Regional Workshop for Policy Advocacy on

Menstrual in School

February 5 - 6, 2017 Tulsipur , Dang

Organized By

Swiss Water and Consortium

(In collaboration with Regional Water, Sanitation and Hygiene Coordination Committee (R - WASH - CC), Mid Western Region

Contents Abbreviation: ...... 3 Acknowledgements ...... 4 Background: ...... 5 Objectives of the Workshop ...... 5 Composition of Participants: ...... 5 DAY 1 ...... 6 Opening session ...... 6 Technical session Proceedings ...... 7 Session 1: Issues and good practices related to MHM in schools (Voices from fields) ...... 7 Floor Discussion ...... 9 Session 2: Sharing of the Study Findi ngs and good practices on MHM in schools ...... 9 Floor discussion ...... 11 School Visit for observation of MHM related facilities in schools ...... 11 Technical Sessions ...... 12 Session 1: Impression sharing of th e field visits ...... 12 Floor Discussion ...... 12 Session 2: Exploration of policies/provisions related to MHM in general and schools, Gap Identification, challenges and ways forward ...... 12 Sharing of the Study Findings on MHM in schools ...... 13 Group work: ...... 13 Presentation of Group Work ...... 13 Closing Session ...... 14 ANNEXES ...... 16

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Abbreviation: CBO Community Based Organization CDC Curriculum Development Centre CEHP Community Empowerment for Program D/PHO District Offic e FCHV Female Volunteer GAF Global Advocacy Fund GOs Governmental Organizations GoN Government of Nepal I/NGO International/Non - governmental Organizations JYRC Junior Youth Red Cross Circle MHM Menstrual Hygiene Management MoE Ministry of Education MoWSS Ministry of Water Supply and Sanitation MoFALD Ministry of Federal Affairs and Local Development MWDR Mid Western Development Region NRCS Nepal Red Cross Society RED Regional Education Directorate RHD Regional Health Directorate R - WASH - CC Regional WASH Coordination Committee SACOSAN South Asian Conference on Sanitation SDG Sustainable Development Goal SMC School Management Committee SRC Swiss Red Cross TdhF Terre des hommes Foundation WASH Water, Sanitation and Hygiene WSSCC Water Supply and Sanitation Collaborative Council

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Acknowledgements

The organizers of the workshop would like to acknowledge the generous support provided by the Swiss Development C ooperation , Switzerland that allowed us to initiate the advocacy work on Menstrual Hygiene Management in Nepal ; as well as the conduction of severa l activities for the advocacy work . The funding was administered through Swiss Water and Sanitation Consortium who offered suppor t and direction for the organization of the w orkshop with the great purpose.

In particular, our thanks goes to Mr. Rames h Boh a ra ( Regional Advisor) , Ms. Radha Paudel (Consultant) for t h e tremendou s support and guidance to make the workshop fruitful; also to SRC, Tdh and Helvetas colleagues who contributed extensively to the plan ning and design of the workshop.

We would like to extend our warmest gratitude to all the participants of the w orkshop, who participated and contrib uted their commitment and enthusiastic support to the w orkshop, forming a unite voice toward addressing the menstrual hygiene issues. Special thanks are extended to the teachers, students, local community member for providing insight into existing menstrual hygiene practices, without which it would not have been possible to develop a meaningful approach for addressing the MHM challenges faced by the girls during their menstruating period.

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Background: Menstrual hygiene management (MHM) is a challenging agenda in developing countries like Nepal. MHM is a subject of ‘silence’, and discussion of the topic among women or even mother s and da ughter s is very limited. Many cultures have taboos attached to this biological cycle . School absenteeism is prevailed high in low socio - economic nations due to poor menstrual hygiene management. Studies conducted in Nepal ha ve shown that majorities of adolescent girl do not go to school during their menstrual periods due to the poor facilities for cleaning, washing and disposing sanitary pads at school. There have been continuous attempts to improve the MHM education and facili ties at schools and also been constructed the incinerators attached with the girls' toilet. Many of the instances technical errors made while constructing incinerators which led the structures poor to user friendly. Such re asons, lack of any other options and social factors were playing role that the adolescent girls and female teachers were often had to miss the school.

SDG target 6.2 also says “by 2030, achieve access to adequate and equitable sanitation and hygiene for all and end , payin g special attention to the needs of women and girls and those in vulnerable situations" . To contribute for achieving SDG, Consortium partners ( Swiss Red Cross , Tdh F oundation and Helvetas) have been promoting MHM in schools in respective working districts, mainly focusing in mid and far western part of Nepal . Trainings on MHM are provided to adolescent girls and female teachers, which include local sanitary pad making skills. The trained school girls were encouraged to transfer the MHM information and skill s to peers. Schools are managing the sanitary pad s for adolescent girls during menstruation period . The girl students are also encouraged to transfer the MHM knowledge and skills to their family members and the community people. The projects have also prom oted the incinerators in the schools, which are attached with the girl toilet for safe disposal and management of menstrual waste. This also includes sustainable mechanism for continuity on availability of the sanitary pad in the schools , w hich has been we ll accepted and appreciated by the projects schools . To scale up these interventions through advocating and sensitizing the relevant authorities on menstrual hygiene management at schools, Consortium partners won the proposal for the utilization of Global Advocacy Fund (GAF) of SDC. Through the GAF, Regional Workshop was organized on February 5 - 6, 2017 in collaboration with Regional Water, S anitation and Hygiene Coordination Committee (R - WASH - CC) Mid - Western Region.

Objectives of the Workshop The overall purpose of the workshop was to advocate on the good practices practiced in the sector of MHM in school by the Swiss Water and Sanitation Consortium to the relevant authorities and to develop a draft advocacy strategy for menstrual hygiene manag ement issue(s).  To discuss on existing policy provision related to MHM and make common understanding on it.  To identify the issues/gaps related to MHM in schools; share good practices and explore the ways forward  To contribute to national policy framework of MHM in Nepal bringing up and feeding ground experiences and lessons

Composition of Participants: The participants were invited from different governmental organizations , I/NGOs, schools and communities. There was the participation from variou s sector s i.e. WASH, Health, Education, Women Development etc. Altogether 8 2 participants from 18 districts, who have been actively working i n menstrual hygiene management agenda , participated in the workshop. The list of the participants along with their details has been presented in Annex - 2 .

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DAY 1 (February 5, 2017)

Workshop Proceedings

Opening session The session was chaired by Mrs. Rita Bhandari Joshi, Regional Director, R egional H ealth D irectorate (RHD) , Surkhet. Mr. Chandra Bahadur KC, Regional Director, Regional Monitoring and Supervision Office ( RMSO ), Surkhet was the chief guest, Mr. Dhruba Raj Regmi, Under Secretary of Ministry of Education, Mr. Babu Ram Gautam, Deputy Director of Curriculum Develop ment Center , Mr. Dambar Bahadur Thapa, Director of Regional Education Directorate, Surkhet and Mr. Ramesh Bohara, Regional Advisor, S wiss Water and Sanitation Consortium were the guest s of the workshop.

Mr. Kamal Baral - Country Coordinator - Swiss Red Cross (SRC) Nepal on behalf of Swiss Water and Sanitation Consortium welcomed all the participants and highlighted the objectives of the workshop. Chief Guest, Mr. Chandra Bahadur KC formally inaugurated the workshop by lighting a lamp ( panas).

Mr. Ramesh Boha ra, Regional Advisor from Swiss Water and Sanitation Consortium introduced about the Consortium, and its presence in Nepal. He briefed on the Consortium (Swiss Red Cross, Helvetas and Tdh) working areas and informed that the Swiss Water and Sanitation cons ortium have been working in 11 Districts of Mid - Western and Far - Western Regions of Nepal

Mr. Babu Ram Gautam from Curriculum Development Center said that they have seriously taken up MHM issue. He informed that MHM related contents have been incorporated in the curriculum of grade 5 - 9 but those are not enough. He added that the curricula is also going to be revised and this subject is addressed well in coming revised in curricula, textbooks, teaching materials and guidelines from grade 4 to 10.

Mr. Dhruba Raj Regmi, Under secretary, Ministry of Education said that there are several organizations including Swiss Water and Sanitation Consortium working in MHM issue but it will not be accessible to all girls and not be sustainable unless the government owns the MHM policy, program and activities. He wished that the workshop would bring some valuable results that would be useful for making policy related to MHM.

Chief Guest, Mr. Chandra Bahadur KC, RMSO said that sanitation campaign would be incomplete u nless the issue of menstrual hygiene would not be addressed by the government. He was very much hopeful that participants from the top to grass root level would discuss on MHM issue and should make the subject of discussion. He also wished that the conclu sion of the regional workshop would contribute for MHM related policy formulation at the national level.

Mrs. Rita Bhandari Joshi, Chair of the opening session, said that MHM is the common concern of health, education, WASH, Women and Children and other s e ctors. Being multi - sectoral concern, only integrated intervention on MHM issue would bring out the good results and changes in the society. She stressed that school girls need to be adequately provided the information related to MHM, and social,

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psycholo gical and religious issue to be taught while teaching anatomy and physiology of reproductive organs and biological process of menstruation. Menstruation restriction has been very big social issue in the Mid - Western and Far - Western Region s . Several NGOs/INGOs and government had already conducted several interventions, but they are not enough. MHM related activities in schools will contribute for development of healthy citizen in the future. She concluded the opening session by promising th at health sector is read y to collaborate with concerned stakeholders and contribute to the promotion of MHM activities in all schools. Mr. Raj Kumar Kshetri, Deputy Programme Director - NRCS CEHP had played the role of Master of Ceremony in the opening cerem ony of the workshop.

Technical session Proceedings

Session 1: Issues and good practices related to MHM in schools (Voices from fields) This session was chaired by Mr. Dhruba Raj Regmi , Under Secretary , Ministry of E ducation and all technical sessions wer e facilitated by Prof. Chitra Bahadur Budhathoki and he was assisted by Mr. Raj Kumar Kshetri - NRCS CEHP .

Ms. Satya Swar , Secretary , Samabikas Nepal - Achham , highlighting the burning issue of Chhaupadi 1 tradition in Achham, said that almost all menstruating girls/women are compelled to stay outside home in small Chhaupadi hut without proper ventilation. Restriction of touch, mobility/entering the sacred place and public places and making food during mens trual period are commonly prevalent. Even though several VDCs are declared as Chhaupadi free VDCs, women are still kept at hut outside home during their menstruating period. She raised many issues from traditional beliefs, social and political leader's pra ctices, lack of proper policy implementation, community awareness to its impact on girl's education and health.

Mrs. Janaki Timilsina, School Teacher - Achham shared about Chhaupadi culture widely prevalent in Accham district and hardship during the period due to many restrictions. She shared that a woman died in Chhaupadi hut due to diarrhea after not being provided with safe water and oral rehydration. She added that existing contents of curriculum and text books are inadequate to teach students about men struation hygiene management and suggested that contents and messages of MHM be included in school curriculum and textbooks from grade four.

Ms. Suntala Shahi, Student - Achham shar ed her experience on menstruation that she had menarche when she was in gr ade 8 and there was no water to clean blood dropped to toilet while urinating. Along with menstruation, she beg a n to feel stress because she had to abstain from doing several things including going to school, eating milk, curd and ghee, touching other pers ons and seeing adult men. Because of unfavorable situation created for menstruating girls, traditional practice associated with menstruation negatively affect girls' study and achievement.

1 https://en.wikipedia.org/wiki/Chhaupadi

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Some girls during the menstruation period still do not come to schoo l because of lack of family support.

Mrs. Danta Shahi, MHM Activist and FCHV - Kalikot district said that women are restricted to enter their houses due to their traditional believes. She also remembered that during insurgency in the past , some women were encouraged to break the traditional rules and stay in home but later they again started to follow the same tradition. She also added that t hough some NGOs had made efforts to change Chhaupadi culture, but they were not fully successful in bringing out exp ected outcomes. She questioned the sustainability of Chhaupadi free VDC and requested to join the hands for social movement against Chhaupadi.

Mr. Kamal Khatri , MHM Activist, Surbodaya Nepal - Jumla shared his field experience that people do not touch the menstruated women for about 7 days in Jumla district . He added that awareness raising interventions agai nst traditional misconceptions and myth practices like folk songs, door - door campaign , mass interaction etc have been done . I ndicators of Chhaupadi fre e village have also been set with the involvement of local people and relevant stakeholders and have been attempting declare Chhaupadi free village.

Ms. Shyam Kala Dangi, Student - Rukum shared that two year ago most of the girls used to absent in the scho ol during the menstruation period due to the lack of separate latrine but now girls have access to separate girl friendly toilet with incinerator and absenteeism of girl student s during menstruation have been remarkably decreased. She also mentioned that they have the skill of mak ing reusable sanitary pads and have been using such pads. She added that now the students can openly talk about menstrual hygiene issues.

Ms. Sita Kumari Bista, School Teacher - Rolpa said that one year back, school didn’t have good water facility and had faced a lot of problems for MHM but now they have enough water at school and it has supported for improved MHM at school. They have also been collecting N Rs. 25 rupees annually from students and manage disposable sanitary p ads for the girls who accidentally have menstruation during school time. She suggested that m enstrual hygiene can be managed by providing students with practical and skill - based education in school.

Mrs. Sabitri Bhandari, President of Active Women Forum for Justice - Chitwan district said that women are often deprived of their rights and have been suffer ing from various myth s, traditional culture and practices of the society. She mentioned that women themselves have to be open - minded and struggle to break such traditional unjustifiable practices regarding menstruation. She suggested that joint efforts need to be made for creating women and girl friendly home and community, girl's friendly school, and local government agencies should also allocate significant fund for promoting menstrual hygiene management in school and ensuring women reproductive rights. She further added that practical education is essential for promoting MHM in school.

Mr. Ganja Man Budha, of School Management Committee, Prabhakar Higher Secondary School - Salyan district said that several ill traditional beliefs and views exists in society but nowadays these traditional belie ves and practices are being gradua lly replaced by new value and practices through the effect of education and training. He said that harmful practice against women and girls can be avoided by involving priest, traditional healers, social and political leaders in social

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movement and existin g curriculum and textbooks should have the practical contents to change the behaviour of students.

Ms. Kabita Gharti, Student - Dang district said that till some years ago, her school had problems of waste management, sanitation and girl friendly toilet , a nd most of the girls did not use to go to school during their menstruation period. Now they have been informed about MHM, also trained on making re - usable sanitary pads using cotton cloths and they have girl's friendly toilet so that absenteeism of girls i n the school has been decreased . As the girls have also skill of preparing reusable sanitary pad, they have been using re - usable sanitary pad and disposable pads as well . Besides this, schools also have provision of re - usable sanitary pad to a girl who acc identally menstruates in school. She also stated that school girls feel free to talk to teachers and others about issue of MHM.

Floor Discussion After sharing the experiences by above mentioned participants , there was open floor discussion for half an hour. Participants expressed their experiences and views on ill practices regarding menstrual restriction and good practices on MHM.

Mr. Dhurba Raj Regmi, Chair of the session concluded the presented views and said that Minis try of Education (MoE) is responsible for developing curricula and it will definitely address MHM issue while developing the school curricula though some issues of menstruation have already been incorporated in the curricula . He also indicated that the pre sence from the Curricul um Development Centre has made the discussion on curricula more effective . He also commented that though there are various efforts regarding MHM but it has not become sustainable due to lack of proper coordination among GOs, I/NGOs a nd concerned stakeholders. He also added that green, peace, clean and safe concept need s to be integrated in school education. For long lasting change and sustainability, knowledge, attitude and skills of the students should be positively changed .

Sess ion 2: Sharing of the Study Findings and good practices on MHM in schools Mr. Dambar Bahadur Thapa, Deputy Director of Regional Education Directorate, Surkhet chaired the second session .

Ms. Shikha Shrestha , Programe Manager , Water Aid Nepal presented findings of a stud y related to MHM in schools which was carried out in Udaypur and Sindhuli district in 2016. The study showed that about 40% and 20% of girl students of Sindhuli and Udayapur respectively miss some part of the school day due to their menstruation . Likewise, 40.8% girls in Udaypur and 16.9% girls in Sindhuli reported of not knowing the cause of menstruation. 18.4% girls reported that they do not use sanitary pad due to embarrassment in buying pads. She also added that mothers we re not informed well a bout the causes of menstruation, though mothers were the main source of information for menstruating girls . Girls were not comfortable taking information from teachers and teachers also felt uncomfortable to teach about menstruation. Disposing of sanitary materials was stressful due to lack of proper facility at schools to maintain privacy. She briefed about mass campaigns conducted by Water Aid for breaking silence, changing misconception and behavior , as well as monitoring mechanism.

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Ms. Shreelata Rana, NRCS CEHP with Prof. Chitra Bahadur Budhathoki , presented key findings of rapid assessment on MHM at school conducted by Ms. Radha Paudel, MHM Activist and Ms. Shreelata Rana i n three districts (Dai lekh, Salyan and Dang) as Ms. Radha could not participate in the workshop. The a ssessment showed that WASH infrastructure s for menstrual hygiene management were not enough in the schools though some of the I/ NGOs with the collaboration with GOs had been su pporting for MHM in schools. The functionality and cleanliness of school latrine was challenging. There was the existence of s ocial belie ves , myths and ill practices regarding menstruation at household , community level and even in schools . Government orga nizations had not had enough attention and programme regarding the MHM in school. It was also reported that some of the school teachers had also misconception regarding menstruation. It was recommended that MHM should be the business of every one and the concerned ministries such as M o E, M o H, MWCW, MoWSS, MoFALD and should work collaboratively in order to promote menstrual hygiene management and remove the social taboos related to menstruation.

Ms. Preeti Gautam, NRCS - CEHP present ed the approac hes and interventions of SRC/NRCS regarding MHM in school. She shared that the interventions are divided into 3 parts i.e. Institutionalization, capacity building and MHM provisions. Under institutionalization, she mentioned that there are students ' clubs ( Junior Red Cross Circle) that are officially accepted by D istrict Education Office and they have annual action plan and are also responsible to carry out school level activities. She highlighted that School WASH training , interaction with students and tea chers and orientation to School Management Committee are done for capacity building of the relevant actors . With this the project ensures/supports the availability of gender friendly toilets with menstrual hygiene management facilities and sufficient availability of water and encourage s school to have provision of sanitary pads with its proper storage and supply mechanism for the proper menstrual hygiene management at schools.

Mr. Prakash Bohara from Tdh Nepal presented their approach regarding MHM i n school. He said that they apply the participatory intervention strategies i.e . baseline assessment, training of trainers, school based training, multi - sectoral commitments and construction of WASH facilities with inc iner ators in schools. He also added th at school training transfers the skills and both teachers and students are able to prepare reusable sanitary pads using cotton cloths and VDC offices have also started to allocate certain fund for school for the training of making reusable pads. He also added that VDC level multi - sectoral stakeholders commitments against discrimination in schools ha ve been made in written form in Salyan.

Mr. Madan Bhatta from Helvetas Nepal presented their good practices and strategies regarding MHM in school. He said t hat there is enough misconception, wrong social beliefs, taboos and mal practice related to menstruation and MHM in communities and schools as well . He mentioned that hygiene literacy class to women group, social campaigns, awareness rising interaction sess ion at school, various competitions and days celebration events in schools, storage of disposable sanitary pad at schools, girls friendly latrines with water facility at school, various trainings to relevant actors have been carried out for the promotion o f MHM in schools. He also added market linkage is essential for sustainability of intervention s . He also recommended wider replication of above mentioned good practices is necessary for promotion of MHM.

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Floor d iscussion After the above mentioned presentat ion , floor was opened for discussion. Participants said that there should be evidence based intervention, reflection and action for promoting MHM in schools as well as community. Mr. Dambar Bahadur Thapa, Chair of the Second Session conclud ed the second session saying that findings of studies and the MHM related good practices presented in this workshop would be valuable for those working in the sectors of promoti ng MHM in schools. He also added that many schools still do not have separate toi lets for girls and boys . So, joint effort is needed to ensure the availability of girl's friendly latrine in each school. Appreciating the good practices presented by some organizations, he requested to other relevant stakeholders to replicate as much as p ossible. He also recommended that contents of menstrual hygiene need to be included in grade 4 and extended contents up to grade 10.

School Visit for observation of MHM related facilities in schools Participants were mainly divided into two groups . Group A visited Amar Secondary School , Urahari VDC and Group B visited Ambeswori Secondary School, Fulbari VDC, Dang district . They were also further divided into two sub - groups within each main group so that they could easily observe and discuss. Two grou ps observed the school facilities which was supported by school students and teachers, after that all members gathered at school ground for the discussion where guests suggested and appreciated the work of the school.

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Day 2 (February 6, 2017)

Technical Sessions Session 1: Impression s haring of the f ield v isits The first session of the second day was chaired by Mrs . Rita Bhandari Joshi, Regional Director of Regional Health Directorate, Surkhet. All four sub - groups share d their impression of school visits.

Group Presentation : Mr. Indra Kumar Sharma and Mr. Baburam Gautam from Group A and Mr. Basant a Shrestha and Ms. Shikha Shrestha from Gr o up B presented the WASH situation of Amar Secondary School and Ambeswori Secondary School respectively . They stated that both school s had waste collection pit, separate toilets for girls and female teachers with sanitary pad disposal provision and other separate toilets for boys and male teachers , provision of child and disable friendly WASH facilities in school , good facilities , trees plantation in school ground . WASH maintenance fund was created by student club named J unior R ed C ross Circles (JRCs) collecting the certain fund annually from the students of grade 6 to 10. They also added that t here was the stock of sanitary pads in school so that girl students c ould easily take and use when they accidently get menstruation. Schools girls had the skill of making reusable sanitary pads using cotton clothes . They shared that there is very basic information about MHM in the text book of grade 6, 7, 9 and 10 . Available c ontents related to and menstrual hygiene were taught and discussed well with the students.

They also recommended to increas e the number of the toilets at Amar school to match the ratio of the students, conduct income generation activities such as vegetable and fruit farming, manage separate room for girls to take rest during menstrual pain, washing and drying facilities for re usable pads, scale up the coordination with local health facilities for health check up of the students when they become sick at the school time , ensure the provision of bio - sand filter etc. F or the promotion of menstrual hygiene management in schools , the y also suggested that MHM related contents should be added bit in curricula from grade 4 to 10 and G ender and WASH focal teacher should be appointed.

Floor Discussion There was open discussion after the presentation of impressions gained from field visits . Being out of the scenario of the school visit, the participants shared the following k e y points for the promotion of MHM.  Menstruation should not be limited on menstrual hygiene . S chool teaching - learning activities are mainly based on theoretical knowled ge, and practical activities related to MHM and reproductive health should be included in school curricula and text books.  MHM activities should not be limited in school, and it should be taken to community through health mother groups and FCHVs.  S chool should establish health care and counseling service unit in school.There should be good coordination between school and local health facility for teaching and learning on reproductive health and MHM issues. Session 2: Exploration of policies/provisi ons related to MHM in general and schools , Gap Identification, challenges and ways forward The second session was chaired by Mr. Baburam Gautam, Deputy Director of C urriculum D evelopment C entre (CDC) .Mr. Guna Raj Shrestha, National Coordinator, Water Suppl y and Sanitation Collaborative Council (WSSCC), presented a paper on policy provision related to MHM in Nepal.He said that government has already developed guidelines for abolition of Chhaupadi practice, but it has not been implemented effectively. He poin ted out the limited provision of MHM issues in National Sanitation and

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Hygiene Master Plan of Nepal. Then he stated the key points of SACOSAN 2016 Bangladesh Declaration. He pointed out the components of integrated management of MHM. At the end, he request ed all participants to promise for breaking silence, talking about menstruation in family, school and community, and being proud of it.

Sharing of the Study Findings on MHM in schools Mr. Surendra Dhakal from UNICEF Kathmandu presented findings of studies that were conducted in schools of 3 districts namely, Parsa, Bajura and Ac h ham among 200 students of each district from intervention and non - intervention schools. Study findings shows that the availability of sanitary materials at school s was comparatively higher in intervention schools i.e . 61% in Ac h ham against 11% in Non - intervention school , 52% Parsa against 0% and 3% in Bajura against 1% in n on - intervention school . He concluded that 60% of girls in Achham and 17% of girls in Bajura were n ot able to sleep in the same house as the rest of the family. He raised a question about the impact of WASH facilities in school on reducing girls' absenteeism in school because before and after intervention, there was no significant change in the rate of adolescents' girl absenteeism in school. He also said that girls' school absenteeism might be influenced by other factors rather than only menstruation. He briefly shared about star approach too. He shared that t he three stars Approach for WASH in Schools is designed to advance the effectiveness of hygiene behavior change programmes, while ensuring that the schools meet the essential criteria for providing a healthy environment for the students. Schools are encouraged to ta ke simple steps toward ensuring t he WASH facilities. Once the minimum standards are achieved, schools are encourag ed to move from one to three stars by expanding hygiene promotion activities and improving infrastructure, especially for girls, ultimately meeting national standards for WASH in schools.

Group work: After presentation of two papers, participants were divided into four groups: 1 . WASH Group, 2 . Education Group, 3 . Health Group, and 4 . Local Development, Women and Child Development Group. Each group discussed on existing poli cy provision, gaps and way forward regarding the MHM .

Presentation of Group Work : The different groups shared as following :

Education Group:  There are some policies related to women's rightand menstruation health but are not being effectively implemented across the country.  There is need of the formulation of MHM related specific policy .  C ontents of menstrual hygiene should be included in the curriculum of grade 4 to 10 .  I ntegrated interventions in the coordination among Education, Health, WASH, Women and Children and other development sectors should be done for the promotion of menstrual hygiene management in schools and community.

Health Group:  Some policy provision s such as ICPD 1994, National Reproductive Health Str ategy 1998, Adolescent Health and Development Strategy 2000, Adolescent Sexual and Reproductive Health Implementation Guidelines 2008 and National 2071 BS are in place .

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 P eer education, school , community based advocacy program and in formal education should be provided as well as life skill training, adolescent friendly health services and youth information centre centr e needs to be established.  A ll health facilities must be adolescent friendly and sanitary pads should be distributed from health institution and FCHVs.

WASH Group:  There are some polic ies such as Sanitation and Hygiene Master Plan, Chhaupadi Abolition Guidelines, SLTC guideline, SACOSAN 2006 Declaration. But except Sanitation and Hygiene Master Plan, other polic ies an d program s related to school WASH are not effectively implemented.  MHM issue has not been incorporated and address in WASH, School Sanitation and Health Programs. School resource person and supervisors supervise the availability of school toilet and water supply, but there is no indicator related to MHM.  Each school should have separate girls toilet with incinerator for the safe disposal of menstrual waste  Provision of rewards should be in place for improving WASH and MHM in school  Public toilets should have the p rovision of menstrual hygiene management facilities

Local Development, Women and Children development Group:  Efforts have been made to implement reproductive health programme , p romoti ng the reproductive rights and women rights, celebrati ng the menstrual hygiene and hand washing day, appointment of gender focal person.  T o eradicate Chhaupadi p ractice and to promote MHM in all schools of Nepal, existing policies, programme, resources and budgets are grossly inadequate. G overnment should form a Nat ional MHM Board, develop joint action plan of Education, Health, WASH, Women and Children, and Development Sectors, and implement integrated WASH and MHM interventions across the country.

Mr. Baburam G a utam, Chair of the s ession concluded the session by saying that CDC will make its efforts to include sufficient contents of MHM in school curricula, teaching and training materials.

Preparation of declaration note of the workshop A technical team was already formed to draft the declaration note based on key messages and conclusion of the two days workshop. Mr. Ramesh Bohara on behalf of technical team presented the drafted declaration note. Participants provided important feedback on draft declaration. Then Technical team fi nalized the Dang Declaration Paper by incorporating feedback and suggestions obtained from participants. During the finalization process of the declaration note, some MHM related videos were displayed in the workshop.

Closing Session Closing session of th e two - day workshop was chaired by Mr. Dhruba Raj Regmi, Under Secretary of Ministry of Education and moderated by Mr. Raj Kumar Ks hetri - NRCS CEHP . Mr. Baburam Gautam from CDC, Ramesh Bohara from Swiss W ater and Sanitation Consortium and Mr. Dambar Bahadur Thapa, Deputy Director of Regional Education Directorate was the guest on dais .

Mr. Ganja Man Budha, on the behalf of community and schools shared his views about the workshop. He said that it was the issue of both male and female so they had to discuss and disclose the hidden issues of MHM. Whether MHM specific policy has not developed yet, all of them should make their efforts to promote MHM at family, school and community.

Ms. Sabitri Bhandari on behalf of I/NGOs and MHM Activists than ked the organizers for creating opportunity to share and discuss on the hidden and socially neglected issue - menstruation hygiene. She

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said that this workshop has encouraged the participants to organize MHM related activities at school, community and grass root level, and conclusion of the workshop, Dang declaration will give insights for the government to formulate national policy, and will knock CDC for revising and including adequate contents of MHM in school curricula.

Ms. Anita Gyawali representing t he government organizations acknowledged the effort of organizers for gathering key persons of government organizations, I/NGOs, schools, communities in one place and exploring their views and experiences of MHM. She also added that integrated interventio ns regarding MHM should be done with strong coordination among the relevant organization and the workshop has already supported to think jointly on MHM and next workshop/meetings should be in the district and VDC level too. For this, all organizations shou ld have strong commitment.

Mr. Dambar Bahadur Thapa, Deputy Director of Regional Education Directorate on behalf of regional level organizations expressed that menstruation has been linked with culture and malpractices regarding these are very common in the families having Hindu religion and it's not easy to remove such malpractice during menstruation with limited efforts. It can be changed gradually through social awareness, education and implementation of MHM related policies and guidelines. He expected that conclusion drawn from this workshop would be useful for formulation of policy and revision of the curricula and textbooks of schools.

Mr. Babu Ram Gautam of CDC on behalf of central level organizations said that MHM can be promoted in schools across the country through the joint efforts with the collaboration among school, community, I/NGOs, CBOs and government agencies. He said that essential contents of MHM will be included in health, science and social studies curricula, and adequate contents and messages of MHM will be included in the curriculum of Health, Population and Environmental Education of Grade 9 and 10 which is in the process of revision. Simple messages of MHM will be included in text books of grade 4, 5 & 6.

Mr. Madan Bhatta - Progra mme Manager, WARM - P/Helvetas Nepal, on behalf of Swiss Water and Sanitation Consortium expressed his sincere thanks to all participants of the workshop. He also acknowledged the supports from Swiss WASH Consortium and sincere efforts of the NRSC/SRC staff for making the workshop successful.

Mr. Dhruba Raj Regmi - Under Secretary of Ministry of Education, Chair of the closing session announced the key message of final Dang Declaration paper (please find annex - 1) and made commitment signing on the declaration paper. All participants signed on the declaration paper and showed the commitment to follow the declaration points . Mr. Regmi said that MHM can be implemented in four phase: P hase 1 : policy development : P hase 2 : planning, P hase 3 : localization of policy and plan, and Phase 4 : implementation and monitoring. He further added that children, girls, youths, local leaders, traditional healers, priest, school teachers, and political party leaders, all concerned stakeholders should be involved in the social movement focusing on MHM. He also pointed out that schools and NGOs should mobilize child clubs in WASH and MHM activities without hampering their classes and without creating mental pre ssure among children. He highly appreciated the efforts of Swiss Water and Sanitation Consortium Partners to organize the workshop and also committed to influence the government for the formulation of MHM related specific policies and guidelines.

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ANNEXES ANNEX - 1

Dang Declaration Paper related to menstrual hygiene management February 6, 2017 (24 th Magh, 2073)

Constitution of Nepal, article 35 sub - articles 4 has ensured the right to access to water, sanitation and hygiene. According to article 38 in 'Women's right' related sub article (1), (2), (3) every woman shall have equal right to lineage without any gender discriminations, every woman shall have the right relating to safe motherhood and reproductive health, there shall not be any physical, menta l, sexual or psychological or any other kind of violence against women, or any kind of oppression based on religious, social and cultural tradition, and other practices. And the Domestic Violence Act 2066 has also a pproved the above enactment. It is mentio ned that these kind of act are punishable and victims have right to get the compensation as per law . Unfavorable to the constitution article, still in different parts of Nepal in the name of religion and cultural beliefs, women's and adolescent are seclud ed as well as discriminated during their natural and biological process i.e. postpartum period, menstrual period and are forced to stay outside the home in Chhaupadi shed , cattle farm with the restriction to have nutritious foods like milk, curd, ghee etc and proper clothing/bed sheet and also have to work on the field during the period instead of the household chores , a nd this customs being the reason behind the gender discrimination, exploitation and violence. To address this issue National level region wise development plan has been prepared by GoN to achieve the sustainable development goal upto 2030 which includes the indicators as,  Increment in th e attendance of female student up to Secondary level.  Elimination of menstruation related discrimination.  Equitable and enough a cc ess to clean drinking water, sanitation and hygiene to everyone  Guarantee of the human right appraising the self - esteem of wom en , girl including the one in vulnerable situation.

As of today, February 6, 2017 we, all governmental and non - governmental organization/ institutions officials and stakeholders show following commitment s toward the implementation of 'Dang Declaration pap er 2073' organized as Regional Workshop in coordination with Regional level Water Sanitation and hygiene Coordination Committee (R - WASH - CC) .

1 . Ensuring the availability of sustainable access to water, sanitation and hygiene including sanitary toilet with m enstrual management facilities for safe disposal of menstrual waste in female toilet 2 . Improving the curriculum of grade 7,8,9 for the inclusion of basic menstrual hygiene management related education, skill and behavior in the curriculum from grade 4 and r equest to Ministry of Education to conduct related trainings to the teachers and students. 3 . Assurance of availability of sanitary pad in required quantity in every school even through the optimum use of local ly available resources. 4 . Collaboration and integration of the interventions of different local institution, related government organizations, national and international non - governmental organizations, citizen society working on menstrual hygiene management sector at VDC/Municipality, district, regi onal and headquarter level and management of appropriate network for the implementation of the integrated activities. 5 . Development of basic criterion for technical subject of menstrual hygiene management of School WASH program and its implementation by ever y institution with the resemblance of it. 6 . Formation of child clubs in every school and conduction of different activities related to sanitation and menstrual hygiene management allocating the responsibilities to both boy and girl students 7 . Every school must integrate the menstrual hygiene topic in their regular extracurricular activities together with proper and sustainable management for provision of required amount of sanitary pads in school

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8 . Coordination with local institutions integrating menstrual hygie ne management issue with governmental service and facilities to create social pressure for the elimination of Chhaupadi shed in the prevalent communities. 9 . Increase awareness among parents, traditional healers, priest, maulana , etc on dire practices like Ch haupadi by organizing special trainings and interaction sessions and disseminate messages through them at community. 10 . Publishing and spreading community based information, education and communication (IEC) materials related to menstrual hygiene management in related places. 11 . Priority will be given to this subject through publicity and spreading awareness message using local means of communication (FM, Television and Newspaper) in local language and culture 12 . Reward system to praise the men and women (one commu nity one exceptional work) who exceptionally works in menstrual hygiene management. 13 . Conduction of effective activities among local level different groups and clubs (mothers group, child club) etc on menstrual hygiene management with the mobilization of FCH Vs. 14 . Determination and inclusion of menstrual hygiene management related indicators in total sanitation plan of district drinking water, sanitation and hygiene/ VDC water, sanitation and hygiene with the initiation to implement the program and allocation o f budget. 15 . Inclusion of menstrual hygiene management indicators under the sanitation indicators in school level plan and joint monitoring of activities by school supervisor and resource person.

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ANNEX - 2 List of Participants

S.N. Name Organization Address Designation 1 Shyam Kala Dangi Shree Himalaya Janata H. Rukum Student S.S 2 Sita Bista Chandra P rabha S.S Rolpa Teacher 3 Ganja M an Budha Pra bh akar Secondary Salyan School Management School Committee 4 Gobinda Khadka Yugbodh Daily Dang Reporter 5 Narayan Aacharya NRCS Dang Chairman 6 Kabita Gharti Magar Amar H.S.S Dang Student 7 Chok Prasad Dhital WSSDO Dang Division Engineer 8 Bhola Prasad Thapa WSSDO Rolpa Sub Division Engineer 9 Dandpani Ghimire DEO Dang Acting DEO 10 Dr. Rajendra GC DHO Rukum Chief Medical Officer 11 Buddhi Ram Gosain NRCS Rolpa District Coordinator 12 Chiranjibi Paudel DEO Rolpa District Education Officer 13 Gopal Sharma Bhattarai Annapurna Post Dang Journalist 14 Suresh Shrestha News 24 Dang Journalist 15 Raj Kumari Rai WDO Salyan Women Development Officer 16 Bishram Adhikari NRCS Dang District Coordinator 17 Ghan Shyam Pokhrel DPHO Dang DPHO 18 Govinda Aacharya DDC Dang NGO Coordinator 19 Raj Kumar Kshetri NRCS CEHP Nepalgunj Deputy Program Director 20 Kalpana Ghimire DEO Pyuthan District Education Officer 21 Gajendra Bahakari WSSDO Dang WSST 22 Tilak Naupane WSSDO Dang Engineer 23 Khagendra Puri NRCS Rukum District Coordinator 24 Shreedhar Gyawali WCO Dang Acting Chief 25 Satya Swar Samabikas Accham Secretary 26 Manju Mahat WDO Accham Women Development Supervisor 27 Shikha Shrestha Water Aid Nepal Kathmandu Program Manager 28 Indra Kumar Sharma NRCS Salyan Secretary 29 Sabitri Bhandari Active Woman's Forum for Chitwan Chairperson Justice 30 Ramesh Bohara Swiss Water & Sanitation Kathmandu Regional Advisor Consortium 31 Bijesh Man Shrestha T erre des hommes Kathmandu WASH Manager (T dh )

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32 Prakash Bohara T erre des hommes Kathmandu Health Program (T dh ) Coordinator 33 Chitra Bdr Budhathoki T ribhuwan University Kathmandu Professor 34 Rubika Shrestha WARMP/HELVETAS Kathmandu Planning, Monitoring and Nepal Information Officer 35 Nilkantha Pandey WARM - P/HELVETAS Surkhet Training & Social Development Officer 36 Madan Raj Bhatta WARM - P/HELVETAS Surkhet Programme Manager 37 Jagat Man Shrestha NRCS CEHP Nepalgunj Consultant 38 Ashim Paudel KIRDARC Kathmandu MEAL Officer 39 Dan Bahadur B.K. RUDEC Nepal Achham Field Supervisor 40 Janaki K. Timilsina Kalika Higher Secondary Achham Teacher School 41 Suntala Shahi Kalika Higher Secondary Achham Student School 42 Amar Mani Poudel NRCS HQ Kathmandu Deputy Director 43 Guna Raj Shrestha WSSCC Kathmandu National Coordinator 44 Gyan Maharjan X - Pose Nepal Kathmandu President 45 Amulya Vaish NRCS CEHP Nepalgunj Finance/ Admin 46 Dr. Dhurba Raj Regmi MOE Kathmandu Under Secretary 47 Babu Ram Gautam Curriculum Development Sanothimi Under Secretary Center 48 Surendra Babu Dhakal UNICEF Nepalgunj WASH Officer 49 Durga Kumari Paudel SAC Surkhet Community Facilitator 50 Preeti Gautam NRCS CEHP Nepalgunj Health Officer 51 Indra Bdr. Thapa SOSEC Nepal Dailekh Field Supervisor 52 Bir Bahadur Basnet NGO Federation Jajarkot Chairperson 53 Chhabi Panta NRCS Jajarkot District Coordinator 54 Kamal Baral SRC Nepal Nepalgunj Country Coordinator 55 ManirajJaisi Prem Devi S. School Dailekh Head Teacher 56 Kanhaiya Lal Bajpai NRCS CEHP Nepalgunj Finance/ Admin 57 Dambar BdrThapa MWRED Surkhet Deputy Director 58 Resham Khadka NRCS CEHP Nepalgunj PMER officer 59 Dileep Kumar WSSDO Bardiya Chief 60 Maheshi Mahata WSSDO Jajarkot Sub - division Chief 61 Basant Man Shrestha DPHO Surkhet Sn. Tech. 62 Lalit Bikram Singh DEO Jajarkot District Education Officer 63 Harak Singh Dhami NRCS Dang Engineer 64 Chandra Kc RMSO Surkhet Regional Director 65 Anita Gyawali W.C.O Dailekh WDO 66 Ramesh Bajgai NRCS CEHP Nepalgunj Technical officer

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67 Chetan Nidhi Wagle MWRHD Surkhet Public Health Officer 68 Khim Bdr Khadka DPHO Nepalgunj Chief Public Health Administrator 69 Rita Bhandari Joshi MWRHD Surkhet Regional Health Director 70 Tulsi Prasad Adhikari MWRHD Surkhet Sn. Auxiliary Health Worker 71 Shankar Bhattrai NRCS CEHP Nepalgunj WASH officer 72 Kaushalya Chaudhary WCO Kalikot Women Development Supervisor 73 Danta Shahi Woman Network Kalikot President /FCHV 74 Padma Kumari Chaulagain HURENDEC (HRDC) Jumla Senior Manager 75 Tekam Oli NRCS Dolpa Dolpa District Coordinator 76 Kamal Raj Khatri Sarbodaya Nepal Jumla Programme Manager 77 Shreelata Rana NRCS CEHP Nepalgunj District Coordinator 78 Padam Rokaya Community Jumla Gender Facilitator 79 Jawaharlal Hamal DEO Mugu District Education Officer 80 Madan Kumar Thapa DEO Humla District Education Officer 81 Naresh Gharti Magar DHO Dolpa Medical Officer 82 GrishPaudel NRCS CEHP Nepalgunj R & T Officer

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ANNEX - 3

Agenda of W orkshop Regional workshop for policy advocacy on Menstrual Hygiene Management (MHM) in schools February5 - 6 , 2017 , Tulsipur, Dang Objectives of the workshop:  To discuss on existing policy provision related to MHM and make common understanding on it  To identify the issues/gaps related to MHM in schools; share good practices and explore the ways forward  To contribute to national pol icy framework of MHM in Nepal bringing up and feeding ground experiences and lessons

Time Activities Facilitators/Presenters Remarks Day 1: Feb 5, 2017 8:00 - 9:00 Breakfast and Registration 9:00 - 10:00 Opening ceremony (1 hr) Chair: Regional Health Directorate 10:00 - 10:30 Tea Break 10:30 - 12:00 Issues and best practices related to MHM in schools (Voices from Chair: Ministry of Education the field) (1.5 hrs) 10:30 - 10:40 Ms. Shyam Kala Dangi (Student - Rukum) Ms. KabitaGharti(Student - Dang) 10:40 - 10:50 Mr. Mani Prasad Jaishi(Teacher - Dailekh) Verbal 10:50 - 11:00 Experience sharing from community Ms. Sita Kumari Bista (Teacher - Rolpa) 11:00 - 11:10 Mr. Gajaman Budha - Chairperson - sharing School Mgmt. Committee - Salyan 11:10 - 11:20 Ms. Danta Shahi (Community Leader - Kalikot) 11:20 - 11:35 Ms. Staya Swar - Samabikas Nepal - PPT Achham 11:35 - 11:50 Mr. Kamal Khatri - Sarbodaya Nepal - Experience sharing from NGOs PPT Jumla 11:50 - 12:10 Ms. Sabitri Bhandari - Active Women PPT Forum for Justice 12:10 - 12:30 Open discussion and sum up by

Chair 12:30 - 1:30 Lunch Break 1:30 - 2:30 Sharing of study findings on Chair: Regional Education Directorate MHM in schools (1 hr) 1:30 - 1:45 Sharing of the experience/study Action Works Nepal PPT findings 1:45 - 2:00 Sharing of the study findings Water Aid Nepal PPT 2:00 - 2:15 Findings sharing of an assessment Swiss Water and Sanitation Consortium PPT 2:15 - 2:30 Discussion and conclusion sharing

by Chair 2:30 - 5:00 Field visit - Observation Coordinators Tea and Group A visits Amar Higher snacks will Group A - Coordinator Secondary School, Dang be served at Group B visits Ambeshwori Group B - Coordinator school

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Secondary School, Dang 7:00 - 8:30 Dinner Day 2: Feb 6, 2017 7:45 - 8:30 Breakfast 8:30 - 9:30 Impression sharing of the field Chair: Regional health Directorate visit 8:30 - 9:20 Participants from both group Max. 10 min (School, Community, GO, NGO and for each INGO) presenter 9:20 - 9:30 Conclusion sharing by Chair 9:30 - 9:50 Tea Break 9:50 - 12:30 Exploration of policies/provisions related to MHM in general and schools in Chair: Curriculum Development Centre particular and identify gaps and challenges and ways forward 9:50 - 10:20 Sharing of the study findings UNICEF 10:20 - 10:40 Presentation on policy frame works Gun Raj Shrestha, National Coordinator, related MHM, relevant other polices Water Supply and Sanitation from right based perspective Collaborative Council (WSSCC) 10:40 - 11:30 Four groups (WASH, Education, He alth, Group work Local development and women/child development) 11:30 - 12:10 Max.10 min Presentation of group work for each group 12:10 - 12:30 Discussion and conclusion sharing

by Chair 12:30 - 1:30 Lunch Break 1:30 - 2:30 Sharing of the draft resolution/declaration paper and A member of Technical team open discussion for common understanding 2:30 - 3:00 Tea and snacks Break 3:00 - 3:30 Audio/Visual sharing GOs, I/NGOs 3:30 - 4:00 Signing Formal announcement and signing Chief Guest flowed by of the workshop declaration others 4:00 - 4:45 Closing ceremony Chair: Ministry of Education 4:45 - 5:00 Group photo 7:00 - 8:30 Dinner

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