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The situation around menstrual hygiene and health in Uganda

Published on: 26/05/2021

Government of Uganda has since 2014 intensified and set the discourse for Menstrual Hygiene Management (MHM).

 

Through the MHM Coalition hosted in the Gender Unit of the Ministry of Education and Sports (MoES), MHM efforts have been promoted including Parliamentary discussions on MHM and incorporation of MHM in the National Development Plan. In 2020, with funding from the Water Supply and Sanitation Collaborative Council and coordination by IRC Uganda, the MoES embarked on the development of a five-year national strategic plan for Menstrual Health and Hygiene.

The process started with a situational analysis of how MHH issues were currently being addressed in relevant sectors. This was followed by a mapping of MHM partners, programmes, approaches and tools. The Situation Analysis report presents the findings of the situational analysis, describes the MHH challenges, and presents recommendations for the way forward.

This article presents a summary of the study findings and provides a status update on the recommendations of the study, by the Government of Uganda.

A quick summary of the study findings

 

knowledgegenerally knowledge about MHH is limited. The role of parents in passing on basic knowledge and information is minimal. Culture locks men and boys from women's menstrual issues.
access to informationright and adequate MHH information is limited. For school girls, a major source of information are schools (61%), peers (45%), workmates (37%) and CSOs/NGOs (27%). 
access and use of MHH materialsdisposable pads are most commonly used among school girls and career women. Due to prohibitive costs, girls and women especially in the rural areas resort to using pieces of cloths as alternatives. 
access to waterof the 353 respondents (comprising of girls, boys, teachers, community men and women), only 207 representing 59% had regular access to water. Most water sources in schools are not conveniently located near wash rooms and changing rooms. 
access to sanitation facilities86% of the districts have separate school toilet facilities for boys, girls and staff. Pupil stance ratio ranges from 49:1 to 103:1, over and above the national standard of 45:1. Less than 50% of schools had wash rooms. Changing rooms are a rare facility in schools as are handwashing facilities. ~20% of girls and boys indicated having a handwashing facility at school. 
waste disposal80% of girls and women dispose their used pads in latrines. Other places for waste disposal include bushes and rubbish pits. There are concerns that some cultures prohibit the burning of used menstrual pads. 
access to other MHH supportonly 3 of the 14 districts provided emergency clothing at school. Out of the 79% women and girls that indicate experiencing menstrual pain, only 28% have access to pain killers. Few schools were found to provide soap and basins to the girls and female teachers. Only 30 out of the 120 teachers interacted with indicated having had a training in MHM. 
social challengestraditional life styles in some communities impede a shift to adoption of better menstrual hygiene management practices. Low education levels affect the adoption of modern MHH practices, especially in rural areas. 
economic challengeswidespread poverty especially in rural areas limits women and girls to afford decent, sanitary materials like pads. Schools have limited funds to provide basic facilities, like water, wash and changing rooms, rest rooms, handwashing facilities, and drying facilities. 
environmental challengespoor menstrual waste disposal is largely attributed to lack of resources to provide appropriate facilities. Waste disposal education is not emphasised under the hygiene and sanitation programmes.
Structural and institutional challenges 
  • WASH committee structures in schools are either non-existent or non-functional. 
  • Teachers are faced with inadequate training in their roles and responsibilities.  
  • There is a lack of a standardized package for MHH information. 
  • Loose MHH coordination mechanisms and structures at national level affects effective MHH at different levels.  
  • The role of the health sector has been observed to be minimal in addressing some of the MHH information gaps.  
  • The public health work force is limited especially in districts. This is worsened by limited availability of resources, affecting public education and programming at both national and decentralised level.  
  • There is a weak link between menstrual health and reproductive health in programming. 
  • Civil society organisations are not offering and training girls and women and others on the whole MHH comprehensive framework. One or two elements are often emphasised (mainly pads), affecting programming and prioritisation in implementation of MHH and all its components.  
  • There is a general lack of a MHH policy to provide government direction/ trajectory, guidance, accelerate programming and propel budgeting in MHH by different stakeholders.  
  • Limited research and documentation about MHH programmes, approaches and best practices have partly affected advocacy for MHH implementation. 
  • There are limited public private partnerships to support implementation of MHH in the various settings. 
  • There is no direct government financing for MHH programmes. Most funding is integrated in nature thus affecting focus on addressing major MHH issues. 
  • There are weaknesses in enforcing regulatory standards for the production of MHH materials such as sanitary pads. Although the Uganda National Bureau of Standards (UNBS) provides Guidelines (2017) for the manufacturing of MHH products (e.g. the re-usable pads), their enforcement of the provisions contained therein is a challenge.  
  • Women and girls have limited awareness about their MHH sanitary consumer rights and therefore cannot hold the manufacturers accountable for any defects and side effects during usage. This exposes the consumers of such products to health risks. 
Follow up on recommendations 

Based on the findings the Ministry of Education has developed a series of recommendations, of which the full set can be found in the report. Till date, the Ministry has made progress by:

  • disseminating the Situational Analysis report to district and national level stakeholders  
  • developing a National Strategic Plan for MHH and sharing this with relevant sectors 
  • carrying out a costing activity of the plan with these relevant sectors 
  • developing and printing guidelines to operationalise the MHH actions in the school settings. 

Next to the above actions, the report expressed the need to develop a multi-stakeholder approach towards MHH interventions and the need for a clear and formal multi-sectoral coordination mechanism for menstrual hygiene management at all levels in the country; from national to local government level. As a first action on this, a Terms of Reference is being developed for constituting a National inter-ministerial Steering Committee.  

And while current MHH interventions focus mainly on public primary schools, the Ministry adopted is now spearheading the development of a training manual for women and girls out of school on MHH.  

 

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