This post was written by Dr. Rachel Linn, a specialist in impact assessment. She has a PhD in International Politics and has worked in developing country contexts across Africa and the Middle East. Rachel leads PEAS’ monitoring and evaluation team, which looks after data and evidence across the organisation along with commissioning external research.

Within the international development community, it’s common to insist that NGO programmes need to be designed based on evidence of what works.

As educators who want to use resources wisely to achieve as much as possible against our goals, we naturally are motivated by the same desire for learning from what already has been tried. However, designing a programme based only on what research says works risks mistaking expertise for actual insight.

Our experience at PEAS implementing our Girls’ Education Challenge (GEC) programme in Uganda over the past four years illustrates the need to balance top-down advice from experts with bottom-up feedback from beneficiaries.

As part of the design a holistic programme focused on tackling the barriers adolescent girls face to school participation, we undertook a mapping exercise to identify what hurdles stood in the way. One issue that comes up frequently is the unique challenge of menstruation for girls living in extreme poverty. Disadvantaged girls struggle with the same things women everywhere do – pain, discomfort, a lack of energy – but have the additional challenge of lacking money to buy sanitary products to allow them to maintain their daily activities.

In terms of how this affects girls’ school participation, our research found adolescent girls reporting they miss on average 2.4 days of school per month due to their periods. This means that – as a result of simply being born with a uterus – girls are missing an entire month of schooling across the year that boys don’t. Viewed in this light, girls’ academic underachievement in poor countries like Uganda feels obvious.

It was clear this was an issue our programme needed to address, and our UK and Ugandan colleagues set about reviewing the international evidence on what types of interventions could help. We settled on implementing a menstrual management pilot project. In brief, the intervention involved distributing reusable sanitary pads and soap to girls, alongside delivering lessons on women’s health and hygiene for girls and boys to increase knowledge and reduce stigma.

It all sounded like a good idea, and – for external communications purposes alone – served as a popular, tangible example of what PEAS was doing to support adolescent girls. However, there were two main problems: (a) the pilot had been designed without sufficient consultation with girls and women from the communities that would receive the intervention, and (b) financial sustainability wasn’t factored in to the initial planning.

As PEAS began to roll out the intervention, we found the problem with (a) was that not everyone was necessarily comfortable with reusable sanitary pads. Caregivers and girls in some communities questioned the hygiene of reusing pads, while others complained that the products provided weren’t always robust enough to be used with confidence.

Secondly, though the towels provided were ‘reusable’ in the sense that they could be washed and re-used multiple times if looked after properly, they did have an expiry date. Once the budget to buy them was used up, it wasn’t clear how or who was meant to fund the replacement costs. PEAS schools – which aim to operate on a low-cost, sustainable model to minimise the need to charge school fees – certainly didn’t have spare budget to buy pads for all girls on an on-going basis. Similarly, while locally produced products had been sought to minimise costs and support local entrepreneurs, even these products still proved too expensive for many of the poorest girls to take over purchasing for themselves.

As a result, while PEAS saw a reduction in the percentage of girls reporting they regularly missed school because of their periods during the pilot, this trend was reversed after the grant funds for the pilot were used up.

In truth, the intervention was always designed as a ‘pilot’, meaning we expected to experiment through implementing it within a smaller subset of our schools, and generate lessons before deciding whether to roll it out to our full network of 28 secondary schools and 15,000+ students in Uganda. In this case, the lessons learnt were the need to:

  • Design programming by combining international evidence with strong, community consultations on what approaches would be most helpful – this is particularly important in an area as personal as menstrual hygiene.
  • Never assume sustainability will just work itself out – If consultations suggest beneficiaries or their sponsors cannot afford something that would be useful to them, giving it out freely without identifying a renewable income source is likely to create more disappointment than progress when the money runs out.

Based on our experience from the pilot, PEAS since has changed our approach to deliver menstrual hygiene and awareness lessons through existing after-school clubs, and to ensure school tuck shops stock the most affordable and appropriate sanitary products for each community. We know that many of our girls still struggle to attend school during their periods, and we still are looking for better solutions. However, we are now talking to both the academics and our audiences as the ‘experts’ on what works for girls, and what is likely to be sustainable.

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