Table of Contents Key Point Summary ............................................................................................................................ 1

Purpose ............................................................................................................................................. 1

Methods ............................................................................................................................................ 1

Respondents ...................................................................................................................................... 1

Findings ............................................................................................................................................. 2

Facilities .................................................................................................................................................... 3

Supplies ..................................................................................................................................................... 5

Knowledge and Education ........................................................................................................................ 9

Stigma and Taboos .................................................................................................................................. 11

Funding for MHM Programming ............................................................................................................. 13

Private Sector Involvement ..................................................................................................................... 13

Key Results and Implications ............................................................................................................ 14

Figures and Tables Figure 1: Map of Plan’s MHM Programs ....................................................................................................... 2

Figure 2: Types of Programming Implemented by Offices ........................................................................... 3

Figure 3: Map of Plan’s Facility-related MHM programs ............................................................................. 4

Figure 4: Type of Facility Adapted for MHM Purposes ................................................................................. 4

Figure 5: Type of Adaptations Made to Make Facilities MHM-friendly ........................................................ 5

Figure 6: Map of Plan’s Supply-related MHM Programs .............................................................................. 5

Figure 7: Types of Supplies Targeted ............................................................................................................ 6

Figure 8: Origins of Products Used in MHM Projects ................................................................................... 7

Figure 9: Types of Financing for MHM Products........................................................................................... 7

Figure 10: Locations Where MHM Products were Distributed ..................................................................... 8

Figure 11: Map of Plan's MHM Education Programs .................................................................................... 9

Figure 12: Locations of MHM-related Knowledge and Education Programming ......................................... 9

Figure 13: Themes and Topics of MHM-related Knowledge and Education Programming ....................... 10

Figure 14: Targeted Audiences of MHM-related Knowledge and Education Programming ...................... 10

Figure 15: Map of Plan's stigma-related MHM programs .......................................................................... 11

Figure 16: Target of Programming Working to Address the Stigma and Taboos of Menstruation ............ 12

Figure 17: Targeted Audiences of Programming Working to Address Stigma and Taboos ........................ 12

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Key Point Summary Overall: The survey found that the majority of responding offices (94%, n=16) implemented

menstrual hygiene management (MHM) programming within the last five years.

Facilities: Most responding offices (94%, n=16) have adapted or constructed sanitation and hygiene facilities for MHM purposes, primarily in schools.

Supplies: The majority of responding offices (88%, n=15) seek to improve women and girls’ access to menstrual hygiene supplies, primarily reusable and disposable pads.

Knowledge and Education: Most responding offices (88%, n=15) work to increase knowledge and skills related to MHM, focusing on topics such as the menstrual cycle, reproductive health, and types of hygiene products.

Stigma and Taboos: The majority of responding offices (82%, n=14) implement activities to address the stigma and taboos associated with menstruation. These activities are primarily implemented in schools, and target a broad array of stakeholders including girls, women, teachers, boys, and men.

Other Topics: Plan’s MHM-related programming is supported by a variety of funders including sponsors and individual givers, corporate partners, and institutional donors. Half of the countries have MHM projects that include engagement with the private sector.

Future: All responding offices (100%, n=17) are interested in implementing MHM programming in the future.

Purpose MHM programming is widespread throughout the Plan Federation; however, there was no centralized understanding of the technical scope or geographic breadth of that programming. The purpose of this MHM survey was to gather data on the types of MHM programming that are being implemented within the Plan Federation. This survey was meant as a rapid review of who was doing what, where, and how within the Plan Federation. It is not a rigorous or exhaustive survey, and the results should be interpreted as such.

Methods This survey was created using Survey Monkey and disseminated through the Plan Federation WASH Network. Initial recipients were asked to forward the survey to other relevant Plan staff. Results were collected between August 9 and August 19, 2016. Seven survey responses with no country origin or contact information were discounted due to incompleteness. When responses were collected from more than one respondent from a single office, the responses were consolidated into one country response. All analysis was completed on a country basis, with 17 countries (out of 71) responding.

Respondents There were 30 complete responses from 17 offices across the Federation. Respondents represented six National Offices where Plan fundraises and 11 Country Offices across the regions where Plan implements its programs. The majority of respondents were from the Asia Region (ARO) and the Region of Eastern and Southern Africa (RESA):

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Region Office (# of respondents)

ARO Plan International Bangladesh (2) Plan International Cambodia (2) Plan International India (1) Plan International Indonesia (3) Plan International Nepal (3) Plan International Sri Lanka (1)

RESA Plan International Ethiopia (3) Plan International Malawi (1) Plan International Uganda (1) Plan International Zambia (2)

WARO Plan International Burkina Faso (1)

ROA No response

NO Plan International Australia (1) Plan International Canada (4) Plan International Germany (1) Plan International Netherlands (2) Plan International UK (1) Plan International USA (1)

Findings The survey found that the majority of responding offices (94%, n=16) have implemented MHM programming within the last five years. All responding offices (100%, n=17) reported interest in pursuing MHM programming in the future. These findings signal a general interest in MHM across the Federation. It is important to note that there may be issues of representativeness due to non-response error; however, the survey results still provide a snapshot of MHM work across the Federation.

Figure 1: Map of Plan’s MHM Programs

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The survey focused on MHM programming that seeks to address:

1) Access to MHM-appropriate sanitation and hygiene facilities including both the construction and adaptation of sanitation and hygiene facilities to accommodate girls’ needs, particularly those related to menstruation;

2) Access to menstrual hygiene supplies including programs that focus on improving the supply chain and availability of menstrual hygiene products in the local markets;

3) Access to MHM knowledge and education including programs that focus on providing information so that girls and women, and men and boys, understand what menstruation is and the variety of options for managing it; and

4) MHM-related stigma and taboos including programs that seek to address the underlying gender inequalities, misinformation, negative cultural practices, and culture of silence that surround menstruation in many places.

Of the responding offices that are implementing or have implemented MHM programs in the last five years: 100% (n=16) adapt or construct sanitation and hygiene facilities for MHM purposes; 94% (n=15) improve women’s and girls’ access to menstrual hygiene supplies; 94% (n=15) improve knowledge and education skills related to MHM; and 88% (n=14) address the stigma and taboos associated with menstruation.

Figure 2: Types of Programming Implemented by Offices

According to the survey results, the majority of responding Plan offices are implementing MHM programming across the four program domains. Given Plan’s strong history of facilities construction, particularly in schools, the frequency of facilities-based interventions is unsurprising. This focus on facilities is also in line with trends in MHM programming implemented by similar organizations throughout the development sector. In addition, the focus on knowledge and education programs is in line with the fact that Plan is known for its community-level behavior change work. Although 14 offices reported implementing activities to combat MHM-related stigma and taboos, it was the least prevalent type of programming; this area will likely become increasingly important as menstruation gains more attention internationally and within the Federation. Stigma-related programming is also the most complex as it requires changing deeply-rooted cultural beliefs and underlying gender inequality; however, it can be very impactful in improving the lives of girls and women.

Facilities Of the responding offices that are implementing or have implemented MHM programs in the last five years, all of them have adapted or constructed sanitation and hygiene facilities for MHM purposes.

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Facilities

Supplies

Knowledge and Education

Stigma and Taboos

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Figure 3: Map of Plan’s Facility-related MHM Programs

Of the respondents who reported implementing facility-related interventions, 100% (n=16) reported targeting schools, 63% (n=10) reported targeting communities, and 31% (n=5) reported targeting health centers. Given Plan’s focus on constructing (girl-friendly) facilities in schools through both education projects and WASH in Schools projects, the prevalence of school-based interventions is expected.

Figure 4: Type of Facility Adapted for MHM Purposes

During these interventions to adapt or construct MHM-friendly facilities, the most common aspects addressed were: access to water and/or handwashing in or near the facility (88%, n=14); ability to lock the latrine from the inside (75%, n=12); disposal (i.e. trash cans, trash chutes, etc.) (75%, n=12); and incineration (50%, n=8). There was a large degree of overlap in the responses to this question; all responding offices reported addressing more than one aspect. This is critical as girls may still struggle to manage their menstruation if any of these aspects are not addressed. In addition to the adaptations listed in the survey, respondents reported adapting facilities to include: a place to hang reusable menstrual pads to dry after washing; a burning chamber attached to the washroom; separate latrines for girls; addition of shelves and racks; construction of separate rooms for changing; and access to soap.

0% 20% 40% 60% 80% 100%

Schools

Communities

Health Centers

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Figure 5: Type of Adaptations Made to Make Facilities MHM-friendly

Examples of programs working to adapt or construct MHM-friendly facilities include:

In Ethiopia, through the Girls Empowerment Through Education project (2013-2016), Plan

renovated the sanitation facilities in eight schools to ensure that girls had access to girl-friendly

sanitation facilities with handwashing stations nearby.

The WASH in Schools Project in Zambia (2013-2015), which improved sanitation and hygiene

facilities at schools, benefitted 11,349 school girls.

In Zimbabwe, the Improving Community-Based Water Supply and Basic Sanitation Project

constructed or adapted girl-friendly sanitation facilities at five schools, including changing

rooms, handwashing stations, and incinerators for disposal of used menstrual hygiene products.

Supplies The majority of responding offices that are implementing or have implemented MHM programs in the last five years (94%, n=15) have programming that seeks to improve women and girls’ access to menstrual hygiene supplies.

Figure 6: Map of Plan’s Supply-related MHM Programs

0% 20% 40% 60% 80% 100%

Access to water and/or handwashing in…

Ability to lock the latrine from the inside

Disposal

Incineration

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In the responding offices that have supply programming, reusable pads (87%, n=13) are the most commonly targeted type of product, followed by disposable pads (60%, n=9). The prominence of reusable pads and disposable pads within Plan programming is in line with general trends within the MHM sector; however, it will be important for Plan offices to consider the sustainability implications of promoting disposable products. While disposable products offer a simple solution for MHM, their disposal can be problematic; the most common methods of disposal include throwing the product in the latrine (which can cause the latrine to fill up more quickly, or to become blocked); incineration or burning (which can release toxins into the air); and landfills (which causes landfills to fill up more quickly). No responding offices currently support the provision of menstrual cups; however, these products may become an interesting option for Plan to explore as – while they are not yet widely promoted – there is growing evidence supporting their acceptability in a number of contexts. In line with this, since the survey was conducted, some Plan offices have begun to explore opportunities related to the promotion of menstrual cups. In addition to the types of supplies mentioned in the survey, two offices reported targeting “other” supplies, which included menstruation hygiene kits in schools and locally-made products.

Figure 7: Types of Supplies Targeted

Of the types of products targeted for distribution through Plan’s programs, offices reported targeting handmade, local products (87%, n=13), followed by manufactured, local products (60%, n=9). Distribution of international products was less common, although still prevalent (47%, n=7). More than half of the offices (60%, n=9) engaged in supply work reported targeting more than one type of product. Relatedly, while 47% of responding offices reported promoting international products, only one office (7%) has targeted only international products; all of the other offices that target international products also target some type of local product. These results indicate that Plan is primarily focused on supporting the development of local products and local markets. Plan should consider the implications of promoting and distributing international products, such as whether this causes market crowd-out for locally-produced items that could create more sustainable access in the long-term, and whether the products are cost competitive and affordable for lower-income populations.

0% 20% 40% 60% 80% 100%

Reusable Pads

Disposable Pads

Tampons

Menstrual Cups

Other (Please specify)

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Figure 8: Origins of Products used in MHM Projects

Offices with supply-related programming used a variety of approaches for financing the MHM products. The most commonly reported approaches were partial subsidization (53%, n=8), and a no-subsidization approach (53%, n=8). 33% (n=5) of offices reported using a free distribution approach. Plan offices should consider the sustainability implications of partial subsidy and free distribution approaches to ensure that there is a plan for sustainable access to MHM products after project end. 33% (n=5) of the offices utilize multiple financing approaches for MHM products, indicating that even within one office, Plan is not applying a one-size-fits-all approach.

Figure 9: Types of Financing for MHM Products

Throughout the Federation, different offices utilize different approaches to partially subsidize the distribution of menstrual hygiene products; additionally, some programs have utilized varied approaches to distribution at different project stages. Some examples include:

In Uganda, Plan partnered with the social enterprise Afripads to provide handmade and manufactured local reusable pads. During the initial phase of the project, pads were subsidized: Plan paid half the cost of manufacturing, reducing the market price so that the end consumer paid half the price. However, this approach led to market distortion and decreased consumer willingness to pay full price for the Afripads products elsewhere. Because of this, Plan has eliminated the partial subsidy, although it has supported the manufacturer’s supply chain to minimize additional costs that would be passed onto the consumer. Plan has also continued to promote the Afripads products. In theory, as the number of pads being bought increases, the cost of production per pad will decrease, which will allow a reduction in the cost of the product.

In Ethiopia, Plan provides interested Village Savings and Loans (VSL) networks with training on the production and marketing of reusable pads, as well as business management skills. Trained VSL networks and associations also receive startup funds to purchase the required materials to begin producing and selling sanitary pads.

In Bangladesh, Plan provided seed funding to help establish “sani-marts,” including purchasing the materials needed to produce sanitary pads and stocking the marts with basic cleaning

0% 20% 40% 60% 80% 100%

Handmade, local product

Manufactured, local product

International product

0% 20% 40% 60% 80% 100%

Free Distribution

Partially Subsidized

No Subsidy Approach

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supplies such as soap and handwashing units. Each package of pads is currently being sold for BDT 40, or about USD 0.50.

Of the responding offices with supply-related programming, the majority focus on improving distribution of these supplies in schools (93%, n=14) and communities (60%, n=9). Given Plan’s focus on working in schools and communities, these results are not surprising; however, health centers may represent an area of opportunity for future interventions. In addition, throughout the Federation, menstrual hygiene products are being distributed through additional channels. Some examples include:

In Mangolpuri, India, Plan supported the sale of menstrual hygiene materials through a vending machine. The vending machine allows women and girls discreet and safe access to sanitary products at the affordable price of 5 INR, or about USD 0.07, for a pack of two pads.

In Malawi, Plan distributed disposable pads in Mulanje district during a massive flooding disaster in 2015 that displaced many people.

In Ethiopia, Plan sells products at health posts, through the VSL network of youth to schools, and through communities.

Figure 10: Locations where MHM products were distributed

In addition to supporting the distribution of supplies, 73% (n=11) of the offices implementing supply-related programming provided training on the production of menstrual hygiene materials. Examples of this type of programming include:

The Banking on Change project in India through which Plan supported the development of sanitary napkins production centers as a livelihood option for women’s groups. The sanitary napkins produced through this project reached 6,000 women.

In Uganda, school girls and teachers are taught how to make reusable pads.

In Malawi, mother groups are trained to make reusable pads.

In Zimbabwe, Plan provided schools with sewing machines and trained the matrons and patrons to make reusable pads.

These results show that Plan has strong experience integrating MHM programming and economic empowerment initiatives that provide livelihood opportunities, strengthen the local markets, and provide women and girls with much-needed access to menstrual hygiene supplies. This experience is an important differentiator for Plan as the sector moves to integrate MHM into sectors outside of WASH. It also may offer opportunities to access a broader range of funding opportunities, as the activities can be framed as women’s empowerment or economic empowerment initiatives as well as MHM.

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Schools

Communities

Health Centers

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Knowledge and Education The majority of responding Plan offices implementing MHM programs (94%, n=15) have activities that aim to increase knowledge and skills related to MHM.

Figure 11: Map of Plan's MHM Education Programs

Of the respondents who reported implementing these types of interventions, 94% (n=14) reported doing so in schools, 80% (n=12) reported doing so in communities, and 20% (n=3) reported doing so in health centers. Again, given Plan’s historical focus on schools and communities, this result is to be expected.

Figure 12: Locations of MHM-related Knowledge and Education Programming

Of the offices that reported implementing knowledge- and education-related interventions, the most common topics and themes were: understanding the menstrual cycle (100%, n=15); menstrual hygiene (87%, n=13); and reproductive health (80%, n=12). It is interesting to note that the topics related to health and biology are more commonly discussed than methods of managing menstruation. It is possible that this is because in many contexts there are fewer cultural barriers to discussing these topics than discussing the practical details of menstruation.

0% 20% 40% 60% 80% 100%

Schools

Communities

Health Centers

10

In addition to the topics listed in the survey, respondents reported providing education on other topics such as: myths and misconceptions related to menstruation; production of reusable pads using local materials; production, marketing, and management of menstrual hygiene-related businesses; linking MHM with early marriage issues; and sensitization of boys and men on MHM and other gender issues.

Figure 13: Themes and topics of MHM-related knowledge and education programming

During these interventions to increase menstrual health knowledge and skills, offices primarily targeted the following audiences: girls (93%, n=14); teachers (87%, n=13); women (80%, n=12); and boys (73%, n=11). In addition to the survey options, other audiences included local government officials and community health workers who can help reinforce important messages on MHM in schools and communities. While three offices (20%) targeted only girls with their education initiatives, the majority of offices targeted multiple audiences. Given Plan’s focus on MHM programming in schools, and that women and girls are most directly affected by MHM, it is to be expected that girls, teachers, and women are the most commonly targeted audiences. Additionally, the majority of responding Plan offices noted that they are targeting men (67%, n=10) and boys (73%, n=11).

Figure 14: Targeted Audiences of MHM-related Knowledge and Education Programming

Some key examples of Plan’s work to improve knowledge and skills related to MHM include:

The Astra Zeneca-funded Youth Health Program in India in which Plan developed a training curriculum consisting of five flip books, five technical documents, and five facilitator guides on the themes of: 1) health and wellbeing; 2) lifestyle education; 3) menstrual hygiene; 4) reproductive health; and 5) water and sanitation. The project also trained peer educators who were then responsible for reaching out to educate girls and boys in the target area. The project reached 40,000 girls and boys.

In Cambodia, through the Promoting Sexual and Reproductive Health and Rights project, Plan educated 15,000 youth, including 8,000 girls, on sexual and reproductive health topics such as menstruation and MHM.

0% 20% 40% 60% 80% 100%

Understanding the menstrual cycle

Reproductive health

Menstrual hygiene

Types of menstrual hygiene products

0% 20% 40% 60% 80% 100%

Girls

Women

Boys

Men

Teachers

Health Providers

Parents

11

To increase knowledge and skills related to MHM, the responding offices used a variety of tools and curricula, including school guides, technical manuals, WASH plans, facilitators’ manuals, government resources, and Plan manuals. These resources provide a critical foundation for the Federation as it pursues MHM programming in the future and should be catalogued and shared more broadly between offices so that they can be adapted and modified for new projects and contexts.

Stigma and Taboos Of the countries that have MHM programming, 88% (n=14) implement activities specifically to address the stigma and taboos associated with menstruation. Although fewer offices are implementing projects to address stigma than other aspects of MHM, Plan is still implementing a significant amount of stigma-related work.

Figure 15: Map of Plan's Stigma-related MHM Programs

Of the respondents who reported addressing stigma and taboos related to menstruation, 100% (n=14) reported doing so in schools, 79% (n=11) reported doing so in communities, and 21% (n=3) reported doing so in health centers. As with the other aspects of MHM programming, Plan’s focus on school- and community-based programming likely explains this targeting breakdown. In addition to the survey options, other reported targets were local government, including the government bureaus of Women and Children Affairs, Health, and Education; and CSOs such as the Women’s Association and Youth Association.

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Figure 16: Target of Programming Working to Address the Stigma and Taboos of Menstruation

During these interventions, the most commonly targeted audiences were: girls (93%, n=13); boys (86%, n=12); men (79%, n=11); teachers (86%, n=12); and parents (86%, n=12). In addition to the survey choices, other reported target audiences included government officials, village health workers, chiefs and village headmen, vendors of sanitary pads, and local traditional healers. All of the offices implementing stigma-related work are targeting multiple audiences with these activities. These results indicate that many Plan offices are already targeting a wide array of stakeholders with activities to reduce MHM-related stigma; this is critical for changing social norms and underlying cultural values and practices.

Figure 17: Targeted Audiences of Programming Working to Address Stigma and Taboos

The responding offices used a variety of approaches to address the stigma and taboos associated with menstrual hygiene, including the approaches detailed below.

Science, Education, and Information: Several offices addressed stigma and taboos using science, education, and information. In Malawi, Plan provided classes addressing stigmas and taboos. MHM projects in India provided children and their parents with scientific knowledge and helped dissect the stigmas, history, and faulty logic underpinning those stigmas. In Zambia, to remove the taboo, Plan educates and sensitizes school populations and surrounding communities concerning the importance of MHM.

Social Arts: Some offices used creative outlets to help address stigma and taboos related to menstruation. In Bangladesh, Plan used theater for development, folk songs, and group discussions to disseminate information about menstruation. In Uganda, Plan used community theater and dialogue to reach communities through simplified ways of learning and action planning.

Awareness-Raising: Several offices raised awareness to address stigma and taboos. Plan International Cambodia raised awareness about MHM to targeted audiences and proposed a call to action. Through support from Plan International UK, stigma was addressed in several

0.00% 20.00% 40.00% 60.00% 80.00% 100.00%

Girls

Women

Boys

0% 20% 40% 60% 80% 100%

Girls

Women

Boys

Men

Teachers

Health Providers

Parents

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countries using in-school fairs and awareness-raising days, and a MHM board game developed by the country offices.

Training: Some offices addressed stigma and taboos through training programs. For example, in Ethiopia, school girls and boys participated in a training of trainers on MHM stigma and taboos; they were then encouraged to discuss their topics with the parents and community elders to disseminate the learning. Teachers, government staff, and CSOs were also trained as trainers so they would be prepared to support the girls and boys. To further target youth populations, the VSL youth networks were trained to promote community dialogues about menstruation through VSLA groups.

Menstrual Hygiene Day: A few offices used Menstrual Hygiene Day (May 28) to help address the stigma and taboos of menstruation. In Bangladesh, this included community awareness, individual counseling, celebrating days related to menstrual hygiene, peer sessions, and peer parenting sessions. Through Plan International Canada, targeted groups were engaged on MHM issues including celebrating Menstrual Hygiene Day. Similarly, around Menstrual Hygiene Day, Plan International USA conducted a series of activities to raise awareness about the importance of and challenges regarding MHM.

Funding for MHM programming Fifteen (94%) offices provided information on the sources of funding for MHM-related programming. As with most of Plan’s programming, offices reported a range of funding sources including sponsors and individual donors, corporate partners, and multilateral and bilateral donors. These reports confirm that a range of donors are interested in and are providing funding for MHM programming.

Private Sector Involvement Only 56% (n=9) of offices have MHM projects involving the private sector. Plan’s engagement with the

private sector primarily falls into two categories: 1) private sector involvement in the supply chain or

product line through partnership arrangements with social enterprises, provision of technical support,

and input into youth associations and VSL; and 2) private sector corporate social responsibility (CSR)

funding.

Some key examples of private sector involvement from within the Federation include:

In Bangladesh, Plan provided technical support and small-scale initial capital for a factory that

produces sanitary napkins.

In Uganda, Plan partners with social enterprise Afripads to support the distribution and sale of their

reusable pad products. Afripads is responsible for marketing and establishing the distribution

network for their product, while Plan helps to generate demand for the product.

In Ethiopia, Plan partnered with social enterprise BeGirl to product test the effectiveness of BeGirl’s

reusable pad and period panty products. Building on the results of this pilot, Plan and BeGirl are

continuing their partnership to bring the BeGirlPanty to 5,000 more girls in Ethiopia as part of a

comprehensive education program.

In Ethiopia, Plan supported the training of a youth association to produce reusable sanitary pads by

providing education, sewing machines, and technical follow-up.

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Some key examples of private sector CSR funding from within the Federation include:

The Barclays-funded Banking on Change project in India through which Plan supported the

development of sanitary napkin production units. Plan trained women in the production and

entrepreneurial skills necessary to develop and maintain MHM businesses.

In India, Procter & Gamble supported a campaign to improve knowledge, attitudes, and practices of 20,000 adolescent girls on reproductive health and menstrual hygiene. In addition to the trainings, the girls received a complimentary pack of sanitary napkins.

Key Results and Implications The results of this survey have confirmed that Plan is a high-performing NGO in terms of the

breadth, scope, and depth of our MHM programming footprint; based on our analysis of the market,

we believe that Plan compares very well to the footprint of our competitors in this space.

The adaptation or construction of MHM-appropriate facilities is the most prevalent type of MHM

programming throughout the Federation. This is likely due to the fact that until recent years, the

adaptation and construction of sanitation and hygiene facilities was the hallmark of Plan’s WASH

work. In addition, this type of facilities-related work can be easily incorporated into larger education

or WASH programs that may not necessarily have an explicit MHM focus.

Plan has a strong base of MHM programming to build upon for future funding and programming

opportunities. There is an extensive variety of tools, curricula, and methodologies being used within

the Federation that could be replicated or adapted for future programs.

As a Federation, Plan needs to proactively share MHM-related program designs, challenges, tools, and lessons learned to promote learning and improve impact.