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Distribution of sanitary pads- evidence based intervention and clueless minority.

Sun, 6 Jul 2014 Source: Zakaria, Mawia

Ghana is emerging as a competitive destination for business despite recent economic challenges

facing the West Africa Country. The government of Ghana has successfully created the

momentum that has the potential to spur growth and bring the country back on the path of

impressive growth and prosperity.

Maintaining this momentum depends on the country fostering inclusive growth. One lever for

change is the opportunity presented by education and literacy. Education can enable high

potential but disadvantaged people to participate effectively in the national and global economy.

Education of the Girl Child presents a dynamic opportunity for female youth to build sustainable

careers and livelihoods

However, one of the major barriers to female access to education has been found to be

inextricably related to menarche and its attendant challenges. In fact, a good number of female

school children fail to report to school when they are in their menses and hence poor

performance and increased likelihood of drop out. The incidence of drop out of the girl child

from school is also related to the incidence of early marriage and its known consequences.

It is in recognition of the importance of the removal of all barriers to education of the girl and the

combat against early marriage that the Dutch Government in partnership with the Government of

Ghana with support from United Nations Children Fund (UNICEF) is currently implementing a

program that is focusing on behavioral change with the aim of increasing educational

opportunities for girls who are currently out of school. Apart from cultural and social norms

which enhance the likelihood of the girl child staying out of school, it has been shown that

difficulties associated with menstruation present a major barrier to access and any intervention

that is intended to eliminate this barrier deserves the support of informed and well-meaning

Ghanaians.

The Evidence

Research Article, ‘Sanitary Pad Interventions for Girls' Education in Ghana: A Pilot Study by

Paul Montgomery, Caitlin R. Ryus, Catherine S.Dolan, Sue Dopson,Linda M. Scott

Abstract

Background; Increased education of girls in developing contexts is associated with a number of

important positive health, social, and economic outcomes for a community. The event of

menarche tends to coincide with girls' transitions from primary to secondary education and may

constitute a barrier for continued school attendance and performance. Following the MRC

Framework for Complex Interventions, a pilot controlled study was conducted in Ghana to assess

the role of sanitary pads in girls' education. Methods; A sample of 120 schoolgirls between the ages of 12 and 18 from four villages in

Ghana participated in a non-randomized trial of sanitary pad provision with education. The trial

had three levels of treatment: provision of pads with puberty education; puberty education alone;

or control (no pads or education). The primary outcome was school attendance.

Results; After 3 months, providing pads with education significantly improved attendance among

participants, (lambda 0.824, F = 3.760, p<.001). After 5 months, puberty education alone

improved attendance to a similar level (M = 91.26,SD= 7.82) as sites where pads were provided

with puberty education (Rural M = 89.74,SD= 9.34;

Per urban M = 90.54,SD= 17.37), all of which were higher than control(M = 84.48,SD= 12.39).

The total improvement through pads with education intervention after 5 months was a 9%

increase in attendance. After 3 months, providing pads with education significantly improved

attendance among participants. The changes in attendance at the end of the trial, after 5 months,

were found to be significant by site over time. With puberty education alone resulting in a

similar attendance level.

Conclusion; This pilot study demonstrated promising results of a low-cost, rapid-return

intervention for girls' education in a developing context. Given the considerable development

needs of poorer countries and the potential of young women there, these results suggest that a

large-scale cluster randomized trial is warranted. Trial Registration

This is an open-access article distributed under the terms of the Creative Commons Attribution

License, which permits unrestricted use, distribution, and reproduction in any medium, provided

the original author and source are credited.

Funding: The study was funded by Templeton College, the John Fell Fund and Green Templeton

College - all at Oxford University. Pads were supplied by Proctor and Gamble. No supporter of

the study had any influence over the publication of any results. The funders had no role in study

design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have read the journal's policy and have the following conflicts:

pads were supplied by Proctor and Gamble. This does not alter the authors' adherence to all the

PLOS ONE policies on sharing data and materials.

Narok, Kenya: An initiative that seeks to provide all secondary school girls in Narok County

with a year’s supply of sanitary pads has been put in place by Narok Deputy Governor Evelyn

Aruasa.

Aruasa says all 10,556 girls in the 94 secondary schools in the county will get sanitary towels at

a cost of Sh9.6 million shillings.

Speaking to The Standard in her office, Aruasa said the move has been informed by the need to

boost girl education, which she says is still low in the county.

“Many school going girls keep missing school during their menses. Because of poverty, most use

pieces of dirty rags, cotton wool, leaves and paper. Some even wash and recycle. These practices

expose them to diseases and discomfort,” she said.

She expressed optimism that the initiative will raise the girls’ academic performance, restore

dignity and self-esteem.

The deputy governor said this will guarantee access to safe affordable, convenient and culturally

appropriate methods of dealing with menstruation.

PARTNERS APPEAL

“Reports from the Ministry of Education indicate that several girls have dropped out of school

because of the stigma associated with the inability to have sanitary pads. This, in the long run,

restricts the girl from accessing education,” she said, adding that in Narok over 70 per cent of the

girls dropped out because of lack of pads.

She appealed to partners to come on board so that the programme can be extended to benefit

girls in primary schools.

She warned that Kenya’s endeavor for gender parity by 2015 or the Millennium Development

Goals (MDGs) will remain unattainable if the girl child is not retained in school.

“Narok is mainly a patriarchal society and thus, as a county, there is need to do something that

will see girls compete favorably with boys. The first step in empowering women is by making

sure they are in a position to compete with her male counterparts in school,” she said, adding that

Narok becomes the first county to launch such an initiative.

SET ASIDE

In the 2012/2013 financial year the Government set aside Sh300 million for the provision of free

sanitary towels to 568,925 needy girls between Classes six and eight. The amount was, however,

slashed to Sh99 million the following year.

According to the United Nations Children’s Fund 2007 report, a girl in primary school between

grades 6 and 8 (three years) loses approximately 18 weeks out of 108 school weeks. A girl in

high school (four years) loses 156 learning days which is equivalent to almost 24 weeks out of

the 144 weeks of school.

Several other studies across Africa have confirmed the relevance and indeed need for free

sanitary pad as an intervention. Indeed the practice is enjoying massive support in Kenya,

Botswana, Rwanda, Uganda, and the likes.

The Intervention

NTERNATIONAL DEVELOPMENT ASSOCIATION PROJECT APPRAISAL DOCUMENT

ON A CREDIT IN THE AMOUNT OF SDR1O1 MILLION (US$156 MILLION

EQUIVALENT) TO THE REPUBLIC OF GHANA FOR A SECONDARY EDUCATION

IMPROVEMENT PROJECT April 24, 2014

PROJECT DESCRIPTION

A. Project Components

20. The proposed Project would support the Government's Community Day Senior High School

program through two components: (i) Support to Increase Access with Equity and Quality in

Senior High Schools; and (ii) Management, Research and Monitoring and Evaluation.

Component 1: Support to Increase Access with Equity and Quality in Senior High Schools (Total

costs including contingencies: US$140.1 million)

21. Component 1 uses a results-based financing (RBF) modality. Disbursements up to a capped

absolute amount will be made against specific line items in the Education sector annual budget,

referred to as eligible expenditure programs (EEPs). These disbursements will be conditioned on

achievement of specified results, as measured by disbursement-linked indicators (DLIs). A

matrix of indicators has been developed to measure performance annually and monitor the

results achieved (Annex 1).

22. Policies and interventions to be supported are grouped into two pillars: (i) increasing access

with equity (geographic, gender, poverty, etc.); and (ii) improving quality of selected low

performing SHS.

23. Pillar 1: Increase Access with Equity (Total costs including contingencies: US$125.1

million): The objective of this pillar is to improve access to senior secondary education and

improve equity in underserved districts and provide scholarship to students from low income

families, especially girls.

24. The SEIP is expected to finance results of the Government's priority program to expand

space through the construction of new senior secondary schools in underserved areas,

rehabilitation and expansion of existing low performing schools and through support for SHS

attainment of disadvantaged students. The Government plans include new construction in the 14

districts where there are no current operating public SHS. In addition, using the agreed selection

criteria for eligible student population compared with available school capacity (effective

demand) combined with district level poverty indicators, an additional 9 districts have been

identified for new construction. The ultimate objective is to create new spaces for those

demanding seats in SHS and to fill these spaces with new students coming from previously

underserved communities. In addition to new schools, this pillar would focus on improving

existing SHS, particularly those with capacity for expansion, demand for SHS places, poor

learning outcomes, drawing on a needs assessment which will determine level of deficiency

(bathrooms, science labs, computer facilities, etc.) and scope for upgrading. Approximately 125

existing schools would be supported. This pillar will improve the Government's targeting of

resources to support increased access by further supporting scholarships to students from low

income families, especially girls.

25. Given the operation's focus on under-served areas and promoting access with equity,

disbursement will be linked to indicators (DLIs) that measure increases in seat availability in

targeted locations for new construction and increased utilization in existing low-performing

schools where new seats are made available. Targeting resources for students from low income

families, especially girls in underserved communities would further strengthen equity reforms.

Therefore, the release of International Development Association (IDA) credit funds will be

linked to achievement of the following DLIs: (i) selection based on targeting of school expansion

in underserved districts (DLIl); (ii) increase in new seats utilized for SHS students in

underserved districts (DLI 2); (iii) increase in utilized seats in existing selected low-performing

schools (DLI3); and (iv) increased enrolment in selected SHS for students from low-income

families, especially girls (DLI4).

26. Pillar 2: Improve the quality of education in selected low-performing Senior High Schools

(Total costs including contingencies: US$15 million): The objective of this pillar is to improve

the quality of SHS, with a focus on mathematics and science education in selected low

performing schools". The SEIP would also strengthen school management, leadership and

expansion of ICT in the 125 selected low-performing schools. In order to improve quality, the

Project will support the Government's program to: (i) strengthen school management, leadership

and accountability; (ii) target interventions to improve the quality of science and mathematics

education; and (iii) introduce School Performance Partnerships (SPPs) based on School

Performance Partnership Plans (SPPPs) to capture quality improvements. The SPPs would

develop mutual accountability between school management and the District Education Oversight

Committee (DEOC) to improve learning performance with the commitment from government

agencies to provide the necessary resources and the responsibility of schools to implement

quality improvement activities with verifiable outcomes. In addition to school-based quality

inputs, training and financing, this pillar will support the systematic collection and publication of

school data for stakeholders to make informed decisions about SHS selection, and for MOE/GES

to make informed decisions about planning and financing SHS.

27. The focus on mathematics and science subjects is aligned with the Government strategy to

encourage these program areas throughout all education levels. The expansion of ICT wireless

connectivity would also allow strengthened science, mathematics and other subject education

through digital content for teachers and students. Schools will have access to an education

portal1 2(i-campus) where teachers and students can utilize multiple online resources that are

expected to support improved teaching and learning. ICT will be used for intensive in-service

support to teachers to improve content knowledge as well as lesson plan preparation, teaching

and learning aids, and videos on good teaching practices and classroom management. The portal

could also serve as a platform for knowledge exchange with national and international networks

and for participation in relevant discussion forums. The SEIP is expected to provide connectivity

to 125SHS.

28. As an intermediate result, completion rates in the targeted schools would be expected to

increase. A longer term impact would be an increase in student achievement in learning

outcomes (as measured by performance in the WASSCE) which is also a year 4 DLR. For this

pillar, release of IDA credit funds would be linked to the achievement of the following DLIs: (i)

annual publication of School Performance Report (DLI 5); (ii) School Performance Partnerships

(SPPs) in 125 beneficiary schools (DLI 6); and (iii) improved learning outcomes in targeted

selected schools (DLI 7).

29. Component 2: Management, Research and Monitoring and Evaluation (Total costs including

contingencies: US$15.9 million): This component aims to strengthen the implementation

capacity of the MOE and GES and its related implementing agencies and assist them to achieve

the objectives of the Government's SHS strategy. This component will support monitoring and

evaluation (M&E), coordination, planning, communication, financial management, procurement,

and safeguards. In addition it will support an active and evolving research agenda to continue to

inform government SHS policy, particularly with regard to financing, social targeting, quality

initiatives, teacher rationalization, and curriculum relevance. This component would complement

implementation of the program pillars with ongoing analyses, strengthening data collection for

school mapping, and establish priorities for new construction, renovations and maintenance.

The establishment of a web platform for school reporting and real time monitoring of all SHS

implementation activities would enhance and strengthen the Education Management Information

System (EMIS) and school mapping in order to help government report on achievement of

results. In addition, funding will be provided to support the independent verification of

disbursement linked indicators and results. Support would also be provided to help the MOE to

design and realize policy reforms, including piloting and evaluating innovative approaches. This

component would finance training, recruitment of short and long-term technical experts,

procurement of goods needed for specific activities, and incremental operating cost.

The pads distribution falls under the component of equity in access and a scholarship package to

high potential but deprived students to enable access secondary education with less difficulties.

Conclusion

From the above lyrics, one can conclude that the minority and sections of the media have

demonstrated stuck ignorance on the relevance of this excellent intervention. It reflects the extent

to which minority legislators are detached from community development issues since all

committed and well-meaning partners in development are unanimous on the relevance of such an

intervention and would gladly support any initiative that would remove barriers to access to

education for the girl child.

Distribution of sanitary pads in a targeted intervention of this nature can be harnessed to address

the issue of low attendance and increased dropout rate amongst females and to contribute to

positive social outcomes for the girls and their communities. The initiative is well thought out

one and holds the potential to address the serious problem of gender inequity in the development

agenda of this country .It has the unique capacity to provide increased chances of employment to

girls who face barriers to employment and end up as head porters or kayayes as the case may be.

The reaction of the minority is out of ignorance. A good number of girls in Ghana do not attend

school when menstruating.

It is highly recommended that the government scales up this program to support more deprived

girls and also endeavor to provide changing facilities such as separate male and female facilities

at schools since lack of changing facilities also hinders menstruating girls from going to school.

By Dr. Mawia Zakaria.

Executive Director

Institute of Social Research and Development (ISRAD)

Accra. 0244601990.

Columnist: Zakaria, Mawia