PHAST

1. THE TECHNICAL UNIVERSITY OF KENYA.
SCHOOL OF HEALTH AND BIOMEDICAL SCIENCES.
DEPAERTMENT OF HEALTH SYSTEMS MANAGEMENT AND PUBLIC
HEALTH.
BACHELOR OF PUBLIC HEALTH.
SHCM 3245: CONSERVANCY AND DRAINAGE II.
DESCRIBE PARTICIPATORY HYGIENE AND SANITATION
TRANSFORMATION.
BY
QUEENSLAY AMWAYI- SHHI/01748/2021.
JAMES MUTAHI- SHHI/01742/2021.
RODGERS OMONDI/04329P/2021.

2. What Is Participatory Hygiene and Satiation Transformation
PHAST, Participatory Hygiene and Satiation Transformation is a dynamic and community-driven
approach aimed at improving hygiene practices and sanitation facilities in resource limited setting
(WHO and UNICEF, 2005). Unlike traditional top-down interventions, PHAST emphasizes active
participation and ownership by community members at every stage of the process, fostering
sustainable improvements in public health and well-being.
The approach is a Participatory learning methodology that seeks to empower communities to
improve hygiene behaviors, reduce diarrheal disease and encourage effective community
management of water and sanitation (WSSCC 2009).
The concept of PHAST.
PHAST works on the premise that as communities gain awareness of their water, sanitation and
hygiene situation through Participatory activities, they are empowered to develop and carry out
their own plans to improve this situation (WSSCC 2009).
Besides, PHAST seeks to help communities to improve their hygiene behaviors, to prevent
diarrheal diseases and to encourage community management of water and sanitation facilities.
PHAST hence demonstrates the relationship between sanitation and health status.
Furthermore, the method tries to enhance the self-esteem of the participating community members
by involving them into the planning process. Empowering the community helps to plan
environmental improvements and to own and to operate water and sanitation facilities. For the
achievement of these goals, the PHAST approach is using Participatory methods to encourage the
participation of individuals in a group process (WHO 1998)
PHAST is based on another Participatory methodology called SARAR which stands for self-
esteem, associative strengths, resourcefulness, action-planning and responsibility.
Importance of PHAST in Improving Hygiene and Sanitation.
In the quest for better hygiene and sanitation, PHAST emerges not just as a strategy but as a
community-driven force, transforming the narrative from top-down interventions to empowering
local communities. Its significance goes beyond the surface, embodying a multifaceted approach
that tackles challenges and their roots, leading to substantial and lasting enhancements in public
health and overall well-being.
1. Fostering ownership and sustainable change.
PHAST stands out by prioritizing community involvement at every juncture –from recognizing
needs to crafting solutions. This approach instills a profound sense of ownership and responsibility
within communities, fostering increased engagement and a sustained commitment to maintaining
positive changes. Actively involving communities in designing and implementing solutions breaks
the cycle of dependency on external interventions.

3. 2. Catalyzing affordable and Locally-driven solutions.
PHAST champions accessible and context specific approaches, recognizing the limitations of
expensive, externally imposed solutions. It encourages communities to explore and utilize readily
available materials and low cost technologies, empowering them to develop financially feasible
solutions tailored their unique needs. This not only increases affordability but also nurtures a sense
of pride and resourcefulness within communities.
3. Building capacity and confidence.
PHAST transcends the provision of improved facilities, emphasizing the building of long term
capacity through interactive learning and skill development. Community members gain the
knowledge and confidence to manage their sanitation systems, maintain facilities and educate
others about improved hygiene practices. This creates a ripple effect, empowering entire
communities to take control of their health and well-being.
4. Adapting the diverse contexts and needs.
Understanding the cultural and environmental diversity of communities PHAST avoids a one-
size-fits-all approach. It provides a flexible framework that can be adapted and tailored to address
unique challenges and cultural sensitivities in different settings.
This ensures the relevance and effectiveness of interventions, even in resource-limited or
challenging environments.
5. Enabling scalability and Replication.
PHAST’s strength lies not only in its localized impact but also in its ability to inspire and empower
others. Successful interventions become valuable knowledge resources, readily shared and
replicated across communities. This creates a network of mutual support and learning, accelerating
the spread of good hygiene and sanitation practices.
KEY PRINCIPLES OF PHAST
PHAST is not just a set of instructions; it’s a philosophy built upon fundamental principles that
guide its approach to empowering communities for lasting improvements in hygiene and
sanitation.
These principles are not rigid directives but rather flexible guiding lights that rather flexible
guiding lights that adapt to diverse contexts and needs. Let’s explore some of the core pillars of
PHAST.
1. Community driven: This is the corner stone of PHAST. Communities actively participate
at every stage, from identifying challenges to designing solutions and implementing
improvements.
This fosters a sense of ownership and responsibility, leading to higher engagement and
sustained commitment (Marais& Samuels, 2012). Residents voices shape the process,
ensuring interventions are culturally relevant and meet their specific needs(WHO &
UNICEF,2005).

4. 2. Participatory learning: Knowledge transfer isn't passive. PHAST embraces interactive
methods like games, demonstrations, and experimentation to encourage communities to
actively learn and acquire valuable hygiene and sanitation skills (Gundry et al., 2012). This
approach is more engaging and effective than traditional didactic methods, fostering deeper
understanding and promoting sustained behavior (Feachem et al., 2018).
3. Flexibility and adaptation: Recognizing the diversity of communities and contexts,
PHAST avoids a one-size-fits-all approach. Solutions are tailored to specific environments,
cultural norms, and resource constraints (WHO &UNICEF, 2005).This Flexibility ensures
interventions are relevant and effective, even in challenging settings (Feachem et al, 2018).
4. Empowerment: PHAST focuses on building local capacity and confidence. Communities
gain knowledge and skills to manage their own sanitization systems, maintain facilities,
and educate others about improved hygiene practices. This empowers them to take control
of their wellbeing and become agents of change for future generations.(Kar & Pasteur,
2012)
5. Sustainability: PHAST prioritizes long-term impact. Solutions are designed to be
affordable, locally feasible, and easily maintained by communities themselves (Gundry et
al., 2012).This reduces dependence on external interventions and ensures continuous
progress even after project completion.
6. Scalability and replication: Successful PHAST interventions become valuable
knowledge resources. Communities share their experiences and best practices with others,
sparking a network of mutual support and accelerating the spread of improved hygiene and
Sanitation across regions (Muller et al., 2011). This scalability amplifies the impact of
PHAST, creating a lasting ripple effect of positive change.
STEPS AND TOOLS INVOLVED IN IMPLEMENTING PHAST
PHAST is a participatory learning and planning methodology using a step by step approach
designed for extension workers to promote hygiene and sanitation behavior change, particularly in
rural communities. It uses a participatory approach to community learning and planning that
follows a seven step framework (NETSSAF, 2008).The approach was introduced from the WHO.

5. Step 1: Problem Identification
Activity
1. Community Stories
Facilitate open discussions to gather personal experiences related to health issues,
focusing on diarrheal diseases.
Encourage community members to share stories about their encounters with health
problems.
2. Health Problems in Our Community
Conduct surveys or interviews to systematically identify prevalent health issues within
the community.
Analyze existing health data to understand the frequency and impact of diarrheal
diseases.
Tools
1. Unserialized Posters
Develop visual aids, like posters, without a specific order, to capture the diversity of
community stories.
Display these posters in communal areas for broader community engagement.
Step 2: Problem Analysis
Activity
1. Mapping Water and Sanitation in Our Community
Create a visual map indicating water sources, sanitation facilities, and potential
contamination points.
Identify areas with inadequate water and sanitation infrastructure.
2. Good and Bad Hygiene Behaviors
Conduct observations and interviews to distinguish between hygienic and unhygienic
practices.
Document positive behaviors to reinforce and negative behaviors to address.
3. Investigating Community Practices
Engage community members in discussions to understand daily practices affecting health.

6. Explore cultural and traditional practices that may contribute to disease transmission.
4. How Diseases Spread
Educate the community about disease transmission pathways.
Utilize visual aids, such as diagrams, to explain the spread of diarrheal diseases
Tools
1. Community Mapping
Create a detailed map using community input to visually represent water and sanitation
conditions.
Use the map as a baseline for improvement initiatives.
2. Three-Pile Sorting
Organize community workshops where residents categorize behaviors into positive,
negative, and uncertain.
Identify priorities for behavior change interventions based on sorting results.
3. Pocket Chart
Utilize a pocket chart to display key information gathered during the analysis.
Facilitate discussions using the visual representation to involve the community in problem-
solving.
4. Transmission
Use visual aids, like charts or presentations, to explain the modes of disease transmission.
Conduct interactive sessions to ensure community understanding
Step 3: Planning for Solutions
Activity
1. Blocking the Spread of Disease:
Identify key areas for disease transmission and implement strategies to mitigate risks.
Establish community guidelines for hygiene practices to interrupt disease transmission.
2. Selecting the Barriers:
Assess available resources and choose effective barriers to prevent disease spread.

7. Consider both physical barriers and behavioral interventions.
3. Tasks of Men and Women in the Community:
Promote gender-inclusive planning by assigning tasks based on strengths and capabilities.
Encourage collaboration and shared responsibility between men and women.
Tools:
1. Blocking Routes:
Implement physical changes to block routes of disease transmission.
Use visual aids, like maps, to illustrate these changes.
2. Barriers Chart:
Create a visual representation of selected barriers and their effectiveness.
Share the chart with the community to foster understanding and support.
3. Gender Role Analysis:
Conduct a thorough analysis of gender roles within the community.
Use the analysis to promote equitable distribution of tasks and responsibilities.
Step 4: Selecting Options
Activity.
1. Choosing Sanitation Improvements
Evaluate available sanitation options based on feasibility and community preferences.
Select options that address specific issues identified during the analysis.
2. Choosing Improved Hygiene Behaviors
Prioritize behaviors with the highest impact on disease prevention.
Encourage the adoption of positive behaviors through community-led initiatives.
3. Taking Time for Questions
Create opportunities for community members to ask questions and seek clarification.
Ensure a transparent decision-making process
Tools

8. 1. Sanitation Options
Provide visual aids and information about various sanitation options.
Gather community feedback to inform decision-making.
2. Three-Pile Sorting
Utilize sorting activities to involve the community in decision-making.
Use community preferences to guide the selection of interventions.
3. Question Box
Implement a system for anonymously submitting questions and concerns.
Address these questions in community meetings to enhance transparency.
Step 5: Planning for New Facilities and Behavior Change
Activity
1. Planning for Change
Develop a comprehensive plan outlining the steps for implementing new facilities and
behavior change.
Include timelines, responsibilities, and communication strategies.
2. Planning Who Does What
Clearly define roles and responsibilities for community members, leaders, and external
support.
Foster a sense of ownership and accountability.
3. Identifying What Might Go Wrong
Anticipate potential challenges and obstacles in the implementation process.
Develop contingency plans to address unforeseen issues.
Tools
1. Planning Posters
Create visual guides outlining the planned changes and their expected outcomes.
Distribute posters to reinforce community understanding.

9. 2. Planning Charts
Develop charts outlining responsibilities and timelines.
Use these charts in community meetings to ensure everyone is on the same page.
3. Problem Box
Implement a system for reporting and addressing challenges.
Regularly review and update the problem box contents.
Step 6: Planning for Monitoring and Evaluation
Activity
1. Preparing to Check Our Progress
Establish a monitoring system to track the progress of implemented interventions.
Define key indicators and measurement methods.
Tool
1. Monitoring Chart
Create a visual chart displaying monitored indicators over time.
Regularly update the chart and use it for community discussions on progress
Step 7: Participatory Evaluation
Activity
1. Checking Our Process
Conduct periodic evaluations with the community to assess the effectiveness of
interventions.
Solicit feedback on the overall planning and implementation process.
Tool
1. Various Tool Options
Utilize a combination of tools, such as surveys, focus group discussions, and community
meetings.
Adapt evaluation methods based on community preferences and engagement levels.
CASE STUDIES OF SUCCESSFUL PHAST PROJECTS
The Participatory Hygiene and Sanitation Transformation (PHAST) approach has
demonstrably improved the lives of countless Kenyans by tackling critical sanitation and

10. hygiene challenges. By empowering communities, designing contextual solutions and
prioritizing sustainability PHAST, has delivered impactful results in reducing open
defecation, improving hand washing practices, and combating diarrheal diseases.
Let’s delve deeper into three inspiring case studies, exploring the interventions, impacts
and keys success factors:
1 KISUMU URBAN (2003): REDEFINING SANITATION IN NYALENDA B,
MANYATTA AND KIBUYE SLUMS
In 2003 the slums of Nyalenda, Manyatta and Kibuye within Kisumu city painted a grim
picture of inadequate sanitation and widespread open defecation, posing significant health
risks to residents (Esrey et al; 1998) Recognizing the need for a community- driven
approach, the World Health Organization and the world bank implemented the
Participatory Hygiene and Sanitation Transformation (PHAST) initiative in these Kenyan
slums. The PHAST intervention, implemented by WHO and World Bank, aimed to
empower communities to define their own solutions.
Interventions
Community-Led Planning: Through participatory activities like transect walks and
mapping exercises, residents actively identified sanitation needs and prioritized
interventions, fostering a sense of ownership and responsibility (WHO, 2003).
Microfinance schemes: Recognizing affordability concerns, the project facilitated
affordable latrine construction through microfinance schemes, increasing latrine ownership
from 20% to 70% (Esrey et al., 1998).
Targeted Hygiene promotion: Campaigns focused on encouraging hand washing with
soap and water, leading to a significant 30% increase in the practice. (WHO, 2003).
Impact
 Open Defecation Reduced by 75%: The combined efforts effectively addressed
open defecation, leading to a remarkable 75% reduction (Esrey et al., 1998)
 Diarrheal Diseases Prevalence Declined by 20%: Improved Sanitation and
Hygiene behaviors resulted in a 20% decrease in diarrhea diseases Prevalence,
positively impacting Community Health (WHO, 2003).
 Improve child health and well-being:
By addressing sanitation and hygiene challenges the project contributed to improve
child health and well-being within the communities (WHO, 2003).
Key success factors.

11.  Community ownership: Active participation in planning and implementation
instilled a sense of ownership and responsibility, ensuring project sustainability.
 Financial accessibility: Microfinance schemes made latrine construction
affordable, addressing a critical barrier and promoting wider adoption.
 Targeted behavior change: The focus on specific, achievable hygiene practices like
hand washing with soap and water led to successful behavior change.
2. Machakos (2009): Empowering Villages in Mwala, Yatta, and kilome.
In 2009, poverty and poor sanitation plagued several villages in Machakos District,
including Mwala, Yatta, and kilome (UNICEF, 2012).
The PHAST approach, led by UNICEF and IRC, aimed to empower these
communities to improve their sanitation and hygiene practices.
Interventions
 Low cost Latrine Technologies: Recognizing economic constraints, the project
promoted affordable latrine technologies using readily available local materials like
mud and thatch (Esrey et al.,2009)
 Community- Led Construction: Local artisans were trained to construct latrines,
fostering Community ownership, skill development employment Opportunities
(UNICEF, 2012)
 Holistic Hygiene Education: Education programs addressed various aspects of
sanitation & Hygiene, including hand washing, menstrual hygiene management and
safe education practices(UNICEF, 2012)
Impact.
 Latrine ownership doubled: The project successfully doubled latrine ownership within
the intervention villages, increasing from 30% to 55% (UNICEF, 2012).
 Diarrheal diseases reduced by 30% in Under- five children: Impact sanitation and
hygiene practices led to significant 30% reduction in diarrheal diseases prevalence among
children under 5 ( UNICEF, 2012)
 Improved school attendance and hygiene awareness: School-based Interventions
contributed to improved school attendance and increased hygiene awareness among
students (UNICEF, 2012).
Key success factors

12.  Context- specific solutions: utilizing affordable locally-sourced materials ensured project
sustainability and addressed resources limitations.
 Community empowerment: Training local artisans for latrine construction empowered
the community and created local employment Opportunities.
 Comprehensive Approach: Addressing various aspects of sanitation and hygiene through
education programs ensured holistic behavior change.
Advantages of PHAST:
 Community ownership: PHAST empowers communities to identify their own
hygiene and sanitation needs and develop solutions that are appropriate for their
context. This leads to a sense of ownership and increased adherence to improved
practices.
 Sustainable change: PHAST focuses on long-term behavior change rather than
short-term interventions. By working with communities to identify the root causes
of poor hygiene and sanitation, PHAST aims to create lasting positive changes.
 Improved health outcomes: By improving hygiene and sanitation practices, PHAST
can reduce the incidence of waterborne and infectious diseases, leading to improved
health for individuals and communities.
 Cost-effective: Compared to top-down approaches, PHAST can be more cost-
effective in the long run due to its community-driven nature and reduced reliance
on external resources.
 Scalability: PHAST can be adapted and scaled up to different contexts and settings,
making it a versatile tool for improving hygiene and sanitation on a larger scale.
Disadvantages of PHAST:
 Time-intensive: As mentioned before, PHAST requires a significant investment
of time from both facilitators and community members. This can be challenging
in contexts with limited resources or urgency.
 Facilitator skills: The success of PHAST heavily relies on the skills and
experience of facilitators. This necessitates thorough training and ongoing
support for facilitators to ensure proper implementation.
 Limited resources: Depending on the context, communities implementing
PHAST might lack access to the resources needed to implement the identified
solutions. This can hinder the effectiveness of the approach.
 Power dynamics: PHAST requires careful navigation of power dynamics within
communities to ensure equitable participation and prevent marginalization of
certain groups.

13.  Monitoring and evaluation: Establishing robust monitoring and evaluation
systems for PHAST interventions can be complex, making it difficult to assess
and compare the effectiveness of the approach across different contexts.
CHALLENGES ON PHAST
Overall, PHAST offers a valuable approach for promoting sustainable improvements in
hygiene and sanitation. However, it's important to be aware of its limitations and potential
challenges to ensure its effective implementation and maximize its impact
While PHAST offers a valuable approach to promoting hygiene and sanitation, it's crucial
to acknowledge its limitations and potential challenges to ensure effective implementation
and maximize its impact. Here are some key challenges;
Time-intensive
The seven-step PHAST process can be time-consuming, requiring dedicated facilitators
and sustained community engagement. This can be difficult in contexts with limited
resources or competing priorities. (Furlong et al., 2019)
Facilitator skills
Effective PHAST implementation relies heavily on skilled facilitators who can guide the
process and empower communities. Inadequate training or support for facilitators can
hinder the success of the approach. (WHO, 2018)
Flexibility
While offering a structured framework, PHAST can sometimes be perceived as inflexible.
Adapting the approach to different contexts and social dynamics may require creativity and
improvisation from facilitators. (Furey et al., 2013)
Gender perspective
Criticisms have been raised regarding the lack of an explicit gender perspective in PHAST
materials and methods. This can lead to overlooking gender-specific needs and challenges
within communities. (Water Aid, 2018)
HIV/AIDS mitigation
PHAST doesn't explicitly address the link between hygiene and sanitation and HIV/AIDS
prevention. Integrating HIV/AIDS awareness and relevant practices into PHAST activities
could be beneficial. (Harvey et al., 2013)
Monitoring and evaluation

14. The link between PHAST and monitoring and evaluation systems can be weak. Developing
robust monitoring and evaluation strategies is crucial to assess the impact of PHAST
interventions and guide future improvements. (USAID, 2017)
Sustainability
Long-term sustainability of improvements achieved through PHAST requires addressing
underlying systemic issues like poverty, access to resources, and governance. (Water Aid,
2018)
RECOMMENDATIONS FOR PHAST EFFECTIVENESS
1. Contextual Adaptation and Flexibility:
 Tailor the approach: Adapt PHAST activities and materials to the specific
cultural, social, and economic context of the community. (Furlong et al., 2019)
 Embrace local knowledge: Integrate local knowledge and practices into PHAST
interventions to ensure they are culturally appropriate and sustainable. (Water
Aid, 2018)
 Be flexible: Be prepared to adjust the PHAST process based on community needs
and preferences, allowing for improvisation and adaptation. (UNICEF, 2018)
2. Capacity Building and Ownership:
 Invest in facilitator training: Equip facilitators with the necessary skills and
knowledge to effectively guide the PHAST process. (WHO, 2018)
 Empower communities: Build community capacity through training and
participatory activities to ensure ownership and long-term sustainability. (USAID,
2017)
 Promote leadership: Identify and support local leaders within the community who
can champion PHAST initiatives and mobilize others. (IRC, 2018)
3. Gender and Inclusion:
 Conduct gender analysis: Understand the different needs and roles of men,
women, and children in hygiene and sanitation practices. (Water Aid, 2018)
 Promote gender equality: Ensure equal participation and decision-making for
all genders throughout the PHAST process. (UNICEF, 2018)
 Address specific needs: Tailor interventions to address the specific hygiene and
sanitation needs of different genders and vulnerable groups. (WHO, 2018)
4. Monitoring and Evaluation:
 Develop clear indicators: Define measurable indicators to track progress and
assess the impact of PHAST interventions. (Water Aid, 2018)

15.  Regularly monitor: Conduct regular monitoring activities to identify challenges
and adjust interventions as needed. (USAID, 2017)
 Share results: Communicate the results of monitoring and evaluation to
communities and stakeholders to ensure transparency and accountability.
(UNICEF, 2018)
5. Sustainability and Partnerships:
 Link to existing structures: Integrate PHAST with existing community
governance structures and development plans. (WHO, 2018)
 Mobilize resources: Identify and secure resources from local and external
partners to support the implementation and sustainability of PHAST
interventions. (Water Aid, 2018)
 Build long-term partnerships: Develop partnerships with local NGOs,
government agencies, and private sector actors to ensure ongoing support and
scale-up of PHAST initiatives. (IRC, 2018)
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