INFORMATIVE TOOL MANUAL - JICA-Net · Informative Tool Manual PHAST CONTENTS Introduction 2 1. Diarrhoea Child 4 2. Story With A Gap (SWAG) 7 3. Identifying And Blocking the Transmission

INFORMATIVE TOOL MANUAL

Participatory Hygiene And Sanitation Transformation

(PHAST)

Lusaka District Health MJapan International Coo

anagement Team peration Agency

Informative Tool Manual PHAST

CONTENTS

Introduction 2

1. Diarrhoea Child 4

2. Story With A Gap (SWAG) 7

3. Identifying And Blocking the Transmission Routes 10

4. Three Pile Sorting 13

5. Sender Cycle 17

6. Solid Waste Ladder 20

7. Hand Washing Ladder 23

8. Hand Washing Times 26

9. Sanitation Ladder 27

10. Water Ladder 30

11. Body Mapping 34

INTRODUCTION

1. Concept of PHAST

Participatory methods recognize that the learner can also offer something to the effort of community development. This approach encourages the participation of individuals in a group process no matter what age, sex, social class or educational background. It works on the premise that all partners are equal. Participatory Hygiene And Sanitation Transformation (PHAST) is one such approach that does not pivot on the premise that knowledge is transferred from well-informed teacher to an eagerly receiving learner. In 1992 the World Health Organisation (WHO)/United Nations Development Planning (UNDP)/World Bank Water and Sanitation group joined forces to develop and produce better methods for hygiene education by adopting Self-esteem, Associative Strengths, Resourcefulness, Action Planning and Responsibility (SARAR) methods to address issues directed to sanitation and hygiene behaviour. A collaborative process to develop and test these methods was launched in1993 in Africa and involved four countries, namely Botswana, Kenya. Zimbabwe and Uganda. This marked the birth of the PHAST initiatives. PHAST subsequently brought together and adopted a number of SARAR activities. The PHAST approach helps people feel more confident about them and enables them to take action and make improvement in the communities. 2. Introduction of PHAST Methodology

The Government of the Republic of Zambia and the Government of Japan agreed in 1997 to implement the Primary Health Care (PHC) project in Lusaka in order to improve the health standard of people in both unplanned and planned settlements. During the implementation of the project, cholera cases were still on the increase. This necessitated a needs assessment survey in environmental health problems using PHAST methodology in 2000. The survey gave birth to a community-based organisation of the George Environmental Health Committee (GEHC), which has several sub-committees

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charged with the responsibility of managing environmental health services and sustainability of programmes. Observing tangible successes achieved using methodology of PHAST in George compound, the LDHMT and JICA PHC Project Team felt needs to standardise the methodology and to design PHAST operational manuals with field tools that have to be suitable to the social and cultural context of Zambia, moreover, Lusaka peri-urban areas. Through the PHAST workshop conducted in George compound, it was observed that visual tools used in the workshop were not always describing real situation of urban settlements of Lusaka. It was also deliberately considered that standardization of the methodology with field tools for Zambia makes it easy for fieldworker not only to plan and organise PHAST workshop but also to reach targeted achievements for improvement of sanitary and hygiene condition. In 2003, the implementation of water and sanitation activities using PHAST methodologies were scaled up to other Lusaka’s peri-urban areas, such as Kanyama, Ngombe, Chawama, Chipata, and Mtendere. After seeing the successes scored in areas that are using PHAST methodology, the Ministry of Health felt that it was imperative to standardize methodology tools to suit both urban and rural communities, hence the revision of the PHAST manual in July 2006. 3. Development of PHAST Informative Tools

Observing tangible success achieved through PHAST methodology, the project realised that some of PHAST tools can also be used for in disseminating hygiene and sanitation messages. 12 tools have been selected as informative tools from original 45 PHAST tools that are specifically suitable for delivering these massages through participatory approach. In developing Informative Tools, use of each of the tools have been simplified with points of emphasis in delivering these messages for facilitating health education and a set of visual tools that are suitable for small group as well as public place health education has been selected. The project edited Informative Tool Manual PHAST for training manual and Informative Tools Kit PHAST for collection of visual aids for health education. The Informative Tool Manual was designed as guides for facilitators to train volunteers with skills in utilisation of each of tools as well as references for facilitators and volunteers.

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Informative Tools

1 Diarrhoea Child

DESCRIPTION This is an analytical, informative and investigative tool, aimed at

assessing and imparting knowledge to community on causes, signs, symptoms and prevention of diarrhoea in babies and children.

PURPOSES

• To determine remedies and treatment seeking behaviours in communities currently prevailing on diarrhoea.

• To assess community on prevention and causes of diarrhoea. • To share appropriate information on prevention and control of

diarrhoea. TARGET GROUP Caretakers of under 5 children METHOD 1. Divide participants into groups (if necessary). 2. Ask participants to mark on the picture where physical signs of

diarrhoea can be seen on a diarrhoea child. 3. Show the participants the pictures depicting different

treatment methods. 4. Using a pocket chart with these pictures ask the participants

to vote against the common method. MATERIALS

• Picture depicting child • Pictures depicting different diarrhoea treatment/preventive

methods available locally • Sugar and Salt Solution (SSS) packets • Pictures showing treatment seeking behaviours, stopping

breast feeding, tablets, traditional healing TIME 15-20 minutes POINTS OF DISCUSSION

• What are the different types of diarrhoea identified by the Community?

• What should be done first when a child has diarrhoea?

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• Do participants understand the need for ORS? • What are the causes of diarrhoea? • What are the preventive measures of diarrhoea?

IN CONCLUSION, EMPHASIZE THE FOLLOWING

• Causes, signs, symptom of diarrhoea • Effects of diarrhoea, such as malnutrition, dehydration and

death • Transmission routes of diarrhoea disease • Different types of diarrhoea disease • The importance of preventive and control measures of

diarrhoea disease • Appropriate home remedies for diarrhoea disease

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Informative Tools

Diarrhoea Child

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Story With A Gap (SWAG)

DESCRIPTION This is an open-ended story designed in such a way that the story

teller finishes prematurely at a point where decisions have to be made and participants are asked to contribute the finishing by making the decisions.

PURPOSES

• It helps community to start identifying themselves with the character/s in the story because the stories should be real life stories and relevant to the subject or situation.

• It also targets; to stimulate active and constructive thinking amongst the

community. to encourage sharing of ideas in decision-making. to empower the community to make decisions in problem

solving. to change and strengthen behaviour towards hygienic

practices in the community TARGET GROUP School children, water collectors, food handlers, marketers, church groups METHOD 1. Facilitators should have a number of pre-arranged stories. 2. Where you (Facilitator) think the community is hesitating to

make a decision or they want you to give them an answer to their problem- you then carefully select a story with a gap and give it to them for stimulation.

3. Allow the Participants to debate the best way of finishing the story.

4. Guide the debate so that it remains focused up to the end where at least the majority if not everybody agree to one thing.

MATERIALS Pairs of pictures, a flip chart, markers and stick stuff TIME 30 minutes

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Informative Tools

POINTS OF DISCUSSION

• Refer to the story and find out if such practices happen in their community.

• Ask them if they consider such practices as problems. • Find out if they can prevent such problems and how. • Find out what lesson/s they have learnt from the story.


• Importance of having sanitary environment and dangers of unsanitary environment

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Story With A Gap (SWAG)

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Informative Tools

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Identifying and Blocking

the Transmission Routes

DESCRIPTION This is an analytical, investigative and informative tool that helps

the community to discover ways to prevent or block diarrhoeal diseases from being spread via transmission routes.

PURPOSE The tool is designed to assist community in:

• identifying actions that can be taken to block the disease transmission routes.

• identifying risk behaviours associated with diarrhoea or other sanitary related diseases.

• acquiring knowledge on hygiene and sanitation and enhancing behavioural change.

• planning for intervention TARGET GROUP Households, school children, food handlers, marketeers, church

groups METHOD 1. Divide participants into groups of ten to twelve members. (if

necessary) 2 Give the participants a set of pictures. 3. Ask the participants to arrange the set of pictures in the way

diarrhoeal diseases are transmitted 4. Indicate possible faecal-oral transmission route using markers. 5. Ask the participants if there is any other homestead places or

activities that are possible route of faecal-oral transmission. 6. Ask the participants to identify barriers to faecal-oral

transmission and place the barriers on the diagram. TIME 20 minutes MATERIALS

• Pictures depicting points in the faecal-oral transmission route • Paper, flipchart, colour pens or markers, stickstuff

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• From the transmission chart, where do you think we can block to prevent the spread of diseases?

• What interventions can be put in place for those areas? • Why have you chosen those interventions? • Are physical barriers such as latrines the only solution?


• Feacal borne diseases can be transmitted in different ways (e.g. through flies, contaminated hands, vegetable, food and water)

• Appropriate preventive measures should be taken on all transmission routes.

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Informative Tools

Identifying and Blocking the Transmission Routes

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Three Pile Sorting

DESCRIPTION The three-pile sorting is an investigative and informative tool that

allows full involvement of the community in sanitation and hygiene activities leading to community behavioural change. It reveals the extent of local health related knowledge. It allows the communities to perceive behaviours and attitudes practiced in the community in a broader sense and categorise them in the columns of “Good”, “Bad” and “In-Between”

PURPOSES

• It helps in discussing topics in sanitation and hygiene practices.

• It also helps in identifying hygiene behaviours that the community will want to:

• change; encourage and strengthen; and introduce in their community.

TARGET GROUP School children, church groups, marketers

Households, food handlers, (topics on water storage) METHOD 1. Ask participants to form groups of five to eight people. (if

necessary) 2. Give participants set of pictures and ask them to sort them into

“Good”, “Bad” and “In-Between”. 3. After 10-15 minutes ask the participants to present their work. 4. Facilitate the discussion by reaching an agreement about

which pictures are the good, bad and in-between. 5. Facilitate further the discussion till the group reaches a

consensus on which sides, “Good” or “Bad”, the “In-between” pictures should be.

6. Be attentive in capturing the knowledge gaps, common behaviours and suggested solutions.

TIME 45 minutes – 1 hour MATERIALS Three Pile Sorting pictures, Stickstuff

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Informative Tools


• What hygiene practices and behaviours can the community identify in the categorization?

• What common good behaviours can be identified in the category?

• Find out what lesson/s they have learnt from the exercise IN CONCLUSION, EMPHASIZE THE FOLLOWING

• Good practices that can prevent hygiene and sanitation related diseases.

• Discourage “Bad” and “In between” practices.

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Three Pile Sorting

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Informative Tools

Three Pile Sorting

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Sender Cycle

DESCRIPTION It is an analytical, conceptual and informative tool used to

investigate and identify the root causes of diseases and appropriate interventions where possible. It also aims at providing information on hygiene and sanitation practices.

PURPOSES

• To assist the community identify root causes of problems and diseases

• To assist the community realize the need to change their behaviour and attitudes which are based on traditional norms and culture.

• To encourage community to take action to avoid the root causes of disease.

• To help the community evaluate and avoid interventions that failed to change attitudes and behaviour towards sanitation and hygiene.

TARGET GROUP Households, food handlers, marketeers, school children, church

groups METHOD 1. Ask participants to come up with groups of five to eight

people (if necessary) 2. Give participants pictures 3. Ask the participants to arrange the pictures in a vicious cycle 4. After 10 to 15 minutes, ask the groups to present the cycle. 5. Ask the participants to discuss the cycle.

MATERIALS Sets of pictures, markers, stickstuff, flipchart TIME 30 minutes POINTS OF DISCUSSION

• Can you explain what you think is happening in the cycle? • What other health problems can arise from such environment? • What are the common causes of such diseases in your

community?

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Informative Tools

• Is it possible to stop the cycle of problems? • What interventions would you put in your community to stop

the cycle of problems?


• Treatment alone is not the solution to faecal borne disease • Possible preventive measures;

using proper and clean toilet disposal of human excreta in the toilet proper disposal of garbage drinking safe water food hygiene washing hands with soap and treated water

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Sender Cycle

(

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EXAMPLE)

Informative Tools

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Solid Waste Ladder

DESCRIPTION This is an investigative, planning and informative tool, which helps

the community to know the stage where they are and the desired goal in terms of solid waste management. It also assists the community to know dangers of poor solid waste management.

PURPOSES

• To determine where the community is in terms of solid waste management.

• To assist community realize the dangers associated with poor solid waste management in order to change their behaviour.

• To assist the community to reach a consensus on the direction and steps needed for making progression on solid waste management.

• To provide knowledge on interventions which are meant to solve the identified root causes of poor solid waste management.


groups MATERIALS pictures depicting various solid waste management methods METHOD 1. Divide participants in small groups. (if necessary) 2. Give the participants a set of pictures 3. Ask the participants to arrange the pictures in the order of

improvements according to their wish, starting with the worst to the best or desired situation.

4. Ask the participants to identify the local common method of solid waste management.

5. Ask each group to present and stimulate full discussion and participation.

6. Ask the participants for ideal method of solid waste management.

TIME 15 - 30 minutes

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• At what level is the community in terms of solid waste management.

• Why hasn’t the community moved from one step to the other along the ladder?

• Which stage would they want to be? • How will they reach the step which is considered as the best?


• Poor solid waste management has negative effect on health • Interventions at different levels need to be looked at; - Household level

Garbage should be separated Garbage should be stored in proper containers (wet waste should be stored in non leaking containers) Storage containers should not be allowed to overspill

- Secondary storage level Garbage should be put in skip bins

Note; As solid waste management require cost, every person/households who produce waste must pay for solid waste management services.

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Informative Tools

Solid Waste Ladder

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Hand Washing Ladder

DESCRIPTION It is an investigative and informative tool which helps community

to analyse hand washing methods and provide appropriate information to encourage the community to adopt a proper hand washing method.

PURPOSES

• To help the community analyse their hand washing methods • To help create awareness to the community on the dangers

of poor hand washing methods and advantages of the proper method


groups METHOD 1. Divide participants in small groups. (if necessary) 2. Give the participants a set of pictures 3. Ask the participants to arrange the pictures in the order of

improvements according to their wish, starting with the worst to the best or desired method.

4. Ask the participants to identify the local common hand washing method.


6. Ask the participants for ideal hand washing method. MATERIALS Pictures depicting various hand washing methods TIME 15-30 minutes POINTS OF DISCUSSION

• What method do the community commonly use along the ladder?

• Are the current methods utilized by the community safe? • What method do the community desire? • Are resources available to meet the desired method?

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Informative Tools


• Hands can be vehicles for transmission of diarrhoeal diseases as they are used for handling clean and dirty items.

• Importance of washing hands with soap and treated running water (pouring method)

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Hand Washing Ladder

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Informative Tools

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Hand Washing Times

DESCRIPTION This is a planning and informative tool for identifying hand washing

times and providing appropriate knowledge to prevent diarrhoeal disease.

PURPOSES

To encourage the community when to wash their hands in order to prevent diarrhoeal diseases

METHOD 1. Divide the participants into small groups (if necessary) 2. Ask the participants to list down the times when they commonly

wash their hands and why. 3. Ask the participants to present and stimulate full discussion

and participation.

MATERIALS Flip chart, markers and stickstuff

TARGET GROUP Households, food handlers, marketeers, school children, church groups


• What is the importance of hand washing? • What are the critical times of hand washing? • Does hand washing prevent diseases and what types of

diseases? IN CONCLUSION, EMPHASIZE THE FOLLOWING

• Hands should always be washed in the following critical times

before handling and eating foods. after using toilet, handling children’s stool and changing baby’s nappies after cleaning toilet after handling garbage

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Sanitation Ladder

DESCRIPTION This is an investigative, informative and planning tool, which helps

the community to identify various sanitation options and determine the merit and feasibility of varying levels of improvements. It assists the community to know dangers of indiscriminate excreta disposal. It also helps in identifying possible challenges in implementing proposed sanitation improvements.

PURPOSES

• To help the communities to describe their own sanitary situation.

• To help the communities to identify options for improving sanitation

• To create awareness to the community on the importance of proper excreta disposal.

METHOD 1. Divide the participants in groups of five to eight. (if necessary) 2. Give the groups various pictures depicting different scenarios of

sanitation. 3. Ask your participants to arrange them in the order of

improvements, starting with the worst to the best or desired situation.

4 Ask the participants to identify the local common method of sanitation


MATERIALS a set of pictures, sticky stuff TIME 15-30 minutes TARGET GROUP Households, food handlers, school children, church groups POINTS OF DISCUSSION

• Which is the common sanitation option in the community? • Discuss options that have been picked as the best by the

communities.

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Informative Tools

• Discuss merits and demerits of each option • Why hasn’t the community moved from the common to the

desired option? • Encourage the group to agree on one sanitation ladder.


• Importance of using proper and clean latrine for excreta disposal

• Importance of using soft paper for anal cleansing

Notes to facilitator

A proper toilet should be sited 30 meters or more away from a water source 2.5 or 3 metres high and 1.3 meter squared(room space)

for the superstructure to ensure privacy covered with lid for the an ordinary pitlatrine orifice 3 metres minimum depth constructed with smooth floor finish for easy cleaning provided with a door or spiral shaped constructed of

durable permanent materials cleaned at least per day

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Sanitation Ladder

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Informative Tools

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Water Ladder

. DESCRIPTION This is an operational/ planning and informative tool that helps the

community to identify various water sources and determine their advantages and disadvantages of each option. It also assists community to know safe water sources available in the community.

PURPOSES

• It helps communities to describe the available water supply situation and know where they are in terms of water sources.

• It creates awareness to the community on improvements that can be done on water sources to prevent water borne diseases.

• It assists communities realise that improvements on water supply systems can be done step by step.

METHOD 1. Divide participants in groups of 5-8 people.(if necessary) 2. Give the groups various pictures depicting water supply systems. 3. Ask participants to arrange the pictures in order of improvements

starting with the worst situation to the best options. 4. Ask participants to present and stimulate full discussion and

participation.

MATERIALS set of pictures, stick stuff, markers and flipchart. TIME 15-30 minutes TARGET GROUP school children, households, water collectors POINTS OF DISCUSSION

• What are the common water sources in the community? • What are the advantages and disadvantages of each water

source? • What is the best water source on the ladder?

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• Importance of preventing contamination of water sources. • Water can be a source of diseases. • Water should be collected ,transported and stored in the

clean, narrow mouth container .

Note to Facilitator

A safe water source should : be sited 30 meters or more from a toilet, soak away or refuse

pit. have proper drain and soak away. be fenced not be used for washing clothes or bathing.

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Informative Tools

Water Ladder

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Water Ladder

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Informative Tools

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Body Mapping

DESCRIPTION This is an informative, monitoring and evaluation tool used to

establish changes that have taken place before and after having access to water supply, sanitation and hygiene education.

PURPOSES To show the benefits that result from having access to safe water

supply and knowledge on sanitation and hygiene. METHOD 1. Let the participants draw a poster of one person (man,

woman or child). 2. From the drawing, indicate conditions before and after a

water supply and sanitation facility is provided to an individual as follows:

Before After

Hair

Eyes

Nose

Body

Fingers

Clothes

Legs

Foot

3. Ask participants to write important changes the have observed. 4. Stimulate a discuss on the lessons learnt from the exercise

TIME 15-30 minutes TARGET GROUP school, children, households, food handlers, and church groups POINTS OF DISCUSSION

• What was the situation on personal and domestic cleanliness before ?

• What has changed? • What areas require further improvement?

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• Importance of practicing personal hygiene to prevent sanitation and hygiene related diseases.

• personal hygiene practices such as: bathing at least once per day with soap and changing to

clean clothes. Washing clothes thoroughly, drying and ironing them. Keep hair clean. Brushing teeth at least twice a day ,if possible every after

a meal. Keep nails short and clean.

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Informative Tools

Body Mapping

BEFORE AFTER

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Documents

INFORMATIVE TOOL MANUAL - JICA-Net · Informative Tool Manual PHAST CONTENTS Introduction 2 1. Diarrhoea Child 4 2. Story With A Gap (SWAG) 7 3. Identifying And Blocking the Transmission