Transforming Menstrual Health in Ethiopia

Posted Junho 2, 2023
Impact Area Water, Sanitation & Hygiene

A Market-Based Approach to Increasing Access to Affordable and Sustainable Hygiene Products

This piece originally ran on the PSI Ethiopia Medium.

By Mekdim Hailu, Project Communication Manager, PSI Ethiopia

Imagine waking up one day and being faced with two unappealing options: staying home and missing school or work, or using rags, newspapers, or ashes as makeshift sanitary pads for menstrual hygiene. This is not a fictional scenario but a harsh reality for many menstruating girls and women in Ethiopia. Lack of access to menstrual hygiene products not only affects women’s education and work, but also puts their health at risk as using unhygienic materials during menstruation can lead to infections and other health problems.

A key challenge in countries like Ethiopia is the inadequate and expensive supply of quality menstrual products. According to Performance Monitoring and Accountability 2020 (PMA 2020), only 28 percent of Ethiopian women report having all the tools they need to manage their menstruation, leaving the majority without access to quality menstrual hygiene products. Shockingly, 25 percent of women do not use sanitary products at all, instead resorting to unhygienic materials such as rags, newspapers, and even ash-filled clothing. Despite successful efforts by advocacy groups to reduce tariffs on menstrual hygiene products from 30 to 10 percent, disposable sanitary pads have become 75 percent more expensive in the last three years. Therefore, it remains important to take additional measures to ensure long-term price stability and create a more affordable supply of a range of such products.

To address sanitation challenges, USAID Transform WASH (T/WASH) is committed to building a sustainable WASH market that includes menstrual hygiene products, such as reusable sanitary pads. T/WASH is working to ensure that these products are accessible and affordable for girls and women throughout Ethiopia, especially in remote rural areas, where access to disposable sanitary pads is limited.

While a few local producers offer washable pads, they are not widely used. However, these pads offer a cost-effective solution in the long run as they can last for years with proper care, unlike disposable pads, which require frequent purchasing. A pack of disposable pads costs an average of 70 Ethiopian birr (US $1.30) while a pack of 4 washable pads is obtainable for 100 birr ($2).

In 2020, T/WASH partnered with MHM product manufacturers Mariam Sheba and Mariod to build market relationships with its retail business partners to offer reusable sanitary pads for girls and women to purchase. Over the past three years, 18 business partners have sold more than 13,000 pads throughout Ethiopia. To expand the offering, T/WASH recently partnered with Mela for Her and Adey Pads, women-led organizations that produce reusable sanitary pads. Mickal Mamo, founder of Adey Pads, expressed her excitement about the partnership with Transform WASH. She said, “We are excited about the journey ahead. Transform WASH will help us enter an established market with an existing supply chain, which will make it easier for us to reach consumers. The market-based approach to sanitation is unique and sustainable, and it’s great to be a part of it.”

By making menstrual hygiene products accessible to everyone in Ethiopia, Transform WASH is not only improving the lives of girls and women, but also paving the way for a more sustainable and equitable society. Menstrual hygiene is a serious challenge in urgent need of attention and action. With efforts like those of Transform WASH, we can make progress toward a future where girls and women have the tools they need to manage their menstruation safely and with dignity. Together, we can change the conversation about menstrual hygiene and positively impact the lives of millions of women and girls.

About Transform WASH

USAID Transform WASH aims to improve water, sanitation, and hygiene (WASH) outcomes in Ethiopia by increasing market access to and sustained use of a broader spectrum of affordable WASH products and services, with a substantial focus on sanitation. Transform WASH achieves this by transforming the market for low-cost quality WASH products and services, stimulating demand at the community level, strengthening supply chains, and improving the enabling environment for a vibrant private market.

USAID Transform WASH is a USAID-funded activity implemented by PSI in collaboration with SNV and IRC WASH. The consortium is working closely with government agencies, including the Ministry of Health, the Ministry of Water and Energy, the One WASH National Program, and regional and sub-regional governments.

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By: Fana Abay, Marketing and Communications Director, PSI Ethiopia

In rural Ethiopia, women and girls often face significant barriers in accessing healthcare facilities, which can be located hours away. Moreover, there is a prevailing stigma surrounding the use of contraception, with concerns about potential infertility or the perception of promiscuity. To address these challenges, the Smart Start initiative has emerged, linking financial well-being with family planning through clear and relatable messaging that addresses the immediate needs of young couples—planning for the lives and families they envision. Smart Start takes a community-based approach, utilizing a network of dedicated Navigators who engage with women in their localities. These Navigators provide counseling and refer interested clients to Health Extension Workers or healthcare providers within Marie Stopes International-operated clinics for comprehensive contraceptive counseling and services.

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Beyond the observed interactions with patients, supervisors heard from community members that they were pleased that CHWs were able to provide essential malaria services in the community. And the data shows the impact.

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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To share the journey to market-based sanitation, representatives of the Ethiopian Ministry of Health and the USAID Transform WASH team took to the stage at the UN Water Conference in 2023.

“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.

Transforming Menstrual Health in Ethiopia

A Market-Based Approach to Increasing Access to Affordable and Sustainable Hygiene Products

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The Consumer as CEO

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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