Embracing Community Participatory Research Approach: The Role of Community Advisory Boards for Research in Conceptualisation of the Enkanyit Ontooyie Menstrual Hygiene Study in Kajiado and Narok Counties, Kenya

Yvonne Opanga, Bernard Mbogo, Joyce Wanjira, Stephen Okumu, Caroline Akinyi

Affiliation: Amref Health Africa in Kenya Research and RMNCAH Program Teams

Every year, school girls in arid and semi-arid regions of Kenya face numerous challenges that result in an average loss of 21-30 days of school attendance due to menstruation. These challenges mainly revolve around the inadequate availability of private and safe spaces for menstrual hygiene in schools. The existing toilets are poorly maintained, unclean, shared between boys and girls, and often have broken doors, which greatly compromises the girls’ privacy.

Additionally, the lack of access to menstrual products pushes girls to use unorthodox means to address the problem. To avoid the shame associated with menstruation, they opt to skip school for a few days until the flow stops. Missing school consistently results in poor performance and eventually dropping out of school. When this happens, they are easily lured by morans and motorcycle riders for transactional sex in exchange for money to buy pads. This leads to an increase in teenage pregnancies and ultimately undergo Female Genital Mutilation/Circumcision (FGM/C) and married off affecting the realization of their dreams and aspirations.

Consequently, most of the menstrual waste especially in schools is disposed of in pit latrines. Since it is non-biodegradable, they fill out the pits more often burdening communities with huge costs to construct new ones and eventually fill out land space. Whereas awareness and knowledge on the proper use of these products is low, menstrual waste thrown away in the open fields poses a risk to animals, children and general environmental conditions

Enkanyit Oontoyie, a Maasai term meaning “dignity for girls,” is a three-in-one toilet facility that combines a toilet, a bathroom, and an incinerator. This innovative model, developed by Malkia Initiative and other WASH stakeholders, has been adopted by the Amref ARP WASH (Erripo) project as a solution for adolescent and teenage girls attending school. The model serves multiple purposes, ensuring regular school attendance by girls during menstruation, addressing their vulnerability to sexual and gender-based violence, and providing them with safe sanitation facilities. The facility consists of a pit latrine, a bath shelter equipped with shelves and connected to a water source for hygienic self-cleansing during menstruation, and an incinerator for the proper disposal of used pads. It offers girls a private and secure environment where they can confidently change their pads and safely dispose of them. The unique design of the facility also provides access to water within its premises, allowing girls to wash their hands after changing pads and even take a bath if needed. Enkanyit Oontoyie is a crucial solution to address the challenges girls face in managing menstruation in schools, promoting their well-being, dignity, and uninterrupted education.

In addition to providing the facility, Amref has partnered with Malkia Initiative to ensure a continuous supply of sanitary pads for school-going girls in selected schools in Kajiado and

Narok counties. Malkia Initiative utilizes a model called Pad Bank to support schools in maintaining year-round access to menstrual products. This model follows a pooled resources approach, which is cost-effective for parents and provides a sustainable solution for schools to improve Menstrual Hygiene Management.

Initially, the initiative offers one-time support with these products. Subsequently, the school management and parents collaborate to set aside funds and contribute towards refilling the pad bank. By combining the Enkanyit Model with the pad bank model, girls in the selected intervention sites will have uninterrupted access to menstrual products throughout the study period. This approach ensures that girls can effectively manage their menstrual hygiene needs and focus on their education without interruptions.

The use of the Enkanyit facility gives girls dignity during menstruation. This means that they can confidently change their used pads and change into clean ones as they maintain the highest level of hygiene. The water connection to the bathroom and toilet enables the user to clean off any mess or soiling herself. Once the used pads are safely wrapped, they are disposed off through an aperture window with access to the incinerator. Depending on the volume of disposed pads, the school management organizes periodic burning which may occur daily, biweekly or weekly. The waste ashes from the combustion are then safely disposed of in the fields or a compost site.

Amref Health Africa is conducting a study to determine the effectiveness of the Enkanjit Oontoyie model in reducing school absenteeism, improving menstrual hygiene practices, and addressing cases of Sexual and Gender-Based Violence (SGBV) in Kajiado and Narok Counties, Kenya. The study will utilize a quasi-experimental design, with schools categorized into intervention and control groups. The Enkanjit Oontoyie facility will be constructed in the intervention schools.

To ensure a successful conceptualization of the study, we have adopted the Community-Based Participatory Research (CBPR) approach. This approach involves equal collaboration between researchers, community members, and representatives from partner organizations throughout the research process. It recognizes the community as a unit of identity, leverages the strengths and resources within the community, fosters collaborative partnerships, integrates knowledge and action for the mutual benefit of all partners, promotes cross-learning, addresses social inequalities, and embraces cyclical and ecological perspectives.

By employing the CBPR approach, we aim to actively involve and empower community members, fostering a sense of ownership and shared responsibility in the research endeavour. This inclusive approach enhances the relevance, validity, and sustainability of the study outcomes, ensuring that the findings effectively inform interventions and policies to improve menstrual hygiene and overall well-being in the target communities.

For the successful execution of the approach, we established Community Advisory Board (CAB) for research that consisted of representatives of the County, sub-county, Ministry of Education (MOE) and Ministry of Health(MOH), Teachers, Parents, link health facility representatives, Community Health Workers (CHWs) and gatekeepers from Narok and Kajiado counties. A brief overview of the study protocol was presented to the CAB members for familiarization with the study. This was followed by a participatory approach of an open discussion where the members gave feedback. The co-creation workshop with the CAB contributed significantly to refining our study in terms of the problem statement of the study, objectives, target population, recruitment procedures, data collection methods, modelling of the innovation to be piloted, community and school entry procedures, necessary approvals required and key ethical issues to be cognisant of during study implementation.

Some of the challenges identified that girls experience during menstruation in schools as discussed by the members included increased school absenteeism, poor concentration in class, low confidence and self-esteem, discomfort for those who attend classes during their menses, negligence of parents on menstrual hygiene, cause unintended pregnancy, lack of access of sanitary pads, Inadequate water supply especially drought seasons, lack of awareness on how to use the Pads. On the model, some of the factors that can influence its functionality include the location of the incinerator, complete combustion, and inadequate water and soap supply. The value added by the CAB was vital in the conceptualization and design of this study.

Amref Health Africa will significantly address gaps in girls’ education through this model; a key social determinant of health especially in arid and semi-arid regions. If this intervention is found to be effective, plans for scaling up this model to additional schools will definitely create a lasting change in menstrual hygiene practices and improved overall health and well-being among these pastoral communities.