Integrating, collaborating and building capacity for menstrual hygiene management

Published on: 23/05/2019

Kenya is recognised as one of the countries that have made progress in policy, processes and practice relating to menstrual hygiene management (MHM). It provides key lessons to other sub-Saharan countries that would like to improve MHM as a crucial aspect of SDGs and related efforts to leave no one behind.

Against that background, the Water Supply and Sanitation Collaborative Council (WSSCC), through IRC Uganda organised a three-day learning visit to Kenya (April 23rd-25th), which attracted ten WASH professionals from the Ministry of Education, Ministry of Health and Ministry of Water and Environment, Water for People and Uganda Water and Sanitation NGO Network (UWASNET).

Hosted by the Kenyan Ministry of Health, the ten-strong delegation from Uganda was led by Julian Kyomuhangi, Commissioner Environmental Health, Ministry of Health. The delegation engaged in a wide range of activities which mainly involved meetings with Kenya Ministry of Education and Ministry of Health; meeting with the Kenya Hygiene Technical Working Group; meetings with key officials and CSOs in Kwale County; and visiting MHM intervention sites in Samburu Ward. The visit was crowned with a reflection on key lessons learnt, and proposed actions for the Uganda MHM coalition.

Key lessons from Kenya

Coordination and Collaboration: The MHM programme in Kenya is government led, with the Ministries of Health, Education and Gender working closely through an MHM working group. A joint annual plan exists, which makes it easier to mobilise resources. The Ministry of Health plays a crucial coordination role bringing together all key stakeholders in MHM including Community Based Organisations, Faith Based Organisations, NGOs, UN-agencies, private Sector and social enterprises. This is done through the Inter Agency Coordination Committee (ICC) and Hygiene Promotion Technical Working group. The Hygiene Promotion Technical Working group and the supporting MHM taskforce coordinate all activities related to the development of the MHM Policy & strategy, capacity building of key stakeholders and addressing standards of menstrual products.

Integration: The realisation that MHM is not a standalone and it relates with other issues like food security, poverty, reproductive health. MHM proponents are using existing structures to push the agenda of MHM. Integration was also observed beyond just institutions but also in terms of activities implementation – integrated in activity budgets. Integration was also observed at household level where MHM has been integrated with Community Led Total Sanitation (CLTS). Integration and joint planning have made it possible to accelerate resource mobilisation and fill the funding gap for MHM.

Capacity building: Kenya has invested in MHM capacity building at national, county and community level. With support from WSSC, the Ministry of Health undertook capacity building for six (6) master trainers on MHM in India. The six have since conducted a series of trainings across the country at national and county level – Training of Trainers (TOT) at national level and training of MHM champions at county level, starting with county first ladies who create an entry point for MHM advocacy. In Kwale county alone, a total of 77 people from the four sub counties were trained in MHM. Several MHM training tools have been developed. These include but are not limited to; the National MHM Training Manual; menstrual wheel; booklet titled "As We Grow Up", conveners manual and WASH infrastructure handbook.

Policy and guidelines: Kenya has clear policies and guidelines on MHM and sanitation, which guide action planning and implementation. MHM interventions and progammes are anchored in a strong legal and policy framework, staring with the Kenyan constitution which recognises MHM as a human right. Basic education Act amendment 2017 provides for free sanitary pads for menstruating girls in primary school. Other legal instruments are: Draft Environmental Health and Sanitation Bill; National Environmental Management and Coordination Act (Waste management regulations 2006); Adolescent Sexual and Reproductive Health Policy 2015; National School Health Policy; Kenya Environmental Sanitation and Hygiene Policy 2016-2030; Draft National Reproductive Health Policy; Draft Neonatal Child and Adolescent Health Policy; Draft Menstrual Hygiene Management Policy and Strategy awaiting endorsement from the PS-MOH Kenya and the Ministers of Education, Health and Gender.

Involvement of prominent personalities at national and county level: Working with prominent people as MHM champions is a good approach e.g the first lady of Kwale and other first ladies.

Innovative approaches like the MHM lab are key for information sharing.

Work through the school management committee at school level since they are the decision makers who support the head teacher.

The disposal of MHM waste products is still a challenge.

Action points for Uganda:

• Develop an MHM policy and strategy, anchored in an Act of Parliament.
• Promote multi-sectoral approach while integrating and mainstreaming MHM. Bring on board line ministries, private sector, etc
• Jointly plan and develop a five-year MHM plan for the country, under the coordination of the National Sanitation Working Group
• Strengthen the school health programme
• Undertake an MHM stakeholders mapping exercise
• Need to develop and M&E frame work for monitoring and Evaluating MHM interventions
• Documentation and sharing of MHM interventions with the wider audience
• Identify and continuously engage MHM champions. This has to be done strategically through well packaged information and tools for the Champions. Delegates in this learning visit should be champions themselves. Also involve other prominent personalities like the First Lady and Minister of Education
• Innovate around menstrual waste disposal management-conduct informative research on what works and what does not
• Build capacity of the stakeholders on MHM; starting with a National level TOT in MHM
• Integrate MHM in the Country Engagement Plan (CEP) and the USF
• Organise a media breakfast meeting on MHM and a stakeholders' meeting to share the lessons from this learning visit.

Tips from Kenyans to Ugandans:

• Policy processes may be delayed but that should not discourage actors. Start on the work and it continuously enriches the draft policy
• Don't create cliques. Open MHM for everybody. Anyone who wants entry, bring them in, build their capacity and move together
• Don't use one piece of research to make conclusions. Don't make assumptions. There's a lot of research and data, only that they have not yet been streamlined. Acknowledge that you're not starting from scratch and build on what others have done.
• Integrate MHM into as many programmes as possible, it speaks to many aspects of life. Also consider the ways in which MHM will help accelerate other agendas e.g Uganda Sanitation Fund
• Train and support champions to adopt a common message to avoid mixed messages. Standardizing peoples understanding will require some financial and human resources .
• Government should be the leader and don't create exclusive clubs for partners who only have big budgets. Small NGOs are just as important.

Read the full report below under Resources.