PHAST and CLTS Training of Trainers (ToT)

PHAST and CLTS Training of Trainers (ToT)

DICKSON OMOSA

Topics for Day 1

1. Introductions2. Health promotion and behaviour change3. Hygiene and sanitation promotion tools

1. Introductions ◦ Name◦ Where you come from◦ Status

1. Introductions – cont’d● harmonization of expectations

◦ What do you intend to gain from this training?

● Setting workshop norms

Daily programme

Time/duration Session8:30am to 10:30am Morning10:30am to 11:00am Break11:00am to 1:00pm Mid-morning1:00pm to 2:00pm Lunch-break2:00pm to 4:00pm Afternoon

1. Introductions – cont’d

Objectives of the workshopu To build up the capacity of trainees to impart

knowledge to their community on prevention of hygiene related diseases.

u To equip trainees with practical facilitation skills.u To provide trainees with a methodology for

community mobilization and planning in order to address existing hygiene and sanitation problems.

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1. Introductions – cont’d

u To discuss factors that affect behaviour and how they can be altered in order to bring about positive hygiene behaviours

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Objectives of the workshop – cont’d1. Introductions – cont’d

2. Experience sharingu What methods/approaches are currently

used for promoting health behaviour change among a) adults and b) children?

u What achievements have been realised?u What challenges have been encountered?u What lessons have been learnt?

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3. Hygiene promotion and behaviour changeu BASNEF Modelu Behaviour change ladder

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Behavioural change (BASNEF Model)Factors Examples Actions neededBeliefs & Attitudes(Individual)

Culture, values, traditions,mass media, education,experiences

Communication programmesto modify beliefs and values

Subjective Norms(Community)

Family, community, socialnetwork, culture, power structure, peer pressure

Communication directed atpersons in family andcommunity who haveInfluence

Enabling Factors(Intersectoral)

Income/poverty, sanitationservices, women’s status,inequalities, employment,agriculture

Programmes to improveincome, sanitation provision,situation of women, housing,skill training

2. There may be a problem but it’s not my responsibility

5. I see the problem and I’m interest to learn more about it

Behaviour Change ladderSrinivasan, 1990

Satisfied with things as they are, see no problem, no reason to change

Person believes the cause of problem and its solution lies with the government or some external agent

Person skeptical about the proposed solutions – technical, financial, capability

Person has fears often well founded about social of economic loss

The responses are increasingly open and confident and come from people who are eager to learn and improve their skills

1. There is no problem

3. Yes, there is a problem, but I have my doubts

4. There is a problem but I’m afraid of changing for fear of loss

6. I’m ready to try some action

4. Hygiene and sanitation promotion toolsu Overview of PHAST and CLTSu Tools for community entryu Triggering

Exploration of key concepts in hygiene promotionu Communityu Community participationu Sustainability u Hygiene u Sanitation u Health

CommunityThe term community refers to a group of people that:Are interdependent on each other and limited by geographical boundaries, share common natural resources (water, means of economic production etc) share a common culture (beliefs, values, livelihoods) experience same problems and are affected in similar ways particularly in cases of a natural calamity.

Community participationThis is best described by the 3Cs:Consultation: (the community normally passive; consultation basically consists of informing or asking specific questions on interventions that have already been decided upon).Contribution: Community may be asked or offer to contribute labour, land, local materials, security, or even money.Control: Consists of decisions on what people actually require, e.g. at identification level, e.g. what to use the donor funds on, forms of local and grassroots institutions that should be established for the project management, and even the right to say “no” to projects that people don’t feel obliged to accept without the fear of losing donor support.

Sustainability “Sustainability” is the ability of a service/facility to continue functioning optimally over a long period of time beyond the intervention period. It is a process that starts from planning stage of a project and depends to a large extent on the proper project identification and on effective and efficient operation and maintenance (O&M) beyond the project lifespan.

Factors that influence sustainability

Environmental Technical

Sustainability

Community

Characteristics of sustainable interventions – cont’du It continues over a prolonged period of

timeu Its management is institutionalized

(community management, gender perspective, partnership with local authorities, involvement of formal/informal private sector).

Characteristics of sustainable interventions – cont’d

➢ It can be operated and maintained at the local level with limited but feasible external support (technical assistance, training, monitoring).

➢ It does not affect the environment negatively.

HygieneHygiene refers to those behaviours or practices that can affect the health of an individual and others either positively or negatively. These practices include but not limited to the collection, storage and use of water, washing hands at critical moments, the availability and proper use of sanitation facilities.

SanitationSanitation is the physical infrastructure that enable people to practice hygienic behaviours. It refers to the use of facilities that keep the environment clean or protect the environment from pollution or contamination.

Hygiene and Sanitation promotionHygiene and sanitation promotion refers to the combination or linkage of good hygiene practices and improved sanitation facilities with the aim of preventing diseases.

Hygiene education

Sanitationfacilities

Hygiene Promotion

HealthHealth as defined by the World Health Organization (1949) is:-The complete state of physical, mental and socio-economic well being of an individual, and not merely the absence of disease or infirmity.

Introduction to hygiene domains

u Personal hygieneu Safe disposal of excretau Household and domestic hygieneu Water hygieneu Food hygiene

Personal hygieneu This refers to the behaviours and practices in

relation to cleanliness of an individual towards self, which can affect one’s own health and the health of others negatively or positively. Critical personal hygiene practices include:

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Personal hygiene continuedWashing hands with running water, soap or ash at the following critical moments:

u after handling faeces, i.e. after visiting latrines and after cleaning the bottom of babies;

u before preparing and serving food;u before and after eating;u before feeding babies;u after handling garbage;

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Personal hygiene continuedu after playing – this is critical especially for children

who, while playing, may touch faeces and other impurities without their knowledge.

u Regular body washingu Keeping finger nails short and clean (faeces can hide

in the crevice of nails)

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Personal hygiene continuedu Brushing teeth after every mealu Sleeping on clean beddingsu Proper and regular use of LLINs and

personal protective measuresu Wearing clean clothes (and shoes)u Keeping hair clean and neat

Safe disposal of excretau This is to ensure that human excreta is

separated and disposed safely in a manner that will not contaminated the environment

u Human excreta is the most important source of diarrhoeal diseases and must be given the due attention it deserves in hygiene and sanitation education.

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Safe disposal of excreta continuedu It has been shown that polluting the

environment, particularly with faeces, could mean that the faeces get its way back into our body through various means or routes (transmission routes will be explained in details in subsequent topics).

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Safe disposal of excreta continuedCritical hygiene practices here include:u Safe disposal of human excreta,

preferably through proper use of latrines.u Keeping latrines clean and covered.

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Safe disposal of excreta continuedu Washing hands with water and soap (or

ash if no soap is available) after defecation or handling children’s faucal matter (this one is also mentioned under personal hygiene).

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Household and domestic hygieneu This consists of keeping the household

and its immediate surroundings clean. Household and domestic hygiene is achieved by:

u Keeping the house and everything in it clean, i.e. keeping the surface of house, furniture, utensils and other equipment clean.

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Household and domestic hygiene cont.u Having proper drainage that ensures there is no

stagnant water near the house as this can be a breeding place for mosquitoes.

u Covering open containers, old tyres and tins that may harbour water in which mosquitoes may breed.

u Sweeping the immediate surrounding of the house (compound) and keeping grass and other vegetation short, since these can be hiding places for mosquitoes.

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Household and domestic hygiene cont.u Safe disposal of dry garbage such pieces of

paper, plastic paper, torn pieces of cloth, broken glass, animal waste etc.

u Safe disposal of wet garbage including left over food stuffs, waste water, fruit peels etc.

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Water hygieneu This refers to protecting water from

contamination and ensuring its safety, from the source to the stomach; including making sure it is purified if there is any contamination at any stage e.g. at source, during transportation or during storage.

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Water hygiene continuedThe common water sources include:-

u Artificial/natural surface water catchments.u Open shallow wells.u Shallow wells with hand pumps.u Rivers.u Boreholes.u Springs.u Rain water harvesting.

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Water hygiene continuedu Of these common water sources, only

water from properly maintained boreholes, shallow wells with hand pump and properly used rainwater roof catchments are safe from contamination at the source.

u All the others are open to contamination at source and should therefore be treated before drinking.

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Water hygiene continuedu However, also when water is safe at the

source it can be contaminated during transportation and storage, and care should be taken to ensure that it remains safe before drinking.

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How to maintain safe water quality from source to the mouth

u Ensuring that human faeces do not get into the water, either at source or during storage. This is achieved by using latrines for defecation.

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How to maintain safe water quality from source to the mouth continued

u Defecation near water sources, especially open wells, and water catchments, or in the bushes or shrubs, means that as soon as it rains, the faeces is swept directly by rain water into the open water sources.

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u During the dry season, owing to water shortage, human beings and animals compete for the scarce water, and any water is consumed regardless of its source or quality, hence the high incidence rate of water related diseases even during dry seasons.

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How to maintain safe water quality from source to the mouth continuedu Constructing raised platform / apron (civil

works) around the open well to protect them from pollutants that may be carried in run off rain water.

u Constructing drain-ways and soak away pits to prevent waste water from being stagnant around the water source and hence encouraging breeding of mosquitoes.

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u Building latrines and bathing facilities downstream and at least 50-100 meters away from water source.

u Keeping animals away from drinking water sources by providing separate animal watering troughs, and by fencing off the water source.

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u Using clean containers to draw, transport and store water at home.

u Using only clean mugs/cups with handle to draw water from the drinking water container, and pouring the water into a separate mug/cup to drink from.

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u Not dipping hands or dirty items into the drinking water container.

u If possible, purify water using the locally acceptable and affordable purification methods (such as sand filtration, chlorination, SODIS or boiling).

u If possible, drinking water container should have a tap at the bottom.

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Food Hygieneu This refer to the management of food, from

the way it is handled, cooked and served to the way it is consumed and stored.

u The critical moments in food management that must be followed at all times:

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Food hygiene continuedDuring handling – preparation or serving:u Making sure your hands are clean while

preparing or serving food.u Using clean, properly washed containers,

utensils, cutting boards.

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Food hygiene continuedu Always washing foods that are taken raw e.g.

fruits, vegetable salads etc.u Cover raw or cooked food to protect them from

attracting flies, rodents or cockroaches.u Regularly cleaning food handling surfaces

such as tables in restaurants.

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Food hygiene continued

During cookingu Making sure food is washed properly with

clean water.u Proper cooking of food in terms of the

temperature and duration of cooking and not serving half cooked food.

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Food hygiene continuedDuring consumptionu Using clean serving utensils and cutlery that

have been washed with clean water.u Eating with clean hands.u Eating food that is properly cooked.

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Food hygiene continuedu Not to eat cold foods that may have been

exposed to contaminating agents (food should be properly warmed if it had been cold for two hours and above).

u Not to eat food that has expired or petrified

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Food hygiene continuedDuring storageu Storing cooked and uncooked food

separately.u Storing food in clean containers.u Storing food by covering it properly to make it

impossible for flies, cockroaches and rodents to access it.

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Overview of PHAST and CLTS

PHAST step-by-step framework

STEP ACTIVITY TOOLSTEP 1: Community entry

Community entry. The River Crossing.

STEP 2: Problem identification

Health problems in our community.

Seasonal calendar.

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PHAST step-by-step framework – cont’d

STEP ACTIVITY TOOLSTEP 3: Problem analysis

1. Mapping water and sanitation in our community2. Good and bad hygiene behaviours.3. Investigating community practices.4. How diseases spread.

1. Community mapping2. Three-pile sorting.3. Pocket chart.4. Transmission routes.

STEP 4: Identification of solutions

1. Blocking the spread of disease.2. Selecting the barriers.

1. Blocking the routes.2. Barriers chart.

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STEP ACTIVITY TOOLSTEP 4: Identification of solutions - cont’d

3. Choosing water improvements.4. Choosing sanitation improvements.5. Choosing improved health behaviours.6. Taking time for questions.

3. Story with a gap.4. Sanitation ladder.5. Three-pile sorting.6. Question box.

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STEP ACTIVITY TOOL

STEP 5 – Planning for implementation and change

1.Tasks of men and women in the community.

2. Selecting beneficiaries.3. Community action plan.4. Identifying what might go

wrong.

1. Gender role analysis.

2. Wealthranking.3. Planning

posters.4. Problem

box.*


STEP ACTIVITY TOOLSTEP 6 – Monitoring Implementation Progress

1. Checking our progress.

1. Monitoring (checking) chart.

STEP 7 – Evaluation

1.Participatory evaluation.

1. Various tool options.

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Introduction to CLTS steps and toolsCLTS approach uses PRA methods to enable local communities to analyse their sanitation conditions and collectively internalise the terrible impact of open defecation (OD) on public health and on the entire environment.

Introduction to CLTS steps and toolsSTEP ACTIVITY TOOL /FACTORS

1. Pre triggering

Selecting a community, introduction and building rapport

Policy environment, physical and socio-cultural conditions

2. Triggering (Matchbox)

Participatory community appraisal and sanitation analysis

Transect walk, mapping, calculation of shit and medical costs, f-diagram and glass of water

3. Post triggering

Action planning by the community

Community action plan, participatory monitoring

4. Scaling up Snowballing effect

PHAST STEP-BY-STEP PROCESS

PHAST

u Participatoryu Hygieneu Andu Sanitationu Transformation

Why use the PHAST methodology?u It offers an interactive approach for

promoting behaviour change by improving uptake, usage and adherence to methods of disease prevention.

PHAST ObjectivesThe objectives of the PHAST approach include:uTo promote the adoption of healthful behaviour among communities.uTo promote improvements in sanitation.uTo enhance community management of facilities.

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PHAST Step 1: Community EntryThis step is designed to help the group understand the role of agencies and the community as partners in development and encourage community participation in activities.

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Community Entry – Cont’d u Purpose: To show participants the different

types of relationships that agencies normally have with communities and demonstrate the importance of community participation in projects. It is also meant to define what is involved in community participation in terms of contribution, ownership and sustainability.

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Problem identification u Activity: Health problems in our communityu Tool: The seasonal calendaru Purpose: To identify the common diseases

in the community and the seasons in which they occur and their causes.

u Materials: Pens, paper, large sheets of paper.u Approximate time: 1 to 2 hours

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STEP 2: Problem identification – cont’d Noteu Explain that the aim of this session is to show

that most of the diseases are either as a result of drinking contaminated water, eating contaminated foods or poor personal hygiene.

u The facilitator may guide the discussion with some technical knowledge but primarily the participants should bring out the information themselves.

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STEP 3: Problem AnalysisThis step will help the group understand how some of its everyday hygiene and sanitation practices may cause diarrhoeal diseases. It will then be able to start considering what can be done to improve practices in order to prevent disease.

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Mapping water and sanitation in our communityu Tool: Community mappingu Purpose: to map the community’s water

and sanitation conditions and show how they are linked.

u Approximate time: 1-3 hours.u Materials: paper, pens, stones, beads,

material scraps, stickers.

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Noteu If the mapping exercise took place on the

ground, ask a member of the community to transfer the model on to a sheet of paper for the community to keep as record to be used for future purposes (planning of activities, monitoring, other agencies coming in to do similar exercise, etc).

CLTS tool: TriggeringTransect walkTransect walk

Activity 2: Good and bad hygiene behavioursu Tool 2: Three-pile sortingu Purpose: To exchange information and

discuss common hygiene behaviours and their impact on health.

u Approximate time: 1- 1½ hours.u Materials: Sets of three-pile sorting drawings

(from toolkit); sets of heading cards – ‘good’, ‘bad’ and ‘in between’.

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Notesu When asking them why they do it, it is

important to not let them hide under the words ‘it is our culture’, but instead they should examine the main cause of why people behave that way or what it is exactly that prescribes that kind of ‘culture’. This is an important discussion and at the same time tricky, because people may easily be put off and refrain from further talking.

Notes – cont’du There may be very good reasons for people

to behave the way they do, even if this turns out to be behaving ‘badly’ from a hygienic point of view. It is useful for the facilitators to try to understand that also, because it may help look for appropriate alternatives. ‘It is our culture’ may include such ‘good reasons’. This requires skilled facilitators, who refrain from pinpointing people’s bad behaviour.

Activity 3: Investigating community practicesu Tool 3: Pocket chartu Purpose: to help the group collect and analyze

information on individual sanitation practices.u Approximate time: 1-2 hoursu Materials: A pocket chart or local alternative

(tins, jars etc.), drawings of defecation sites (latrines, open ground, forest, bushes, river etc.), voting materials such as pebbles or seeds, blank paper.

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Notesu Stress the need for people to be honest

when placing tokens.u Once the community worker has come to

grasps with the implementation of the pocket chart exercise, he or she can also adapt it by using different drawings to identify for example when people wash their hands with water and soap, or from which water source people fetch their drinking water.

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Activity 4: How diseases spreadTool 4: Transmission routes – the ‘F’

diagramu Purpose: to help participants discover

and analyse how diseases are spread.u Approximate time: 1 – 1 ½ hours.u Materials: large paper, marker pens, tape,

drawings.

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Triggering: Glass of water

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Fluids/Water

Fields/Soil

Flies

Fingers

Food/water MouthFaeces

The F-diagram (Transmission routes)

STEP 4: Identification of solutionsu Planning for solutions in hygiene and

sanitation training has a number of steps.u Purpose: to help participants discover

and analyse solutions for the problems identified.

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Activity 1: Blocking the spread of diseaseTool 1: Blocking the routesu Purpose: to identify the actions that can be

taken to block disease transmission routes.u Approximate time: 30 minutes – 1 houru Materials: blocking the routes drawings,

transmission routes diagrams (from previous activity), paper,marker pens, and tape.

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Principles of good facilitationCharacteristics of an effective facilitator:

1)Listening skills – Listens carefully, observant, sensitive to body language and courteous.

2)Comprehension skills – Verifies information, understands contents and methods, periodically reviews/recaps and ensures everyone understands.

Principles of good facilitation-cont’dCharacteristics of an effective facilitator:

3)Team building skills – Promotes a team spirit, addresses participants’ concerns and manages group power dynamics.

4)Communication skills – Good teaching skills, uses visual aids, able to speak audibly/clearly and presents concepts in simple language.

Principles of good facilitation-cont’dCharacteristics of an effective facilitator:

5)Organizational skills – Preparation, time management and adapts to the situation-flexible.

6)Personal characteristics – Curious, patient, self-confident, non-authoritarian, tolerant and able to accept constructive criticism.

Principles of good facilitation-cont’dDos’ and Don’ts of facilitation:Dos Don’tsListen actively Judge while listeningClarify information – probe Make assumptionsShow interest Loose track by getting bogged

down in details and side-trackedJump to conclusionsInterruptGive advice unless it is needed by the other person

Comparison between teaching and facilitatingTeaching FacilitationIs based on the assumption that the teacher knows it all and learners are empty vessels

The participants and the facilitators are taken to be on the same level of knowledge

The aim of teaching is to impart knowledge to learners

The aim of facilitation is to provoke collective action by a given group

In most cases teaching employs frontal lecturing of learners on different topics

Facilitation employs diverse interactive tools to foster active participation of the group.

Principles of good facilitation-cont’d

Activity 2: Selecting the barriersTool 2: Barriers chartu Purpose: to analyse how effective the blocks

are and how easy or difficult they would be to put in place.

u Approximate time: 30 minutes to 1 houru Materials: transmission routes diagrams with

blocks, tape, pins, pens and paper.

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Activity 3: Choosing water improvementsTool 3: Story with a gapu Purpose: To engage community members as

a group in planning water improvements.u Approximate time: 1-2 hours.u Materials: One set of “before” and “after”

water related drawings. “Before”: A community water source that is poorly maintained and “After”: An improved and well-maintained water source.

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Activity 4: Choosing sanitation improvementsTool 4: Sanitation ladderPurpose: To help participants describe the

community’s sanitation, identify an option or options for improving sanitation, and discover that improvements can be made step-by-step.

Approximate time: 1-2 hoursMaterials: several sets of sanitation ladder

drawings from the PHAST toolkit, large-size paper to which drawings can be attached (optional), sticky tape. *

Activity 5:Choosing improved hygiene behavioursTool 5: Three-pile sortingu Purpose: To help the group identify hygiene

behaviours that it: wants to change, wants to encourage and reinforce, and wants to introduce into the community.

u Approximate time: 1 houru Materials: A set of three-pile sorting

drawings used in Step 3: Activity 2.*

Activity 6:Taking time for questions

Tool 6: Question boxu Purpose: to provide an opportunity for

participants to ask questions about the process (or other matters), to obtain information and feedback from other participants, and to help the group recognize the wealth of knowledge and information it possesses collectively.

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STEP 5: Planning for Implementation and change

This step has four activities:u Activity 1: Tasks of men and women in

the community to identify who can take responsibility for what activities in relation to water, sanitation and hygiene.

u Activity 2: Selecting beneficiaries helps the group identify who among the community members needs to be given priority during the implementation.

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Planning for Implementation and change continuedu Activity 3: Developing a community

action plan helps the group plan the actions and steps for implementing the solutions it has decided on and allocate responsibilities.

u Activity 4: Identifying what might go wrong enables the group to foresee possible problems and plan ways to overcome them.

Activity 1: Tasks of men and women in the community

u To identify who can take responsibility for what activities in relation to water, sanitation and hygiene.

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Tool 1: Gender role analysisPurpose:u To raise awareness and understanding of

which household and community tasks are done by women and which are done by men.

u To identify whether any changes are required in relation to implementing and sustaining improved hygiene behaviours and practices at the household and community levels.

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u Approximate time: 1 hour.u Materials: 3 separate large drawings of: a

man, a woman, and a man and a woman together, 12 or more task drawings, pens and paper.

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Activity 2: Selecting beneficiaries

u Helps the group identify who among the community members needs to be given priority during the implementation.

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Tool 2: Wealth ranking

u Purpose:u To investigate perceptions of wealth

differences and inequalities in a community.

u To identify and understand local indicators and criteria of wealth and well-being.

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Wealth ranking continuedu To map the relative position of all the

households in a community and to establish which members within the community are the most destitute as these should be the main beneficiaries of the planned interventions.

u Time: 2-3 hours.u Materials: pens and cards.

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Activity 3: Developing a community action plan

u Helps the group plan the actions and steps for implementing the solutions it has decided on and allocate responsibilities.

Activity 3: Developing a community action plan (CAP)u Tool: Planning posters, community

action planu Purpose: to enable participants develop a

plan to achieve changes in sanitation and hygiene behaviours and to help identify who will take responsibility for carrying out the steps in the plan and set a timeframe for implementing the plan.

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u Approximate time: 3-4 hoursu Materials: set of planning posters, the

“now” and “future” options (from Step 4: Activity 3, 4 and 5), sticky

u tape, pens and pieces of paper or cards for writing down names and deadlines

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Activity 4: Identifying what might go wrong

u Enables the group to foresee possible problems and plan ways to overcome them.

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Tool: Problem Boxu Purpose: to get the group to think about

possible problems in implementing the plan, and devise ways of overcoming them

u Time: 1 houru Materials: cards or paper and pens,

Container (such as a basket, a hat or a box)

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Implementation of PHAST:•Building the capacity of local implementing partners (LNGOs) on the PHAST methodology

•Training local resource persons (Hygiene promoters and masons) on PHAST and other technical issues

•Community mobilization through hygiene promoters using PHAST

•Development of CAP for improving water, sanitation and hygiene in the target communities

Project activities in relation to implementation of CAPs

1. Baseline studies and/or review of CAPs2. Facilitation of CAP implementation with

focus on:u Hygiene and sanitation awareness raising u Household latrine constructionu Rehabilitation/construction of water sourcesu Proper solid waste disposalu Prevention of malaria

STEP 6: Monitoring Implementation progress

u In this activity, the group fills in a chart for monitoring its progress towards achieving its goals as defined in the CAP. Means are identified for measuring progress, how often this needs to be done and who will be responsible for doing it.

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Activity: Checking our progress

Tool: Monitoring chartPurposeu To establish a procedure for checking

progress, to decide how often checking should be done and who should be responsible for this.

u To set a date for the evaluation activity which will take place with the wider community

Duration: 2 hours

Monitoring chart

Goal (problem to be addressed)

Number/ amount

How to measure

How often to measure (frequency)

By whom (responsibility)

STEP 7: Evaluation

Tools that can be used include:u Seasonal calendaru Community mapu Community Action Plan (CAP)u Pocket chartu Community/transect walku Socio-drama

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Activity: Participatory evaluation

Behaviour Change communication strategyu Current behaviors/attitudes u Desired behaviors/attitudesu Target u Communication objectives u Key Benefits u Key Barriers u Draft Messages u Interventions

End of workshop evaluation1. What have you learnt from this

workshop?2. How do you plan to use the newly

acquired knowledge and skills on PHAST and CLTS? a) Individually and b) as a department

3. How can we improve on the facilitation of similar trainings/workshops in future?

Training objectives and expectationsTraining objectives Participants expectations

Thank you for your active participation!!!

Email: [email protected]