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 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


Seven steps to community planning for the prevention of diarrhoeal disease




1. Problem identification

1. Community stories
2. Health problems in our community

1. Unserialized posters
2. Nurse Tanaka

This step has two activities:

1. Community Stories is designed to help the group express important concerns and issues facing its community

2. Health problems in our community aims to focus discussion on health-related issues.

By the end of these two activities, the group should have identified the main issues facing its community and have decided if diarrhoea is a priority problem. It should also be interested in and willing to follow the process trough to the next step.

Activity 1: Community stories


· to enable group members to identify important issues and problems facing their community
· to help build a feeling of team spirit and mutual understanding
· to generate group self-esteem and creativity


· 1-2 hours


· tool: unserialized posters
· sticky tape

Sample unserialized posters

What to do

1. Ask the participants to form groups of 5-8 persons. Give each group a set of materials.

2. Give the groups the task using these words:

“Each group will choose 4 drawings from the set Working together, develop a story about your community using the 4 drawings you have selected. Give names to the people and to the place where the story is taking place. Your story should have a beginning, a middle and an ending.”

3. Give the groups about 15-20 minutes to make up their story.

4. When all the groups are ready, ask each group to tell its story to the other participants using the drawings it chose. Let the groups decide how they will tell their story to the other participants. Possible options include:

- a single person selected by the group
- a number of persons selected by the group
- participants act out their stories.

5. Invite the other participants to ask questions about the story and let the group answer them.

6. Once all the stories have been told, invite the group to discuss the main points of each story.

7. The following questions can be used to help stimulate the discussion, if the group is very quiet or silent:

- Are these stories about events happening now in this community?
- What issues were raised that could be considered to be problems in the community?
- How could these problems be resolved?
- What other (or similar) problems does your community face?

8. If the group did not come up with any problems related to water and sanitation, try the activity again using a set of drawings which are less general. Use instead a set of drawings which are more directly related to health and sanitation issues. Facilitate the activity in the same way as before.

9. 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. Let the small groups make up their stories by themselves. Do not offer guidance or assistance on what the subject of the groups' stories might be.

2. The purpose of this activity is to help the group express issues that are of concern to it. Don't worry if health issues are not directly identified. (The next activity will help the group to do this.)

3. If it appears that the group would like to work on issues which are not related to environmental sanitation, try to put it in touch with appropriate institutions, government departments, development agencies or nongovernmental organizations.

4. Groups will frequently find this activity stimulating and enjoyable, and may come up with two stories or ask for a second chance. If time permits, carry out the activity again since it may help you to discover important information about the 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.