2009 Kenya: Evaluation of PHAST tool for the promotion hygiene Sanitation in the GOK/UNICEF Programme of cooperation
Author: IRC International Water and Sanitation Centre and NETWAS International
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PHAST stands for Participatory Hygiene and Sanitation Transformation. It was launched as a tool for sanitation and hygiene promotion at a workshop in Kenya in 1993 by the Regional Water and Sanitation Group for Eastern and Southern Africa (RWSG-ESA) of the UNDP-World Bank Water and Sanitation Program, and the Community Water Supply Unit of the World Health Organization-Geneva Office. Five countries (Botswana, Ethiopia, Kenya, Uganda and Zimbabwe) were invited, through UNICEF-ESARO, to pilot the methodology.
Piloting in Kenya started in 1993. PHAST was used as a tool in the Government of Kenya/UNICEF hygiene and sanitation programme and has since passed through several phases. The transition between the different phases was prompted by annual reviews and lessons learnt. Over the past eight years the GOK/UNICEF program has spent over USD 500,000 on PHAST, including support for hardware (latrines, tools and drainage) in schools and communities.
The programme adopted an operational research approach, in which the results of each activity are used to design and refine subsequent initiatives. This required objective analysis of results against a model, and identifying opportunities and especially strategies on how to hand over the responsibility for change to communities and households. The programme learnt a lot from the communities and made progressive improvements. Significant changes included (a) a shift of emphasis from knowledge or message-based to practice-based communication supported by knowledge; (b) a shift from an institutional focus to a focus on community-based structures and the use of social context and cultural forms of communication.
From March to May 2005 the GOK/UNICEF programme conducted a detailed review of the conceptual basis of PHAST based on Grounded Theory Method and the implications of how it should be used and linked up with hygiene and sanitation marketing. The insights gained from the review were used to modify the original terms of reference and the geographical target area.
The GOK/UNICEF programme now believes that it has reached a point where it would like to scale up PHAST applications to communities, whole districts and the country.
The evaluation of PHAST was carried out in the context of the GOK/UNICEF 2004-2008 programme of cooperation, where large-scale approaches are required to accelerate progress towards achievement of the Millennium Development Goals in hygiene and sanitation.
The evaluation was based on strategies and activities at national, district and community level. It focused on five districts, namely Kwale, Garissa, Turkana, Kisumu and Nairobi. Persons from these districts met at a preparatory workshop in Nairobi in the beginning of January. Together with the team, they developed a questionnaire that would be used in the field to evaluate PHAST. UNICEF and district staff members in the field were instrumental in bringing the two study teams into contact with a number of stakeholders at district and community level. Key persons interviewed in the field were: district officers from relevant ministries; NGO representatives, practitioners and community resource persons, including public health technicians, teachers, and CBO representatives; and members of the community.
Based on the evaluation, the following recommendations are divided into four levels: general, national, district and community:
Findings and Conclusions:
Based on the field work, it is clear that:
• PHAST does have an influence in bringing about hygiene behaviour changes. During the field work, various success stories on the role of PHAST in the communities were cited.
• PHAST empowers and encourages total participation among all stakeholders.
• There is a willingness/eagerness to be trained/capacitated/informed about the tool at all levels.
• PHAST promotes collaboration between stakeholders in the planning and implementation cycle.
• PHAST can be used alongside other participatory methods (e.g. CLTS, etc)
• Local adaptation of PHAST is easy and user friendly.
• The methodology is quite time-consuming and is taught in a fixed order, which limits its flexibility.
• It has no explicit gender perspective in content, methods, processes or training.
• There is no clear link with HIV/AIDS mitigation: for example for HIV-affected households.
• There is weak link of PHAST in relation to monitoring and evaluation.
Based on the recommendations below, it is clear that PHAST does have a role at all levels. The preparatory workshop, field visits, and feedback workshop have clearly revealed that PHAST is an acceptable method that works well in the Kenyan context.
Below are the further suggested recommendations at the national, district and community level.
National level recommendations
• The Environmental Sanitation and Hygiene Working Group plays an active role in coordinating learning and sharing around PHAST. This critical working group at the national level should continue to be strengthened and supported. Also of importance is that all the members of the working group be trained in the PHAST methodology. In addition, the national working group should develop clear guidelines for the district level working groups (and lower) on how to work with PHAST.
• Effective external financial support should continue to be made available by the government, donors and the project teams to enhance PHAST (e.g. training, technical advice, support and mentorship).
• There is a need to have monitoring and evaluation systems for PHAST in place to enhance better documentation of best practices and lessons learnt.
• There is a need for PHAST to be integrated into educational institutions of learning at all levels (e.g. universities, colleges and schools).
• PHAST should be gender mainstreamed at all levels. In addition focus on diseases such as HIV/AIDs should be included in the PHAST tools.
District level recommendations
• PHAST is under the responsibility of the District Environmental Sanitation and Hygiene Working Group. In some districts, this working group is already established. However, in districts where this is not the case, these need to be formed, strengthened and supported. Also of importance is that all members of the working group be trained in PHAST. In addition, the working group should get clear guidelines from the national level on how to work with PHAST. This entails that PHAST should have harmonized guidelines in terms of how it is used at the district level.
• In order to enhance inter-sectoral cooperation for the use of PHAST at the district level, the District Environmental Sanitation and Hygiene Working Group needs to be strengthened.
• For PHAST to gain strength and recognition, newly recruited District Public Health Officers and others (e.g. PHO, PHT, etc) should be trained in this methodology.
• Effective facilitation of PHAST requires a paradigm shift from didactic/training approaches; many practitioners lack confidence in their ability to shift from the position of expert/teacher to that of facilitator. They see PHAST as something that should be taught, though the original idea is that it needs to be facilitated. Training of facilitator skills at district level is essential.
• Inter-district learning and sharing platforms for PHAST should be set up, either through provincial offices, or through the District Environmental Sanitation and Hygiene Working Group , which can play a critical role in this respect.
• Local monitoring and impact measurements (e.g. baseline information) need to be strengthened at the district level through better documentation of best practices and lessons learnt.
• PHAST tools should be animated and specifically made culturally sensitive for each district.
• PHAST tools should be electronically available (e.g. DVD, CD Rom) and also in laminated picture sheets (e.g. A4 sets) at the District Public Health Offices.
Community level recommendations
• There is a need to strategically explore ways of using PHAST to create demand for better hygiene and sanitation at the grass root level. This entails using methods like animation, sanitation marketing, etc.
• There is a need to develop criteria guidelines for selecting persons to be trained as ToTs for PHAST.
• Information flows should be encouraged right from the village level through, for example, the use of chalk boards indicating all relevant information.
• For PHAST to become an integral part of community life, it is critical that it be accepted in the local culture. Basic principles such as time availability, budgetary allocation and number of training courses should be given serious consideration.
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