Scaling an Effective Menstrual Hygiene Program in Madagascar

Through a randomized controlled trial in 140 Madagascan schools, we partnered with CARE to show that a comprehensive hygiene and menstrual health program significantly improved girls' learning outcomes (+0.15 SD increase). The program combined Young Girl Leaders who combated menstrual stigma and spread healthy hygiene behaviors among peers, with sanitation infrastructure, teacher training on hygiene, and distributing sanitary pads. The program had effects through psychosocial channels, including by reducing stress and bullying and improving motivation and social connections between students. Building on this evidence, Madagascar's Ministry of Education has expressed strong interest in scaling the intervention to 2,000 secondary schools across the country's 16 poorest regions, financed as part of a 180m World Bank project. The scaled program will reach approximately 712,000 students between 2025-2030. CARE would work with local NGO partners to deliver the program’s soft components using a cascade training model to maintain program fidelity. The implementation and coordination of the construction of infrastructure remains to be decided. Our proposal seeks to ensure effective scale-up through: (i) diagnostic research across roll-out regions to inform program adaptation for diverse cultural and socioeconomic contexts; (ii) comprehensive monitoring of implementation fidelity across all regions; and possibly (iii) embedding a JPAL technical staff member within the Ministry to coordinate and oversee adaptation and monitoring.