“Healthy bodies, healthy minds”: barriers and solutions to implementing a menstrual hygiene management program in South Sudan

Abstract

Abstract Background Menstrual hygiene management (MHM) can be challenging for women and girls living in conflict-affected low- and middle-income countries, where access to menstrual products, soap, water, and private sanitation facilities is often limited. In response to these challenges, the Canadian Red Cross, in partnership with the South Sudan Red Crescent and the South Sudanese Government, implemented the Healthy Bodies Healthy Minds (HBHM) program from 2020–2023 to support MHM in South Sudan. Despite growing attention to MHM needs, few studies have examined the on-the-ground realities of implementing MHM programming in fragile settings. To address this gap, this study aimed to (i) describe the implementation of HBHM, (ii) identify barriers faced during implementation, (iii) identify potential solutions to overcome barriers, and (iv) understand the impact of the COVID-19 pandemic on program delivery. Methods Data was collected through key informant interviews with individuals involved in program design and implementation and were analyzed via thematic analysis. A total of 14 respondents were interviewed. Results Respondents identified several interrelated and compounding barriers, including resource constraints, logistical challenges, competing stakeholder interests/priorities, ongoing conflict, and climate change. To mitigate these barriers and improve the delivery of MHM programs, respondents recommended solutions and strategies such as extending implementation timelines, planning program activities around anticipated climate events, and strengthening inter-organizational collaboration. The COVID-19 pandemic introduced additional barriers, particularly by restricting the movement of people and goods. However, it also yielded unexpected benefits, notably expanding the project’s reach beyond the target group of girls to the broader community. Conclusions Implementation of the HBHM program was impacted by several interrelated and compounding factors including resource constraints and logistical challenges, protracted conflict, climate change, and COVID-19, however, collaboration between implementing partners and agility in the approach to program rollout supported enhanced program reach. International partnerships enabled community-level implementation, which proved especially effective for continued program implementation. Additionally, the shift to a more community-based model resulted in benefits to the broader community, offering another key insight that should be considered in the design of future MHM programs in South Sudan and similar contexts.Plain English summary Many girls in low- and middle-income countries, including those in conflict-affected areas, face challenges in managing their menstruation due to limited access to menstrual products, clean water, and safe, private spaces. When these needs are not met, girls may miss school and experience feelings of shame, anxiety, and depression. Strong menstrual hygiene management (MHM) programs in these settings are essential for supporting the health of girls. From 2020 to 2023, the Canadian Red Cross partnered with the South Sudan Red Crescent and the South Sudanese government to implement the Healthy Bodies Healthy Minds program in Gogrial West County, South Sudan. This program aimed to support the MHM of girls in the region. We studied this program to understand the challenges it faced and how these could be overcome. Interviews with 14 people involved in program design and management revealed several barriers to the program’s implementation, including resource shortages, logistical difficulties, competing priorities among stakeholders, and climate change. To address these challenges, interviewees recommended a variety of strategies such as extending program timelines, planning activities around anticipated climate events, and strengthening collaboration between organizations. These insights can help guide the design of future MHM programs to better support girls’ health and wellbeing.