long writing sample_katherine gambir_msh proposal

My Body, My Health, Period.

Improving menstrual health among adolescent females in Achham, Nepal

AUTHORS: Jenna Bhaloo

Mary Beth Dawson

Katherine Gambir

Kelly Necastro

Shamoore Simpson

RESPONSE TO: GH887 Maternal and Child Health Grants Foundation RFP

DATE SUBMITTED: December 4, 2015

My Body, My Health, Period. | 2

TABLE OF CONTENTS

PROPOSAL SUMMARY ...................................................................................................................... 4

EXECUTIVE SUMMARY ...................................................................................................................... 5

SITUATIONAL ANALYSIS ................................................................................................................... 6

PROGRAM OVERVIEW ....................................................................................................................... 8

LOGIC MODEL ..................................................................................................................................... 9

TECHNICAL PLAN ............................................................................................................................ 10

MONITORING & EVALUATION ......................................................................................................... 13

SUSTAINABILITY STATEMENT ....................................................................................................... 17

ORGANIZATIONAL REVIEW ............................................................................................................ 18

PROGRAM MANAGEMENT .............................................................................................................. 19

BUDGET SUMMARY ......................................................................................................................... 20

ANNEX ............................................................................................................................................... 22

REFERENCES ................................................................................................................................... 40


ACRONYMS

GBV Gender-based violence

M&E Monitoring and Evaluation

MHM Menstrual Hygiene Management

MHMP Menstrual Hygiene Management and Puberty

SGBV Sexual- and gender-based violence

WASH Water, Sanitation, and Hygiene


PROPOSAL SUMMARY Title My Body, My Health, Period. Improving menstrual health among adolescent females in Achham District, Nepal Organization Name DEVI (meaning “goddess” in Sanskrit) Key Personnel Jenna Bhaloo, MPH, Technology & Innovation Officer Mary Beth Dawson, MPH, Health Program Coordinator Katherine Gambir, MPH, Training Advisor Kelly Necastro, MPH, Monitoring & Evaluation Advisor Shamoore Simpson, MPH, Program Manager Program Summary

The My Body, My Health, Period Program aims to improve menstrual health for adolescent females, ages 10-16 years, in the Achham District of Nepal by eliminating chhaupadi, the practice in which females are isolated in an outdoor shed (chhaupadi goth) during menstruation, and improving school achievement for adolescent females. DEVI will partner with locally based non-governmental organizations, WaterAid and Samabikas Nepal, to implement key activities over a three-year timeframe. DEVI’s program utilizes a modified version of WASH United’s evidence-based Menstrual Hygiene Management and Puberty (MHMP) curricula for adolescents, which has been implemented with success in India. DEVI’s My Body, My Health, Period. Program will achieve its intended outcomes through community-level trainings on MHMP as well as the construction of female-friendly latrines in schools, and the implementation of WASH United’s modified curricula by teachers in lower secondary and secondary schools in Achham.

Key Objectives

1. By one year post-baseline, there is a 90% increase in adolescent females who report living in a household during menstruation.

2. By three years post-baseline, there is a 50% increase in attendance rates of adolescent females in lower secondary and secondary school levels.

3. By three years post-baseline, there is a 75% increase in adolescent females who report practicing menstrual hygiene management.

Key Activities

1.1 Partners hold community trainings on MHMP and latrine building

1.2 Community meetings for community members to adapt the program’s MHMP curricula to schools in Achham

2.1 School staff measure female school attendance

2.2 School staff track adolescent females’ educational achievement over time (e.g., grades, literacy rate)

3.1 Train teachers to implement the MHMP curricula

3.2 Teachers implement and teach curricula as part of standard education in schools

3.3 Community members build female-friendly latrines in schools

Proposed Dates January 1, 2016 – December 31, 2018 Proposed Budget $465,595 USD over three years


EXECUTIVE SUMMARY

This proposal is prepared by DEVI, (meaning “goddess” in Sanskrit), a non-profit and non-governmental organization based in Kathmandu, Nepal. Since its establishment in 2007, DEVI has dedicated its existence to igniting social change to improve adolescent health and reduce gender inequalities in education and health in Nepal. Nepal is a low-income country in Southeast Asia with a population of 28.17 million people. The country is divided into five regions and 75 administrative districts. Achham district is located in Nepal’s remote and mountainous western region. About 99% of the population practices Hinduism and is firmly rooted in traditional and religious practices. Chhaupadi is a Hindu practice in which females are isolated in an outdoor shed (chhaupadi goth) during menstruation for up to 13 days. Although chhaupadi was nationally outlawed in 2005, up to 95% of Achham still engages in this tradition (UN, 2010). Due to isolation, stigma, exposure to outdoor elements, and several behavioral restrictions during chhaupadi, adolescent females experience an increased risk of chronic and severe reproductive health problems. In addition, educational achievement is much lower among adolescent females due to low school attendance rates during menstruation. Chhaupadi prevents females from attending school during menstruation, which exacerbates gender-based educational disparities; female literacy rate in Achham is 42.9% and the male literacy rate is 70.7% (Central Bureau of Statistics, 2013). To address the health issues and educational disparities caused by chhaupadi, DEVI proposes the My Body, My Health, Period. Program to improve menstrual health among adolescent females (ages 10-16 years) in Achham, Nepal. This program addresses the attitudes and behaviors surrounding menstruation, using lower secondary and secondary schools as a platform to implement menstrual hygiene management and puberty (MHMP) curricula. This program also mobilizes community members to prioritize menstrual health, build female-friendly latrines in schools, and take ownership of the program’s components. This will be a three-year program, operating on a total proposed budget of $465,595 USD. By partnering with WaterAid and Samabikas Nepal, DEVI will achieve the following objectives over three years in order to eliminate chhaupadi, increase the educational achievement of adolescent girls, and improve menstrual hygiene management:

By one year post-baseline, there is a 90% increase in adolescent females who report living in a household during menstruation.

By three years post-baseline, there is a 50% increase in attendance rates of adolescent females in lower secondary and secondary school levels.

By three years post-baseline, there is a 75% increase in adolescent females who report practicing menstrual hygiene management regularly.

The My Body, My Health, Period. Program embodies the GH887 Grant Foundation’s desire to improve child and maternal health, and we are eager to begin this endeavor. DEVI Program Headquarters Kathmandu, Nepal


SITUATIONAL ANALYSIS I. Country Overview Nepal is a low-income country in Southeast Asia with a population of 28.17 million people (The World Bank, 2015b). The country is divided into five regions and 75 administrative districts (MOHP, 2012). Despite improvements in economic and social indicators, large disparities exist between and within regions, notably access to and quality of health services. While Nepal has made strides in improving access to basic education (Grades 1-8), many children do not continue past basic education and educational quality at all levels remains a problem (The World Bank, 2015b). Maternal mortality in Nepal is 281 deaths per 100,000 live births, much higher than the Millennium Development Goal of 70 deaths per 100,000 live births (UN, 2013). Achham District Achham district is located in Nepal’s far-western region (Figure 1), with a population of 257,477 (54% female, average household size= 5) (UNFCO, 2013). This region’s remoteness and hilly terrain make transportation difficult and therefore access to basic services is also limited. Achham is particularly prone to natural disasters, such as floods and landslides (UNFCO, 2013). Almost the entire population (99.4%) practices Hinduism (Central Bureau of Statistics, 2013). Educational disparities in literacy and school enrollment in Achham are much larger than national averages (Central Bureau of Statistics, 2013). Refer to Table 1 for more information about literacy and school enrollment statistics in Achham.

Table 1: Literacy and School Enrollment in Achham District

Achham District Female Male

Overall Literacy (56.8%) 42.9% 70.7%

Net Enrollment Ratio 89.0% 94.6%

Source: Central Bureau of Statistics, 2013

In 2004, the Ministry of Health and Population implemented the National Reproductive Health Strategy and Plan for 2004-2009, which aims to improve the reproductive health of adolescents. Program activities conducted in Achham included: a “train-the-trainer” training on school-centered peer education; interactive youth program for adolescents in school; and gender-based violence (GBV) training for service providers (World Health Organization, 2014). The implementation of the National Reproductive Health Strategy is especially important in Achham due to the normalization of gender-based discrimination among its residents. Adolescent women who menstruate are most vulnerable to gender based discrimination because menstruation is a source of shame and taboo within Nepal (UN, 2013). In addition, due to early marriage, females experience pregnancy at a younger age; with a prevalence of 42% among Nepali adolescents aged 15-19. Pregnancies at such an early age of development create health risks for these adolescents and their children (UN, 2013). Both the gender-discrimination and risks around adolescent women’s health are exacerbated by the practice of chhaupadi. This practice is one form of gender-based discrimination during menstruation, and it is estimated that 50% to more than 95% of women in the district practice it (Kunwar, 2013; UN, 2013). II. Chhaupadi Chhaupadi is a traditional religious practice rooted in Hinduism, in which women and girls are isolated in an outdoor shed (chhaupadi goth) during menstruation. The traditional Hindu practice of chhaupadi began in western Nepal and can be traced back for centuries (Ranabhat et al, 2015). The period of isolation during chhaupadi is longest during the first and second menstrual cycles, for a length of about 12 to 13 days (Bhandaree et al, 2013). In western Nepal, the average

Figure 1: Achham, Nepal


age of menarche is 12.7 years (+/-0.95) (Sunuwar et al, 2010). Required isolation during menstruation negatively affects school attendance because girls are not allowed to leave the chhaupadi goth during menstruation; and therefore, repeated cycles of interrupted schooling often results in eventual school dropout. Gender disparities in school attendance increase around reproductive age for females (DHS 2011 Nepal, Figure 2). Furthermore, inadequate sanitation facilities at schools, including separate latrines for girls and boys, is common and compounds this attendance issue (UN, 2013).

Target Population: Effects on Health of Adolescent Females Due to physical and emotional isolation, stigma, and a number of behavioral restrictions during menstruation, chhaupadi has a number of adverse health effects for adolescent girls. Females may experience hypothermia, injuries such as snake bites, and are at increased risk of sexual violence while in the chhaupadi goth (Kadaryia & Aro, 2015). Females also experience poor mental health outcomes due to social isolation and stigmatization. Suicide is a leading cause of death among Nepali women of reproductive age, and 21% of these deaths occur in women under the age of 18 (Ranabhat et al, 2015; UN, 2013). Females staying in the chhaupadi goth also experience nutrition-related morbidity and mortality (e.g., anemia, undernutrition, stunting) due to restrictions on access to food and safe water during chhaupadi (Bergstrom, 1990; Ministry of Health and Population of Nepal, 2010). More specifically, food restriction and limited water access due to chhaupadi were statistically significant determinants of reproductive health problems for females (Bergstrom, 1990; Ranabhat et al, 2015). These chhaupadi-related reproductive health problems included: painful urination, abnormal discharge, genital itching, chronic pelvic pain and foul smelling menstruation. The authors concluded that these issues may be symptoms of more complex health problems such as uterine fibroids, cervical and uterine cancer, and urinary or reproductive tract infections. Prevalence of uterine prolapse in Nepali adolescents is particularly high, with facility-based reports estimating a range of 9-35% (UN, 2013). This is especially important as the risk of uterine prolapse increases with adolescent pregnancies (Lien et al, 2012). III. Determinants of Chhaupadi by Level of the Socioecological Model The practice of chhaupadi is embedded deeply into the culture and religion of Nepal, but is also heavily influenced by other sectors like policy and the educational system. Figure 3 summarizes the complexity of the socioecological determinants of chhaupadi.

Figure 2: Age-specific Attendance Rates

Figure 3: Chhaupadi Socioecological Model


IV. Anti-Chhaupadi Initiatives National and international organizations, women’s development offices and women’s groups are currently working to end the long-standing tradition of chhaupadi in Nepal (Shrestha, 2013):

Samabikas Nepal is a key national, grass-roots organization based in Achham district focused on empowering women and girls and advocating for their human and reproductive health rights. Samabikas led the “Campaign against Chhaupadi and Other Forms of Traditionally Discriminatory Practices against Women”, which trained women and created support groups in western Nepal, which led to “Chhaupadi Free” zones (Shrestha, 2013; Kunwar, 2013; GRM, 2014)

WaterAid is an international non-governmental organization which works with marginalized populations to provide increased access to water, sanitation, and hygiene (WASH). WaterAid first included MHM in its WASH programs in India in 2007, and has since fully integrated MHM into its WASH programs including those implemented in Nepal. WaterAid’s approach includes providing training to develop MHM programs, demonstrating appropriate facility design for latrines for effective MHM, increasing access to sanitary products, advocacy, education, and awareness.

The Rights, Democracy, Inclusion Fund (RDIF), a partner organization of Samabikas, has also been a key player in specifically addressing chhaupadi at the community level. They formed Chhaupadi Monitoring Committees for each ward comprising a village and each Village Development Committee (Spotlight, 2013b; Spotlight, 2013a) and focused on building self-confidence in refusal to engage in chhaupadi.

Save the Children Norway has been involved the Chhaupadi Elimination Program in Achham district, in partnership with the Ministry of Women, Children and Social Welfare (Uprety & Bhandari, 2013). They incorporated the following components: involvement of local religious and political leaders; engagement of males; creation of mass awareness of harmful effects of chhaupadi by leveraging local media; networking between local government, community-based organizations and women’s groups; and health campaigning to teach girls and women how to manage menstrual bleeding and empower them to attend school regardless of menstruation (Uprety & Bhandari, 2013).

Nepal’s Women and Child Development Offices in the districts of Achham and Doti have implemented an awareness program that advocates for women’s rights, opposes chhaupadi, and promotes infrastructure-level changes such as the availability of girl-friendly toilets (UNFCO, 2013). In 2008, the Ministry of Women, Child and Social Welfare established guidelines for the eradication of chhaupadi on a national scale, including the formation of anti-chhaupadi committees in each district of Nepal (Kunwar, 2013).

Mai Bhagawati Marginalized Women’s Group in Goganpani of Dailekh, is a community initiative grounded in group discussion classes through which women confront taboos affecting their livelihood and make decisions (Oxfam, 2013). Women have dismantled chhaupadi sheds or repurposed them (Oxfam, 2013).

PROGRAM OVERVIEW

The My Body, My Health, Period. Program aims to improve menstrual health for adolescent females, ages 10-16 years, in the Achham district of Nepal. DEVI will partner with WaterAid and Samabikas Nepal to implement key activities over a three-year timeframe. DEVI’s program utilizes a modified version of WASH United’s evidence-based Menstrual Hygiene Management and Puberty (MHMP) curricula for adolescents, which has been successfully implemented in India, Kenya, and Bangladesh. DEVI’s My Body, My Health, Period. Program achieves its outcomes through community-level trainings on MHMP, the construction of female-friendly latrines in schools, and the implementation of MHMP curricula by teachers in lower secondary and secondary schools. WaterAid staff will lead community-level trainings and DEVI will work with Samabikas Nepal to engage and mobilize community members to attend these trainings. Refer to Annexes 1 and 2 for more information about key stakeholders and DEVI’s partners in the My Body, My Health, Period. Program. Overall, this program aims to improve adolescent females’ menstrual health by eliminating chhaupadi through community mobilization and empowerment of adolescent females.

LOGIC MODEL



TECHNICAL PLAN

GOAL To improve menstrual health for adolescent females, ages 10-16 years, in Achham, Nepal. Target Population DEVI’s My Body, My Health, Period. Program targets the following populations in Achham, Nepal:

Primary: Adolescent females (ages 10-16 years) Secondary: Adolescent males, school teachers, parents and community members Geographic Area Achham, Nepal was selected as DEVI’s strategic area because chhaupadi originates from this mountainous region. Despite being nationally outlawed in 2005, chhaupadi is widely practiced in Achham, with up to 95% prevalence in some parts of the district. Technical Intervention Package Our intervention includes a school-based MHMP curricula for lower secondary and secondary schools in Achham and community-level training on menstrual hygiene management (MHM) and the construction of female-friendly latrines in schools. The curricula are drawn from WASH United’s evidence-based MHMP curricula for adolescents (See Annex 3). Because we are implementing an impact evaluation, all lower secondary and secondary schools in Achham will be randomized between the intervention group – schools that receive the My Body, My Health, Period. Program, and the control group – schools that do not receive the program. Levels of Implementation DEVI’s My Body, My Health, Period. Program has a two-pronged approach to eliminating chhaupadi and improving menstrual health for adolescent females: encouraging community ownership and mobilization for prioritizing menstrual health and building female-friendly latrines in secondary schools; and implementing a school-based MHMP in lower secondary and secondary schools in Achham. PROJECT STRATEGY Eliminating chhaupadi, a practice deeply rooted in traditional and religious customs, is key to improving menstrual health among our target population. To do this, DEVI’s school- and community-based program relies on behavior change modeling, and community engagement and mobilization. Our partners, WaterAid and Samabikas Nepal, will assist in engaging community members, as they have partnerships with Achham’s leaders from their existing programs. A Community Mobilization Approach to Eliminating Chhaupadi DEVI will achieve household level behavior change by engaging key community actors such as religious leaders, secondary school teachers and staff, and parents. For adolescent females to be allowed to stay in the house during menstruation, key community members must prioritize adolescent females’ health and understand the importance of menstrual hygiene management. Our school-based curricula adapted from WASH United will be implemented in lower secondary and secondary schools in Achham. A. Community-Level Training on MHM and Construction of Female-Friendly Latrines WaterAid staff will host community-level trainings on MHM and the benefits and construction of female-friendly latrines in schools. These trainings will mobilize community members to build such latrines in Achham’s schools. B. School-Based Curricula on Menstrual Hygiene Management and Puberty Trained lower secondary and secondary school teachers will implement MHMP curricula for adolescents attending these schools in Achham. Adolescent males will receive the puberty curriculum, while adolescent females will receive both the puberty and MHM curricula. Changing the School Environment to Increase Female Educational Achievement The school-based curricula and community-level training will ensure that schools become female-friendly. As community members build female-friendly latrines in schools, adolescent females will be able to attend school during menstruation due to increased access to private, female-designated latrines at school. The school-based curricula will also encourage


adolescent males not to stigmatize female peers about menstruation. This change in behavior, facilitated by a change in school environment, is key to increasing school attendance among female adolescents during menstruation, which improves the overall educational achievement of this population. Please refer to Annex 8 for more details about DEVI’s Behavior Change Model. OBJECTIVES

1. By one year post-baseline, there is a 90% increase in adolescent females who report living in a household during menstruation.

2. By three years post-baseline, there is a 50% increase in attendance rates of adolescent females in lower secondary and secondary school levels.

3. By three years post-baseline, there is a 75% increase in adolescent females who report practicing menstrual hygiene management regularly.

Objective 1: By one year post-baseline, there is a 90% increase in adolescent females who report living in a household during menstruation. Rationale: Menstruating females sent to the chhaupadi goth during menstruation often face many negative health outcomes including malnutrition, urinary and reproductive tract infections, pneumonia, hypothermia, snake bites, sexual violence, and isolation, among others (Kadaryia & Aro, 2015; Bergstrom 1990; Ministry of Health and Population of Nepal 2010; Ranabhat et al, 2015). To achieve our intended impact to improve menstrual health among adolescent females, the practice of chhaupadi must be eliminated. To eliminate chhaupadi, the community as a whole must mobilize to prioritize health over traditional and religious beliefs perpetuating chhaupadi. In doing so, this brings menstruating females back into the home. Activities 1.1 WaterAid hosts community-level trainings on menstrual hygiene management

1.1.1 Module 1: Strategies for aligning traditional and religious beliefs with chhaupadi elimination 1.1.2 Module 2: The importance of MHM 1.1.3 Module 3: Building female-friendly latrines at schools

Rationale: DEVI will partner with two local organizations, Samabikas Nepal and WaterAid, who are already working in the district of Achham to eliminate chhaupadi. To encourage the elimination of chhaupadi and debunk the myths surrounding menstrual hygiene, DEVI will engage Samabikas Nepal to help conduct community outreach. WaterAid will host community level trainings on the importance of MHM, strategies to align traditional beliefs with menstrual health for adolescent females, and how to build female-friendly latrines. These training activities will ensure that chhaupadi elimination is sustainable. 1.2. WaterAid and Samabikas Nepal conduct meetings for community members and local partners to adapt the WASH United MHMP curricula (See Annex 3) to the context of the Achham school system. Rationale: DEVI has selected WASH United’s evidence-based MHMP curricula, which has been implemented in many countries, including India. WaterAid and Samabikas will conduct meetings with community leaders, school staff and teachers, and parents to adapt the curricula to ensure that it is tailored to the community and school system context within Achham. The engagement of community members in adapting the curricula will facilitate community acceptance and ownership of the program, and most importantly, prioritize menstrual health in the community. Objective 2: By three years post-baseline, there is a 50% increase in attendance rates of adolescent females in lower secondary and secondary school levels. Rationale: Menstruating adolescent females in Achham typically do not attend school because they are practicing chhaupadi or are fearful of being stigmatized for attending school by family members, adolescent male peers, and


neighbors during menstruation. An increase in school attendance rates of adolescent females would indicate that adolescent females are attending school regularly and are not missing school days due to menstruation. Activities 2.1 DEVI engages school staff to measure female school attendance Rationale: Measuring school attendance allows school staff to identify students who may be missing school during menstruation. Through community mobilization and the implementation of the school-based MHMP curricula, DEVI aims to emphasize the importance of equitable education, specifically promoting school attendance for menstruating adolescent females. 2.2 School staff track adolescent females’ educational achievement (e.g., grades, literacy) Rationale: The implementation of MHMP curricula and female-friendly latrines in schools will reduce menstruation stigma and enable girls to practice MHM. In turn, females will attend school during menstruation and more easily focus on their education, overall improving educational achievement. In the absence of menstrual taboos, adolescent females will be empowered and have self-efficacy to attain higher educational achievement. Attendance will be used as a proxy of achievement since it is a more tangible and systematic indicator to measure. Objective 3: By three years post-baseline, there is a 75% increase in adolescent females who report practicing menstrual hygiene management regularly. Rationale: Currently, menstrual hygiene management is not practiced regularly in Achham. In order to improve menstrual health among adolescent females in this district, DEVI plans to engage school teachers and staff to desensitize taboos surrounding menstruation by implementing an MHMP curricula for adolescents. To further facilitate the MHM practices, the curricula will teach girls how to create and reuse their own sanitary pads using locally sourced materials. Activities 3.1 Train the teachers to implement the curricula Rationale: After the community is mobilized, Samabikas and WaterAid will train secondary school teachers to implement the school-based curricula. As students learn about MHMP in school, girls will be able to effectively manage their menstrual health using the facilities and knowledge gained from the curricula. 3.2 Teachers implement MHMP curricula as part of standard education in schools Rationale: DEVI understands that menstruation is a sensitive topic and believes that with proper knowledge, adolescents will be empowered to decrease the stigma associated with this topic. DEVI aims to integrate MHMP curricula into the standard education of schools in Achham to reinforce the importance of menstrual health. As a standard part of education in schools, MHMP content will be taught once a week. 3.3 Community members build female-friendly latrines in schools Rationale: For adolescent females to practice MHMP, they need adequate female-friendly latrines, which include locked doors, hand washing stations, and adequate disposal sites for sanitary products at school. The presence of female-friendly latrines at school will encourage adolescent females to attend school during menstruation because proper facilities will exist to help manage their menstruation in a comfortable and sanitary way. Please refer to the Gantt chart in Annex 4 for more detailed information of our project timeline.


MONITORING & EVALUATION

DEVI is committed to robust monitoring and evaluation of its programs. DEVI’s M&E staff will use process indicators throughout our program’s lifecycle to monitor progress, and will assess the impact of the program using outcome indicators during evaluation.

MONITORING PLAN DEVI will continuously and routinely monitor program activities to ensure they are implemented as planned. The Save the Children’s MHM Knowledge, Attitude and Practice (KAP) and the WASH observation checklist will be the primary data source for the process indicators (See Table 2). For a complete list of indicators, see Annex 5, Monitoring Chart). Table 2. Modified Monitoring Chart

Activity Indicator Data Source Frequency

Objective 1: By one year post-baseline, there is a 90% increase in adolescent females who report living in a household during menstruation.

1.1 WaterAid holds community level trainings on menstrual hygiene management (MHM)

1.1.1 Module 1: Strategies for aligning tradition and religious beliefs with chhaupadi elimination 1.1.2 Module 2: The importance of menstrual hygiene management 1.1.3 Module 3: Building female-friendly latrines at schools

% of training participants who score over 85% on training satisfaction survey

Training satisfaction form

Beginning of years 1, 2, and 3

1.2. Conduct meetings for community members to adapt the WASH United Menstrual Hygiene Management and puberty curricula to the context of the Achham school system

% of community members who actively participate in meetings

Meeting notes At least 2 meetings in the beginning of years 1,2, and 3

Objective 2: By three years post-baseline, there is a 50% increase in attendance rates of adolescent females in lower secondary and secondary school levels.

2.1 Engage school staff to measure female school attendance

% of girls who report missing school days due to menstruation

School attendance records

Attendance records will be collected monthly; KAP surveys will be administered yearly

2.2 School staff track adolescent females’ educational achievement over time (e.g., grades, literacy)

% increase in literacy rates among adolescent females

Literacy test Beginning of years 1,2, and 3

Objective 3: By three years post-baseline, there is a 75% increase in adolescent females who report practicing menstrual hygiene management regularly.

3.1 Train the teachers to implement the curricula % of teachers who score 90% or higher on training satisfaction survey

Training satisfaction form


3.2 Teachers implement MHM & Puberty Curricula as part of standard education in schools

% of schools with MHM in their curriculum

Lesson reports, Self-report from students

Monthly and bi-annually


% of females (9-16 years) who report using female-friendly latrines

WASH observation checklists, Self-report


Data Collection Program activities will be routinely monitored to ensure they are being carried out as planned. Research assistants will attend all community-level trainings to monitor their occurrence and quality. Research assistants will complete forms that outline when and where the workshop is taking place, the number of trainers, and the number of participants. The research assistants will also administer pre- and post-surveys to the community members and school staff regarding what they learned in the workshop and their attitudes about MHM to determine whether or not workshop objectives were met. School administrators will aggregate monthly attendance reports and quarterly educational achievement


tests from teachers and provide them to the M&E Advisor, who will aggregate and disseminate findings to primary stakeholders on a quarterly basis. Finally, research assistants will fill out bi-monthly WASH observation checklists to determine the quality and maintenance of the female-friendly latrines in schools. Dissemination The M&E Advisor will aggregate data and report to the Program Manager on a monthly basis during the first year, and a quarterly basis during years two and three. The majority of program activities occur in the first year, so monthly updates are necessary. However, fewer activities will occur in years two and three, so only quarterly reports are necessary. Written reports about the progress of the project will be distributed to stakeholders biannually, including the GH887 Grants Foundation, the Ministry of Education, the Ministry of Health and Population, Samabikas Nepal, and WaterAid. Monitoring will be discussed with Samabikas, school staff, and research assistants during the refresher trainings at the beginning of years two and three. Improvements to the program implementation, training curricula, and school curricula will be made as necessary.

EVALUATION PLAN DEVI will perform a rigorous evaluation to determine the extent of impact our program had on our main outcomes of interest among the target population. The evaluation indicators were suggested by the WHO/UNICEF Joint Monitoring Programme (JMP) questionnaire for the 2015 Sustainable Development Goals (See Annex 6, Evaluation Chart, for a complete list of indicators). Although data will be collected for each of these indicators, the M&E Advisor and the research assistants will discuss which indicators to assess in the final evaluation report based on the specific context of Achham (See Table 3. Modified Evaluation Chart below).

Table 3. Modified Evaluation Chart

Evaluation Question Indicator Data Source Frequency


Has community members’

knowledge of MHM increased?

% of community members who score

at least 90% on MHM exam

Survey at baseline and end of project

using a Save the Children’s MHM

Knowledge, Attitude and Practice

(KAP) questionnaire

Beginning of year 1 and end

of year 3

Have community members’

positive attitudes toward MHM

increased?

% of community members who score

at least 90% on MHM exam

Objective 2: By three years post-baseline, there is a 50% increase in attendance rates of adolescent females in lower secondary and secondary

school levels.

Have adolescent females’ school

attendance rates increased?

% of females (9-16 years) whose

school attendance rate is over 85%

Attendance, truancy, and enrollment

records


of year 3

Have adolescent females’

educational achievement rates

improved?

% of females (9-16 years) who score

at least 90% of literacy test

Literacy test

Objective 3: By three years post-baseline, there is a 75% increase in adolescent females who report practicing menstrual hygiene management

regularly.

Has adolescent females’

knowledge regarding MHM

increased?

% of females (10-16) who score at

least 90% on MHM exam

WHO/UNICEF Joint Monitoring

Programme (JMP) questionnaire


of year 3


Objective 3: By three years post-baseline, there is a 75% increase in adolescent females who report practicing menstrual hygiene

management regularly. (Continued)

Have adolescent females’ positive

attitudes regarding MHM

increased?

% of adolescent females who score

at least 90% on MHM attitude

questions

Survey at baseline and end of project

using a Save the Children’s MHM

Knowledge, Attitude and Practice

(KAP) questionnaire

Have MHM practices increased

among adolescent females?

% of adolescent females who report

practicing menstrual hygiene

management

Have MHM promotive practices

increased among community

members?

% of females (10-16 years) who

reporting practicing chhaupadi in the

past month

Has adolescent females’

menstrual health improved?

% of females (10-16 years) who

report having had one or more

urinary tract infections in the past

year

Data Collection DEVI will perform a randomized, quasi-experimental, mixed-methods, pre-and post-test study to evaluate the knowledge, attitudes, and practices of adolescent females regarding menstrual health. We will conduct a baseline survey within the first month of the project, before activities begin. DEVI will conduct an end-of-program survey in the last quarter of year three using the same question and sampling strategy as the baseline survey. Results from the end-of-program survey will be compared to baseline results to determine whether knowledge and practice of menstrual hygiene management increased over the course of the program. DEVI will adapt the Save the Children’s MHM Knowledge, Attitude and Knowledge, Attitudes, and Practice (KAP) survey to align with our specific program for the baseline and end-of-program surveys. Consultation from Samabikas Nepal during survey development will ensure its appropriateness and validity for the context. We will use a cluster-randomized design since the intervention is occurring at the facility (i.e., school) level. Each cluster represents a catchment area of a lower secondary or secondary school, including the communities served by the school. Although 280 schools in Achham will be affected by the program, we will only randomize 32 total schools (clusters) for evaluation purposes. Because our program takes place at the school level, it is appropriate to conduct our evaluation at the school level. Prior to randomization, schools will be purposively selected to ensure representation with respect to the following characteristics: number of students, proportion of girls and boys, socio-economic status, and literacy rates. Based on data from several sites, we anticipate 50% of girls would have achieved our outcome of practicing MHM regularly without our program. With 15 girls per cluster (480 total girls across 32 schools), an alpha of 0.05 and a coefficient of variation of 0.20, we would have 85% power to detect an increase of 20% (from 50% to 70%) achieving the primary outcome.

Ten research assistants will work a total of 48 days administering surveys to a total of 480 adolescent females. All analyses will be by intention to treat. The M&E Advisor will analyze differences in the proportion of women who receive the My Body, My Health, Period. Program using generalized estimating equations to account for the cluster randomized design. Qualitative Methods DEVI will conduct focus group discussions to assess social norms with rich, detailed contextual data and allow for triangulation with the quantitative data. Four focus group discussions will be conducted at baseline and program end: one with 6-8 female adolescent girls in the intervention group, one with 6-8 community members in the intervention group, one with 6-8 adolescent females in the control group, and one with 6-8 community members from the control


group. One research assistant will facilitate the discussion, while another research assistant will take notes during the discussion. All research assistants will be fluent in Nepali and knowledgeable of different language dialects in Achham. DEVI will select facilitators who are experienced in interacting with adolescent females and are comfortable speaking about sensitive topics. Facilitators will use creative ways to engage adolescent females in discussion, such as games, role play, small group work and opportunities to draw and write, while remaining neutral and objective. Data Analysis Quantitative Analysis The ten research assistants will work for three days to input survey data into CSPro software. The M&E Advisor will create a form using CSPro that looks identical to the survey form, which will include logic and validation. The research assistants will enter the data and check for missing values. The M&E Advisor will spot-check the data to ensure validity. Then, the M&E Advisor will export the data into R for quantitative analysis. Bivariate analyses including t-tests and chi-square tests will be used to assess baseline characteristics between the intervention and comparison groups. The M&E team will use Chi-square tests to compare the percentage of female adolescents who practice menstrual hygiene management in the intervention and comparison groups. Finally, multivariate analyses will be employed to assess if or what other variables are creating differences in MHM practices between the intervention and comparison groups. Qualitative Analysis One research assistant will spend three days transcribing focus group discussions into English from paper to electronic files. Two research assistants will then use NVivo to organize and code data by themes. Research assistants will send their findings to the M&E Advisor for review, and collaborate with her to draw and verify conclusions. Dissemination DEVI values community participatory research and engagement through the entire lifecycle of its program and beyond. DEVI will hold meetings with all of its stakeholders after the end of the program to disseminate findings from the aggregated monitoring and evaluation of the data. Meetings will be held with the GH887 Grants Foundation Committee, the Department of Women and Children, the Ministry of Health and Population, the Ministry of Education, Samabikas Nepal, Achham school districts, and WaterAid. Meetings will also be held with school staff, including principals and teachers. Finally, meetings will be held with adolescent females and community members of the targeted communities to inform them on the progress made in their respective communities. Information will be provided to each stakeholder in an appropriate form, which may include a written report, an oral presentation, or hands-on activity.


SUSTAINABILITY STATEMENT

DEVI is committed to creating a sustainable program in Achham. Stakeholders will have collaborative or representative roles from planning through evaluation to ensure multilevel and multi-sector implementation. Long-term sustainability relies on teachers, community members, and the quality and efficacy of the program’s curricula to eliminate chhaupadi and improve adolescent females’ education and menstrual health. The My Body, My Health, Period. Program is grounded in the local community, building from existing community resources to address its own needs. DEVI also builds on the momentum and mobilization that Samabikas Nepal and WaterAid have created in Achham to support the elimination of chhaupadi and female empowerment. As trusted community leaders, Samabikas Nepal and WaterAid staff will engage community members and garner trust in DEVI’s program. Women and girls involved in My Body, My Health, Period. will take advantage of Samabikas Nepal’s pre-existing women’s support groups for additional support outside of school. WASH United’s MHMP curricula has demonstrated effectiveness in training over 1,000 adolescents in India, Kenya and Bangladesh (Jurga, n.d.). The curricula is holistic in coverage of context-specific topics related to MHMP, inclusive for adolescent males, fun, and interactive. The curricula use game-based and participant-centered learning to foster health behavior change and health education. The program’s community-level meetings also provide community members an opportunity to revise curricula according to evolving community norms around menstruation and puberty. The My Body, My Health, Period. Program encourages adolescents to become peer leaders and ambassadors of MHM for community members and younger peers by disseminating knowledge to the community. By increasing their sense of empowerment and self-efficacy for MHM, DEVI’s program supports youth as agents of change in their communities. This ultimately creates a self-sustaining initiative that is routinely replenished with newly-trained community members. This modality of peer leadership has already emerged in Indian communities that have completed MHMP trainings using WASH United’s curricula. Assuming its effectiveness, the integration of program curricula into existing academic curricula is a sustainable model. Female teachers, as local community members and credible disseminators of MHM curricula to adolescent girls, further support the viability and sustainability of the program. The construction of female-friendly hygienic facilities at participating schools provides environmental change to support behavior change. Latrines and disposal mechanisms will be maintained by school staff to ensure regular accessibility. WaterAid staff on-the-ground with ample training and toolkits on MHM will remain in close partnership with program staff to guide development of the built and social environments to support MHM practice at schools.


ORGANIZATIONAL REVIEW

Mission DEVI (meaning “goddess” in Sanskrit) is a Kathmandu-based non-profit, non-governmental organization dedicated to igniting social change to improve adolescent health and reduce gender inequalities in education and health in Nepal. Through youth empowerment and community mobilization, DEVI envisions all girls and boys in Nepal having equal opportunity in education and health. Experience Since its foundation in 2007, DEVI has implemented 15 programs throughout the country to reduce gender inequalities in education and health. DEVI has partnered with several key organizations such as UNICEF, WaterAid, Samabikas Nepal, and WASH United to achieve a sustainable, measurable impact on adolescent well-being. Since its initiation, DEVI has provided services to over 25,000 adolescents with minimal overhead costs. Ten of the fifteen of the programs have concluded their original grant funding and have become self-sustaining, with continued funding from various local, national, and international donors. Financial Support DEVI receives funding from several of Nepal’s major aid donors, including the World Bank, USAID, the Bill and Melinda Gates Foundation, and UNICEF. DEVI’s My Body, My Health, Period. three-year program will operate on a total budget of $465,595 USD. Project Management


PROGRAM MANAGEMENT

KEY PERSONNEL Key personnel are seasoned professionals from interdisciplinary fields, including private and public sector consulting, community health, clinical care, international intergovernmental organizations, and academic research and have worked with diverse populations.

Jenna Bhaloo, MPH, Technology & Innovation Officer Jenna Bhaloo is trained in using digital health to strengthen health systems and build capacity in Nepal. While at the WHO, she assisted in the development of an HIV viral load testing training tools for health care workers. Her recent work includes developing a virtual agent designed to provide Cognitive Behavior Therapy (CBT) and reduce readmission rates for patients with chronic pain and comorbid depression after discharge from Boston Medical Center. Based in Achham, she uses technology and searches for innovative methods to inform DEVI’s program design, implementation, and evaluation.

Mary Beth Dawson, MPH, Health Program Coordinator Mary Beth Dawson is invested in improving women’s health outcomes in low resource settings. She worked on various adolescent health projects during her time in the Maternal, Newborn, Child and Adolescent Health department at the WHO. She also contributed to the preparation of a 2014 WHO report entitled Health for the World’s Adolescents: A Second Chance in the Second Decade. As DEVI’s Health Program Coordinator, she oversees the implementation of our interventions to improve adolescent health.

Katherine Gambir, MPH, Training Advisor Katherine Gambir is committed to improving women’s reproductive health and has four years of public and private sector consulting experience and demonstrated success in capacity building. In one UNICEF-supported Community-Led Sanitation (CLTS) program in Zambia, she trained over 20 Zambian government officers in a health data information system, and trained over 30 community health workers in behavior change communication and community engagement principles. Fluent in Nepali, she works with DEVI’s partners to train community members and leaders who are integral to our program's success.

Kelly Necastro, MPH, Monitoring & Evaluation Advisor Kelly Necastro is dedicated to the education and empowerment of women and girls to improve global public health and development. While working with the Kenyan Ministry of Health, she developed a model to evaluate community participation in primary health care within the southern Kajiado sub-county. She also led her research team in presenting findings and motivating community members and stakeholders. Kelly oversees the monitoring and evaluation of DEVI’s programs throughout Nepal.

Shamoore Simpson, MPH, Program Manager Shamoore Simpson is passionate about youth programming and program development. She has extensive experience in program management and implementation, and consultation work with a variety of organizations. She is uniquely positioned to oversee DEVI program staff and her approach to training program staff to develop better community relations guarantees sustainability for DEVI’s programs and partnerships.


BUDGET SUMMARY

DEVI requests a three-year budget of $465,595 USD from the GH887 Grants Foundation for implementation of our school-based menstrual hygiene program. The chart below shows the allocated cost of each category of our budget. Please refer to Annex 7 for our line item budget.

BUDGET JUSTIFICATION Assumptions

WASH United only charges a fee for using their curricula if training from their organization is required; The My Body, My Health, Period. Program will require training from WASH United as our partners, WaterAid and Samabikas Nepal will organize the trainings for implementation of the curricula.

Our partners, WaterAid and Samabikas Nepal, are both hired as subcontractors for our program. All DEVI staff are based within Nepal and thus are paid based on a Nepali pay scale, which is then converted to

US dollars. The My Body, My Health, Period. Program staff has limited turnover. DEVI has existing office space in Achham District from previous programs in the district.

A. Salaried Employees Program management salaries were determined based on the average Nepal based yearly salary of similar positions using Payscale and JobsNepal (2015). The program manager salary was determined first, and then used as a benchmark for all other subsequent management and staff. All salaries decrease annually as the time commitment to the program decreases with the assumption that the community members in Achham are implementing the program themselves and all components will transition to community ownership and sustainability.

B. Consultants Research Assistants Research assistants will be hired from Tribhuvan University’s Achham campus as consultants to assist with monitoring and evaluation. These salaries are adjusted based on project time contribution.

C. Benefits Fringe benefits for program staff and consultants were calculated using the GH887 Grants Foundation predetermined rates for federal awards. Fringe benefits for program staff were calculated using the rate of 26.7%. Fringe benefits for consultants were calculated using the rate of 8.1%.

D. Travel & Per Diem Domestic Travel (from Kathmandu to Achham) Airfare was based on estimates from major airlines; airfare rates are significantly less expensive when booking 2-3 months in advance. The Monitoring and Evaluation Advisor and Program Advisor will make 2 yearly visits.


The Research Assistants are based at the Tribhuvan University Achham campus and will only require daily stipends for travel within the district. All other units are based on fieldwork staff who arrive to Achham in Year 1 and leave Achham in Year 3.

Per-Diem The in-country and transit per diem rates were based on the United States Department of State estimates, while the units were based on the Fieldwork Personnel’s need to be in Nepal. The ground transportation costs of $100 were based on the recommendation of the GH887 Grants Foundation.

E. Monitoring and Evaluation The M&E budget is 10% of the total annual budget for each program year as we heavily value the success and sustainability of our program. Baseline evaluation costs only occur in year one as this is one time beginning of program process, and the end of program evaluation costs are only at the end of the program. Monitoring occurs throughout the entire program.

F. Other Direct Costs For our program to be successful, our field office in Achham will require funding for daily operations and other activities such as training workshops, curricula development and printing, and transportation.

WaterAid – Subcontractor WaterAid is partially funded through this program as our partner, and we will be using them solely as trainers and not coordinators for the training component of the program. WaterAid serves in the training aspect of this project and the fee was based on 50% of the salary of the Fieldwork Personnel. In years two and three, WaterAid will only participate in the program periodically for refresher trainings and new teacher trainings, thus requiring a smaller time commitment.

Samabikas Nepal – Subcontractor Samabikas Nepal is partially funded through this program as our partner, and we will be using them solely as community mediators during the community meetings. WaterAid serves in the training aspect of this project and the fee was based on 50% of the salary of the Fieldwork Personnel. Similar to WaterAid, in years two and three Samabikas Nepal will periodically be involved for refresher meetings as it is assumed the community will need to meet less often or will create their own meetings.

Equipment Two computers and one color-printer will be required in our office. Including software and upkeep, this one-time equipment purchase was priced at $2,000. Communication equipment, including phones, long-distance calling, internet, and office supplies were priced at $200 per month. Because Achham is located in the mountainous, rural region of Nepal, an investment in two motorcycles would assist in transportation from site to site, which will reduce travel time within the district. Online quotes show that used Honda motorcycles can be purchased for about $2,000. Fuel and maintenance costs of the motorcycles were priced using average gas prices, which were $0.76/liter as of 2015 in Nepal.

Workshops & Meetings Materials will need to be printed for training workshops and for the school-based curricula (i.e. user manual for teachers and handouts, if necessary, for the students). Photocopying and large printing costs were priced at $150 per month. Meetings among the DEVI field staff in Achham will be held on a monthly basis. There will be more community meetings in the first year compared to years two and three in order to mobilize the community and engage them to eliminate chhaupadi and improve menstrual hygiene management among adolescent girls; traditional tea and snacks will be served at these community meetings.

International communications between our Achham field office and our Boston headquarters office is essential. Courier and packaging services will be needed monthly to ensure communication. G. Overhead Costs The indirect cost rate is based on the off-campus rate for the Modified Total Direct Costs (MTDC) Formula.


ANNEX

Annex 1. Stakeholder Analysis


Stakeholder Stake in the Project (How will impact/be impacted by the project?)

What do we need from them? Level of Influence (in the success/failure of project)

Stakeholder Management

Strategy

The Nepal National Government

The project affects members of the Nepali population. It will ultimately impact the menstrual health of females in this population and overall health of national population, e.g., social and economic.

Strict enforcement of existing policy in Nepal’s Interim Constitution of 2007 (articles 12, 20, 29(2)) to eliminate chhaupadi in Nepal. Continuing implementation of the National Strategy and Action Plan for combatting gender-based violence.

High – If the government enforces existing policies, it will garner support and legitimacy of DEVI’s program in local communities

Collaborative

Achham local governments

The project will engage community leaders who will serve as facilitators of community-level behavior change.

Accept and promote project and its legitimacy so the behavior change becomes new social norm.

Very high – Essential for community engagement and mobilization.

Collaborative

Nepal Government Department of

Women and Children

The project will be affected by this department’s efforts to empower women, especially those who are economically or socially disadvantaged.

Continue efforts to promote women’s rights and elimination of gender-based violence through human dignity and social justice perspective.

Moderate – Without this department’s focus on women’s rights, chhaupadi will continue to be a neglected issue

Representative

Nepal Government Ministry of Health

and Population

The project will be affected by their National Plan of Action on Children, which promotes child-friendly environments, and eliminates all forms of discrimination against children.

Continue to promote child rights through human dignity and social justice perspective.

Moderate – Essential for project’s sustainability. DEVI’s success depends on their approval and support to ensure that our objectives align with existing national health policy and structure.

Representative

Nepal Government Ministry of Education

The project will change the standard of education in Achham.

Continue to ensure quality and equitable education for all.

Moderate – Essential for project’s sustainability. DEVI’s success depends on their approval and support to ensure that schools implement MHM curricula and female-friendly environments.

Representative

Lower secondary and secondary schools in

Achham

The project will foster greater attendance and academic achievement of adolescent females. Teachers will implement MHMP curricula.

Integrate MHMP curricula into overall school curricula.

Very high – Success of the project is dependent on schools’ acceptance and alignment with its mission and objectives.

Collaborative

Samabikas Nepal This organization provides a foundation for this project. The project will complement their efforts to eliminate chhaupadi in the western and far western region of Nepal. This organization will also help facilitate trainings and mobilize community members for latrine-building.

Continue campaign to eliminate chhaupadi in Nepal. Facilitate adaptation of curricula to community context as community leaders. Use existing mobilized groups to support trainings and latrine-building. Encourage women and girls to join existing women’s support groups as an afterschool resource for social support.

High – Success of this project relies on momentum of current campaign efforts.

Collaborative

WASH United This organization provides the project’s MHMP curricula. MHMP curricula Very high – DEVI’s success relies on quality and effectiveness of their curricula.

Collaborative

WaterAid This organization provides the training for community members. “Menstrual Hygiene Matters” modules and toolkits will guide dissemination of knowledge regarding menstrual health and building of female-friendly latrines at schools.

Subject matter expertise on MHM and latrines to promote MHM. Facilitate trainings as teaching/technical team. Continue campaign efforts on menstrual hygiene and sanitation in schools in Nepal.

Very high - DEVI’s success relies on quality and effectiveness of community education and sensitization and the community’s trust in WaterAid.

Collaborative

Adolescent females (10-16 yrs.)

The primary objective of the project is to improve menstrual health for adolescent girls.

Receive and use MHM information and skills. Very high – If female adolescents do not understand the importance of MHM, they will not practice it.

Representative

Teachers The project will engage teachers to implement MHMP curricula.

Implement MHMP curricula. Very high – If teachers do not understand the importance of MHM, they will not be successful in promoting it.

Collaborative

Community members The project aims to change their attitudes and behaviors related to menstruation.

Participate in project training, mobilize resources to build latrines, and lead efforts to eliminate chhaupadi in local communities.

Very high - If community members do not understand importance of MHM, they will not mobilize to build latrines or eliminate chhaupadi.

Collaborative

Adolescent males (10-16 yrs.)

The project aims to change their attitudes and behaviors related to menstruation.

Receive and use information about puberty and females’ menstrual health.

High – If males do not change their attitudes toward menstruation, they will continue to stigmatize females.

Representative

Annex 2. Letters of Understanding


Ministry of Women, Children and Social Welfare Department of Women and Children Shree Mahal, Pulchowk, Lalitpur Tel: 977-1-5547013 November 22, 2015 Program Manager DEVI Program Kathmandu, Nepal Dear Shamoore Simpson, As the implementing arm of the Ministry of Women, Children and Social Welfare of the government of Nepal, the Department of Women and Children aims to empower women, especially those who are economically poor, socially deprived or disadvantaged. We recognize the need for menstrual hygiene management among the national adolescent female population. We believe our goal to achieve gender equality in Nepal aligns with your program’s goals to eliminate the practice of chhaupadi and improve menstrual health. We can ensure the continuation of our efforts to promote women’s rights and elimination of gender-based violence through the lenses of human dignity and social justice. We are in agreement with your decision to begin program implementation in the far western region, particularly the Achham district, as evidenced by the high prevalence of gender inequities and the practice of chhaupadi. We commend your dedication to progressing women’s rights by improving health and education among Nepal’s most marginalized communities. We are looking forward to support your efforts to enhance our existing “Awareness Programme against Chhaupadi” in partnership with the Women and Child Development Offices in Achham.

We are pleased to serve in a representative role for your initiative. As the Director General of the Department of Women and Children, I certify the commitment of our aforementioned support, contingent upon receipt of a FY2016 GH887 Maternal and Child Health Grants Foundation grant.

Sincerely,

Keshab Prasad Regmi Director General Department of Women and Children Ministry of Women, Children and Social Welfare



WASH United Headquarter Berlin Blucherstrasse 22, 2nd entrance, 3rd floor 10961 Berlin Germany Tel: +49 30 555 768 060

November 22, 2015 Program Manager DEVI Program Kathmandu, Nepal Dear Shamoore Simpson, Thank you for contacting Wash United to collaborate with the DEVI Program through the adoption and adaptation of WASH United’s Menstrual Hygiene Management (MHM) and Puberty curricula targeting girls and boys. WASH United is dedicated to sharing our expertise and unique methodology to help build a global movement around menstrual health. Our innovative methodology is unique in targeting multiple interpersonal levels of influence in addition to girls themselves, e.g., boys as peers. Curricula are designed to promote fun and engaging learning environments by emphasizing group interaction, game-based learning and positive communication.

WASH United believes that adequate MHM is comprised of four key components: information and education, access and hygienic use of feminine care products and personal hygiene, access to private and safe facilities with water and soap, and safe mechanisms for disposal. Our curricula are designed to support female empowerment by breaking down taboos, making girls, boys and teachers comfortable to speak and learn about menstrual health and puberty, and supporting girls to practice MHM at school and at home in safety and privacy. As you adapt the curricula to the community context of Achham in partnership with local organizations, we will remain available for consultation to ensure appropriateness and accessibility of the materials for your target populations. We look forward to marketing your program as another success story in showing that Menstruation Hygiene Matters!

We are pleased to serve in a collaborative role for the implementation of your program. I certify the commitment of our aforementioned support, contingent upon receipt of a FY2016 GH887 Maternal and Child Health Grants Foundation grant.

Sincerely,

Ina Jurga Head of WASH in Schools WASH United



Nepal Schools GPO Box: 19153 Kathmandu, Nepal Tel: 980-2-011622 November 22, 2015 Program Manager DEVI Program Kathmandu, Nepal Dear Shamoore Simpson, As President of Nepal Schools, I recognize that communities across the country face different barriers to school attendance and achievement. The district of Achham is particularly vulnerable to low rates of attendance given the remoteness, poverty and lack of infrastructure of the region. Early marriage and cultural taboos against menstruation, including the practice of chhaupadi, place even bigger obstacles among Nepali girls at lower secondary and secondary school levels. I commend the DEVI organization for its commitment to eliminating chhaupadi in Achham and bringing sanitation to schools where students are in dire need. Nepal Schools supports the mission of the DEVI program and is pleased to collaborate on a pilot effort.

Please consider this communication an agreement to collaborate as DEVI continues to plan its programming pending identification and approval of menstruation hygiene management and puberty curricula, and identification and approval of intervention schools. I have corresponded with the superintendent in Achham, Narash Tamang, so he is prepared to hear from you and partner moving forward.

Thus, Nepal Schools is aligned with the mission and activities of DEVI. Support is contingent upon receipt of a FY2016 GH887 Maternal and Child Health Grants Foundation grant.

Sincerely,

Dinesh Bastola President Nepal Schools



Government of Nepal Ministry of Health and Population Ramshahpath, Kathmandu 44600, Nepal Tel: 977-1-4262543 November 22, 2015 Program Manager DEVI Program Kathmandu, Nepal Dear Shamoore Simpson, As the governmental entity responsible for improving the condition of health services and public health in Nepal, the Ministry of Health and Population agrees that the implementation of the DEVI Program, as a non-governmental organization, will foster overall national development. The DEVI Program aligns well with the Ministry’s current National Plan of Action on Children, which promotes child friendly environments and strives to eliminate all forms of discrimination against children. Nepal has a rich cultural history that is deeply rooted in religious beliefs and traditional practices. We recognize chhaupadi as a traditional practice imposing great harm and burden on women and girls in our population. Without grassroots-level efforts by organizations such as yours, chhaupadi will continue to remain a neglected public health issue that threatens human dignity and social justice on an international scale.

We approve of your initiative and are pleased to commence a representative role in the DEVI Program. We can ensure the continuation of our efforts to promote the empowerment of children, women and other marginalized groups of our people. Given the Ministry’s role in health promotion at the population level, we can help formulate health promoting policies and foster coordination of efforts with village development committees at the community level, especially in hard to reach and relatively disadvantaged districts such as Achham.

As the Minister of Education, I certify the commitment of our aforementioned support, contingent upon receipt of a FY2016 GH887 Maternal and Child Health Grants Foundation grant.

Sincerely,

Ram Janam Chaudhari Minister Ministry of Health and Population



Samabikas Nepal P.O Box 7770, Ekantakuna Lalitpur, Nepal Tel: +977-1-5537103 November 22, 2015 Program Manager DEVI Program Kathmandu, Nepal Dear Shamoore Simpson, Thank you for contacting Samabikas Nepal to collaborate with your organization on the elimination of chhaupadi and promotion of menstrual health in Achham. We commend your commitment to join this worthy cause. Samabikas is proud to have mobilized community leaders, teachers, adolescent girls and boys and women’s groups in a social awareness-raising campaign against this pervasive practice of gender-based violence. Thus far, our efforts have been proven successful in the declaration of three villages within the Achham district as chhaupadi-free zones and creation of leadership opportunities for women who used to be victimized by chhaupadi. Our campaign, however, still faces strong resistance and resentment from those firmly holding onto traditional beliefs. Therefore, the timing of your initiative’s implementation will help drive the momentum of the anti-chhaupadi movement forward. We are pleased to offer our support and partner with DEVI. Samabikas staff look forward to helping engage community members in your training and latrine-building initiatives. We can guarantee that these community members will serve as passionate and motivated partners based on the personal relationships that we have together. As community leaders, they are well-versed in the dynamics, assets and needs of their communities in order to help adapt your MHM and Puberty curricula appropriately to reach our youth. We also encourage your program participants to join, even create their own, women’s support groups to serve as a safe place for discussion and social support outside of the classroom. It is our hope that girls in your program will emerge as leaders in our communities and break down taboos against menstruation proudly. As the President of Samabikas Nepal, I look forward to our partnership based upon receipt of a FY2016 GH887 Maternal and Child Health Grants Foundation grant.

Sincerely, Dhurbar Sunar President Samabikas Nepal



Government of Nepal Ministry of Education Singhaurbar, Kathmandu 44617, Nepal Tel: +977-1-4200340 November 22, 2015 Program Manager DEVI Program Kathmandu, Nepal Dear Shamoore Simpson, As the governmental entity responsible for the development of education in Nepal, we recognize the negative effect that taboos regarding menstruation have placed upon women and girls in our population. We approve of your initiative and are pleased to commence a representative role in the DEVI Program. We can ensure the continuation of our efforts to bring quality and equitable education to the national population. As you know, the far western region of the country, particularly Achham as one of the most remote and poor districts, faces grave gender-based inequities. The overall literacy rate in Achham is 53%; the women’s literacy rate in Achham is 37%. We commend your grassroots efforts to mobilize and educate the Achham community to improve women’s rights and ultimately women’s health by focusing on eliminating the traditional practice of chhaupadi.

We are looking forward to witnessing the successes of female-friendly school environments in the district. As there are 62 secondary schools serving our adolescents in Achham, there is great potential to bring widespread social change by fostering educational achievement through the DEVI Program. Based on your example and the program’s results, the Ministry will consider widespread implementation of menstrual hygiene management and puberty curricula throughout the secondary-level educational system in Nepal.

As the Minister of Education, I certify the commitment of our aforementioned support, contingent upon receipt of a FY2016 GH887 Maternal and Child Health Grants Foundation grant.

Sincerely,

Giriraj Mani Pokharel Minister Ministry of Education



WaterAid 47 – 49 Durham Street London, SE11 5JD United Kingdom November 22, 2015 Program Manager DEVI Program Kathmandu, Nepal Dear Shamoore Simpson, WaterAid is committed to working with local partners to create locally-owned, long-lasting solutions in order to deliver services to communities in need. Together, we work with the poorest and most marginalized communities to set up practical and sustainable water, sanitation and hygiene projects that meet their needs. We are pleased to add DEVI as a local NGO partner in the far western region of Nepal and provide financial support, training and technical advice for your program. WaterAid Nepal’s most recent campaigns directly support the DEVI program by advocating for menstrual hygiene and school sanitation. As you are aware, menstrual health is a neglected priority in Nepal. Many women and girls, nationwide, are victimized by stigma and taboos that are deeply rooted in Nepali culture. WaterAid Nepal has advocated for menstrual health at regional and national levels by meeting with and lobbying government officials. We have focused our menstrual hygiene campaign efforts on demystifying menstruation taboos to foster public discussion on this public health issue. For example, WaterAid Nepal created an art exhibition in 2011 as part of its campaign to encourage community members to talk about menstruation and menstrual hygiene. WaterAid Nepal has also campaigned and advocated for sanitation in schools. Only 64% of government schools in Nepal have adequate toilet facilities and only 40% have facilities for girls. We believe that providing adequate sanitation at schools will dramatically increase school attendance. WaterAid will continue to advocate for better sanitation at school and district levels in Nepal. In partnering with your organization, we can bring special attention to need for female-friendly facilities in the district of Achham as a method to fight the discriminatory practice of chhaupadi that is prevalent in the region. Ventilated improved pit (VIP) or composting latrines are recommended for the local sanitation situation in Achham. DEVI is free to use WaterAid’s robust “Menstrual Hygiene Matters” modules and toolkits as you implement and develop your program. Thus, I certify the commitment of WaterAid’s aforementioned financial, training and technical support, contingent upon receipt of a FY2016 GH887 MCH Grants Foundation grant.

Sincerely, Barbara Frost Chief Executive WaterAid

Annex 3. WASH United MHMP Curricula: Sample


WASH United Menstrual Hygiene Management (MHM) Curricula: Sample Materials

Adolescent males

Adolescent females

Objectives

Annex 4. Gantt Chart


No.

Task

Project Timeline Post-Baseline (Sept-Aug)

People Responsible Materials Required Year 1 Year 2 Year 3

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

1 By one year post-baseline, there is a 90% increase in adolescent females who report living in a household during menstruation.

1.1 Partners hold community level trainings on MHM

WaterAid, Samabikas Nepal, community members

MHM/puberty curricula, meeting space

1.1.1 Module 1: Importance of MHM



1.1.2 Module 2: Strategies for aligning chhaupadi elimination with religious beliefs



1.1.3 Module 3: Building female-friendly latrines at schools


Meeting space, latrine materials, trash bin, lock, doors, roof

1.2 Conduct community meetings for community members to adapt the program’s MHM/puberty curricula to schools in Achham

Community members, School staff and teachers, DEVI program staff

MHM/puberty curricula

2 By three years post-baseline, there is a 50% increase in attendance rates of adolescent females in lower secondary and secondary school levels.

2.1 School staff measures female school attendance

School staff and teachers, DEVI M&E team

School attendance records (bookkeeping)

2.1.1 School Staff track adolescent females' educational achievement over time (e.g. grades, literacy)

School staff book keeping

3 By three years post-baseline, there is a 75% increase in adolescent females who report practicing menstrual hygiene management

3.1 Train the teachers to implement the curricula (annually)

WaterAid, School teachers

MHM curricula for females, MHM/puberty curricula for males

3.2 Teachers implement and teach curricula as part of standard education in schools

School teachers MHM curricula for females, MHM/puberty curricula for males


Community members Latrine materials, trash bin, lock, doors, roof

Annex 5. Monitoring Chart


MONITORING CHART Activity Indicator Description Rationale Data Source Collection Method Frequency Use

Objective 1: By one year post-baseline, there is a 90% increase in adolescent females who report living in a household during menstruation

1.1 WaterAid holds community level trainings on menstrual hygiene management (MHM)

1.1.1 Module 1: Strategies for aligning tradition and religious beliefs with chhaupadi elimination 1.1.2 Module 2: The importance of menstrual hygiene management 1.1.3 Module 3: Building female-friendly latrines at schools

# of community members who attend training % of training participants who score over 85% on training satisfaction survey

These indicators assess the training reach and quality/satisfaction

Community members must participate in the training to participate in the program

Training attendance sheets, Training satisfaction form

Research assistants will collect attendance sheet and satisfaction forms


Program Manager will use the data to make any necessary improvements to training reach and quality.

1.2. Conduct meetings for community members to adapt the WASH United Menstrual Hygiene Management and puberty curricula to the context of the Achham school system

# of community members (including teachers) who attend meetings % of community members who actively participate in meetings

These indicators assesses community members’ engagement and participation in adapting the MHM & Puberty curricula

Community members should attend and participate in meetings with program staff to adapt the curricula to the Achham context for the curricula to be better received by adolescent females

Meeting attendance sheets, Meeting notes

Research assistants will collect attendance sheets and write meeting notes for each meeting

At least 2 meetings in the beginning of years 1, 2, and 3

Program Manager will use the data to make any necessary improvements to reach and participation engagement

Activity Indicator Description Rationale Data Source Collection Method Frequency Use


2.1 Engage school staff to measure female school attendance

% of girls who report missing days of school due to menstruation % of girls who feel they can go to school when they are menstruating

School staff will track attendance, truancy, and enrollment records for each pupil on a daily basis

If adolescent females practice MHM at school, they will go to school during their menses.

School attendance records, Save the Children’s MHM Knowledge, Attitude and Practice (KAP)

Research assistants will collect school attendance records on a monthly basis and administer the KAP survey to adolescent females

Attendance records will be collected monthly; KAP surveys will be administered yearly

Program Manager will use the data to make any necessary improvements to reach and participation engagement. Program Manager will report findings to school staff.

2.2 School staff track adolescent females’ educational achievement over time (e.g., grades, literacy)

% increase in literacy rates among adolescent females

These indicators assess adolescent females’ educational achievement

If adolescent females practice MHM at school, they will improve their educational performance.

Literacy test Research assistants will administer literacy tests to adolescent girls


Program Manager will use the data to make any necessary improvements to reach and participation engagement. Program Manager will report findings to school staff.

Annex 5. Monitoring Chart


Activity Indicator Description Rationale Data Source Collection Method Frequency Use


3.1 Train the teachers to implement the curricula

# of teachers who participate in training % of teachers who score 90% or higher on training satisfaction survey % of teachers who can answer a basic set of questions regarding MHM

These indicators assess the training reach and quality/satisfaction

Teachers must participate in the training to understand the content and implement the MHM & Puberty curricula

Training attendance sheets, Training satisfaction form

Research assistants will collect, knowledge test, attendance sheets, and satisfaction forms


Program Manager will use the data to make any necessary improvements to training reach and quality.

3.2 Teachers implement MHMP Curricula as part of standard education in schools

% of schools with MHM in their curriculum % of girls who received information regarding MHM from school before the onset of menarche

These indicators assess whether MHM & Puberty Curricula is being implemented as part of standard education in schools

If students receive the curricula, girls will practice MHM

Lesson reports, Self-report from students

Research assistants will aggregate monthly lesson reports and quarterly reports from students


Program Manager will use the data to make any necessary improvements to curricula training and curricula. Program Manager will disseminate findings to school staff and discuss at community meetings and MHM trainings


% of females (9-16 years) who report using these latrines % of lower secondary schools and % of secondary schools with adequate WASH facilities that facilitate MHM, includes multiple indicators related to waste disposal, water access and private, safe and clean latrines:

If schools have female-friendly latrines, girls will practice MHM at school.

WASH observation checklists, Self-report

Research assistants will aggregate monthly WASH Observation checklists and bi-annually self-report surveys


Program Manager will use the data to make any necessary improvements to curricula training. Program Manager will disseminate findings to school staff and discuss at MHM community trainings

Annex 6. Evaluation Chart


EVALUATION CHART

Evaluation Questions

Indicator Description Rationale Data Source Collection Method Frequency Use


Has community

members’

knowledge

regarding MHM

increased?

% of community members who score at least 90%

on MHM exam

These indicators

assess the

knowledge of

community

members

regarding MHM.

If community members do not have a

positive attitude about MHM and its

purpose, they are less likely to

practice it.

Survey at

baseline and

end of project

using a Save the

Children’s MHM

Knowledge,

Attitude and

Practice (KAP)

questionnaire

Research assistants will

randomly distribute

surveys to community

members and adolescent

females in the

intervention clusters (via

random sampling and

random route sampling)

Beginning of

year 1 and end

of year 3

DEVI will use

the aggregate

data to

determine the

impact of the

program and

distribute

findings to

stakeholders at

the end of year

3

Have community

members’ positive

attitudes regarding

MHM increased?

% of community members who score at least 90%

on MHM exam

These indicators

assess the

attitudes of

community

members

regarding MHM.




Have adolescent

females’ school

attendance rates

increased?

% of females (10-16 years) whose school

attendance rate is over 85%

# of school days missed per month by adolescent

females

This indicator

assesses

adolescent

females’

attendance rates

If adolescent females practice MHM

at school, they will go to school

Attendance,

truancy, and

enrollment

records


randomly distribute



females in the

intervention clusters (via

random sampling and


Beginning of

year 1 and end

of year 3

DEVI will use

the aggregate

data to

determine the

impact of the

program and

distribute

findings to

stakeholders at

the end of year

3

Has adolescent

females’ educational

achievement rate

improved?

% of females (10-16 years) who score at least 90%

of literacy test.

% of females (10-16 years) who matriculate from

secondary school.

% of females (10-16 years) who enter higher

education

These indicators

assess adolescent

females’

educational

achievement

If adolescent females practice MHM

at school, they will improve their

educational performance.

Literacy test,

National

Secondary

School

Examination

Test


randomly distribute

literacy tests to

adolescent girls and

collect attendance data

from teachers in

intervention clusters and

non-intervention clusters

(via random sampling

and random route

sampling)




Has adolescent

females’ knowledge

regarding MHM

increased?

% of females (10-16) who score at least 90% on

MHM exam

% of females (10-16) that can identify that

menstruation is a normal biological function of

These indicators

assess the

knowledge of

adolescent

females regarding

If adolescent females do not

understand MHM and its purpose,

they are less likely to have a positive

attitude about it.

WHO/UNICEF

Joint Monitoring

Programme

(JMP)


randomly distribute



females in the

Beginning of

year 1 and end

of year 3

DEVI will use

the aggregate

data to

determine the

impact of the



the female body

% of females (10-16 years) who know how to

hygienically manage menstruation

MHM. questionnaire intervention clusters (via

random sampling and


program and

distribute

findings to

stakeholders at

the end of year

3 Have adolescent

females’ positive

attitudes regarding

MHM increased?

% of adolescent females who score at least 90%

on MHM attitude questions

These indicators

assess the

attitudes of

adolescent

females regarding

MHM.

If community members do not have a

positive attitude about MHM and its

purpose, they are less likely to

practice it.

Survey at

baseline and

end of project

using a Save the

Children’s MHM

Knowledge,

Attitude and

Practice (KAP)

questionnaire

Have MHM practices

increased among

adolescent females?

% of adolescent females who report practicing

menstrual hygiene management

% of menstruating adolescent females who report

using safe sanitary hygiene products

% of adolescent females who clean their used

sanitary hygiene products during menstruation

when necessary

% of adolescent females who report using bathing

spaces during menstruation

% menstruating adolescent females who report

safe disposal of used sanitary hygiene products

This indicator

assesses the

practice of MHM

among adolescent

females.

If adolescent females practice MHM,

they are unlikely to improve their

menstrual health.

Have MHM promotive

practices increased

among community

members?

% of females (10-16 years) who reporting

practicing chhaupadi in the past month

% of community members reporting they have

deconstructed the chhaupadi goth in their home

or have helped another person deconstruct their

chhaupadi goth

This indicator

assesses the

likelihood of

practicing of

MHM among

adolescent

females.

If community members deconstruct

chhaupadi goths in their community,

they are actively eliminating

chhaupadi. If females report living in

home during menstruation, they are

not living in the chhaupadi goth when

they are menstruating.

Has adolescent

females’ menstrual

health improved?

% of females (10-16 years) who report urinary

tract infections in the past year

% of females (10-16 years) who report

reproductive tract infections in the past year

% of females (10-16 years) who report GSBV in

the past 6 months

These indicators

assess adolescent

females’

menstrual health

If adolescent females practice their

MHM, their menstrual health will

improve



Annex 7. Line Item Budget PROJECT TOTAL

$/UNIT UNIT # UNITS TOTAL # UNITS TOTAL # UNITS TOTAL # UNITS TOTAL

A. SALARIES

General Management (Kathmandu-based)

Program Manager 2,000.00$ Month 12 24,000 9 18,720 6 12,979 27 55,699

Monitoring and Evaluation Advisor 1,500.00$ Month 9 13,500 6 9,360 6 9,734 21 32,594

Technology and Innovation Officer 1,500.00$ Month 9 13,500 6 9,360 6 9,734 21 32,594

Fieldwork (Achham-based)

Health Program Coordinator 1,500.00$ Month 9 13,500 6 9,360 4 6,490 19 29,350

Training Advisor 1,500.00$ Month 9 13,500 6 9,360 4 6,490 19 29,350

Subtotal-Salaries 48 78,000 33 56,160 26 45,427 107 179,587

B. CONSULTANTS

Tribhuvan University Research Assisstant $15 Day 16 240 8 125 16 260 40 624










Subtotal-Consultants 160 2,400 80 1,248 160 2,596 400 6,244

C. BENEFITS

Fringe Benefits 26.70% 20,826 26.70% 14,995 26.70% 12,129 47,950

Consultants Fringe 8.10% 194 8.10% 101 8.10% 210 506

Subtotal-Benefits 21,020 15,096 12,339 48,456

D. TRAVEL & PER DIEM

Domestic Travel (Kathmandu to Achham)

Airfare (From Kathmandu to Dhangarihi) $250 RdTrip 7 1,750 2 520 4 1,082 13 3,352

Per Diems- Transit $141 Day 7 987 2 293 4 610 13 1,890

Per Diems- In Country $188 Day 7 1,316 3 587 4 813 14 2,716

Ground Transportation $25 RdTrip 27 675 24 624 24 649 75 1,948

Subtotal-Travel 48 4,728 31 2,024 36 3,154 115 9,906

E. MONITORING & EVALUATION

Baseline Evaluation 5.00% 7,476 7,476

Monitoring 5.00% 7,476 10.00% 9,827 5.00% 4,406 21,710

End of Program Evaluation 5.00% 4,406 4,406

Subtotal-Monitoring & Evaluation 14,953 9,827 8,813 33,593

F. OTHER DIRECT COSTS

Courier/Shipping Services (FedEx, DHL, Nippon) $100 Unit 3 300 3 312 3 324 9 936

Photocopy/printing (large jobs) $150 Month 12 1,800 12 1,872 12 1,947 36 5,619

Educational Materials $100 Month 6 600 12 1,248 12 1,298 30 3,146

Communications (long distance phone, travel use) $200 Month 12 2,400 12 2,496 12 2,596 36 7,492

Equipment (two computers, printer, and maintenance) $2,000 Unit 1 2,000 0 0 0 0 1 2,000

Office Supplies (pens, paper, flipcharts, etc) $15 Month 12 180 12 187 12 195 36 562

Workshops $100 Workshop 6 600 6 624 6 649 18 1,873

Motorcycles $2,000 Unit 2 4,000 0 0 0 0 2 4,000

Motorcyle Fuel & Maintenance Costs $100 Month 12 1,200 12 1,248 12 1,298 36 3,746

Tea/Snacks for Community Meetings $25 Month 12 300 6 156 3 81 21 537

Subcontractor - WaterAid $1,500 Month 10 15,000 6 9,360 6 9,734 22 34,094

Subcontactor - Samabikas Nepal $1,500 Month 10 15,000 4 6,240 4 6,490 18 27,730

Subtotal-ODC 98 43,380 85 23,743 82 24,612 265 91,735

TOTAL DIRECT COSTS 164,481 108,098 96,941 369,520

OVERHEAD 26.00% 42,765 26.00% 28,105 26.00% 25,205 96,075

GRAND TOTAL 207,246 136,203 122,146 465,595

Year 1 Year 2 Year 3



F. OTHER DIRECT COSTS

Courier/Shipping Services (FedEx, DHL, Nippon) $100 Unit 3 300 3 312 3 324 9 936

Photocopy/printing (large jobs) $150 Month 12 1,800 12 1,872 12 1,947 36 5,619

Educational Materials $100 Month 6 600 12 1,248 12 1,298 30 3,146

Communications (long distance phone, travel use) $200 Month 12 2,400 12 2,496 12 2,596 36 7,492

Equipment (two computers, printer, and maintenance) $2,000 Unit 1 2,000 0 0 0 0 1 2,000

Office Supplies (pens, paper, flipcharts, etc) $15 Month 12 180 12 187 12 195 36 562

Workshops $100 Workshop 6 600 6 624 6 649 18 1,873

Motorcycles $2,000 Unit 2 4,000 0 0 0 0 2 4,000

Motorcyle Fuel & Maintenance Costs $100 Month 12 1,200 12 1,248 12 1,298 36 3,746

Tea/Snacks for Community Meetings $25 Month 12 300 6 156 3 81 21 537

Subcontractor - WaterAid $1,500 Month 10 15,000 6 9,360 6 9,734 22 34,094

Subcontactor - Samabikas Nepal $1,500 Month 10 15,000 4 6,240 4 6,490 18 27,730

Subtotal-ODC 98 43,380 85 23,743 82 24,612 265 91,735

TOTAL DIRECT COSTS 164,481 108,098 96,941 369,520

OVERHEAD 26.00% 42,765 26.00% 28,105 26.00% 25,205 96,075

GRAND TOTAL 207,246 136,203 122,146 465,595

Inflation Factors-Salaries 4.00%

Other 4.00%

Annex 7. Line Item Budget


Annex 8. Behavior Change Model

The Behavior Change Model at the core of the DEVI Program depicts the behavior change of increased practice of menstrual hygiene management (MHM) among adolescent females attending lower secondary and secondary schools receiving the intervention in the district of Achham. This model is informed by Social Cognitive Theory (SCT), Social Norms Theory (SNT) and the Theory of Planned Behavior (TPB). MHM behavior is influenced by theoretical constructs operating at levels of the individual, interpersonal relationships and community/environment. For example, behavioral intention and perceived behavioral control are key constructs of the TPB that determine whether an adolescent female will engage in MHM. For behavior change to occur, the adolescent female must be motivated and believe she has the ability to perform the desired behavior. Self-efficacy is a key construct of SCT also driving behavior change; an adolescent female must feel confident in her ability to perform MHM. Reciprocal determinism is another key construct of SCT that recognizes dynamic interactions between an individual, her actions, and her environment. The creation and respected use of female-friendly sanitation facilities simultaneously reinforces MHM so that behavior change can be maintained. The successful practice of MHM at the individual level depends upon social norms to create an environment (e.g., school and home) that accepts and facilitates its practice. SNT targets peer influence as a key driver of social norms among a group. By focusing on changing misperceptions of menstruation among peers at school, e.g., menstruation is natural and is not a means for isolation, individual behavior change is more likely to occur given that it is now accepted among the peer group. The WASH United MHMP curricula addresses social norms by using interactive and experiential learning to actively engage the target audience and provide positive messaging around MHMP. The following are behaviors among other target groups of the program that must occur to support the practice of MHM among adolescent females. These changes in behavior can be outlined using the model above.

Adolescent males stop engaging in stigmatizing behaviors Teachers implement MHM and Puberty curricula Community members build latrines


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