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Thank you @Lunette Projects Lune Group! It is so great to see so many menstrual health related projects taking innovative approach to increasing access to menstrual health information and products. You .Hub concept is very exciting as well and in fact exactly the type of network that we would want to work with collaboratively as part of our scale up model in Uganda!

3) Would be helpful to better understand your pilot or program to-date, what’s worked well what would you like to improve or iterate on? How do you recruit and support women as entrepreneurs in this process? Is this a livable income or supplemental? What’s in the sales toolkit and training?

With funding from the Reproductive Health Supplies Coalition, the MCMAP project evaluated the efficacy of six MC pricing, distribution & payment models for delivering menstrual cups in urban and rural settings in order to scale up availability of menstrual cups to youth (aged 15-30 years) at point of access in Uganda and to promote a policy environment conducive to effective supply and distribution.

Six models were implemented in partnership with Marie Stopes Uganda (MSU), Welthungerhilfe (WHH) & private pharmacies supplied by Ruby Cup Uganda by integrating menstrual cup sales into our partners existing service delivery channels from November 2016 to October 2017. The project resulted in the distribution of 1605 menstrual cups, training of relevant staff within the partner organisations, provision of ICT and marketing materials, stakeholder engagement, local level demand creation activities, continued monitoring and evaluation of sales and activities was well as a policy assessment. The project aimed to sell 285 menstrual cups across the different models, this has been superseded largely due to the success of two sales models, the WHH “Goat and Cup for work scheme” and MS Ladies Model. Sales in MS Clinics, among savings groups and in pharmacies did not take off, however the project has proven that with the right inputs and acceptable pricing, menstrual cup sales are possible.

79% of all menstrual cup sales reached girls and women between the ages of 15 and 30. 34% menstrual cups were sold to girls and young women aged of 15-24. Very encouragingly across the two successful sales models, a number of cups were sold to mothers and grand-mothers to provide cups to daughters and granddaughters.

A key success factor for the two best performing models has been the presence of trusted and motivated community based sales agents and promoters. As a new product, shared experiences from fellow community members has been crucial to building trust in the product. Through community level sensitization and demand creation, we have also seen a marked change in male attitudes. We will now look to build on these experiences for a sales toolkit that can be used across partners. We will also look at increasing cup sales to adolescents through parents and adult relatives, building on the sales strategies employed by successful MS Ladies.

Recruitment of sales agents:
We work in partnership with organizations that have existing distribution channels, as such the sales agents or entrepreneurs are recruited by partners according to their existing mechanisms. In terms of income to sales agents, this will also depend on how the model is implemented by our partners and the level of subsidization or reductions in cup costs achieved during the project. For example, MS Ladies currently purchase cups from Marie Stopes for 10,000UGX and sell the cups at a price capped at 25,000UGX. MS Ladies who have built demand are now selling most of their cups at 25,000UGX and report being happy with the profits made and are regularly restocking. We aim for the menstrual cups to be a product among other goods and thus the income would be supplemental to other sales.

Sales Toolkit:
As part of the MCMAP project we have prototyped different training approaches and ICT and marketing materials. We aim to combine these into a consolidated sales toolkit to support sales agents across partners to deliver information about menstrual cups, build demand and provide continued support. We expect the toolkit to include a refined training session, a set of user friendly, portable ICT materials to aid in knowledge dissemination and a set of marketing materials that sales agents can use. However as this will be developed using a human-centered design approach and in collaboration with partners to fit into their existing training and support processes, the contents and design of the toolkit will be shaped by feedback from partners, sales agents, MC users and potential customers’ and may end up being radically different to our current expectations.

2) Why hasn't existed up to now? Regulation? Financial? Social/cultural? Access (i.e., geographic constraints, etc? and how can your team uniquely tackle some of these barriers?

Womena was born out of an identified need to address the lack of menstrual knowledge and adequate menstrual management methods for girls and women in Uganda. The menstrual cup is still a new product on the Ugandan market. Although Womena has worked with partners to distribute over 3000 menstrual cups in Uganda, expanding to a market based solution is new. Until now menstrual cups are not readily available in Uganda, due to; high commercial price, limited suppliers, lack of registration as a medical product at a national level, low public awareness about the product and lacking SRH knowledge dissemination & education.

Lack of awareness and demand: Although awareness is growing, there is little knowledge of the menstrual cup as an accepted choice for menstrual management in Uganda. As we have noted, as the menstrual cup is a vaginally inserted product, there are some perceived social/cultural barriers related to this. The menstrual cup is also often related to family planning methods and the misconceptions and fears around infertility and cervical cancer that accompany family planning methods often also apply to menstrual cups. Through our work with the menstrual cup in Uganda, we have developed and tested a sensitization and training model to tackle these perceived issues and have distributed menstrual cups through partner organizations successfully across the in a variety of context. We also have established partners who have community based sales agents and facilitators, many of whom are menstrual cup users themselves. Based on information received in training, they are able deliver messages about the comfort and safety of menstrual cups in a contextually relevant way. Our growing cohort of menstrual cup users also contribute to debunking myths and misconceptions by sharing their experiences. We will also leverage the local knowledge of existing sales agents, community facilitators and menstrual cup users to create a sales toolkit that helps our sales agents address these issues.

Lack of supply and high sales cost: There is currently one commercial importer of menstrual cups in Uganda however import volumes are low, the supply network has been limited to pharmacies in Kampala and the sales price is often considered too high. The menstrual cup is sold commercially at 18 – 22 USD. Due to low levels of awareness about the menstrual cup, this sales price is not conducive to increased sales, at the moment. We do expect that with the right market segmentation and increased demand for the menstrual cup, these price levels can be achieved on the long run.

We have already established acceptable sales prices through our pilot project. In order to achieve these prices and maintain momentum build by the pilot, we will look at stopgap subsidization until the commercial price of menstrual cups can be achieved through higher import volumes and diversity on brands available on the market.

Currently the import volumes of menstrual cups are low, this raises the unit price of the cup. We aim to address this by building a better understanding of procurement and import options as part of the project to find optimal import conditions. We also know that cheaper cups do exist on the market, this project aims to create demand and thus a more inviting environment for more menstrual cup brands to enter the market. As we are not tied to a single brand or provider, we are ideally positioned to find solutions that work across partners.

Regulation: The menstrual cup is not currently registered as a medical product in Uganda. As such distribution through public channels is not possible. Through our Market Advocacy approach we will continue to engage the Ministries of Health and Education to solidify support as well as continue our current work in achieving product registration. We have already achieved a tax exemption for menstrual cups which is positively contributing to a more favorable regulatory environment.