The Now Exchange

The Now Exchange is an organization committed to increasing health access and choice for women in the garment sector. It will use garment factory clinics as a channel to distribute women’s health services. This entails:

-Strengthening the clinic health system by further training health workers (typically nurses);

-Providing free access to women’s health services, currently focusing on menstrual hygiene management and contraceptives.

TNE is particularly focused on amplifying the use of proven, scalable family planning options with long-term success rates (i.e. Sayana Press). It is currently building out its strategy and consulting relevant experts for a menstrual hygiene management program rollout in early 2020.

TNE’s effort is well-aligned with the government’s 2020 commitment to bolstering family planning services in RMG factories- signaling the urgency and relevance of this model to improve health services and outcomes for the 3 million women working in this sector.

15% of all women in Bangladesh (between 16-30) work in the garment sector (approximately 3 million total). Nationally, 17% of married women in Bangladesh have unmet contraceptive needs. In the Gazipur region (selected for pilot due to its high density of garment factories, the rate is 22.4%. A Matlab family planning analysis showed that a variety of family planning options is an important influencer of overall contraceptive use.

Factories with 300+ employees are required to have on-site health clinics. Studies by BSR indicate that most factories have zero (or extremely minimal) women's health services, including family planning (due to limited time from long working hours) and menstrual hygiene management. Lack of access to these services have impacts on: women's short and long-term health, economic outcomes and mobility, and social structures and expectations. 

As EngenderHealth noted in a Bangladeshi women's health pilot, workers without sufficient access to family planning are more likely to take maternal leave for an unwanted pregnancy, face health complications, or leave work entirely. Improved women's health in the sector is advantageous for all stakeholders: workers with improved knowledge will create a stable, healthy workforce for factories that will allow women to freely make decisions around work and motherhood.

TNE will partner directly with factories and tailor its solutions to the needs and wants of that factory's employees. In each factory TNE partners with, it will consult the factory management on their self-identified gaps and existing strengths. It will additionally engage factory staff (predominantly women, but including men, given their role in decision making) on conversations around family planning and menstrual hygiene, and open a line of communication in which they can surface other topics that are important to them.

TNE's first partnership is with a factory in Sreepur (Gazipur District) of approximately 1,000 employees. The Now Exchange has already hosted a series of conversations, surveying 10% of the factory, to better understand their needs and wants as it pertains to health services. The outcome from our initial engagement indicated that menstrual hygiene management services are both a need and want expressed by workers, as well as contraceptive education. TNE learned a contraceptive access rollout would need to be accompanied by a workshop, and TNE is adjusting its programs for the coming year accordingly based on their feedback.

TNE will train health workers and fund health supplies in employment-based clinics. TNE will first secure garment factory partnerships in which they will agree to have their clinic health workers participate in a baseline data collection survey that informs TNE of the workers’ health needs and wants. Secondly, TNE will secure the health supplies that correspond to the demands of workers; TNE is particularly focused on amplifying the use of proven, scalable options - specifically contraceptives with long-term success rates in mitigating drop-out rates, such as the Sayana Press. It will also provide cross-gender educational services directly to garment workers to ensure that solutions are accompanied by opportunities to ask questions and receive health knowledge regardless of service uptake. Thirdly, TNE will ensure clinic staff is trained to provide these services and eventually become a central hub for women’s health needs. Lastly, TNE will collect feedback from clinics about health supply needs & distribution and implementation challenges, tailoring offerings and training methodologies accordingly.

TNE fundamentally seeks to redefine the exchange between workers who make goods and retailers who profit. TNE is advocating for corporate investment into the health of its workers, creating social good for better business. This broader goal will be reflected in TNE's long-term partnership and funding strategy, which will target retailers that are involved in the same supply chains as the factories that TNE is working with.

We intend to scale the short-term impact: increased access to services and the provision of clinic health worker training, to longer-term impact: a replicable way for retailers to invest in health services for workers in their supply chain. Ultimately, TNE aims to complement stakeholders in creating an environment where women have more decision making power around their economic goals. TNE would like to include economic impact (i.e. reduced absenteeism, worker productivity) in their measurement strategy and seeks advisory from MIT Solve/Tiger IT Foundation on accurate and feasible ways of doing this.

We are utilizing and strengthening an existing channel (the garment factory health clinic) to reach garment workers and address their health needs in a way that does not exacerbate existing time and economic constraints. NGOs and the Government of Bangladesh are already doing critical work around health services, particularly family planning; however, there are still documented gaps in health service uptake (remaining unmet contraceptive need and menstrual hygiene management). TNE is innovative because it is harnessing a ubiquitous, legally mandated, but under resourced channel (garment factory clinics) and strengthening it to meet the needs of the primary demographic that drives the Bangladeshi garment industry. It is also plans to use a peer education model for workshops, which has the potential to be effective in disseminating information around sensitive health topics (especially when literacy is a challenge). 

TNE is complementing and strengthening existing stakeholders by focusing a) on the health service points that most directly interact with workers and b) ensuring that services offered and education provided are worker-centered. This constructs a model that can be replicated across different clinics while still taking into account the nuanced needs and wants of individuals within each garment factory. The innovation of TNE lies in the scaling potential and distribution model, which in turn will feed its funding/partnership strategy (to include retail partners as investors in the health of workers).

TNE's Theory of Change identifies three problems: 

• An unmet need and desire for improved women's health in the RMG sector (contraceptives, menstrual hygiene management, pregnancy information, gender-based violence response, mental health)
• Under-trained and under-resourced health workers
• Workers have logistical constraints regarding access to health care due to long working hours

 TNE's solution includes:

•  Increased access to services
• Training for clinic health workers
• Information about health services available through both TNE and other health services in their vicinity

TNE's activities includes: 

• Provision and distribution of health supplies (i.e. contraceptives, pads)
• Education and workshops to accompany health services (i.e. contraceptive education workshops, menstrual cloth hygiene education); plans to incorporate a peer-to-peer model    
• Training for health trainers (best practices and injection, handling questions around family planning)

The intended outputs include: 

• Decrease dropout rates, increase adherence to health services of workers' choice
• Increase informed decision-making around and beyond family planning
• Increase awareness/knowledge of rights to healthcare, types of health services available, best practices and risks
• Increase sites where workers can receive discrete and safe information and services around their health

The long-term intended outcomes of these programs are to:

• Enable realization of sexual and reproductive health rights
• Decrease unwanted pregnancies, and enable women who want to work longer to do so
• Create new spaces for self advocacy and conversations around well-being
• Build new accountability for retailers (i.e. measuring their commitment to worker health)
• Strengthen clinic's ability to respond to health needs

With additional funding, TNE can be increasingly ambitious with the size of factories it targets for partnership. The following metrics are using moderate assumptions about factory sizes based on research/relationships that have been explored thus far. Generally, larger factories will have a slightly higher number of nurses on site; the 1 year and 5 year projections include larger factories, which would be feasible with additional funding. This funding would not only allow TNE to work with more health workers and garment workers, but also scale operations/staffing to provide increased, high-quality services.

Health Workers Trained

Current: 1 clinic = 2 health workers

1 Year: 3 clinics (assuming 4 health workers avg.) = 12 health workers

5 Years: 15 clinics x ~5 health workers avg.) = 75 to be trained

Garment Workers Reached

Current: 1000 workers (~800 women)

1 Year: 3 clinics x 2,000 workers = 6,000 workers

5 Years: 15 clinics x 3,000 workers = 45,000 workers to be reached

In the next year, TNE aims to see a measurable increase in knowledge and changed attitudes related to good health practices among women in the factory. This includes increased knowledge around various family planning options (for men and women), menstrual hygiene management practices, and other areas of knowledge that workers themselves hope to expand on. TNE has no intention to pressure workers to uptake a particular service. Rather, TNE will provide resources with the information necessary to make more informed choices throughout their lives, creating a lasting impact. TNE aims to diversify the health services currently offered (i.e. uptake of pads, condoms, contraceptives, gender-based violence education etc.). In the next year, TNE will deliver menstrual hygiene products and contraceptives (starting with condoms) based on demand from the first partnered factory. TNE will also measure user satisfaction around these services and the accompanying workshops.

In the next five years, TNE aims to expand its services to more factories. By that point, TNE plans to scale the repeatable aspects of its service model (health training, service provision) while embodying a human-centered design approach in which the needs/wants of garment workers will preempt any services that are implemented. At that point, every factory should have programs that look slightly different, based on factory worker wants, management dynamics and preferences, etc. Also at the 5 year mark, TNE will have reached out to retail companies with the goal of acquiring their sponsorship for future expansion (detailed in financial sustainability model). TNE hopes to implement its first retailer-sponsored factory expansion by year 4.

One barrier TNE has started to face - and anticipates in the future - is around running effective workshops during working hours. It is difficult to get the full enthusiasm and participation of factory managers, who are concerned about workers losing too much time to outside programming. TNE also anticipates challenges around ensuring adequate stock of health supplies. In the long term, TNE Is concerned about data collection processes; it aims for clinic health workers to maintain data points around women's health needs and questions, but that plan has not been finalized and is contingent on their interest and bandwidth to do that.

Another barrier for TNE is around hiring (identifying relevant talent). This coincides with the legal barrier around NGO registration and TNE's ability to hire and pay employees.

Cultural barriers include some shyness and hesitation around particular conversations, such as menstrual hygiene, gender-based violence, and other somewhat taboo topics.

TNE will clearly communicate with factory owners and managers ahead of implementation and when discussing partnership, to ensure everyone's awareness of the time/efforts required for workshops. TNE's offerings are free for factories specifically to offset the burden of time taken from workers, and it's committed to making sure workshops are concise and cognizant of workers' schedule and commitments. 

Around the data collection and health supply measurement barrier, TNE is exploring financial incentives for clinic health workers to compensate them for the additional work of tracking these items. TNE is also exploring the role peer educators can play in this process.

 TNE has begun engaging lawyers in Dhaka around the NGO registration process, and has consulted NGOs that already have registration; partnership rather than registration appears to be a more viable route for TNE's operations in Bangladesh.

We are addressing the hiring barrier by building local contacts, and are excited to have brought on our first volunteer that we hope to eventually hire contingent on funding and legal next steps. We are also engaging with Farah's (CEO) family members and network in Dhaka to find individuals with relevant connections.

TNE is ensuring its team puts any workshop curriculum through a rigorous sensitivity review, and is utilizing existing and tested materials (TNE adapted materials from a well-developed curriculum from the NGO HerHealth). TNE will continuously seek information about how workers are receiving/responding to services and adjust accordingly. TNE is also committed to seeking discrete, respectful ways of distributing services and having conversations.

The Now Exchange has not fully rolled out its services, but has engaged a factory partner in Sreepur, Gazipur where it conducted an initial workshop and survey to understand what services/education would be most desired and needed. This engagement received a 5/5 approval rating, accompanied by a request for future services directly from garment workers. When asked which subjects they would like further education on, 28% of surveyed workers requested family planning workshops; 21.3% for menstrual hygiene management and 20.7% for STI and sexual health information. When asked which services they would like to see, there was an equal demand for menstrual products and condoms (27.3% for each). TNE will be meeting their top demands in the coming year, and is currently in the process of securing supplies, developing education materials, and planning forthcoming travel, exploring legal next steps, hiring, etc.

2 FTE (Co-Founders)

1 Volunteer

Farah Momen is CEO & co-founder of TNE overseeing business strategy, operations and development. She is currently studying Business for Social Impact and Human Security at The Fletcher School of Law and Diplomacy, where she is also on the leadership team of the Design Thinking Group. She is uniquely positioned to deliver on the TNE's mission due to her previous work advising start-ups and and leading funding competitions for entrepreneurs. She has a strong base in fundraising, program management, and building relationships with corporate partnerships through her experience working at MaRS Discovery District, one of North America's largest innovation hubs. She is also Bangladeshi American, and has a strong network of family members involved in the garment sector and pharmaceutical industries in Dhaka, Bangladesh. Further, she is very comfortable with the cultural and linguistic dynamics that come with this project due to her background. 

Farah has known Giulia Bova (the other co-founder) for ten years, since they studied together at McGill University. Giulia oversees the health access and educational and training initiatives of TNE. She is well-positioned to deliver women's health solutions due to her experiences in education, training, and reproductive health. Giulia has five years of teaching experience and curriculum development, and she served as a Peace Corps Volunteer in Rwanda, where she spearheaded local health and education initiatives, such as a gender equality/youth leadership camp, teacher trainings, and malaria workshops. She is currently an M.A. candidate at the Korbel School of International Studies, focusing in global health affairs.  

We are utilizing the HERHealth curriculum developed by Business for Social Responsibility to implement effective MHM, family planning, and sexual health workshops. We started using these resources after conversations and  approval from BSR. We have an idea-sharing partnership with the Good Business Lab (an innovation start-up in India) due to the similar work that they are doing with women's health initiatives in the labor force. In particular, we are working with their program staff to share best practices around effective MHM implementation activities. 

We currently have ongoing conversations with the Urban Development program under BRAC in Dhaka because we are exploring successful distribution models (i.e. through their One Stop Service Center model). We also aim to collaborate with BRAC through idea-sharing around women's health workshops and deliverables in garment factory clinics. We visited their facilities and met with their program staff when we visited Dhaka in July of 2019. 

Lastly, we met with a local chapter of Rotary International in Dhaka in July of 2019, which has opened up conversations for a potential partnership in the future.

TNE's primary beneficiaries are:

• RMG Factory Workers: they receive services via improved and increased health supplies, TNE workshops, and more equipped health clinics
• RMG Factory Owners: they receive free education for their health workers and factory staff, which in turn creates a healthier, less absent, more engaged workforce
• RMG Clinic Health Workers: they receive increased training, equipping them better for their jobs in the factory and future employment; this enforces stronger relationships between them and factory workers. TNE is exploring financial compensation for a) any increase in labor expected of them and b) increased engagement from nurses/doctors around TNE's mission

TNE's secondary beneficiaries are:

• Suppliers: this is a simple exchange of goods (contraceptives, pads, etc.) and money
• Donors: TNE creates impact for its donors in exchange for funding
• NGOs: TNE is eager to share information and approaches, amplifying the work of existing NGOs and replicating existing successes

TNE's long term beneficiaries are private sector retailers, who TNE will engage for their CSR sponsorship to benefit workers in their supply chains. They benefit from improved health conditions in factories they engage with, and likely the fulfillment of their own CSR goals.

TNE is currently funded via grants, and it can ensure sustainability through cautious engagement of a) factory partners, as the amount of funding dictates the size of factory TNE will engage and b) activities, as TNE will engage in activities with sensible associated costs (i.e. affordable and locally available contraceptives).

In the long term, TNE will engage retailers for their sponsorship of future factory expansions. Targeted companies will include ones in the supply chains of TNE's partnered factories, as well as entities that have signed onto global safety and worker standards agreements. These agreements serve as an explicit commitment made by companies to a) centralize the needs of workers and b) take a preventative approach to health and safety, serving as leverage points for TNE’s fundraising efforts (sponsorship packages to cover the costs of services in new factories + TNE’s trainings and operations). Their sponsorship would be a) a continuation of their existing CSR efforts and b) a low-cost way to support workers in their own supply chain. 

TNE could additionally independently expand to additional factories with financial support from partner NGOs, allowing TNE’s success metrics to be shared by multiple stakeholders. 

Before TNE can engage retailers, it must demonstrate its impacts and scaling potential in the coming 3-4 years using grant funding, existing and new (this is where MIT Solve/Tiger IT funding fits well), to reach the goal of a retailer-sponsored factory pilot by year 5.

The Now Exchange is very excited about the opportunities that the Tiger IT Foundation could potentially provide in order to support our mission. TNE faces several logistical barriers that could be alleviated by being selected as a winner of the Tiger Challenge. As it stands, we do not have office space to operate out of in Dhaka, which is necessary for many of our planning meetings and hiring local staff. Additionally, we are navigating legal steps around NGO registration in Bangladesh. Since we are still in the process of exploring our best options for operating in Bangladesh, we would greatly appreciate mentorship and support from experienced professionals with regards to navigating legal issues. Similarly, it has been difficult to hire personnel for positions such as Lead Health Trainer and Program Manager to be based in Dhaka without us actually being based in Bangladesh as an official NGO. We hope to learn from and work alongside the Tiger IT Foundation in order to overcome legal barriers, build stronger networks for hiring, and continue to work through the inevitable iterations that will arise over the next few years as our organization continues to expand its reach. 

We would like to pursue a partnership with Business for Social Responsibility (BSR) - and similar organizations - due to their experience implementing women's health workshops in garment factories in India and Bangladesh, and measuring the success of those workshops. Specifically, we are interested in a Measurement & Evaluation (M&E) partnership that would allow us to distribute effective assessments to test baseline and endline knowledge before and after delivering workshops. 

We are interested in collaborations around measuring and documenting the effects of health services on women's use of health clinics, satisfaction with services, and business gains for the targeted factories (in terms of reduced absenteeism and increased worker productivity). We would like to partner and/or share best practices around how to measure and document these pieces of data in our interventions. 

We are interested in working with organizations that could potentially provide us with connections for future factory partnerships, and idea-sharing resources in terms of best practices when working with factories on women's health issues. Organizations with commitments from large retailers for investments into women's health would be of particular interest.

We are interested in working with other organizations operating with employment-based service delivery models, and generally organizations in the SRHR and menstrual hygiene management fields in Bangladesh and beyond. Some organizations of note are: Marie Stopes, Engender Health, Ella Pad, Saathi Pads, and branches of BRAC outside of Urban Development (such as Health, Nutrition and Population as well as Water, Sanitation and Hygiene).