Introducing the idea and getting feedback on the Bfree Duo menstrual cup-cervical cap device from South Sudanese adolescent girls living in the Palorinya Refugee Settlement in Uganda.
Public Health Ambassadors Uganda (PHAU) performing a Flash Mob to promote the use of condoms to Uganda Youth.
Due to structural gender inequalities, adolescent girls living high-risk zones greatly struggle to protect their menstrual, sexual and reproductive health. Like the proverbial elephant in the room, there remains a paucity of attention and real investments directed to improve this situation. The Bfree Duo is an innovative and discreet female initiated multi-purpose prevention technology developed to help girls manage their menstrual health, prevent pregnancy, HIV and other STIs.
What specific problem(s) are you trying to address?
Children make up 62 percent of the 1.8 million people who have fled South Sudan due to armed conflict. Many of those escaping South Sudan are adolescent girls who were personally subjected to extreme violence, rape, and rape-related pregnancy. Many of these refugees now live in Ugandan refugee settlements. One such settlement is Bidi Bidi, currently the world's largest refugee camp. Many of the teenage girls lack the personal health knowledge and product support needed to protect themselves. They remain "exposed to abuse, sexual exploitation, lack of parental support, domestic violence, and child prostitution amongst other risks." (UNICEF 2017) Engagement in transactional sex further places them at higher risk of pregnancy, HIV and STIs.
Esther, a South Sudanese Refugee lining up to receive her menstrual pads at the distribution site Zone 3, Palorinya Refugee Settlement.
Distribution point and process in Zone 3 of Palorinya Refugee Settlement. Each name is openly called out for distribution of menstrual pads and other items.
Answering individual questions, getting individual feedback from the adolescent girls at Utula Secondary School in Palorinya Refugee Settlement on our intended programme around the Bfree Duo product.
What are some of your unanswered questions about the problem(s) you are working to address?
The complexity of the challenge keeps me up at night. We have to test our prototypes and model of delivery and iterate where necessary. We still need to test our model of delivery and test our hypothesis that by protecting the cervix with the Bfree Duo, the incidence of unplanned pregnancy, HIV infection and other STIs will be reduced. We have partners already in Uganda and hope to broaden partnerships to better ensure positive health and social impact for adolescent girls in the settlements.
Explain Your Idea
We don't presume to have all the answers but believe any action trumps inaction. We're committed to fulfilling our promise to deliver products to improve health and socioeconomic outcomes for adolescent girls globally. Over the past five years, adolescent girls living in rural areas and slums of East Africa have increasingly adopted the menstrual cup as a means to better manage their menses. Many of these same girls asked if they could use the menstrual cup as a contraceptive device. By asking this question they provided vital information sowing the seed that germinated the development of the Bfree Duo. These girls were seeking a female initiated discreet contraceptive device to help eliminate the often challenging need to negotiate use of a condom. Additionally, they sought a solution that would reduce the need for parental consent or a visit to a clinic to access contraception. Another common issue broadly communicated by adolescent girls is the fear of side effects and infertility reportedly associated with hormonal contraceptive use. We listened, are developing and want to deliver the Bfree Duo. Adolescent girls will receive comprehensive education on personal health and biology, training on product use with the provision of a Bfree Duo. The choice of whether they use it solely as a menstrual cup, as a contraceptive device or in both capacities is their own personal choice. To note, we do anticipate our plan to pivot reflecting feedback, monitoring, and evaluation data.
This image introduces Abigail and the challenges she faces managing her menstrual and reproductive health. Abigail's challenges include: access to a sufficient monthly supply of menstrual pads, discreet and non-hormonal contraceptive solutions and sanitation challenges in where to discard her used menstrual pads as pit latrines cannot handle the bulk resulting in the latrines filling up rapidly and malfunctioning, and not least the constant threat of sexual gender-based violence (SGBV).
Abigail hears at an Edutainment event designed and hosted by the youth-led organization PHAU that an easier, more discreet, and youth-focused product solution is available called the Bfree Duo. She learns from PHAU that training sessions on the benefits, how to use and maintain the reusable product will be held in designated zones. All are invited. WoMena has trained the trainers how to sensitize and educate the young women, where to access the product and where they can seek continuous support.
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Name the three most important ways that your idea will address your identified problem(s).
Our solution will positively impact the lives of adolescent girls by partnering with them to be their own change agents. Girls given the tools to better manage their personal health and hygiene will experience fewer barriers to improved health and socioeconomic outcomes. We plan a youth-led program to more effectively communicate achievable goals. Our solution will:
1. empower adolescent girls with the knowledge and support to manage their own personal hygiene needs,
2. provide them with an affordable, safe, discreet and more permanent solution to manage their monthly periods and reproductive needs,
3. instill confidence to remain in school, prevent and reduce the incidence of secondary risks related to teenage pregnancy.
How is your idea unique?
Ours will be the only dual menstrual and contraceptive device available on the market especially one that may also reduce the risk of HIV, HPV and other STIs. The Bfree Duo is essentially a multi-purpose assistive and preventive technology. Evidence-based data provides the confidence we have in claiming the positive impact our product will have on the lives of adolescent girls especially those in need of a discreet, affordable, easy to use, safe, reusable, environmentally low impact solution. Our goal is bold and ambitious. The challenges we face demand bold solutions. Unless the girls are provided with an individual menstrual cup and a diaphragm or cervical cap this combination merely approximates our inclusive innovation but at a much higher cost. Ours is a game-changing positive disruptor. Additionally, we have an amazing youth-led Ugandan partner, PHAU, on board who are enthusiastic that our innovation will achieve our objective to impact and improve the lives of adolescent girls.
What are some outstanding concerns or questions that you have regarding your idea?
Approvals to import menstrual cups into Uganda has met with challenges as the Ugandan National Drug Authority (NDA) say it is not their jurisdiction. Predicates and precedents exist. Menstrual cups are already distributed by Marie Stopes in Uganda but the contraceptive aspect of the device will require a clinical trial like those conducted by FemCap and the PATH developed SILCs Diaphragm. I'm in consultation with Nancy Muller of PATH on the process they followed for product approval in Uganda.
Who are your end users?
Adolescent girls ranging in age from 13-19 living in Bidi Bid refugee settlement are our end-users. These girls are in great need of comprehensive reproductive education and provision of safe, affordable, easy to use and effective products to manage menstruation and prevent unplanned pregnancy. We hope at minimum 5k girls per year will benefit from product, knowledge, and support delivered effectively. Self-confidence is negatively affected when menstrual pads are unavailable, in short supply as they are in the refugee settlements - 3 pads per girl per month - and too expensive to purchase monthly. A high percentage of girls are reported to engage in high-risk transactional sex to buy pads often leading to pregnancy, HIV and other STIs.
Christina is 15 years of age. She had many questions and offered open feedback in how she saw the Bfree Duo assisting with their many and great challenges managing their menstrual and reproductive health.
Many of the adolescent girls wanted to know if the Bfree Duo would hurt on insertion or while in place and whether it would prevent them from engaging in physical activities. They asked such questions like 'how often they would have to empty it as a menstrual cup?' and 'how long should they leave the device in after sex as a cervical barrier device?' They were reassured that they would receive thorough training and education on how to properly use and maintain their own personal Bfree Duo.
A discussion with the girls about giving back to their communities, the importance of civic engagement, sharing what they've learned with their mothers, sisters, and extended community.
In consultation with adolescent girls at Self Help Secondary School in Palorinya Refugee Settlement in Northern Uganda, home to over 160,000 South Sudanese refugees most of which are women and children.
Interactive discussion with adolescent girls to get their feedback on the Bfree Duo menstrual cup-cervical cap.
Where will your idea be implemented?
What is the primary type of emergency setting where your innovation would operate?
Tell us more about the emergency setting that you intend to implement in
Bidi Bidi is now host to 272k refugees and Palorinya another 162K. According to Unicef, there are almost 13,836 adolescent girls living in the Bidi Bidi refugee settlement. Our primary proposed implementation setting is Secondary Schools. UNHCR data from February 2017 estimate 4600 adolescent girls combined enrolled in secondary schools in Bidi Bidi and Palorinya Settlements. Language differences must be accounted for but interpreters were readily available during our initial assessment visits.
What is your organization's name?
Women's Global Health Innovations Corp.
Tell us more about you.
WGHI is a social enterprise with creative partner organizations in East Africa. We've been in partnership with NGOs in Uganda for over two years combined, WoMena and PHAU respectively. WoMena will carry out a trainer of trainers program utilizing their comprehensive and established education program designed specifically for Ugandan populations with cultural context integral. Public Health Ambassadors Uganda, PHAU is a youth-led organization creatively targeting menstrual and reproductive issues throughout Uganda. ZanaAfrica provides our business management oversight. I will be focused on this project full time. As a team, we are competent, experienced and highly motivated to fulfill our shared mission to improve SRH for adolescent girls.
Nia Teen Comic has been developed by our partner ZanaAfrica to support knowledge delivery in a creative, personalized, colorful and dynamic way. Knowledge on the changes teens can expect with adolescence is presented in a manner that adolescent girls and boys can personally own, read at their leisure or share in peer to peer discussions.
Some of the contents of the Nia Teen Comic. The comic is printed in on high-quality paper and the content visually engaging with a diverse range of subjects tailored for the complex issues associated with adolescence.
An example of content. Here embarrassing scenarios of adolescence are addressed. Again, using colorful, engaging, and youth-relatable illustrations.
Designing the bfree duo.
3D Rendering of our bfree menstrual cup.
Women's Global Health Innovations Logo
What is the current scale of your proposed innovation?
Regional - within countries in 1 geographic region
Experience in Implementation Country(ies)
Yes, for more than one year.
Expertise in Sector
Yes, for more than a year.
Women's Global Health Innovations is a Canadian corporation. The research team members are currently in Canada and France. Our Implementation partners are registered and based in Uganda.
What is your organizational status?
Registered for-profit company, including social enterprises.
What is the maturity of your innovation?
Existing Prototype or Pilot: Tested a part of my solution with users and am iterating.
How has your idea changed based on feedback?
Our marketing and branding approach changed due to feedback from the adolescent girls. We're now in communication with dkt International who primary expertise is social marketing to oversee our marketing and branding campaign. Also, feedback from the girls, Head Masters of schools, Office of the Prime Minister, UNHCR and NGO representatives strengthened our resolve to implement the Bfree Duo programme in the shortest timeline possible. Feedback honed our perspective on the logistical challenges given the isolation of the refugee settlements enforcing the importance for cyclical ideation, iteration, implementation, and testing of the product and knowledge delivery. Visiting the refugee settlements in person informed a clearer perspective on the many challenges related to distribution logistics, communication strategies, and systems designed for sustainability and continued support. We saw firsthand the evidence of the fewer spaces made available for adolescent girls to attend school.
We are presently in talks with dkt International to design and implement our social marketing campaign as opposed to working with more traditional marketing firms we've interviewed, for example, McCann or Huge Inc.
Brainstorming at the WoMena office in Kampala, Uganda on initial iteration of a program design and implementation to deliver knowledge, support, product, create M&E indicators and a feedback loop to improve the chance of success for the Bfree Duo to sustainably address the menstrual and contraceptive needs of adolescent girls and women in Palorinya and Bidi Bidi Refugee Settlements.
Who will implement this idea?
This idea will be implemented in a collaborative and team effort. I will devote a full-time effort both in Canada and on the ground in Uganda. The partnership will include PHAU overseeing the Edutainment design and implementation. WoMena will initially train 20 trainers on SRH and product knowledge. Felix Mubuuke will oversee monitoring, evaluation, accountability, and learning. It is also anticipated that this partnership team will include IDEO to assist with design, prototyping, implementation, and assessment throughout the project's 18-month grant phase and hopefully beyond. Two full-time (FT) and one part-time (PT) staff will support from Canada, 1 PT in France, 3 FT with PHAU, and 3 PT with WoMena both in Uganda. Felix will consult PT from Palorinya Refugee Settlement.
Using a human-centered design approach, you may uncover insights that lead to small or foundational changes to your organization’s existing strategy or processes in order to unlock the potential of your idea. How would your organization go about making such changes?
Strategic and foundational changes are anticipated especially when integrating a human-centered design approach. Currently, final decisions are made by me, the founder, but only after broad consultation with the entire team and our advisors. As a start-up company, strategies, and processes are still fluid and buy-in is made in collaborative consultation. Our shared values in regard to our mission to make a positive social impact for adolescent girls living in extreme poverty and displaced by violence, war and disaster have helped us build a strong, creative, and experienced business team with shared goals and a long view to go to scale. We anticipate challenges and welcome foundational changes necessary to unlock the potential and sustainably realize our idea, goals, and mission.
What challenges do your end-users face? (1) What is the biggest challenge that your end-users face on a day-to-day, individual level? (2) What is the biggest systems-level challenge that affects your end-users?
The biggest challenge for adolescent girls is maintaining their reproductive health, accessing enough menstrual pads and discreet contraception methods. Only 3 pads are distributed to girls per month. This is far from adequate as they need at least 3 per day for often 5+ days. Most report the time spent trying to source more pads and often resorting to unsanitary solutions. Additionally, the menstrual pads chafe and the associated odor is embarrassing. The lack of facilities to dispose of the used pads is a problem. Most girls throw them in the pit latrines resulting in premature fill-up and irreparable blockages. The greatest systems-level challenge is logistics. Distribution of menstrual pads is done monthly. Accessing contraception is complex, socially and systematically challenging.
Meeting with representatives of MTI in Palorinya Refugee Settlement. MTI oversees all reproductive health delivery in Palorinya Refugee Settlement. They shared the overriding challenges relating to contraception acceptance indicating side effects as a major barrier and the need for non-hormone based contraceptive technology development.
Tell us about your vision for this project: (1) share one sentence about the impact you would like to see from this project in five years and (2) what is the biggest question you need to answer to get there?
IMPACT: By 2023, we aim to scale to reach a minimum of 25k+ adolescent girls combined in Refugee Settlements with Bfree Duos, supporting edutaining sexual and reproductive health education and training of 100 trainers in partnering NGOs to provide continued local support and increase product uptake.
QUESTION: How do we measure our model to know when and where to adjust so as to effectively, accountably, and sustainably expand to meet the needs of adolescent girls more broadly across Africa?
What is it that most attracted you to Amplify instead of a more traditional funding model?
OpenIDEO's Amplify's human-centered design approach is hugely exciting, inspiring and motivating. The opportunity to collaborate with OpenIDEO's outside the proverbial box, dynamic, creative and iterative approach to solving some of the greatest global reproductive health challenges for girls 'amplifies' my enthusiasm that our programme will be validated in a shorter timeline. More traditional funding models in my experience tend to be top-down focused with end-user feedback largely neglected.
Do you intend to implement your Amplify idea in refugee camps / temporary settlements?
We aim to implement our Amplify idea in a refugee camp / temporary settlement.
How long have you and your colleagues been working on this idea together?
How many of your organizations’s paid, full-time staff are currently based in the location where the beneficiaries of your proposed idea live?
Is your organization registered in the country you intend to implement your idea in?
We are a registered entity, but not in the country(ies) in which we plan to implement our idea.
My organization's operational budget for 2016 was:
Between $100,000 and $500,000 USD
What do you need the most support with for your innovation?
Business Development / Partnerships Support