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Jennifer commented on The Period Project: A Combined Approach to MHM in Tanzania

Hello OpenIDEO team!
Thanks so much for your feedback! We're thrilled you're excited about our project, as the coordinated approach has such potential. Other questions really made us think. Here are our answers:
1) Our M&E Framework is uploaded which should help clarify our ToC. An overall Program Coordinator has been added to the budget to ensure smooth coordination. Individual inputs and activities from each partner are intertwined to combine and contribute to the long-term outcomes and ultimate goal. The interconnected nature of the project, and the partners, will help ensure continued coordinated workings.
We work closely with Womena, our Ugandan prtner, as our programs are very similar. By collecting data on the same indicators, results have greater validity and generalisability across East Africa.
Our ToC posits that improved menstrual/reproductive health, increased educational outcomes and therefore higher levels of education attained, increased financial independence, and decreased menstrual stigma all contribute to an improved quality of like for beneficiaries.
Menstrual/reproductive health involves understanding of workshop content that can be utilised to produce long-term behavioural change, for example, hanging reusable MMM in sunlight to kill bacteria. Such an action is enabled not only through knowledge, but also through decreased menstrual-related stigma so that both menstruators and non-menstruators are comfortable with MMM hanging in full view. It also involves understanding menstruation, to enable better planning and tracking. Menstrual disorders can be symptoms of underlying causes, and through tracking, menstruators can better understand their body, and be enabled to seek medical attention and receive an accurate diagnosis. Additionally, feeling comfortable every period with the chosen MMM, and not having issues such as itching, chafing, or bruising, has a major impact on a menstruator’s ability to concentrate at school, or participate in all activities and aspects of life, especially the more physical ones.
Decreased menstrual stigma within schools and the community frees menstruators to practice healthier and safer MHM habits, and partake in more daily school, work, and social activities that are valuable for mental health. Taking a community-based approach, which includes activities such as government, school, and parent meetings, and Last Mile’s presence in the community, ensures that education and inclusive messaging is spread beyond direct beneficiaries. The 321 hotline, although targeted for menstruators, is an open resource available to anyone who wishes to access the information, with the long-term goal of having a section for non-menstruators as well. The informational posters Femme will hang in schools will also be targeted towards men and boys, to help create a more supportive environment for menstruators.
With greater confidence and agency, improved ability to concentrate in class, and reduced absenteeism, schoolgirls are more likely to achieve better academic results. This means they are more likely to enrol in higher education, and research has demonstrated that women with higher levels of education are healthier and contribute significantly to their community’s development and their country’s GDP. Additionally, they are more likely to use family planning and practice safe sex, have fewer children, have healthier children, and prioritise education for their children. Prioritising girls’ education over subsequent generations will significantly decrease gender inequalities in schooling and job/hiring sectors, which will in turn further promote environments that are conducive to girls’ education.
2) The Last Mile component has been expanded to include more SRH products: condoms, a laminated calendar with whiteboard marker to track periods (not beads, because period lengths range from 21-45 days in adolescence), Marni Sommer's 'The Puberty Book' written in Tanzania, family planning methods via partnership with local clinics, Panadol, individual Femme Kit items, and several kit options.
3) Twaweza includes government partnerships and parents' meetings to ensure sensitisation and cooperation, avoid parents not allowing daughters to use products, accusing daughters of having sex because they track their periods, or reinforcing other common myths. Viamo's hotline is based on the most commonly asked questions Femme receives and will be updated semiannually. It doesn't require smartphones or literacy to access. Last Mile is developing financing scheme because menstrual products unaffordable upfront, especially cups. The Twaweza Program has question periods because we're not allowed to directly address sex-ed in schools - it will instead be emphasised at the community level. Teachers' workshops occur separately from students' because of abuses, forced pregnancy tests, & ensuring girls are comfortable to ask sex-related questions without teachers thinking they are having sex

Thank you so much, Steven!

-There haven’t been any for GWD, as far as we know, which is why we proposed this project. This community-based, educational approach is one Femme has been developing in our MHM education programme, knowing the importance of community involvement
-MHM for GWD is in its infancy, and results will provide a basic blueprint for future projects in similar settings
-This population suffers from double discrimination; having a disability, and being female. That is why workshops and sensitisation for the greater community, such as Kungwis (impart knowledge and wisdom regarding menstruation and SRH to teenagers), BWD, parents/caregivers of GWD, and key government staff are included
-GWD are the primary focus. Working with those around them to address taboos and myths will enable a safer, healthier, and more confident MHM
-Both. Femme’s experience has shown that simply supplying a MMM is insufficient. Uptake is often low and usage flawed. By tackling wider-held myths, we aim to create an environment that supports the menstruator, whether or not she is a GWD
-The Training of Trainers with Kungwis will ensure information is passed on to all girls. Building the capacity of YDCP staff on MHM will positively affect future GWD who attend. Key government officials who participated in FGDs will attend workshops, to raise awareness of the issues GWD (and all menstruators) face, and contribute to supportive, informed policy-making
-The pilot ran in 2016 in Moshi, TZ with 15 GWD and their caregivers, a very limited scope. We learnt that M&E data collected from caregivers is very poor, and are modifying tools to collect information from GWD. The curriculum needs to be more user-friendly, based on needs assessments and in consultation with YDCP staff. Teachers need to be trained in order to maximise learning. BWD and male caregivers need to be included, and relationship/SRH issues taught
-Femme has seen no participation from GWD. We work primarily in secondary schools, and communities, and people with disabilities are generally excluded from these settings due stigma. Most children with disabilities (CWD) are left at home without education. In the community, CWD are generally considered useless; training or educating them is a waste of time. The pilot with GWD in Moshi is one of the first examples of MHM addressing the unique needs of this hard-to-reach population
-Myths, taboos, and misinformation abound and pervade all aspects of life, and it is often not enough to debunk the myth; respected community leaders must be on board, hence the community-based approach. Menstrual blood is generally thought to be cursed in some way, or hold destructive powers. Menstruators cannot touch living things (plant, animal), restricting their activities, especially if their income is food- or farming-related. Anyone knowing another’s menstrual status (especially a male) is an huge shame that affects how MMM is sourced, washed, dried, and stored. 99% of secondary school WASH facilities in Tanzania are inappropriate for a menstruating girl: no doors/locks for privacy, light to see, space to change, water/soap, or disposal. Along with verbal abuse from male students and teachers, girls are more likely to miss altogether, or leave early to change, increasing the risk of falling too far behind and dropping out. Fathers aren’t told when their daughter reaches menarche, as he may want to have sex with her. Menarche is traditionally seen as a sign girls are ready for sex, marriage, and children, and are married off or viewed differently In Tanga, menstruators may not cross a crossroad or sit near a male, which severely limits their movement and has consequences for economics, health, and safety of both individual and family. Girls have far less power in society, and Femme has found that supplying them with a MMM is useless if parents/community resist the product or the teachings. Parents, communities, elders, and policy-makers need to be included as well, which is one of the reasons we have expanded the scope of this proposed programme to include Kungwis to help the community overcome resistance towards modern MMM
-No comprehensive or standardised indicators exist for MHM and programme success; Femme is currently developing indicators in partnership with 2 MHM NGOs in East Africa. Our logic model gives an idea of the milestones and indicators that would be success
GWD using their MMM MHM (safely washing, drying, and storing)
Increased knowledge of puberty, anatomy, menstruation, SRH Health (decrease in symptoms related to poor MHM, unsafe sex)
Increased agency for GWD (increased confidence, feeling of importance, feeling that have a voice)
Decreased stigma for all menstruators (Kungwis and families not perpetuating myths)
Kungwis teaching (all) girls about good MHM, SRH, increasing their confidence in themselves and ability to manage their periods, not emphasising sex, antiquated gender roles, and shaming/abusing girls in their charge