With the government of Rwanda and USAID, SNV co-developed a Menstrual Health and Hygiene (MHH)-friendly WASH package, which was implemented at scale across 19 schools in rural Rwanda. The SNV MHH WASH package, developed as part of the Gikuriro project of USAID’s Integrated Nutrition and WASH Activity (INWA), embodies the promise of inclusive WASH access. The package offers MHH-compliant WASH facilities, which are complemented by multi-level governance and monitoring arrangements.
A woman is estimated to have 3,000 days of menstruation in her lifetime. Students who complete basic education (grades 4-10) menstruate a total of 450 days.
Uncovering some MHH bottlenecks
Until 2015, Rwanda – through the Ministry of Education (MINEDUC) – provided little guidance for WASH facilities in schools. Though a minimum health package requirement was stipulated, the construction of sex-segregated toilets and the availability of sanitary pads, water and soap, handwashing points and minimum cleaning materials (e.g., detergent, soap, brooms, etc.) were considered ‘good-to-have’ and were entirely dependent on resource availability.
Across 14 schools in the districts of Kayonza, Kicukiro, Ngoma, Nyabihu, Nyanza, Nyarugenge, Ruhango and Rwamagana, an SNV rapid needs assessment found that:
- Only two schools met the MINEDUC standard of 30 and 40 students per stance for girls and boys, respectively.
- Some were found without separate toilet blocs for administrative staff.
- Many toilets were poorly maintained and not convenient to use.
- Many were ill equipped to enable girls to manage their MHH.
- Security concerns and the lack or absence of private toilets were the top-most issues voiced out by adolescent girls.
A separate study that explored school toilet policy framework and enforcement found that schools lacked mechanisms to improve hygiene behaviour (and facility maintenance) and mobilise school/community engagement to sustain new behaviours.
Hence, overcoming MHH/sanitation bottlenecks in schools meant introducing inclusive sanitation facilities, coupled with a system of multi-level collaboration to ensure sustained use and access to services.
Introducing MHH-informed WASH facilities
SNV introduced new toilet designs and implemented optional sanitation standards mentioned in the Rwanda Ministry of Education’s school health minimum package of May 2014. Sanitation facilties included: (1) sex-segregated toilets, (2) handwashing facility with permanent water, (3) MHH-compliant toilets, and (4) free or subsidised arrangements for sanitary napkin access. Toilet designs were reinforced by technical recommendations for rainwater harvesting systems.
Nineteen schools received new WASH facilities through the project, which included:
- a Ventilated Improved Pit (VIP) latrine with 13 stances (six for girls, six for boys, and one for students with disability);
- urinals for boys;
- an MHH room for girls;
- handwashing facilities with soap; and
- two rainwater harvesting tanks equipped with 10 cubic meters of storage capacity, with the necessary connections.
On average, the WASH facilities improved the ratio of students per stance; from 73 down to 51 and 69 down to 49 students per stance, for boys and girls respectively. Beaming with pride, one schoolgirl informant said, ‘We have more, cleaner and hygienic toilets. There is even a shower for girls and female teachers, and an incinerator for the disposal of sanitary napkins, which helps us to keep our toilets clean.’
Harnessing multi-level collaboration to sustain WASH progress
Stakeholder involvement throughout the project – from the selection of project sites to project implementation oversight – successfully triggered the commitment of multiple stakeholders to follow through with their roles and responsibilities to sustain WASH progress.
A joint monitoring team – composed of a representative from each district and school, an SNV water engineer, and a sub-partner WASH officer – was established to oversee construction works. SNV water engineers advised on the technical integrity and feasibility of construction works, the appropriateness of materials used, etc. Upon the delivery of facilities, the same team assumed the responsibility of regularly checking the quality (and use) of facilities, taking appropriate/corrective measures to ensure the sustainable management of infrastructure, and strengthening the role of local authorities and the school leadership in managing the school WASH system: school toilets, MHH rooms, and rainwater harvesting systems.
In schools, student-run School Health Clubs (SHCs) were set up to assist in behavioural communications change activities and on-site monitoring. For each SHC, a Social Economic Development Officer (SEDO) was delegated to serve as a mentor. Linkages between SHCs, Parent-Teacher Associations (PTAs) and Community Health Clubs (CHCs) were created. All SHCs received training in the different facets of sanitation and hygiene, MHH, and efficient use of water and basic kitchen gardening techniques to care for the school’s vegetable plot. With the CHCs, SHCs are now conducting school community outreach activities to promote sanitation and hygiene in hosting communities; in addition to taking turns in cleaning schools and toilets. They also regularly check rainwater harvesting tanks to ensure water availability.
Finally, SNV co-designed several guidelines and procedures with the Ministry of Health and Education and partners to ensure that the project's approach informs efforts to sustain or replicate progress. These include a National Sanitation and Hygiene Training Manual, Dialogue tools for SHCs and Standard toilet designs for schools.
 A. Mooijman, Girl-friendly toilets for schoolgirls: helping adolescent girls, The Hague, IRC, 2006.
 However, achievement is still below the national standard of 40 and 30 students per stance for boys and girls, respectively. Further efforts are needed to meet the standard.
 Sanitation facilities in schools were delivered by SNV in collaboration with SNV USA as part of the USAID's Integrated Nutrition and Water, Sanitation and Hygiene Activity (INWA) programme in Rwanda. INWA is a cross-sectoral nutrition and WASH programme, implemented by the Catholic Relief Services and SNV respectively.