Skip to content


Evaluating Menstrual Hygiene and Health Development Impact in Ethiopia

We are carrying out an impact evaluation of the french Development Agency's Menstrual Hygiene and Health Development Impact Bond in Ethiopia to verify impact and build the global evidence base on Menstrual Health Hygiene programming.


The challenge

Although Menstrual Hygiene and Health (MHH) can have a substantial impact on girls and women living in the developing world, the area remains overlooked and underfunded. To build up the evidence around MHH and to mobilise private funding, the Agence Française de Développement (AFD) and CARE have developed a pilot programme that uses a Development Impact Bond (DIB) to fund the implementation of an MHH programme in Adama in the Oromia region of Ethiopia.

The programme comprises three integrated pillars of intervention:

  • Awareness-raising and advocacy activities to improve MHH knowledge among communities, change beliefs about menstruation and create demand for products;
  • Production and distribution activities to strengthen the local supply of a variety of MHH products that meet different needs; and
  • Water and sanitation infrastructure activities to improve the access to, and utilisation of, MHH-friendly, sustainable facilities in schools, with a focus on women and girls.

Overall, the programme aims to promote gender equality by encouraging the adoption of MHH practices and the change of beliefs related to menstruation among girls of school age and their communities to empower girls and women.

Our role

Itad, together with Stats4SD and JaRco, have been appointed by AFD to carry out an impact evaluation of this DIB to fulfil two purposes:

  • provide robust data to verify that pre-defined social outcomes have been achieved which will enable AFD to repay social investors; and
  • to collect additional, relevant data on eight knowledge indicators (e.g. increased self-confidence or self-efficacy of women and girls), thereby making a substantial contribution to the evolving knowledge base on how to improve girls’ and womens’ self-confidence, understanding and self-management related to MHH in Ethiopia and globally.

Our approach

Our impact evaluation approach is based on a quasi-experimental design anchored in the difference-in-difference method. To ensure a focus on outcomes related to gender equality as opposed to sector-specific impacts, Itad’s impact evaluation examines specific outcome indicators assumed to lead to the empowerment of women and the reduction of gender equalities.

These include increased self-confidence of women and girls, reduced absence at work/school and increased participation, improved community perceptions about MHH, reduced urinary/vaginal infections and improved affordability of MHH products.

Team members
Callum Taylor