Evaluating the Efficacy of Community Menstrual Health Programs in Kakira Town Council

Final Report:

In this capstone project, I sought to investigate the effectiveness of menstrual health (MH) programming with a community in Uganda. There were two main objectives in the course of this project. The first objective was to evaluate the delivery and structure of MH programming in Kakira Town Council. The second objective was to compile suggestions from the community on how MH services could be strengthened. While we managed to complete the two objectives, it was not without its successes and challenges. In this reflection, I will walk through the story of my project and how it fits into the broader scope of my academic and professional journey.

The original plan for this project was to work with the Foundation for Sustainable Community based Development (FSD) and St. Francis Health Care in Jinja, Uganda. Before any part of the project began, however, we ran into our first challenge. In early June, right around when I was supposed to start the project, Uganda announced a national lockdown due to COVID. At the time of the announcement, they planned for approximately five weeks of lockdown. As a result, I could no longer work with St. Francis. Their clinic was halting their programming and mobilizing themselves as a COVID care unit. This left me without a host organization. FSD provided me with a couple different options, one of them being to work with the Kakira Outgrowers Rural Development fund (KORD). KORD is a corporate social responsibility organization for a sugar cane company in Kakira. They work with the community on a variety of projects from health, sanitation, and education. Their past experience in menstrual health made them an apt choice for switching organizations. After discussion with my faculty advisor and my location supervisors, we ultimately decided to make the switch to work with KORD.

I began the program with KORD in the second week of July. We started with a few cultural competency classes and research workshops. Then we went into project development. I had two on-location supervisors. We would typically meet for an hour every Monday, and then the rest of the week would be independent work on my part. This had its strengths and weaknesses. One strength it provided was that I was able to incorporate the program flexibly into the other things I was doing this summer. It also helped avoid Zoom fatigue. On the weaknesses though, this meeting schedule created a sometimes passive work experience. We would typically meet, and set a deliverable goal for the end of the week. Aside from that meeting, I was more or less on my own at home, not really getting to engage with the community. At times, this made it difficult to feel like the project was significant or feel engaged with the work. However, as the program progressed, I began to have more work and the project felt significantly more full by the time the summer ended.

The dynamic in the data collection part of the project was one of the most interesting things to me. We had a team of about ten research assistants who went out into the community and surveyed about 500 adolescents and young adults. On one hand, the data collection felt very impersonal to me. Due to internet challenges, it was not feasible for me to be on Zoom calls with the community members. Therefore, I provided them with questionnaires and guides, and then I received a spreadsheet of data via email. All of this happened without ever getting to chat with the community. It made me feel really disconnected from the data collection process, and it feels weird organizing all the data without ever getting to know the people themselves. However, despite this depersonalization, this strategy of data collection also likely worked in my favor. Relying on a team of assistants who were familiar and well-established in the community — especially in terms of trust and local language — likely helped increase both the number of respondents and the quality of the responses. Furthermore, about half of the research team identified as female. Given the female-specific topic of this project, it likely helped that some of the respondents were being surveyed by a female researcher as opposed to me, a non-local male.

From the surveys with the community members and the interviews with community leaders, we had two primary findings. First, there is a great need for pads. That was not as surprising of a result, but it was good to confirm the need considering that Kakira Town Council has not evaluated that need before. Additionally, our work provided quantitative statistics for future policy and financial appeals. The second finding demonstrated a tension between the community and town leaders. A large majority of the respondents indicated some level of dissatisfaction with the poor leadership from the Town Council on the issues of menstrual health. Many said that the Town Council does not take the issue seriously and does not provide the assistance necessary for proper menstrual health management. However, that tension appears to go beyond the Town Council, as the community leaders said that they cannot provide the community support if the ministries of health at the national level will not support them. As such, it seems like a string of tensions throughout all levels of leadership have exacerbated many of the menstrual health problems in the community.

From these findings and subsequent follow-up conversations with leaders, a few recommendations were proposed. One of the recommendations was to host radio programs that the community could listen to that would discuss menstrual health topics. This way, information can be easily accessed by people who may not be able to attend the menstrual health programs. Another suggestion was for the community leaders to attend the menstrual health sessions, which would hopefully help foster a more serious and committed attitude to issues of menstrual health. Finally, community leaders and members are committed to being stronger advocates for themselves regarding finances and resources at higher ministerial levels. Especially from the community leaders, there will be a greater push to advocate for the community and get them the resources and support that they are asking for.

 With this project, I hope to contribute to the growing discussion of menstrual health in Kakira Town Council. Given that little work has been done in Kakira regarding menstrual health, this project offered an opportunity to formally get the ball rolling on the discussions and steps needed to improve menstrual health in the community. Especially for the community leaders, this was an important opportunity for them to reflect on the needs of their community and learn about a previously unknown perspective to them. The hope is that they will see menstrual health issues as an important matter for their community, and, in coordination with community members, can take more active steps to improve the quality of health in the town.

On a personal note, this capstone granted me an opportunity to explore a public health and policy project. As I proceed down the medical school path, public health and healthcare policy continue to be interests that I want to carry into my practice. The capstone was formative for helping me explore the type of work that I hope to keep exploring in my graduate and career studies.