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International Federation for Red Cross and Red Crescent National Societies

Regional Delegation Nairobi Health and Care Support Unit



One of the community sessions: a community member presenting a community map



16-21 st May 2005

May 2005


Facilitation and Report by Rebecca Kabura Senior Regional WatSan Officer

Table of Contents

List of Abbreviation 1ii

Acknowledgements 2

1.Introduction 4

2. The Training Workshop 3

Methodology 7
Key Recommendations 7
Limitations 8
Challenges 10
Overview of Water and sanitation activities 11
Conceptual back ground of PHAST 13
Concepts in health 19
PHAST steps and activities 46
Conclusion 47
Terms of reference 48
Workshop program 49
Handouts 50

List of Abbreviations

ICRC International Committee for the Red Cross

IFRC International Federation of Red Cross and Red Crescent National societies

ITN Insecticide Treated Nets

NS National Society

PHAST Participatory Hygiene and Sanitation Transformation

RDN Regional Delegation Nairobi

SARAR Self Esteem Associative Action Planning and Resourcefulness

I wish to register my gratitude to all those who made this mission a success. Special thanks go to Fidel Pena the
IFRC WatSan coordinator who was my host , facilitated the whole process and in additional provided all the logistical
support and Naomi Jackson and Katrina Orflet who worked alongside me. All the workshop participants who worked
very hard under a very tight schedule and made the training process an eye opener and an enriching process. The
community members and partners visited, interviewed and of course all the volunteers who have worked together to
make the Tsunami operation a success.

Its also worth mentioning all the support accorded to me by Uli Jaspers head of WatSan unit Geneva and Robert
Fraiser Senior WatSan officer Geneva, Vera Bensmann (Nairobi Regional Delegation) Health and Care Coordinator.
My dearest friends Noor Pwani Senior WatSan officer and John Muathe WatSan /Health program assistant who gave
me all the morale and desk top support for the mission.

Special thanks to SrilLanka Red Cross National Society and all the families whose lives the Tsunami altered forever
my heart goes out to them. The opportunity to work in this beautiful country especially in this healing phase has
enriched my life and I hope the seed of change I have planted will flourish and be part of f the healing process.

This report documents the proceeding of the PHAST training conducted in Colombo by IFRC and Sri Lanka Red
Cross National Society.10 participants were trained as trainers in the PHAST methodology and these are mainly
persons involved directly or indirectly in Water and Sanitation programs.

An earthquake measuring 8.9 on the Richter scale struck the area off the western coast of northern Sumatra on 26
December, triggering massive tidal waves or tsunamis that swept into coastal villages and seaside resorts. One of
the hardest hit areas is Sri Lanka with 70 percent of the coast being damaged. In terms of Water and sanitation an
estimated of 45,000 toilets/latrines were destroyed or rendered unusable. About 76,000 ring wells were destroyed by
the Tsunami floodwaters directly or indirectly through saline and/or pollution. Most of the ring wells in southern
coastal areas yield only saline water and are therefore traditionally only used for washing and cleaning purposes.
Trucking of potable water in coastal areas is standard practice and piped water supply is only available in densely
populated areas and settlements.

The overall health and water and sanitation sectors in Sri Lanka are extremely precarious after the disaster. Large
numbers of affected families are still living in temporary shelters provided by Government and International
Organizations. The water and sanitation sector has been severely affected in the coast line of Sri Lanka and
Infrastructure where has deteriorated where it existed. People living in transit camps have access to clean water in a
basis of 175 litres per family, one toilet per 8 persons.

Hygiene promotion is an issue that is common to all camps in all Districts but is not being carried out with the
desirable intensity and needs to be reinforced both in terms of increased partnerships on hygiene promotion as well
as increased interface of hygiene promoter and camp residents.

IFRC started operation in the Tsunami Operation since 26th December, 2006. Emergency phase is over and
rehabilitation phase is starting for a period of 1 year. Water and Sanitation intervention in the rehabilitation phase has
to be consistent with IFRC policy. With the three components integrated: Water, Sanitation and Hygiene Promotion.
PHAST is a methodology used by IFRC that encourages community participation and links hygiene promotion with
the construction of water and sanitation infrastructure. Since Sri Lanka Red Cross Society is not experienced in
running integrated water and sanitation programs, the RDN Senior WatSan Software officer who is well versed in the
approach and hygiene promotion programming was engaged to give technical support on how to start the program in
the country together with all the components of the Red Cross/Red Crescent Movement present in the country.

The five day training workshop was part of this programming process and was a highly participatory workshop,
building on the participants own experiences and knowledge .Although one afternoon was reserved for field
simulation of some of the PHAST activities and tools in Bentota village one of the areas Sri Lanka Red Cross has
activities this was not possible due to time limitation and the tight schedule.

It is expected that after this training the participants can then organize a similar training at the national level involving
representatives of various branches either already undertaking or have intentions of undertaking WatSan programs
and can assist in the formation of PHAST groups so that the every target household can be reached and there can
be the desired trickling down effects.


2.1 Methodology and Workshop Process

The training method was itself highly participatory and experiential. It was situation-centered and focused on the
realities of the participants, based on their areas and fields of operation as well as their own experiences. It relied on
discussions and action based methods, rather on presentation of the facilitator. Most of sessions were in group work
after brief introduction of the activity by the facilitator. Plenary, recaps and evaluation of the days activities was also
done which embraced the principles of adult learning and team spirit. The toolkit used was informed by field
simulations undertaken near Portville, one of the Tsunami affected areas in Ampura district in the previous two weeks

The process for the entire workshop consisted of the following steps:

1. Pair wise introductions: In this method each participant was asked to introduce his partner ; -his name ,last
childish thing he had done ,what languages he speaks ,what he likes about Sri Lanka Red Crescent and what
he does not understand about Sri Lanka Red Cross and how they intended to apply the PHAST methodology.
2. Fixing the workshop timetable and ground rules: The facilitator asked the participants to amend or adopt.
Participants decided that they would work from 9.00 a.m. to 5.00 p.m. everyday, with tea break at 10.00,
-10.15prayer/lunch break at 12.30 -1 p.m. and afternoon tea break at 3.00- 315 p.m.
3. Leveling of expectations and fears and agreement on responsibility for learning : This helped the
facilitator to understand and take into consideration the needs of participants and to compare these with the
stated objectives of the workshop.
4. Plenary discussions on experiences and lessons. The discussions and lesson learning focused mainly on
the understanding and applicability of the particular tools as well as the facilitation skills, including teamwork
among the group members.
5. Field pre-testing: This was not done due to time limitations although this would have been ideal to strengthen
the participants skills in the application of PHAST.
6. In all cases, training on facilitation and communication skills as well as the importance of teamwork
among group members was part and parcel of the whole process as was the daily evaluation. Daily evaluation at
the end of each day was meant to enable the facilitator to gauge the level of learning and general feelings of
participants in order to be able to make any necessary improvements on the delivery of the training exercise
based on the results of the results. Also part and parcel of the whole training exercise was the recap of the
previous days proceedings by groups of participants, at the beginning of every subsequent day. This served to
bring out key lessons and to identify areas that needed further clarification or attention.
7. On the last day of the training exercise, participants discussed how to implement PHAST.
8. Additional technical handouts on water and sanitation programming were given to the participants. They were
also encourage t he PHAST guidance notes for WatSan programming


1. An incremental approach for the initial phase is practical and PHAST pilots will be more apt and the lessons
from the pilots can be used to inform and strengthen the next phase of program. Proper mapping and
selection of the branches has to be done to identify the relevant pilot branch.
2. How PHAST will be presented to the community has to be given due considerations. Community entry is
crucial, the use of local volunteers, translations of training materials into the local dialects and developed
within the local context has to be done.
3. The involvement and ownership of Sri Lanka Red Cross in taking the leading in the PHAST process remains
a challenge and there is need for demystification of the approach within the integrated health and care
programs. For the next level of training, a proper selection criterion has to be developed and it would be
more appropriate if both the head quarter level and the field level officers are involved in the training and
program design.
4. While programming for PHAST, a thorough analysis of possible expected benefits or impacts of PHAST
needs to be done so that programming is done within a realistic framework to avoid raising undue
expectations. Normally health gains and any other gains from a hygiene promotion take a long time to be
5. Initial assessment of the current situation has to be done to inform the programming process. This can
either be done through undertaking a comprehensive baseline or situation analysis that will be project
specific so that this can be used to triangulate the problems identified in the PHAST training process.
Assessing the impact of intervention is tied to strong monitoring and evaluation component factored in the
hygiene promotion and WatSan program as a whole. Realistic indicators have to be set and harmonized
through a community driven process.
6. The strength of PHAST lies in how the community is directly involved in the design of and implementation of
interventions. Such a process calls for a lot of flexibility and moving together with the community and this
therefore calls for a community driven process.
7. Institutional collaboration is crucial since coordination remains a challenge in relation to hygiene promotion
and education. Currently there is no any other organization using PHAST apart from the Federation and
therefore there is a big opportunity for IFRC to introduce PHAST through a concerted effort.
8. Volunteer motivation is vital to making the program a success since this a very involving community driven
process. Volunteer policy has to guide how volunteers are recruited and motivated within the program and a
common approach has to be applied when either IFRC or the PNS are implementing PHAST and other
community projects.
9. For the PHAST program to be successful the link with Sanitation Promotion has to be established and it
would be indeed strategic to begin the plot where there are intentions of also undertaking Sanitation
10. Documentation of good practice especially the lessons learnt will assist in shaping and profiling the WatSan
program. Cross fertilization of ideas and lessons needs to be encouraged across programs and branches
and review meetings structured within the program.
11. While designing WatSan proposals there should be budget lines factored for the various activities related to
WatSan projects. These include development of Information Education Communication (IEC), assessments
and documentation.
12. The first phase of development of the PHAST toolkit has been completed but the next stage step is to adapt
the tool further at the national level workshop and there after it can be adopted to be the Sri Lanka PHAST


The objective of the training was to train IFRC water and Sanitation staff involved in Water and Sanitation and the Sri
Lanka Red Cross staff in PHAST methodology as highlighted in the workshop objectives. However this was not
possible due to unavoidable circumstances. The workshop was supposed to be conducted for 6 days and a field
simulation exercise factored in , however this was not possible due to time limitations .The field trips were very
informative but more time was needed for in-depth interactive with the community and more locations be visited.


This is a country that has been affected by Tsunami and the social structures torn apart. This has had implications on
the cohesiveness of the community. A lot of expectations have also been raised in the relief phase in the process of
trying to address the overwhelming needs. An integrated and holistically approach has to be taken up since there are
immediate needs which sectoral projects may not be fully able to address. Many community members are still
traumatized and are trying to redefine their lives. Their coping mechanisms have to be reinforced, supported and may
be through Psycho- social support programs.

Institutional collaboration is essential since it is not possible to work alone in this intricate and dynamic set up. The
link with the government is important since it still remains the prerogative of the government to address the needs of
its populace. The overwhelming needs are beyond what the government can handle or address and with all various
agencies working in the Tsunami operation, joint strategies have to be developed to avoid duplication and instead
enhance synergy among the various players and even donors. The emergency relief phase is over and in this
transition period into the rehabilitation phase the challenge remains how to program within such a dynamic
environment and still keep abreast of the community processes, yet it is within this context that PHAST will be


The fist session of the workshop was the introductory remarks. The individual participants were asked to do pair wise
introduction; introduce his partner, the last childish thing they had done, the languages they speak, what they like
about Sri Lanka and what they dont understand about Sri Lanka culture and the application of PHAST /hygiene
activities. There after the workshop time table and ground rules were fixed. The facilitators asked the participants to
amend or adopt this. Participants decided that they would work from 9.00 a.m. to 5.00 p.m. everyday, with tea break
at 10.00 -10.15 am, lunch break at 12.30 -1.30 p.m. and afternoon tea break at 3.00-3.15 p.m. The leveling of
expectations and fears and agreement on responsibility for learning was done which assisted the facilitator to
understand and take into consideration the needs of participants and to compare these with the stated objectives of
the workshop.

(Below is a summary of the participants fears and expectations)

Fears of the participants Expectations of the Norms of the workshop

No enough time Learn how to implement No mobile phones
May delay to start activities How can PHAST be Time keeping
applied for other
community issues
Dont know how to start PHAST How to develop Listening to each other
activities monitoring and
evaluation tools
Dont know how PHAST will relate with How to define PHAST Respect to each others views
my activities


The main aim of the workshop was to train the work shop participants involved in water and sanitation programs so
that they can adopt/adapt PHAST methodology in their work.

1. Provide the participants with an approach for empowering communities to reduce and eventually eliminate water
and sanitation related diseases.
2. Provide the participants with methods that can lead to community management of water and sanitation facilities.
3. To enable participants acquire knowledge and practical skills in the use of participatory hygiene education tools.
4. To impart knowledge and practical skills to participants that would enable them evaluate behavior change in
hygiene, sanitation and water interventions using participatory methods.


The Federation WatSan unit has four focal persons based in Geneva, in Africa there are 8 delegates and 2 are
regional delegates, In America there are 3, while 7 are based in Asia Pacific and for Tsunami related activities there
are 16 delegates and 1 Coordinator based in the Tsunami affected areas. In Sri Lanka the current team comprises of
the WatSan Coordinator and 1 WatSan delegate an additional delegate for projects in the North will soon join the
team. There is an open position for a trainee delegate.

Water and Sanitation is a Health initiative, clearly defined and seen as one of the most important aspects of
preventive/public health. The Federations basic health policy has underlined the need for a community-based
approach. Community Based Health Care can therefore not be considered without addressing the issue of Water and
Sanitation coverage. WatSan sub unit is part of the public health unit in Geneva and within the national societies is
part of health and care unit within the integrated approach where this exists. The role of the federation is to
strengthen and build the capacity of the national societies and be able to implement the WatSan activities better.

The activities are implemented guided by the IFRC WatSan policy and every national society is expected to adapt
and work within the policy frame work. This policy applies to all Water and Sanitation interventions carried out by
National Societies and the International Federation. National Societies and the International Federations
programming and advocacy aims at incorporating Water and Sanitation objectives into general health and
development programmes as well as in emergency situations.

Key points within the policy include; the importance of baseline and proper assessments before initiating any
programmes and gender balance is crucial. Ensuring community participation and management in the various
programmes is core in reducing implementation costs and encouraging ownership. Communities should naturally
be involved from the onset. Participatory techniques (such as PHAST-Participatory Hygiene and Sanitation
Transformation) are well established in Federation Water and Sanitation/Health programmes.

Regular exchange of information between the water supply and sanitation sector and the health information system
and where possible and feasible collect and analyze health statistics and trends before starting any Water and
Sanitation intervention and to monitor them during and after implementation to determine the projects impact upon
the health status of the beneficiaries, and/or governments.

The need for software leading the hardware if not parallel before introducing the hardware is priority. Due
consideration should be given to the use of appropriate local technologies and cultural preferences for the
sustainability of the work. Ensuring full attention is given to the development of human resources like National
Society staff, delegates and volunteers in the area of Water and Sanitation. Suitable training is required in technical,
managerial and public health areas for most Water and Sanitation initiatives. Response to emergencies and disasters
(population movements, camp situations etc.) which require Water and Sanitation interventions with qualified
personnel following Red Cross/Red Crescent and other technical standards is also an important element.

Design and implement Water and Sanitation operations aiming at an effective evolution from relief to development
and consideration of ntegration of related sectors e.g. Health and HIV/AIDS programmes, food security,
organizational development, disaster preparedness, as much as possible, keeping in mind that programmes can
have a developmental character right from the start and do not always evolve out of an emergency situation.

Formulation of clear exit or phasing out strategies at an early stage of any Water and Sanitation intervention
,recognizing the responsibility of the National Societies and the International Federation for the long term impact and
durability of technical installations.

National Societies and the International Federation have the responsibility to ensure that all Water & Sanitation
activities and programmes are carried out in compliance with this policy; that all staff and volunteers participating in
such programmes are aware of the rationale and content of the policy. The Federation has developed the (GWSI)
Global Water and Sanitation Initiative whose focus is on long term programming yet using appropriate technology
and building on existing community structures. This is based on the realization that short term projects are neither
cost effective nor sustainable. Currently a GWSI checklist has been developed.

In terms of operations ICRC which has been operating in Sri Lanka long before the Tsunami and is responsible for
coordinating activities in the North and the East while IFRC is operating in the South and West. Based on the Seville
agreement, the areas of operation have to be adhered to and Sri Lanka Red Cross is the host .The opportunities for
IFRC are in undertaking hygiene promotion, waste water and water provision. Despite an influx of donors after the
Tsunami, sanitation has attracted very low funding and the same applies for rural water supply.


Given the fact that hygiene and sanitation behavior change at the personal, household and community level is
capable of effectively mitigating against deaths due to diarrhoeal diseases, it was deemed necessary to devise a
methodology for promotion of hygiene and sanitation behavior change. It is this concern that led to the birth of PHAST
Participatory Hygiene and Sanitation Transformation since 1992 during a joint initiative by UNDP, the World Bank and
WHO to review SARAR methodology. PHAST is therefore anchored or based on the SARAR concept and has
adapted/adopted SARAR and Participatory Rural Appraisal (PRA) tools to enable development agencies involved in
hygiene and sanitation promotion secure the participation of communities whose hygiene and sanitation behaviors,
habits and practices, they seek to change or transform. It has been piloted in America, Asia and Africa. In Asia and
Africa, PHAST has been successively adapted to suit the local context by different agencies as an effective software
tool in addressing hygiene promotion, local capacity building, stakeholder involvement, monitoring and evaluation.
The use of pictures and drawings facilitates the visualisation of the everyday hygiene and sanitation behaviors of the
people and helps facilitators to discuss issues that would otherwise be difficult to talk about without inhibitions or
feelings of shame.


PHAST is an acronym for Participatory Hygiene and Sanitation Transformation, which is a community management
tool, designed to promote the empowerment of communities. It enables communities to identify and analyze their
problems and make informed decisions on what options they want to pursue as their solutions .It also allows
communities to monitor and eventually evaluate theses activities to check for progress and document lessons learnt.
This makes it an effective hygiene promotion tool as it ensures that beneficiaries benefit from the installed facilities
for water and sanitation because they have improved hygiene behavior.

PHAST aims to ensure that the installed water and sanitation facilities deliver optimum health and social benefits,
which can be sustained at the community level in the long term.

PHAST has three main objectives:

1. The promotion of improved hygiene behaviour

2. Improvements to sanitation
3. Community management of water and s sanitation facilities

It does this by:

Demonstrating the relationship between sanitation and health status

Increasing the self esteem of community members
Empowering the community to plan environmental improvements and to own and operate water and sanitation

Because the PHAST process involves seeking communities knowledge, attitude, practice and most importantly
'buying in', it generally takes a relatively long time (an average of 2-3 months) to implement successfully. It is
composed of 7 main steps, each with its own activities and objectives as well as tools. These include making choices
about the different technology options available. To enable participants understand the use and place of hygiene and
sanitation promotion (using the PHAST methodology) in the overall context of health, was also introduced.

The facilitator talked about problem identification and problem solving in relation to PHAST and community problem
identification and problem solving.

1. To identify problem
2. Route cause of the problem
3. Number of people affected
4. Options in solving problems
5. Mode of solving problems
6. Selecting appropriate option
7. Solution achieved.


1. Identify problem
2. Problem analysis
3. Planning for solution
4. Selecting for solution
5. Facility and behavioral change
6. Planning for monitoring and evaluation
7. Participatory evaluation

The PHAST Process

A STEP may contain one or more activities aimed at achieving one overall objective.
An ACTIVITY is what the group works through to discover the information and skills necessary to reach an
understanding or take an action.
TOOLS are the techniques and materials the facilitator uses to help the group work through an activity.


To enable participants acquire skills to improve participatory learning and facilitation skills.
To enable the participants to adopt participatory learning tools with a view of producing context and culturally
specific tools.
To demonstrate participatory learning methods in this regard, aim to obtain a multiplier effect through
training of volunteers.
To develop realistic work plans at branch level with regard to water and sanitation, hygiene promotion and
community management
To impart knowledge and practical skills to participants that would enable them to evaluate behavior change
in hygiene, sanitation, water and health interventions using participatory methods.


Around 2.2 million people die of basic hygiene related diseases, like diarrhea, every year. The great majority is
children in developing countries. Interventions in hygiene, sanitation and water supply make proven contributors to
controlling this disease burden. For decades, universal access to safe water and sanitation has been promoted as an
essential step in reducing this preventable disease burden. Nevertheless the target "universal access" to improved
water sources and basic sanitation remains elusive. The "Millennium Declaration" established the lesser but still
ambitious goal of halving the proportion of people without access to safe water by 2015. Achieving "universal access"
is an important long-term goal. How to accelerate health gains against this long-term backdrop and especially
amongst the most affected populations is an important challenge. There is now conclusive evidence that simple,
acceptable, low-cost interventions at the household and community level are capable of dramatically improving the
microbial quality of household stored water and reducing the attendant risks of diarrhoeal disease and death. Simply
providing access to improved water and sanitation does not imply the use or the much expected health benefit .The
promotion of fundamental behavior changes is key to integrating the appropriate use of services.
Research shows that hygiene-related practices such as safe disposal of faeces and hand washing after contact with
faecal material can reduce the rates of intestinal infection considerably. Consider the following figures:

Hand washing with soap and water can reduce diarrhoeal disease by 35% or more.
Hand washing can also help to reduce the prevalence of eye infections such as conjunctivitis and trachoma.
Pit latrines, when used by adults and for the disposal of young childrens stools, can reduce diarrhoea by 36% or
Protection of water from faecal contamination can also reduce diarrhoea, because some diarrhoeal infections
are water-borne. Improved water quality can be associated with up to a 20% reduction in diarrhoea.
Water quality in the home can be improved by using only a protected water source for drinking purposes; by
keeping water storage vessels clean, covered and out of the reach of young children and domestic animals; by
boiling water where practical; or by putting water in clear plastic containers and exposing them to sunshine for
several hours.
In the special case of guinea worm, filtering with a cloth filter can provide complete protection from new
Increased quantity of water used, which results from better access to water, can bring about 20 % reduction in
incidence of diarrhea. Hygiene has five domains as already introduced.


5.1.0 HEALTH

Facilitators notes

Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or
infirmity. It is a fundamental human right and attainment of the highest possible level of health is a most important
worldwide social goal whose realization requires the action of many other social and economic sectors in addition to
the health sector. World Health Organization (WHO)


Health is everybodys concern and every individual has a right to basic health knowledge and health care, also a duty
to help others to maintain and improve their health. The health of a community depends on people who are active
and not passive towards health.
The figure below is an illustration of the factors that give health its full meaning. All these factors need to be present
in order for one to be termed as healthy.


A healthy environment

Helping others


Being fit

Happy relationships

Healthy mind

Comments: The curative aspect of health is also a contributor to health.


Before participatory as a concept was introduced the term community was defined

Group 1

Community: Group of people at the same geographical location sharing services and has common interests

Group 2

Community: a group of people who have one or more of the following in common area, religion, race culture, gender
family, culture age occupation and social status

Input by facilitator

Community is a group of people who:

Are interdependent of each other and limited by geographical boundaries

Share common natural resources
Share a common culture
Experience same problems

Despite common characteristic traits, there is a general recognition that even within a community, there would still be
sub-groups, each with specific interests and goals, and development facilitators should be sensitive to such groups
even though it might be impossible to satisfy the needs of all sub-groups within a community. An example to illustrate
this could be the level of enthusiasm for sanitation awareness campaigns among village members who already have
and are using latrines and those who do not have. Similarly, even within the same community, there will be people
who are better off than others or who are more influential than others.

Group Task: Define the concept participatory

Group 1

Participatory concerns active involvement at all stages of all stakeholders concerned in a project.

Group 2

All people equally involved, responsible, self conscious, community exchange of views and no discrimination

Facilitators notes

How far can participatory methods be applied within a socialist state?

Participatory Development Pillars


Sharing of ideas, knowledge, skills Methods and tools

Roles of facilitators while working with participatory methodologies and tools

Explain to the community the purpose and uses of specific tools in relation to each activity and your reasons
for wanting them to engage in the exercise.
Explain the procedure for undertaking the exercise and let them engage in it.
Facilitate discussions on the problems or topics raised and identify:

What are the issues?

What is the reason behind the issues/problems raised?
What can the people do to prevent problems and areas in which they may require external input?
Use the information obtained to decide, together with the people, the next course of action.


Task for group work

Define: the concept Hygiene

Group 1
Cleanness from inside out
Body hygiene
Control of garbage and contamination sources
Protection mosquitoes
Use of tools
Prevention such as vaccination, waste treatment, recycling

Group 2
Protection against contamination which may lead to diseases
Correct procedures
Proper food storage
Clean water
Personal hygiene

Facilitators Notes

Hygiene: Is the study of health and observance of health rules and measures of preserving health .This involves the
5 areas of health also commonly known as 5 hygiene domains. These includes personal hygiene, water hygiene, and
food hygiene, and environmental hygiene, domestic and household hygiene

Hygiene promotion is more specific and more targeted than health promotion. It focuses on the reduction and
ultimately the elimination of diseases and deaths that originate from poor hygiene conditions and practices. Hygiene
promotion encourages all the hygienic conditions and behaviors that can contribute to good health .It aims to
stimulate the right behavior change .It starts with systematic data collection to find out and understand what different
groups of people know, what they want and why is it so, the results are used to identify and implement activities that
enable different groups to measurably reduce risky conditions and practices to strengthen positive situations and

The difference between hygiene promotion and health promotion; Hygiene promotion is more specific and
more targeted than health promotion. It focuses on the reduction and ultimately the elimination of diseases and
deaths that originate from poor hygiene conditions and practices. For example, good hygiene conditions and
practices are enhanced when people can consume water that is safe, use sufficient amounts of water for personal
and domestic cleanliness, and dispose of their solid and liquid wastes safely. A person may have good hygiene
behaviour, but not be healthy for other reasons. Good or bad health is influenced by many factors, such as the

environment (physical, social and economic). For example, in social environments where people are marginalised
because of their gender, economic status or religious affiliation, and have no influence whatsoever on decisions that
affect their daily lives, they are likely to be prone to anxiety or depression, which can lead to mental problems.

Difference between hygiene promotion and hygiene education; Education usually means teaching people,
e.g. about what makes them ill and what they must or must not do. Often it is didactic. In the case of hygiene
education for example, the educators may want to teach people the germ theory of disease in order to discourage
transmission through unhygienic practices. Such information has its place, e.g. when people themselves want to
know how they can avoid getting a particular disease. However, successful hygiene promotional programmes do not
instruct people. They promote healthy conditions and practices in others, usually more effective ways than
'teaching', e.g., by improving access to the means for better hygiene and health, social marketing, participatory
learning, and peer influence. In hygiene promotion, the individuals and communities themselves review their hygiene
practices and develop ways of improving them. Hygiene promotion begins with what people know and builds
on their existing knowledge .

An effective water and sanitation program integrates the five hygiene domains (which is basically software) and
sanitation, which normally refers to facilities or hardware.


Group Work Task: Define the concept Sanitation

Group 1

Active decontamination, purifying water, sewage disposal, water storage and transport, water sources

Group 2

Devices such as showers, latrines showers, sewage systems, waste management, treatment and transport, recycling

Facilitators notes

Sanitation refers to all measures that help break the cycle of disease, community environmental sanitation usually
involves hygienic (i .e safe) disposal of human and animal excreta, waste water, vector control and other hygienic

Over years there has been more focus on water rather than sanitation since it is easier to address water component
in Water and Sanitation projects rather than Sanitation which is more complex and involves more collective decision
making process both at household and community levels.

About 2.4 billion people globally live under highly unsanitary conditions and have poor hygiene behaviours,
which increase their exposure to risks of incidence and spread of infectious diseases. Also, water stored at
home is often contaminated by inadequate management and handling.

Diarrhoea, which is spread easily in an environment of poor hygiene and inadequate sanitation, kills 2.2
million people each year, most of them are children under 5 years.

Sanitation Promotion

Sanitation is the hardware side of the promotional activity. It refers to improved water and sanitation facilities such as:

Improved sanitation facilities (latrines, garbage disposal pits, waste water drainage etc),
Improved water facilities,
For environmental sanitation to be successful vector control and eradication should also be undertaken.

On the other hand, hygiene and sanitation promotion refers to the combination of, and linkages or relationship
between the hygiene domains and the improved facilities. Without one, the other cannot succeed, and the sanitation
facilities have to be maintained if hygiene and sanitation are to succeed.

Overleaf is a diagram that places the concept of hygiene and sanitation promotion in perspective.

ig. 4: The PHAST Concept (H&S promotion are two sides of the same coin)

Results in improved behaviour &

Aimed at encouraging behaviour proper maintenance of water and
& conditions which help prevent sanitation facilities, which work
WATSAN related diseases together to form a hygienic and
healthy environment

Communication of Results in reduction of

behavioural practices Emphasis on gradual peoples exposure to disease Emphasises gradual
related to health by providing a clean improvement in
improved behaviour behaviour change

Hygiene Promotion

Sanitation Promotion

Is the software component of WATSAN. It

comprises the following messages or
domains of hygiene behaviour

Includes messages or the 5

domains of hygiene Includes promo
behaviour improved sanit
Evaluation of Day 1 facilities
Safe water Proper food Proper
Safe disposal of Domestic &
hygiene hygiene
human excreta Personal Environmental hygiene

An attempt was also done to define transformation which is the last acronym in PHAST and is actually the resultant
of any hygiene promotion programme.


Transformation in general refers to a complete change in appearance and character especially for the better. In
hygiene and sanitation promotion, this refers to adoption and use of safer hygiene and sanitation practices, marked
by actions, which translate to improved health status.

After a series of activities of trying to develop common definitions on the key concepts and health and PHAST the
various PHAST activities and tools were introduced.


The participants were given a set of pictures depicting various scenes showing different ways of facilitating
community meetings.

Group Work Task: From the pictures given identify the best pictures and the worst in relation to communicating
hygiene messages and give reasons. The pictures depicted the following scenarios.

Class setting, Poster displayed on a tree, use of letter, a household visit, a bad community meeting with some people
sleeping , a good community meeting with a facilitator using both oral and visual aids.

Communication is an interactive process involving the receiver and the sender of the message The means used is to
transmit the information also very important and if no due consideration is given to this communication barriers may

Best method

Use of oral and written or audio visual aids such as in PHAST is important to hold the interest of every body.

Worst method

The use of letter since most of the people may not read the letters and this is also not interactive.

A key factor in hygiene and sanitation promotion is the communication channels, that is, the ways and means of
communicating and disseminating hygiene and sanitation messages. For this reason, participants were asked to
identify the various communication channels for hygiene and sanitation promotion as well as for communicating other
health issues to the community. According to participants, examples of community communication channels normally
used in Sri Lanka include: Radio, Newspapers, Music, Mass Campaign using microphones, Dances, Demonstration
(Action), Folktales, Word of Mouth, Pictures, and Posters


For each day , the facilitator would give an outline of the activity and how to undertake the tool there after the
participants would break up into three or four groups as need dictated then there will be presentations by each
group and a plenary session with the facilitator summing up the discussions for that activity .The key focus was on
lessons learnt by the participants




In this step there are two activities


The activity is designed to help the group express important concerns and issues facing the community. The
objective of activity is;

To enable the group members to identify important issues and problems facing their community
To help build a feeling of team spirit and mutual understanding
To generate group self esteem and creativity

In community the stories activity, the unserialised posters tool was used.


For this activity the participants were divided into two groups and given a set of posters depicting different scenarios
of typical life in Sri Lanka.

Group Work Task: Select a few of the posters and arrange the posters into a series to make up different stories
reflecting community life.

Emerging issues from both group stories; Wife beating, community solving problems together, sense of family,
common disasters

The group found this session enjoyable and it was possible to find out which issues are of concern and in one the
groups the effects of Tsumani disaster were highlighted. ACTIVITY 2: HEALTH PROBLEMS IN OUR COMMUNITY

PROPORTIONAL PILING TOOL (identification and prioritization tool)

This is a simple (voting) method of prioritizing problems and options. It follows the sessions on problem identification
and analysis. After community members have identified all their problems and these have been analyzed, they are
facilitated to prioritize these problems with a view to making choices for possible interventions.

Participants are given a limited but equal number of local materials stones, pebbles, grain or whatever is lying
around. Whatever material is decided upon should be of more or less equal size.
For this case the tool was used to identify common community health problems.

Group Work Task: Each participant was given a piece of paper and asked to use these to vote for the most
important problem Participants voted according to individual perceptions and feelings about each problem. The
problem or option with the greatest heap/pile is the peoples priority.
(This is not a PHAST tool but can easily assist in the identification of community problems).

1. Decide on the number of issues on which you want to make a decision on, e.g. the first one, two, three, four or
five issues
2. Arrange the issues or their symbols in a vertical order
3. Give a limited but equal number materials to each participant
4. Explain that each individual is to use his/her materials independently - to make a decision on the priority
problem or option.
5. Explain that one can use his/her materials to vote for one or two or all of the problems or options that are most
pressing for him/her. The issue that is most pressing to the individual gets the most voting materials.
6. Invite participants to undertake the voting exercise.
7. Analyse with participants the outcome of the exercise and discuss its implications to the community or the
planning exercise.

For training purposes the participants chose five main diseases in the community as shown in the table below.

1. 5 cards, each with a different colour was used represent each identified disease
2. 8 pink papers per person were given to each participant and then they were asked to vote on the cards
according to their knowledge of the existence of the disease in the community

Emerging issues from the exercise

Results of proportional piling

Name Of Disease Number Of Votes Ranking

Snake bites 11 4
Diahorrea 16 2
Asthma 6 5
Dengue fever 19 1
Malaria 12 3

The group could not have consensus on some of the activities therefore the pair wise matrix was introduced which
involved comparison of two variables and scoring

Pair wise Ranking

Asthma Snake fever Dengue fever Malaria Diahorea

Asthma xxx xxx Xxx xxx xxx 2 2

Snake bites A xxx Xxx xxx xxx 0 3
Dengue fever DF DF Xxx xxx xxx 4 1
Malaria A M DF xxx xxx 2 2
Diahorea D D DF M xxx 2 2

In this case there is a tie between malaria ,asthma and diahorea and there maybe need to analysis further why the
choices they have made .In this case the group agreed that the three were preventable and can be thus be
addressed using a common approach. ACTVITY 2: HEALTH PROBLEMS IN OUR COMMUNITY

The activity is designed to help identify important health problems in the community and to discover which ones can
be prevented by community action. Nurse Tanaka tool is used.


The participants were given drawings of different group of people and a drawing of a nurse standing outside a health

Group Work Task : These people are visiting the clinic, identify the health problems they have, and then arrange the
drawings in a sequence beginning with the first person to the last of who should see the nurse first and give an
explanation for your answer.

Common health problems identified include: Worms, depression, routine check up, broken limbs, snake bites ,
heart attack, infant death , vaccinations, infections in the foot, woman beaten by the husband, pregnant woman, and
heart disease.

It was realized most of these health problems can be prevented through proper health care. The government policy
stipulates free medical care for all although in reality people have to wait for long to get proper attention so they seek
alternative such as home remedies

Facilitators notes

This activity may show people do not know lack health knowledge and may assist in generating discussions on
disease transmission routes and what can be done.



This step has four activities:

1. Sketch-mapping water and sanitation in our community

2. Good and bad hygiene behaviour
3. Investigating community practices
4. How diseases spread


This assists the participants to map those water and sanitation problems which could lead to diarrhoeal diseases.

Community map tool is used in this activity and the purpose of the map is to map the communitys water and
sanitation conditions and show how they are linked and to develop a common understanding vision and
understanding of the community.


Input by facilitator

Purpose of a sketch map

A community sketch map is a tool or device for recording data or information about an area its boundaries and
significant features. It can also be used to understand the social and even economic conditions in a given community.

Characteristics of a sketch map

They are not to scale

They allow for the use of local symbols and materials to represent the issues under discussion
They guide discussions with visual features
They focus attention on issues under investigation
They are easy to draw, even on the ground and the drawing can later be transferred to paper

Types of Sketch maps

Sketch maps can be divided into:

1. Resource maps, which illustrate either the physical resources crops, water points, grazing areas, vegetation,
mountains etc.
2. Social maps, which illustrate the social conditions and situations of a community such as houses, health and
sanitation facilities, schools shopping areas,
3. Mobility maps, which illustrate the pattern of peoples movement (mobility) in giving directions or areas, for
given purposes.

Since drawing these maps doesnt require special expertise or equipment (they can first be drawn on the ground,
using whatever materials are lying around), and since the drawing can be a group activity, they can provide an
excellent opportunity for sharing information between community development workers (the facilitators) and
community members as well as for identifying local problems and potentials. Each side has its special knowledge,
of course; the extension agents might be better informed about technical matters, such as the potential for water
supplies or problems of soil erosion, but the local people will have direct knowledge about such things as boundaries
and inter-group relationships and they will certainly have a sharper insight into the social and political problems
experienced by the community.

Note: In hygiene and sanitation promotion, a sketch map would be used to determine the water sources, defecation
areas and health facilities within a given community.


To draw a sketch map, the materials required will consist of anything at hand, marker pens and large sheets of paper
for transferring the model to a more permanent and displayable format.

Procedure of facilitating the drawing of a sketch map

1. Decide which kind of map(s) will be drawn and whether it will be constructed inside (if the meeting venue is a
room) or outside, on the ground or on paper.
2. You can divide participants into groups by gender (of male and female) or you can work with the whole group. (If
there is diversity in terms of background and experience, you can use this as the criteria for division into groups.

Whichever way you choose, emphasize that this is a job for everyone (in the group), not just the person with an
artistic flair or the most learned member of the community.
3. If it is a basic sketch map, ask the people to plot the boundaries and then the positions of either the physical
resources water sources, farming areas, grazing areas, forests, conserved natural resources, areas affected by
soil erosion etc - or the social amenities - schools, health facilities, houses etc if it is a social map.
4. If the mapping exercise took place on the ground, ask a member of the community (with artistic flair or a member
of the facilitating team) to transfer the model on to a sheet of paper.
5. Display the products on the wall.
6. Invite each group to present its map, focusing on issues or themes that they wish to highlight.
7. Use the highlighted themes or issues to generate further discussions with the community.

Issues to consider at the end of this exercise and the resultant discussions that has been generated

What was your purpose of drawing the map

What do you know about the community, which you didnt know before?
How will this knowledge help you continuing your work with this community or in identifying and planning

Group Work Task: Draw a village map of any community in Sri Lanka.

Lessons learnt

When asked what lessons they had learnt from the exercise, participants had these to say:

Learned to see the area under different perceptions

Noticed things about the area that they were not aware existed
Learned to share information while working as a group on the map

Asked about the uses of a mapping exercise to the community, participants had these to say:

To study the community

Assists to identify areas that will need PHAST intervention to enable you make your plan of action
Helps in the situation analysis of an area
It can be used as an analytical tool, e.g. to discuss problems that can result from locating latrines near a water
source. This would help the community to understand one source of diarrhoea in the village.

(It is important to keep the map since it serves as a good evaluation tool).


The activity helps the group to look more closely at common hygiene and sanitation practices and to identify how
these may be good or bad for health. For this activity 3 Pile sorting tool is used.



To exchange Information and discuss common hygiene practices according their good and bad impacts on health.

Group Work Task: Participants were divided into two groups and each was given about 30 posters and was asked
to sort them out and stick them under any of the three behaviors.

1. Good behavior those that show activities that are good for health
2. Bad behavior those that show activities that are good for health
3. In between behavior those that show activities that are neither good or bad for health

They were asked to select one person from their group to give a presentation on their findings.

Overleaf are some of the descriptions of the pictures.

Good behaviour

Woman washing a childs hands with water and soap

Man taking a shower
Food covering
Woman washing utensils
Man collecting water and covering it after use
Woman leaving the toilet with different pail for washing water
Man using one container for collecting water and a separate container to dip in the major container

Bad behaviour

Cooking food and not covering it

Water and container left uncovered flies everywhere
Man drinking water straight from large water pot
Man from toilet and does not wash hands
Animals licking utensils and drinking water from the cooking pots
Open defecation near the house
Child eating his food with the cat licking the plate
Animals and humans swimming in the water reservoir

In between (not sure)

People eating with their hands

A mother washing a childs face but using only water
Washing dishes on the floor
Milking a cow but not sure if the person doing this has washed her hands

What do we do about the in-between behaviour?

There should be no in-between behavior because this kind of behaviour puts the person at a risk and any risky
behavior is not good for health.

What are the common hygiene practices that need to be emphasized?

Food and water covering

Regular bathing
Use of water and soap when washing hands
Proper garbage disposal
Washing dishes after eating and not leaving them scattered

What was notable is that the tools are not used to test peoples knowledge or to investigate or correct their personal
behavior but rather o provide a starting point for discussion on local hygiene and sanitation beliefs and practices

Key issues discussed were;

What is preventing the community from adapting good hygiene practice?

Is there a reason why communities are still using the bad practices?


The purpose of the activity is to help the group collect and analyze data on actual sanitation practices in the
community. A pocket chart tool is used

Pocket Chart Tool

For training purposes it was used to analysis the hygiene behavior of the participants. In this case it was hand
washing with soap and water before meals.

The hygiene practice investigated was hand washing before eating meals in the field. This involved having 3 posters;
eating without washing hands, washing hands with water only, washing hands with water and soap. A pocket chart
tool was used for this exercise and the participants had to put their vote in one of the three pockets showing different
hygiene behaviors. To capture behaviors of men and women, the women were (unknown to them) given a different
vote color from the men.

Results of the voting exercise

Gender Water And Water Only No Total

Soap Hand washing
0 4 0 4
Men 1 2 1 4

Total 1 6 1 8

Comments of participants on the outcome:

Based on the findings of the activity women washed more than men though they only used water
It is also a challenge to practice hand washing due to water shortages in the rural areas especially with soap at
all times.

Use of Pocket chart in the community:

Educate people on hand washing using water and soap

To investigate if people practice positive hygiene behaviour
After the exercise, a discussion should be stimulated to discuss the constraints of why people do not practice
good hygiene behaviour
What can be done to influence each other to practice good behaviour

Why encourage people to wash hands using soap and water?


To reduce the transmission of diarrhoeal diseases

Hands are often used more than any other part of the body making it a major carrier of germs
A pocket chart can be used to teach people better behaviour habits
It can also be used to determine the route of transmission of disease
Clean hands means good health and vice versa

Some concerns:

There is need to teach people how to wash their hands properly especially under their finger nails and
thoroughly rubbing their hands together while washing.

Other uses of pocket chart tool:

The pocket chart can be used to target the following hygiene behaviour

Use of latrine
Garbage disposal
Food storage
Water uses
Good habits and bad habits
Breast feeding


The purpose is help the participants discover and analyze how diarrhoeal can be spread through the environment
and the tool used is faecal transmission routes.


This tool is normally used to look at how faeces can contaminate the environment and lead to diarrhoeal.

Group Work Task: The participants were divided into three groups and given a set of posters showing different bad
behaviours, a housefly, and a pair of hands. Then they were asked to identify various routes diseases can be spread.

NB The three pile sorting tools can also be used for this activity.

Transmission routes

Diseases are spread through 5 Fs - Faeces, Flies, Fingers, Fields and Food. A chart showing the 5 Fs was
presented and discussed by participants.


Some routes are more direct than others such as sucking unwashed fingers after latrine use.
The housefly is the main transmitter of diarrhoeal disease through faeces
Most of the bad behaviour practices causing diseases transmission can be stopped/blocked very easily i.e.
covering food, washing hands, using a pit latrine properly
Unwashed hands are one of the main causes of diseases transmission hands are normally used for eating

The housefly was identified as a vector (a small disease carrier animal) others include mosquito, rats, bedbugs,
lice etc.



Faeces Mouth



F- chart


Malaria routes was also discussed to demonstrate the versatility of PHAST methodology in addressing other
community diseases

Group work Task: Each group was given as set of pictures depicting different malaria ways malaria can be spread
and asked to identify different malaria routes

Routes identified:-

Stagnant water
Long grass
Bushy wet vegetation
Sleeping without nets
Wearing short tight clothes

underlying causes mentioned were:-

Dams being used water sources
Lack of information
Lack of drugs
Lack of medication
Laziness & ignorance
Living in water logged areas


Possible solutions:-
Use of nets
Traditional herds
Clearing bushes
Communal clean ups
Draining of stagnant water



This step has three activities

1. Blocking the spread of diseases

2. Selecting the barriers
3. Tasks of men and women in the community

6.3.1 Activity 1: Blocking The Spread Of Diseases

Blocking the spread of diseases helps the participants to discover ways to prevent diarrhea diseases from being
spread via the transmission routes identified I the previous activity. The faecal route barrier tool was used.


The objective of the tool:

1 Is to help the participants discover ways to prevent or block diseases from being spread via transmission
2 To analyze how effective the blocks are and how easy or difficult it would be put to put in place .


Use of latrine
Covering of latrine
Well covering
Food and water covering
Separate of animals from drinking water sources

6.3.2 Activity 2: Selecting The Barriers

This activity helps the group to analyse the effectiveness and ease of actions to block transmission routes and
choose which they want to carry out themselves.

Group Work Task: Participants were then asked to prioritize some of the easy and effective options for preventing
diseases based on the previous exercise of hygiene domains the previous day.

Easy to do was in relation to;

o To easy to communicate
o Easy to do
o Local resources are available
o Easy to adapt


Diahorea Matrix Barrier

Easy In between Hard

Effective Hand washing with water Safe water for bathing Flashing latrines
and soap
Appropriate storage of food
Food and water covering
Heating the food

In between Hand washing - -

Pit latrines
Covering wells

Not effective Eating curd - -

Malaria matrix barrier

Easy In between Hard
Effective Garbage disposal Covering water containers Spraying
Draining stagnant water
Covering small water
Changing water vase
Changing rat trap water
Clearing wild vegetables

In between Burning plants Widow nets Coils

Clean up Wearing long clothes Malaria pills
Sticky tape

Not effective Natural remedies Use of frogs Bat farm

6.3.3 Activity 3: Task for Men and Women

The activity identifies which are the roles undertaken by men, women and children and who would be able to take
additional tasks to introduce changes necessary to prevent diarrhoeal diseases.


The purpose of this tool is to:

Raise awareness and understanding of which household and community tasks are done by women and which
are done by men
To identify whether any change in task allocation would be desirable and possible

Typical Tasks for women in the village

Time Tasks
5 am Washing face SHINF
515 -600 lighting the fire , Prepare break fast
6-7 Prepare school children washing dressing
7.15 -8.30 Sweeping the house ,cleaning dishes
8.30 Bathing
9-10 Preparing lunch
10.30-11.30 Fetching firewood
12.30-1.30 Feeding the children
1.30 Housework washing dishes
1.30- 2.00 Resting sewing handcrafts
2-3.00 Preparation of tea and drinking tea
3-3.30 Helping children with homework
4-4.30 Prepare supper
4.30--5 Make tea for the husband
5.15 Fetching water from the family traditional well and

Washing children
6.00 Light the lamp and pray together
6.00-6.30 Feeding children and parents eat

7.00-7.15 1 Socialize family

8.00- Children go to sleep
8.00- 9.00 Parents eating
9.30-Bedtime Washing plates

Typical tasks for men in the village

Time Tasks for Men
6.00-6-30 Washing face ,grooming
Take tea
6.30-4pm Paddy fields ,weeding
11.30-1 Lunch time Resting
1-4.00 Start work
4.00-4.30 Travel by bicycle
4.30-5.00 Shower
5.00-5.15 Tea
5.15-4 Town socialse
6.30 -7.15 Play with children
7.15 -8.00 Talking with wife supper
8.00-8.45 1 Dinner
8,45-9.15 Talk with wife
9.30 Go to bed

The gender task analysis is a very involving activity and brings out the issues of gender and who does what and
why .For this activity analysis were done focusing on a Buddhist community and the experience might be different
for a Muslim community or a Christian community. What is obvious is that women are engaged in activities that
might not be considered as non productive since they do not generate any income and are domestic oriented yet
their role as care givers ,in reproductive health ,social roles can not being ignored and this is very important when
tasks or community contribution on lab our is been discussed. It is also possible to see how much time is spent on
water and sanitation related activities and what is the implication of introducing hygiene promotion within such a



By the end of this step the communities are supposed to be able to make informed choices about the changes to
facilities and hygiene behaviours it wants to make.

This step has three activities

1. Choosing sanitation improvements

2. Choosing improved hygiene behaviours
3. Taking time for questions

6.4.1 Activity 1 and 2: Choosing Water and Sanitation Improvement and Choosing Hygiene
Behaviors Improvement

Both activities assist the communities to assess their sanitation and hygiene situation and decide on what changes
they want to make.

Choosing/Selecting Water and Sanitation Options Tool (Options Assessment Tool)

In order to make informed decisions with regard to choice of technology and other interventions, participants need to
be facilitated to know all the possible options for solving any particular problem, and all their implications. These
should include causes of problems, resources required to undertake each possible option, the cost of each resource
(cost of implementation), the capacity of the community to implement, manage and maintain each option. With this
kind of knowledge, the people would be able to choose an appropriate, affordable and easy to manage option. The
matrix overleaf is a sample options assessment matrix

Note: The exercise on choice of options requires input of the technical staff, to enable members of the community
make informed choices, in terms of cost of implementation and maintenance as well as spare parts (where



Choosing sanitation improvements helps the group to assess the communitys sanitation situation and decide on the
changes it wants to make. In this case the sanitation ladder too


The purpose of the activity helps participants to describe the communitys water situation and identify options for
improving water situation and discover the improvements can be made step by step.

Group Work Task

The participants were given a set of water options and asked to arrange them in the form of a ladder starting from the
what they considered the worst to the best and why.

Then they were asked to consider where the community is at present and where they would like the community to be
one year from now. They also identified the advantages and difficulties they would met as they move from one stage
to the other.

The context was in two (camps, traditional villages)

Options presented

Open defecation

Flash toilet
Dry latrine
Latrine with septic tank

The desired is the modern toilet however there is no hand washing facility

Current situation

Open defection
Use of traditional latrine


Privacy, smell, convenience location, habit, clean, availability of water

What is considered clean may vary from community to community depending on their perception

Ritual cleaning
o Sometimes it is easy to confuse ritual cleaning with the practice of safe hygiene practices and
sometimes as much as community can practice ritual cleaning they may not wash hands
before eating.

o Poverty and lack of knowledge on how to adapt the options available
o Lack of knowledge and awareness


Choosing water improvements helps the group to assess the communitys sanitation situation and decide on the
changes it wants to make. In this case improvement may be in terms of quality, quantity and access


The participants were given a set of water options and asked to arrange them in the form of a ladder starting from the
worst to the option they consider the best. Then they were asked to consider where the community is at present and
where they would like it to be one year from now. They also identified the advantages and difficulties they would met
as they move from one stage to the other.

Options presented
Water bowser
Taps stand
Unprotected spring
Hand pump

Protection of water from animals
Protection from contamination from humans
Emergency to development
Mixed uses


The main priority of the community is on availability and not quality

The ecological issues around the water table and salinity of the water and cost are some of the reasons people use
certain choices versus others.

Facilitators notes

When designing a water intervention it is very important to keep in mind the mixed needs or uses for water in each
community .Technology option chosen has to be guided by this consideration part from the other technical issues on
operation and maintenance .At this point it may be useful to bring on board the a water engineer to discuss the
viability of each option.


This helps the group to decide which hygiene behaviors it wants to work on with the community and the 3 pile sorting
tool used.

The purpose of the tool is to assist the group identify hygiene behaviors they want to change, encourage and maybe
introduce in the community.

The groups were given drawings from the 3 pile sorting drawings and asked to identify three drawing depicting 3
hygiene behaviors they agreed as being healthy and which they would like to encourage and one more that they
agree as being unhealthy and they would like to discourage.

Group presentation

The activity reflected what had already being presented in the 3 pile sorting and barrier chart activities.


This gives the participants a chance to ask questions and obtain feedback from fellow participants, thus increasing
the confidence and self-reliance of the group.


The participants were asked to write down one question each on any subject that they would like to ask the facilitator
and then put it in the box. The facilitator took the questions and re-distributed them at random to the participants and
asked them to answer the questions. This was a big surprise for the participants since they expected the facilitator to
answer them.

Some of the questions were based on the workshop topics while others were more general. What was interesting
was to see the participantss creativity in answering the questions.

Objectives of the Question Box

To provide an opportunity for participants to ask questions about the process and any other information.
To help the group recognize the wealth of knowledge they have collectively

Build confidence and self reliance of the group

Lessons learnt

There is no hard or difficult question

If somebody is not able to answer a question one can always throw it back to the others in a group since
there is a wealth of knowledge in group work.This can also encourage group work and team sprit


This step is important since it paves the way for planning for solutions and action. While choosing hygiene and
sanitation activities or actions it is important that the actions are easy to do and are at the same time effective in
resolving the problem.

6.5.1 Planning for change

This helps the group plan the action steps for implementing solutions it has decided on. This is by developing a plan
to implement changes in sanitation and hygiene behaviors

Water options

In this the water options discussed were in two contexts

Emergency and Non emergency

Picture Quantity Quality Cost

Digging trench around E = ok E=not ok $1000
water reservoir NE =not ok
NE =not ok
Household covering the E = ok E=not ok No cost and is hygienic
water and proper NE =not ok
transportation NE =not ok
Small natural Pond E = ok E -not ok No cost
NE -not ok
NE =not ok
Traditional Well E = ok E- not ok $ 50
NE- not ok $500
NE =not ok

Water trucking E- ok E-ok High overhead cost

NE-ok NE -ok And will depend on the
number of trips
Lined community well E- ok E-Not ok $ 350
NE-ok NE not ok
Taps E- ok Community can contribute
NE-ok NE =ok
Hand pump E- ok $300-400Hand pump
Afrdevi NE-ok $ 5%25 per meters


Safe water cycle

The different water sources have implication on water safety; some sources are safe while others are not.
How water is water transported, treated and stored in the household is important. Even in a situation where the
source is safe there are chances of recontamination in these three levels.

Below are key issues to be considered in water safety.

Is the water normally covered when transporting it?

Is the water treated at the household?
How is the water stored after treatment?
Is drinking water scoped or poured out?
Are there different containers used for water storage and are they covered?

The current focus of the Sri Lankan government is more urban which translates to less resources in the rural areas
There is need therefore for community directed initiatives to meet un met water needs..

Sanitation options

Criteria developed

Maintenance and operation

Geology rocky ,sandy
Hydrology water level
Quantity community /household solution
Cost sustainability some options may start of as expensive and in the long
term be cheap
Secure distance from the water source

Options proposed

SWAB Latrine- Dry latrine

PVC Available
Sand plats available using cement to make the slab
Very easily available
It can easily be cleaned
Temporary once the container is full and can easily be moved away
When water table is very high the solution is to build it upwards

Dimensions of the latrine

Superstructure/ logs, nails

Ceramic slab

$ 20- 30 dependants on the locally available materials

Open bottom latrine flush toilet

Dimensions of a flush toilet

Super structure ,ceramic Slab

Depth minimum of 6m (may change depending on soil type, water table and population to be served

It is more environmental friendly if considerations on where the water will drain are taken into account.
Connection to the septic tank may also be an option where it is possible to drain off the sludge
The cost may slightly be more in comparison to the others options however it can be cheaper if locally available
resources are used for the super structure
They take longer to fill since they are draining off the water and also it may depend on the family size.

Cost $ 70-90

Septic Tank

There are normally three compartments it may have a separate soak pit or it can be jointed directly to a
municipality sewer
This is more permanent
The first chamber receives the urine (liquid) and feaces (solid) where the two are allowed to settle down for
decomposition (urine and faeces). Finer particles of the solids and liquid waste then overflow to the second
compartment where the flow is much reduced and this allows the further settlement of the heavier particles. In this
chamber, one can begin to notice that the sewage is gaining some level of clarity. The partially clear sewage then is
forced to rise to the top, further screening only the lightest suspended matter to rise to the top. At this stage the liquid
(sewerage) has more clarity and overflows through a buffer wall to a collector pipe which leads the liquid to a
soakaway pit or to a municipality main sewer line.

This is a good solution, it closed and long term

Low maintenance
Available in the country is not high due to social economic reasons
if done in the proper way it is safe and is environmentally safe
May be more expensive since it requires presence of water although can be used at a communal level
Not a solution for the temporary camp situations since this more off a long term solution term

6.5.2 Planning Who does what

The purpose is to identify who takes responsibility for carrying out the steps in the plan and setting a time frame for
the activity.

For this exercise :Fencing of a water pond was identified


(The Transformation Process)

The objective of this tool is to analyze the different stages of behaviour change and to show that change process is
gradual. According to the participants transformation is the final stage in the change process.


Definitions from participants

Change of habit
Change of idea, behaviour, culture, lifestyle, beliefs, bad and good behaviour
Risky behaviour to safe behaviour
Process of Change
Reduce disease incidence
Complete change from past bad behaviours and to present better behaviours
Change of attitudes from negative to positive attitude
Complete change of ways
Building confidence
Self reliance and self esteem

Change from Bad habit to good habit, directing the community to come to a decision, build self confidence, sharing
ideas and responsibility and to identify their problems and prioritise solutions, choosing options, choosing what tools
to use themselves and to eventually come up with a plan of action.

Group Work Task

Participants were asked to arrange the sentences given below from worst (first) to best (last).

This seven steps illustrates the stages of behaviour change (bottom-top)

1 I am willing to demonstrate the solutions to others and advocate change

2 I am ready to try some action
3 I see the problems and am interested in learning more about it
4 There is a problem but am afraid of changing for fear of loss
5 Yes there is a problem but I have my doubts
6 There maybe a problem but it is not my responsibility
7 There is no problem


Identify and know which stage the community is in.

It is a tool to understand that change is a process and does not take place overnight
It helps to know the realities of each community ,since each community is different
For adaptation changes take time and practice
Social change is slow and gradual
To help the community think /see /visualise that is possible to move from a bad to a better situation
Help the community identify their visions
To help fight resistance there are many reasons why people are not willing to change
Changing peoples behaviour is attitudinal

Why People Refuse To Change

Inherited beliefs or values

Fear of Culture loss
Fear of loss of power or authority
Does not want new interventions
Fear to be unable to adapt to expected standards

Lack of finances
Environmental i.e. Nomadic way of life
Sustainability of new ways
Lack of awareness (do not relate their lifestyle with the existing problem)
Difficult to adjust to foreign methodology
Lack of sufficient information
Lack of education
Lack of demonstration misunderstanding
Lack of trust
Religious beliefs
Refusing to take responsibility
Laziness (too much work to bring about change)

Why Do People Change?

Answers by participants

Good practice
More learned, more educated
Realization and understanding of better hygiene methods
To sort out their problems
Status raising of living standards
Awareness of problems, i.e. diseases, risks etc
Acceptance that we have a problem and we must change
Through awareness there is the agreed distribution of roles and responsibility

Input by facilitator


Making life easier is the most powerful reason why people change or adopt new hygiene facilities, other reasons
include the facilities being; (closer, reliable, predictable, easier, safer, nuisance)


Aiming for peoples understanding and have insight into and respect for the local knowledge i.e. (realisation
need for change, implication)


Influence from others (demonstration by giving examples)

Time, energy, finances for the new practices


Ability to make your own decisions, being independent

Motivating changes in hygiene practices also means addressing issues of means, control and power in
hygiene practices. The community is free to use their skills and resources the process provides new skills and

When learning, people remember:

20% of what they hear (hearing sense)

40% of what they hear and see (hearing and sigh)
80% of what they discover for themselves (action)


Increasing peoples knowledge automatically changes peoples behaviour

Universal hygiene messages can be given

(Assumptions are that these are superior to the local insights need for local adaptation)

Telling people what to do solves the problems

(Telling people what to do often does not get a chance to relate it to their own experiences)

When people know about health risks, they take action

(Better education does not by itself reduce the risks of transmitting these diseases, only action can)

Any improvements are equally useful

(Although action is needed it is not effective when a very wide range of behaviours are targeted or only point out the
multitude of places where water and sanitation related diseases could be transmitted. Concentration on those risks
is more important)


This activity helps development agencies to pre-empt what might go wrong. Since a lot of work has been done
with the community right from problem identification to analysis but more crucially after the community action plan
has been prepared. This is important since the CAP is a contract between the people and the agency. Both sides
should forestall anything that can prevent or delay its implementation.

Task Group Work

The participants were divided into three groups and asked to select one options out of the ones proposed in
planning for solutions activity and then show the steps to implementing it .

Group One

1. Water option

Communal Well

Contact irrigation department /PH ground investigation

Select the most convenient location with the community
Contract for building
Water testing
Hand over to the community

2. Sanitation options

Flushing latrine

Information from the community
Environment friendly
Discuss cost
Who will do it
Operation and maintenance

3. Hygiene promotion

o Hand washing with soap

o Use of latrine

Step1 Identify the reasons why people need to change to their habits

o Assessment of current situation

o Meeting the communities to understand what they will accept and are willing to change
o Meeting with other technical groups to look for feasible devices
o Community ownership and management
o Monitoring and evaluation


The question box is used to:

Identify what possible problems may arise during the implementation of the action plan.
Assist the communities and agency to think ahead of how to solve such possible problems.

To practice this tool, participants were given six pieces of paper and asked to direct /ask two questions to each of the
three sectors previously identified. Questions were then redistributed to the participants, and then they were asked to
imagine they were community members answering the questions.

Based on the sample action plan (above), participants were asked to identify what might go wrong during the
implementation of the [sample) action plan. Below is a list of what they identified.

Unskilled labour
Lateness of funds
No resources for activity
Selection of the site
Rejection of the concept
Community unwilling to participate



Lack of clear communication is one of the things that can go wrong there is need for further development of
analytical skills.
The question box is a very practical tool that can be used in day-to-day planning.



This step has only one activity. In this activity the group fills in a chart for checking (monitoring) its progress towards
achieving its goals means are identified for measuring progress, how often this needs to be done and who will be
responsible for doing it.

What Is Monitoring and Evaluation


Checking progress of activity in the project

Assesses what has been done
Follow up of plan of action
Regular/daily review of plans and activities

Evaluation focuses on the whole project
There is be mid term evaluation and end of year evaluation
Evaluation looks at the overall objective of the project, both failures and successes
Evaluation can also be done by external person for objectivity purposes

There are several ways of confirming if the intended objectives have being met this include:

Reports both narrative and financial

Field visits
Discussions with the beneficiaries and partners
Checking accounts and assets of the project
Checking for impact which is the changes supposed to have taken place as a result of the project

Input by facilitator

Monitoring is checking the progress of an activity or project towards meeting its objectives.
In this activity a monitoring chart is used.

To establish a method of checking our progress
To decide how often checking should be done and who to do it
The terms where, who, why, when and how were introduced.

Monitoring is the short tem checking of what has gone right or wrong according to what we set out to do from the
beginning, our plan. Evaluation is normally done at the end and will involve checking through the whole programme.
Its focus is on the long term and is normally done at the end of the project or some projects may have mid tem

The participants agreed it is important to check if your activities were going on well so that if things are not going on
well they can be changed or improved.
The participants were then asked to draw up a plan of action and show how an evaluation can be conducted

Monitoring chart
Number How to measure How often By whom

Which Hygiene Practices Can Be Targeted?

Below is a table showing various hygiene practices, falling under four different categories: sanitation, water, food and
environment. It also shows a list of hygiene conditions and practices that may be locally important and can also be
used as possible indicators

An Indicator is simple a sign showing that change has happened or is taking place. This can also be used as a
checking method/tool and used to check the impacts/results of the project. It is very important to be sure of what
hygiene domain/domains you are targeting in relation to behaviour change. The hardware factors such as
construction, use and maintenance of facilities can also be used as indicators. It is better to agree with the
community on just a few indicators rather than trying to achieve all, when you design your project.

Hygiene Domain Relevant Conditions and Practices

Sanitation Location of defecation sites

Latrine structure and cleanliness
Disposal of childrens faeces
Use of cleansing materials
Number of users of facilities
Sanitation habits of different groups
Water Placement of latrines in relation to water sources
Different water sources used, and daily and seasonal patterns
Average distance to water
Amount of water used per person per day
Water quality at source and home
Water storage practices
Methods of water treatment
Water handling in the home
Water use and re-use
Hand washing (including religious rituals)
Bathing (children and adults)
Clothes washing
Previous experience of water source management

Environment Household refuse disposal
Disposal of household wastewater
Condition of storm water drains
Management of domestic animals
Evidence of stagnant water around dwelling or water point
Vector control problems
Slaughtering facilities
Burial of the dead

Criteria For Evaluating/Checking Likelihood of Behaviour Change

1. Health impact of behaviour: the more the change of behaviour eliminates/reduces the health problem-the
higher the chances of it to succeed
2. Frequency of behaviour: if the change of behaviour can be done occasionally and still has a significant value
-it is not tough /rigid to do.
3. The practice is already widely practiced: it is within the local context
4. The action is simple and involves one action to succeed and not many actions required
5. It is cost effective: the cost of engaging in the behaviour requires only existing local resources

6. There are many positive results of the behaviour change
7. Brief period: can be accomplished in a brief time /period
8. Obvious signs of change: the change in behaviour cannot be missed-it can easily be seen
9. It is not foreign: there are several existing practices which are similar in the area and have worked

According to the World Health Organization (WHO), the following three hygiene behaviours lead to greatest reduction
in diarrhoeal morbidity:

Safer disposal of faeces, particularly faeces of young children and babies and people with diarrhoea.
Hand washing, after defecation, after handling babies faeces, before feeding and eating, and before handling
Maintaining drinking water free from faecal contamination, in the home and at the source.

Simple Guide For Conducting Participatory Evaluation

(A good evaluation involves all or a few of the project stakeholders especially the community members and partners
coming up with a list of indicators drawn from the above hygiene domain practices that can be targeted and agreed
on with the stakeholders right from the beginning of the project therefore it would be good to know what was the
situation before and what is the situation now after the project has come /started.) Below is a simple guide

What risky practices are widespread in the community?

How many people employ risky practices and who are they?
Why are these people/groups using these practices?
Which risky practices can be altered/ changed?
What motivates those who currently use safe practices?

To have good indication of what change we want to achieve/it would be good to do a simple baseline surveys before
the project intervention - which will indicate the 'current situation' and another follow up survey as part of the
evaluation to show the 'situation after' the project intervention. On the basis of this we can say the project has had
good or bad impact.

A combination of other evaluation methods can be used such as a walk around the village, focus group discussions,
mapping, semi structured interviews, community stories etc.

How many people are we targeting for evaluation purposes and what are the sample sizes? How many? How
many men /women children and youth?
Need to interview people we interviewed before the intervention and after the intervention to check if change
any occurred
For comparison purposes it is important to compare the results of people involved in the intervention and
people not involved in the project
A combination of methods can be used to verify the information this includes the PHAST tools under the
monitoring matrix (refer to the PHAST training step by step manual
The results of the evaluation need to be analysed in order to come up with impacts of the project in relation to
social, economic health, community participation, stakeholder collaboration, increased awareness and
skills enhancement etc.



This step is carried out after the community has implemented its plan, perhaps months or one year after.
It is normally carried out jointly with the community members and other stakeholders based on the indicators that had
been agreed upon during the action plan.

How much has been done in the community
How much of the plan still needs to be done
Any problems or difficulties encountered
Any corrective actions that is needed

Various tool options

In order to accomplish all the activities identified in the PHAST process it is equally important to focus on who is the
implementer at the community level .The participants were asked to put on volunteer (this was a flip chart which
was drawn to depict a community volunteer) and the fix on him skills and qualities they expected him to have do the

Qualities and skills of Volunteer identified

Handy ,
Open minded
Open heart
Self confident
Good listener
Good walker
Friendly voice
Good communication skills
Loves to make jokes with people
Loves people
Technical skills
Good walker
Well acquainted with local habits

As a reaction to this the Federation WatSan Coordinator pointed out that it is not possible to have this type of person
sine he does not exist .On the same side of the coin is do we have the same qualities ourselves?. What became
apparent is that, any person who is available and willing to volunteer can be trained on the methodology. It will also
be easier to implement since the person is drawn from he community.

In his closing remarks the Federation WatSan Coordinator thanked all the participants for having made the training a
success .The next phase of work will be to hold the national workshop and most of the participants from this
workshop will be asked to facilitate .He acknowledged the efforts of Mrs Anu who was the workshop artist, who made
it possible to have a PHAST toolkit through her creative drawings.

This workshop was a starting point for hygiene promotion in water and sanitation programs in Sri Lanka. There is
much to be done in relation to programming. Nether less the sprit of willingness to learn depicted in the training
process is an asset towards this process. The recommendations capture some of the issues which need to be taken
into account when designing the program. In addition there are challenges ahead which will also shape the
process .But the desire and the resilience attitude of the trainers will make this program a success.

The facilitator appreciates the support given in the course of this workshop.

Annex 1


For starting the Hygiene promotion program in Water and sanitation Program in Sri Lanka (Tsunami
Operation) based in PHAST methodology

Name of facilitator: Rebecca Kabura


Context of the humanitarian crisis

1. An earthquake measuring 8.9 on the Richter scale struck the area off the western coast of northern Sumatra on 26
December, triggering massive tidal waves or tsunamis that swept into coastal villages and seaside resorts. One of
the hardest hit areas is Sri Lanka with 70 percent of the coast being damaged.

2. In terms of Water and sanitation an estimated of 45,000 toilets/latrines have been destroyed or rendered unusable.
About 76,000 ring wells have been destroyed by the Tsunami floodwaters directly or indirectly through saline and/or
pollution. Most of the ring wells in southern coastal areas yield only saline water and are therefore traditionally only
used for washing and cleaning purposes. Trucking of potable water in coastal areas is standard practice and piped
water supply is only available in densely populated areas and settlements.

Humanitarian situation

3. The overall health and water and sanitation sectors in Sri Lanka are extremely precarious after the disaster. Large
numbers of affected families are living in temporary shelters provided by Government and International
Organizations. Last figures shown that at least 27,739 families are living in 319 transit camps.

a) Water and sanitation

4. The water and sanitation sector has been severely affected in the coast line of Sri Lanka. Infrastructure has been
deteriorated if exists.

5. People living in transit camps have access to clean water in a basis of 175 liters per family, one toilet per 8

6. Hygiene promotion is an issue that is common to all camps in all Districts but is not being carried out with the
desirable intensity and needs to be reinforced both in terms of increased partnerships on hygiene promotion as well
as increased interface of hygiene promoter and camp residents.

Justification and timing

7. IFRC starts operation in the Tsunami Operation since 26th December, 2006. Emergency phase has been over and
rehabilitation phase is starting for a period of 1 year. Water and Sanitation intervention in the rehabilitation phase has
to be consistent with IFRC policy and the three components should be integrated: water, sanitation and hygiene

8. PHAST is a methodology used by IFRC that encourages community participation and links hygiene promotion with
the construction of water and sanitation infrastructure.

9. Since Sri Lanka Red Cross Society is not experienced in running integrated water and sanitation programmes, a
well prepared facilitator in this matter is needed to start the program in the country together with all the components
of the Red Cross/Red Crescent Movement present in the country

Global Objective

10. Establishment of viable and sustainable hygiene promotion teams in communities that are going to be involved in
construction of water and sanitation infrastructure.

Specific objective

11. Adaptation and implementation of PHAST Methodology in water and sanitation programs in the Districts affected
by disaster in Sri Lanka

12. Assess the program proposal, in accordance with IFRCs mandate, in order to establish coherent and clear
objectives, and to produce recommendations for improving the effectiveness of the near future operation.

Work Plan

Preparation of materials for first Training of trainers of PHAST:

13. The facilitator should prepare materials, manuals and necessary arrangements for the first Training of Trainers of
PHAST in Sri Lanka. Also during this week interviews with some of key people in Red Cross Movement, Ministrys
are going to be arrange in order to give a broth idea about the Sri Lankan context. This phase will also include a visit
to affected area.

PHAST Training of trainers:

14. The facilitator will conduct a 6 day training of trainers about PHAST methodology in Colombo city supported by
IFRC WatSan staff. The participants will be mainly volunteers of Sri Lanka Red Cross Society and WatSan staff from
the different PNS present in the country. A preselection has to be made before by IFRC WatSan department.

Revision of programme proposal

15. The facilitator should revised the programme proposal for the initial period of rehabilitation phase (2005) and
make proper recommendations to assure the coherence and possible success of the Water and Sanitation
intervention in Sri Lanka..


16. A report comprising all the activities done during the 3 weeks should be submitted before departure to WatSan
Coordinator in Sri Lanka IFRC Delegation.

17. The tasks under this participation will be 3 weeks, starting no later than second week of May, 2005.

Annex 2





Day 1 Introductions
Expectations /Fears
Objectives of the workshop
Brief overview of the Sri Lanka Red Cross and IFRC WatSan
Conceptual back ground of PHAST
Community participation concepts
Community stories (unserialised posters)
Community health problems (Nurse Tanaka)
Facilitation skills( photo parade tool )
Community health stories (Proportional Piling)
Mapping water and sanitation facilities in the community
(Community mapping tool)
Good and bad hygiene behavior (3 pile sorting tool) )
Investigating community practices (pocket chart tool)
How diseases spread.
(Diarrhea route tool )
(Malaria route tool )
Blocking the spread of diseases
(Diarrhea tool )
(Malaria tool ) demonstration on ITNS
Selecting the barriers (Barriers chart tool)
Tasks for men and women (Gender task analysis)
Choosing water and sanitation improvements
(Water ladder tool )
(Sanitation ladder tool )
Choosing improved behavior (3 pile sorting)
Taking time for questions (Question box tool )
Planning for change
(Resistance to change continuum tool )
Planning for change for change (planning posters)
Planning who does what (Gender task roles )

Identifying what may go wrong (Problem box tool)
Preparing to check our progress (monitoring chart tool)
Checking our progress (various tools)
Preparation for field work
Field work
Day 6 Evaluation of field work
Action Plan
Workshop closure

Annex 3

Additional Reading for Participants


Gender Sensitive Programming.

A cultural factor of particular importance in improving hygiene practices is gender. Gender is the culturally defined
division of work and areas of responsibility, authority and cooperation between men and women .For every
improvement related to health and hygiene one must therefore ask if it concerns men, women or both and whether
either category has specific needs, priorities and resources. Communication channels and messages must be
developed for both men and women.

A gender strategy is also needed in community managed hygiene programmes, because what motivates men to
support and adopt hygiene changes differs from the factors which stimulate women.
Without a good gender strategy women often find that their physical work in hygiene has increased, while decision
and management positions have gone to men .A gender strategy helps men and women both take part in decisions
and find common solutions for conflicting interests.

When dealing with gender, it is important to note that women and men do not necessarily belong to one homogenous
groups, but may have different concerns according to age, class economic and educational status and ethnic and
religious group it is not enough to consult and plan separately with men and women without distinguishing also
between wealth, age and other socio economic and cultural divisions in the society. In most areas of domestic
hygiene, the women are most involved they do the work and take management decisions in and around the house,
educate the children and are change agents in contacts with other women.

6 steps for gender approach in hygiene programs

Assess with men and women what male and female hygiene practices need to be changed and who has the
responsibility authority and means for Action
Chose and test key messages, products and communication channels for change on relevance for and
applicability by women and men
Get understanding and acceptance from men for women to take part in the consultation process and in
management decisions and functions
Assess whether the programs addresses also men to improve their own hygiene practices and support hygiene
improvements of their children and women in their home and community.
Ensure that the program does not increase womens burden, but contributes to better division of work,
responsibility between women and men
Ensure equal representation of men and women in training programs and adjust training events
to overcome cultural limitations for womens participation

A Note for PHAST Trainers

PHAST involves a total of 17 activities although the training process is flexible to accommodate the interest of various
participants. For example within a developmental context other than training context, PHAST tools can be used to
address the different issues within the project cycle.

For any PHAST training to be successful;

1. The PHAST trainers should be experienced enough to allow the introduction of the PHAST steps in a flexible
manner, not necessary according to the book (introduction to PHAST step-by-step guide). For this reason,
trainers should have enough experience and flexibility to be able to adapt or even replace a tool [suggested in
the book] if one is found not to be applicable.
2. While PHAST training assumes that participants already have knowledge and experience in the use of SARAR
and PRA, upon which PHAST is anchored and that such participants are already experienced facilitators, this is
not always the case. For this reason trainers should try to include sessions geared towards strengthening the
facilitation skills of participants, such as dry runs or simulation/role play exercises and video feedback sessions.
3. For lesson learning and developing confidence and self-esteem of participants as well as local capacity building,
the facilitators should begin from the local reality of the participants, i.e. from what the participants already knows
and have experience in. This also helps to identify participants who can help out during the training, as resource
4. The use of local materials and local examples should be encouraged as much as possible.

Annex 4: References (Materials Used to prepare and deliver the training)

ARCHI 2010 ARCHI Making a difference to the health of vulnerable people in Africa

Boot Marieke and Cairncross Sandy: Actions Speak: The study of hygiene behavior in water and sanitation projects
(IRC) 1993

Lyra Srinivasan: Tools for Community Participation: A manual for training trainers in participatory techniques (UNDP)

RC/RC East Africa: Review of Participatory hygiene and sanitation transformation (PHAST) August 2003

Valerie and Bernadette Kanki: Happy Healthy and Hygiene: How to set up hygiene promotion programme (UNICEF)

UNDP and the Government of Kenya: Capacity 21 Kendelevu Toolkit - A manual for Trainers in Participatory and
Sustainable Development

WHO, SIDA UNDP-World Bank: PHAST Step-by Step-Guide - A participatory approach for the control of Diarrhoeal
Diseases, 1998