The ZOA Imvepi Menstrual cup Scale up project was conducted by ZOA and WoMena Uganda as part of a project led by ZOA in consortium with IAS (International Aid Services) and MI (Malteser International) and funded by the United States Government. The project benefited 416 people among whom were direct beneficiaries and support persons.

Below are the three main activities that included training of different stakeholders and sensitization of communities about Menstrual Health Management and the menstrual cup use and care.

• Refresher Training of Trainers
  The activities lasted for about three weeks from in August and the project design included a two-day refresher Training of Trainers (ToTs) CARE Trainers from Imvepi Refugee Settlement. These trainers had in 2017 received the Menstrual Health Management (MHM) and Menstrual Cup (MC) training from WoMena Uganda in collaboration with CARE International and these trainers conducted the community sensitization and the training of benefices. The refresher Training of Trainers participants included nine CARE International trainers, two male and four female teachers, one Windle international staff and one ZOA staff who at the end of the training received certificates of attendance.

• Community Sensitisation
  In order to engage the community surrounding Lanya Primary School and ensure community acceptance of the menstrual cups, a holistic community engagement model to improving menstrual health was utilized. WoMena Uganda trainers and the CARE international ToTs conducted a five-hour information session at Lanya Primary School on menstrual health, menstrual cup use and care to 103 male and female parents, guardians of the beneficiaries and wider community. The program was conducted in English and translated into Arabic and Kakwa by the ToTs to ensure community members understood the content. The activity was also attended by local leaders and a representative from the office of the Prime Minister.

• Training of Beneficiaries
  Following the ToT Refresher training , Womena Uganda led eight comprehensive training sessions over a period of eight days with the CARE international ToTs to adolescent school girls of Lanya Primary School. The total number of female students of reproductive age was 296. All beneficiary trainings started with questions to the participants about their expectations and by setting ground rules. Participants were also given exercises such group work and role play. To ensure active participation, ToTs asked follow-up questions, called upon participants to do different demonstrations like hand washing and cup insertion and removal. Each training session had participants from different classes from P1 to P6, with an age range of 12-19 years.

Menstrual kits were procured and distributed by ZOA. The menstrual kit contents were developed according the Untied Nations High Commissioner for Refugees (UNHCR) standards. The kit materials included; bathing soap, washing soap, three pairs of knickers, one ten-liter bucket and a menstrual cup. Menstrual Calendar and the Menstrual Diaries were also provided by WoMena Uganda.

Project outcomes

Some of the achievements included, activity participation from the CARE International TOTs, male and Female community members, and the adolescent girls during the training. Substantial male involvement was seen during TOT refresher and the community sensitization meeting were the Head Master and deputy of Lanya primary school attended the refresher training and primary six (P6) boys of Lanya Primary School joined the community sensitization information session.

The boys contributed to the training by demonstrating hand washing and gave different ideas on how to support girls during their menstrual periods, for example making sure that as brothers to menstrual cup recipients, they keep the cups safe while at home and instead of laughing at the girls if they have stained their skirts, they would take them to the senior women teacher for further support. The male community members also appreciated the program and receiving information on menstrual health. One male participant stated that as the heads of the family, men now know their responsibility to support their daughters and wives by buying them menstrual products to use while in their period.

In some contexts, the introduction of menstrual cups to younger girls, raises concerns about loss of virginity due to using the cup. However, during the training and sensitisation activities, neither parents nor girls raised any issues related to virginity and the cup. Although the correlation between the menstrual cups and virginity was not mentioned by participants, the ToTs ensured that girls were taught about the hymen and virginity to enable informed decision making on use of the cup.

At the end of each training session, evolution tests were filed out by the participants to assess their knowledge retention.
On average the score on the menstrual cups test was 83%, demonstrating a good level on knowledge by participants (target 75%). The target score on the menstrual knowledge test is 75% correct responses. Only 21% of participants met this requirement, and for the menstrual health management test the school girls scored poorly. This reflects the difficulties in completing the evaluation form based on observations during the training. Although this tool has worked well in the past in other contexts to evaluate the level of understanding and knowledge retention from training, it is clear that this tool was not appropriate for this particular group. This may have been due to lower levels of literacy, divergence in languages spoken by participants and the larger group numbers.

The last question of the evaluation test for both the ToTs and the beneficiaries showed a high satisfaction of the training. 87% of the beneficiaries said the training was very good, 9% said it was good, one percent said it was not good or bad and three percent of the beneficiaries did not answer/ tick the question.

After all the trainings, ZOA has already started conducting the follow up activities and this is going to be done for three months with support from the CARE trained trainers and remote support from WoMena through phone calls. More participatory methods of evaluating knowledge retention should be utilized during follow up. WoMena is developing a voting-based evaluation tool that will be tested during the follow up visit.