Participatory Hygiene and Sanitation Transformation. The PHAST Initiative

Describes an exciting new approach, based on an innovative set of participatory techniques, that has demonstrated its ability to promote hygienic behaviour, sanitation improvements, and community management of water and sanitation facilities. Known as the Participatory Hygiene and Sanitation Transformation, or PHAST, initiative, the approach was carefully developed and tested in both urban and rural areas of four African countries: Botswana, Kenya, Uganda, and Zimbabwe. Results of these tests indicate an unprecedented involvement of communities, the particular suitability of PHAST techniques to resource-poor settings, and remarkable success in terms of environmental and behavioural improvements.
The initiative is described in five sections. The first explains how PHAST functions as a core set of concept-based tools, methods, and materials, which integrate basic epidemiological concepts with a participatory methodology. Central to the approach are a respect for people's innate ability to address and resolve their own problems, a creative learning approach based on active discovery by the community, and firm evidence that lasting change in human behaviour depends on understanding and believing. The document explains how the approach stimulates a very high degree of community involvement and enthusiasm while also allowing outsiders to appreciate the depth and breadth of local knowledge and intuition. Most important, results show that the approach works to transform the helpless mentality associated with ignorance or poverty into self-esteem and confident self-help, even in the absence of literacy or formal schooling.

Section two explains how the methodology was developed at workshops in African countries. These workshops developed an approach that relies heavily on both the training of extension workers and on the development of graphic materials in locally adapted sets, or "toolkits". These include posters depicting routes of oral-faecal contamination and various preventive measures, and drawings and photographs produced for a popular exercise in "three-pile sorting", where depicted situations are sorted as good, bad or in-between. Other tools include a pocket chart which serves as an investigative tool, visual materials that help distinguish between illnesses requiring curative attention and those that can be addressed through a preventive strategy initiated by the community, and instructions for preparing community maps.
Subsequent sections give examples of the impressive - and continuing - results of the initiative, whether involving behavioural change or the construction and maintenance of latrines, and set out lessons learned, particularly concerning the approach's capacity to help communities determine what they really need and are prepared to pay for in terms of money, resources, and time. A final section gives advice on how the approach can be adopted more widely and discusses the enabling factors involved.ecx