BackgroundThere is a significant gap in empirical evidence on the menstrual hygiene management (MHM) challenges faced by adolescent girls and women in emergency contexts, and on appropriate humanitarian response approaches to meet their needs in diverse emergency contexts. To begin filling the gap in the evidence, we conducted a study in two diverse contexts (Myanmar and Lebanon), exploring the MHM barriers facing girls and women, and the various relevant sectoral responses being conducted (e.g. water, sanitation and hygiene (WASH), Protection, Health, Education and Camp Management).MethodsTwo qualitative assessments were conducted: one in camps for internally displaced populations in Myanmar, and one with refugees living in informal settlements and host communities in Lebanon. Key informant interviews were conducted with emergency response staff in both sites, and focus group discussion and participatory mapping activities conducted with adolescent girls and women.ResultsKey findings included that there was insufficient access to safe and private facilities for MHM coupled with displacement induced shifts in menstrual practices by girls and women. Among staff, there was a narrow interpretation of what an MHM response includes, with a focus on supplies; significant interest in understanding what an improved MHM response would include and acknowledgement of limited existing MHM guidance across various sectors; and insufficient consultation with beneficiaries, related to discomfort asking about menstruation, and limited coordination between sectors.ConclusionsThere is a significant need for improved guidance across all relevant sectors for improving MHM response in emergency context, along with increased evidence on effective approaches for integrating MHM into existing responses.

The original CHPS model deployed nurses to the community and engaged local leaders, reducing child mortality and fertility substantially. Key scaling-up lessons: (1) place nurses in home districts but not home villages, (2) adapt uniquely to each district, (3) mobilize local resources, (4) develop a shared project vision, and (5) conduct “exchanges” so that staff who are initiating operations can observe the model working in another setting, pilot the approach locally, and expand based on lessons learned.

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Massive population displaceMent has becoMe a reality across much of the world, with an estimated 60 million people currently displaced by war, conflict, or disaster (unhcR, 2015). With nearly half of the displaced comprising girls and women (unhcR, 2015), there has been a growing impetus within the humanitarian response community to better address the gender-specific needs of displaced populations. this includes increasing efforts by many international relief organizations to mainstream gender priorities through targeted policy, programming, and research (Gasseer et al., 2004;Kovacs and tatham, 2009;Mazurana et al., 2011). a critical gender issue that has yet to be adequately prioritized is that of meeting the menstrual hygiene management (MhM) needs of adolescent girls and women. Girls and women across low-income contexts face numerous challenges managing their menstruation safely, hygienically, and with dignity including physical access to latrines during menstruation, dedicated places of disposal for materials, and being able to manage menses without shame and repercussions (house et al., 2012;Mahon and Fernandes, 2010;sebastian et al., 2013). in emergencies, they face additional challenges. Girls and women who flee their homes may not be able to carry adequate supplies of materials (cloths, pads, underwear) to manage monthly bleeding. they may prioritize children, the elderly, and other family members' needs over their own body-related needs. they may be on the move, or living in crowded, unsafe environments that lack access to private and safe water and toilet facilities (especially at night) for changing menstrual materials and washing themselves (parker et al., 2014;sommer, 2012; iFRc, 2013;hayden, 2012). they may lack mechanisms for privately disposing of used materials, or for discreetly washing and drying reusable menstrual materials. all of these factors increase women and girls' exposure to risk of sexual violence and exploitation in humanitarian settings (sommer et al., 2014;Gosling et al., 2011;davoren, 2012).the range of challenges girls and women face may differ if an emergency is acute or protracted, urban or rural, or if they find themselves on the move, living in camps, host communities, or informal settlements. Girls and women from different cultures will also have unique menstrual beliefs that influence how they manage menstruation, including strongly held taboos around disposal of menstrual waste (e.g. burying versus burning, or disposing of waste in a secret manner) (hayden, 2012;sommer, 2012;sommer et al., 2013;Kjellén et al., 2011) and methods for washing and drying used menstrual materials (de lange et al., 2014; nawaz et al., 2006). they may, for example, prefer to manage menstruation in private bathing spaces instead of toilets. the varying socioeconomic backgrounds of the changing displaced global population may influence preferences for menstrual material distributions. as with other interventions in emergencies, the type of emergency (e.g. natural disasters, acute conflict) will d...

BackgroundRapid urban population growth is of global concern as it is accompanied with several new health challenges. The urban poor who reside in informal settlements are more vulnerable to these health challenges. Lack of formal government public health facilities for the provision of health care is also a common phenomenon among communities inhabited by the urban poor. To help ameliorate this situation, an innovative urban primary health system was introduced in urban Ghana, based on the milestones model developed with the rural Community-Based Health Planning and Services (CHPS) system. This paper provides an overview of innovative experiences adapted while addressing these urban health issues, including the process of deriving constructive lessons needed to inform discourse on the design and implementation of the sustainable Community-Based Health Planning and Services (CHPS) model as a response to urban health challenges in Southern Ghana.MethodsThis research was conducted during the six-month pilot of the urban CHPS programme in two selected areas acting as the intervention and control arms of the design. Daily routine data were collected based on milestones initially delineated for the rural CHPS model in the control communities whilst in the intervention communities, some modifications were made to the rural milestones.ResultsThe findings from the implementation activities revealed that many of the best practices derived from the rural CHPS experiment could not be transplanted to poor urban settlements due to the unique organizational structures and epidemiological characteristics found in the urban context. For example, constructing Community Health Compounds and residential facilities within zones, a central component to the rural CHPS strategy, proved inappropriate for the urban sector. Night and weekend home visit schedules were initiated to better accommodate urban residents and increase coverage. The breadth of the disease burden of the urban residents also requires a broader expertise and training of the CHOs.ConclusionsAccess to improved urban health services remains a challenge. However, current policy guidelines for the implementation of a primary health model based on rural experiences and experimental design requires careful review and modifications to meet the needs of the urban settings.