The International Federation Software Tools For Long-Term Water and Sanitation Programming

The International
Federation software tools

for long-term water and
sanitation programming
© International Federation
of Red Cross and Red Crescent Societies
Any part of this handbook may be cited, copied, trans-

lated into other languages or adapted to meet local
The International needs without prior permission from the International

Federation of Red Cross and Red Crescent Societies, pro-
vided that the source is clearly stated.
Federation’s Global The maps used do not imply the expression of any opinion
Agenda on the part of the International Federation of Red Cross

and Red Crescent Societies or National Societies concern-
ing the legal status of a territory or of its authorities.
(2006–2010) Cover photo: Andrew McColl/International Federation
Over the next five years, the collective focus of

the Federation will be on achieving the following
goals and priorities:
Special thanks to all who have helped to make this publi-
cation possible. Especially Mimi Khan, Mary Mwangi
Our goals and Rebecca Kabura.
Goal 1: Reduce the number of deaths, injuries

and impact from disasters.
Goal 2: Reduce the number of deaths, illness-

es and impact from diseases and public health
emergencies.
Goal 3: Increase local community, civil society

and Red Cross Red Crescent capacity to address
the most urgent situations of vulnerability.
Goal 4: Promote respect for diversity and

human dignity, and reduce intolerance, discrim-
ination and social exclusion.
Our priorities
Improving our local, regional and international
capacity to respond to disasters and public
health emergencies.
Scaling up our actions with vulnerable commu-

nities in health promotion, disease prevention
and disaster risk reduction.
Increasing significantly our HIV/AIDS pro-

gramming and advocacy.
2007
Renewing our advocacy on priority humanitari- International Federation of
Red Cross and Red Crescent Societies
an issues, especially fighting intolerance, stigma
and discrimination, and promoting disaster risk P.O. Box 372
reduction. CH-1211 Geneva 19
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E-mail: secretariat@ifrc.org
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The International Federation software tools for water and sanitation programming | 1
Contents
Glossary 10
Background 10
Chapter 1 Hygiene promotion and behaviour change 10
Chapter 2 Community management 10
Chapter 3 PHAST 10
Introduction to PHAST 10
PHAST Training 10
PHAST deployment 10
PHAST in emergencies 10
PHAST toolkit 10
Chapter 4 Additional PHAST tools for Red Cross and Red Crescent
water and sanitation programming 10
Gender checklist 10
Monitoring and evaluation tools 10
2 | International Federation of Red Cross and Red Crescent Societies
Background
Glossary
ARCHI African Red Cross Health Initiative
Hardware and software in water
and sanitation programming
CBFA Community-Based First Aid Lack of access to safe water, basic sanitation and poor hygiene
practices are a major cause of disease and death among many
CBO Community-Based Organization
of the world’s poor. Recognizing this fact, the International
DREF Disaster Response Emergency Funding Federation of Red Cross and Red Crescent Societies assists vul-
nerable communities to gain access to safe water supply and
GWSI Global Water and Sanitation Initiative
sanitation while encouraging improved hygiene practices, both
GWA Gender and Water Alliance in times of disaster and in the longer term developmental con-
text. Since 1994, International Federation water and sanitation
HQ Headquarter
efforts have served over 9 million people worldwide, and dur-
IDP Internal displaced person ing the period up to 2015, the Federation intends to increase
this figure significantly.
IEC Information, Education and Communication
ME Monitoring and Evaluation The International Federation advocates the integration of hard-
ware and software for water and sanitation interventions. In
NDRT National Disaster Response Team
this context, “hardware” is defined as the engineering in-
NGO Non-Governmental Organization puts related to appropriate equipment and construction, such
as tanks, pipes, pumps and latrines. “Software” can be de-
OM Operation and Maintenance
fined through activities in the areas of hygiene promotion, local
PHAST Participatory Hygiene capacity-building, stakeholder involvement, monitoring and
and Sanitation Transformation evaluation of impact and encouraging behavioural change, in
order to ensure that water and sanitation systems deliver the
PRA Participatory Rural Appraisal optimum and most sustainable health and social benefits to the
RDRT Regional Disaster Response Team end users.
ToT Training of Trainers The 2003 water and sanitation policy states:
UNDP United Nations Development Programme
WASH Water, Sanitation and Hygiene The International Federation and each National Society shall re-
alize that the hardware (e.g. pumps, pipes) aspects of water and
WHO World Health Organization sanitation interventions are easier to implement compared to the
software aspects. Hygiene promotion (hygiene education, commu-
nity participation and management etc.) must be established par-
allel to, if not, before introducing the hardware. Hardware
installations need to be sustainable for the community with the
ability to maintain them leading to long-term ownership. This
will ensure best possible community ownership, management and
commitment. In emergencies minimum aspects of hygiene promo-
tion need to be established.
This integrated approach has been adopted by International

Federation under the GWSI (Global Water and Sanitation Ini-
tiative 2005) establishing a set of criteria that should be met
by all the Red Cross Red Crescent water and sanitation players.
Software component – This is an ‘umbrella term’ used within the GWSI framework to cover
a range of strategies aimed at preventing water and sanitation-related diseases and optimizing the short-
term effects of water and sanitation interventions. It includes the use of community participation meth-
ods and social marketing strategies to promote health and hygiene behaviour, and should also encom-
pass the community management of engineering installations, which is important for effective buy-in
and medium- to longer-term sustainability.
Software component
Behavioural change
Community management
(hygiene promotion)
Community management refers to community control and ownership of water and sanitation sys-
tems. This is crucial since the aim is to make the community accept responsibility for maintaining their
water systems. Community management covers two areas:
1. Community operation and maintenance (OM): Basic WASH (Water, Sanitation and Hygiene)
knowledge and technical and managerial skills at Red Cross Red Crescent and community level
should be established and, or improved. The training and expanding of community skills often
increase levels of confidence and ownership within the community and ensure better delivery of
services.
2. Community contribution to cost (operating and capital): Resource mobilization is vital to de-
veloping sense of ownership within the community and makes the water system durable since
the community assumes responsibility for maintenance. A combination of legal ownership, work
and economic contribution strengthen the identity that the community has with their water sys-
tem. The community should establish the rules, regulations and sanctions and put such practices
in place to ensure sustainability and scaling-up.
Behavioural change relates to hygiene and means not just having a sense of ownership for pipes
and tanks, but also having a general view of the health problems in the community due to unsafe water,
inappropriate sanitation and hygiene practices. According to UNICEF (1999), hygiene promotion con-
sists of a planned approach to preventing diarrhoeal diseases through the widespread adoption of safe
hygiene practices.
Experience has showed that PHAST – Participatory hygiene and sanitation transforma-
tion, acts as the backbone of software activities since, throughout the seven steps, the two core soft-
ware elements, (hygiene promotion and community management), are widely addressed.
When implementing steps one and two, the community gains a basic understanding of the health im-
plications of poor water supply and sanitation and learns to identify health problems, due to unsafe
sanitation and hygiene practices. During steps three and four, the community develops a belief in their
ability to solve their own problems and is empowered to make environmental improvements. All these
elements provide the community with a very strong sense of ownership. During the next phase, the
community is able to set up their own management system, select the principles for appropriate and suit-
able operation and maintenance practices, and commit towards behavioural change.
Depending on the scenario, PHAST should be used as a very dynamic and flexible methodology since
the sessions might include more or less emphasis on community management or behavioural change.
Moreover, additional activities might be implemented such as, large-scale hygiene promotion campaigns
in those scenarios where illness and death are more often linked to poor sanitation and hygiene, than
to inadequate water supply. In these cases, the software component should be strongly linked to the
health sector. Water and sanitation should be clearly-defined within the health initiative, and treated as
one of the most important aspects of preventive/public health. In fact, the International Federation’s
basic health policy has underlined the need for water and sanitation to be part of the public health
structure within the National Societies, as part of their health and care agenda.
In those scenarios where there is no access to safe water and appropriate sanitation services due to a lack
of management, the software component should be strongly linked to the hardware planning process,
bringing together the community and engineering aspects of the project. The selection of appropriate
technical options and management system should involve the community through a participatory
process in which the community is an active partner and not simply a passive recipient. Partnership helps
to sustain a project because it confers dignity and a sense of value on the vulnerable. When they realise
that they can do, and achieve things for themselves, they learn how to replace wrong behaviours with
right ones.
This guide
This water and sanitation software guide and the tools included in the CD-ROM, should be used in
conjunction with a water and sanitation project in which the software component has to be developed.
The package contains a technical guide which provides the basic and generic guidelines to implement
the software programme and a set of general references and tools to better accomplish the dif-
ferent steps of the process. These tools are included in a separate CD-ROM to be used alongside these
guidance notes.
This technical guidance does not contain theory and principles of hygiene promotion, community
management, participatory processes and community mobilization, since there are many excellent man-
uals and guides which cover these aspects; (a broad representation of these is contained on the CD-
ROM)
The Red Cross Red Crescent experience, particularly in the last decade, shows that most field workers
address water and sanitation developmental interventions with an increasing degree of participatory ap-
proaches and methodologies, ensuring that the target communities determine their own health priori-
ties and how they intend to tackle them.
The target audience of this manual is those Red Cross Red Crescent workers currently engaged in the
water and sanitation or public health sector. Its aim is to give key guidelines on implementing the soft-
ware component of water and sanitation programmes; to better reduce or contain water, sanitation and
hygiene-related morbidity and mortality through participatory processes, as much as practicable; and
to improve the community management system of the water and sanitation facilities.
Chapter 1
Hygiene promotion and behaviour change
What is hygiene?
Definition 11: outsider’s view or scientific perception
It is the study of health and observance of health rules and measures of preserving health. Hygiene is
the practice of keeping one’s self and one’s surroundings clean, especially to avoid illness and the spread
of infection. It focuses on diseases which are spread by the faecal-oral route, particularly the diarrhoeal
diseases which kill two to three million children under five each year. Research has shown that changes
to a very few practices can have a huge impact.
Definition 2: insider’s view or the perception of the actors themselves

Most people don’t usually practise hygiene for health reasons. There are other motivations such as, a
general dislike of dirt, an aesthetic preference for cleanliness, a desire to protect their children and them-
selves from dangerous, external influences, or, (most commonly of all), considerations of status, self-re-
spect and social standing.
What is hygiene behaviour?

Boot and Cairncross (1993) defined hygiene behaviour as the wide range of actions associated with the
prevention of water and sanitation-related diseases. Hygiene behaviour involves five areas of health, also
known as the five hygiene domains. These are:
Elaborate table on the five hygiene domains

Cluster of hygiene practices Relevant features and activities
Sanitation excreta disposal Location of defecation sites
(Cluster A) Latrine maintenance (structure and cleanliness)
Disposal of children’s faeces
Hand washing at critical times (after cleaning children’s
bottoms; after handling children’s faeces; after defecation)
Use of cleansing materials
Water Protecting of water source(s)
Water sources Location of latrines in relation to water source
(Cluster B) Maintenance of water source
Water use at the source
Other activities at the water source
Water collection methods and utensils
Water treatment at the source
Methods of transporting water
Water Water-handling in the home
1. Definition 1 and 2: Sandy Water uses Water storage and treatment in the home
Cairncross and Valerie Curti.
London School of Hygiene and (Cluster C) Water use (and reuse) in the home
Tropical Medicine.
Hand washing at critical times (before or after certain

activities, including religious rituals)
Washing children’s faces
Bathing (children and adults)
Washing clothes
Food Food handling or preparation
Food hygiene Utensils used for cooking, serving food, feeding young
(Cluster D) children, and for storing left over food
Hand washing at critical times
(before handling food, eating, feeding young children)
Reheating of stored food before serving
Washing utensils and use of a dish rack
Domestic environment Sweeping of floors and courtyards
and environmental hygiene Household refuse disposal
(Cluster E) Cleanliness of footpaths, play areas and roads
Management of domestic animals
(Cattle, dogs, pigs, chickens)
Drainage of surrounding areas (location of stagnant water
and other mosquito-breeding sites)
Condition of housing
What is hygiene promotion?

According to UNICEF (1999), hygiene promotion is a planned approach to preventing diarrhoeal dis-
eases through the widespread adoption of safe hygiene practices. It begins with, and is built on, what
local people know, do and want.
Hygiene promotion encourages all the hygienic conditions and behaviours that can contribute towards
good health. It aims to stimulate and facilitate the right behaviour change. Research has shown that hy-
giene-related practices such as safe disposal of faeces and hand washing after contact with faecal mate-
rial can reduce the rates of intestinal infection considerably. Consider the following figures:
■ There is now conclusive evidence that simple, acceptable, low-cost interventions at the house-
hold and community level are capable of dramatically improving the microbial quality of house-
hold stored water and reducing the attendant risks of diarrhoeal diseases and death.
■ Hand washing with soap and water can reduce diarrhoeal disease by 35 per cent or more.
■ Hand washing can also help to reduce the prevalence of eye infections such as conjunctivitis and
trachoma.
■ Pit latrines, when used by adults and for the disposal of young children’s stools, can reduce di-
arrhoea by 36 per cent or more.
■ Protection of water from faecal contamination can also reduce diarrhoea, because some diar-
rhoeal infections are water-borne. Improved water quality can be associated with up to a 20 per
cent reduction in diarrhoea.
■ Increased quantity of water used, which results from better access to water, can bring about a 20
per cent reduction in incidence of diarrhoeas.
Hygiene promotion vs. health promotion

Hygiene promotion is more specific and more targeted than health promotion. It focuses on the re-
duction and ultimately the elimination of diseases and deaths that originate from poor hygiene condi-
tions and practices. For example, good hygiene conditions and practices are enhanced when people can
consume water that is safe, use sufficient amounts of water for personal and domestic cleanliness, and
dispose of their solid and liquid wastes safely. However, a person may have good hygiene behaviour, but
not be healthy for other reasons. Good or bad health is influenced by many factors, such as the envi-
ronment (physical, social and economic).
Hygiene promotion vs. hygiene education

Education usually means ‘teaching people’, e.g., about what makes them ill and what they must or must
not do. Often it is didactic(tending to lecture others excessively). In the case of hygiene education for
example, the educators may want to teach people the germ theory of disease in order to discourage
transmission through unhygienic practices. Such information has its place, e.g., when people themselves
want to know how they can avoid getting a particular disease.
However, successful hygiene promotional programmes ‘do not instruct people’. They promote healthy
conditions and practices in others, usually more effective ways than ‘teaching’, e.g., social marketing, par-
ticipatory learning, and peer influence. In hygiene promotion, the individuals and communities them-
selves review their hygiene practices and develop ways of improving them. ‘Hygiene promotion begins
with what people know and builds on their existing knowledge ’. In other words, hygiene promotion
includes strategies that encourage or facilitate a process whereby people assess, make considered choices,
demand and sustain hygienic and healthy behaviours.
In hygiene promotion, there is always a hardware aspect to any promotional activity. This relates to im-
proved water and sanitation facilities, such as:
■ improved sanitation facilities, (latrines, garbage disposal pits, waste water drainage etc.);
■ improved water facilities; and
■ for environmental sanitation to be successful, vector control (techniques to enable individuals to
take action against diseases carried by insects and other vectors) and eradication should also be
undertaken.
On the other hand, hygiene promotion refers to the combination of, and linkages or relationship be-
tween the hygiene domains and the improved facilities. Without one, the other cannot succeed.
What is hygiene behaviour change?

Hygiene behaviour change is the action of replacing current unsafe hygiene practices with improved be-
haviour. Those who plan and manage hygiene promotion programmes often want to promote hygiene
by educating people on the links between good hygiene and better health. However, local people them-
selves often do not see the health benefits as the primary reason to change their behaviours. There is the
paradox that for the quickest and widest adoption of new behaviours, it is often better to rely on social
ambitions than on health arguments to motivate people to adopt better hygiene practices. Conven-
ience, status, esteem and financial gain are the stronger driving forces that affect people’s decisions on
many aspects of their lives.
According to the BASNEF model2, an individual will take up a new practice when he/she believes that
the practice has sufficient benefits – beliefs: culture, values, traditions, mass media, education experi-
ences, etc. – and then he/she will develop a positive attitude to the environment. Positive or negative
influence from others – subjective norms: family, community, social network, culture, social change,
power structure, peer pressure – who are important to that individual will also influence their decision
to try the new practice. Skills, time and means – enabling factors: income, poverty, employment, in-
2. John Hubley (1993) equalities, etc., – are also required to take up the new practices.
What is the approach to hygiene promotion?

There are basically two approaches to hygiene promotion or two methods to be used to promote be-
haviour change:
■ Directive approach: The approach based on precepts developed by marketing specialists in

the private sector. The marketing approach is typically implemented by the private sector at
household level. A principle of the approach is to base hygiene promotion programmes on un-
derstanding of consumer behaviour. Once the formula is right, the marketing approach can be
taken quickly and easily to scale.
■ Participatory approach: A more flexible and participatory approach by which communi-
ties are empowered to decide for themselves which changes they should make. PHAST method-
ology is naturally related to this approach since it is a grass-roots process implemented at
community level. These communities are more likely to achieve objectives which are theirs: peo-
ple participate by consent and are not ‘manipulated’ by outsiders.
Empowerment is part of a process of social change,
one benefit of which is sustained and contin-
ued behaviour change.
The directive approach has been widely

implemented in the water and sanita-
tion sector with very good results in
some cases, so it should not be un-
derestimated when compared to
participatory methodologies. The
Literature review
activities related to a social mar-
General references are included
keting approach might be an
excellent opportunity to com- in the software water and sanitation CD-ROM:
plement interventions based
General concepts: General hygiene promotion references
on participatory principles
(such as PHAST) and increase General concepts: Community participation
the adherence to key hygiene
messages. Implementation tools: Hygiene promotion campaigns
Implementation tools: Hygiene promotion training
Implementation tools: Hygiene and sanitation in schools
Chapter 2
Community participation
and community management
What is community participation?

The concept of participation is concerned with the involvement of the local people (community),
whether in rural or urban areas, in the management of issues and conditions affecting their lives. It em-
powers the local people by enabling them to analyse, make decisions, plan, and act on development ac-
tivities that should improve the quality of their lives. Community participation is enhanced through
participatory methodologies. The emphasis and strength of participatory methodologies are in facili-
tating or enabling the beneficiaries to make use of their knowledge and capabilities in order to institute
sustainable local actions and institutions.
According to UNICEF, community participation is a development process based on dialogue, consul-

tation with, and empowerment of, people in a community to identify their problems, decide how best
to overcome them, and to make plans to seek appropriate solutions and assistance.
Nevertheless, because of the actions of international agencies and national governments who have tended
to “know what is best for the people, make decisions and plans for the people, and carry out actions that are
meant to improve the life of the people”, local people’s knowledge and capabilities have been suppressed
over the years, to the extent that they do not see or feel themselves capable of acting for themselves. In-
stead, they have been reduced to perpetual dependance. The challenge is for development workers to
facilitate the change of this attitude and belief, and enable the people to rediscover their innate strengths
and capabilities and to redirect the same to their own development – hence, the concept of community
participation. Participatory methodologies and tools are designed to enable development facilitators or
workers to face and overcome this challenge. While using participatory tools, outsiders, (including em-
ployees of international or local agencies) should see themselves as facilitators or promoters of develop-
ment and not as the main actors. They are challenged to explore the three essential elements:
■ Consultation (which is usually passive and basically consists of informing or asking specific ques-
tions on interventions that have already been decided on);
■ Contribution (of labour, locally available materials and even cash money when appropriate);
■ Control (which consists of decisions on what people really require, e.g. decisions at the project
identification stage, i.e. what to use donor funds on, forms of local and grass roots institutions
that should be established for project management and even the right to say “no” to projects that
people do not feel obliged to accept without the fear of losing donor support).
Most development agencies that try to embrace community participation often find themselves at the
level of consultations only, while the more daring try to insist on contribution. Very few agencies are
ready to embrace real participation by enabling people to take full control of the development process,
which should be the ultimate aim in all cases.
What is community management?

Community management reflects the idea that communities should operate and maintain their own
water and sanitation facilities. The community takes on the full range of management tasks related to
maintaining a water and sanitation facility. The core of community management is making decisions:
controlling the facilities and the decisions related to them.
Typical roles of Red Cross Red Crescent personnel involved in water and san-
itation programming have the responsibility to support com-
a water and sanitation munities beyond helping them to install a system and then
leaving them with the sole responsibility for managing it. In
the Red Cross Red Crescent water and sanitation programmes
committee: the community management system usually relies on the com-
munity water and sanitation committees. Different factors
– Representing the community in contacts need to be considered when establishing or strengthening
with government, support agencies and water and sanitation committees at community level:
private sector.
1. Community structures: communities already have
– Coordinating roles with other community mechanisms for managing issues of common interest and
institutions or decision-making bodies. for resolving disputes. Wherever possible we should respect
– Ensuring efficient and effective overall their strengths and work with them. However, existing
structures may become overwhelmed. In this case, an al-
management of the facilities ternative needs to be explored with the community.
– Ensuring equity of water use and
distribution 2. Clarifying roles: how are the structures responsible for
the management of the water and sanitation facilities
– Ensuring equity in decision making linked to the community: Who does what? Who needs to
– Financial planning, calculating and be seen when something breaks down? What is expected
organizing contributions from people? Who reports to whom? Who collects fees?
Who audits? The roles and responsibilities of all actors
– Organizing and supervising effective OM should be clearly defined.
– Enforcing rules and regulations
3. Representation: Committees are the backbone to sus-
– Maintaining accurate records, including
taining water and sanitation facilities. Usually, the control
financial records, minute of meetings or and decision-making process rests in their hands. However
other relevant information. they can only function if their decisions are supported by
– Promoting hygienic behaviours and the whole of the community. That is why representation of
the community in its committee is crucial. Very often
effective use of the facilities women are left out. However, it is not always possible to
– Holding and leading regular meetings. enforce gender representation on the committees and par-
allel structures of women and men need to be created.
OM responsibilities: 4. Ownership: Sense of ownership makes communities ac-

cept responsibility for maintaining their facilities. Sense of
– Upkeep and repair of systems ownership might be created in different ways: (i) cost re-
covery or payment to strengthen the identity that the com-
– Monitoring system performance munity has with the facility and (ii) legal ownership. These
– Problem analysis (when a problem can be two factors allow the community to be perceived as an as-
fixed locally and when outside help is sociate rather than a beneficiary.
necessary)
5. Cost recovery: To ensure sustainable water and sanita-
– Collecting user fees tion intervention users must be willing to pay for water,
– Enforcing regulations and bylaws. both in times of limited cash income and in times of high
water availability from alternative sources. People also have
Community water, community management: to trust in the system and its managers. Capacity, trust and
from system to service in rural areas, ITDG.
willingness to pay, are essential to make cost recovery work.
Inability to pay-issues should be addressed by the commu-
nity (this can help decide who should be exempt from pay-
ment).
6. Rules, regulation and enforcement: Rules and regulations are required to control both the
behaviour of water users and that of committee members. Regulations should be enforced via a sys-
tem of social sanctions. Additionally, the committee should be sufficiently respected within the com-
munity to ensure payment of fees. The power to enforce any type of control, other than social,
should derive from a framework of laws and statutes, (through legalized registration with local gov-
ernment, registration of a constitution, etc.).
7. Training: Separation of roles in the committees should be established: technical roles, (pump min-
ders, caretakers, operators, engineers, etc.), and managerial roles, (members of the committee re-
sponsible for strategic decisions, such as tariffs, service level, etc.). Operation and maintenance
training should be distinct from community management training.
8. Volunteer service: In some complex water schemes, the caretaker position needs to be formal-
ized and paid, but usually caretakers and committee members are volunteers. Those members need
to be part of a larger support structure. Training and capacity
building need to be a conducted on a regular basis
rather than a one-off occasion since training
increases levels of confidence and owner-
ship.
9. Monitoring: Different systems

for monitoring might be estab-
lished by the committee and Literature review
by the users. Committees
should be able to visit house- General references are included
holds on a regular basis in in the software water and sanitation CD-ROM:
small rural communities
and users should be able to General concepts:
have access to financial ac- Sustainability for water and sanitation projects
counts and minutes of
meetings. Involvement of General concepts:
local water boards in moni- Community management
toring or auditing activities is
recommended. Implementation tools:
Community management system
Link between software

and hardware
The project cycle (logical sequence of activities to accomplish the project’s goal) has been used in the
PHAST methodology as a basic structure to consolidate the process resulting in a seven step programme:
(1) problem identification, (2) problem analysis, (3) planning for solutions, (4) selecting the technol-
ogy options and, (5) the management system of those facilities, and (6) monitoring and (7) evaluation.
The involvement of the community throughout the entire PHAST process ensures that behaviour
change occurs not only towards health problems but also to community management. Using PHAST
as an entry point at community level makes it possible to build trust, capacity and most importantly,
establishing a dialogue between engineers and the community ensuring that all the above aspects are fully
addressed.
Chapter 3
PHAST (Participatory hygiene
and sanitation transformation)
3.1 – Introduction to PHAST
What is PHAST ? 3
Participatory hygiene and sanitation transformation is an innovative approach to promoting hygiene,

sanitation and community management of water and sanitation facilities. It is an adaptation of the
SARAR4 methodology of participatory learning, which builds on people’s innate ability to address and
resolve their own problems. It aims to empower communities to manage their water and control sani-
tation-related diseases. It does so by promoting health awareness and understanding which, in turn, lead
to environmental and behaviour improvements.
PHAST brief history 5
■ February 1993: PHAST initiative is born. Partners: WHO, UNDP, World Bank, PROWWESS.
■ August 1993: Selection of countries: Botswana, Kenya, Uganda and Zimbabwe.
■ September 1993: One-week PHAST pre-planning workshop (Kenya).
■ October 1993: Training of trainers (Uganda).
■ November – December 1994: Country level field projects.
■ December 1994: Review.
■ November 1996: PHAST initiative report.
■ 1998: First edition of PHAST step-by-step guide.
3. WHO -
http://www.afro.who.int/wsh/
The PHAST initiative report contains the results and findings from four countries’ field-level projects. pdf/phastinitiative/whatisphast.
pdf
The projects in Botswana, Kenya, Uganda and Zimbabwe shared a set of common results6: 4. SARAR: stands for Self-esteem,
■ All the community members gained self-esteem. They started to believe in their ability to solve Associative strengths,
Resourcefulness, Action
their own problems. They understood that what they could do with their own resources was Planning and Responsibility.
enough to make a significant improvement to their health. 5. WHO -
■ They all had a basic understanding of the health implications of poor water supply and sanita- http://www.afro.who.int/wsh/
pdf/phastinitiative/howphastbe
tion. They understood that the diseases they have experienced most frequently are linked to exc- gan.pdf
reta. 6. WHO -
http://www.afro.who.int/wsh/
■ They all gained a sense of common purpose and an understanding of planning change in their
pdf/phastinitiative/theimpacto
communities. ncommunities.pdf
PHAST seven step-by-step

Step Activity Tool
Step 1: Community stories Unserialised posters (2 hours)

Problem identification Health problems in our community Nurse Tanaka (1.5 hours)
Step 2: Community mapping Community map (2.5 hours)

Problem analysis Good and bad hygiene behaviours 3-pile sorting (1.5 hours)
Investigating community practices Pocket chart (2 hours)
How diseases spread Transmission routes (2 hours)
Step 3: Blocking the spread of disease Blocking the routes (1 hour)

Planning for solutions Selecting the barriers Barriers chart (1 hour)
Tasks for men and women Gender role analysis
(1.5 hours)
Step 4: Choosing sanitation Sanitation and water ladder

Selecting options and water options (2 hours)
Choosing improved behaviours Three pile sorting (2 hours)
Taking time for questions Question box (1 hour)
Step 5: Planning for change Planning posters (2.5 hours)

Planning for new facilities Planning who does what Planning posters (2 hours)
and behaviour change Identifying what might go wrong Problem box (1 hour)
Step 6: Preparing to check our progress Monitoring chart (2 hours)

Preparing to check
our progress
Step 7: Checking our progress Various tool options e.g. socio-

Checking our progress drama and planning posters
(2.5 hours)
For the purposes of this guide, the above PHAST process involving all seven steps shall be known as the
‘standard PHAST process’.
Each of the PHAST steps is implemented using a tool kit (as indicated in the above table), most of
which are comprised of a series of pictures. The manual followed is the PHAST Step-by-Step Guide:
A participatory approach for the control of diarrhoeal diseases, which takes the reader systematically
through each of the steps, detailing how to undertake each activity, its purpose and the relevant mate-
rials to implement each step..
General readings (Introduction to PHAST) and the PHAST manual in English, French
and Spanish can be found on the software water and sanitation CD-ROM: Imple-
mentation tools < PHAST.
The International Red Cross

and Red Crescent Movement and PHAST
Hygiene promotion was highlighted in the International Federation water and sanitation policy. The
policy acknowledged that participatory techniques such as PHAST are well established in International
Federation water and sanitation health programmes. However, it stressed that hygiene promotion, (in-
cluding hygiene education, community participation, management and sustainability), must be estab-
lished parallel to, if not before the introduction of the water and sanitation hardware. The policy also
emphasised that water and sanitation and health programmes should, where possible, be closely inte-
grated. The PHAST step-by-step guide for the control of diarrhoeal diseases is the basis on which the
International Federation implements its PHAST strategy.
Since 2000, PHAST has been undertaken by many Red Cross Red Crescent National Societies at com-
munity-level worldwide. The PHAST step-by-step guide has been translated into many different local
languages. From 1993 to 1996, the International Federation Regional Delegations supported water and
sanitation programmes in over 40 countries. They now advocate the use of this method to ensure that
the installed water and sanitation facilities deliver optimum health and social benefits which can be sus-
tained in the long term.
In 2003, a PHAST review7 workshop was undertaken. The 6-day event was attended by water and san-
itation staff from eight National Societies in eastern Africa (Ethiopia, Kenya, Mozambique, Rwanda,
Tanzania, Uganda, Zambia and Zimbabwe). A second PHAST review workshop was conducted in
2006, in Mombasa (Kenya) and it was attended by 11 National Societies (Ethiopia, Burundi, Kenya,
Comoros, Uganda, Rwanda, Seychelles, Djibuti, Sudan, Tanzania and Somaliland).
The first review of PHAST undertaken in eastern Africa was followed by the PHAST draft Guidance
Notes for the use of PHAST in Red Cross Red Crescent water and sanitation programming. This was
produced by the International Federation PHAST group and included: a background to PHAST; the key
lessons learned and remaining challenges; suggestions of how PHAST can be shortened and improved
in both development and emergencies; its integration with ARCHI and CBFA; and a number of PHAST
tools which are not included in the original PHAST manual, which are useful for monitoring and eval-
uation. Most of the contents in this guide are based on the original findings from that workshop.
In 2004, the International Federation launched its new Global Water and Sanitation Initiative (GWSI).
It includes the number of past Red Cross Red Crescent water and sanitation beneficiaries, as well as those
it aims to include from 2004 to 2015. The GWSI also outlines the type of response it delivers and
methodologies used, including aspects of both software and hardware. The key factors of its success and
International Federation partnerships are also outlined in the Initiative. The GWSI encourages National
Societies to adopt a common approach, methodology, timescale and economy of scale. It also provides
a framework within which National Societies can increase their contributions to meeting the water and
7. The final reports and
sanitation and health components of the millennium development goals (MDGs). The GWSI is per- appendices are included in the
ceived as the way forward in its 10-year commitment to the International Federation’s contribution to software water and sanitation
CD-ROM: Implementation <
meeting water and sanitation MDGs. PHAST < PHAST Review.
Guiding principles
for Red Cross Red Crescent PHAST programmes
Community-based Red Cross Red Crescent volunteers
Community-based Red Cross Red Crescent volunteers are the key to successful implementation of
PHAST programmes. They are exclusively placed to mobilize their own communities and guide the pop-
ulation through the PHAST steps, whilst at the same time maintaining a strong link with their local Red
Cross Red Crescent branch. PHAST takes from two to six months for implementation. During this time
the volunteers provide services to their communities by contributing a few hours of their time each
week. It is essential that volunteers are well-managed. This means supervising their recruitment, sup-
port training and refresher courses, and ensuring that they are closely monitored at all times. If PHAST
volunteers remain involved with health and, or water and sanitation programs over a long period of
time, it helps to increase their capacity and strengthen the community and its response system.
Emergencies including epidemic outbreaks

In times of disaster, Red Cross Red Crescent PHAST volunteers living in their own communities are
well-placed to respond immediately to water, sanitation and hygiene needs. During an epidemic out-
break, it will be advantageous to call on networks of pre-trained, Red Cross Red Crescent volunteers al-
ready living in the communities. They can be mobilized quickly, and provided with key messages to help
with disease prevention.
Links with other programmes

It is important for PHAST programmes to collaborate with other Red Cross Red Crescent commu-
nity- based initiatives, especially where there is overlap. The integration of PHAST with other Red
Cross Red Crescent programmes at the community level must be examined more closely in order to max-
imise resources. Some systems have been developed integrating PHAST and CBFA (Community- Based
First Aid) programmes. The ARCHI toolkit, used in Malaria and HIV and AIDS prevention compo-
nents of community-based health programmes, has also been integrated in PHAST activities. Com-
munity-based tools used by the Red Cross Red Crescent have been harmonized recently to produce a
simplified tool box to promote a more integrated approach to community programming.
This tool box, CBFA and ARCHI toolkit, are included on the software water and san-
itation CD-ROM: Implementation < PHAST < Link with other Red Cross Red Crescent
programmes.
Integrating hygiene promotion

and community management systems.
Problem identification
The community has a basic
understanding of the health
implications of poor
water supply and sanitation.
Step 1
Participatory Problem analysis
evaluation
Step 7 Step 2
Community Planning for solutions

Planning for The community develops
monitoring Step 6 Step 3 a belief in their own ability
and evaluation to solve their own problems.
Step 5 Step 4
Planning for new facilities Selecting technology

and behaviour change options – Empowering
Empowering the community the community to plan
to own and operate water environmental improvements.
and sanitation facilities and
commit behavioural change.
Through steps one, two and three, communities can determine their own priorities for disease preven-
tion and come to a consensus regarding the hygiene behaviours and sanitation systems most suited to
their specific environment. People within the community possess an enormous health-related experience
and knowledge. With the appropriate support, all people, regardless of their educational background,
are capable of understanding that faeces carry disease and can be harmful. They can learn to trace the
faecal-oral route of disease-transmission within their own environment and further, identify appropri-
ate barriers accordingly.
Through steps four, five, six and seven, the community gains enough information and experience to
begin to address its own problems. Communities will be able to assess their current circumstances ac-
curately and devise a plan for future improvements. Moreover when people know that they are re-
sponsible for finding a solution they start to demand information.
The involvement of the community will result in a higher level of effectiveness and sustainability than
could be expected from externally-imposed solutions. Those that create decisions within the commu-
nity will be committed to following them through, thereby creating sustainability. Through this creative
learning approach, based on real experience, individuals can evaluate and change their own behaviour.
Core activities for implementing

a PHAST programme
Core activities Resources Outputs
Identification of gaps and areas for intervention
WASH literature review WASH documents to review Literature review report
Institutional mapping of other Stakeholder analysis and Venn Stakeholder analysis report
stakeholders diagram
Baseline survey focusing on water, PHAST baseline survey Baseline survey report
hygiene and sanitation
Gender analysis Gender checklist Gender analysis report
PHAST programme
Design of selection criteria for PHAST Selection checklist PHAST implementers identified
trainers, PHAST volunteers and
community mobilizers to be involved in
the PHAST programme.
Simplification of the PHAST WHO PHAST WHO Manual Adapted PHAST manual for ToT and
manual and translation into the local volunteers
language
PHAST training (trainers and PHAST Manual for ToT and volunteers Register of PHAST trainers
volunteers) and development of action 2 ToT and 30 volunteers
plan PHAST training report
Adaptation, testing and development IEC material database PHAST toolkit adapted to the target
of PHAST toolkit Local artist community
PHAST deployment at community level PHAST kit for volunteers Register of PHAST implementers
1 implementer and 25 households
PHAST ME report
Linking with the hardware component
Mapping of water and sanitation PHAST step two Map of water and sanitation facilities
facilities
Participatory selection of technical PHAST (steps four and five)

options Engineer and local water board
Hardware component
Planning for new facilities Manual for community water and Community management component
sanitation committees (water and sanitation committee)
Technical and managerial training of Engineer and local water board

community water and sanitation
committees
Hygiene social marketing – Mass campaign design
Hygiene practices assessment
Identification of target audience

Baseline survey report Hygiene education
Identification of key communication PHAST (steps one and two) Communication plan
messages Literature review report
Identification of channels of
communication
Design and production of IEC IEC material database

materials
Participatory monitoring and evaluation
Impact survey PHAST baseline survey Impact survey report
Developing a set of SMART indicators Diagram of indicators Diagram of indicators
Establishing a monitoring system Quarterly HH monitoring sheet Quarterly monitoring reports

based in coaching groups
Establishing community-based PHAST (steps six and seven) PHAST implementation report
monitoring and evaluation
Benefits and constraint of Red Cross

Red Crescent PHAST programmes
Benefits
■ PHAST has helped the community to identify its own problems, understand what they can do,
and has motivated them to plan and seek their own viable solutions.
■ PHAST has helped the community to become self-reliant, with a common purpose, which re-
sults in a sense of ownership of facilities.
■ PHAST has encouraged the community to plan for preventive activities and the community
management of water supplies.
■ Communities can better understand the issues of poor sanitation, how latrines can help reduce
diseases, the importance of keeping water safe and hand washing.
■ PHAST involves both men and women who should be represented at all stages of its imple-
mentation. In some refugee situations PHAST has encouraged women to be water pump tech-
nicians, and PHAST has been shown to empower women.
■ The methodology used in PHAST can conceivably be used in the training of other topics such
as HIV and AIDS and malaria (by modifying the tools).
■ PHAST has raised the profile of the Red Cross.
■ Some PHAST groups have reported that they have begun to undertake income generating proj-
ects.
■ PHAST groups can work closely with water committees and neighbourhood health committees
where they already exist, rather than developing parallel structures. Where these committees
exist, members can join PHAST groups.
■ There has been some success when using PHAST tools with children; hence it is good to involve
schools in PHAST especially because children are powerful agents for behaviour change.
Constraints
■ There is a risk of overlapping and duplication between the roles of the PHAST groups, water and
sanitation committees and neighbourhood health committees. Where present in communities,
these groups should link up to avoid this.
■ Long-term refugees or IDP can be harder to motivate to take part in PHAST as they have more
of a dependency mentality.
■ There are usually not enough tool kits for each volunteer.
■ The time period over which PHAST is undertaken is sometimes too long and communities lose
concentration and interest and attendance falls off (it can be difficult to keep the same groups
consistently).
■ Sometimes it is not possible to hold PHAST meetings with communities for a whole day as they
are busy working. It is recommended to meet the community for no more than two hours per
day and extend the period of implementation.
■ PHAST and CBFA can take a different and contradictory approach by not using the same
methodologies. CBFA is often taught in a didactic fashion.
■ Some National Societies in conflict areas or urban areas find it difficult to recruit volunteers.
Communities in these areas may still be traumatised and difficult to work with. They may have
high expectations of receiving aid, which may weaken community participation and increase ex-
pectations on National Societies.
■ PHAST is difficult to implement in National Societies which are in the process of restructuring.
■ There is still a need to convince donors to incorporate PHAST into ongoing water and sanita-
tion Red Cross Red Crescent projects, which often have a greater focus on hardware.
■ Not all National Societies have a water and sanitation strategy which advocates that hardware and
software are complementary.
■ Reluctance from some to use PHAST as they feel that in asking the communities about their
health concerns, the community will request interventions that the National Society cannot de-
liver.
3.2 – PHAST training
Stages of PHAST training

It is recommended to conduct PHAST training following the cascade-model below:
Level 1
headquarter national level
PHAST Training of trainer
Level 2 branch regional level

1 trainer 1 trainer 1 trainer
PHAST training for volunteers PHAST training for volunteers PHAST training for volunteers
Level 3 sub-branch discrict level

1 coaching/leader/ 1 coaching/leader/ 1 coaching/leader/
supervising group supervising group supervising group
Level 4 community level

group deployment
group deployment
group deployment
group deployment
group deployment
group deployment
group deployment
group deployment
group deployment
group deployment
group deployment
group deployment
group deployment
group deployment
group deployment
group deployment
group deployment
group deployment
PHAST volunteers
PHAST volunteers
PHAST volunteers
PHAST volunteers
PHAST volunteers
PHAST volunteers
PHAST volunteers
PHAST volunteers
PHAST volunteers
PHAST volunteers
PHAST volunteers
PHAST volunteers
PHAST volunteers
PHAST volunteers
PHAST volunteers
PHAST volunteers
PHAST volunteers
PHAST volunteers
Levels one and two: PHAST master trainer and trainers
A trainer is the person who guides the group through the agenda in order to communicate specific
knowledge about WASH, PHAST methodology and community mobilization.
The master trainer will train the future PHAST trainers of the National Society and should, there-
fore, be someone with great experience in PHAST methodology. They should also be able to demonstrate
strong communication skills, commitment and the ability to facilitate participatory learning. Some Na-
tional Societies in different regions have developed a large pool of PHAST trainers who can be used at
regional level to conduct PHAST ToT (Training of Trainers) and support the National Society in devel-
oping a plan of action for the PHAST programme. PHAST ToT training should be held for a maxi-
mum of 25 people. The suggested ratio of facilitators to participants is, 1 facilitator to 20-25 participants.
The trainers will train future PHAST volunteers and will act as a point of contact for PHAST at
branch level. They will provide support and training to volunteers and can be recruited from the exist-
ing pool of health instructors. Furthermore, they can gain additional skills in community-based par-
ticipatory approaches and WASH knowledge.
Red Cross Red Crescent National Societies with experience in PHAST methodology
Americas Asia Europe Africa

and Pacific
Guatemalan Indonesian Red Red Crescent Zambia Red

Red Cross Cross Society Society of Cross Society
Honduran The Thai Red Tajikistan Mozambique
Red Cross Cross Society Red Cross
Salvadorian Cambodian Red Society
Red Cross Society Cross Society Zimbabwe Red
Peruvian Myanmar Red Cross Society
Red Cross Cross Society Malawi Red
Venezuelan Cross Society
Red Cross Burundi
Paraguayan Red Cross
Red Cross Ethiopian Red
Cross Society
Red Cross
Society of
Eritrea
Red Crescent
Society of
Djibouti
Kenya Red
Cross Society
Rwandan
Red Cross
Somali Red
Crescent Society
Tanzania Red
Cross National
Society
The Uganda
Red Cross
Society
Level three: Coaches

A coach can be defined as someone who ensures that networks of community volunteers are recruited,
trained, motivated, supervised and monitored on a continual basis. Coaches might be recruited from
the pool of experienced and skilled volunteers involved in community health programmes. The key
qualities of a coach are likely to be: organization, administration, commitment and flexibility, and an
empowering approach to hygiene promotion.
Why coaching groups?

It is possible to manage only a maximum of 20 volunteers effectively, in an area where their work loca-
tions are close together and distance between work sites are short. Where distances are greater, fewer vol-
unteers can be managed. The suggested ratio of coaches to volunteers is: 1 coach to 6-7 volunteers. In
a large project, these coaching groups at branch or sub-branch level might require a branch coordina-
tor to report to the headquarter.
Coaches should be part of the PHAST volunteer group8, receiving the same training and carrying out
the same activities at community level, but also assisting and supervising the less-experienced volunteers
during the implementation activities at community level. They will be responsible for the weekly group
meetings during the six-month programme period. The role of the coaches is to lead the PHAST group
through the PHAST seven-step process over six months and, in particular, to encourage people to at-
tend the weekly group meetings.
They should have good facilitation skills and strong links with the local Red Cross Red Crescent branch
staff. They should also be able to produce regular reports on the progress of the groups for the branch.
When they have completed the PHAST training, they may have a role in overseeing the collection of
baseline data and help with its analysis. Where group members need to write regular monitoring re-
ports, coaches may well be able to help them with this. Coaches gaining experience might be consid-
ered for future training of trainers.
Level four: Community-based volunteers

Volunteers should be recruited to work in the community where they live. They will be able to contribute
to the PHAST programme on a regular basis and as much as they can. For the implementation of a stan-
dard PHAST programme it is expected that they contribute five hours a week, (depending on the na-
tional volunteers policy), though this varies within different communities. Volunteers will mobilize their
communities to undertake the step-by-step PHAST activities and will maintain an active link between
their communities and local Red Cross Red Crescent branches, reporting back to their coaches regu-
larly on activities undertaken. Volunteers should be equipped with a PHAST tool kit, a loudspeaker,
monitoring sheets and a T-shirt and cap.
During the review workshops, volunteers’ retention was raised as a key issue in implementation of
PHAST. Experience has shown that existing volunteers policies might be very helpful in implementing
PHAST programmes. The following chart outlines examples of how PHAST volunteers are managed
in PHAST programmes:
Contribution Allowance Equipment

Kenya Red 1-2 hours / day Transport and lunch T-shirts, caps, bags, stationary
Cross Society 2 days / week allowance
The Uganda Red 1-2 hours / day Lunch allowance and Gumboots, raincoats, badges,
Cross Society 2 days / week transport refunds T-shirts, caps, stationary,
bicycles for coaches
Ethiopian Red 2 hours / day Lunch allowance at Shoes, T-shirts and caps
8. This position could be a full-
time, contracted staff as some
Cross Society 2 days / week the time of training
sub-branches are nearly as
strong as their branch offices Rwandan 2 hours / week Transport and Bicycles, (one per pair), T-shirts
and have large programme Red Cross lunch allowance and stationary
areas. If this is the case, then
some sub-branches could fall
into level two. The role
Somali Red 2 hours / week Transport and lunch T-shirts
described below can vary from Crescent Society allowance
one National Society to
another since a coach’s working Tanzania Red 2 hours / day Monthly allowance Gumboots and raincoats
hours cannot be restricted to
only 12 hours per month, Cross National
(e.g., Human resources
volunteer policy for Society
Cambodian Red Cross
Society).
Phast trainings Trainers – level 1 Sub-branch field Community-

(Branch level) officer or trainer based volunteer
– level 3 (Branch - level 4
level)
Purpose of To develop a pool of To develop a pool of To develop skills that

the training course trainers within the PHAST volunteers within allow the volunteers to
National Society that will the National Society that teach friends and
train PHAST volunteer will implement the PHAST neighbours about hygiene
groups at branch level. process at community and health promotion.
level.
Educational ■ Principles of hygiene ■ Principles of hygiene ■ Principles of hygiene

objectives promotion. promotion. promotion.
■ Methods for community ■ Methods for community ■ Methods for community
participation, especially participation, especially participation, especially
in PHAST. in PHAST. in PHAST.
■ Adult learning ■ Community mobilization ■ Community mobilization
techniques. techniques. techniques.
■ Volunteer management. ■ Monitoring tools. ■ Monitoring tools.
■ Monitoring and
evaluation tools for
behaviour change in
hygiene, sanitation and
water interventions using
participatory methods.
Selection criteria ■ Strong commitment and ■ Willingness to ■ Willingness to volunteer

ability to facilitate volunteer. up to 12 hours per
participatory learning. ■ Ability to train others, month.
■ Broad experience in a since after the workshop ■ Be a peer to the target
variety of health and they will be expected to group (i.e., mother,
environmental train either at the youth, etc.).
programmes, preferably branch or community ■ Be respected by the
in Red Cross Red Crescent level. community.
programmes at branch ■ Ability to disseminate ■ Must live in the village.
level. PHAST trainer can health messages. ■ Have enough time to
be recruited from the Experience in Red Cross commit to the
existing pool of trainers Red Crescent programme.
and volunteers of community health ■ Willing to adapt to new
community-based health programmes is an ideas.
care (CBFA) or water and asset. ■ Strong belief in the
sanitation programmes. ■ Literate - can read and programme’s aims and
■ Logistics and training write in local language. objectives.
organization (venue, ■ The participants must ■ Good negotiator.
transport, materials, come from the project ■ Limited writing skills
etc.). area. Branch may be necessary, but
■ Experience in effective representation in order not for everyone.
community action to ensure branch level ■ Ability to use PHAST
planning. buy-in of the process. tools and other
■ Participatory ■ Gender and age equity. information, education,
monitoring. communication (IEC)
■ Strong problem analysis materials.
and logical planning
framework skills.
■ Resource management.
Lessons learned and good practices

regarding PHAST training:
1. Red Cross Red Crescent volunteers already involved in other projects with a water and sanita-
tion component, (e.g., food security), can become PHAST volunteers.
2. In the debate about whether PHAST volunteers should be Red Cross Red Crescent members
first, it was considered a priority to recruit good leaders to PHAST groups and to have members
who are already active in their communities and are able to undertake community mobilization.
Ideally, these may be Red Cross Red Crescent volunteers, but this is not essential. PHAST groups
are ideal recruiting ground for Red Cross Red Crescent volunteers.
3. National Societies implement PHAST in different ways, e.g., the training of Red Cross Red
Crescent volunteers is not always undertaken sequentially from steps one to seven. In some in-
stances, volunteers are trained initially in steps one and two, after which they go directly into the
field to practise the skills they have learned.
4. The PHAST master trainers should be experienced enough to allow the introduction of the
PHAST steps in a flexible manner, i.e., not necessarily sticking rigidly to the PHAST step-by-
step guide. For this reason, master trainers should have enough experience and flexibility to be
able to adapt, or even replace a tool, (as suggested in the guide), if one is found to be inappro-
priate.
5. While standard PHAST training assumes that participants already have knowledge and experi-
ence in the use of SARAR and PRA, upon which PHAST is anchored, and that such participants
are already experienced facilitators, this is not always the case. For this reason, trainers should try
to include sessions geared towards strengthening the facilitation skills of participants, such as
dry-runs or simulation and role play exercises, and video feedback sessions.
6. The best way to develop participants’ confidence, self-esteem and capacity building, is to use
real-life examples for training, i.e., what they already know and have experience of. This can also
help identify participants who can provide assistance during the actual training course.
7. Literacy is a basic criterion for a PHAST group member, Red Cross Red Crescent volunteer, as
they need to be able to document and fill in reporting forms. However, other ways of reporting
can be explored in order to reach the widest range of community representation, (especially in
the community-based PHAST groups).
8. PHAST group leaders who become coaches should be better qualified than the PHAST group
members, Red Cross Red Crescent volunteers. Leaders need to have the skills which will enable
them to coordinate volunteer activities: make regular visits to discuss reports, and coordinate
their work with the branch level water and sanitation programme coordinator.
9. PHAST training materials can be improved by adapting and translating them into local lan-
guages to make them more relevant to the local context.
10. To exchange experiences, review PHAST progress and strengthen the skills and knowledge of the
volunteers, a refresher course should be factored in every two years when designing a PHAST pro-
gramme.
11. Certificates to be given at the end of the first cycle.
12. Special attention should be paid to the concept of ‘participation’ during training, as in many
National Societies, this term is widely taken to mean “cheap village labour”.
Day Module Activity Tool
1 Module 1 - Introduction, expectations - Presentation

Introduction - Ground rules - Group dynamics
Definitions - Introductory talk - Brainstorming
- Principles of hygiene promotion
and sanitation
2 Module 2 - Adult learning process - Comparative pictures

How people learn - Participation and experience-based learning - Role play
Working with people - Methods on community participation - 3-pile sorting
Communication skills - Communication skills - Group dynamics
PHAST introduction - Introduction to PHAST and PHAST tool kit - Brainstorming
2 Module 3 - Community stories - Unserialized posters

PHAST methodology step 1: - Health problems of the community - Nurse Tanaka
Problem identification - Baseline survey
3 Module 3 - Mapping water and sanitation - Community mapping

PHAST methodology step 2: in our community - 3-pile sorting
Problem analysis - Good and bad hygiene behaviours - Pocket chart
- Investigating community practices - Transmission routes
- How diseases spread
4 Module 3 - Blocking the spread of diseases - Blocking the routes

PHAST methodology step 3: - Selecting the barriers - Barriers chart
Planning for solutions - Tasks for men and women in the community - Gender role analysis
5 Module 3 - Choosing sanitation improvements - Sanitation options/ladder

PHAST methodology step 4: - Choosing improved hygiene behaviours - Three pile sorting
Selecting options - Taking time for questions - Question box
- Linking with the engineer
6 Module 3 - Planning for change - Planning posters

PHAST methodology step 5: - Planning who does what - Story with a gap
Planning new facilities - Identifying what might go wrong - Problem box
and behaviour change - Resistance to change
continuum
7 Module 3 - Preparing to check our progress - Monitoring checking chart

PHAST methodology step 6: - Coaching system - Developing participatory
Planning for monitoring and indicators
evaluation - Household quarterly
monitoring sheet
8 Module 3 - Checking our progress - Various tool options

PHAST methodology step 7: - Baseline survey
Participatory evaluation
9 Module 4 - Constraints of using PHAST - Dynamic group

PHAST review - Lessons learnt - Brainstorming
Development of Plan of Action - Volunteers’ recruitment and management
- Plan of action
10 Module 5 - Channels of communication (folk media) - Dynamic group

Mass hygiene education campaign - IEC materials - Role play
Three steps PHAST - Activities with children - Photo parade
11 Field visit Visit to a project site
12 Evaluation workshop Feedback Chart

This 12-day programme is only a standard guide. Some of the activities can be done in the same day
and the programme reduced to a 10-day training session. Also note that module five might be interesting
only for those National Societies that seek to increase capacities in the hygiene promotion sector dur-
ing times of emergency.
Further to PHAST ToT, a “Plan of Action” should be developed by the participants for their respective
branches. This should include a definition of the roles of those involved, including volunteers, coaches
and branches. It should also define how the programme will be implemented, by whom, in which areas,
who and what are the links with the community, and ways to mobilize them. An exit strategy and mon-
itoring indicators should be developed from the outset.
General references to PHAST training can be found on the software water and san-
itation CD-ROM: Implementation tools < PHAST < PHAST training.
Chapter 3.3 – PHAST implementation

PHAST consists of 17 activities organized in seven main steps. One activity is usually carried out each
week and the whole programme, typically, lasts from four months to six months. The first five steps
are about helping the group to develop a plan to improve water supply, sanitation and hygiene behav-
iour, while steps six and seven consist of monitoring and evaluation.
Members of PHAST groups are encouraged to share what they learn with their neighbours and the rest
of their community. Since they are volunteers, it is often difficult for group members to meet more than
once a week. The core group of community volunteers trained at sub-branch level will be expected to
form, and train, in a cyclical manner, PHAST groups (15 – 25 households) within the targeted villages
during the “action” period. An initial community level training will cover an average of four months de-
pending on availability of the villagers and seasonality.
The activities use pictures, drawings and charts as tools to help kick-start discussions at the weekly meet-
ings. Talking about sanitation and hygiene can be difficult for many people.
Shortening PHAST
There does not appear to be a clear way of shortening the PHAST process in a development context
without interfering with the natural progression of activities and, thereby losing its impact. Where
PHAST is a burden on the community, (as identified by some community members and Red Cross Red
Crescent trainers), it may be necessary to change the programming of PHAST, in which case, the fol-
lowing issues should be taken into consideration:
1. Facilitating more sessions per week at community level. (E.g., activities one and two of step five i.e.,
‘planning for change’ and ‘planning who does what’, might be merged into one activity, since they
are inter-related). This presents several dilemmas:
■ Overwhelming communities with PHAST activities in the face of competing community needs
in terms of time. The involvement of urban populations may be very difficult to sustain.
■ Going through the PHAST process too quickly and not having real impact or community buy-
in.
■ Volunteer fatigue. A programme would require more volunteers so that volunteers are not re-
quired to work more than four hours a week. The alternative is to remunerate the volunteers and
risk losing the spirit of volunteerism and its sustainability. In some cases, large numbers of vol-
unteers are required to facilitate the PHAST groups (as the PHAST process aims to include 5 per
cent of the target population as members of PHAST groups).
2. Leave the shortening of the PHAST process to the discretion of the programme manager based on
the baseline survey findings, particularly where hardware already exists and there is no need for tech-
nology choice.
During the developmental phase, where water and sanitation hardware facilities are necessary, the
PHAST process should be undertaken as set out in the original standard guidelines for PHAST, pro-
duced by the World Bank/UNDP. There might be a need, however, to change the programming and
facilitation of the PHAST process, rather than the content, as it is important to keep the tools them-
selves intact, and the order in which they are implemented.
PHAST implementation – lessons learned

1. Steps one and two can be integrated as part of the activities needed to carry out the baseline sur-
vey. The implementation of these two initial steps can be supported by externally-trained Red
Cross Red Crescent facilitators from either the branch or sub-branch (district) offices, using a
range of methods: key informant interviews, mapping, focus group discussions, household inter-
views, etc.
2. In steps three, four and five community leaders and key informants should be involved in the ses-
sions. At this stage, the PHAST group should link with the water and sanitation community com-
mittee and the engineers. Furthermore, the community might select a group of volunteers to be
trained specifically in health and hygiene issues. Additional hygiene-related topics that the com-
munity is interested in should be added, i.e., prevention of malaria, dengue, worms, skin disease,
etc. Also, depending on National Society health policy, first-aid training and key health messages,
especially mother-child topics such as, immunization, breast feeding, nutrition, etc.
3. Hardware activities should begin once step five is complete and especially after the community
have agreed to their and roles and responsibilities in community management. Starting some basic
construction activities after step five, based on the community’s demands, help to create trust and
reliance on Red Cross Red Crescent, as the community realises that “talk is finally translated into
action”.
4. PHAST groups have been motivated by holding competitions between different PHAST groups
in the same and different areas and by distributing T-shirts and badges. These competitions have
attracted crowds and served to disseminate information.
5. There is a risk of overlapping and duplication between the roles of the PHAST groups, water and
sanitation committees and community health committees. Where present in communities, these
groups should link up to avoid this. In Somalia, integrating PHAST groups in the already exist-
ing community water and sanitation committees has been seen as a valuable resource developed
by the project.
6. It is important to forge strong links between PHAST programmes and National Society head-
quarters staff, especially where National Societies are running large programmes. Projects which
are in remote regions require structured visits as part of the process of monitoring and evaluation.
7. It is important that National Society Branch Secretaries strengthen their links with water and san-
itation projects which includes giving them more support. It is also important that branch secre-
taries are fully up to date with the PHAST process and its activities.
8. PHAST should involve both men and women who should be represented at all stages of its im-
plementation. For example, in some PHAST projects, women have been encouraged to be water
pump technicians.
9. It is useful to involve children as beneficiaries in water and sanitation projects, especially in PHAST
activities in particular schools. In Somalia a project called ‘CHAST’ has been developed which
is an adaptation of both PHAST and child to child methodologies.
10. Red Cross National Societies implement PHAST in different ways, e.g., the training of PHAST
group members and Red Cross Red Crescent volunteers is not always undertaken sequentially
from steps one to seven. In some instances, Red Cross Red Crescent volunteers are trained ini-
tially in steps one and two, after which they go to the field directly and practice the skills they have
learned before progressing to the following steps.
11. It is crucial for the correct deployment of PHAST to have a pre-developed volunteer policy within
the National Society since this is what will guide the National Society on how to motive and re-
tain PHAST volunteers. The policy should outline the roles and expectations of volunteers, as
well as the upgrading process. Institutional strengthening under the Organizational Development
sector is recommended.
12. A system of rewarding and upgrading volunteers through the coaching system has to be main-
streamed in the volunteer policy.
13. The average working hours for volunteers is up to a maximum of two hours per week, depending
on the activity. Volunteers must not volunteer for more than two hours in a week, except in ex-
ceptional cases.
14. PHAST sessions can be run targeting special vulnerable groups i.e., mothers with children under
five that subsequently might form a group responsible for passing on information to other moth-
ers at household level.
3.4 – PHAST in emergencies
Community participation in emergencies

The Red Cross Red Crescent experience, particularly in the last decade, shows that most field workers
address water and sanitation developmental interventions with an increasing degree of participatory ap-
proaches and methodologies, ensuring that the target communities determine their own health priori-
ties and how they intend to tackle them. However, in emergency situations, it is widely assumed that
this approach is not appropriate as the target groups are often unable to make decisions or assume con-
trol, especially in the most immediate post-emergency scenario.
In an emergency, when rapid action is needed, it is too easy for the relief workers to make assumptions
about people’s needs and priorities. It may be actually very difficult to set up an effective mechanism
for consultation and participation in the early phase of the emergency. However, a special effort should
be made to at least establish the principles of consultation and participation, which can be developed
over time. Past experience has shown that community participation in the response phase and, in the
communication of specific hygiene messages in the immediate aftermath of a disaster, ensures sustain-
able and incremental improvements in environmental health.
In disaster response, community cohesion is usually affected, family units are split and individuals are
involved in search and rescue or distribution of vital relief items. At this stage, the identification of
needs relies on volunteers, trained professionals and the availability of community members for assess-
ment. Therefore, definition of response is limited. In recovery, community leadership may be stronger
since the situation may be more stable as the vital needs of families and community members are met..
Defining the stage at which relief workers should introduce participatory methodologies varies from
one scenario to another. Over the years, the International Federation has implemented water and san-
itation programs with National Societies as a response to emergencies and as a strategy towards disas-
ter preparedness. Introducing PHAST in eastern Africa in 1999 as a community management disaster
tool has shown that when a disaster occurs those Red Cross Red Crescent National Societies that have
been working on participatory methodologies as part of emergency prevention and preparedness, are bet-
ter able to introduce the participative elements in the response efficiently from the outset. Uganda Red
Cross society was one of the pioneer organizations to implement Primary Health Care, including
PHAST in 1981, within a total of four pilot branches and later expanding to 17, (in Kampala, north
and south western parts of the country). The target groups were peri-urban and rural communities,
refugees and internal displaced persons.
In May 2002, in response to a growing concern about the implementation of PHAST by National So-
cieties in the east Africa region, the International Federation Regional Delegation in Nairobi produced
a concept paper for hygiene promotion in emergencies, “When PHAST needs to be FAST”.
In 2003, the first PHAST review in Kampala, Uganda, examined whether PHAST could successfully
be shortened in emergency without losing its impact and the community ‘buy-in’ seen to be so essen-
tial to its successful implementation. New guidelines were produced for shortening the PHAST process
during an emergency and also specifically during a cholera epidemic.
PHAST in refugee or displaced camps

Assumptions: The National Society has been implementing PHAST before the onset of an emergency
and has trained volunteers in PHAST methodology and has already developed PHAST toolkits.
Timeframe: PHAST should be initiated within two weeks of the arrival of refugees or IDP for a pe-
riod of implementation of eight weeks. A PHAST session might be undertaken in a period of one week
depending on the nature of each emergency and access to the affected population. Following the im-
plementation of PHAST sessions, the team might focus on community management of facilities and
dissemination of hygiene messages.
During the acute phase of an emergency, the PHAST process should be shortened as follows:
Step Activities Tools Purpose Timeframe

1 Health problems Nurse Tanaka To identify possible Day 1: 1-1 ½
in our community health risks posed hours session
by displaced status.
2 Good and bad 3-pile sorting To allow for in-depth Day 2: 1-1 ½
hygiene behaviour analysis of problems hours session
and their causes.
Investigating Pocket chart Day 2: 1-2 hours
community practices sessions / group.
How disease spreads Transmission Day 2: 1-1 ½
routes hours session
3 Blocking the spread Blocking the routes To analyse possible Day 3: 30 min –
of disease solutions to identified 1 hour
causes of problems.
4 Choosing improved 3-pile sorting To identify key Day 3: 1 hour
hygiene behaviours messages for improved
hygiene.
5 Who does what Planning posters To distribute roles and Day 4: 1-2 hours
responsibilities with
regard to management
of communal facilities
for both men and
women, including
management of water
points, ensuring latrine
cleanliness and vector
control activities.
6 Preparing to check Monitoring chart To monitor change Day 4: 2 hours
our progress in the displaced
population.
Activities which may be removed from the standard PHAST process during emergencies:
■ Community stories
■ Community mapping
■ Tasks for men and women
■ Choosing improved water and sanitation facilities
■ Taking time for questions
■ Planning for change
■ Identifying what may go wrong
■ Checking our progress
Tips
We might develop some cross-checking mechanisms to ensure consistency and that the in-
formation communicated in step one. We can conduct interviews with key personnel such as,
health staff and community leaders, for example.
A rapid hygiene and sanitation appraisal should be undertaken as part of the ongoing as-
sessment.
Step four can include a presentation about the different sanitation and water supply op-
tions that might be implemented in the camp quickly - design principles, maintenance require-
ments, etc. The PHAST groups might be a good entry point for community consultation.
The hygiene key messages identified through step four might be used to develop a massive
hygiene education campaign. Some of the PHAST members might be involved in the dissemi-
nation activities.
Step five might be linked to the establishment of community committees and technical train-
ing. Some of the PHAST members might be involved in the committees.
In Step six, the role of the Red Cross Red Crescent volunteers in the monitoring system and
the specific activities that will be carried out, (e.g., household visits), should be explained to
the community.
In some cases, (population displacement across the border), it will be necessary to use in-
terpreters to talk to the target beneficiaries. Interpreter should be native speaker, preferably
from the same social group as the target community. It is also preferable to start training com-
munity-based volunteers in order to avoid the need for interpreters.
The PHAST toolkit should be adapted to the community as soon as possible, especially in
those cases where there are differences in dress, physical features or community customs of the
target community.
PHAST for in-country disease outbreaks like cholera

A rapid appraisal should be undertaken as outlined above. During an outbreak, the PHAST process
should be shortened as follows:
Step Activity Tool(s) Purpose Timeframe

2 Community mapping Community Day 1: 1-1 ½
mapping hours session
In-depth analysis of
Good and bad 3-pile sorting the disease outbreak Day 1: 1-2 hours
hygiene behaviour and its cause sessions/group
How disease spreads Transmission routes Day 1: 1-1 ½
hours session
3 Blocking the spread Blocking the routes Day 2:
of disease To analyse possible 30 min – 1 hour
solutions to identified
Selecting the barriers Barriers matrix causes of problems Day 2:
30 min – 1 hour
4 Choosing improved 3-pile sorting To identify key messages Day 3: 1 hour
hygiene behaviour for improved hygiene
behaviour
6 Preparing to check Monitoring chart To monitor according Day 4: 2 hours
our progress to agreed standards
Activities that may be removed from the standard PHAST process:

■ Community stories
■ Health problems in our community
■ Investigating community practices
■ Tasks for men and women
■ Choosing improved water and sanitation activities
■ Taking time for questions
■ Planning for change
■ Planning who does what
■ Identifying what may go wrong
■ Checking our progress
After the emergency phase of the disease outbreak, the community can be taken through the PHAST
process as a developmental or post relief phase.
Tips
Specific sessions might be designed for cholera transmission routes and prevention measures.
General references about cholera are included on the software water and sanitation CD-ROM:
General concepts < WASH related diseases < Cholera.
Uganda
Red Cross emergency response
during the cholera outbreak
Since 1979, there has been a chronic outbreak of cholera in the Hoima, Bundibugyo and Kibale Districts in
western Uganda. The situation is aggravated by a lack of sanitation facilities and safe water, unsafe cultural beliefs
of these communities and cross border population movement. All these areas are landing sites, and depending on the
fishing season, each of these areas is subject to continuous rotational movement. The source of water for these communities
is Lake Albert. The commonly-used methods for water treatment are chlorination and boiling.
In 2006, there were 98 reported cases and 33 deaths. Since this was a situation beyond the ability of Uganda Red Cross they
applied for Disaster Response Emergency Funding (DREF), in which the Uganda Red Cross Society disaster management programme
became the focal point for the implementation of the cholera DREF response. The programme had NDRT, (National Disaster Response
Team), members who were based all over the country. There were also Red Cross Action Teams in 33 of the 49 branches with 15 radio-
based stations.
The Programme dealt with both preparedness and response activities. These include:
1. Setting out response mechanisms at community level, (community-based action teams).
2. Equipping warehouse with emergency stocks, (non-food items).
3. Awareness, education and development of IEC materials on common disasters.
As part of activity three, ‘Shortened PHAST’ trainings were conducted targeting at least 100 volunteers. They were deployed
in the affected communities and conducted one week – hygiene-promotion sessions with the community action teams.
The methodology used was three step PHAST with focus areas in first aid, cholera prevention, control and basic hygiene
and sanitation promotion:
Step one – Problem identification
Step two – Design of immediate response
Step three – Activity design and monitoring and evaluation
As a result of the response the Uganda Red Cross Society contributed to contain the outbreak in the affected area through
increasing awareness of safe hygiene practices using a community-based action approach.
Lessons learned
Volunteers’ fatigue. Volunteers had to carry out intensive door-to-door sensitization for a considerable time.
Equipment for volunteers should be available since they were frequently involved
in burying activities.
A cholera kit should be considered when outbreaks occur in extended
geographical areas with lack of health facilities, personnel and other
actors. Training volunteers to use the cholera kit is essential.
South Asia
Accessibility was a problem due to the landscape Earthquake – Pakistan:
Sustainability of interventions is a real problem in those ensuring gender equity and community
areas with very low water and sanitation coverage. participation in the water and sanitation
These areas should be a priority for future water programme is included in the software water and
and sanitation interventions. sanitation CD-ROM: Implementation < PHAST <
Migration is a key element: continual PHAST in emergency.
hygiene promotion of activities
should be carried out in these The case study reveals the findings of the
communities. implementation of PHAST activities during the
transition between the onset of the
emergency and the recovery phase.
3.5 – PHAST Step Tool Set of drawings

tool kit Step 1: Unserialized posters Set 1: 10-15 drawings
Problem identification (A4 size) showing scenes of
everyday community life.
The PHAST tool kit con-
Nurse Tanaka Set 2: 30 drawings
sists of drawings made by
(A4 size) of people in the
a local artist reflecting the
community.
local culture and condi-
tions. A set of drawings Step 2: Community map -
should be developed Problem analysis 3-pile sorting Set 3: 30 drawings
specifically for every activ- (1/4 of A4 size) of everyday
ity in each step. The set hygiene practices, both good
should be composed of and bad in the local culture.
the following tools:
Pocket chart Some of the drawings
from set three can be used.
Transmission routes Some of the drawings
from set three can be used.
Step 3: Blocking the routes Some of the drawings
Planning for solutions from set three can be used.
Barriers’ chart -
Gender role analysis Set 4: Three drawings
(A4 or larger) of a man,
woman, man and woman
together, boy, girl and boy
and girl together.
12 drawings of daily household
and community tasks related to
water, sanitation and hygiene
practices.
Step 4: Sanitationwater ladder Set 5: From 2 to 10 drawings
Selecting options (A4 size) of different human
excreta disposal methods, both
hygienic and unhygienic.
3-pile sorting -
Question box -
Step 5: Planning posters Set 6: 2 large drawings, one
Planning for new facilities showing a problem situation
and behaviour change and another showing a greatly
improved situation or solution to
the problem.
Problem box -
Step 6: Monitoring chart -
Preparing to check
our progress
Step 7: Various tool options e.g.
Checking our progress socio-drama and
planning posters -
Total 6 sets – 100 drawings

Prototype tool kit

Standard drawings: Different sets of standard drawings in black and white have been developed
and can be applied modifying those aspects, (custom, housing, clothing, etc.), that need to be adapted
to the target area. These drawings can be found on the CD-ROM: International Federation IEC ma-
terials database. The modifications can be made by tracing or photocopying the original and using
colour to show the local variations.
Using photographs or existing materials: Photographs showing scenes of everyday commu-

nity life might be useful to develop drawings and or, they can be used directly for certain tools, e.g., san-
itation options and the planning process. Existing posters, leaflets, etc., might contain drawings that can
be used in three-pile sorting, for example. Technical and project manuals can also be a good source of
pictures and drawings.
It is recommended to develop the tool kit containing all the required materials for a group or commu-
nity of 20-25 households, as follows:
■ Box or bag for the whole tool kit.
■ One folder for each step, complete with brief instructions in local language.
■ One folder for each activity, (each packaged separately within the steps’ folders), the associated tool
and any other required materials for the activity, complete with brief instructions in the local lan-
guage. Laminating the game cards for each activity in a different colour, is recommended.
■ The “Seven steps of PHAST” outline and chart in the local language.
■ Extra materials such as paper, markers, tokens, sticky tape. The monitoring tools, (templates, sheets,
checklists, etc.), should be printed and bound and included in the toolbox or bag.
All game cards and instructions should be laminated on both sides to protect them against weather,
dirt and frequent handling. Game cards will also have serial numbers printed on the reverse in, to make
them easily identifiable.
Adapting the prototype tool kit – steps

Step one: Find an artist. The ideal artist is someone who has artistic skills, takes part in Red Cross Red
Crescent activities at community level and lives in, or close to, the target communities.
Step two: The artist should attend a complete PHAST training workshop and should be briefed ini-
tially in PHAST methodology and given a set of standard drawings. Moreover, the artist should attend
field visits with participants to make initial sketches. Then, while the workshop is taking place, the artist
should develop the sets that can be used and discussed in the training sessions. This is a practical and
participatory form of pre-testing.
Step three: The artist should produce a complete set of drawings to be pre-tested in the target com-
munity. This can be done by taking the drawings to the community and asking people if what they see
correctly portrays their local environment and cultural features. Drawings should be modified accord-
ing to the feedback received.
Step four: A master set of drawings, in black and white, should be kept so that they can be photo-
copied. A tool kit should be produced for every PHAST team.
Examples of pre-adapted toolkits can be found on the software water and sanita-
tion CD-ROM: Implementation < PHAST < PHAST tool kit adaptation (Niger and So-
malia).
Chapter 4
Additional PHAST tools for Red Cross
Red Crescent water and sanitation
programming
4.1 – Gender checklist
Gender refers to the different roles, rights and responsibilities of men and women, and the relationship
between them. Gender does not simply refer to women or men, but to the way their qualities, behav-
iours and identities are determined through the process of socialization. Gender is generally associated
with unequal power, freedom of choice and access to resources. The different roles of women and men
are influenced by historical, religious, economic and cultural realities. These roles and responsibilities
can, and do, change over time.
The term “gender”, as recognized by the Gender and Water Alliance, also considers the intersection of
women’s experience of discrimination and human rights’ violations not just on the basis of their gen-
der but also on the basis of race, ethnicity, caste, class, age, ability or disability, religion, and a host of
other factors.
Women and men are defined in different ways in different societies; the relations they share constitute
what is known as gender relations. Gender relations constitute, and are constructed by, a range of in-
stitutions such as the family, legal systems, or the market. Gender relations are hierarchical relation-
ships of power between women and men and tend to disadvantage women. These hierarchies are often
accepted as ‘natural’ but are, in fact, socially-determined relationships, culturally-based, and subject to
change over time. Gender relations are dynamic, characterized by both conflict and co-operation, and
mediated by other factors, including caste, class, age, marital status or position in the family.
Differences between the sexes, such as the ability to give birth, are biologically-determined and are dif-
ferent from socially-prescribed gender roles.
Recognizing the above, a gender analysis refers to a systematic way of looking at the different effects of
development on women and men. Gender analysis requires separating data by sex and understanding
how labour is divided and valued. Gender analysis should be conducted at all stages of the development
process; one must always ask how a particular activity, decision or plan will affect women differently from
men.
Gender, water, sanitation and hygiene 9
A focus on gender differences is of particular importance with regard to hygiene and sanitation initia-
tives. Gender-balanced approaches should be encouraged in plans and structures for implementation.
Access to adequate and sanitary latrines is a matter of security, privacy and human dignity, particularly
for women. However, even in places with adequate latrine coverage, the availability of sanitation facil-
ities does not necessarily translate into effective use. This is due to taboo, cultural norms and beliefs.
9. Mainstreaming gender in
water management – Women are acutely affected by the absence of sanitary latrines:
A practical journey to
sustainability: A resource guide
■ When women have to wait until dark to defecate and urinate in the open, they tend to drink less
(UNDP). during the day, which causes all kinds of health problems, e.g., urinary tract infections.
■ Women can be sexually assaulted or attacked by wild animals when they go into the open for defe-
cation and urination.
■ Hygienic conditions are often lacking at public defecation areas, leading to worms and other water-
borne diseases.
■ Girls, particularly after puberty, miss school due to lack of proper sanitary facilities.
At the community level, hygiene and sanitation are considered a women’s issue, but they impact on
both genders. Yet societal barriers continually restrict women’s involvement in decisions regarding san-
itation improvement programmes. Thus, it is important that sanitation and hygiene promotion and
education are perceived as a concern of women, men and children, and not just of women.
The drinking water supply sector has a long history of examining the roles of women, due to the high
visibility of women carrying water over long distances in many countries. The effort to expand access
to water supply has also led the way in evolving a gender-based approach that takes account of chang-
ing social structures, and their effects on the way that women and men use and manage water resources.
Considerable achievements have been made in incorporating a gender analysis into local drinking water
supply programmes.
Gender is a critical factor in ensuring sustainability and hence, the overall success of water projects.
Gender mainstreaming is a way to ensure that there is adequate representation of men and women in
operation, maintenance and management of programmes projects.
General references about how to integrate gender needs in WASH (Water, Sanita-
tion and Hygiene) programming are included on the software water and sanitation
CD-ROM: General concepts < Gender.
Gender checklist for water and sanitation programming

General data
Total number of family’s data disaggregated by age and sex.
Number of families headed by females, and number by males.
Child-headed families.
Number of unaccompanied boys and girls, elderly, disabled.
Water collection, transportation and allocation at HH level

Patterns of water collection, (water fetching and carrying): Time spent (hours per day).
Relationship between water collection and girl child school attendance.
Gendered division of access to means of water transportation. When the family has access to
privet transport, (bicycle, donkey, motorbike, etc.), do men retain the priority in its use leaving
women to travel by foot?
Patterns of water allocation among the family members: sharing, quantity, quality.
Access to and control over water sources

The different uses and responsibilities for water by men, women and children, (e.g., cooking,
sanitation, gardens, livestock, etc.).
Who makes the decisions about water use in the community: (water irrigation, domestic use,
watering livestock, selling water, brick-making, etc?) Do women have access to income-gener-
ating activities related to water?
Gender division of time-use in the household

Who makes the decisions about time spent at household level?
Normal means of handling, storing and treating water at household level.
Who is responsible for household hygiene? Who is responsible for hygiene and sanitation
practices at community level? If women are responsible for the hygiene status of themselves and
their families, what level of knowledge and skills do women have?
Technical option or OM
Gendered division of responsibilities for maintenance and management of water and sanita-
tion facilities. Are women equally represented on community development committees, water
committees, community associations, etc? Which roles do women represent in those associa-
tions? Do they have access to the treasury?
Who maintains the latrines and water points?
Does the community need technical training on latrine use for operation and maintenance and
hygiene and or, managerial training for maintenance?
Options for convenient, user-friendly designs, low cost and affordable facilities.
Physical designs for water points and latrines appropriate to water source, number and needs
of users.
Does the community need facilities adapted for the disabled and elderly, (especially female)?
Privacy and security

Location and design for privacy and security of water points and latrines, and bathing facili-
ties.
Safety around water sources, especially if women and children are primary users. Do women
feel constrained to travel alone in public to the water point or sanitation facilities because of
real danger of aggression or social disapproval?
Sanitary habits of women and girls

What is appropriate to discuss? What types of materials are appropriate to distribute? How
are children’s faeces treated? What are the cultural issues with regard to water and sanitation
activities during pregnancy, menstruation, anal cleansing, etc?
Cultural issues
What are the main cultural issues which impact upon women’s and men’s access to water?
What can be reinforced and introduced?
Traditional gender roles and power structure

How do women perceive themselves in traditional roles and active participation? How much
of this can be changed and how much is it not possible to change?
Who decides how much money should be spent on water?
If programmes are based on demand-responsiveness: there needs to be an awareness of the
possible exclusion of women-headed households that are unable to make contributions.
4.2 – Monitoring and evaluation tools

Monitoring is the day-to-day management task of collecting and reviewing information that reveals
how an operation is proceeding and what aspects of it, if any, need correcting. Monitoring in hygiene
promotion is a continuing function that uses the systematic collection of data on specified indicators
to inform management and the main stakeholders of the extent of progress and achievement of hygiene
improvement.
Evaluation is the objective assessment of an ongoing or completed water and sanitation operation, pro-
gramme or policy, or its design implementation and results. The aim is to assess the project’s, relevance,
whether it is sustainable and if the objectives and overall goals have been met. An evaluation should pro-
vide information that is credible and useful, so that lessons can be used in management decision-mak-
ing for the next part of the project cycle.
The PHAST programme contains a number of monitoring and evaluation tools which can be used by
facilitators and or, volunteers:- Examples of monitoring charts: Community stories (unserialized posters),
Health problems in our community (nurse Tanaka), Good and bad hygiene behaviour (three pile sort-
ing), Investigating community practices (pocket chart), How disease spreads (Transmission routes), Se-
lecting the barriers (barriers chart), Tasks of men and women in the community (gender role analysis),
Choosing sanitation and water options or improvement (sanitation and water ladder), Choosing im-
proved hygiene behaviours (three pile sorting), Planning for change (planning posters), etc.
Although the standard PHAST process covers monitoring and evaluation, it could still benefit from
additional tools. These were developed during the Review of PHAST in east Africa at the end of 2003
and at other regional and International water and sanitation follow-up meetings. They include, (1)
baseline survey tools, (2) essential indicators and (3) quarterly monitoring tools.
General references to monitoring and evaluation can be found on the software

water and sanitation CD-ROM: Monitoring and evaluation tools < General readings.
1. Baseline survey
A survey is a useful tool for assessing programme needs and evaluating programme achievements and
progress. A survey is conducted to collect additional data from a population. Its purpose is to gather in-
formation that is not routinely collected by existing information systems.
The baseline study is the analysis and description of a situation prior to the programme against which
assessments or comparisons can be made. The baseline study provides a benchmark for our programme
objectives, focusing mainly on water, sanitation and recommended hygiene behaviour. The baseline
provides the framework for monitoring and evaluation, with a follow-up study, (typically mid-way
through the operation), to facilitate final analysis and overall impact of the programme.
Principles to be applied to the PHAST baseline study:

■ Baseline data is always required.
■ Baseline studies can be time-consuming and expensive. If possible, existing secondary sources should
be used to collect data.
■ A baseline study should be followed by an impact study which should use the same methodology
and study the same samples or sites to generate comparative data.
■ A baseline survey should ideally be conducted before implementation of PHAST activities at com-
munity level.
General references about how to implement a survey are included on the software
water and sanitation CD-ROM: Assessment tools < Survey < How to conduct a sur-
vey (manuals) including short guidance notes for survey (International Federation).
Different examples of questionnaires are included on the software water and san-
itation CD-ROM: Assessment tools < Survey < Examples of questionnaires, (including
PHAST baseline survey – International Federation). The PHAST baseline survey questionnaire does not
have to be used uniformly by all Red Cross Red Crescent National Societies. It can be used as a tem-
plate and adapted accordingly. Here are some suggestions for using this questionnaire:
■ The questionnaire is aimed at mothers and female caretakers.
■ Each questionnaire should take approximately 30 – 40 minutes to complete.
■ The questionnaire will be completed by a volunteer. It is often better for volunteers to work in pairs,
especially if they are women.
■ The questionnaire will be analysed at Red Cross Red Crescent branch and or, headquarters level.
■ It should take at least two days to train a volunteer to complete the questionnaire.
■ Where possible, volunteers who undertake to complete the questionnaire will have undergone pre-
vious PHAST or CBFA training.
■ As it is rarely possible to include the entire target group in a survey, a limited number of respondents
should be selected. This is known as the sample. The characteristics of the sample should be simi-
lar to the total population so it is as representative as possible. Different ways of obtaining a sample
include: random sampling (picking names from a hat or at random from a list; interval sampling:
(selecting persons from a list at regular intervals); or cluster sampling: (where groups of people,
rather than individuals, are selected to comprise the sample).
■ The baseline survey should take no longer than 1-2 weeks to complete. One way to calculate the total
time needed to conduct a baseline survey is to take a sample size of 100 households, for example,
hence 100 questionnaires. If one person or a team of two, can complete six questionnaires in a day,
it will, therefore, take one person 17 days to complete all 100 questionnaires, or two people 8.5
days. (Note: time should be allowed for travelling to the community, walking between houses and
introductions).
■ The baseline survey should not be followed up more than once a year.
2. 5 Essential indicators for PHAST activities 10
A list of key hygiene indicators for monitoring PHAST was identified during the PHAST review work-
shop held in Uganda in 2003.
Sanitation
■ Use of latrines.
■ Presence of children’s faeces in courtyard.
■ Presence of animals in the house.
■ Presence of refuse pit.
■ Cleanliness of latrine.
■ Presence of bathing facilities in the household.
■ Number of bed nets, (ITN), or vector control initiatives.
■ Hand washing at key times, (after contact with faecal matter and before handling food).
■ Presence of hand washing facility, (sign of use, location of facility, presence of soap or other clean-
ing agent).
Safe water
■ Use of safe drinking water, (from safe source or disinfection of water),
10 Based on assessing hygiene
■ Clean drinking water is stored in covered container. improvement – Guidelines for
■ Water supply system functional. household and community
levels (EHP - USAID)
■ Quantity and quality of water, (refugees only).

■ Household management of diarrhoea.
■ Knowledge of ORT, (use of salt and sugar or ORS).
There are four indicators in the above list which are shown to have a proven impact on decreasing di-
arrhoeal diseases. They should always be included when monitoring PHAST activities.
Percentage of caretakers
with appropriate hand washing
behaviour
Note: In case hand washing practice cannot be verified by observation, this alternative indicator might
be used: Percentage of caretakers who report having used soap for hand washing at least at two critical
times during past 24 hours.
Definition: Appropriate hand washing behaviour includes three elements: (1) hand washing supplies,
(2) hand washing at critical times and (2) hand washing technique:
(1) Hand washing supplies: water, soap, ash or other detergent, a device that facilitates hand
washing at a basin, sink, bucket or tippy tap, and a clean towel or cloth (optional).
(2) Critical times for hand washing (WHO):

■ After defecation
■ After cleaning babies’ bottoms
■ Before food preparation
■ Before eating
■ Before feeding children
(3) Hand washing technique:

■ Uses water
■ Uses soap ash or other detergent
■ Washes both hands
■ Rubs hands together at least three times
■ Dries hands hygienically by air drying or using a clean cloth
Calculation: [Number of caretakers in the sample who demonstrate appropriate hand washing] vs.
[Total number of caretakers interviewed in the sample].
Source of information: Hand washing can be measured by self-reporting of critical times and demon-
stration of technique in a household survey. Data on hand washing behaviour can also be obtained
through direct observation in the household. This is recommended since there is the interviewee’s ten-
dency to over-report desirable behaviours.
Target values: Hygiene promotion programmes have demonstrated significant increases in improved
hand washing behaviours. Targets aimed at increasing hand washing by 50 per cent over the baseline,
are realistic and attainable.
PHAST monitoring activities and tools related to this indicator:

Activity: Good and bad hygiene behaviour (Tool: Three pile sorting). This tool may help to monitor the
level of adherence to specific hygiene and sanitation practices within the community.
Activity: How disease spreads (Tool: Transmission routes). Activity: Selecting the barriers (Tool: Barri-
ers chart). These tools may help to analyse the level of knowledge gained by the community about how
diarrhoeal diseases can be spread through the environment.
Model questions for the questionnaire:

■ Can you show me how you wash your hands?
■ Does the person use water? Determine whether washing hands is practiced using recycled water and
whether it constitutes a considerable risk of faecal contamination.
■ Does the person use soap (or alternative)?
■ Are both hands washed?
■ Does he or she rub hands together, three times or more?
■ How does the person dry their hands?
■ Does the towel or cloth appear to be clean?
Percentage of households with

access to an improved and
hygienic sanitation facility
Definition: Access means that any member of the household should be allowed to use the facility at any
time, day or night. The facility should be located within a convenient distance from the user’s dwelling,
(30 metres or less). An improved facility means that the toilet design is culturally acceptable and safe.
Hygienic means that there are no faeces on the floor, seat or walls and there are few flies. Using sanita-
tion facilities means that a sanitation facility is the predominant means of excreta disposal for household
members >12 months of age.
Calculation: [Number of households in the sample with an improved and hygienic sanitation facility]
vs. [Total number of households in the sample].
Sources of information: Information concerning usage of sanitation facilities can be obtained through
a household survey in which the surveyor asks the mother or household head about the family latrine
and then inspects the latrine to see if it is, (1) functioning, (2) hygienic and (3) shows signs of use.
Note: For children, the question should not be whether they use the toilet themselves, but rather if their fae-
ces are disposed of at the toilet.
Target values: To ensure health impact within the community, at least 75 per cent of households in
that community should have access to, and use of, latrines. (Bateman and Smith 1990)

Activity: Investigating community practices (Tool: Pocket chart). This tool may help to monitor the level
of adherence of specific hygiene and sanitation practices within the community.
Model questions for the questionnaire:
■ What kind of toilet facility does this household use?
■ Where is the latrine located?
■ How many households share this latrine?
■ May I see the latrine? (Observation: Is there faecal matter present inside?)
■ Where do you usually wash your hands?
Percentage of households
with access to improved
water source
Definition: Access to the water supply means it should be available within 30 minutes, or a 1km radius
of the household in rural areas, and 5 minutes, or 200 metres in urban areas, (includes travelling there
and back, waiting and collecting). The total time to fetch water, including time travelling to and from
the source, queuing, and filling containers, should be as short as possible.
Calculation: [Number of households in the sample with access to an improved water source] vs. [Total
number of households in the sample]
Source of information: Data are collected from a survey of a random sample of households. A cluster
survey should not be used because water sources may be location-related. The survey should be carried
out at the time of the year when water supply is lowest or when most sources have run dry. The surveyor
should visit each house or compound and verify access to a water supply as defined above. In some
cases, the distance to the water supply might be measured to ensure it falls within the prescribed 1km
radius.
Target Values: Based on available research, an acceptable maximum time and distance is estimated as
follows: access should be within 30 minutes or 1km of the household in rural areas, and 5 minutes or
200 metres in urban areas, (including time to travel there and back, wait for and collect water).

Activity: Investigating community practices (Tool: Pocket chart). This tool may help to monitor the
level of adherence of specific hygiene and sanitation practices within the community.
Model questions for questionnaires:
■ What is the main source of drinking water for members of this household?
■ How long does it take you to go to your main water source, get water, and come back?
Percentage of households that

have access to water treatment
supplies
Definition: Water treatment supplies would include one of the following: (1) Hypochlorite solution,
(2) Water filter and (3) Bottles for solar disinfection.
Calculation: Number of households with water treatment supplies divided by the total sample size.

Activity: Investigating community practices (Tool: Pocket chart). This tool may help to monitor the
level of adherence to specific hygiene and sanitation practices within the community.
Model questions for questionnaires:
■ Do you treat your water in any way to make it safer to drink? If yes, what do you usually do to the
water to make it safer to drink? (Only check more than one response if several methods are usually
used together, for example, cloth filtration and chlorine.)
■ When did you last treat your drinking water using this method?
■ If water is treated by a method other than boiling, may I see the product or device?
General references for WASH Indicators can be found on the software water and
sanitation CD- ROM: Monitoring and evaluation tools < WASH indicators.
3. Quarterly monitoring tools: PHAST monitoring sheets

In addition to undertaking a baseline survey and following it up on a regular basis, additional regular
monitoring of the impact of PHAST can also be undertaken on a quarterly basis. This can be done by
PHAST facilitators in their own communities. Results can then be compared and used to track changes
related to each intervention.
A PHAST monitoring sheet should be created containing the five essential indicators using the corre-
sponding tools as PHAST activities: (investigating community practices; good and bad behaviours; block-
ing the routes and selecting the barriers) and the questions related to the PHAST questionnaire. This sheet
can be filled in for the first time during the initial implementation of the PHAST steps by the PHAST
facilitator and then subsequently with the same PHAST group members once every quarter.
An example of a PHAST quarterly monitoring sheet format for household general observation is in-
cluded in the software water and sanitation CD-ROM: Monitoring and evaluation < Training module
PHAST monitoring and evaluation (International Federation). It is not necessarily intended that this
be used uniformly by all Red Cross Red Crescent National Societies, but rather as a template and adapted
accordingly.
Both the completed monitoring sheets, along with observation sheets, can then be given to the local Red
Cross Red Crescent coaches to check that all key indicators for PHAST have been measured. PHAST
facilitators may need to be paid per diem for work undertaken during these quarterly one-day meetings.
During the quarterly meetings, PHAST facilitators should ensure that all the key indicators selected for
the PHAST programme are measured and recorded. This can be achieved by way of information gath-
ered during discussions with PHAST group members and the completion of PHAST monitoring sheets,
as well as through observation of households. The PHAST step-by-step guide contains all the activities
and tools which should be used to complete the PHAST programme.
The Fundamental Principles of the International
Red Cross and Red Crescent Movement
Humanity Independence
The International Red Cross and Red Crescent Movement, The Movement is independent. The National Societies,
born of a desire to bring assistance without discrimination to while auxiliaries in the humanitarian services of their
the wounded on the battlefield, endeavours, in its governments and subject to the laws of their respective
international and national capacity, to prevent and alleviate countries, must always maintain their autonomy so that they
human suffering wherever it may be found. Its purpose is to may be able at all times to act in accordance with the
protect life and health and to ensure respect for the human principles of the Movement.
being. It promotes mutual understanding, friendship,
cooperation and lasting peace amongst all peoples. Voluntary service
It is a voluntary relief movement not prompted in any
Impartiality manner by desire for gain.
It makes no discrimination as to nationality, race, religious
beliefs, class or political opinions. It endeavours to relieve the Unity
suffering of individuals, being guided solely by their needs, There can be only one Red Cross or Red Crescent Society in
and to give priority to the most urgent cases of distress. any one country. It must be open to all. It must carry on its
humanitarian work throughout its territory.
Neutrality
In order to enjoy the confidence of all, the Movement may Universality
not take sides in hostilities or engage at any time in The International Red Cross and Red Crescent Movement, in
controversies of a political, racial, religious or ideological which all societies have equal status and share equal
nature. responsibilities and duties in helping each other, is worldwide.
For further information,
please contact:
Uli Jaspers
The International Federation
Manager – Water and Sanitation unit
of Red Cross and Red Crescent
Societies promotes the humanitarian
Health and Care department
activities of National Societies among Tel.: +41 22 730 44 72
vulnerable people. E-mail: uli.jaspers@ifrc.org
By coordinating international
Robert Fraser
disaster relief and encouraging
development support it seeks Senior Officer – Water and Sanitation unit
to prevent and alleviate Health and Care department
human suffering. Tel.: +41 22 730 44 16
E-mail: robert.fraser@ifrc.org
100400 10/2007 E 2,000
The International Federation,

the National Societies and
the International Committee Libertad Gonzalez
of the Red Cross together constitute WatSan Officer – Water and Sanitation unit
the International Red Cross and Health and Care department
Red Crescent Movement. Tel.: +41 22 730 44 41
E-mail: libertad.gonzalez@ifrc.org

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The International

Federation software tools

Any part of this handbook may be cited, copied, trans-

The International needs without prior permission from the International

Agenda on the part of the International Federation of Red Cross

Over the next five years, the collective focus of

Goal 1: Reduce the number of deaths, injuries

Goal 2: Reduce the number of deaths, illness-

Goal 3: Increase local community, civil society

Goal 4: Promote respect for diversity and

Scaling up our actions with vulnerable commu-

Increasing significantly our HIV/AIDS pro-

Chapter 1 Hygiene promotion and behaviour change 10

Chapter 2 Community management 10

This integrated approach has been adopted by International

Definition 2: insider’s view or the perception of the actors themselves

What is hygiene behaviour?

Elaborate table on the five hygiene domains

Hand washing at critical times (before or after certain

What is hygiene promotion?

Hygiene promotion vs. health promotion

Hygiene promotion vs. hygiene education

What is hygiene behaviour change?

What is the approach to hygiene promotion?

■ Directive approach: The approach based on precepts developed by marketing specialists in

The directive approach has been widely

What is community participation?

According to UNICEF, community participation is a development process based on dialogue, consul-

What is community management?

OM responsibilities: 4. Ownership: Sense of ownership makes communities ac-

9. Monitoring: Different systems

Link between software

Participatory hygiene and sanitation transformation is an innovative approach to promoting hygiene,

PHAST brief history 5

PHAST seven step-by-step

Step 1: Community stories Unserialised posters (2 hours)

Step 2: Community mapping Community map (2.5 hours)

Step 3: Blocking the spread of disease Blocking the routes (1 hour)

Step 4: Choosing sanitation Sanitation and water ladder

Step 5: Planning for change Planning posters (2.5 hours)

Step 6: Preparing to check our progress Monitoring chart (2 hours)

Step 7: Checking our progress Various tool options e.g. socio-

The International Red Cross

Emergencies including epidemic outbreaks

Links with other programmes

Integrating hygiene promotion

Community Planning for solutions

Planning for new facilities Selecting technology

Core activities for implementing

WASH literature review WASH documents to review Literature review report

Gender analysis Gender checklist Gender analysis report

Participatory selection of technical PHAST (steps four and five)

Technical and managerial training of Engineer and local water board

Hygiene social marketing – Mass campaign design

Hygiene practices assessment

Identification of target audience

Design and production of IEC IEC material database

Participatory monitoring and evaluation

Impact survey PHAST baseline survey Impact survey report