Evaluation of School Wash, Sanitation and Hygiene (SWASH) Project: Has it Adressed Menstrual Health and Hygiene Management (MHHM) Related Challenges Facing School Girls in Muheza District?

Background: Many countries especially in Africa and Asia lack menstrual hygienic facilities in public places especially in schools where it is needed the most. The facilities entail sanitary pads, water to wash hands, clean toilets with locking doors, and disposal areas for sanitary pads. This goes in hand to low level of MHHM understanding among both girls and boys. Methodology: This study was a concurrent mixed methods with analytical cross sectional study design where a formative evaluation approach was employed. 8 private and government secondary schools were purposely selected where 503 respondents were involved out of which, 458 girls were used as quantitative sample while 42 girls students were selected for in depth interviews out of quantitative sample, 5 FGD’s each comprised 8 girls’ students, 3 FGD’s for boys each comprised 8 students, 16 teachers and 5 District Managers were used in this study as a part of qualitative sample. Data were quantitatively analyzed with the help of Stata 13, Python and QGIS for geospatial analyses. Qualitative analysis involved content analysis technique with the help of Atlas ti and online word cloud tools. Results: it was found that none of 8 schools has met 100% MHHM requirements as envisaged in the guideline, mean students ratio per pit hole were observed to be 52 with the worst situation in government schools (>100 for some schools). Activeness of SWASH clubs is a challenge with its non-availability in private schools. Operations and maintenance was another challenge where non availability of soaps, emergency pads, water and dilapidated infrastructure were prevalent in government schools. With one sample test of proportions, it was observed that 0.14 is the proportion of girls’ experience and observations of teasing/embarrassment from school boys during menstruation periods (p<0.001). Age were observed to have a weak positive relationship to students’ performance (r=0.35) while menstrual experience years moderate (r=0.52). “Form II”, “Form III” and “Form IV” are 1.04, 1.36 and 1.39 respectively times likely to have desirable awareness level (>= 50%) compared to “Form I” (p>0.05), primary and secondary educated mothers are 10% and 6% less likely to have desirable MHHM understanding compared to university educated mothers (p=0.732 and 0.33 respectively) whereas Mothers who have not gone to school are 80% less likely to have a good understanding level than University/College mothers (p=0.033). Implementers’ commitment and responsiveness towards SWASH project in the area of MHHM was a challenge since implementers do not have profound insights on what the project is all about with less prioritization of MHHM and school health matters as academic matters are. Conclusion: Unreliable funds, worse situation in MHHM operations and maintenance, lack of awareness on SWASH project, poor sectorial coordination and non-consideration of MHHM issues as vital are major challenges impinging smooth implementation of SWASH project. Considerable measures are to be taken by government and project designers in areas of scale up, implementation and progress monitoring so as to ensure achievement of envisioned outcomes.