Project SHE_LimSanMiguel_HSS

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Project SHE: Innovating for girls’ health and education in western Kenya
Emilia San Miguel and Bernadette Lim
Harvard Summer School in Kisumu, Kenya
July 10, 2013
I. Executive Summary
Project SHE is a packaged innovation that will increase school performance and
knowledge, attitudes, and practices regarding menstrual health among Kenyan school girls in
standards 4 to 8. Through Project SHE, 60 primary schools in western Kenya will be provided
access to sanitation facilities, hygiene supplies, and menstrual health and management (MHM)
education for girls.
Currently, efforts by NGOs addressing menstrual hygiene and education often center on
merely one of the components of Project SHE—building sanitation facilities, distributing
sanitary pads or teaching menstrual health education. Depending on the priorities of these NGOs,
many schools receive zero, one, or at most two of the components of Project SHE, leaving many
girls underserved in their menstrual health needs. Moreover, aside from limited access to these
interventions, discussion of menstrual health and its developmental effects is nonexistent in
primary school health curriculum and is rarely a topic of open discussion. As a result, students
and teachers are not aware of the knowledge, attitudes, and practices central to understanding
menstrual health and its effects on the development of adolescent girls. Project SHE combines
existing NGO programs that provide access to sanitary facilities and supplies with menstrual
health education to comprehensively address girls’ menstrual health needs.

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The implementation of all three components of Project SHE requires collaboration
among NGOs and the Kenyan government. With support from UNICEF and other donors,
SANA International constructs girls’ latrines and washrooms in primary schools throughout
western Kenya to improve hygiene and sanitation as well as girls’ attendance. Long-term
partnerships with sanitary pad-providing NGOs in western Kenya will be established to fulfill
girls’ needs during menstruation. MHM education will be implemented through SANA’s school
health clubs to educate students and teachers from standards 4 through 8 on proper hygienic
practices and the developmental process of menstruation. Additionally, Project SHE will work
with multiple NGOs, the Ministry of Public Health, and the Ministry of Education to include
menstrual health in future revisions of the Kenyan national school health policy curriculum.
Acting as a precedent for networking and collaboration among NGOs supplying
sanitation facilities and products, Project SHE is a novel collaboration that utilizes existing
frameworks in government, education, and NGO efforts to create a powerful delivery mechanism
of menstrual health support for primary school girls in western Kenya.
II. Background
Girls’ education: benefits, barriers, and existing efforts
The importance of girls’ education is widely documented. Numerous studies have
demonstrated that educating a girl will produce better health outcomes for both her and her
future children (Herz & Sperling, 2004, p. 27-29). Additionally, educating a girl is an economic
investment for both her and her community. A study by Goldman-Sachs has calculated that if
every sub-Saharan African were to ensure the universal education of girls, they would boost their
GDP by 0.2% annually (2008). Finally, promoting girls’ education is essential to achieving

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Millennium Development Goals 2 and 3—achieving universal primary education and gender
equity. However, despite the demonstrated importance of girls’ education, many girls around the
globe face structural barriers to achieving their educational aspirations. Among these barriers are
school fees, home responsibilities and widespread preferences for educating boys (UNICEF, n.d.,
p. 1-12). In addition, however, there is another potential obstacle that every girl attending school
will face: menstruation.
For many girls across east Africa, difficulties posed by menstruation are exacerbated by a
lack of safe, private girls-specific latrines, creating a barrier to school attendance. Researchers
Birdthistle, Dickson, Freeman and Javidi found in 2011 that many girls report feeling threatened
by unisex latrines: they would rather skip school than change their sanitary towels or use the
latrines without the guarantee of safety and privacy (26-29). This lack of sanitation facilities has
contributed to girls’ absenteeism across the developing world, notably in Bangladesh (BRAC
Research and Evaluation Division, 2013, p. 86). In Kenya, the situation is the same (Rukunga &
Mutethiea, 2006). Additionally, many girls report skipping school because of a lack of access to
sanitary pads. Girls without pads report anxiety about soiling themselves during their periods and
embarrassing themselves in front of fellow students and male teachers. As a result, many elect to
stay home. In Kenya alone, the average menstruating-age girl misses 39 days of school a year
due to lack of sanitary pads, decreasing pupil-teacher contact time by 10 to 25 percent (Kibira,
2011, para. 3; Kaberia, 2012, para. 9). This problem is not confined to any one region of Kenya,
either: according to the Education Minister, there are 2.6 million Kenyan girls in need of sanitary
pads (Kaberia, 2012, para. 10). Over time these 2.6 million girls accrue educational disadvantage
that leads to girls eventually leaving school (Otieno, 2012, para. 4). This is a serious problem:

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out of the estimated 4.5 million girls who attend primary school, only about 80,000 will enroll in
university (Kibira, 2013, para. 7).
A meta-analysis by Oxford University suggests, however, that providing girls with
sanitary pads will increase school attendance (Scott, et. al, 2009, p.2). Additionally, UNICEF
recommends the implementation of sanitary facilities as another way to increase school
attendance (UNICEF, n.d.). Per these suggestions, both the government of Kenya and NGOs are
working to combat the problem. First, the Parliament abolished the luxury tax on imported
sanitary pads, making them more affordable. However, even at this reduced price, sanitary pads
remained out of reach for many girls, whose parents often would have to choose between food
and pads. As a result, last year the Kenyan government became the first African government to
include the provision of sanitary pads in its education budget. Although these efforts are
admirable, most girls still do not receive pads. Money was only allocated for 400 thousand girls
to receive pad rather than the 2.6 million girls in need (White Mukuria, 2013). The allocated
amount has since been cut to compensate for increased security near the Somali border.
Moreover, regional government distributors of pads are unreliable and often divert the pads to
other sources for profit (White Mukuria, 2013). In addition to the government, many non-profits
are attempting to supply sanitation facilities and sanitary pads, yet there is evidence of a lack of
coordination and of duplication among these NGOs. Finally, most organizations operate with
little emphasis on sustainability.
Working with SANA International
Our work with SANA International began as part of the Harvard Summer Program in
June 2013. SANA is an NGO based in Kisumu, Kenya that supplies sanitation facilities, WASH

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(Water, Sanitation, and Hygiene) education and community water supplying projects. As interns,
SANA asked us to evaluate the effectiveness of their girls’ latrine-building project, which they
believed would increase girls’ attendance. During our research and interviews with teachers and
students, however, we realized that their conclusion might be incomplete. In addition to the lack
of latrines, a majority of girls indicated that a main barrier in attendance is the lack of access to
sanitary pads. Also indicated was the void of menstrual health education in primary schools.
According to UNICEF, a comprehensive approach to menstrual health management and
education requires three components: sanitation facilities, sanitary pads, and menstrual health
education (Sommer, Vasquez & Sahin, 2012, p. 34-35). Project SHE was formulated in response
to these needs, which led us to the formation of our research question: does the packaged
provision of girls’ latrines; free sanitary pads; and hygiene education improve school
performance and menstrual health knowledge, attitudes and practices for Kenyan girls in
standards 4-8?!!
III. Description of Innovation
Project SHE is an innovation that combines three key interventions aimed to
comprehensively address girls’ menstrual health in 60 primary schools in western Kenya by
providing access to girls’ sanitation facilities, hygiene supplies, and menstrual health and
management (MHM) education.
Individually, each of the SHE interventions has been proven to improve girls’ health and
educational outcomes. However, with most NGOs and government efforts concerned with their
own singular interventions, girls rarely benefit from the provision of all three components.
Currently, there are no efforts in western Kenya that have attempted to combine these efforts and

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deliver all three SHE interventions to primary schools. As a result, Project SHE will foster
collaboration among existing menstrual health efforts to provide access to all three SHE
interventions in order to improve school performance and menstrual health for primary school
girls. An illustration of the Project SHE component is shown in Graphic 1.
Graphic 1: Components of Project SHE
Provision of all three SHE interventions requires intimate collaboration between SANA
International, NGOs, and the Kenyan government. Detailed descriptions of each SHE
intervention is further outlined and illustrated in Table 1.
Hygiene!supplies!
(sanitary!pads)!
Menstrual!
Health!
Education!
Sanitary!
Facilities!
(latrines)!
Project+
SHE+

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Table 1: Components of the SHE Interventions
Intervention
objective
Description of intervention component Actors involved in
intervention
implementation
Sanitation facilities
Objective: Increase
access to private and
separate sanitation
facilities for girls
• SANA is funded by UNICEF and other donors to
construct separate sanitation facilities with girls’
latrines and washrooms in 60 primary schools in
western Kenya (for map, see Appendix 1.1).
• Latrines are built to accommodate suggested 25:1
pupil to latrine ratio for girls and 30:1 ratio for boys.
• 1-2 washrooms are built depending on the size of the
primary school.
• Approximately 8 schools undergo construction at one
time. Schools are prioritized according to need
determined by school’s current pupil to latrine ratio.
• Sanitation facilities take approximately 3-4 months to
complete.
• In some schools, additional latrines are built
specifically for disabled children.
Girls’ WASH Painting Competition
• Inspired SANA’s community contribution model of a
payment of 10% of sanitation facility costs, girls will
be able to design and paint the walls of their
sanitation facility with WASH designs as a buy-in in
order to promote responsibility and usage of the
facility.
• School health clubs will conduct a week-long design
competition for girls in standards 4 to 8. This will
occur one week prior to the opening of the sanitation
facility.
• Designs will incorporate sanitation and hygiene
messages and images.
• Selected designs will be painted by the artist and
displayed on the front wall of the sanitation facility.
• If success is achieved during first pilot test, the
project will be expanded for boys’ sanitation
facilities.
SANA International
Hygiene supplies
Objective: To
increase access to
sanitary pads by
establishing
Establishing partnerships for sanitary pads
• Long-term partnerships are established between
SANA and NGOs to provide a continuous and
reliable supply of sanitary pads in one of four
respective “zones” where sanitation facilities are built
(for map, see Appendix 1.2).
Huru International,
ZANA Africa, Days
for Girls International,
Afri-can Trust (for a
detailed description on
these NGOs, see

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partnerships between
SANA and like-
minded NGOs
• Zones are created according to the capacity and
available sanitary pad supply of each NGO.
• Partnerships last 2-3 years (depending on agreement
between SANA and the respective NGO) and are
renewable.
• Depending on the type of sanitary pad provided (re-
usable or disposable), each NGO is required to
communicate and agree with SANA on the frequency
and availability of its sanitary pad provision.
• Monthly activity reports will be required between
SANA and NGOs. Each partner will be responsible
for their funding portfolios but will share budget
expenditures directly related to partnership initiative.
• Agreement will be officiated by the mutual signing of
a Memorandum of Understanding (see Appendix
2.2).
• Schools receiving pads will be asked to contribute as
much money as they can (as determined by the
administration council)
• A partnership between SANA and Afri-can Trust was
recently initiated to provide sanitary pad supplies for
250 schools in the Nyanza region from 2013-2016.
Distribution of sanitary pads to schools
• Bulk supplies of sanitary pads will be given to
schools at the beginning of each month by NGOs or
as agreed in the MOU.
• Sanitary pads will be given to the designated teacher
in charge of the school health club.
• Special requests for additional sanitary pads will be
officiated by designated teacher to school’s
respective SANA representative.
Appendix 2.1
MHM education
Objective: To
implement MHM
education through
school health clubs
and in Kenya’s
national school
health policy
MHM education in school health clubs
• An education advisory board comprised of
representatives from SANA and Ministry of Public
Health will be formed to decide curriculum content
(see Appendix 3).
• Once finalized, MHM curriculum will be introduced
at TOT (Training of Teachers) Sessions. Training
sessions are held after construction completion.
Sessions are organized and led by SANA and
representatives from the Ministry of Public Health.
• Trained teachers are required to lead at least one
school health club meeting centered on MHM each
trimester to students in standards 4 to 8.
SANA International,
Ministry of Public
Health, Ministry of
Education

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Inclusion of MHM education in Kenyan National School
Health Policy
• A policy advisory board comprised by
representatives from SANA, NGO partners, Ministry
of Public Health, and Ministry of Education will be
formed to decide MHM curriculum content for
standards 4 to 8.
• The implemented MHM curriculum of school health
clubs will serve as a guide for national MHM
curriculum.
• Curriculum will undergo revision with Ministry of
Public Health.
• Final approval and revision will be done with the
Ministry of Education.
• Estimated timeline of this effort will be 1-2 years.
Implementation of Project SHE at schools will be done on a case-by-case basis. Each
school will receive all three SHE interventions. Access to all three SHE interventions will be
available to all girls, yet monitoring and evaluation will only be conducted for girls in standards
4 to 8 who have begun menstruation. The use of sanitation facilities, sanitary pad provision, and
MHM curriculum to school health clubs will be initiated within the same trimester as soon as
sanitation facility design and construction, sanitary pad supply, and curriculum training is
finalized. A detailed timeline for Project SHE can be found in Appendix 4.
IV. Monitoring and Evaluation
We will design a prospective study to assess the impact of schools that receive girls’
sanitation facilities, sanitary pads and menstrual health education. While access to all three SHE
interventions will be available to all girls in each primary school targeted by Project SHE, the
population of the study will be restricted to post-menarche western Kenyan primary school girls
in standards 4-8 in order to streamline monitoring, survey distribution, and logistics.

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Before the implementation of the Project SHE components into the targeted schools,
none of which currently have any SHE components, we will collect baseline data for our two
primary outcomes: girls’ performance on the annual national exam and girls’ current knowledge,
attitudes and practices regarding menstrual health. The data including girls’ performance on the
annual national exam will be collected from the school administration. The girls’ pre-
intervention knowledge, attitudes and practices will be assessed with a KAP questionnaire, a
preliminary example of which can be found in Appendix 5. The questionnaire has been adapted
from another questionnaire used to study girls’ menstruation in Nepal. Before distribution of the
questionnaire, we will verify the questionnaire with adolescent health expert. After verification,
this questionnaire will be distributed to all girls in standards 4-8. For the purposes of our study
and to avoid the uptake of confounding data, the responses of post-menarche girls will be
extracted from among the pool of all respondents. At the end of the school year and after the
implementation of all SHE components, the same questionnaire will again be distributed and the
girls’ performance on the annual national exam will again be collected.
In addition to the primary outcomes of exam performance and menstruation knowledge,
attitudes and practices, we will collect data regarding two process indicators: educational
outcomes and public health outcomes. Included under educational outcomes is school
attendance. The data for this metric will come from the school administration. Included under
public health outcomes are the pupil to latrine ratio, the incidence of WASH related disease
(diarrheal, gastrointestinal), and girls’ access to three sanitary pads per day if needed. Data will
come from both the school administration as well as the pre- and post-intervention KAP
questionnaire.

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An outline of primary outcomes and process indicators that will be measured is displayed
in Table 2.
Table 2: Project SHE Outcomes and Metrics
Primary Outcomes
1. Increased school performance of girls in standards 4-8 as
measured by scores on the national exams
2. Increased knowledge, attitudes and practices regarding
menstrual health
a. Attitudes regarding school attendance during menses
• Comfort going to school during menstruation
• Comfort using latrines
b. Knowledge/Practices in menstrual health education
• How to hygienically wash reusable sanitary pads
• Knowledge of menstruation as a biological process
Process Indicators
1. Educational outcomes
• Attendance for girls in standards 4-8
2. Public Health Outcomes
• Pupil to latrine ratio
• Incidence of wash related disease
• Access to 3 sanitary pads per day (if needed)
We define success as an increase across several metrics: an increase in girls’ performance
on the national exams, improved knowledge, attitudes and practices regarding menstruation,
improved attendance and more access for girls to three sanitary pads per day. We also hope to
see a decrease in two metrics: the pupil to latrine ratio as well as the incidence of WASH related
diseases at school.
In order to establish and implement its various components, Project SHE will require a
substantial amount of time to establish and implement its various components. Establishment of
the school curriculum and partnerships with NGOs will be a multi-year process. For a detailed
timeline refer to Appendices 4.1 and 4.2.

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VI. Sustainability
Project SHE’s greatest source of support is its collaboration with SANA International.
Local support for the continuity and expansion of Project SHE efforts will be sustained by:
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1. Funding for quality sanitation facilities – SANA International is a well-known NGO whose
reputation for quality sanitation facilities in schools and communities has earned funding
from prominent international aid organizations such as UNICEF, WaterCan, USAID, and the
Bill and Melinda Gates Foundation. SANA’s current efforts in building sanitation facilities
for girls are well-received, which increases the possibility of expanding construction of
sanitation facilities for girls in more schools throughout western Kenya.
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2. Established partnership for sanitary pad provision with Afri-can Trust - SANA’s recent
partnership with Afri-can Trust to provide sanitary pads for 25 schools in the Nyanza region
demonstrates its commitment to comprehensively addressing the menstrual health needs of
girls. This partnership is a precedent for initiating future partnerships that will occur for
schools that will benefit from Project SHE.
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3. Reliable monitoring and evaluation procedures – SANA conducts rigorous monitoring and
evaluation for each of the primary schools it serves through weekly site visits and regular
communication with each school’s head teacher. Through these weekly site visits, monthly
reports that accompany the provision of sanitary pads can be further monitored through these
weekly follow-up visits and interaction with school personnel and students.
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4. Existing collaboration with Kenyan government and other NGOs – SANA’s established
collaboration with the Ministry of Public Health will serve as an invaluable resource to the

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advocating for the integration of MHM into school health club curriculum and Kenyan
National School Health Policy.
In addition to the local support we have to continue Project SHE, opportunities for expansion
beyond western Kenya are possible through additional sanitation and sanitary pad-providing
NGOs in other countries. For example, collaboration can be created among organizations of
Uganda Water and Sanitation NGO Network (UWASNET) and sanitary pad NGOs such as
AfriPADS, Generation Youth, and Makapads to address menstrual health needs for girls in
Uganda. Another innovative collaboration similar to Project SHE can be replicated in other
countries.
Barriers that may hinder the implementation of Project SHE include the difficulty of
ensuring partnerships with resource-limited NGOs supplying sanitary pads, requiring teachers to
implement MHM into school health club curriculum and the financial costs of sanitary pad
provision to families. Recognizing financial limitations, Project SHE is partnering with multiple
NGOs to supply sanitary pads to its schools at an affordable cost and is considering the resources
and capacity of each NGO partner when deciding the number of schools it will serve. Effective
implementation of MHM curriculum in school health clubs will be evaluated according to scores
on the post-KAP questionnaire administered at the end of the year. If scores show minimal or no
improvement, rigorous follow-up training with the school health club patron will be conducted in
order to improve curricula implementation for the upcoming year.
Unintended consequences that may arise in the implementation process include the
interruption of sanitary pad distribution by teachers and the disposal of sanitary pads. Weekly
follow-up visits by SANA staff members and interviews with girls’ in standards 4 through 8 will
be conducted to ensure the availability of sanitary pads. Disposal of sanitary pads was taken into

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consideration when considering partnerships with NGOs that distributed one-time use sanitary
pads. ZanaAfrica is carefully chosen as the only NGO providing sanitary disposable pads for
Project SHE: its product is biodegradable, eco-friendly, and locally manufactured. Additionally,
the NGO integrates waste management education in its product distribution. Future partnerships
with NGOs that provide sanitary pads are carefully formulated according to products’
sustainability and ease of use and management.
VII. Implications and Conclusion
Girls in all settings experience the challenges that accompany adolescent development
and menstruation; yet, girls’ experiences are as varied as their settings. Therefore, local,
comprehensive solutions are needed to respond to the barriers that menstruation and
development may pose. As NGOs and governments act to address girls’ unique needs, they
cannot act solely on their own priorities, and individual efforts are not enough to address girls’
total menstrual health needs. The result of this incomplete approach is a lack of girls’ sanitary
facilities, sanitary pads and menstrual health education, or in duplication resulting in incomplete
coverage.
Project SHE bridges the effective yet disconnected interventions that currently improve
girls’ menstrual health. Collaboration and coordination among these efforts and interventions is
the basis of Project SHE, which implements the most effective menstrual health interventions
available to primary school girls in western Kenya. Addressing the challenges that emerge from
the onset of menstruation for adolescent girls is inherently complex, especially in a resource-
limited setting. Yet, by recognizing existing efforts that tackle the multiple dimensions of
adolescent menstrual health that are so often present in developing regions such as western

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Kenya, innovation can emerge from the unique combination of these interventions. Ultimately,
by the provision of sanitation facilities, sanitary pads, and menstrual health education, Project
SHE sets a new standard for the collaboration needed to comprehensively improve health and
education for adolescent girls.

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Works Cited
Birdthistle I., Dickson K., Freeman M., Javidi, L. (2011) What impact does the provision of
separate toilets for girls at schools have on their primary and secondary school enrolment,
attendance and completion?: A systematic review of the evidence. London: EPPI-Centre,
Social Science Research Unit, Institute of Education, University of London.
BRAC Research and Evaluation Division. (2013). Achievements of BRAC Water, Sanitation and
Hygiene Programme Toward Millennium Development Goals and Beyond. Dhaka,
Bangladesh: Author. Retrieved from
http://bracresearch.org/monographs/Monograph_60.pdf
Herz, B., & Sperling, G.B. (2004). What Works in Girls’ Education: Evidence and Policies from
the Developing World. Council on Foreign Relations. New York.
Kaberia, Judie. (2012, May 8). Kenya: Treasury Directed to Give Sh2.6b for Sanitary Pads.
Retrieved from http://allafrica.com/stories/201205090094.html/
Kibira, Henry. (2013, May 29). Kenya: Murugi Presses for Free Sanitary Pads in Schools.
Retrieved from http://allafrica.com/stories/201305291304.html/
Kibira, Henry. (2011, November 7). Kenya: Provide Girls with Sanitary Towels, Mutoko Tells
State. Retrieved from http://allafrica.com/stories/201111080065.html/
White Mukuria, M. (2013, June 21). Interview.
Otieno, Samuel. (2012, March 9). Kenya: Safaricom Donates Pads to Girls in Siaya. Retrieved
from http://allafrica.com/stories/201203091421.html/
Lawson, Sandra. (2008). Global Economics Paper No: 164. Goldman Sachs.

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Rukunga, G. & Mututhiea, D. (2006). WELL Factsheet - Regional Annex East Africa: School
Sanitation and Hygiene Education (SSHE). African Medical and Research Foundation.
Retrieved from http://www.lboro.ac.uk/well/resources/fact-sheets/fact-sheets-
htm/RSA%20SSHE%20Kenya.htm
Scott, L., Dopson, S., Montgomery, P., Dolan, C., Ryus, C. (2009). Impact of Providing Sanitary
Pads to Poor Girls in Africa. Oxford University. Retrieved from
http://www.doublexeconomy.com/wp-content/uploads/2010/09/University-of-Oxford-
Sanitary-Pad-Study.pdf
UNICEF. (n.d.) Barriers to Girls’ Education, Strategies, and Interventions. Retrieved from
http://www.unicef.org/teachers/girls_ed/BarrierstoGE.pdf/
WaterAid in Nepal. (2009). Is menstrual hygiene and management an issue for adolescent school
girls? A comparative study of four schools in different settings of Nepal. Kathmandu,
Nepal: Author.
Sommer, M., Vasquez, E. & Sahin, M. (2012). WASH in Schools Empowers Girls’ Education:
Proceedings of the Menstrual Hygiene Mangement in Schools Virtual Conference 2012.
UNICEF.

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Appendix 1.1: Map of SANA school coverage and donors

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Appendix 1.2: Map of SANA school coverage and NGO coverage “zones”

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Appendix 2.1: NGO Partners for Sanitary Pad Provision
NGO Description Primary Schools Served
Days for Girls
International
Days for Girls International provides menstrual
health kits containing 3 re-usable sanitary
pads, soap, and underwear for girls and
mothers. Kits range from $4-$10. Volunteers
and NGOs are able to attain these kits
according to request. Funding for these
sanitary pads will initially be provided by
SANA. Long-term funding for this project will
be attained through grants.
Migiro, Abimbo, Chamgaha, Nyaguda,
Chianda, Madiany, Maturi, Kasiri
ZanaAfrica ZanaAfrica provides disposable sanitary pads
and accompanying health education to schools
in Kenya. Funding for sanitary pad provision
will be covered by ZanaAfrica.
Oren, Wanganga, Rae, Paw Tenge, Rarieda
Kaloo, Sondu, Agai, Nyabondo Girls, Kabete,
Atela
I-Care Pads by
Afri-can
Foundation
I-Care provides each girl with an “I-Care Pad
bag” that includes 4 re-usable pads and a
washing instructions booklet. Schools pay 50
shillings per product.
Nyanginja, Sabako, Gongo, Ogal, Rota,
Nyawara, Kodiaga Prison, Wachara, Obede,
Dago Thim, Yath Reteng, Ezra Gumbe, Chiga,
Kadiju, Omung’I, Anywang, Buoye, Karombe,
Kibigori Railway, Kibigori, Othoro, Kojwach,
Nyasore, Ogera, Kabonyo
Huru
International
Huru International provides menstrual health
kits with 4 re-usable pads and a booklet on
HIV/AIDS awareness. Each kit is $10.
Funding will initially be provided by SANA.
Long-term funding for this partnership will be
attained through grants.
Uriri, Ading’o, Piny Owacho, Rapogi Mixed,
Oyani, Paga
NB: Ten missing schools are still in the process of being finalized with SANA. These schools will most
likely be provided sanitary pads through I-Care Pads and/or ZanaAfrica.

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Appendix 2.2: Sample Memorandum of Understanding (MOU)
(To be adapted for future NGO partnerships)
SAMPLE MEMORANDUM OF UNDERSTANDING
BETWEEN
SANA INTERNATIONAL
AND
AFRI-CAN TRUST
[AFRI-CAN TRUST LOGO]
The memorandum of understanding (MOU) is a partnership agreement drawn between SANA
International and Afri-Can Trust.
I. BACKGROUND
1.2 Background Information about SANA International and Afri-Can Trust
SANA is a registered NGO that has been established rom the Rural Domestic Water Supply and
Sanitation Programme (RDWSSP) in a major effort to encourage and promote further
propagation of WATSANdevelopment in the region. Its operational principles and
methodologies are along the lines of those of RDWSSP and methodologies that aimed to ensure
long term sustained WATSAN delivery. The mission of the organization is to contribute to
improved access to safe water and proper sanitation by the needy population through promotion
of participatory approaches and sustainable technologies. SANA International has secured
funding from two donor partners, SIMAVI and UNICEF NL for the implement of the Football
for Water, Sanitation and Hygiene (F4WASH) program and will also seek collaborative support
in implementing the sanitary towels for schools component of F4WASH program.
Afri-Can Trust is a not-for-profit organization registered in the Republic of Kenya and it is based
in Kisumu City, Nyanza Province and has a liaison office in Amsterdam, Netherlands. Afri-Can
Trust works in collaboration with individuals, communities, and institutions to alleviate poverty
and secure socio-economic empowerment and justice through community based approaches.
Afri-Can Trust enterprise development, promotion of modern agro-technology, vocational
technical training, and job placement and support for the vulnerable youth in the society. Afri-
Can Trust also offers information and linkage/referral services.

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This partnership is developed in the contet of F4WASH program which is an initiative of an
alliance of Dutch based partners namely: The Royal Netherlands Football Association (KNVB),
SIMAVI, UNICEF NL, Vitens-Evides International (VEI), AKVO and Ministry of Foreign
Affairs Netherlands on one part; and the Kenya partners that include SANA International,
KIWASCO, CABDA, Afri-Can Trust, KYFA, TYSA, CREATA, and Moving the Goalposts
(MGTP).
II. PURPOSE
SANA International and Afri-Can Trust agree to establish a mutually beneficial partnership with
a focus on joint and complementary relationship on issues pertaining to promotion of girls’
empowerment through the use of I-Care pads in the Football for WASH Program.
III. ROLES AND FUNCTIONS OF PARTNERSHIP
A. Common Functions
1. SANA International and Afri-Can Trust will pursue common goals for mutual
benefit in ensuring participatory professionalism and excellence in discharging
their responsibilities in promoting girls’ empowerment and access to menstrual
hygiene management information in the Football for WASH program.
2. SANA International and Afri-Can Trust will together share expertise, experiences
and support training programs and sharing information on menstrual hygiene
management as a pathway to girls’ empowerment.
3. SANA International and Afri-Can Trust will be associated in information
exchange through regular stakeholder meetings and workshops.
4. SANA International and Afri-Can Trust will hold joint planning and monitoring
activities together with the communities involved and subsequently develop and
sign the mous with the communities/school management committies.
B. SANA International
As an equal and willing partner in this joint initiative SANA International will play the
following principal roles:
1. Collaborate with staff and management of Afri-Can Trust in the development and
management of the partnership.
2. Share experiences and expertise with Afri-Can Trust for the purposes of
promoting girls’ empowerment and access to menstrual hygiene management
information.

! 23
3. Provide regular upfront (at least one week in advance) updates and information to
Afri-Can Trust’s with regard to new developments and emerging issues in the
F4WASH program.
4. Provide logistics (means of transport) intermittently (on an alternating basis with
Afri-Can Trust)during joint field trips within Kisumu and in Migori. This
principle will apply for any other field trip arranged by the two partners outside
Kisumu.
5. Take the lead in operating the regular meetings.
6. As the lead agency, receive reports from Afri-Can Trust and compile consolidated
reports for submission to the donors and partners.
C. Afri-Can Trust
As an equal and willing partner in this joint initiative Afri-Can Trust would play the
following principal roles:
1. Collaborate with staff and management of SANA International in the
development and management of the partnership.
2. Provide the resources required (I-Care pads) to facilitate promoting girls’
empowerment.
3. Share experiences and expertise with SANA International for the purposes of
promoting girls’ empowerment and access to menstrual hygiene management
information.
4. Provide logistics (means of transport) intermittently (on an alternating basis with
SANA International) during joint field trips within Kisumu and Migori. This
principle will apply for any other field trip arranged outside Kisumu.
5. Submit activity reports based on agreed schedules to SANA International for final
compilation and submission to the donors and partners.
IV. FUNDING
1. The partners will be responsible for their funding portfolios but will share the
financial reports (budget expenditure reports) directly related to this partnership
initiative.
2. SANA International will be responsible for its costs related to its staff and any
other expenditure that is necessary to maintain their regular operations.
3. Afri-Can Trust, however, will also be responsible for its costs related to its staff
and any other expenditure that is necessary to maintain their regular operations.

! 24
4. In the event of joint funding or proposal development, the responsibilities,
activities and budget lines will be dictated by the requirements of the joint
initiative.
V. ADMINISTRATIVE PROCEDURES
• Governance: SANA International and Afri-Can Trust governing structure will be
respected and partnership will not reflect or restructure governance.
• Management: Similarly the technical management of SANA International or Afri-
Can Trust may initiate partnership with another institute to complement the
existing partnership, but any complementary partnership affecting SANA
International and Afri-Can Trust partnership should have the other partner’s
consent to be effected.
• Quality Control: SANA International and Afri-Can Trust will constantly review
and update the rules, regulations and operations to ensure continuous improvement
in the quality of interventions/programs provided jointly.
• Reporting: In the context of this partnership, all reports will be submitted to
SANA International for consolidation and subsequent dissemination to donors and
the partners.
VI. ETHICAL CONSIDERATIONS
SANA International and Afri-Can Trust partnership will adhere to the laid down
ethics as contained in the documents of the two Institutions in all their operations.
VII. DURATION OF PARTNERSHIP
Unless otherwise stated, the partnership duration shall coincide with the program
duration and shall run through the period 2012-2016.
VIII. ENFORCEMENT/AMENDMENTS
1. The MOU shall enter into force upon signing by the duly authorized
representatives of the two partners.
2. This MOU constitutes an agreement between the partners hereto. This MOU may
be modified, altered, revised, extended or renewed by mutual written consent of
both partners, by the issuance of written amendment, signed and dated by
authorized representatives of both the partners.
IX. OTHER STIPULATIONS
1. On matters of dispute, the first option will be consultation between the technical
management departments of the institutions. The second level will be between the
leadership of SANA International and Afri-Can Trust. If grievances are not
adequately addressed by internal mechanisms, a third party of their common

! 25
choice can be brought in as a mediator. Court of law will be the last resort to
resolve disputes.
2. Either party will have the freedom to terminate partnership with a prior notice of a
length of time required for the completion of an approved joint project.
3. The best interest of both partners and the law of The Republic of Kenya guides all
joint regulations, decisions and activities.
Compliance
SANA International and Afri-Can Trust on signing this MOU will have committed themselves to
comply and accept the terms and conditions stated herein.
Signed:………………………………… Signed:
…………………………………
Date: ………………………………… Date:
…………………………………
[name of signatory] [name of signatory]
[title of signatory] [title of signatory]
Witnessed by: Witnessed by:
………………………………………….
………………………………………….
Date: ………………………………… Date:
…………………………………
[name and title of signatory] [name and title of signatory]

! 26
Appendix 3: Menstrual Health Management (MHM) Curriculum
Goals:
• Provide education to students and teachers in standards 4 to 8 regarding menstrual health,
with an emphasis on the social, emotional, and psychological developmental changes that
accompany adolescent puberty for girls
• Engage students and students of both genders in open discussion and de-stigmatization of
menstrual health and management
• Provide practical management strategies in schools to address girls’ menstrual health
needs
Target audience:
Students and teachers in standards 4 to 8
Educational Advisory Board for MHM Curriculum in School Health Clubs:
Bernadette Lim, Intern, SANA International
Emilia San Miguel, Intern, SANA International
Jacob Achollah, Program Manager, SANA International
Anne Kombija, Project Officer, SANA International
Mazudi Olilo, Kisumu District Public Health Officer
Educational Advisory Board for MHM Curriculum in National School Health Policy:
Emilia San Miguel, Intern, SANA International
Bernadette Lim, Intern, SANA International
Rosemary Moi, Community Development Officer, SANA International
Megan Mukuria, CEO and Founder of ZANA Africa
Mazudi Olilo, Kisumu District Public Health Officer
Esther Muguri, Member of Parliament, Central Highlands
Overview of Implementation:
An initial MHM curriculum guide will be implemented through SANA International’s School
Health Clubs and will be presented at TOT (Training of Teacher) Training Sessions. At the same
time, Project SHE will utilize this detailed curriculum guide as a guide for the integration of
MHM into Kenya’s National School Health Policy.
Adopted Curriculum Sources:
-“Growing Up at School - a guide to menstrual management for school girls” by Annie
Kanyemba (implemented in Zimbabwe)
-“Sharing simple facts – a useful guide to menstrual health and hygiene” by Santha Sheela Nair
Below is a condensed outline of main topics regarding MHM. A detailed curriculum guide will
be produced and finalized after meeting of the educational advisory board to be implemented at
the September 2013 TOT Training of School Health Club Patrons.
• Overview of adolescent puberty

! 27
• Biological processes
• Physical changes
• Strategies to adjust to changes
• Emotional changes
• Strategies to adjust to changes
• Overview of menstruation
• Topics include: age of onset, length of menses period, physical symptoms, emotional
symptoms
• Overview of managing menstruation
• Personal hygiene
• Products used to accommodate menstruation
• Management of period pains
• Disposal of sanitary pads

! 28
Appendix 4: Gantt charts for Project SHE
Please refer to attachment, “Appendix 4.1 and 4.2.pdf”
Appendix 5: KAP questionnaire for Project SHE
Questions adapted from 2009 WaterAid Report “Is menstrual hygiene and management an issue
for adolescent school girls? A comparative study of four schools in different settings in Nepal.”
1. Did you use sanitary products during your last MP?
(circle your answer)
Yes No
If you answered no, please only answer question a) and then proceed to question 2.
a. If you answered no, did you use anything else instead?
(write your answer)
b. If yes, what kind of product did you use during your last MP?
reusable (washable) pads disposable pads tampon
If you circled reusable (washable) pads, please skip questions c, d, e, and f.
If you circled disposable pads, please skip questions g and h.
c. What is your favorite product to manage your MP?
reusable (washable) pads disposable pads tampon
d. If you use disposable sanitary pads, how often do you have access to them?
all of the time most of the time not usually never
e. How much does one pack of disposable sanitary pads cost?
(write your answer)

! 29
f. How do you dispose of your disposable sanitary pads? (burn, throw away with
other trash, bury)
burn throw away with other trash bury
g. If you use reusable pads, did anyone ever teach you how to wash them?
yes no
h. If you use reusable pads, how do you clean them?
Outside home without sunlight
Outside home with sunlight
Inside home without direct sunlight
Inside home with direct sunlight
2. Have you (or do you have a friend/sister who has) ever missed school because of your (or
her) MP?
Yes no
a. Why? Circle your answer:
Lack of privacy for cleaning/washing
Fear that others may realize she is having her MP
Lack of way to throw away menstrual rags/pads
No water supply
Pain/discomfort
Other - please explain:

! 30
3. Did you know about menstruation before experiencing your first MP?
Yes no
If yes, please answer questions a and b. If no, please skip questions a and b.
a. Who taught you about MPs?
(please circle all that apply)
Mother teacher
Sister friend
Health worker other: explain ______________________
b. What did they teach you?
(please write)
4. Are MPs a normal bodily process, an abnormal bodily process or don’t know?
(please circle)
Normal process abnormal process don’t know
5. Do you bathe during menstruation?
(please circle)
Yes no
If yes, please answer a and b. If no, please skip a and b.
a. If yes, how often?
(please circle)
every day every other day less than that
b. Do you use soap to clean your genitals?
(please circle)
yes no

! 31
6. What do boys think about MPs? Why do you think they think that way?
(please write)
7. Who do you feel comfortable talking to about MPs?
(circle all that apply)
friends/peers mother sister teacher
8. Do you use the girls’ latrines?
(please circle)
yes no
Please answer all the questions
a. Have you ever used the latrines during your MP?
Yes no
b. How was the experience?
(please write)
c. Pick circle words that you would use to describe the latrines:
Safe unsafe dirty clean
Private public pretty ugly
9. Do you like school?
(please circle)
I love school! School is alright. I don’t like school.
a. Do you plan to go to secondary school?
Yes no

! 32
b. Do you plan to go to university?
Yes no
I am more comfortable using the latrines now that they are new.
Agree very much/ agree a little/don’t’ know/disagree a little/disagree very much
-2 -1 0 +1 +2
My teacher will give me three disposable sanitary pads a day if I need them and ask for them.
All the time/some of the time/don’t know/not usually/never
-2 -1 0 +1 +2
I feel comfortable going to school during my MP.
Agree very much/ agree a little/don’t’ know/disagree a little/disagree very much
-2 -1 0 +1 +2

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