A Bloody Serious Matter Improved dignity and healthy menstruation for girls and women in Uganda SUMMARY
In Uganda menstruation is limiting girls to reach their full potential. They don’t receive proper information about how to manage their menstruation and they don’t have access to menstrual products or to safe and clean latrines. Taboos and myths surrounding menstruation also limit what they are allowed to do when menstruating. Many girls drop out of school because they fear embarrassing situations at school. This Menstrual Health & Hygiene project aims to: 
(1)  Improve knowledge and break menstruation taboos among 53,502 adolescent girls, boys, men and women,  
(2) Improve MHH practices, 
(3) Increase access to affordable and hygienic sanitary pads, 
(4) Increase access to girl friendly toilets and water at schools, and 
(5) Ensure MHH in included in national and regional policies. 
The project will be implemented in 3 selected sub-counties: Kitayunjwa, Balowoli and Kagumba in Kamuli District –from November 2020 until the end of September 2022. In Uganda menstruation is surrounded by many myths and taboos and often is not talked about at all. As a result many girls are not prepared for their first menstruation and think they are sick or even dying. Girls receive little to now information on how to manage their period in a hygienic manner and menstrual pads are often not available or unaffordable (or not prioritized within the household). This is why girls and women often use old rags, banana leaves or newspapers as pads which can cause serious health problems. In Uganda more than halve of the adolescent girls don’t go to school when they are menstruating because they cannot afford menstrual pads or the latrines at school are absent or not suitable to change their pads. This translates into a loss of 8-24 days of school a year !  
In Uganda parents often believe that when a girls gets her first period it’ s better to take her out of school and get her married. Due to the many taboos and myths surrounding menstruation, girls are restricted to participate in everyday activities like going to the mosque or the church. People even believe that when a menstruating girl walks through your garden, the plants will die! When girls are allowed to stay at school they risk the chance of getting laughed at by boys or they get scolded at by teachers when they stain their school uniforms. After being laughed at once, many girls don’t dare to return to school. The absence of good support to teenage girl during their menstruation accounts to a big proportion of school dropout of girls. Nationally the momentum on MHM has increased including: coordination of MHM initiatives under Ministry of Education and Sports, signing of MHM charter , pronouncement by government to supply free pads (presidential pledge),&  development of MHM standard materials (MHM Manual). However operationalization of the commitments including  the MHM charter, , lack of MHM policy & strategy anchored in act of parliament, lack of standard national guidelines on MHM, inadequate Monitoring & evaluation framework, & limited engagement of cultural and social norm power holders continue to emerge as gaps that need re-dress by both state and non-state actors. Within the project Plan International has develop an approach which focusses on eliminating the barriers girls and women face when having their period through:
1.	Increasing the knowledge on what menstruation is and how to manage it hygienically; through training teacher on how they can teach girls and boys about menstruation, and by providing information to the wider community through radio shows and billboard.
2.	Improve access to affordable and hygienic menstrual hygiene pads; through teaching girls, boys and local entrepreneurs how to make re-usable sanitary pads.
3.	Improving access to toilets at schools that include facilities to manage your menstruation (like emergency pads, a bin, water to clean yourself and a mirror to check for stains).
4.	Breaking taboos en myths surrounding menstruation; through community and school plays taboos and myths are discussed, challenged and broken.
Now the current MHM project is running to its end, Plan International wants to use the momentum and track record it gained to scale up its MHM interventions in more communities in the districts of Kamuli and Tororo and work with the national government to further develop the national MHM approach to ensure MHM no longer is a limiting factor for women and girls throughout Uganda to reach their full potential. Plan International has successfully been implementing a Menstrual Health & Hygiene (MHH) projects in Uganda since 2012 and has improved the knowledge, attitudes and practices of more than 197,000 women, girls, boys and men on menstruation. As a result more girls are successfully attending school (94.9%) compared to 56% at the beginning of the project. Thanks to the project interventions there is also an increasing buy in by the different stakeholders including the government that agrees that improving access knowledge, attitudes and practices on MHM is needed to ensure girls and women reach their full potential. 
Plan International wants to use the momentum and track record it gained to scale up its MHM interventions in more communities in the districts of Kamuli and Tororo and work with the national government to further develop the national MHM approach to ensure MHM no longer is a limiting factor for women and girls throughout Uganda to reach their full potential. 53,502 Rural women, men , boys and girls

Direct:  11.727 girls and 11268 boys and 369 women and 301 men
Indirect: 7847 girls and 5647 boys and 9439 women and 6904 men

Target group: 
Primary target group:  29,382, girls and women   

Secondary target group: 
o	150 teachers
o	80 local entrepreneurs
o	40 health workers 
o	40 local leaders In a bid continue build on the activities of the previous project and  address the gaps  identified in Kamuli  district,  the project will execute soft and hard ware activities including:
	Training of 42  School health clubs on MHH
	Training of 150 teachers as  TOTs on MHH
	Training of 130  Village health teams  & Health  workers on MHH
	Training of local entrepreneurs( Tailors, retail shop owners) on making  and sale of hygienic pads
	Training of  15 drama groups on MHH theatre for development
	Community Dialogues (drama sessions on MHH)
	Training of  40 cultural and religious leaders as MHH champions of change 
	Media  campaigns ( Radio Talk shows and spots)
	National level  Engagement &  campaigns on MHH
	School Hygiene competitions
	National level  Advocacy and  engagements on MHH
	Construction of  13 gender friendly latrines
	Construction of  15  Inclusive boreholes Financial sustainability
The project will develop mechanism geared towards empowering communities mobilise resources for continued functionality of the WASH infrastructure constructed.  Plan international  Uganda’s staff, together with local government members, will carry out the training, including the collection of the payments for the services to grant the corrective maintenance. This will improve the knowledge and will therefore grant the use of these systems, the payment for the services and the future economic sustainability.
Institutional sustainability
Plan International Uganda has been working closely with the National and District governments to include MHH in the National school curriculum and include MHH rooms as part of the national school latrine designs. This project will support with the roll out of these policies and the training of the government staff to ensure MHH activities are scaled up and sustained even without the support of Plan International. 
Within this project Plan will work with and through the government and community systems that are already in place to ensure ownership of the MHH activities and complete transfer of responsibilities from the start.
Ecological sustainability
The project has a technology that doesn’t impact on the environment in the selected schools. On the other hand, the selected areas have a large amount of water, so the withdrawal isn’t a problem for the environment and the future water supply. In addition excess water will be used for irrigation of fruit trees in school that have a positive contribution to environment.
The incorporation of sanitation and hygiene techniques through construction of gender friendly sanitary facilities will counter the impact of the current bad practices (Open defecation) as a result of high latrine pupil stance ratios in the environment. The contaminated water and the lack of community sanitation (such as the defecation in common areas) endanger not only the community health, but also the environmental health (contamination of the groundwater, local crops, etc.).
 The latrine design  adopted allows for  appropriate disposal of pads through  burning in the incernirator  attached on the latrine block. This will deter  indiscriminate disposal  of  used pads  that may contribution to environmental  degradation .
The training for the hand pump mechanic associations will improve the coordination between communities and Handpump mechanics. This will enable the reduction of the number of boreholes that are non-operational, reducing the parts that are scrapped and the wastes (such as greases) that are dumped to the environment
Technical sustainability
The chosen technology (drilling of deep boreholes), developed by a local company selected after a bidding that is in line with the national policies, is promoted by the Ministry of Water and Environment as the most simple technology for the isolated rural communities and as the most used technology in the selected area. The technical level required for its repair and maintenance is simple, although the lack of capabilities makes it necessary to provide training for the local technicians. 
Plan Uganda will work with the water, health and education departments in the district, and with the 15 committees, in execution of the WASH in schools interventions. The committees will be trained in technical issues, the roles of the local actors will be defined, the places that will be drilled will be selected, and awareness rising about the water value chain will be undertaken.  
Social sustainability
The 15 water management committees will manage the operation and maintenance of boreholes hand pumps. Their members are democratically selected by their communities, also considering the female and child representation (at least one boy and one girl and 50% feminine representation). This will grant that the diversity of opinion will be considered in all the decisions that the committees will take. Additionally, the children will receive support to ensure their effective participation in the water user associations and to ensure that they support other people in the maintenance of the water inputs. The school Health Clubs established in schools will promote the participation of the youngest people and enhancing their social inclusion in the local policies. 
Additionally, the communities will be able to appropriate the materials because of the negotiation of a tariff model that is proper and accessible for the communities (between € 0.74 per year). On the other hand, the training in preventive maintenance for the community volunteers will enhance the ownership, as far as the communities are in charge of the management of their own water resources. 
These elements will also enhance the target population ownership, so that the democratic participation and the spaces for the discussion, participation and the spaces for the discussion, participation and transparency will ensure a high social sustainability. Lessons learned from the previous MHH project will be taken onboard in this project.  
Involvement of boys and men as MHH champions to de-mystify myths and stereotypes on MHH that dehumanize  girls and women,  working  with the social enterprise  through an appropriate model  that meets the needs of beneficiaries at the bottom of the pyramid & training  of appropriate local resource persons in schools  to continue conveying the MHH message among  girls.   The project therefore will consider identifying & training boys and men as change agents, engage and empower local entrepreneurs (men groups, tailors, retail shop owners) in pads making, business skills and marketing. These will be   linked to financial institution to enable tapping into WASH credit facilities to scale up MHH products business. Mindful of lack of control on transfer of trained teachers (MHH TOTS) 4-5 teachers per school will be trained