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Example 1: Sexual Abuse Nurse Examiners Program

Tulsa, Oklahoma

In Tulsa, the Sexual Abuse Nurse Examiners Program, a national program, has been recognized by the Ford Foundation and Kennedy School of Government for its innovation and effectiveness. The program, which brings together police, forensic nurses, and health and legal agencies to provide fast and humane treatment to victims, has worked to treat over 500 sexual assault victims. Victims are examined in a peaceful area of the hospital, warmly decorated in a homelike manner to provide a supportive, welcoming environment. Tulsa police officials have found the program to be effective in improving the quality of forensic evidence, and they've been able to increase the rate of convictions because victims are more willing to undergo the examinations.

We spoke with Kathy Bell, SANE coordinator for Tulsa, about how the program has managed to attract support from the many agencies and offices involved.

CTB: Can you tell me a little bit about how the SANE program got started?

Bell: What was happening here in Tulsa is that rape victims went to any one of the five hospital emergency departments. Law enforcement came out, and then they sat and waited their turn. A lot of rape victims (gave up and) went away. The people that actually did do the exams hadn't been trained in evidence collection. So there were just a lot of frustrating situations for everybody involved--the victim, the advocacy program, law enforcement, and prosecutor's office.

So we developed a task force and started doing some problem identification and problem solving. In the course of that, we found out about some nurse examiner programs that were out there, in places like Memphis, Amarillo, and Minneapolis. We got information from them, and then took the things that made sense for this community. Then we got a group of nurses together--there were thirty that were originally trained--and then developed a training program. The task force had met for about a year, up to a year and a half. And then they started doing exams in July of 1991.

They started with about 15 or 16 nurses that had been trained. One of the main issues that came up early on was a site to do the exams. They had been being done in all of the hospitals. We originally decided that they weren't even going to do the exams in a hospital; they were going to do them outside the hospital at the College of Medicine. But about two weeks before we were going to start, the College of Medicine backed out as a site for the exams for security reasons. They're not a 24 hour facility, and I think they hadn't really thought through that the exams aren't all done Monday through Friday during business hours. It's evenings, nights and weekends, holidays--times when people aren't around. So they were trying to figure out something else because the ER is not an appropriate spot for rape victims. With that, the mayor got involved and pulled together all the powers that be within the different organizations : law enforcement, prosecutor's office, health department, all the hospitals, victims advocacy programs, etc. Various community leaders then just volunteered the things that the program needed to go. the CEO of Hillcrest Medical Center volunteered their building as a site for the exams. So then we got it set up, and they started doing exams on July 1, just like they had originally planned.

CTB: Wow. So it was this task force that you mentioned earlier that really started the ball rolling on getting all of these groups together?

Bell: Yes. And it primarily was led by the police department and the advocacy program. It was a joint push there to develop the task force and get everybody to sit down at the table.

CTB: So how do you keep all of these different pieces involved now that the program is going? What kind of things do you have to do to maintain those relationships ?

Bell: Just mainly open communication with them. You know, we're going to be working hand in hand with each one on a very regular basis. The nurses are in the exam room with law enforcement and with the advocacy program every time we do an exam. We interact with the health department each time that we refer someone to them for STD follow-up. Every time we do an exam we interact with law enforcement. And then the law enforcement, the prosecutor's office, and our examiners interact in the filing of the charges. Ongoing, constant communication is the key. We have regular meetings every other month. We've asked the defense attorneys to come participate in our training and they don't want to do that, but we don't see ourselves as a prosecutor's witness only. That's how the defense sees us. I also have a monthly newsletter that goes out to all of these people plus a lot of other people. There are 65 people on my mailing list that regularly get communication from me. Those are probably the main ways.

CTB: So, aside from the groups that are immediately involved, what other groups or persons do you look at as being really important to keep interested in supporting for the program?

Bell: I would say maybe not necessarily any group, per say, but maybe just the community as a whole. And they're going to do that with educational programs out in the community, whether Call Rape (the local victims' advocacy group) is presenting them, whether the police department is presenting them, whether the nurses are presenting them. We get some media attention with that.

CTB: It sounds like a very effective program, and a perfect example of bringing together people from a bunch of different segments of the community and putting together a really effective program.

Bell: Right. And what makes it work is the respect each group will have for the other groups. We each have our role, and even though the roles may overlap a little bit, we each have our own distinct piece of the pie. For example, I'm not going to step in and do the investigation because that's law enforcement's role. It's my role to provide medical treatment. I'm not going to try the case; the prosecutor's office is going to do that. And so we have to respect the other groups involved and know that they're going to take the ball when it gets to them and they're going to carry it until it moves to the next person.


Example 2: Gaining Support for Specific Programs: The Sanitary Towels and Undergarments Program for Disadvantaged Young Women in Kiambu County, Kenya, by Fountain of Hope Youth Initiative

Sarah Mintz, who brought a donation to the program, with James Waruiru, project manager of Fountain of Hope Community Initiative.



The Sanitary Towels and Undergarment Program for Disadvantaged Young Women was established, rather inadvertently, by James Waruiru and Grace Mutura, and is now coordinated by Polly Kamau and Penina Muthoni.

One afternoon in 2007 while the team was handing out food donations to needy households, a poor single mother brought her daughter to the center for counseling. The daughter had bled through a rag she utilized as a makeshift sanitary pad. The menstrual blood saturated her dress, showing an embarrassing red stain. This made her peers laugh and ridicule her, which was traumatizing. She vowed never to return to that school with no desire to place herself in an environment where she faced shame and scorn from her classmates, both boys and girls.

Through the Fountain of Hope Youth Initiative (FOHYI), which was founded to respond to the psychosocial needs of families affected by or infected with HIV/AIDS, the team counselled the girl and bought her a single packet of sanitary pads. The following month she turned up again and the team contributed about half a dollar to buy her another packet. On the third month she showed up with five friends, all in the same predicament, suffering in silence. This is how the program was born.

FOHYI needed to gather more information to better understand the issue and respond appropriately. A study was conducted by reviewing published reports from humanitarian agencies and compiled citations that offered brief but concise information on the problem.

Problem Statement

Significant barriers to high-quality menstrual hygiene management (MHM) persist across Kenya and remain a challenge for low-income women and girls. Research shows they face monthly hardships, with 65% unable to afford sanitary pads. Only 50% openly discuss menstruation at home. Just 32% of rural schools have a private place for changing menstrual products, and only 12% of young women and girls are comfortable receiving related information from their mother. More jarring statistics signal that menstruation is tied to fundamental risks and issues of gender inequality, with studies showing two out of three users of pads in rural Kenya receive them from sexual partners and one in four girls do not associate menstruation with pregnancy. (Reference: Menstrual Health in Kenya|Country Landscape Analysis

According to a 2007 UNICEF report, a girl in primary school between grades six and eight (three years) loses approximately 18 weeks out of 108 school weeks due to her menstrual period. A girl in high school (four years) loses 156 learning days, which is equivalent to almost 24 weeks out of 144. Most impoverished women use dirty pieces of rags, cotton or wool, leaves, and paper as improvised menstrual napkins. This unsanitary and degrading practice exposes women to a number of diseases, including bacterial vaginosis and yeast infections. It also brings discomfort and lowers self-esteem.

Current Menstrual Hygiene Management

Menstrual Hygiene has remained a taboo subject, stigmatized even among practical engineering circles that are accustomed to dealing with unmentionables such as excreta. Women and girls make up 50% or more of the users of Water, Sanitation, and Hygiene (WASH) services, which seem to ignore the needs of half the population that menstruate on an average of 3,000 days over their lifetime. These are basic needs regarding water, space for washing, personal cleaning, menstrual materials, and facilities for the proper disposal of used materials.  Women need to be able to manage this biological function with safety and dignity. – Reference: Preparatory Input on MHM for End Group by Archana Patkar, Year 2001

WHO/UNICEF Joint Monitoring Program for Water Supply & Sanitation -

Beneficiaries of the sanitary towels program.


Why try to attract support for specific programs instead of the whole initiative?

To make a program permanent

By examining how this program was started, we see that a fundamental need drove the FOHYI team to respond. The team was passionate about helping disadvantaged girls stay in school during their menstrual periods, but the organization struggled with raising funds for a program while the number of those in need kept increasing. The anticipated funds from the government and local corporations was not forthcoming, and the risk of closure was inevitable. The team needed to find other means of support for this project to ensure sustainability.

In order to achieve that goal, they sought support from the following groups and organizations:

Women’s Groups

They spoke to women’s church groups and urged members to consider buying just one extra sanitary pad each month to donate to the project. Many found this easy, so the donations started to trickle in. Before long the project was collecting enough supplies to keep a number of girls in school. The project now enjoys the solid support of volunteers who serve in the distribution of supplies while educating girls on hygiene, sexuality, Christian purity, abortion, and career mentorship. These services are free, provided by the women who support the project. It has greatly relieved financial strain, allowing the small funds that are collected to pay off fiscal debts for the program.

School Leaders, Guidance Counselors, and Teachers

School leaders, guidance counselors, and teachers have all helped in the selection of program beneficiaries. Because of a very tight budget, it’s important to ensure that the neediest recipients, who would most likely stay at home during their periods, are the ones first served.

Schools and Churches

During distribution and training, church and school halls were used for meetings. These spaces were donated by the community, equipped with chairs, tables, and projectors, which offered a fitting environment for learning.

Transport by Expat-to-Expat

The significant growth of this program can be attributed to the generous support from Expat-to Expat, a company owned by a Dutch business man based in Nairobi, Kenya. Expat-to-Expat focuses on helping expatriates settle in Nairobi. For years, with its fleet of cars, the company has provided reliable assistance whenever the program needs to transport supplies and volunteers for its activities.

Photo of program volunteer Mrs Wambui Kigoiyo providing reproductive heath and hygiene education.
Program volunteer Mrs. Wambui Kigoiyo provides reproductive health and hygiene education.

Support from Unlikely Sources

Menstrual Supplies Donated from Post-Menstruating Women.

The program has sparked the interest of older, post-menopausal women who donate to the project as a show of solidarity and support. This has become a morale booster for the team and a competitive challenge for menstruating women in the churches to offer their support to the program.

Former Beneficiaries as Program Ambassadors

To ensure sustainability of the program, former beneficiaries are recruited to become ambassadors after they have completed school or after marriage to return and offer support by either fundraising or volunteering. Currently a number of young women offer assistance during distribution as a show of gratitude to the program. This has greatly lessened the workload of the program team.


Making a Limited-Time Program Last Longer

A year after inception, the number of beneficiaries keeps increasing. What started as a one-off helping one girl has given birth to a program commanding attention and sustainability. The impact has been phenomenal. Many teachers attest that academic performance has improved for girls who missed school during their periods, prior to the program. They have noted more engagement in extracurricular activities as well.

Because this program is not dependent on a single source of support, there are increased survival possibilities. Diverse contributors make sustainability a reality. There is also increased local ownership of the project, and every stakeholder feels obligated to keep this program going.


Raising Support for the Whole Organization

When FOHYI began this sanitary towels program, the organization had no idea it would grow in terms of impact and popularity, more than any other programs run by the organization. It has won a number of accolades including second place in 2010’s Out of the Box Prize competition run by the Community Tool Box. Proceeds raised through this project have gone a far to ensure sustainability of other programs run by the organization.

As a result of the sanitary towels program, FOHYI has been featured in print and electronic media. The praise and recognition it receives has helped the organization gain much-needed publicity and support mobilization.



When designing a project it is advisable to have a wide resource mobilization strategy. A project can be shut down if it depends on a single donor as its source of support. Diverse contributors make sustainability a reality. When you increase local ownership of a project, every stakeholder feels obligated to keep the program going.


Contributed by James Waruiru, founder of Fountain of Hope Life Centre, 2016 Community Solutions Program Leader, and Intern with the Community Tool Box.