September 2016

  • Achieving the Sustainable Development Goals

    The Sustainable Development Goals (SDGs) seek to end poverty and hunger, realise universal human rights, achieve gender equality and the empowerment of every woman and girl, and ensure the lasting protection of the planet and its natural resources. Our Public Affairs Officers shared their thoughts on achieving the global goals.

August 2016

July 2016

June 2016

  • Trachoma is the world’s leading cause of preventable blindness. Young people with trachoma are unable to go to school, while adults are unable to work or care for themselves and their families. According to the local health department, Simanjiro district in the Manyara region of Tanzania has a trachoma prevalence rate of 65%.

    The biggest causes of trachoma’s continued existence are: 1) open defecation, which is partially practiced due to low latrine coverage (an average of 23.7%); 2) traditional norms and customs that don’t encourage good sanitation (e.g. toilet use use of toilet and good hygiene practice). Once contracted, the disease spreads due to poor sanitation and hygiene practice. The situation is further complicated by a limited water supply. Due to prohibitively high running costs, the most common source of water is boreholes.

    To prevent the further spread of this fast growing tragedy, the trachoma elimination strategy we have adopted, SAFE (Surgery, Antibiotic, Face Washing and Environmental Sanitation), needs more stakeholders to shift their focus from curing the disease to preventing it. Our SAFE Project will focus on prevention through a comprehensive WASH programme that will emphasise the importance of facial cleanliness, hand washing and environmental sanitation.

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    Overall objective

    To prevent the spread of trachoma by changing community behaviour towards good personal hygiene and environmental sanitation practices within the project areas. We will do this by implementing the WHO strategy on eradicating trachoma in an integrated WASH intervention.

    Specific objectives

    • To improve sanitation and hygiene practice at schools and in the community through education and campaign programmes to minimize the spread of trachoma.
    • To build community capacity and strengthen managerial competency to sustainably manage the existing water scheme,
    • To build community capacity and raise awareness of trachoma prevention and control measures at early case identification for treatment.
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    Together with local partner CBHCC, Simavi implement the Trachoma SAFE Communities programme to prevent the further spread of trachoma by changing community behaviour towards good personal hygiene and environmental sanitation practices within the project areas. We will do this by implementing the WHO-implemented SAFE strategy on eradicating trachoma in an integrated WASH intervention.

    The SAFE-strategy stands for Surgery, Antibiotic, Face Washing and Environmental Sanitation. Within our programme, Simavi will specifically focus on the Facial cleanness (F) and Environmental sanitation (E) components of the SAFE Strategy.

    There are eight main strands to our approach:

    1. Create awareness amongst stakeholders at different levels to facilitate achievement of the project’s core objective.
    2. A baseline survey on hygiene practice in the community.
      We’ll use different tools to identify environmental sanitation and hygiene practice in schools and the community. For example, pupils will be given a checklist to fill out under the supervision of school health teachers.
    3. Identification and Training of Community Owned Resource Personnel (CORP).
      CHBCC will recruit CORPs who will be responsible for raising awareness of facial cleanliness and environmental sanitation information among their fellow community members. They will also contribute to eliminating trachoma disease within project areas by using different approaches, including Community Led Total Sanitation (CLTS), Participatory Hygiene And Sanitation Training (PHAST), and a Rights Based Approach (RBA). CORPs will be carefully selected and must be literate, locally resident and acceptable to the community.
    1. Identification and Training of Artisans.
      Together with the community, CBHCC will select artisans to be trained in two wards. These artisans will be responsible for the construction and rehabilitation of latrines in his/her community. In addition, the artisans will also disseminate personal hygiene behaviour and environmental sanitation information so that every household in the projects areas has access to a latrine and knows how to use it properly.
    1. Training of school head teachers and health teachers.
      In cooperation with head teachers and school committees, CBHCC will select health teachers, who will in turn select health club members to be role models and ambassadors for personal hygiene and environmental sanitation in schools. These school health club members will use different approaches to scale-up personal hygiene and environmental sanitation messages to other pupils (and the rest of the community). These will include Child Hygiene And Sanitation Training methodology and a Child-to-Child approach. The school health club members will contribute to eliminating trachoma disease within, and outside,  school by ensuring every pupil is a watchdog for personal hygiene and environmental sanitation.
    1. An inter-school personal hygiene and environmental sanitation competition.
      In collaboration with ward education officers, ward health officers, school head teachers, school health teachers and school health club members, CBHCC will organize an inter-school personal hygiene and environmental sanitation competition based on school personal hygiene and environmental sanitation status.
    1. Participation towards a WASH commemorative calendar for advocacy.
      In cooperation with Simanjiro District CBHCC will participate to an exhibition of a WASH commemorative calendar for advocacy at different levels, including water week, hand washing day, toilet day and trachoma disease events. This will scale up trachoma prevention, raise awareness among different groups at different levels and increase networking between stakeholders.
    1. Identification of community role models for advocacy
      Together with the community CBHCC will identify individual role models in two wards who will scale up trachoma prevention and control practices in their community for eliminating open defecation. These volunteers will also collaborate with selected CORPs and artisans to share ideas and scale up positive personal hygiene and environmental sanitation practices in their communities.
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    The implementation phase of this programme will fully start in 2017. We conducted some activities in 2016, but spent most of the time in inception phase and preparing baselines.

    # trainers trained to include WASH and trachoma sensitisation in their school curriculum (target 2016: 16, realisation 2016: 16)
    # hand washing facilities built or rehabiliateed at schools (target 2016: 8, realisation 2016: 8)
    # school health ckubs that have been established or activated to provide hygiene promotion and education (with a focus on facial and environmental cleanliness to prevent trachoma) (target 2016:  10, realisation 2016: 8)
    # schools where WASH sensitisation campaignes are organised (with a focus on facial and environmental cleanliness to prevent trachoma) (target 2016: 10, realisation 2016: 8)

    Situation Approach Result
  • 3 Questions

    Hilda Alberda is Simavi’s Director Monitoring, Evaluation and Learning and an expert on Menstrual Health. In 2016, she was invited by Léo Heller, the UN Special Rapporteur on the Human Right to Safe Drinking Water and Sanitation, to take part in an expert consultation on ‘Gender equality in the realisation of the human rights to water and sanitation’. Together with a group of experts, Hilda discussed topics such as menstruation, specific challenges that women face in accessing WASH, and how to combat gender-based violence related to water and sanitation – in short, a lot of issues close to Simavi’s heart.

May 2016

  • More than one fifth of the world’s population consists of women of reproductive age. On average, a woman spends seven years of her life menstruating, making menstruation a natural and essential part of the reproductive cycle. In addition to menstruation, women also experience other forms of vaginal bleeding and at the end of the reproductive cycle they experience menopause. It is an essential human right to have the ability to manage menstrual health and all other forms of vaginal bleeding with adequate knowledge, safety, and dignity and without stigma. Menstruation is a highly relevant theme in Bangladesh as it plays a role in the interplay between health, hygiene and development issues.

    Though MH has recently gained attention in the global development agenda, it is still a taboo topic in many countries, including Bangladesh, where cultural beliefs and social norms restrict the participation of women and girls in society during menstruation. Furthermore, women and girls lack access to the information, products and infrastructure that is needed to manage menstruation with dignity. This has a severe impact on their health, well-being, and the realisation of their rights. It should be noted that adolescent girls, and girls and women living with a disability, are especially vulnerable to negative outcomes related to menstruation, including effects on their overall self-esteem and confidence.

    Bangladesh is currently experiencing rapid economic growth and industrialisation. As well as the rest of the country, this also has a positive impact on the situation of Bangladeshi women and girls, as shown by more girls enrolling in junior secondary school, girls and women’s improved academic performance, and more young women participating in (formal) employment.

    At the same time, Bangladesh remains a country with deep-rooted cultural traditions that determine gender roles and form the basis of gender discrimination against girls and women. Many Bangladeshi girls and women face malnutrition and gender based violence, while child maternal mortality rates are high. The Ritu programme is positioned within this contrast of steady economic growth and regressive social and cultural barriers that prevent girls and women from exercising their basic rights.

    The Ritu programme

    Ritu is a girls ’name and means ‘season’ in Bengali and is also used to indicate menstruation in Bangladesh. A suitable name for a programme that aims to promote improved Menstrual Health (MH) among school-going girls in Bangladesh.

    Read the study protocol here.

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    Expected impact

    • Improved health and well-being of girls between 10 and 13 years in Netrakona, Bangladesh.

    Specific objective

    • Improve menstrual hygiene and related well-being of girls between 10 and 13 years in Netrakona, Bangladesh.

    Outcomes

    • Increased knowledge and improved attitudes and practice on menstrual hygiene of girls, boys, men and women.
    • Increased commitment towards menstrual hygiene management by the government and civil society in Bangladesh.
    • Women and girls have access to better MHM facilities at schools and affordable (biodegradable) sanitary napkins.

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    Together with RedOrange -a Bangladeshi  media and communication agency-, knowledge institute TNO, and with support of the Embassy of the Kingdom of the Netherlands (EKN), Simavi implements the Ritu programme to promote menstrual health in Bangladesh. Our main goal is to structurally improve the health, wellbeing, and social and economic participation of girls between 10 and 13 years old.

    The Ritu Programme consists of three main elements: 1) the interventions in Netrakona that are directly targeted at school girls, 2) a national communication and advocacy campaign, and 3) the development of a biodegradable sanitary pad.

    The programme started with a six month inception phase, that provided us with the opportunity to consult existing rigorous evidence on menstrual health programming in Bangladesh and on a global level. Based on this information, gaps were identified and used to design our formative research. Based on the information gathered, the final mix was further defined in a series of workshops with the partners and with the support of the Impact Centre Erasmus University (more information on Evidence Informed Programming can be found here). 

    1. Empower girls, women, men and boys (communities) to have a better understanding of MHM and engage in healthy behaviour, including accessing safe and quality MHM services.

    In Netrokona, Bangladesh, Simavi combines WASH and SRHR interventions in schools and communities to improve overall well-being of girls during their menstrual health as part Ritu programme. Simavi works with two local partners: BNPS, that implements the training of teachers and parents on menstrual health and DORP, that realizes gender sensitive toilets through a resource mobilisation method.

    The programme in Netrakona consists of an evidence informed mix of interventions that is carefully sequenced. Based on the idea that toilets need to be in place in order for girls to practice their newly learned behaviour, our interventions in schools are sequenced as follows: 1) kick-off in schools to inform teachers and students about the programme, 2) budget tapping process with students and School Management Committee to realize toilets, 3) training of head master and 10 teachers and parents of the school girls.

    To ensure a conducive menstrual health environment in schools, BNPS trains an average of 10 teachers per school, in addition to the headmaster. The comprehensive manual that is used for the training of both teachers and parents is rights-based, is based on WASH and SRHR information and combines key information with interactive exercises. Topics range from the reproductive cycle, gender, the role of men, influence of contraceptive use on menstruation, to negotiation skills, good practices to maintain hygiene, guidelines for girl friendly toilets and nutrition. As part of the training, BNPS works with teachers to integrate the different sections of the manual in the existing lesson plan in correspondence with the national curriculum. The quality and progress of the training of teachers and the implementation of the new knowledge and skills in the class room is carefully monitored by the partners and Simavi’s Ritu team. Support systems and refresher trainings are designed based on the progress of teachers and the overall school environment against the set indicators.

    Menstrual Health Training Manual 

    To ensure that in addition to the school environment, girls are supported to improve their menstrual health at home, BNPS trains the parents of the girls following the same manual as is used to train the teachers. The sessions are supported with printed information and education materials that RedOrange  developed  together with Simavi.

    1. Build an enabling environment in which government and civil society actors show more commitment towards MHM.

    As part of their communication strategy, our partner RedOrange developed and implemented a range of edutainment materials and events that aim to influence the national discourse on menstrual health. This includes the Ritu website and Facebook Page. RedOrange also produced a successful TV Series called The Best School for Girls. Together with Simavi, RedOrange also organised the launch of the Ritu programme and the yearly celebration of MHM Day.

    As part of the Simavi programme, Simavi brought together a range of different stakeholders from SRHR, WASH, Education, Government and the Private Sector, working on menstrual health in Bangladesh. Together, these stakeholders formed the MHM Platform that is chaired by our partner BNPS. The members of the platform jointly advocate for integration of menstrual health in the Teacher Training and Secondary School curricula as well as for the implementation of gender sensitive WASH in schools.

    Simavi has also trained local NGOs on menstrual health to strengthen their capacity following our MH manual.

    1. Ensure that affordable and sustainable MHM services are in place and utilised.

    Our local WASH partner DORP works closely with School Management Committees and groups of parents in communities to realise gender sensitive toilets. To realize these toilets, DORP implements a social accountability approach named budget tapping. This approach builds on a joint budget tapping exercise where DORP mapped budget available for sanitation in schools at different government levels in Bangladesh. This exercise identified a discrepancy between budget allocated by the national government and the actual expenditure on district an union level. Through the budget tapping approach, DORP works with schools to allocate money for MHM friendly toilets from school and where needed to access available government budget. School Management Committees and students are empowered to use social accountability methods to voice their demands to Union or District level government representatives. At the same time, DORP raises awareness of local government representatives on the importance of MHM friendly toilets and supports the budget allocation process.

    As partner in the Ritu project TNO took the necessary actions to ensure that biodegradable sanitary napkins will become available in Bangladesh. The collaboration of TNO and the Dutch company Rodenburg Biopolymers since 2016 resulted in coming to a successful recipe for the industrial production of biodegradable thin foil at an affordable price. This foil is made of an innovative blend of potato starch and clay and can be used as water resistant ant-leakage layer in sanitary pads. Based on this business case analysis it is shown that biodegradable sanitary napkins can be sold for 0,05 US dollar per napkin which is equal to the current lowest price for which basic napkins are available in Bangladesh at the moment. TNO is working with a Bangladeshi sanitary pad producer to produce biodegradable sanitary pads using the foil.

    Ensuring programme quality

    Simavi works closely with Impact Centre Erasmus University to ensure programme quality. For example, the different trainings that are part of the programme have all been piloted to ensure that these resulted in the wanted change in knowledge and skills. Furthermore, the quality and progress of the training of teachers and the implementation of the new knowledge and skills in the class room is carefully monitored by the partners and Simavi’s Ritu team. This means that Simavi also monitors the capacity of staff that implement the trainings. Support systems and refresher trainings are designed based on the progress of teachers and the overall school environment against the set indicators. 

    Randomized Controlled Trial

    In addition to in-depth monitoring of quality and progress, the programme is evaluated through a Randomized Controlled Trial (RCT) in close collaboration with the Maastricht University and Johns Hopkins University. With this RCT we aim to contribute to the current evidence base of MH programs by conducting the first large scale RCT study on the impact of a MH program. We aim to i) compare the school attainment and psychosocial wellbeing of girls across our control and treatment groups, ii) analyze the exact costs per treatment and its cost-effectiveness and iii) explore how the school-level and household-level intervention components affect the lives of girls and iv) analyze the change in perceptions of MHM among pupils, teaching staff and parents.

    Read the study protocol here.

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    This programme is still running up to March 2020. A thorough needs assessment , a baseline as well as a programme evaluation have been conducted. The final programme report including the RCT findings follow after the end of the programme.

    Situation Approach Result

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