Cover Image
close this bookPHAST Step-by-Step Guide: A Participatory Approach for the Control of Diarrhoeal Disease (PHAST - SIDA - UNDP - WB - WHO, 2000, 137 p.)
close this folderPart I: Introduction to the PHAST
close this folderPurpose and overview of the guide
View the documentWhy use this guide?
View the documentWho this guide is for
View the documentWhat PHAST tries to achieve
View the documentWhat are participatory methods?
View the documentWhy use participatory methods?
View the documentPHAST and empowerment
View the documentHow the guide is organized

Why use this guide?

“The project has not come a day too soon. It has been an eye-opener for the team. It provided us with an opportunity to observe at close quarters the health problems of the underprivileged, undernourished and deprived inhabitants of the slums. The team could observe the problems of slum-dwellers in depth. These people have the zeal, understanding and willingness to improve their lot. With a little initiative, constant follow-up and some services, they could do away with unsanitary conditions, fight diseases and improve the environment through this participatory approach.”

Comments received from community workers after field tests of this guide in India

How many times have you seen something being done for a community, although the community neither saw the need for it, nor supported it? Failure is likely in such cases. The participatory approach outlined in this guide aims to prevent such situations. The steps in the guide can help you to enable community members to work out what they want to do, how it should be implemented, how it should be paid for and how to make sure that the community can sustain it in the future.

The participatory process leads to programmes that are much more likely to be successful than those which impose solutions on communities. Take the time to read on and see how straightforward this approach is. It will involve a little more of your time now but will save you a lot of time in the future. It will be worth the effort on your part because you will have better results. You will find that the groups you work with will be much more interested and involved in the activities you undertake together.


More particularly, in terms of hygiene and sanitation, this guide:

- provides those working in water supply and sanitation with a new model for changing hygiene behaviour

- provides those involved in the prevention of cholera and other diarrhoeal diseases with a tool for empowering communities to eliminate such water and sanitation-related diseases

- provides community workers with methods that can lead to community management of water and sanitation facilities.

The participatory methods described in this guide will lead to knowledge/empowerment and responsibility on the part of the community with whom you work. So by using them, you can make an important contribution to the fight for better environments and better health.

Who this guide is for

This guide helps community workers to use a methodology for community hygiene behaviour change and to improve water and sanitation facilities. The name of this methodology is PHAST (Participatory Hygiene and Sanitation Transformation). It is based upon another participatory methodology called SARAR, which stands for Self-esteem, Associative strengths, Resourcefulness, Action-planning, and Responsibility. (See the inside back cover for details of how participatory approaches were developed.)

Before using this guide with communities, you must have received training in either PHAST or SARAR. (See inside front cover for information on training in participatory methods.) After training, the guide will serve as a reminder of how to facilitate each activity. Once you have become familiar with the sequence of activities, you will depend less on the guide.

If you are a project manager and interested in designing a participatory workshop for community workers, Tools for community participation: a manual for training trainers in participatory techniques, by Lyra Srinivasan, will provide you with further information.

What PHAST tries to achieve

PHAST seeks to help communities:

- improve hygiene behaviours
- prevent diarrhoeal diseases
- encourage community management of water and 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 facilities.

The methods for achieving these goals are called participatory methods.

What are participatory methods?

Participatory methods encourage the participation of individuals in a group process, no matter what their age, sex, social class or educational background. They are especially useful for encouraging the participation of women (who in some cultures are reluctant to express their views or unable to read and/or write.) Participatory methods are designed to build self-esteem and a sense of responsibility for one's decisions. They try to make the process of decision-making easy and fun. They are designed for planning at community level. Participants learn from each other and develop respect for each other's knowledge and skills.

Why use participatory methods?

Participatory methods have succeeded where other strategies have failed. They are based on principles of adult education and have been field-testing extensively.

Field experience has shown that participatory methods can lead to a far more rewarding experience for community workers. Having tried participatory techniques and found the experience worthwhile, community workers usually do not want to return to their earlier methods.

The activities in this guide are based on principles of participatory learning for sanitation change. These principles are explained in a companion volume in this series entitled The PHAST initiative: Participatory Hygiene and Sanitation Transformation. A new approach to working with communities. (See References.)

PHAST and empowerment

The PHAST approach helps people to feel more confident about themselves and their ability to take action and make improvements in their communities. Feelings of empowerment and personal growth are as important as the physical changes, such as cleaning up the environment or building latrines. These personal development principles are well illustrated by the following quotations from people who have participated in a PHAST activity.

“I've been to a lot of community meetings over the years but have never been able to speak out. Because I can't read and write I lacked confidence. But with these methods I feel confident to speak. When I see a drawing of a problem in our community, I say to myself, “I know this problem and I can speak about it.””

“I used to think it was somebody else's problem and wait for others to do something. Now I don't want to wait, I want to start work now!”

“All my life people have been coming here and telling us what to do. This is the first time anyone ever listened to what we think.”

So it is important to evaluate the overall results of the activities both in terms of sanitation improvements and empowerment. Communities can find it very difficult, though, to evaluate their progress in terms of behaviour changes, improvement in facilities, such as clean properly functioning latrines, and effective use of these facilities. The guide therefore includes activities to enable a community group to evaluate its progress. This would be internal evaluation. Sometimes, an outside or external evaluation to provide specific information, perhaps for comparison with another programme, may also be required. If this is the case, you may need to involve someone with the skills to collect this information and to write a report of their findings. You should find out if information of this kind is needed before you start work with your community group. If so, a participatory approach to monitoring and evaluation should be used by the person(s) who will collect the information. They should be involved from the very start, attend all the meetings and be treated in the same way as any other participant. The outside evaluation person should involve the community as much as possible in information collection and most importantly report any findings to the group in a way it will understand and find interesting.

Suggestions for designing an external evaluation can be found in Hygiene evaluation procedures: approaches and methods for assessing water- and sanitation-related hygiene practices. (See References.)

Key definitions

A step may contain one or more activities, aimed at achieving one overall objective.

An activity is what the group works through in order to discover the information and skills necessary to reach understanding or take a decision.

A toolkit is the set of materials (such as drawings) that the facilitator uses as visual aids for facilitating activities. Different participatory toolkits can be created - for example, one for diarrhoeal diseases, another for nutrition and another for AIDS. Part III provides guidance on how to create a toolkit.

Tools are the techniques and materials used by the facilitator to help the group work through an activity. They should be adapted to the environment and circumstances of the group you are working with. You can also add to them on the basis of your own experience. See Part III for lists of sample drawings.

How the guide is organized

The guide has seven steps. The first five help you take the community group through the process of developing a plan to prevent diarrhoeal diseases by improving water supply, hygiene behaviours and sanitation. The sixth and seventh steps involve monitoring (that is, checking on progress) and evaluation. The information gained from these activities is used to work out whether the plan has been successful.

Each step contains between one and four activities. Instructions on how to facilitate each activity are provided under the following headings:

- Purpose
- Time
- Materials
- What to do
- Notes.

Most of the activities require the use of drawings or a chart, called “tools”, to help facilitate the discussion.

The diagram shows the seven steps, outlines the activities of each and the tools used. You may wish to tick off the activities and tools as you complete them.

Seven steps to community planning for the prevention of diarrhoeal disease