Building a sustainable model to promote menstrual, sexual and reproductive health (MSRH) amongst secondary school girls in Tanzania

一个女孩的教育会影响她的健康，她未来家庭的健康，以及她未来的经济潜力。这种积极联系的越来越多的证据加强了改善青春期女孩受教育机会的国际决心。来自东非和南部非洲的证据表明，由于月经、性和生殖健康(MSRH)问题，女孩的入学受到严重阻碍。特别是，年轻女孩缺乏管理月经的知识、月经管理产品、学校的水和卫生设施以及管理月经的社会支持。男学生和工作人员普遍存在的欺凌行为增加了围绕月经的高度羞愧和焦虑，并鼓励女孩将自己排除在学校活动之外。此外，2017年人权观察的一份报告指出，坦桑尼亚每年有8000多名女孩因怀孕而被学校开除。这一研究项目的长期目标是通过制定可持续和可扩展的干预措施来改善坦桑尼亚及其他地区女孩的健康和发展成果，以改善女孩的健康和福祉。该项目的目标与大多数可持续发展目标直接相关，这些目标包括：第1项(消除贫穷)、第3项(健康和福祉)、第4项(优质教育)、第5项(两性平等)、第6项(清洁水和卫生设施)、第10项(减少不平等)、第11项(可持续城市和社区)、第13项(气候行动)、第16项(和平、正义和强有力的机构)和第17项(促进千年发展目标的伙伴关系)。该项目是两个领先的研究机构(一个在英国，一个在坦桑尼亚)、一个设在坦桑尼亚的国际非政府组织和坦桑尼亚北部两个地区的地方政府当局之间的合作伙伴关系。总体目标是在坦桑尼亚政府结构内制定可扩展的MSRH综合干预措施，以改善MSRH的做法和看法以及整体学校氛围，以确保中学女生的心理社会福祉以及最佳的学校参与和表现。这将通过3个具体目标实现：1)完善由非政府组织牵头的现有MSRH方案，以更好地让地方政府参与，并通过男孩参与、改进疼痛管理活动以及纳入水和卫生设施改善活动来加强学校部分。2)与政府和学校合作，制定机制，将MSRH干预整合到官立学校中。3)试行改进的MSRH干预措施，以评估(A)可行性(包括每名学生、学校和地区的成本)、可持续性和可接受性，以及(B)对MSRH实践和看法以及整体学校氛围的影响。我们的研究项目将直接惠及(1)坦桑尼亚少女和男孩及其社区；(2)教师和学校官员；(3)地方和国家政府。我们的项目将推进经验性知识，并进一步发展关于整体和嵌入式月经、性和生殖健康项目如何影响女孩发展的理论倾向。这些研究结果将有利于(4)政策制定者、(5)研究人员和(6)国际/执行组织。

A girl's education impacts her health, the health of her future family, and her future economic potential. The growing evidence of this positive association has strengthened international resolve to improve educational opportunities for adolescent girls. Evidence from East and Southern Africa has shown that girls' participation in schools is severely hampered by menstrual, sexual, and reproductive health (MSRH) issues. In particular, young girls lack the knowledge, menstrual management products, water and sanitation facilities in schools, and social support to manage their menses. Pervasive bullying by male students and staff adds to the high levels of shame and anxiety surrounding menstruation, and encourages girls to exclude themselves from school activities. Furthermore a 2017 Human Rights watch report stated that more than 8,000 girls in Tanzania are expelled from school each year due to pregnancy. The long-term aim of this research project is to improve health and development outcomes among girls in Tanzania and beyond by developing a sustainable and scaleable intervention to improve girls' health and wellbeing. The aims of this project directly relate to the majority of Sustainable Development Goals including: number 1 (end poverty), 3 (good health and wellbeing), 4 (quality education), 5 (gender equality), 6 (clean water and sanitation), 10 (reduced inequalities) 11 (sustainable cities and communities), 13 (climate action), 16 (peace, justice, and strong institutions) and 17 (partnerships for the goals). The project is a partnership between two leading research institutes (one in the UK and one in Tanzania), a Tanzanian-based international NGO, and the local government authorities within two northern regions of Tanzania. The overall aim is to develop a scaleable comprehensive MSRH intervention within Tanzanian government structures to improve MSRH practices and perceptions and the overall school climate to ensure the psychosocial wellbeing and optimal school participation and performance of secondary school girls.This will be achieved through 3 specific objectives:1) To refine an existing NGO-led MSRH programme to better engage local governments, and enhance the school component through the engagement of boys, refinement of the pain management activities, and inclusion of water and sanitation facility improvement activities. 2) To work with government and schools to develop mechanisms to integrate the MSRH intervention within government schools. 3) To pilot the refined MSRH intervention to assess (a) feasibility (including cost per student, school and district), sustainability and acceptability and (b) effect on MSRH practice and perceptions and the overall school climate. Our research project will directly benefit (i) Tanzanian adolescent girls and boys and their communities; (ii) teachers and school officials and (iii) local and national government. Our project will advance empirical knowledge and further develop theoretical dispositions on how holistic and embedded menstrual, sexual and reproductive health projects can impact on a girl's development. These findings will be beneficial to (iv) policy makers, (v) researchers and (vi) international/implementing organisations.