Consumer-Powered Healthcare for Her: What Menstrual Health Can Teach Us

Posted November 11, 2018
Impact Area Adolescents & Youth, Sexual & Reproductive Health, Water, Sanitation & Hygiene

By: Maria Carmen Punzi Menstrual Health Focal Point, PSI Europe @psiimpact, Cristina Ljungberg Maverick Collective Founding Member @cjljungberg @caseforher

Menstruation is a critical but often overlooked component of girls’ sexual and reproductive health (SRH). Since 2016, PSI has joined forces with Maverick Collective member Cristina Ljungberg to make periods a priority in Nepal’s adolescent health landscape. The goal was to improve the health and lives of Nepali girls by designing innovative strategies addressing menstrual health and hygiene.

From the start, the team was warned that no Nepali girl—especially no rural Nepali girl—would open up about her period. Within the first year, however, the team met over 100 girls who, in private, had many questions, about periods and sex. This raises the question: what role can—and does—menstrual health play in family planning (FP) and SRH work?

Menstruation can be a conversation starter to familiarize youth with fertility and SRH. PSI’s work with adolescents repeatedly shows that adolescent girls don’t identify as sexually active and are uncomfortable in conversations about FP. Educating girls and boys about the bodily changes that come with puberty and menarche is an opportunity to introduce them to the concept of fertility. The reproductive cycle can encourage girls to seek FP methods later in life. Dispelling myths around periods and side effects of contraceptives can kick-start a healthy journey down the SRH path.

Contraceptives often change bleeding patterns, and young women need to be prepared. Contraceptives can affect menstrual patterns, including a heavier flow, spotting or stopping bleeding altogether. Often in developing countries, adolescent girls fear disclosing irregular menstruation, concerned about stigma related to infertility and marriageability. Period irregularity is a leading cause for contraceptive discontinuation. When addressing girls, we need to understand their fears and desires and use the proper counseling tools such as FHI 360’s NORMAL to inform them about menstrual bleeding changes. This insight can also help refine and strengthen the effectiveness of FP interventions, helping girls and young women feel confident about their contraceptive choices.

Going forward, is menstruation key to SRH innovation? Period blood contains unique health data and can be used as a noninvasive method for early disease diagnosis and management. When girls and women understand their cycle, they gain valuable insights about their fertility—and overall health—and are better equipped to report anomalies to their doctors and make consumer-powered decisions. As we keep working with, and not just for, girls and women, we cannot ignore the important role menstruation plays in their sexual and reproductive lives. Can we imagine a world in which, instead of managing menstruation, we see menstruation as a tool to improve the health of girls and women?

Banner image: © PSI Nepal

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Supervisors directly observed how CHWs performed malaria rapid diagnostic tests (RDTs) and administered artemisinin-based combination therapy (ACT). They recorded CHW performance using the digitized checklist, interviewed community members, reviewed records, and provided on-the-spot coaching. They also interviewed the CHWs and tried to resolve challenges they expressed, including with resupply of commodities or equipment immediately or soon afterwards.

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In IM-supported areas of Mali, 36% of CHWs in the first round were competent in performing the RDT, which rose to 53% in the second. 24% of CHWs in the first round compared to 38% in the second were competent in the treatment of fever cases and pre-referral counseling. Between both rounds, availability of ACT increased from 80 percent to 90 percent.

Supportive supervision with interviews and observations at sites improved the basic competencies of CHWs between the first and second rounds, and additional rounds will help to understand the longer-term programmatic benefits.

Taking a market-based approach to scale sanitation in Ethiopia

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“Rather than relying on traditional aid models that often distribute free or heavily subsidized sanitation products, market-based sanitation creates sustainable and affordable solutions, integrating market forces and supporting businesses to grow.”

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Here’s what it looks like in practice.

In July 2020, PSI Angola, alongside the Angolan digital innovation company Appy People, launched Kassai, an eLearning platform that targets public sector health workers in Angola. Through funding from USAID and the President’s Malaria Initiatve (PMI), Kassai features 16 courses in malaria, family planning, and maternal and child health – with plans to expand learning topic areas through funding from ExxonMobil Foundation and private sector companies. A partnership with UNITEL, the largest telecommunication provider in Angola, provides all public health providers in Angola free internet access to use Kassai.

Kassai’s analytics system to follow learners’ success rate and to adjust the course content to learners’ performance and needs. Kassai analytics are integrated with DHIS2 – the Health Management Information System (HMIS) of Angolan MOH, to be able to link learners’ knowledge and performance with the health outcomes in the health facilities. The analytics track learners’ performance by course and gives visibility by health provider, health facility, municipality, and province. Each course has pre-and post-evaluation tests to track progress of learning, too.

By the end of 2022, there were 6,600 unique users on the Kassai platform and 31,000 course enrollments. PSI Angola’s partnership with UNITEL, the largest telecommunication provider in Angola, allows for free internet access to learn on the Kassai for all public health providers in Angola. Building on its success for malaria training, Kassai now also provides courses in family planning, COVID-19, and maternal and child health. This reduces training silos and provides cross-cutting benefits beyond a single disease.

Implementing the SLPM digital ecosystem brings numerous benefits to health systems. It allows for more strategic and efficient workforce training and performance management, enabling ministries of health to track changes in health workers’ knowledge, quality of care, service utilization, and health outcomes in real time. The ecosystem also supports better stewardship of mixed health systems by facilitating engagement with the private sector, aligning training programs and standards of care, and integrating private sector data into national HMIS. Furthermore, it enables the integration of community health workers into the broader health system, maximizing their impact and contribution to improving health outcomes and strengthening primary healthcare.

Consumer-Powered Healthcare for Her: What Menstrual Health Can Teach Us

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Digitalizing contraceptive counseling to reach rural women and girls in Ethiopia

Building community health worker capacity to deliver malaria care

Taking a market-based approach to scale sanitation in Ethiopia

Promoting self-managed care like Self-testing and Self-Sampling

Using peer coaches to counter HIV stigma in South Africa

simplifying consumers’ journey to care in Vietnam

Engaging the private sector for disease surveillance in Myanmar

Training health workers in Angola

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