Adaptive Management meets Menstrual Hygiene

August 15, 2018

     By Duncan Green     

I recently visited Tanzania to look at adaptive management in the Institutions for Inclusive Development (I4ID) programme, a big (£12m over 5 years) project that is trying to use AM approaches in a fast-closing political space (more on that to follow, once Irene Guijt and I finish the draft paper). One highlight was watching some top convening and brokering in action, on the topic of menstrual hygiene management (MHM). It was a fascinating insight into the people and tactics that need to come together to make AM work.

The issue: only a small fraction of Tanzanian women are using improved menstrual products like sanitary pads. The remaining 80% are reported to be using a variety of materials from cloth rags, ugali, soil, cow dung, to corn cobs. Reusable cloth rags are mostly used, but due to cultural sensitivities, poor management of them has been linked to increased cases of discomfort, fungus, UTIs, and other related diseases.

The key figure for I4ID is an Exfamer, Mwanahamisi Singano (universally known as Mishy, above). She’s a classic campaigner and a great networker. Before joining I4ID, she’d been active in the Tanzania Gender Networking Programme (TGNP – Tanzania’s largest women’s/feminist movement). On International Women’s Day this year, Mishy was facilitating a TGNP event, after which they got into a conversation about MHM.

TGNP wanted to lobby for free sanitary pads in schools (girls miss classes because of the lack of facilities). The trouble was that the politics were all wrong – an opposition MP had already proposed the idea, and been rejected. What’s more Kenya’s experience when it adopted a similar policy was that it was very difficult to implement in practice. Mishy and TGNP had allies in government (feminists, old school friends etc) who wanted to move forward, but needed a different angle to distinguish their demands from those of the opposition.

So they had a problem, allies on the inside, and a coalition of activists, NGOs and aid organizations who were already working on various aspects of the issue and were keen to step it up. They needed a quick win to gain some momentum and profile, and found it in VAT – Tanzania’s equivalent of the tampon tax. Exemption would reduce the wholesale price by 18% at a stroke, paving the way for increased demand. Mishy worked with TGNP to coordinate the lobbying – they got the support of women MPs and the Ministries of Health and Education, who agreed to take it to the real decision maker – the Ministry of Finance. The MoF checked how much it would cost, found it to be fairly small (due to the low levels of demand) and signed off. Voila – quick win!

They had some momentum, what next? I4ID was looking for a niche – something not already being done by other actors. UNICEF and WaterAid were working on infrastructure (eg school toilets and water), Plan was working on menstrual health education. I4ID reckoned the big gap was sorting out the market, which could also benefit out of school girls and older women. Could they pull together the various manufacturers and distributors to work together to boost access and lobby for policy change?

Which is how we ended up sitting in on a meeting of 8 manufacturers at the I4ID office. ‘Human Cherish’, ‘Relief Pad’, ‘Glory Pads’, ‘Elea Pads’ and ‘Lunette Menstrual Cups’, among others, were more accustomed to being in competition with each other, but Mishy had brought them together essentially to try and persuade them to set up a business association. The table groaned under both a range of products and some serious snacks – drinks, biscuits and samosas.

The dynamics were fascinating. Mishy, a quietly determined woman in black headdress with large gold hoop earrings, proved an effective chair. She expertly summed up I4ID’s role: ‘what are we bringing is the glue, we don’t have any product, or interests.’

The discussion rapidly got technical – government certification, medical trials, bureaucratic obstruction, and the occasional Tanzanian twist – reusables are more likely to be popular because in the villages, disposables have a problem: ‘when you throw pads away here, people think the witches will take them and women will never get pregnant’.

Some of the private sector reps are natural advocates. ‘We should make the government feel involved in the discussion/research from the outset, not just bombard them with findings that they then reject.’ ‘Could we reduce transport costs to rural villages by getting Coca Cola to give us space on its trucks, or doing a deal with medical suppliers?’

Mishy winds up the meeting, and in the last 15 minutes goes round the table, getting the companies to sign up to a join marketing effort. She says I4ID could find and pay a consultant to design a joint marketing plan, and the reps jump at the idea – research and technical assistance are I4ID’s second main tool, along with convening/brokering.

Summarizing: what I saw was a combination of some key features involved in Adaptive Management.

  • Well-networked local activists and ‘development entrepreneurs’, with good facilitation skills
  • Agile money that can stump up small amounts quickly for a meeting hall on International Women’s Day, or a quick bit of market research
  • Quick wins to get momentum
  • A systems approach to spotting drivers and blockers of change
  • It may be easier to do this kind of work on ‘new’ issues – menstruation is hardly new, but it has previously been a taboo in public policy. That means that positions are not entrenched, and institutions and opinions are more malleable and (dare I say it?) amenable to evidence.

Next up, the joys of solid waste management…..