International Federation for Red Cross and Red Crescent National Societies

Regional Delegation Nairobi Health and Care Support Unit

SRI LANKA RED CROSS NATIONAL SOCIETY AND INTERNATIONAL FEDERATION OF RED CROSS AND

RED CRESCENT NATIONAL SOCIETIES

One of the community sessions: a community member presenting a community map

PHAST TRAINING WORKSHOP HELD IN COLOMBO

16-21st May 2005

May 2005

__________________________________________________________________

Facilitation and Report by Rebecca Kabura Senior Regional WatSan Officer

Table of Contents

List of Abbreviation 1iiAcknowledgements 2

1.Introduction 44

2. The Training Workshop 36

Methodology 7Key Recommendations 7Limitations 8Challenges 10Overview of Water and sanitation activities 11Conceptual back ground of PHAST 13Concepts in health 19PHAST steps and activities 46Conclusion 47Terms of reference 48Workshop program 49Handouts References

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List of Abbreviations

ICRC International Committee for the Red Cross

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IFRC International Federation of Red Cross and Red Crescent National societies

ITN Insecticide Treated Nets

NS National Society PHAST Participatory Hygiene and Sanitation Transformation RDN Regional Delegation Nairobi

SARAR Self Esteem Associative Action Planning and Resourcefulness

Acknowledgement

I wish to register my gratitude to all those who made this mission a success. Special thanks go to Fidel Pena the IFRC WatSan coordinator who was my host , facilitated the whole process and in additional provided all the logistical support and Naomi Jackson and Katrina Orflet who worked alongside me. All the workshop participants who worked very hard under a very tight schedule and made the training process an eye opener and an enriching process. The

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community members and partners visited, interviewed and of course all the volunteers who have worked together to make the Tsunami operation a success.

It’s also worth mentioning all the support accorded to me by Uli Jaspers head of WatSan unit Geneva and Robert Fraiser Senior WatSan officer Geneva, Vera Bensmann (Nairobi Regional Delegation) Health and Care Coordinator. My dearest friends Noor Pwani Senior WatSan officer and John Muathe WatSan /Health program assistant who gave me all the morale and desk top support for the mission.

Special thanks to SrilLanka Red Cross National Society and all the families whose lives the Tsunami altered forever my heart goes out to them. The opportunity to work in this beautiful country especially in this healing phase has enriched my life and I hope the seed of change I have planted will flourish and be part of f the healing process.

1.0 INTRODUCTION

This report documents the proceeding of the PHAST training conducted in Colombo by IFRC and Sri Lanka Red Cross National Society.10 participants were trained as trainers in the PHAST methodology and these are mainly persons involved directly or indirectly in Water and Sanitation programs.

An earthquake measuring 8.9 on the Richter scale struck the area off the western coast of northern Sumatra on 26 December, triggering massive tidal waves or tsunami’s that swept into coastal villages and seaside resorts. One of the hardest hit areas is Sri Lanka with 70 percent of the coast being damaged. In terms of Water and sanitation an estimated of 45,000 toilets/latrines were destroyed or rendered unusable. About 76,000 ring wells were destroyed by

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the Tsunami floodwaters directly or indirectly through saline and/or pollution. Most of the ring wells in southern coastal areas yield only saline water and are therefore traditionally only used for washing and cleaning purposes. Trucking of potable water in coastal areas is standard practice and piped water supply is only available in densely populated areas and settlements.

The overall health and water and sanitation sectors in Sri Lanka are extremely precarious after the disaster. Large numbers of affected families are still living in temporary shelters provided by Government and International Organizations. The water and sanitation sector has been severely affected in the coast line of Sri Lanka and Infrastructure where has deteriorated where it existed. People living in transit camps have access to clean water in a basis of 175 litres per family, one toilet per 8 persons.

Hygiene promotion is an issue that is common to all camps in all Districts but is not being carried out with the desirable intensity and needs to be reinforced both in terms of increased partnerships on hygiene promotion as well as increased interface of hygiene promoter and camp residents.

IFRC started operation in the Tsunami Operation since 26 th December, 2006. Emergency phase is over and rehabilitation phase is starting for a period of 1 year. Water and Sanitation intervention in the rehabilitation phase has to be consistent with IFRC policy. With the three components integrated: Water, Sanitation and Hygiene Promotion. PHAST is a methodology used by IFRC that encourages community participation and links hygiene promotion with the construction of water and sanitation infrastructure. Since Sri Lanka Red Cross Society is not experienced in running integrated water and sanitation programs, the RDN Senior WatSan Software officer who is well versed in the approach and hygiene promotion programming was engaged to give technical support on how to start the program in the country together with all the components of the Red Cross/Red Crescent Movement present in the country.

The five day training workshop was part of this programming process and was a highly participatory workshop, building on the participants’ own experiences and knowledge .Although one afternoon was reserved for field simulation of some of the PHAST activities and tools in Bentota village one of the areas Sri Lanka Red Cross has activities this was not possible due to time limitation and the tight schedule.

It is expected that after this training the participants can then organize a similar training at the national level involving representatives of various branches either already undertaking or have intentions of undertaking WatSan programs and can assist in the formation of PHAST groups so that the every target household can be reached and there can be the desired trickling down effects.

2.0 TRAINING WORKSHOP

2.1 Methodology and Workshop Process

The training method was itself highly participatory and experiential. It was ‘situation-centered’ and focused on the realities of the participants, based on their areas and fields of operation as well as their own experiences. It relied on discussions and action based methods, rather on presentation of the facilitator. Most of sessions were in group work after brief introduction of the activity by the facilitator. Plenary, recaps and evaluation of the day’s activities was also done which embraced the principles of adult learning and team spirit. The toolkit used was informed by field simulations undertaken near Portville, one of the Tsunami affected areas in Ampura district in the previous two weeks .

The process for the entire workshop consisted of the following steps:

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1. Pair wise introductions: In this method each participant was asked to introduce his partner ; -his name ,last childish thing he had done ,what languages he speaks ,what he likes about Sri Lanka Red Crescent and what he does not understand about Sri Lanka Red Cross and how they intended to apply the PHAST methodology.

2. Fixing the workshop timetable and ground rules: The facilitator asked the participants to amend or adopt. Participants decided that they would work from 9.00 a.m. to 5.00 p.m. everyday, with tea break at 10.00, -10.15prayer/lunch break at 12.30 -1 p.m. and afternoon tea break at 3.00- 315 p.m.

3. Leveling of expectations and fears and agreement on responsibility for learning: This helped the facilitator to understand and take into consideration the needs of participants and to compare these with the stated objectives of the workshop.

4. Plenary discussions on experiences and lessons. The discussions and lesson learning focused mainly on the understanding and applicability of the particular tools as well as the facilitation skills, including teamwork among the group members.

5. Field pre-testing: This was not done due to time limitations although this would have been ideal to strengthen the participants’ skills in the application of PHAST.

6. In all cases, training on facilitation and communication skills as well as the importance of teamwork among group members was part and parcel of the whole process as was the daily evaluation. Daily evaluation at the end of each day was meant to enable the facilitator to gauge the level of learning and general feelings of participants in order to be able to make any necessary improvements on the delivery of the training exercise based on the results of the results. Also part and parcel of the whole training exercise was the ‘recap’ of the previous day’s proceedings by groups of participants, at the beginning of every subsequent day. This served to bring out key lessons and to identify areas that needed further clarification or attention.

7. On the last day of the training exercise, participants discussed how to implement PHAST. 8. Additional technical handouts on water and sanitation programming were given to the participants. They were

also encourage t he PHAST guidance notes for WatSan programming

KEY RECOMMENDATIONS

1. An incremental approach for the initial phase is practical and PHAST pilots will be more apt and the lessons from the pilots can be used to inform and strengthen the next phase of program. Proper mapping and selection of the branches has to be done to identify the relevant pilot branch.

2. How PHAST will be presented to the community has to be given due considerations. Community entry is crucial, the use of local volunteers, translations of training materials into the local dialects and developed within the local context has to be done.

3. The involvement and ownership of Sri Lanka Red Cross in taking the leading in the PHAST process remains a challenge and there is need for demystification of the approach within the integrated health and care programs. For the next level of training, a proper selection criterion has to be developed and it would be more appropriate if both the head quarter level and the field level officers are involved in the training and program design.

4. While programming for PHAST, a thorough analysis of possible expected benefits or impacts of PHAST needs to be done so that programming is done within a realistic framework to avoid raising undue expectations. Normally health gains and any other gains from a hygiene promotion take a long time to be realized.

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5. Initial assessment of the current situation has to be done to inform the programming process. This can either be done through undertaking a comprehensive baseline or situation analysis that will be project specific so that this can be used to triangulate the problems identified in the PHAST training process. Assessing the impact of intervention is tied to strong monitoring and evaluation component factored in the hygiene promotion and WatSan program as a whole. Realistic indicators have to be set and harmonized through a community driven process.

6. The strength of PHAST lies in how the community is directly involved in the design of and implementation of interventions. Such a process calls for a lot of flexibility and moving together with the community and this therefore calls for a community driven process.

7. Institutional collaboration is crucial since coordination remains a challenge in relation to hygiene promotion and education. Currently there is no any other organization using PHAST apart from the Federation and therefore there is a big opportunity for IFRC to introduce PHAST through a concerted effort.

8. Volunteer motivation is vital to making the program a success since this a very involving community driven process. Volunteer policy has to guide how volunteers are recruited and motivated within the program and a common approach has to be applied when either IFRC or the PNS are implementing PHAST and other community projects.

9. For the PHAST program to be successful the link with Sanitation Promotion has to be established and it would be indeed strategic to begin the plot where there are intentions of also undertaking Sanitation Promotion.

10. Documentation of good practice especially the lessons learnt will assist in shaping and profiling the WatSan program. Cross fertilization of ideas and lessons needs to be encouraged across programs and branches and review meetings structured within the program.

11. While designing WatSan proposals there should be budget lines factored for the various activities related to WatSan projects. These include development of Information Education Communication (IEC), assessments and documentation.

12. The first phase of development of the PHAST toolkit has been completed but the next stage step is to adapt the tool further at the national level workshop and there after it can be adopted to be the Sri Lanka PHAST tool.

LIMITATIONS

The objective of the training was to train IFRC water and Sanitation staff involved in Water and Sanitation and the Sri Lanka Red Cross staff in PHAST methodology as highlighted in the workshop objectives. However this was not possible due to unavoidable circumstances. The workshop was supposed to be conducted for 6 days and a field simulation exercise factored in , however this was not possible due to time limitations .The field trips were very informative but more time was needed for in-depth interactive with the community and more locations be visited.

CHALLENGES

This is a country that has been affected by Tsunami and the social structures torn apart. This has had implications on the cohesiveness of the community. A lot of expectations have also been raised in the relief phase in the process of trying to address the overwhelming needs. An integrated and holistically approach has to be taken up since there are immediate needs which sectoral projects may not be fully able to address. Many community members are still traumatized and are trying to redefine their lives. Their coping mechanisms have to be reinforced, supported and may be through Psycho- social support programs.

Institutional collaboration is essential since it is not possible to work alone in this intricate and dynamic set up. The link with the government is important since it still remains the prerogative of the government to address the needs of its populace. The overwhelming needs are beyond what the government can handle or address and with all various agencies working in the Tsunami operation, joint strategies have to be developed to avoid duplication and instead enhance synergy among the various players and even donors. The emergency relief phase is over and in this transition period into the rehabilitation phase the challenge remains how to program within such a dynamic environment and still keep abreast of the community processes, yet it is within this context that PHAST will be implemented.

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DAY.1

The fist session of the workshop was the introductory remarks. The individual participants were asked to do pair wise introduction; introduce his partner, the last childish thing they had done, the languages they speak, what they like about Sri Lanka and what they don’t understand about Sri Lanka culture and the application of PHAST /hygiene activities. There after the workshop time table and ground rules were fixed. The facilitators asked the participants to amend or adopt this. Participants decided that they would work from 9.00 a.m. to 5.00 p.m. everyday, with tea break at 10.00 -10.15 am, lunch break at 12.30 -1.30 p.m. and afternoon tea break at 3.00-3.15 p.m. The leveling of expectations and fears and agreement on responsibility for learning was done which assisted the facilitator to understand and take into consideration the needs of participants and to compare these with the stated objectives of the workshop.

(Below is a summary of the participants’ fears and expectations)

Fears of the participants Expectations of the participants

Norms of the workshop

No enough time Learn how to implement PHAST

No mobile phones

May delay to start activities How can PHAST be applied for other community issues /needs

Time keeping

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Don’t know how to start PHAST activities

How to develop monitoring and evaluation tools

Listening to each other

Don’t know how PHAST will relate with my activities

How to define PHAST Respect to each other’s views

Objectives

The main aim of the workshop was to train the work shop participants involved in water and sanitation programs so that they can adopt/adapt PHAST methodology in their work.

1. Provide the participants with an approach for empowering communities to reduce and eventually eliminate water and sanitation related diseases.

2. Provide the participants with methods that can lead to community management of water and sanitation facilities.3. To enable participants acquire knowledge and practical skills in the use of participatory hygiene education tools.4. To impart knowledge and practical skills to participants that would enable them evaluate behavior change in

hygiene, sanitation and water interventions using participatory methods.

1.0 OVERVIEW OF RED CROSS MOVEMENT AND WATER AND SANITATION PROGRAM ACTIVITIES

The Federation WatSan unit has four focal persons based in Geneva, in Africa there are 8 delegates and 2 are regional delegates, In America there are 3, while 7 are based in Asia Pacific and for Tsunami related activities there are 16 delegates and 1 Coordinator based in the Tsunami affected areas. In Sri Lanka the current team comprises of the WatSan Coordinator and 1 WatSan delegate an additional delegate for projects in the North will soon join the team. There is an open position for a trainee delegate.

Water and Sanitation is a Health initiative, clearly defined and seen as one of the most important aspects of preventive/public health. The Federation’s basic health policy has underlined the need for a community-based approach. Community Based Health Care can therefore not be considered without addressing the issue of Water and Sanitation coverage. WatSan sub unit is part of the public health unit in Geneva and within the national societies is part of health and care unit within the integrated approach where this exists. The role of the federation is to strengthen and build the capacity of the national societies and be able to implement the WatSan activities better.

The activities are implemented guided by the IFRC WatSan policy and every national society is expected to adapt and work within the policy frame work. This policy applies to all Water and Sanitation interventions carried out by National Societies and the International Federation. National Societies and the International Federation’s programming and advocacy aims at incorporating Water and Sanitation objectives into general health and development programmes as well as in emergency situations.

Key points within the policy include; the importance of baseline and proper assessments before initiating any programmes and gender balance is crucial. Ensuring community participation and management in the various programmes is core in reducing implementation costs and encouraging ownership. Communities should naturally be involved from the onset. Participatory techniques (such as PHAST-Participatory Hygiene and Sanitation Transformation) are well established in Federation Water and Sanitation/Health programmes.

Regular exchange of information between the water supply and sanitation sector and the health information system and where possible and feasible collect and analyze health statistics and trends before starting any Water and

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Sanitation intervention and to monitor them during and after implementation to determine the projects impact upon the health status of the beneficiaries, and/or governments.

The need for software leading the hardware if not parallel before introducing the hardware is priority. Due consideration should be given to the use of appropriate local technologies and cultural preferences for the sustainability of the work. Ensuring full attention is given to the development of human resources like National Society staff, delegates and volunteers in the area of Water and Sanitation. Suitable training is required in technical, managerial and public health areas for most Water and Sanitation initiatives. Response to emergencies and disasters (population movements, camp situations etc.) which require Water and Sanitation interventions with qualified personnel following Red Cross/Red Crescent and other technical standards is also an important element.

Design and implement Water and Sanitation operations aiming at an effective evolution from relief to development and consideration of ntegration of related sectors e.g. Health and HIV/AIDS programmes, food security, organizational development, disaster preparedness, as much as possible, keeping in mind that programmes can have a developmental character right from the start and do not always evolve out of an emergency situation.

Formulation of clear exit or phasing out strategies at an early stage of any Water and Sanitation intervention ,recognizing the responsibility of the National Societies and the International Federation for the long term impact and durability of technical installations.

National Societies and the International Federation have the responsibility to ensure that all Water & Sanitation activities and programmes are carried out in compliance with this policy; that all staff and volunteers participating in such programmes are aware of the rationale and content of the policy. The Federation has developed the (GWSI) Global Water and Sanitation Initiative whose focus is on long term programming yet using appropriate technology and building on existing community structures. This is based on the realization that short term projects are neither cost effective nor sustainable. Currently a GWSI checklist has been developed.

In terms of operations ICRC which has been operating in Sri Lanka long before the Tsunami and is responsible for coordinating activities in the North and the East while IFRC is operating in the South and West. Based on the Seville agreement, the areas of operation have to be adhered to and Sri Lanka Red Cross is the host .The opportunities for IFRC are in undertaking hygiene promotion, waste water and water provision. Despite an influx of donors after the Tsunami, sanitation has attracted very low funding and the same applies for rural water supply.

4.0 CONCEPTUAL BACK GROUND OF PHAST

Given the fact that hygiene and sanitation behavior change at the personal, household and community level is capable of effectively mitigating against deaths due to diarrhoeal diseases, it was deemed necessary to devise a methodology for promotion of hygiene and sanitation behavior change. It is this concern that led to the birth of PHAST Participatory Hygiene and Sanitation Transformation since 1992 during a joint initiative by UNDP, the World Bank and WHO to review SARAR methodology. PHAST is therefore anchored or based on the SARAR concept and has adapted/adopted SARAR and Participatory Rural Appraisal (PRA) tools to enable development agencies involved in hygiene and sanitation promotion secure the participation of communities whose hygiene and sanitation behaviors, habits and practices, they seek to change or transform. It has been piloted in America, Asia and Africa. In Asia and Africa, PHAST has been successively adapted to suit the local context by different agencies as an effective software tool in addressing hygiene promotion, local capacity building, stakeholder involvement, monitoring and evaluation. The use of pictures and drawings facilitates the visualisation of the everyday hygiene and sanitation behaviors of the people and helps facilitators to discuss issues that would otherwise be difficult to talk about without inhibitions or “feelings of shame”.

4.1 AIMS AND OBJECTIVES OF PHAST

PHAST is an acronym for Participatory Hygiene and Sanitation Transformation, which is a community management tool, designed to promote the empowerment of communities. It enables communities to identify and analyze their problems and make informed decisions on what options they want to pursue as their solutions .It also allows communities to monitor and eventually evaluate theses activities to check for progress and document lessons learnt. This makes it an effective hygiene promotion tool as it ensures that beneficiaries benefit from the installed facilities for water and sanitation because they have improved hygiene behavior.

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PHAST aims to ensure that the installed water and sanitation facilities deliver optimum health and social benefits, which can be sustained at the community level in the long term.

PHAST has three main objectives:

1. The promotion of improved hygiene behaviour 2. Improvements to sanitation3. Community management of water and s sanitation facilities

It does this by:

Demonstrating the relationship between sanitation and health status Increasing the self esteem of community members Empowering the community to plan environmental improvements and to own and operate water and sanitation

facilities

Because the PHAST process involves seeking communities’ knowledge, attitude, practice and most importantly 'buying in', it generally takes a relatively long time (an average of 2-3 months) to implement successfully. It is composed of 7 main steps, each with its own activities and objectives as well as tools. These include making choices about the different technology options available. To enable participants understand the use and place of hygiene and sanitation promotion (using the PHAST methodology) in the overall context of health, was also introduced.

The facilitator talked about problem identification and problem solving in relation to PHAST and community problem identification and problem solving.

1. To identify problem2. Route cause of the problem3. Number of people affected4. Options in solving problems5. Mode of solving problems6. Selecting appropriate option7. Solution achieved.

SEVEN STEPS IN PHAST

1. Identify problem2. Problem analysis3. Planning for solution4. Selecting for solution5. Facility and behavioral change6. Planning for monitoring and evaluation7. Participatory evaluation

The PHAST Process

A STEP may contain one or more activities aimed at achieving one overall objective. An ACTIVITY is what the group works through to discover the information and skills necessary to reach an

understanding or take an action. TOOLS are the techniques and materials the facilitator uses to help the group work through an activity.

4.2 WHY THE FEDERATION USES PHAST

To enable participants acquire skills to improve participatory learning and facilitation skills. To enable the participants to adopt participatory learning tools with a view of producing context and

culturally specific tools. To demonstrate participatory learning methods in this regard, aim to obtain a “multiplier effect through

training of volunteers. To develop realistic work plans at branch level with regard to water and sanitation, hygiene promotion and

community management

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To impart knowledge and practical skills to participants that would enable them to evaluate behavior change in hygiene, sanitation, water and health interventions using participatory methods.

4.3 JUSTIFICATION FOR HYGIENE AND SANITATION PROMOTION

Around 2.2 million people die of basic hygiene related diseases, like diarrhea, every year. The great majority is children in developing countries. Interventions in hygiene, sanitation and water supply make proven contributors to controlling this disease burden. For decades, universal access to safe water and sanitation has been promoted as an essential step in reducing this preventable disease burden. Nevertheless the target "universal access" to improved water sources and basic sanitation remains elusive. The "Millennium Declaration" established the lesser but still ambitious goal of halving the proportion of people without access to safe water by 2015. Achieving "universal access" is an important long-term goal. How to accelerate health gains against this long-term backdrop and especially amongst the most affected populations is an important challenge. There is now conclusive evidence that simple, acceptable, low-cost interventions at the household and community level are capable of dramatically improving the microbial quality of household stored water and reducing the attendant risks of diarrhoeal disease and death. Simply providing access to improved water and sanitation does not imply the use or the much expected health benefit .The promotion of fundamental behavior changes is key to integrating the appropriate use of services.

Research shows that hygiene-related practices such as safe disposal of faeces and hand washing after contact with faecal material can reduce the rates of intestinal infection considerably. Consider the following figures:

Hand washing with soap and water can reduce diarrhoeal disease by 35% 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 diarrhoea by 36% or

more. Protection of water from faecal contamination can also reduce diarrhoea, because some diarrhoeal infections

are water-borne. Improved water quality can be associated with up to a 20% reduction in diarrhoea. Water quality in the home can be improved by using only a protected water source for drinking purposes; by

keeping water storage vessels clean, covered and out of the reach of young children and domestic animals; by boiling water where practical; or by putting water in clear plastic containers and exposing them to sunshine for several hours.

In the special case of guinea worm, filtering with a cloth filter can provide complete protection from new infections.

Increased quantity of water used, which results from better access to water, can bring about 20 % reduction in incidence of diarrhea. Hygiene has five domains as already introduced.

5.0 CONCEPTS IN HEALTH

5.1.0 HEALTH

Facilitators’ notes

Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity. It is a fundamental human right and attainment of the highest possible level of health is a most important worldwide social goal whose realization requires the action of many other social and economic sectors in addition to the health sector. World Health Organization (WHO)

5.1.2 WHY ADDRESS THE ISSUE OF HEALTH

Health is everybody’s concern and every individual has a right to basic health knowledge and health care, also a duty to help others to maintain and improve their health. The health of a community depends on people who are active and not passive towards health.The figure below is an illustration of the factors that give “health” its full meaning. All these factors need to be present in order for one to be termed as “healthy”.

5.1.3 FACTORS THAT INFLUENCE “HEALTH”

A healthy environment

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Helping others

HEALTH Being fit

Happy relationships

Healthy mind

Comments: The curative aspect of health is also a contributor to health. 5.2.0 PARTICIPATORY

Before participatory as a concept was introduced the term community was defined

Group 1

Community: Group of people at the same geographical location sharing services and has common interests

Group 2

Community: a group of people who have one or more of the following in common area, religion, race culture, gender family, culture age occupation and social status

Input by facilitator

Community is a group of people who:

Are interdependent of each other and limited by geographical boundaries Share common natural resources Share a common culture Experience same problems

Despite common characteristic traits, there is a general recognition that even within a community, there would still be sub-groups, each with specific interests and goals, and development facilitators should be sensitive to such groups even though it might be impossible to satisfy the needs of all sub-groups within a community. An example to illustrate this could be the level of enthusiasm for sanitation awareness campaigns among village members who already have and are using latrines and those who do not have. Similarly, even within the same community, there will be people who are better off than others or who are more influential than others.

Group Task: Define the concept participatory

Group 1

Participatory concerns active involvement at all stages of all stakeholders concerned in a project.

Group 2

All people equally involved, responsible, self conscious, community exchange of views and no discrimination

Facilitators’ notes

How far can participatory methods be applied within a socialist state?

Participatory Development PillarsAttitude

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Sharing of ideas, knowledge, skills Methods and tools

Roles of facilitators while working with participatory methodologies and tools

Explain to the community the purpose and uses of specific tools in relation to each activity and your reasons for wanting them to engage in the exercise.

Explain the procedure for undertaking the exercise and let them engage in it. Facilitate discussions on the problems or topics raised and identify:

What are the issues? What is the reason behind the issues/problems raised? What can the people do to prevent problems and areas in which they may require external input? Use the information obtained to decide, together with the people, the next course of action.

5.3.0 HYGIENE

Task for group work

Define: the concept Hygiene

Group 1 Cleanness from inside out Body hygiene Control of garbage and contamination sources Protection mosquitoes Habits Use of tools Prevention such as vaccination, waste treatment, recycling Sustainability

Group 2 Protection against contamination which may lead to diseases Correct procedures Proper food storage Clean water Personal hygiene

Facilitators Notes Hygiene: Is the study of health and observance of health rules and measures of preserving health .This involves the 5 areas of health also commonly known as 5 hygiene domains. These includes personal hygiene, water hygiene, and food hygiene, and environmental hygiene, domestic and household hygiene

Hygiene promotion is more specific and more targeted than health promotion. It focuses on the reduction and ultimately the elimination of diseases and deaths that originate from poor hygiene conditions and practices. Hygiene promotion encourages all the hygienic conditions and behaviors that can contribute to good health .It aims to stimulate the right behavior change .It starts with systematic data collection to find out and understand what different groups of people know, what they want and why is it so, the results are used to identify and implement activities that enable different groups to measurably reduce risky conditions and practices to strengthen positive situations and behaviors.

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The difference between hygiene promotion and health promotion; Hygiene promotion is more specific and more targeted than health promotion. It focuses on the reduction – and ultimately the elimination of diseases and deaths that originate from poor hygiene conditions 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. 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 environment (physical, social and economic). For example, in social environments where people are marginalised because of their gender, economic status or religious affiliation, and have no influence whatsoever on decisions that affect their daily lives, they are likely to be prone to anxiety or depression, which can lead to mental problems.

Difference between hygiene promotion and 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. 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., by improving access to the means for better hygiene and health, social marketing, participatory learning, and peer influence. In hygiene promotion, the individuals and communities themselves review their hygiene practices and develop ways of improving them. ‘Hygiene promotion begins with what people know and builds on their existing knowledge ’.

An effective water and sanitation program integrates the five hygiene domains (which is basically software) and sanitation, which normally refers to facilities or hardware.

5.4.0 SANITATION

Group Work Task: Define the concept Sanitation

Group 1

Active decontamination, purifying water, sewage disposal, water storage and transport, water sources

Group 2

Devices such as showers, latrines showers, sewage systems, waste management, treatment and transport, recycling

Facilitators’ notes

Sanitation refers to all measures that help break the cycle of disease, community environmental sanitation usually involves hygienic (i .e safe) disposal of human and animal excreta, waste water, vector control and other hygienic behavior.

Over years there has been more focus on water rather than sanitation since it is easier to address water component in Water and Sanitation projects rather than Sanitation which is more complex and involves more collective decision making process both at household and community levels.

About 2.4 billion people globally live under highly unsanitary conditions and have poor hygiene behaviours, which increase their exposure to risks of incidence and spread of infectious diseases. Also, water stored at home is often contaminated by inadequate management and handling.

Diarrhoea, which is spread easily in an environment of poor hygiene and inadequate sanitation, kills 2.2 million people each year, most of them are children under 5 years.

Sanitation Promotion

Sanitation is the hardware side of the promotional activity. It refers to improved water and sanitation facilities such as:

Improved sanitation facilities (latrines, garbage disposal pits, waste water drainage etc), Improved water facilities, For environmental sanitation to be successful vector control and eradication should also be undertaken.

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On the other hand, hygiene and sanitation promotion refers to the combination of, and linkages or relationship between the hygiene domains and the improved facilities. Without one, the other cannot succeed, and the sanitation facilities have to be maintained if hygiene and sanitation are to succeed.

Overleaf is a diagram that places the concept of hygiene and sanitation promotion in perspective.

ig. 4: The PHAST Concept (H&S promotion are two sides of the same coin)

Evaluation of Day 1

An attempt was also done to define transformation which is the last acronym in PHAST and is actually the resultant of any hygiene promotion programme.

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Aimed at encouraging behaviour & conditions which help prevent WATSAN related diseases

Communication of behavioural practices related to health

Emphasis on gradual improved behaviour change

Is the software component of WATSAN. It comprises the following messages or domains of hygiene behaviour

Safe water hygiene Safe disposal of

human excreta

Proper food hygiene

Proper

Personal hygiene

Domestic & Environmental hygiene

Hygiene Promotion

Results in improved behaviour & proper maintenance of water and sanitation facilities, which work together to form a hygienic and healthy environment

Results in reduction of peoples exposure to disease by providing a clean environment

Emphasises gradual improvement in behaviour change

Includes messages or the 5 domains of hygiene behaviour Includes promotion of

improved sanitation facilities

Sanitation Promotion

5.5.0 TRANSFORMATION

Transformation in general refers to a complete change in appearance and character especially for the better. In hygiene and sanitation promotion, this refers to adoption and use of safer hygiene and sanitation practices, marked by actions, which translate to improved health status. After a series of activities of trying to develop common definitions on the key concepts and health and PHAST the various PHAST activities and tools were introduced.

PHOTO PARADE TOOL

The participants were given a set of pictures depicting various scenes showing different ways of facilitating community meetings.

Group Work Task: From the pictures given identify the best pictures and the worst in relation to communicating hygiene messages and give reasons. The pictures depicted the following scenarios.

Class setting, Poster displayed on a tree, use of letter, a household visit, a bad community meeting with some people sleeping , a good community meeting with a facilitator using both oral and visual aids. Communication is an interactive process involving the receiver and the sender of the message The means used is to transmit the information also very important and if no due consideration is given to this communication barriers may emerge.

Best method

Use of oral and written or audio visual aids such as in PHAST is important to hold the interest of every body.

Worst method

The use of letter since most of the people may not read the letters and this is also not interactive.

A key factor in hygiene and sanitation promotion is the communication channels, that is, the ways and means of communicating and disseminating hygiene and sanitation messages. For this reason, participants were asked to identify the various communication channels for hygiene and sanitation promotion as well as for communicating other health issues to the community. According to participants, examples of community communication channels normally used in Sri Lanka include: Radio, Newspapers, Music, Mass Campaign using microphones, Dances, Demonstration (Action), Folktales, Word of Mouth, Pictures, and Posters

DAY 2

For each day , the facilitator would give an outline of the activity and how to undertake the tool there after the participants would break up into three or four groups as need dictated then there will be presentations by each group and a plenary session with the facilitator summing up the discussions for that activity .The key focus was on lessons learnt by the participants

6.0 PHAST STEPS, ACTIVITES AND TOOLS

PHAST STEP 1

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6.1.0 STEP 1: PROBLEM IDENTIFICATION

In this step there are two activities

6.1.1 ACTIVITY 1: COMMUNITY STORIES

The activity is designed to help the group express important concerns and issues facing the community. The objective of activity is;

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

In community the stories activity, the unserialised posters tool was used.

UNSERIALISED POSTERS TOOL

For this activity the participants were divided into two groups and given a set of posters depicting different scenarios of typical life in Sri Lanka.

Group Work Task: Select a few of the posters and arrange the posters into a series to make up different stories reflecting community life.

Emerging issues from both group stories; Wife beating, community solving problems together, sense of family, common disasters

The group found this session enjoyable and it was possible to find out which issues are of concern and in one the groups the effects of Tsumani disaster were highlighted.

6.1.2.1 ACTIVITY 2: HEALTH PROBLEMS IN OUR COMMUNITY

PROPORTIONAL PILING TOOL (identification and prioritization tool)

This is a simple (voting) method of prioritizing problems and options. It follows the sessions on problem identification and analysis. After community members have identified all their problems and these have been analyzed, they are facilitated to prioritize these problems with a view to making choices for possible interventions.

Participants are given a limited but equal number of local materials – stones, pebbles, grain or whatever is lying around. Whatever material is decided upon should be of more or less equal size.

For this case the tool was used to identify common community health problems.

Group Work Task: Each participant was given a piece of paper and asked to use these to vote for the most important problem Participants voted according to individual perceptions and feelings about each problem. The problem or option with the greatest heap/pile is the people’s priority.

(This is not a PHAST tool but can easily assist in the identification of community problems). Procedure

1. Decide on the number of issues on which you want to make a decision on, e.g. the first one, two, three, four or five issues

2. Arrange the issues or their symbols in a vertical order3. Give a limited but equal number materials to each participant

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4. Explain that each individual is to use his/her materials – independently - to make a decision on the priority problem or option.

5. Explain that one can use his/her materials to vote for one or two or all of the problems or options that are most pressing for him/her. The issue that is most pressing to the individual gets the most voting materials.

6. Invite participants to undertake the voting exercise.7. Analyse with participants the outcome of the exercise and discuss its implications to the community or the

planning exercise.

For training purposes the participants chose five main diseases in the community as shown in the table below.

1. 5 cards, each with a different colour was used represent each identified disease2. 8 pink papers per person were given to each participant and then they were asked to vote on the cards

according to their knowledge of the existence of the disease in the community

Emerging issues from the exercise

Results of proportional piling

Name Of Disease Number Of Votes Ranking Snake bites 11 4Diahorrea 16 2Asthma 6 5Dengue fever 19 1Malaria 12 3TOTAL

The group could not have consensus on some of the activities therefore the pair wise matrix was introduced which involved comparison of two variables and scoring

Pair wise Ranking

Asthma Snake fever Dengue fever Malaria Diahorea

Asthma xxx xxx Xxx xxx xxx 2 2Snake bites A xxx Xxx xxx xxx 0 3Dengue fever DF DF Xxx xxx xxx 4 1Malaria A M DF xxx xxx 2 2Diahorea D D DF M xxx 2 2

In this case there is a tie between malaria ,asthma and diahorea and there maybe need to analysis further why the choices they have made .In this case the group agreed that the three were preventable and can be thus be addressed using a common approach.

6.1.2.2 ACTVITY 2: HEALTH PROBLEMS IN OUR COMMUNITY

The activity is designed to help identify important health problems in the community and to discover which ones can be prevented by community action. Nurse Tanaka tool is used.

NURSE TANAKA TOOL

The participants were given drawings of different group of people and a drawing of a nurse standing outside a health clinic.

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Group Work Task: These people are visiting the clinic, identify the health problems they have, and then arrange the drawings in a sequence beginning with the first person to the last of who should see the nurse first and give an explanation for your answer.

Common health problems identified include: Worms, depression, routine check up, broken limbs, snake bites , heart attack, infant death , vaccinations, infections in the foot, woman beaten by the husband, pregnant woman, and heart disease.

It was realized most of these health problems can be prevented through proper health care. The government policy stipulates free medical care for all although in reality people have to wait for long to get proper attention so they seek alternative such as home remedies

Facilitators’ notes

This activity may show people do not know lack health knowledge and may assist in generating discussions on disease transmission routes and what can be done.

PHAST STEP 2

6.2.0 STEP 2: PROBLEM ANALYSIS

This step has four activities:

1. Sketch-mapping water and sanitation in our community 2. Good and bad hygiene behaviour 3. Investigating community practices 4. How diseases spread

6.2.1 ACTIVITY 1: MAPPING WATER AND SANITATION IN OUR COMMUNITY

This assists the participants to map those water and sanitation problems which could lead to diarrhoeal diseases.

Community map tool is used in this activity and the purpose of the map is to map the community’s water and sanitation conditions and show how they are linked and to develop a common understanding vision and understanding of the community.

COMMUNITY MAP TOOL

Input by facilitator

Purpose of a sketch map

A community sketch map is a tool or device for recording data or information about an area – its boundaries and significant features. It can also be used to understand the social and even economic conditions in a given community.

Characteristics of a sketch map

They are not to scale They allow for the use of local symbols and materials to represent the issues under discussion They guide discussions with visual features They focus attention on issues under investigation They are easy to draw, even on the ground and the drawing can later be transferred to paper

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Types of Sketch maps

Sketch maps can be divided into:

1. ‘Resource maps’, which illustrate either the physical resources crops, water points, grazing areas, vegetation, mountains etc.

2. ‘Social maps’, which illustrate the social conditions and situations of a community such as houses, health and sanitation facilities, schools shopping areas,

3. ‘Mobility maps,’ which illustrate the pattern of people’s movement (mobility) in giving directions or areas, for given purposes.

Since drawing these maps doesn’t require special expertise or equipment (they can first be drawn on the ground, using whatever materials are lying around), and since the drawing can be a group activity, they can provide an excellent opportunity for sharing information between community development workers (the facilitators) and community members – as well as for identifying local problems and potentials. Each ‘side’ has its special knowledge, of course; the extension agents might be better informed about technical matters, such as the potential for water supplies or problems of soil erosion, but the local people will have direct knowledge about such things as boundaries and inter-group relationships – and they will certainly have a sharper insight into the social and political problems experienced by the community.

Note: In hygiene and sanitation promotion, a sketch map would be used to determine the water sources, defecation areas and health facilities within a given community.

Materials

To draw a sketch map, the materials required will consist of anything at hand, marker pens and large sheets of paper for transferring the model to a more permanent and displayable format.

Procedure of facilitating the drawing of a sketch map

1. Decide which kind of map(s) will be drawn and whether it will be constructed inside (if the meeting venue is a room) or outside, on the ground or on paper.

2. You can divide participants into groups by gender (of male and female) or you can work with the whole group. (If there is diversity in terms of background and experience, you can use this as the criteria for division into groups. Whichever way you choose, emphasize that this is a job for everyone (in the group), not just the person with an artistic flair or the most learned member of the community.

3. If it is a basic sketch map, ask the people to plot the boundaries and then the positions of either the physical resources –water sources, farming areas, grazing areas, forests, conserved natural resources, areas affected by soil erosion etc - or the social amenities - schools, health facilities, houses etc – if it is a social map.

4. If the mapping exercise took place on the ground, ask a member of the community (with artistic flair or a member of the facilitating team) to transfer the model on to a sheet of paper.

5. Display the products on the wall.6. Invite each group to present its map, focusing on issues or themes that they wish to highlight.7. Use the highlighted themes or issues to generate further discussions with the community.

Issues to consider at the end of this exercise and the resultant discussions that has been generated

What was your purpose of drawing the map What do you know about the community, which you didn’t know before? How will this knowledge help you continuing your work with this community or in identifying and planning

projects?

Group Work Task: Draw a village map of any community in Sri Lanka.

Lessons learnt

When asked what lessons they had learnt from the exercise, participants had these to say:

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Learned to see the area under different perceptions Noticed things about the area that they were not aware existed Learned to share information while working as a group on the map

Asked about the uses of a mapping exercise to the community, participants had these to say:

To study the community Assists to identify areas that will need PHAST intervention to enable you make your plan of action Helps in the situation analysis of an area It can be used as an analytical tool, e.g. to discuss problems that can result from locating latrines near a water

source. This would help the community to understand one source of diarrhoea in the village.

(It is important to keep the map since it serves as a good evaluation tool).

6.2.2 ACTIVITY 2: GOOD AND BAD HYGIENE BEHAVIOURS

The activity helps the group to look more closely at common hygiene and sanitation practices and to identify how these may be good or bad for health. For this activity 3 Pile sorting tool is used.

3 PILE SORTING TOOL

Objective

To exchange Information and discuss common hygiene practices according their good and bad impacts on health.

Group Work Task: Participants were divided into two groups and each was given about 30 posters and was asked to sort them out and stick them under any of the three behaviors.

1. Good behavior those that show activities that are good for health 2. Bad behavior those that show activities that are good for health 3. In between behavior those that show activities that are neither good or bad for health

They were asked to select one person from their group to give a presentation on their findings.

Overleaf are some of the descriptions of the pictures.

Good behaviour

Woman washing a child’s hands with water and soap Man taking a shower Food covering Woman washing utensils Man collecting water and covering it after use Woman leaving the toilet with different pail for washing water Man using one container for collecting water and a separate container to dip in the major container

Bad behaviour

Cooking food and not covering it Water and container left uncovered – flies everywhere Man drinking water straight from large water pot Man from toilet and does not wash hands Animals licking utensils and drinking water from the cooking pots Open defecation near the house Child eating his food with the cat licking the plate Animals and humans swimming in the water reservoir

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In between (not sure)

People eating with their hands A mother washing a child’s face but using only water Washing dishes on the floor Milking a cow but not sure if the person doing this has washed her hands

What do we do about the in-between behaviour?

There should be no in-between behavior because this kind of behaviour puts the person at a risk and any risky behavior is not good for health.

What are the common hygiene practices that need to be emphasized?

Food and water covering Regular bathing Use of water and soap when washing hands Proper garbage disposal Washing dishes after eating and not leaving them scattered

What was notable is that the tools are not used to test people’s knowledge or to investigate or correct their personal behavior but rather o provide a starting point for discussion on local hygiene and sanitation beliefs and practices

Key issues discussed were;

What is preventing the community from adapting good hygiene practice?Is there a reason why communities are still using the bad practices?

6.2.3 ACTIVITY 3: INVESTIGATING COMMUNITY PRACTICES

The purpose of the activity is to help the group collect and analyze data on actual sanitation practices in the community. A pocket chart tool is used

Pocket Chart Tool

For training purposes it was used to analysis the hygiene behavior of the participants. In this case it was hand washing with soap and water before meals.

The hygiene practice investigated was hand washing before eating meals in the field. This involved having 3 posters; eating without washing hands, washing hands with water only, washing hands with water and soap. A pocket chart tool was used for this exercise and the participants had to put their vote in one of the three pockets showing different hygiene behaviors. To capture behaviors of men and women, the women were (unknown to them) given a different vote color from the men.

Results of the voting exercise

Gender Water And Soap

Water Only NoHand washing

Total

Women 0 4 0 4

Men 1 2 1 4

Total 1 6 1 8

Comments of participants on the outcome:

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Based on the findings of the activity women washed more than men though they only used water It is also a challenge to practice hand washing due to water shortages in the rural areas especially with soap at

all times.

Use of Pocket chart in the community:

Educate people on hand washing using water and soap To investigate if people practice positive hygiene behaviour After the exercise, a discussion should be stimulated to discuss the constraints of why people do not practice

good hygiene behaviour What can be done to influence each other to practice good behaviour

Why encourage people to wash hands using soap and water?

Comments

To reduce the transmission of diarrhoeal diseases Hands are often used more than any other part of the body making it a major carrier of germs A pocket chart can be used to teach people better behaviour habits It can also be used to determine the route of transmission of disease Clean hands means good health and vice versa

Some concerns:

There is need to teach people how to wash their hands properly especially under their finger nails and thoroughly rubbing their hands together while washing.

Other uses of pocket chart tool:

The pocket chart can be used to target the following hygiene behaviour

Use of latrine Garbage disposal Food storage Water uses Good habits and bad habits Breast feeding Vaccination

6.2.4 ACTIVITY 4: HOW DISEASES SPREAD

The purpose is help the participants discover and analyze how diarrhoeal can be spread through the environment and the tool used is faecal transmission routes.

TRANSMISSION ROUTES TOOL

This tool is normally used to look at how faeces can contaminate the environment and lead to diarrhoeal.

Group Work Task: The participants were divided into three groups and given a set of posters showing different bad behaviours, a housefly, and a pair of hands. Then they were asked to identify various routes diseases can be spread.

NB The three pile sorting tools can also be used for this activity.

Transmission routes

Diseases are spread through 5 Fs - Faeces, Flies, Fingers, Fields and Food. A chart showing the 5 Fs was presented and discussed by participants.

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Comments

Some routes are more direct than others such as sucking unwashed fingers after latrine use. The housefly is the main transmitter of diarrhoeal disease through faeces Most of the bad behaviour practices causing diseases transmission can be stopped/blocked very easily i.e.

covering food, washing hands, using a pit latrine properly Unwashed hands are one of the main causes of diseases transmission hands are normally used for eating

food.

The housefly was identified as a vector (a small disease carrier animal) others include mosquito, rats, bedbugs, lice etc.

F- chart

MALARIA ROUTES

Malaria routes was also discussed to demonstrate the versatility of PHAST methodology in addressing other community diseases

Group work Task: Each group was given as set of pictures depicting different malaria ways malaria can be spread and asked to identify different malaria routes

Routes identified:-

Stagnant water

Flies

Fields

Fluids

FaecesFood Mouth

Fingers

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Long grass Bushy wet vegetation Sleeping without nets Wearing short tight clothes

underlying causes mentioned were:-

poverty Dams being used water sources Lack of information Lack of drugs Lack of medication Laziness & ignorance Living in water logged areas

Possible solutions:- Use of nets Traditional herds Fumigation Clearing bushes Communal clean ups Draining of stagnant water

PHAST STEP 3

6.3.0 STEP 3: PLANNING FOR SOLUTIONS

This step has three activities

1. Blocking the spread of diseases2. Selecting the barriers 3. Tasks of men and women in the community

6.3.1 Activity 1: Blocking The Spread Of Diseases

Blocking the spread of diseases helps the participants to discover ways to prevent diarrhea diseases from being spread via the transmission routes identified I the previous activity. The faecal route barrier tool was used.

BLOCKING THE TRANSMISSION ROUTES TOOL

The objective of the tool:

1 Is to help the participants discover ways to prevent or block diseases from being spread via transmission routes.

2 To analyze how effective the blocks are and how easy or difficult it would be put to put in place .

DIARRHEA BARRIERS

Use of latrine Covering of latrine Well covering Food and water covering Separate of animals from drinking water sources

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6.3.2 Activity 2: Selecting The Barriers

This activity helps the group to analyse the effectiveness and ease of actions to block transmission routes and choose which they want to carry out themselves.

Group Work Task: Participants were then asked to prioritize some of the easy and effective options for preventing diseases based on the previous exercise of hygiene domains the previous day.

Easy to do was in relation to;

o To easy to communicate o Easy to do o Local resources are available o Easy to adapt

o BARRIER CHART TOOL

Diahorea Matrix Barrier

Easy In between Hard Effective Hand washing with water

and soap

Food and water covering

Heating the food

Safe water for bathing

Flashing latrines

Appropriate storage of food

In between Hand washing

Pit latrines

Covering wells

- -

Not effective Eating curd - -

Malaria matrix barrier Easy In between Hard

Effective Garbage disposal

Draining stagnant water

Covering small water ponds

Changing water vase

Changing rat trap water

Covering water containers Spraying

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Clearing wild vegetables

In between Burning plants

Clean up

Widow nets

Wearing long clothes

Sticky tape

Coils

Malaria pills

Not effective Natural remedies Use of frogs Bat farm

6.3.3 Activity 3: Task for Men and Women

The activity identifies which are the roles undertaken by men, women and children and who would be able to take additional tasks to introduce changes necessary to prevent diarrhoeal diseases.

GENDER TASK ANALYSIS/24 HOUR CALENDAR TOOL

The purpose of this tool is to:

Raise awareness and understanding of which household and community tasks are done by women and which are done by men

To identify whether any change in task allocation would be desirable and possible

Typical Tasks for women in the village Time Tasks 5 am Washing face SHINF

515 -600 lighting the fire , Prepare break fast

6-7 Prepare school children washing dressing

7.15 -8.30 Sweeping the house ,cleaning dishes

8.30 Bathing

9-10 Preparing lunch

10.30-11.30 Fetching firewood

12.30-1.30 Feeding the children

1.30 Housework washing dishes

1.30- 2.00 Resting sewing handcrafts

2-3.00 Preparation of tea and drinking tea

3-3.30 Helping children with homework

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4-4.30 Prepare supper

4.30--5 Make tea for the husband

5.15 Fetching water from the family traditional well and Washing children

6.00 Light the lamp and pray together

6.00-6.30 Feeding children and parents eat

7.00-7.15 1 Socialize family

8.00- Children go to sleep

8.00- 9.00 Parents eating

9.30-Bedtime Washing plates

Typical tasks for men in the village Time Tasks for Men 6.00-6-30 Washing face ,grooming

Take tea

6.30-4pm Paddy fields ,weeding

11.30-1 Lunch time Resting

1-4.00 Start work

4.00-4.30 Travel by bicycle

4.30-5.00 Shower

5.00-5.15 Tea

5.15-4 Town socialse

6.30 -7.15 Play with children

7.15 -8.00 Talking with wife supper

8.00-8.45 1 Dinner

8,45-9.15 Talk with wife

9.30 Go to bed

The gender task analysis is a very involving activity and brings out the issues of gender and who does what and why .For this activity analysis were done focusing on a Buddhist community and the experience might be different for a Muslim community or a Christian community. What is obvious is that women are engaged in activities that might not be considered as non productive since they do not generate any income and are domestic oriented yet their role as care givers ,in reproductive health ,social roles can not being ignored and this is very important when tasks or community contribution on lab our is been discussed. It is also possible to see how much time is spent on water and sanitation related activities and what is the implication of introducing hygiene promotion within such a setup.

PHAST STEP 4

6.4.0 STEP 4: SELECTING OPTIONS

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By the end of this step the communities are supposed to be able to make informed choices about the changes to facilities and hygiene behaviours it wants to make.

This step has three activities

1. Choosing sanitation improvements

2. Choosing improved hygiene behaviours

3. Taking time for questions

6.4.1 Activity 1 and 2: Choosing Water and Sanitation Improvement and Choosing Hygiene Behaviors Improvement

Both activities assist the communities to assess their sanitation and hygiene situation and decide on what changes they want to make. Choosing/Selecting Water and Sanitation Options Tool (Options Assessment Tool)

In order to make informed decisions with regard to choice of technology and other interventions, participants need to be facilitated to know all the possible options for solving any particular problem, and all their implications. These should include causes of problems, resources required to undertake each possible option, the cost of each resource (cost of implementation), the capacity of the community to implement, manage and maintain each option. With this kind of knowledge, the people would be able to choose an appropriate, affordable and easy to manage option. The matrix overleaf is a sample options assessment matrix

Note: The exercise on choice of options requires input of the technical staff, to enable members of the community make informed choices, in terms of cost of implementation and maintenance as well as spare parts (where applicable).

SELECTING OPTIONS

6.4.1 ACTIVITY 1: CHOOSING SANITATION IMPROVEMENTS

Choosing sanitation improvements helps the group to assess the community’s sanitation situation and decide on the changes it wants to make. In this case the sanitation ladder too

SANITATION LADDER TOOL

The purpose of the activity helps participants to describe the community’s water situation and identify options for improving water situation and discover the improvements can be made step by step.

Group Work Task

The participants were given a set of water options and asked to arrange them in the form of a ladder starting from the what they considered the worst to the best and why.

Then they were asked to consider where the community is at present and where they would like the community to be one year from now. They also identified the advantages and difficulties they would met as they move from one stage to the other.

The context was in two (camps, traditional villages) Options presented

Open defecation Flash toilet

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Dry latrine Latrine with septic tank

The desired is the modern toilet however there is no hand washing facility

Current situation

Open defection Use of traditional latrine

Consideration

Privacy, smell, convenience location, habit, clean, availability of water

What is considered clean may vary from community to community depending on their perception

Ritual cleaning o Sometimes it is easy to confuse ritual cleaning with the practice of safe hygiene practices and

sometimes as much as community can practice ritual cleaning they may not wash hands before eating.

Difficulties o Poverty and lack of knowledge on how to adapt the options available o Lack of knowledge and awareness

6.4.2 ACTIVITY 2: CHOOSING WATER IMPROVEMENTS

Choosing water improvements helps the group to assess the community’s sanitation situation and decide on the changes it wants to make. In this case improvement may be in terms of quality, quantity and access

WATER LADDER TOOL

Task The participants were given a set of water options and asked to arrange them in the form of a ladder starting from the worst to the option they consider the best. Then they were asked to consider where the community is at present and where they would like it to be one year from now. They also identified the advantages and difficulties they would met as they move from one stage to the other.

Options presented Water bowser Taps stand Unprotected spring Hand pump Well

Considerations

Protection of water from animals Protection from contamination from humans Emergency to development Mixed uses

Advantages

The main priority of the community is on availability and not quality

Difficulties

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The ecological issues around the water table and salinity of the water and cost are some of the reasons people use certain choices versus others.

Facilitator’s notes

When designing a water intervention it is very important to keep in mind the mixed needs or uses for water in each community .Technology option chosen has to be guided by this consideration part from the other technical issues on operation and maintenance .At this point it may be useful to bring on board the a water engineer to discuss the viability of each option.

6.4.3 ACTIVITY 3: CHOOSING IMPROVED HYGIENE BEHAVIORS

This helps the group to decide which hygiene behaviors it wants to work on with the community and the 3 pile sorting tool used.

3 PILE SORTING TOOL

The purpose of the tool is to assist the group identify hygiene behaviors they want to change, encourage and maybe introduce in the community.

Task The groups were given drawings from the 3 pile sorting drawings and asked to identify three drawing depicting 3 hygiene behaviors they agreed as being healthy and which they would like to encourage and one more that they agree as being unhealthy and they would like to discourage.

Group presentation

The activity reflected what had already being presented in the 3 pile sorting and barrier chart activities.

6.4.4 ACTIVITY 3: TAKING TIME FOR QUESTIONS

This gives the participants a chance to ask questions and obtain feedback from fellow participants, thus increasing the confidence and self-reliance of the group.

QUESTION BOX TOOL

The participants were asked to write down one question each on any subject that they would like to ask the facilitator and then put it in the box. The facilitator took the questions and re-distributed them at random to the participants and asked them to answer the questions. This was a big surprise for the participants since they expected the facilitator to answer them.

Some of the questions were based on the workshop topics while others were more general. What was interesting was to see the participants‘s creativity in answering the questions.

Objectives of the Question Box

To provide an opportunity for participants to ask questions about the process and any other information. To help the group recognize the wealth of knowledge they have collectively Build confidence and self reliance of the group

Lessons learnt

There is no hard or difficult question If somebody is not able to answer a question one can always throw it back to the others in a group since

there is a wealth of knowledge in group work.This can also encourage group work and team sprit

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PHAST STEP 5

6.5.0 STEP5 : PLANNING FOR NEW FACILITIES AND BEHAVIOUR CHANGE

This step is important since it paves the way for planning for solutions and action. While choosing hygiene and sanitation activities or actions it is important that the actions are easy to do and are at the same time effective in resolving the problem.

6.5.1 Planning for change

This helps the group plan the action steps for implementing solutions it has decided on. This is by developing a plan to implement changes in sanitation and hygiene behaviors

Water options

In this the water options discussed were in two contexts

Emergency and Non emergency

Picture Quantity Quality Cost Digging trench around water reservoir

E = ok

NE =not ok

E=not ok NE =not ok

$1000

Household covering the water and proper transportation

E = ok

NE =not ok

E=not ok NE =not ok

No cost and is hygienic

Small natural Pond E = ok

NE =not ok

E -not ok NE -not ok

No cost

Traditional Well E = ok

NE =not ok

E- not ok NE- not ok

$ 50$500

Water trucking E- ok NE-ok

E-okNE -ok

High overhead cost And will depend on the number of trips

Lined community well E- ok NE-ok

E-Not ok NE – not ok

$ 350

Taps E- ok NE-ok NE =ok

Community can contribute

Hand pump Afrdevi

E- ok NE-ok

$300-400Hand pump $ 5%25 per meters

*

Safe water cycle

The different water sources have implication on water safety; some sources are safe while others are not. How water is water transported, treated and stored in the household is important. Even in a situation where the source is safe there are chances of recontamination in these three levels.

Below are key issues to be considered in water safety.

Is the water normally covered when transporting it? Is the water treated at the household?How is the water stored after treatment?

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Is drinking water scoped or poured out?Are there different containers used for water storage and are they covered?

The current focus of the Sri Lankan government is more urban which translates to less resources in the rural areas There is need therefore for community directed initiatives to meet un met water needs..

Sanitation options

Criteria developed

Maintenance and operation Geology rocky ,sandy Hydrology water level Quantity community /household solution Cost –sustainability some options may start of as expensive and in the long

term be cheap Secure distance from the water source

Options proposed

SWAB Latrine- Dry latrine

PVC Available Sand plats available using cement to make the slab Very easily available It can easily be cleaned Temporary once the container is full and can easily be moved away When water table is very high the solution is to build it upwards

Dimensions of the latrine

Superstructure/ logs, nails Ceramic slab Hole

$ 20- 30 dependants on the locally available materials

Open bottom latrine –flush toilet

Dimensions of a flush toilet

Super structure ,ceramic Slab Depth minimum of 6m (may change depending on soil type, water table and population to be served

It is more environmental friendly if considerations on where the water will drain are taken into account. Connection to the septic tank may also be an option where it is possible to drain off the sludge The cost may slightly be more in comparison to the others options however it can be cheaper if locally available resources are used for the super structure They take longer to fill since they are draining off the water and also it may depend on the family size.

Cost $ 70-90

Septic Tank

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There are normally three compartments it may have a separate soak pit or it can be jointed directly to a municipality sewer

This is more permanent The first chamber receives the urine (liquid) and feaces (solid) where the two are allowed to settle down for decomposition (urine and faeces). Finer particles of the solids and liquid waste then overflow to the second compartment where the flow is much reduced and this allows the further settlement of the heavier particles. In this chamber, one can begin to notice that the sewage is gaining some level of clarity. The partially clear sewage then is forced to rise to the top, further screening only the lightest suspended matter to rise to the top. At this stage the liquid (sewerage) has more clarity and overflows through a buffer wall to a collector pipe which leads the liquid to a soakaway pit or to a municipality main sewer line.

This is a good solution, it closed and long term Low maintenance Available in the country is not high due to social economic reasons if done in the proper way it is safe and is environmentally safe May be more expensive since it requires presence of water although can be used at a communal level Not a solution for the temporary camp situations since this more off a long term solution term

6.5.2 Planning Who does what

The purpose is to identify who takes responsibility for carrying out the steps in the plan and setting a time frame for the activity.

For this exercise :Fencing of a water pond was identified

RESISTANCE TO CHANGE CONTINUUM TOOL

(The Transformation Process)

The objective of this tool is to analyze the different stages of behaviour change and to show that change process is gradual. According to the participants transformation is the final stage in the change process.

WHAT IS TRANSFORMATION?

Definitions from participants

Change of habit Change of idea, behaviour, culture, lifestyle, beliefs, bad and good behaviour Risky behaviour to safe behaviour Process of ‘Change’ Reduce disease incidence Complete change from past bad behaviours and to present better behaviours Change of attitudes from negative to positive attitude Complete change of ways Building confidence Self reliance and self esteem

Change from Bad habit to good habit, directing the community to come to a decision, build self confidence, sharing ideas and responsibility and to identify their problems and prioritise solutions, choosing options, choosing what tools to use themselves and to eventually come up with a plan of action.

Group Work Task

Participants were asked to arrange the sentences given below from worst (first) to best (last).

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This seven steps illustrates the stages of behaviour change (bottom-top)

1 I am willing to demonstrate the solutions to others and advocate change2 I am ready to try some action3 I see the problems and am interested in learning more about it4 There is a problem but am afraid of changing for fear of loss5 Yes there is a problem but I have my doubts6 There maybe a problem but it is not my responsibility7 There is no problem

Objectives

Identify and know which stage the community is in. It is a tool to understand that change is a process and does not take place overnight It helps to know the realities of each community ,since each community is different For adaptation – changes take time and practice Social change is slow and gradual To help the community think /see /visualise that is possible to move from a bad to a better situation Help the community identify their visions To help fight resistance – there are many reasons why people are not willing to change Changing peoples behaviour is attitudinal

Why People Refuse To Change

Inherited beliefs or values Fear of Culture loss Fear of loss of power or authority Does not want new interventions Fear to be unable to adapt to expected standards Lack of finances Environmental i.e. Nomadic way of life Sustainability of new ways Lack of awareness (do not relate their lifestyle with the existing problem) Difficult to adjust to foreign methodology Lack of sufficient information Lack of education Lack of demonstration – misunderstanding Lack of trust Religious beliefs Refusing to take responsibility Laziness (too much work to bring about change)

Why Do People Change?

Answers by participants

Good practice More learned, more educated Realization and understanding of better hygiene methods To sort out their problems Status – raising of living standards Awareness of problems, i.e. diseases, risks etc Acceptance that we have a problem and we must change Through awareness there is the agreed distribution of roles and responsibility

Input by facilitator

Facilitation

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Making life easier is the most powerful reason why people change or adopt new hygiene facilities, other reasons include the facilities being; (closer, reliable, predictable, easier, safer, nuisance)

Understanding

Aiming for peoples understanding and have insight into and respect for the local knowledge i.e. (realisation – need for change, implication)

Influence

Influence from others (demonstration by giving examples) Time, energy, finances – for the new practices

Autonomy

Ability to make your own decisions, being independent Motivating changes in hygiene practices also means addressing issues of means, control and power in

hygiene practices. The community is free to use their skills and resources – the process provides new skills and resources

When learning, people remember:

20% of what they hear (hearing sense)40% of what they hear and see (hearing and sigh)80% of what they discover for themselves (action)

General-Assumptions

Increasing peoples’ knowledge automatically changes people’s behaviour

Universal hygiene messages can be given(Assumptions are that these are superior to the local insights need for local adaptation)

Telling people what to do solves the problems(Telling people what to do often does not get a chance to relate it to their own experiences)

When people know about health risks, they take action(Better education does not by itself reduce the risks of transmitting these diseases, only action can)

Any improvements are equally useful(Although action is needed it is not effective when a very wide range of behaviours are targeted or only point out the multitude of places where water and sanitation related diseases could be transmitted. Concentration on those risks is more important)

6.5.3. ACTIVITY 3: IDENTIFYING WHAT MAY WRONG

This activity helps development agencies to pre-empt what might go wrong. Since a lot of work has been done with the community right from problem identification to analysis but more crucially after the community action plan has been prepared. This is important since the CAP is a contract between the people and the agency. Both sides should forestall anything that can prevent or delay its implementation.

Task Group Work

The participants were divided into three groups and asked to select one options out of the ones proposed in planning for solutions activity and then show the steps to implementing it .

Group One

1. Water option

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Communal Well

Contact irrigation department /PH ground investigation Select the most convenient location with the community Contract for building Water testing Hand over to the community

2. Sanitation options

Flushing latrine

Assessment Information from the community Location Environment friendly Discuss cost Who will do it Materials Operation and maintenance

3. Hygiene promotion

o Hand washing with soap o Use of latrine

Step1 Identify the reasons why people need to change to their habits

o Assessment of current situation o Meeting the communities to understand what they will accept and are willing to change o Meeting with other technical groups to look for feasible devices o Community ownership and management o Monitoring and evaluation

THE PROBLEM BOX TOOL

The question box is used to:

Identify what possible problems may arise during the implementation of the action plan. Assist the communities and agency to think ahead of how to solve such possible problems.

To practice this tool, participants were given six pieces of paper and asked to direct /ask two questions to each of the three sectors previously identified. Questions were then redistributed to the participants, and then they were asked to imagine they were community members answering the questions.

Based on the sample action plan (above), participants were asked to identify what might go wrong during the implementation of the [sample) action plan. Below is a list of what they identified.

Conflict Unskilled labour Lateness of funds No resources for activity Selection of the site Rejection of the concept

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Community unwilling to participate

Comments

Lessons

Lack of clear communication is one of the things that can go wrong there is need for further development of analytical skills.

The question box is a very practical tool that can be used in day-to-day planning.

PHAST STEP 6

6.6.0 STEP 6: PLANNING FOR MONITORING AND EVALUATION

This step has only one activity. In this activity the group fills in a chart for checking (monitoring) its progress towards achieving its goals means are identified for measuring progress, how often this needs to be done and who will be responsible for doing it.

What Is Monitoring and Evaluation

Monitoring

Checking progress of activity in the project Assesses what has been done Follow up of plan of action Regular/daily review of plans and activities

Evaluation Evaluation focuses on the whole project There is be mid term evaluation and end of year evaluation Evaluation looks at the overall objective of the project, both failures and successes Evaluation can also be done by external person for objectivity purposes

There are several ways of confirming if the intended objectives have being met this include:

Reports both narrative and financial Field visits Discussions with the beneficiaries and partners Checking accounts and assets of the project Checking for impact which is the changes supposed to have taken place as a result of the project

Input by facilitator

Monitoring is checking the progress of an activity or project towards meeting its objectives. In this activity a monitoring chart is used. Purpose

To establish a method of checking our progress To decide how often checking should be done and who to do it The terms where, who, why, when and how were introduced.

Monitoring is the short tem checking of what has gone right or wrong according to what we set out to do from the beginning, our plan. Evaluation is normally done at the end and will involve checking through the whole programme. Its focus is on the long term and is normally done at the end of the project or some projects may have mid tem evaluations.

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The participants agreed it is important to check if your activities were going on well so that if things are not going on well they can be changed or improved.The participants were then asked to draw up a plan of action and show how an evaluation can be conducted

Monitoring chart

GOALNumber or Amount

How to measure How often By whom

Which Hygiene Practices Can Be Targeted?

Below is a table showing various hygiene practices, falling under four different categories: sanitation, water, food and environment. It also shows a list of hygiene conditions and practices that may be locally important and can also be used as possible indicators

An Indicator is simple a sign showing that change has happened or is taking place. This can also be used as a checking method/tool and used to check the impacts/results of the project. It is very important to be sure of what hygiene domain/domains you are targeting in relation to behaviour change. The hardware factors such as construction, use and maintenance of facilities can also be used as indicators. It is better to agree with the community on just a few indicators rather than trying to achieve all, when you design your project.

Hygiene Domain Relevant Conditions and Practices

Sanitation Location of defecation sites Latrine structure and cleanliness Disposal of children’s faeces Use of cleansing materials Number of users of facilities Sanitation habits of different groups

Water Placement of latrines in relation to water sources Different water sources used, and daily and seasonal patterns Average distance to water Amount of water used per person per day Water quality at source and home Water storage practices Methods of water treatment Water handling in the home Water use and re-use Hand washing (including religious rituals) Bathing (children and adults) Clothes washing Previous experience of water source management

Environment Household refuse disposal

Disposal of household wastewater Condition of storm water drains Management of domestic animals Evidence of stagnant water around dwelling or water point Vector control problems Slaughtering facilities Burial of the dead

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Criteria For Evaluating/Checking Likelihood of Behaviour Change

1. Health impact of behaviour: the more the change of behaviour eliminates/reduces the health problem-the higher the chances of it to succeed

2. Frequency of behaviour: if the change of behaviour can be done occasionally and still has a significant value -it is not tough /rigid to do.

3. The practice is already widely practiced: it is within the local context 4. The action is simple and involves one action to succeed and not many actions required 5. It is cost effective: the cost of engaging in the behaviour requires only existing local resources 6. There are many positive results of the behaviour change 7. Brief period: can be accomplished in a brief time /period 8. Obvious signs of change: the change in behaviour cannot be missed-it can easily be seen 9. It is not foreign: there are several existing practices which are similar in the area and have worked

According to the World Health Organization (WHO), the following three hygiene behaviours lead to greatest reduction in diarrhoeal morbidity:

Safer disposal of faeces, particularly faeces of young children and babies and people with diarrhoea. Hand washing, after defecation, after handling babies’ faeces, before feeding and eating, and before handling

food. Maintaining drinking water free from faecal contamination, in the home and at the source.

Simple Guide For Conducting Participatory Evaluation

(A good evaluation involves all or a few of the project stakeholders especially the community members and partners coming up with a list of indicators drawn from the above hygiene domain practices that can be targeted and agreed on with the stakeholders right from the beginning of the project therefore it would be good to know what was the situation before and what is the situation now after the project has come /started.) Below is a simple guide

What “risky” practices are widespread in the community?How many people employ risky practices and who are they?Why are these people/groups using these practices?Which risky practices can be altered/ changed?What motivates those who currently use “safe” practices?

To have good indication of what change we want to achieve/it would be good to do a simple baseline surveys before the project intervention - which will indicate the 'current situation' and another follow up survey as part of the evaluation to show the 'situation after' the project intervention. On the basis of this we can say the project has had good or bad impact.

A combination of other evaluation methods can be used such as a walk around the village, focus group discussions, mapping, semi structured interviews, community stories etc.

How many people are we targeting for evaluation purposes and what are the sample sizes? How many? How many men /women children and youth?

Need to interview people we interviewed before the intervention and after the intervention to check if change any occurred

For comparison purposes it is important to compare the results of people involved in the intervention and people not involved in the project

A combination of methods can be used to verify the information this includes the PHAST tools under the monitoring matrix (refer to the PHAST training step by step manual

The results of the evaluation need to be analysed in order to come up with impacts of the project in relation to social, economic health, community participation, stakeholder collaboration, increased awareness and skills enhancement etc.

PHAST STEP 7

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6.7.0 PHAST 7: PARTICIPATORY EVALUATION

This step is carried out after the community has implemented its plan, perhaps months or one year after. It is normally carried out jointly with the community members and other stakeholders based on the indicators that had been agreed upon during the action plan.

How much has been done in the community How much of the plan still needs to be done Any problems or difficulties encountered Any corrective actions that is needed

Various tool options

In order to accomplish all the activities identified in the PHAST process it is equally important to focus on who is the implementer at the community level .The participants were asked to put on volunteer (this was a flip chart which was drawn to depict a community volunteer) and the fix on him skills and qualities they expected him to have do the tasks.

Qualities and skills of Volunteer identified

Handy , Friendly Open minded Language Clean Open heart Self confident Healthy Punctual Good listener Good walker Friendly voice Humble Good communication skills Reliable Loves to make jokes with people Loves people Technical skills Understanding Good walker Doer Creative Honest Sensitive Motivated Well acquainted with local habits Reliable

As a reaction to this the Federation WatSan Coordinator pointed out that it is not possible to have this type of person sine he does not exist .On the same side of the coin is do we have the same qualities ourselves?. What became apparent is that, any person who is available and willing to volunteer can be trained on the methodology. It will also be easier to implement since the person is drawn from he community.

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CLOSING REMARKS

In his closing remarks the Federation WatSan Coordinator thanked all the participants for having made the training a success .The next phase of work will be to hold the national workshop and most of the participants from this workshop will be asked to facilitate .He acknowledged the efforts of Mrs Anu who was the workshop artist, who made it possible to have a PHAST toolkit through her creative drawings.

This workshop was a starting point for hygiene promotion in water and sanitation programs in Sri Lanka. There is much to be done in relation to programming. Nether less the sprit of willingness to learn depicted in the training process is an asset towards this process. The recommendations capture some of the issues which need to be taken into account when designing the program. In addition there are challenges ahead which will also shape the process .But the desire and the resilience attitude of the trainers will make this program a success.

The facilitator appreciates the support given in the course of this workshop.

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Annex 1

TERMS OF REFERENCE

For starting the Hygiene promotion program in Water and sanitation Program in Sri Lanka (Tsunami Operation) based in PHAST methodology

Name of facilitator: Rebecca Kabura

Introduction

Context of the humanitarian crisis

1. An earthquake measuring 8.9 on the Richter scale struck the area off the western coast of northern Sumatra on 26 December, triggering massive tidal waves or tsunami’s that swept into coastal villages and seaside resorts. One of the hardest hit areas is Sri Lanka with 70 percent of the coast being damaged.

2. In terms of Water and sanitation an estimated of 45,000 toilets/latrines have been destroyed or rendered unusable. About 76,000 ring wells have been destroyed by the Tsunami floodwaters directly or indirectly through saline and/or pollution. Most of the ring wells in southern coastal areas yield only saline water and are therefore traditionally only used for washing and cleaning purposes. Trucking of potable water in coastal areas is standard practice and piped water supply is only available in densely populated areas and settlements.

Humanitarian situation

3. The overall health and water and sanitation sectors in Sri Lanka are extremely precarious after the disaster. Large numbers of affected families are living in temporary shelters provided by Government and International Organizations. Last figures shown that at least 27,739 families are living in 319 transit camps.

a) Water and sanitation4. The water and sanitation sector has been severely affected in the coast line of Sri Lanka. Infrastructure has been deteriorated if exists.

5. People living in transit camps have access to clean water in a basis of 175 liters per family, one toilet per 8 persons.

6. Hygiene promotion is an issue that is common to all camps in all Districts but is not being carried out with the desirable intensity and needs to be reinforced both in terms of increased partnerships on hygiene promotion as well as increased interface of hygiene promoter and camp residents.

Justification and timing

7. IFRC starts operation in the Tsunami Operation since 26th December, 2006. Emergency phase has been over and rehabilitation phase is starting for a period of 1 year. Water and Sanitation intervention in the rehabilitation phase has to be consistent with IFRC policy and the three components should be integrated: water, sanitation and hygiene promotion.

8. PHAST is a methodology used by IFRC that encourages community participation and links hygiene promotion with the construction of water and sanitation infrastructure.

9. Since Sri Lanka Red Cross Society is not experienced in running integrated water and sanitation programmes, a well prepared facilitator in this matter is needed to start the program in the country together with all the components of the Red Cross/Red Crescent Movement present in the country

Global Objective

10. Establishment of viable and sustainable hygiene promotion teams in communities that are going to be involved in construction of water and sanitation infrastructure.

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Specific objective

11. Adaptation and implementation of PHAST Methodology in water and sanitation programs in the Districts affected by disaster in Sri Lanka

12. Assess the program proposal, in accordance with IFRC’s mandate, in order to establish coherent and clear objectives, and to produce recommendations for improving the effectiveness of the near future operation.

Work Plan

Preparation of materials for first Training of trainers of PHAST:13. The facilitator should prepare materials, manuals and necessary arrangements for the first Training of Trainers of PHAST in Sri Lanka. Also during this week interviews with some of key people in Red Cross Movement, Ministry’s are going to be arrange in order to give a broth idea about the Sri Lankan context. This phase will also include a visit to affected area.

PHAST Training of trainers:14. The facilitator will conduct a 6 day training of trainers about PHAST methodology in Colombo city supported by IFRC WatSan staff. The participants will be mainly volunteers of Sri Lanka Red Cross Society and WatSan staff from the different PNS present in the country. A preselection has to be made before by IFRC WatSan department.

Revision of programme proposal15. The facilitator should revised the programme proposal for the initial period of rehabilitation phase (2005) and make proper recommendations to assure the coherence and possible success of the Water and Sanitation intervention in Sri Lanka..

Report

16. A report comprising all the activities done during the 3 weeks should be submitted before departure to WatSan Coordinator in Sri Lanka IFRC Delegation.

Timetable17. The tasks under this participation will be 3 weeks, starting no later than second week of May, 2005.

Annex 2

PHAST TRAINING PROGRAM

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SRI LANKA RED CROSS /IFRC DRAFT PHAST TRAINING PROGRAMME

16-21/5/2005

DAY TIME ACTIVITY FACILITATOR Day 1 Introductions

Expectations /Fears Objectives of the workshop Brief overview of the Sri Lanka Red Cross and IFRC WatSan activities Conceptual back ground of PHAST

Community participation concepts Hygiene Sanitation Transformation

EVALUATIONDay 2 RECAP

Community stories (unserialised posters) Community health problems (Nurse Tanaka)

Facilitation skills( photo parade tool ) Community health stories (Proportional Piling) Mapping water and sanitation facilities in the community (Community mapping tool)Good and bad hygiene behavior (3 pile sorting tool) )

Investigating community practices (pocket chart tool)EVALUATION

Day 3 RECAPHow diseases spread.

(Diarrhea route tool ) (Malaria route tool )

Blocking the spread of diseases (Diarrhea tool ) (Malaria tool ) demonstration on ITNS

Selecting the barriers (Barriers chart tool) Tasks for men and women (Gender task analysis)

EVALUATIONDay 4 RECAP

Choosing water and sanitation improvements (Water ladder tool ) (Sanitation ladder tool )

Choosing improved behavior (3 pile sorting) Taking time for questions (Question box tool )

Planning for change (Resistance to change continuum tool )Planning for change for change (planning posters) Planning who does what (Gender task roles )

Identifying what may go wrong (Problem box tool) EVALUATION

Day 5 RECAPPreparing to check our progress (monitoring chart tool) Checking our progress (various tools) Preparation for field work

Field work Day 6 Evaluation of field work

Action Plan Workshop closure

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Annex 3

Additional Reading for Participants

Gender

Gender Sensitive Programming.

A cultural factor of particular importance in improving hygiene practices is gender. Gender is the culturally defined division of work and areas of responsibility, authority and cooperation between men and women .For every improvement related to health and hygiene one must therefore ask if it concerns men, women or both and whether either category has specific needs, priorities and resources. Communication channels and messages must be developed for both men and women.

A gender strategy is also needed in community managed hygiene programmes, because what motivates men to support and adopt hygiene changes differs from the factors which stimulate women.Without a good gender strategy women often find that their physical work in hygiene has increased, while decision and management positions have gone to men .A gender strategy helps men and women both take part in decisions and find common solutions for conflicting interests.

When dealing with gender, it is important to note that women and men do not necessarily belong to one homogenous groups, but may have different concerns according to age, class economic and educational status and ethnic and religious group it is not enough to consult and plan separately with men and women without distinguishing also between wealth, age and other socio economic and cultural divisions in the society. In most areas of domestic hygiene, the women are most involved they do the work and take management decisions in and around the house, educate the children and are change agents in contacts with other women.

6 steps for gender approach in hygiene programs

Assess with men and women what male and female hygiene practices need to be changed and who has the responsibility authority and means for Action

Chose and test key messages, products and communication channels for change on relevance for and applicability by women and men

Get understanding and acceptance from men for women to take part in the consultation process and in management decisions and functions

Assess whether the programs addresses also men to improve their own hygiene practices and support hygiene improvements of their children and women in their home and community.

Ensure that the program does not increase women’s burden, but contributes to better division of work, responsibility between women and men

Ensure equal representation of men and women in training programs and adjust training events to overcome cultural limitations for women’s participation

A Note for PHAST Trainers

PHAST involves a total of 17 activities although the training process is flexible to accommodate the interest of various participants. For example within a developmental context other than training context, PHAST tools can be used to address the different issues within the project cycle.

For any PHAST training to be successful;

1. The PHAST trainers should be experienced enough to allow the introduction of the PHAST steps in a flexible manner, not necessary according to the book (introduction to PHAST step-by-step guide). For this reason,

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trainers should have enough experience and flexibility to be able to adapt or even replace a tool [suggested in the book] if one is found not to be applicable.

2. While PHAST training assumes that participants already have knowledge and experience 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/role play exercises and video feedback sessions.

3. For lesson learning and developing confidence and self-esteem of participants as well as local capacity building, the facilitators should begin from the local reality of the participants, i.e. from what the participants already knows and have experience in. This also helps to identify participants who can help out during the training, as resource persons.

4. The use of local materials and local examples should be encouraged as much as possible.

Annex 4: References (Materials Used to prepare and deliver the training)

ARCHI 2010 ARCHI Making a difference to the health of vulnerable people in Africa

Boot Marieke and Cairncross Sandy: Actions Speak: The study of hygiene behavior in water and sanitation projects (IRC) 1993

Lyra Srinivasan: Tools for Community Participation: A manual for training trainers in participatory techniques (UNDP) 1990

RC/RC East Africa: Review of Participatory hygiene and sanitation transformation (PHAST) August 2003

Valerie and Bernadette Kanki: Happy Healthy and Hygiene: How to set up hygiene promotion programme (UNICEF) 1998

UNDP and the Government of Kenya: Capacity 21 Kendelevu Toolkit - A manual for Trainers in Participatory and Sustainable Development

WHO, SIDA UNDP-World Bank: PHAST Step-by Step-Guide - A participatory approach for the control of Diarrhoeal Diseases, 1998

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