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View the documentPromoting sanitation through community participation in Bolivia - Betty Soto T.1
View the documentStrengthening a rural sanitation programme using participatory methods in Uganda - John Odolon1

Strengthening a rural sanitation programme using participatory methods in Uganda - John Odolon1

1 Network for Water and Sanitation (NETWAS), Entebbe, Uganda.

The Rural Water and Sanitation (RUWASA) Project (Phase I) of the Ugandan Government was started in January 1991 with the aim of improving the standard of living of various rural populations by reducing diseases related to unsafe water and poor sanitation.

Specific objectives included the following:

- to provide protected water sources and hygienic sanitation facilities to the population in the project area; and

- carry out information, education, and training activities for both project-level staff and users aimed at adoption improved hygiene behaviour.

Problems faced by the RUWASA Project in 1993

In 1993, the findings of the Joint Review Mission,2 project monitoring reports and studies, as well as observations by project visitors, indicated that the efforts of social mobilizers (health assistants and community development assistants) were not bringing about the desired behaviour, especially at the level of the water-user committees (WUC). In particular:

· WUC members could not easily identify who was using their water source.

· Precise details of the sanitation situation of the water users were not known.

· There was a tendency for the community to rely heavily on external support (from health workers, RUWASA or NGOs) to identify and provide interventions for sanitation and hygiene problems.

· There was hardly any evidence of extensive practice of hygienic behaviour, for example, handwashing, after latrine use.

2 The RUWASA Joint Review Mission, an independent body that does not include project staff, is part of the project's monitoring and evaluation mechanism. Membership includes: Ministry of Health (Departments of Environmental Health and Health Education), Ministry of Gender and Community Development, Ministry of Finance/Planning, Consultants (Engineers and Socio-Economists), and DANIDA.

So what was the problem? Partners' participation at household and community level had been limited to providing cheap labour and available materials. It was assumed that, having been duly instructed on their roles, the WUC would ensure water source maintenance and the practice of hygienic behaviour.

A closer look at the mobilization and training techniques revealed that the approach did not adequately equip the mobilizers with the necessary skills to bring about participation or a sense of ownership at community level. The training methodology was mainly didactic, interspersed with classroom-based discussions, role playing and video shows on operation and maintenance. The result was that the WUCs had little contact with the realities of hygiene, sanitation, and the water use and behaviour around them.

Response to the problems identified

On the recommendation of the Joint Review Mission, and in collaboration with WHO and with SARAR training experts from the UNDP/World Bank Regional Water and Sanitation Group in Nairobi, the project undertook to develop and try out PHAST participatory tools. A Guide for training water user committees using participatory tools was developed to assist the social mobilizers in their training activities. A pilot project was carried out in Mukono District, and on the strength of its success, the participatory training methodology was extended to cover the other districts where RUWASA was active. The subjects covered included community map-building, hygiene education, WUC responsibilities, and evaluation. The designed training was not limited to hygiene education and sanitation. The tools used were:

- mapping;
- sanitation ladder;
- poster and picture activities for discussion of faecal routes and barriers;
- gender task analysis;
- story with a gap; and
- other planning exercises.

(See Table 1 for more detailed description of the tools.)

Results of using the PHAST participatory approach

The principal benefits of using the PHAST participatory methodology were that the WUC and other community members actively participated in discussions related to sanitation, hygiene behaviour, water source maintenance, gender, and planning. The use of pictorial illustrations facilitated and generated discussion. This was a positive departure from the previous didactic approach.

The community members demanded the tools so that they too could train others. This reflected a feeling of empowerment: community members wanted to take charge of project activities themselves. It also showed that the tools were easy to understand and use at grass-roots level. Lessons learned included:

· The methodology is user-friendly.

· The methodology is interesting, provokes discussion, and brings out real-life experiences that cannot be brought out using traditional training methods.

· The approach is learner-centred, empowering the learner to think, and to identify and address (find solutions to) problem situations.

· The methodology eases work on the side of the trainer-facilitator.

· The methodology can be used in a structured manner, as in the RUWASA Project, or in a non-structured manner (e.g. Water Aid and KUPP use informal community members who are trained to train other community members).

· Training is continuous at the community level.

Table 1. Description of participatory tools

Tool

Description

Mapping

Group participants use whatever materials are available to them to create a map of their community showing its water-supply sources and sanitation facilities. This helps communities to visualize their overall situation. The simplest method is to use a stick to draw in the earth. If paper is available to the group, it can draw on this and stick cloth, feathers, beads, and seeds, etc. to it, for the purposes of illustration. The group then uses this map as a discussion point to look more deeply into the water and sanitation issues that the community is facing. This activity is an investigative one and helps the group to identify important issues.

Sanitation ladder

This uses a set of pictures or photos of different sanitation options. Participants arrange these on a scale from worst to best, like steps on a ladder. They identify their own situation and look at the merits and feasibility of moving up the scale (ladder).

Poster and picture activities for discussion of faecal routes and barriers

This activity starts with a set of posters-pictures showing different ways in which faecal-oral contamination can occur. Participants organize these pictures based on what they know about diarrhoeal disease transmission. The second part of the activity involves working out how these transmission routes can be blocked. To help with this part, participants are provided with pictures of common “barriers” (both technological and behavioural) that can be used to block any of the transmission routes of faecal-oral disease. The “barriers” are then looked at and classified according to their effectiveness and practicality.

Gender task analysis

This activity involves group participants sorting a set of pictures which depict normal household and community tasks on the basis of who would normally perform them: a man, a woman, or a man and woman jointly. This activity enables the group to objectively assess the way tasks are distributed by gender. It highlights any disproportion between the tasks done by men and those done by women.

Story with a gap

Members of the group use two pictures, one showing a “before” scene (a problem situation) and the other showing an “after” scene (a greatly improved situation or the problem's solution). The group uses these two pictures to stimulate discussion on the steps that would have been involved in moving from the “before” situation to the “after” situation. In this way, they fill in the “gap” in the story. This is a useful planning tool for group participants because it helps to simplify the planning process by breaking it down into a series of steps.

Three-pile sorting

Participants sort pictures or photos of hygiene- and sanitation-related situations, according to whether they are considered “good”, “bad” or “in-between”.

Assessment of the tools used

Table 2 overleaf shows the tools that were pretested and adapted by the project, and the experience of their use.

Outcomes of the RUWASA Project

To closely monitor the effect of using the PHAST participatory methodology for training at the grass-roots level, the mobilization and training units of the project followed up 19 WUCs in three different subcounties of Ikumbya (Iganga District), Bussede (Jinja District), and Kauga (Mukono District). A checklist of indicators of good WUC performance was drawn up as follows:

- proper record of water source users;

- existence of operation and maintenance funds, collection and use;

- existence of caretakers (for preventive maintenance and hygiene education);

- good general condition of the water sources (fencing, cut grass, soakaway, drains); and

- hygiene education activities (e.g. production of posters on hygiene).


The following observations were made:
- 79 per cent of WUCs had updated lists of water source users;

- 64 per cent of WUCs had collected and were using operation and maintenance funds to pay handpump mechanics, and buy grease and spares;

- 71 per cent of WUCs had proper records related to using operation and maintenance funds;

- 100 per cent of caretakers had spanners and were carrying out preventative maintenance;

- 15 per cent of the WUCs remunerated their caretakers with Shs 800-2000 (US$ 0.90-2.10);

- 100 per cent of WUCs had hygiene and sanitation messages embedded in their bylaws (for example, stipulation of use of clean utensils for collecting water) but there was no indication of direct intervention, such as meetings on hygienic behaviour; and

- 5 per cent of WUCs had an updated list of latrine and sanplat coverage of its water users as a basis for follow-up on sanitation activities.

Table 2. Pretested tools adapted by the project

Tool

Experiences

Unserialized posters, photo parade

Easy to use as starters

Community mapping

Very good for establishing base-line - sanitation, infrastructure, etc.

Sanitation ladder

Easily understood and used; also establishes sanitation base-line

Faecal routes

Useful to start off a hygiene education discussion

Faecal barriers

Enables community members to think of solutions to hygiene problems that are within reach

Gender task analysis

Evokes lively discussion, which is difficult to halt; brings to light gender roles and distribution; ice breaker

Story with a gap

Eases planning discussions

Three-pile sorting

Useful for hygiene behaviour discussion

Health case study

Not much used

Roles and responsibility chart

Has been applied with success in RUWASA area by mobilizers

A total of 18 homes of water users were visited. Of these, latrine coverage was 89 per cent: 72 per cent of the latrines were hygienic (clean floor with sanplats), and 6 per cent had a hand-washing facility. The availability of these data contrasted sharply with the previous situation when it was difficult to obtain accurate information at the WUC committee level.

Acceptance of participatory approaches at institutional level

So far, the acceptance and use of the PHAST participatory methodology has largely been limited to water and sanitation projects. At policy level (ministries or agency headquarters), the Ugandan Ministry of Health supports the Uganda Community Based Health Care Association, which uses a lot of PRA approaches, although support is still very limited. The methodology is sometimes thought to be time-wasting! Training institutions, such as the Nzamisi School of Social Development and the School of Hygiene, Mbale, have embraced this methodology, especially for the practical training of students in the field.

Generally, decision-makers exposed to the methodology have shown serious interest and implicitly supported its use.

Acceptance at the community level

The communities appreciate use of the PHAST approach during training. In the RUWASA Project area, WUC members have requested PHAST tools because they would like to use them to mobilize other community members! They have been spurred into action.

Reactions of other community members

· There is full community participation in discussion, irrespective of gender, social status or educational levels.

· Communities have recommended the use of PHAST for all training activities and that everyone should be trained using this approach.

· The participation in training is consistent throughout the period.

· During community-level meetings, tasks are allocated and sanctions agreed on for non-performance.

· Some behaviour changes have been observed, including handwashing.

· The general level of cleanliness has improved.

Constraints experienced

· Supervisors and policy-makers not exposed to the methodologies have shown a lack of support.

· Tools have not been durable enough, although lamination has been tried out with some success.

· Artists who draw pictures for the participatory tools are not always available and need training when present.

· Producing materials on a small scale is expensive.

· Training costs may be prohibitive, since a full-scale workshop requires about 10 working days.

· The participatory approach is time-consuming.

Conclusion

The RUWASA Project experience has largely consisted of re-activation of the roles of WUC committees, extension workers, and their supervisors.

Over the last two years, PHAST participatory techniques, based on the SARAR methodology, have been successfully tried out, to bring about community-level transformation of hygiene practices related to sanitation, and water collection, storage, and use.

Information on participatory approaches can also be found in the following articles: Participatory approaches to hygiene behaviour-change and sanitation, The PHAST initiative, and Using participatory methods to promote sanitation in Bolivia.

Background reading

SDC. Participatory rural appraisal (PRA): working instruments for planning, evaluation, monitoring and transference into action (PEMT). Berne, Swiss Directorate for Development Cooperation and Humanitarian Aid, 1993.

Pretty JN et al. A trainer's guide for participatory learning and action. London, International Institute for Environment and Development, 1995 (Participatory Methodology Series).

Simpson-Hrt M, Sawyer R, Clarke L. The PHAST initiative: participatory hygiene and sanitation transformation, a new approach to working with communities. Geneva, World Health Organization, 1996 (unpublished document WHO/EOS/96.11).

Srinivasan L. Option for educators: a monograph for decision makers on alternative participatory strategies. New York, PACT Communications Development Service Inc., 1992. (PACT can be contacted at: 777 UN Plaza, New York, NY 10017, USA.)

Srinivasan L. Tools for community participation: a manual for training trainers in participatory techniques. New York, UNDP, 1990, (PROWWESS/UNDP Technical Series Involving Women in Water and Sanitation).