Executive Summary
PHAST stands for “Participatory Hygiene and Sanitation Transformation”. The approach is a participatory learning methodology that seeks to help communities improve hygiene behaviours, reduce diarrhoeal disease and encourage effective community management of water and sanitation services (WSSCC 2009). It aims at empowering communities to improve hygiene behaviours, preventing diarrhoeal diseases, and encouraging community management of water and sanitation facilities. It uses a participatory approach to community learning and planning that follows a seven-step framework (NETSSAF 2008). The approach was introduced from the World Health Organisation (WHO). Although PHAST is traditionally used in the development context, it also applies to emergencies if shortened. The practical feasibility of a shortened methodology for the emergency context has been proved, for instance in the intervention following the 2005 Pakistan Earthquake. Although different approaches to shortening the methodology exist, the steps Problem Identification, Problem Analysis and Selecting Options for Solutions are considered of particular relevance for the emergency context. The approach is most applicable in camps, where communities have stayed together for a while (GWC 2009).
The Concept of PHAST
PHAST works on the premise that as communities gain awareness of their water, sanitation and hygiene situation through participatory activities, they are empowered to develop and carry out their own plans to improve this situation (WSSCC 2009).
Besides, PHAST seeks to help communities to improve their hygiene behaviours, to prevent diarrhoeal diseases and to encourage community-management of water and sanitation facilities. PHAST hence demonstrates the relationship between sanitation and health status (see also invalid link).
Furthermore, the method tries to enhance the self-esteem of the participating community members by involving them into the planning process. Empowering the community helps to plan environmental improvements and to own and to operate water and sanitation facilities. For the achievement of these goals, the PHAST approach is using participatory methods to encourage the participation of individuals in a group process (WHO 1998).
PHAST is based on another participatory methodology called SARAR, which stands for self-esteem, associative strengths, resourcefulness, action-planning and responsibility. The PHAST method strives for joint revealing of causes of health illnesses, cooperative analysis of the issues, equal participation of people in discussions and cooperative search for solutions (TURATBEKOVA 2005). Hygiene behaviour targeted through participatory methods are hand washing, drinking boiled or chlorinated water, defecation in latrines, safe faeces disposal and safe water handling (TURATBEKOVA 2005).
The Seven Step Participatory Approach
PHAST uses a seven-step participatory approach to facilitate a community planning process (see below).
Each step contains between one to four activities a group has to go through to improve their community planning on hygiene and sanitation. These activities shall take place in a participatory manner to enhance the participation of individuals (see Participatory Hygiene and Sanitation Transformation (PHAST) factsheet for details on non-emergency PHAST process).
The seven steps to community planning of PHAST. Source: WHO (1998)
PHAST in Emergency Contexts
PHAST has proven useful to rapidly identify risk practices and to target risk groups through hygiene promotion campaigns. PHAST can be used to develop a strategy for reducing the disease transmission risk in camps.
Methods to Adapt PHAST for Emergencies
There are various approaches to shortening PHAST to make it a “fast PHAST” that is applicable in emergency contexts. The methodology can be shortened by applying only the first three steps, namely Problem Identification, Problem Analysis and Planning for Solution (Table 1, and full session guide for applying them in emergencies is provided in TURATBEVOKA 2005). The information and insights gained through these three steps can then be used for planning a hygiene promotion campaign. The methods and tools employed by PHAST, such as three-pile sorting and mapping, are also useful in facilitating interaction and discussion with affected communities (TURATBEVOKA 2005). As such, this “fast PHAST” can also serve as means for community mobilisation that can be built upon in the campaign (GWC 200, see Camp Hygiene Promotion Campaigning in Early-Stage Emergencies and Camp Hygiene Promotion Campaigning in Later-Stage Emergencies factsheets).
Gonzalez and Kubara (2006) have modified the core PHAST process by applying only steps two (Problem Analysis), three (Planning for Solutions), four (Selecting Options), and six (Planning for Monitoring and Analysis).
Timeline for Applying PHAST in Emergency Settings
The core PHAST process devised for development contexts generally takes six months (PARKINSON 2013, see Participatory Hygiene and Sanitation Transformation (PHAST) factsheet). For emergency contexts, it should be initiated within two weeks upon the arrival of refugees or Internally Displaced People (IDPs) and be implemented over an eight week period (GONZALEZ and KABURA 2006).
In general, the PHAST approach is most effective for creating long-term positive behavioural change around hygiene when the refugee population has stayed together for a while and has experienced a sense of community already prior to the displacement. It is generally more applicable to post-emergency phases and implementation in the earlier emergency phase may be challenging (JOHN HOPKINS UNIVERSITY AND IFRC 2008). However, if the process is shortened, it is also applicable in early phases. Implementation is easiest if humanitarian actors are already trained in PHAST. However, proper training in PHAST is often a limiting factor to using PHAST in emergency settings.
Introduction to the NETSSAF Participatory Planning Approach, a tutorial and guideline for sustainable sanitation planning
This presentation describes the NETSSAF participatory planning approach in a brief manner.
BARRETO DILLON, L. BUZIE FRU, C. (2008): Introduction to the NETSSAF Participatory Planning Approach, a tutorial and guideline for sustainable sanitation planning . (= Proceedings of the NETSSAF Final Conference “Pathways towards Sustainable Sanitation in Africa" ). Ouagadougou (Burkina Faso): Network for the development of Sustainable Approaches for large scale implementation of Sanitation in Africa (NETSSAF) URL [Accessed: 18.07.2019] PDFUganda Red Cross Emergency Response during the Cholera Outbreak
The International Federation of the Red Cross (IRFC) has been implementing PHAST in emergencies when volunteers are already trained and the toolkits already are available. During a Cholera outbreak in west Uganda, they applied steps one, two, three. For the first step, the IFRC conducted a rapid assessment to determine the knowledge, skills, and practices amongst household in relation to Cholera. For step two the IRFC analysed the problem through household visits and applied pole shorting of linking good and bad practices to disease, pocket charting of practices and behaviour, transmission route identification, and the last activity to explore blocking transmission routes. In step, the third step the IRFC monitored hygiene activities through weekly household visits and reached 5335 households. They found that the community participation is crucial in empowering the population.
GONZALEZ, L. KABURA, R. (2006): Uganda Red Cross Emergency Response during the Cholera Outbreak. Geneva: IFRC URL [Accessed: 13.11.2016]Hygiene Promotion in Emergencies
This Global Wash cluster manual provides training materials and handouts for facilitators to train hygiene prompters. It contains advice on hygiene promotion related non-food items selection and delivery. The WASH related non-food items briefing paper addresses maximizing benefits of the distribution of hygiene items, selection of hygiene items, guidance on distribution and tips for improving distribution of items, as well as suggestions for improved coordination.
GWC (2009): Hygiene Promotion in Emergencies. A Briefing Paper. New York: Global WASH Cluster URL [Accessed: 08.11.2016]Water, Sanitation, and Hygiene in Emergencies
The International Red Cross’s Health Guide Book provides a chapter providing guidance to improving water, sanitation, hygiene and vector control in emergency settings. It provides information on assessing needs in different phases, identifying the vulnerable group, and determine diseases to target. It provides guidance on disease transmission, community involvement in disease prevention with detail on the requirement in early emergencies phases.
JOHN HOPKINS UNIVERSITY IFRC (2008): Water, Sanitation, and Hygiene in Emergencies. Baltimore: John Hopkins University URL [Accessed: 14.11.2016]A Review of Evidence-based for WASH Interventions in Emergency Response/Relief Operations
This review discusses evidence on different approaches to Water, Sanitation, and Hygiene interventions contrasting the development context to the emergency content. Using reviews of cases, the report discusses the types of hygiene promotion interventions commonly applied and the approaches commonly applied. The report details the shift towards trend towards integrated approaches to after, sanitation, and hygiene. Requirements for effective hygiene promotion in emergencies are explored for different approaches to hygiene promotion as well as programming and implementation issues.
PARKINSON, J. (2009): A Review of Evidence-based for WASH Interventions in Emergency Response/Relief Operations. London: Atkins URL [Accessed: 14.11.2016]PHAST for an Emergency
PHAST Step-by-Step Guide: A Participatory Approach for the Control of Diarrhoeal Disease
This guide provides a detailed description of the approach and his related core elements. The seven-step approach guides the reader and user through all important aspects of the PHAST planning process. Furthermore, important participatory methods for planning activities are described and training materials are included.
WHO (1998): PHAST Step-by-Step Guide: A Participatory Approach for the Control of Diarrhoeal Disease. Geneva: World Health Organisation WHO URL [Accessed: 26.04.2019]2009 Annual Report
The Water Supply and Sanitation Collaborative Council's mission is to achieve sustainable water supply, sanitation and hygiene for all people in the world. This is the annual report 2009 of WSSCC.
WSSCC (2009): 2009 Annual Report. Geneva: Water Supply & Sanitation Collaborative Council (WSSCC) URL [Accessed: 18.06.2019]Hygiene and Sanitation Promotion
Somali PHAST Step-by-Step Guide
This guidebook is based on the WHO guidebook and provides the same information in a more compact form. It comes with selected participatory activities for the single planning steps
CARITAS SWITZERLAND/LUXEMBOURG - SWISSGROUP (2007): Somali PHAST Step-by-Step Guide. Geneva: CARITAS SWITZERLAND/LUXEMBOURG - SWISSGROUP URL [Accessed: 10.02.2010]The NETSSAF Participatory Planning Approach
This document presents an overview of some existing participatory sanitation planning tools, illustrating the scope of the steps and some of the common methodologies employed in the various frameworks.
NETSSAF (2008): The NETSSAF Participatory Planning Approach. South Africa: Network for the Development of Sustainable Approaches for Large Scale Implementation of Sanitation in Africa. [Accessed: 10.02.2010] PDFProspective Review of PHAST
The review also comments on the status of implementation of PHAST in the eastern and southern Africa region. Furthermore it provides some specific country information of selected African countries and presents concrete lessons learnt.
UNDP & WSP (1998): Prospective Review of PHAST. Nairobi: UNDP-World Bank Regional Water and Sanitation Group East and Southern Africa URL [Accessed: 19.06.2019]Hygiene framework
This document sets out WaterAid’s framework for hygiene promotion and behaviour change in the countries where it works. It will also help organisations that work on hygiene in the context of water, sanitation and hygiene (WASH) programmes.
WATERAID (2012): Hygiene framework. London: WaterAid URL [Accessed: 19.06.2019]Hygiene and Sanitation Software. An Overview of Approaches
In sanitation and hygiene programme and service delivery, several methods are used to engage target groups in development programmes to enable behavioural change and/or create a demand for services. These methods or approaches are generally referred to as ‘software’, to distinguish them from the provision of ‚hardware‘. This publication takes an in-depth look at the various hygiene and sanitation software approaches that have been deployed over the last 40 years in all types of settings – urban, informal-urban and rural, and aims to address such issues as what a particular approach is designed to achieve, what it actually comprises, when and where it should be used, how it should be implemented and how much it costs, etc.
PEAL, A. EVANS, B. VAN DER WOORDEN, C. (2010): Hygiene and Sanitation Software. An Overview of Approaches. Geneva: Water Supply & Sanitation Collaborative Council (WSSCC) URL [Accessed: 16.06.2019]The PHAST Initiative. A New Approach to Working With Communities.
In this document, the PHAST approach is explained from a methodological and historical point of view in a brief and concise manner.
WHO (1997): The PHAST Initiative. A New Approach to Working With Communities.. Geneva: World Health Organisation URL [Accessed: 22.04.2012]Hygiene and Sanitation Promotion
Improving nutrition outcomes with better water, sanitation and hygiene: Practical solutions for policy and programmes
This document, jointly prepared by WHO, UNICEF and USAID, summarizes the current evidence on the benefits of WASH for improving nutrition outcomes and describes how WASH interventions can be integrated into national nutrition policies and programmes to add value.
WHO WHO (2015): Improving nutrition outcomes with better water, sanitation and hygiene: Practical solutions for policy and programmes. Geneva: WHO URL [Accessed: 24.11.2015]Uganda Red Cross Emergency Response during the Cholera Outbreak
The International Federation of the Red Cross (IRFC) has been implementing PHAST in emergencies when volunteers are already trained and the toolkits already are available. During a Cholera outbreak in west Uganda, they applied steps one, two, three. For the first step, the IFRC conducted a rapid assessment to determine the knowledge, skills, and practices amongst household in relation to Cholera. For step two the IRFC analysed the problem through household visits and applied pole shorting of linking good and bad practices to disease, pocket charting of practices and behaviour, transmission route identification, and the last activity to explore blocking transmission routes. In step, the third step the IRFC monitored hygiene activities through weekly household visits and reached 5335 households. They found that the community participation is crucial in empowering the population.
GONZALEZ, L. KABURA, R. (2006): Uganda Red Cross Emergency Response during the Cholera Outbreak. Geneva: IFRC URL [Accessed: 13.11.2016]Participatory Hygiene and Sanitation Transformation (PHAST): A methodology for sustainable hygiene and sanitation behaviour change with experience from the Bawku West District of Ghana
Experiences with PHAST in western Ghana.
NUNOO, D., MUMUNI, O and NUKUNU, N. (2009): Participatory Hygiene and Sanitation Transformation (PHAST): A methodology for sustainable hygiene and sanitation behaviour change with experience from the Bawku West District of Ghana. Accra (Ghana): West Africa Regional Sanitation and Hygiene Symposium. URL [Accessed: 19.06.2019]Prospective Review of PHAST
The review also comments on the status of implementation of PHAST in the eastern and southern Africa region. Furthermore it provides some specific country information of selected African countries and presents concrete lessons learnt.
UNDP & WSP (1998): Prospective Review of PHAST. Nairobi: UNDP-World Bank Regional Water and Sanitation Group East and Southern Africa URL [Accessed: 19.06.2019]Participatory Hygiene and Sanitation Transformation (PHAST) prevent child parasitic enteric infections in Kyrgyz villages
This PowerPoint presentation deals with the connection between hygiene, water supply and an enhancement of the health situation in the Kyrgyz Republic.
WORLD BANK (n.y): Participatory Hygiene and Sanitation Transformation (PHAST) prevent child parasitic enteric infections in Kyrgyz villages. pdf presentation. WORLD BANK. [Accessed: 10.02.2010] PDFPHAST Step-by-Step Guide: A Participatory Approach for the Control of Diarrhoeal Disease
This guide provides a detailed description of the approach and his related core elements. The seven-step approach guides the reader and user through all important aspects of the PHAST planning process. Furthermore, important participatory methods for planning activities are described and training materials are included.
WHO (1998): PHAST Step-by-Step Guide: A Participatory Approach for the Control of Diarrhoeal Disease. Geneva: World Health Organisation WHO URL [Accessed: 26.04.2019]PHAST (Participatory Hygiene and Sanitation Transformation)
This chapter provides detailed information on PHAST with step by step guidance for implementation and respective activities and tools for each step of PHAST for emergencies. Application of PHAST in emergencies is also addressed. Core implementing activities and benefits and constraints of the Red Cross Red Crescent PHAST programs are detailed. Further resources and information is available by CD-ROM.
IFRC (2007): PHAST (Participatory Hygiene and Sanitation Transformation). In: IFRC ; (2007): The International Federation Software Tools for Water and Sanitation Programming. Geneva: 17-55. URL [Accessed: 02.01.2017]Introduction to the NETSSAF participatory planning approach - A tutorial and guideline for sustainable sanitation planning
The NETSSAF tutorial for sustainable sanitation planning introduces a participatory planning approach. It targets planners of sanitation programmes in West Africa and provides guidance in facilitating “informed choices” in consultation with users and other stakeholders.
Water sanitation hygiene
This link brings you to the official homepage of the WHO and its water and sanitation department.
