Abstract
BACKGROUND: Recognizing the importance of menstrual health and hygiene, governments worldwide, including India, are working towards improving awareness, infrastructure and access to essential products and services. Odisha's state-led "Khushi" programme, launched in 2018, is one such initiative providing free sanitary napkins to schoolgirls in government and government-aided schools to improve menstrual hygiene and reduce dropouts. Our study aims to explore the perspectives and barriers in the implementation of the Khushi programme in Odisha. METHODOLOGY: This paper emanates from a larger study on menstrual health in Odisha, conducted from September 2021 to December 2022, focussing on qualitative insights into the implementation challenges of the Khushi programme. It examines stakeholder perspectives through in-depth interviews with key officials from health and education departments and focus group discussions with schoolgirls. In addition, relevant programme documents and government policies were reviewed. RESULTS: Our study findings related to the systemic bottlenecks in the implementation of the Khushi programme have been summarized under key thematic domains: (1) approach to micro-planning; (2) interdepartmental convergence; (3) indenting and supply chain; (4) capacity building; and (5) monitoring and supervision. This study underscores the importance of designing and implementing a comprehensive behaviour-change strategy that should capitalize on the existing collaboration between the health and education departments, while addressing identified weaknesses. CONCLUSIONS: The Khushi programme has the potential to bring about a paradigm shift in menstrual health behaviour among schoolgirls. To maximize its impact, the government may adopt a comprehensive strategy, including strengthening menstrual-hygiene-compliant school infrastructure, providing education and sensitization for both implementers and beneficiaries, and integrating environment-friendly menstrual hygiene products in the programme.