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

backgroundMenstrual 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.

methodsData 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.

resultsRespondents 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.

conclusionsImplementation 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.