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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 II: Step-by-Step Activities
close this folderStep 1: Problem identification
View the document(introduction...)
View the documentActivity 1: Community stories
View the documentActivity 2: Health problems in our community

Activity 2: Health problems in our community


· to help identify important health problems in the community and to discover which of them can be prevented through community action


· 1-1½ hours


· tool: Nurse Tanaka
· pins, tacks or sticky tape
· pens and paper
· coloured stickers (optional)

Sample drawings for nurse Tanaka

What to do

1. If there has been a break between this activity and the previous one, start with a group discussion to review what was learned or decided at the previous meeting.

2. This activity can be carried out in a single group if does not contain more than 30 people. If the group is larger than this, you will need to split it into small groups. It is best to have enough drawings so that each person can participate.

3. Put up a drawing showing a health centre and a health worker such as a doctor or nurse. Give the drawing of the health centre the name of the nearest local health centre with which the group is familiar.

In many societies people go to traditional healers in addition to, or instead of, a health centre. If this applies to the group you are working with, include a drawing of a local traditional healer along with or instead of the health worker. Participants can then choose either the health worker, or the traditional healer, depending on who they would normally see when they suffer from particular symptoms or illnesses.

4. Show the drawings of the different people to the group. Give the group the task using these words:

“These people are coming to visit Nurse/Doctor [say local name] at the [say local name] health centre. Choose one drawing each and come and stick your person next to the health centre and explain why the person is visiting the health centre.”

5. Once all the drawings of people have been used, ask the group the following question:

“Are there any problems that we have forgotten?”

Record any additional problems that participants mention.

6. If the group is literate, ask a participant to write down on small strips of paper the reason why each person is visiting the health centre, and stick these next to the person. The writing should be large enough for all the group to see.

7. Now ask the group the following question for each problem identified:

“Do you have any ideas about why people might have [state the problem]?”

The group should be able to remember its answers but they can also be written down next to the problem if the group wishes.

If participants have questions about the causes of diseases, redirect them to the group to find out what other participants think. If the group cannot come up with certain answers, ask it to identify a way of obtaining the necessary information.

8. Continue the group discussion but this time ask the group to think about what it could do to deal with the causes of the problems. Go through the causes one at a time. Ask the group the following question:

“Does anyone have any ideas about how this problem could be prevented?”

Again, the group should be able to remember this information, but it could also be written up next to the causes.

9. Ask the group to sort the problems into those which could be prevented by community action and those which will continue to require treatment at the health centre.

10. Ask the group to identify and highlight those problems which could be prevented and which it thinks are related to water, sanitation and hygiene practices.

Underline words or use coloured stickers on the figures to show which problems the group thinks are related to these factors. Use local descriptions for the technical terms, for sicknesses, and for specific sanitation and hygiene practices.

11. Facilitate a discussion with the group on what it has learned during this activity, what it liked and what it did not like about this activity.


1. If the group describes symptoms (stomachache, fever, etc.) rather than naming specific diseases or conditions, this is OK.

2. Don't worry if the group “misses out” what you think are important diseases. This is a discovery in itself. It means that you will need to consider how to help the group discover this information by itself. Do not suggest diseases you know of and think the group has missed. Let the group make suggestions based on its knowledge and experience.

3. If participants hesitate to choose between the nurse/doctor and the traditional healer, you can help by reminding them that the type of health problem, not the choice of healer, is what is important.

4. This activity may have shown you that the group lacks health knowledge. If this is so, the next step will be to help the group find out for itself how disease can be spread by: the way people handle water; the way human waste is disposed of and personal hygiene behaviours.

This new knowledge may make the group change its opinion of how disease can spread through its community through its hygiene and sanitation practices.