Acceptability, Cost, and Uptake of a Multicomponent Menstrual, Sexual, and Reproductive Health Intervention in Secondary Schools in Northwest Tanzania: Lessons From the PASS MHW Pilot Study

Abstract

Negative menstruation experiences adversely affect schoolgirls' social participation, education, and overall health, yet comprehensive menstrual health interventions are limited in Tanzanian schools. This study evaluated the feasibility, acceptability, cost, and potential impact mechanisms of a comprehensive school-based menstrual, sexual, and reproductive health (MSRH) intervention. The intervention, piloted in four secondary schools, included education sessions for girls and boys, pain management, distribution of menstrual kits (reusable pads and menstrual cups), WASH improvements, and stakeholder engagement. A mixed-methods process evaluation assessed acceptability, fidelity, cost, context, and potential impact mechanisms using qualitative methods (in-depth interviews, focus group discussions, and WASH observations) and quantitative methods (survey questionnaires, structured observation of education sessions, costing, and monitoring data). The intervention was well received by students, teachers, and local government authorities; MSRH education reached 86% of schoolgirls and 72% of schoolboys, while over 93% of girls received menstrual kits. Total implementation cost across the four schools was 111,347,467 TZS (38,003 GBP), approximately 39.05 GBP per student, lower than comparable initiatives in East Africa. Findings indicate the intervention is feasible and acceptable in school settings and can inform future menstrual health and hygiene programs, though further research is needed to assess broader effectiveness and sustainability.