Background

Nepal CRS Company (Nepal CRS), in partnership with German Development Cooperation (GDC)’s Improvement of Maternal and Child Care in Remote Areas (IMCCR) Project, Nepal CRS has undertaken the social marketing of biodegradable sanitary napkins in Dadeldhura, Doti, Baitadi and Bajhang Districts of Sudurpaschim Province in Nepal with main focus on the schoolgirls in public schools. Through, its local implementing partner, Multipurpose Development Society (MPDS) Dadeldhura had implemented the MHM projects in basic and secondary government schools in Baitadi, Bajhang, Doti, and Dadeldhura districts. The project aimed to increase the availability of biodegradable napkins and sanitary pads at affordable prices. It also aimed to raise the awareness, reduce the social stigma, taboos and norms which are related to menstruation Nepal CRS has also envisioned in improving Menstrual Hygiene Management (MHM) of women and girls to practice hygienic ways of taking care of their periods by using sanitary pads or napkins and supports to ensure their dignity.

Although menstruation is normal phenomenon many of the women and adolescent girls face different obstacles to healthy menstrual hygiene practices in Nepal. Mostly in rural areas of Nepal, many adolescent girls do not have the access to education on sexual health, reproductive health, or menstrual health. The study also suggests that the use of sanitary napkins in rural areas are poorer (50% in urban vs 19% in rural), while the use of old pieces of cloth was higher among rural (35%) than urban (14%) adolescent girls according to NFCC 2016. It also states that one of the major consequences of the lack of proper management of menstrual hygiene among school children is the dropout of female students from school. The MHM project is focused on improving MHM of women and adolescent girls to practice hygienic ways of taking care of their periods by using biodegradable sanitary napkins and provide the support to ensure dignified menstruation through BCC activities. It also aims to bring the positive changes in the schoolgirls and women’s knowledge, attitude, and practices (KAP) related to menstruating health and hygiene management in the project districts. Furthermore, it also aimed to improve the supply side by providing sanitary napkins at no/low cost in the program area.

Objectives of the MHM Project

• To improve the awareness of schoolgirls and women of the selected districts on MHM
• To improve knowledge and awareness of sanitary napkins
• To change the behaviour among girls and women to adopt safer and healthier practices during menstruation
• To increase the availability and accessibility of sanitary napkins in the project area through social marketing and free distribution or subsidized rates through selected health facilities of the program districts

There are four major components of the project. They are included (i) the collaboration with Improvement of Maternal and Child Care in Rural Areas (IMCCR) focused government health facilities where Nepal CRS distributes free sanitary pads to post-partum mothers coming to IMMCR hospital in Dadeldhura (ii) School Orientation Program where teacher and students of targeted four districts of Sudurpaschim Province on MHM by using IEC/BCC materials, (iii) Mass Communication in this components different radio talk shows and jingles are conducted to deliver MHM related information, and benefits of sanitary napkins through local stations and different advertisement are also made in local language and lastly (iv) Sales and Marketing by Nepal CRS where IEC/BCC materials availability and sales of ‘Freedom napkins’ are marketed and special attention will be given to the outlets nearest to schools.

Objectives of the End-line Survey

The main objective of the end-line survey is to capture the end-line values based on the project objectives compared to the baseline survey.

General Objectives

• To evaluate the effectiveness of the MHM project interventions in bringing positive changes in the schoolgirls and women’s knowledge, attitude and practice relating to menstrual health and hygiene management in the project districts.

Specific Objectives

• To assess the menstrual hygiene knowledge, attitude and practices among schoolgirls; key influencers and school teachers (male and female)
• To assess the current availability, accessibility and affordability of sanitary napkins/pads
• To assess the demand for “Freedom Sanitary napkins” at the retail level. (Purchasing and coupon usage)
• To assess the knowledge, attitude and practices (KAP) related sanitary napkins products
• To identify the media habits and awareness of existing menstrual hygiene management massages
• To assess the status of school absenteeism due to menstruation
• To compare the Baseline results vs End-line results of MHM project indicators

The end-line survey will be carried out in line with the project indicators as outlined in logical framework and M&E plan. The evaluation will help to assess project’s achievements at the end of the implementation period. End-line survey will compare the results defined in the result framework, including the baseline survey, and perform further evaluation to systematically assess the projects’ effectiveness and impact. The survey will include a final evaluation component to identify good practices, problems and challenges faced during implementation and how those were overcome and addressed.

Scope of Work

PHRD team will carry out MHM survey in the Dadeldhura, Doti, Baitadi, and Bajhang Districts of Sudurpaschim Province in Nepal addressing the schoolgirls in basic and secondary public schools and FCHV and health workers in health care facilities. The endline study will assess the project’s deliverables and results of the project by appropriate data collection methods (mix method) from schools. This study will assess the current status of the program outcomes and outputs, and establish the progress measures based on project indicators. The progress will also be measured and compared against the baseline and end line to assess and quantify the achievements, recommendations and challenges at the end of the project implementation period.

In the endline survey, PHRD team will be principally responsible for conducting the evaluation study, proposing the methodology, finalizing the tools, questionnaires and instruments, training to Field researcher, field data collection and management and preparing and submitting final reports. All the mentioned tasks and processes will be conducted in close collaboration with sectorial specialists and project focal persons from CRS Nepal. The brief description of the different activities for the evaluation work is presented below:

• Socio-economic (including demographic) status of the sample adolescents and health worker
• Existing facilities at school and healthcare facilities
• KAP among girl students on MHM related issues
• MHM practice among adolescents’ girls in project schools and communities
• Existing facilities for MHM in schools
• Stigma and discrimination, taboos related to menstruation
• Capacity of local level institutions (school, School management committees, health facilities, municipality office) to implement and monitor policies on MHM.

PHRD Nepal will be responsible for designing the overall methodology and finalizing digital survey tools in CAPI (Computer Assisted Personal Interview).