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05 December 2018

Participatory Hygiene and Sanitation Transformation (PHAST) in Camps

Author/Compiled by
Juri Lienert (seecon international gmbh)
Luisa Muenter (cewas)
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).

Advantages
Extremely rewarding for both community members and community workers, by involving the communities in their project planning and implementation through participatory techniques.
Communities gain confidence and responsibility for their own projects and have a clear say in what they want and do not want.
Effective involvement of the community in monitoring and evaluation ensures that the services put in place respond to the needs of the community and that essential direct feedback provided can serve to change activities as necessary.
Trained community workers in participatory techniques, with proper guidance and management, can become a lasting asset to the program and the community (WORLD BANK 2007).
Disadvantages
Requires in-depth training of community workers in participatory techniques, including regular refresher courses. This has budget implications.
It is generally necessary to select experienced community workers to take part in the training. A basic two-weeks training does not guarantee that the community workers are able to successfully use the approach in their communities.
It requires an intensive management structure. This is feasible in smaller “grass-roots” projects but becomes problematic if the aim is to “go to scale” at a programmatic or national level.
Relatively time-intensive in their use. The approach requires that the beneficiary communities are available to go through the participatory exercises. This may be seen as a burden if not properly discussed with the community beforehand (WORLD BANK 2007). The core PHAST process generally takes six months to be implemented over a two-month period for emergency settings.
Factsheet Block Title
The Concept of PHAST
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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).

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The Seven Step Participatory Approach
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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).

 Figure 1: The Seven Steps to Community Planning of PHAST. Source: WHO 1998

The seven steps to community planning of PHAST. Source: WHO (1998) 

Factsheet Block Title
PHAST in Emergency Contexts
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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).

Applicability

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. 

Library References

Introduction to the NETSSAF Participatory Planning Approach, a tutorial and guideline for sustainable sanitation planning

This paper presents the NETSSAF participatory planning approach in a brief manner.

BARRETO DILLON, L. BUZIE FRU, C. ONADIPE, E. ROBERTI PÉREZ, L. (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: Network for the development of Sustainable Approaches for large scale implementation of Sanitation in Africa (NETSSAF). [Accessed: 02.04.2010] PDF

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]

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 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]
Further Readings

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] PDF

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]

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]

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]
Case Studies

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] PDF
Training Material

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]

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]

Alternative Versions to