1. Introduction to PHAST approach & Field’s applications in Vietnam Hanoi School of Public Health, 11 th of March 2009 1 Introduction to PHAST approach & Field’s applications in Viet Nam Presented by the French Red Cross (FRC) and the German Red Cross (GRC) At the Hanoi School of Public Health On the 11 th of March 2009

2. Introduction to PHAST approach & Field’s applications in Vietnam Hanoi School of Public Health, 11 th of March 2009 2 Presentation contents 1.The FRC and GRC Water and Sanitation programmes in Viet Nam 2.Some necessary concepts 3.Generalities on PHAST 4.PHAST step-by-step 5.Advantages and disadvantages of PHAST approach

3. Introduction to PHAST approach & Field’s applications in Vietnam Hanoi School of Public Health, 11 th of March 2009 3 1. The FRC and GRC Watsan Progammes in Viet Nam 1.1. The VNRC/FRC programme “Strengthening the capacities of the EMG of Bac Kan province to acquire a hygienic and sanitary environment and an access to drinking water”. 3-year project funded by EuropeAid (European Commission) Target: 3 communes (33 villages) composed of 1500 households/7500 persons; 99% EMG (Tay, Dao, Hmong) Objectives: Develop VNRC capacities Improve beneficiaries health Provide access to water and sanitation infrastructures

4. Introduction to PHAST approach & Field’s applications in Vietnam Hanoi School of Public Health, 11 th of March 2009 4 1. The FRC and GRC Watsan Progammes in Viet Nam 1.2. The VNRC/GRC CBHC Programme Community Based Health Care and Brunch Development Northern Vietnam – CBHC 4 - Year Project in Bac Ninh, Bac Giang, Cao Bang and Lang Son Provinces Objectives: 1.Provision of water supply and sanitation as well as prevention of water-borne diseases is improved through Community participation. 2.VNRC branches have increased capacity to deliver regular and sustainable quality humanitarian services to the most vulnerable people. Target group: 4500 HH and 5000 direct beneficiaries (total approximately 27 000 person) will benefit from the interventions.

5. Introduction to PHAST approach & Field’s applications in Vietnam Hanoi School of Public Health, 11 th of March 2009 5 2.1. What are participatory approaches? Participatory approaches encourage the participation of individuals in a group process, no matter their age, sex, social class, ethnic group… They are especially useful for encouraging the participation of women. Participatory methods aim: to build self-esteem and sense of responsibility and to help people to be more confident. to ensure the “programme” is designed for but also BY the people who will enjoy its benefits. 2. Some necessary concepts

6. Introduction to PHAST approach & Field’s applications in Vietnam Hanoi School of Public Health, 11 th of March 2009 6 2.2. Examples of participatory approaches SARAR SARAR: Self Esteem, Associative Strength, Resourcefulness, Action Planning and Responsibility PRA PRA: Participative Rural Appraisal PHAST and… PHAST… The General Aim is:  to assess, prioritize, plan, create, organize, and evaluate development initiatives.  to ensure sustainability through the involvement and participation of all stakeholders but more specifically of the beneficiaries themselves. 2. Some necessary concepts

7. Introduction to PHAST approach & Field’s applications in Vietnam Hanoi School of Public Health, 11 th of March 2009 7 2.3. Hygiene education and hygiene promotion Hygiene Education: Hygiene Education helps to increase the knowledge of people about behaviors and practices resulting in good or bad health by teaching them.  Hygiene education is broadly used in Viet Nam and it is based on an unilateral up-to-bottom knowledge transmission. Teacher – Students Hygiene Promotion: Hygiene promotion encourage people to adopt safe hygiene practices by supporting them to identify themselves the good and bad behaviors. The aim is to facilitate the process and the beneficiaries “ignite” themselves.  Hygiene Promotion utilizes the bottom-up approach: it is based on the baseline conditions of the beneficiaries: what the people know, do and want to change. 2. Some necessary concepts

8. Introduction to PHAST approach & Field’s applications in Vietnam Hanoi School of Public Health, 11 th of March 2009 8 3.1. What is PHAST? Definition:PParticipatory HHygiene AAnd SSanitation TTransformation PHAST seeks to help community to: Improve hygiene behaviors Prevent diarrhoeal diseases Encourage community management of water and sanitation infrastructure. It does it by: Demonstrating the relationship between sanitation and health status Increasing the self-esteem of community members Empowering the community to plan environmental improvements and operate water and sanitation facilities. 3. Generalities on PHAST

9. Introduction to PHAST approach & Field’s applications in Vietnam Hanoi School of Public Health, 11 th of March 2009 9 3. Generalities on PHAST 3.2. Where does PHAST come from? (1/2) It was initially supported by the World Health Organization and the World Bank. PHAST was adapted from the SARAR approach in the early 90’s and developed in Africa with a focus on hygiene promotion. PHAST is used since the mid 90’s by the Red Cross Movement and a water and sanitation policy for the RC Federation was formally introduced in 2003.

10. Introduction to PHAST approach & Field’s applications in Vietnam Hanoi School of Public Health, 11 th of March 2009 10 3. Generalities on PHAST 3.2. Where does PHAST come from? (2/2) In Viet Nam, PHAST was introduced in 2000 and the original PHAST version was translated in Vietnamese in 2001. In 2002, the WHO and the Department of Preventive Medicine of MoH released a first adaptation of the original PHAST for Viet Nam. PHAST was used in several provinces of Vietnam from 2002. PHAST was recently adapted for EMG and poor illiterate people by the Red Cross in Viet Nam.

11. Introduction to PHAST approach & Field’s applications in Vietnam Hanoi School of Public Health, 11 th of March 2009 11 3. Generalities on PHAST 3.3. What are PHAST contents and tools? PHAST is composed of 7 steps. Each step is including up to 3 different activities. For each activity, tools are needed: tools are the techniques and materials used by the facilitators to help the group work through an activity. These tools and the manual for facilitator (guiding the facilitator in its tasks) constitute the PHAST toolkit. PHAST activities are implemented by the community and facilitate by a facilitator properly trained.

12. Introduction to PHAST approach & Field’s applications in Vietnam Hanoi School of Public Health, 11 th of March 2009 12 3. Generalities on PHAST 3.4. What is the role of the facilitator? The facilitator shall SUPPORT, HELP and FACILITATE the community to implement PHAST activities. They shall NOT ACT AS A TEACHER by “giving” the knowledge to people. The facilitator shall NOT DO the activities instead of the villagers. The facilitator should: Support the villagers to identify their problem Help them to find and choose solutions Support them in planning the implementations of these solutions Help them on how to monitor and evaluate the progress Facilitate discussions

13. Introduction to PHAST approach & Field’s applications in Vietnam Hanoi School of Public Health, 11 th of March 2009 13 4. PHAST step-by-step 4.0. The seven steps Step 1: Problem Identification Step 2: Problem Analysis Step 3: Planning for solution Step 4: Selecting options Step 5: Planning for new facilities and behaviors’ change Step 6: Planning for monitoring and evaluation Step 7: Monitoring and Evaluation

14. Introduction to PHAST approach & Field’s applications in Vietnam Hanoi School of Public Health, 11 th of March 2009 14 4. PHAST step-by-step 4.1. Step 1: Problem Identification Activity 1: Mapping of the village The villagers describe the water and sanitation status in their village. They analyze the weaknesses and the lack. Activity 2: Health problem in the community The villagers describe the health status in their village. They point the most common diseases.

15. Introduction to PHAST approach & Field’s applications in Vietnam Hanoi School of Public Health, 11 th of March 2009 15 4. PHAST step-by-step 4.2. Step 2: Problem Analysis Activity 3: Good and bad hygiene behaviors The villagers identify the behavior which can be good or bad for health. Activity 4: Investigating community practices The villagers collect and analyze data on actual behavior in the community. Activity 5: Diseases transmission The villagers look at how feces can contaminate the environment and spread diseases

16. Introduction to PHAST approach & Field’s applications in Vietnam Hanoi School of Public Health, 11 th of March 2009 16 4. PHAST step-by-step 4.3. Step 3: Planning for solutions Activity 6: Blocking the spread of diseases The villagers discover ways to prevent or stop diarrhoeal diseases from being spread via the transmission routes. Activity 7: Selecting barrier The villagers analyze the effectiveness and the ease of actions to block transmission routes and choose which they want to carry out themselves. Activity 8: Task of men and women in the community The villagers figure out who would be able to undertake additional tasks to introduce the necessary changes.

17. Introduction to PHAST approach & Field’s applications in Vietnam Hanoi School of Public Health, 11 th of March 2009 17 4. PHAST step-by-step 4.4. Step 4: Selecting Options Activity 9: Choosing improved hygiene behaviors. The villagers choose the hygiene behaviors they want to choose and commit to change them Activity 10: Choosing new water and sanitation facilities The villagers analyze the different solutions existing to improve the water and sanitation status of the community and choose the most suitable ones.

18. Introduction to PHAST approach & Field’s applications in Vietnam Hanoi School of Public Health, 11 th of March 2009 18 4. PHAST step-by-step 4.5. Step 5: Planning for news facilities and behavior’s change Activity 11: Planning for change The villagers plan the action steps needed to implement the hygiene and facilities change they select. Activity 12: Planning who is doing what The villagers assign responsibilities for each action steps Activity 13: Identifying what might be wrong The villagers foresee the possible problems and plan solutions to overcome them.

19. Introduction to PHAST approach & Field’s applications in Vietnam Hanoi School of Public Health, 11 th of March 2009 19 4. PHAST step-by-step 4.6. Step 6: Planning for Monitoring & Evaluation Activity 14: Preparing monitoring and evaluation The villagers decide all together how they will monitor and evaluate the actions planed which means to decide: What will be the indicators? What is the objectives for each indicators? Who will be responsible for monitoring? How often monitoring will be held? Etc.

20. Introduction to PHAST approach & Field’s applications in Vietnam Hanoi School of Public Health, 11 th of March 2009 20 4. PHAST step-by-step 4.7. Step 7: Monitoring & Evaluation Activity 15: Monitoring and Evaluation This step is carried out once the project/activities are over. Evaluation should allow to answer the following questions: How much has been done by the community? How much of the plan still remains to be done? What was successful? What were the difficulties encountered? Etc. Several tools can be used to implement this step as: Monitoring sheets, socio-drama, pocket chart, mapping

21. Introduction to PHAST approach & Field’s applications in Vietnam Hanoi School of Public Health, 11 th of March 2009 21 5. PHAST advantages and disadvantages 5.1. Advantages PHAST covers the “soft” and “hardware” parts of Water and Sanitation programme. PHAST is a Project Assessment/Development tool The villagers have an opportunity to share their skills and to help each others. The villagers become able to express the questions which they always find difficult to mention in pulbic and find solutions themselves. PHAST encourages villagers to take part actively in analyzing and developing ideas. PHAST encourages women to take part in activities.

22. Introduction to PHAST approach & Field’s applications in Vietnam Hanoi School of Public Health, 11 th of March 2009 22 5. PHAST advantages and disadvantages 5.2. Disadvantages (1/2) PHAST is only a tool! Firstly PHAST toolkit need to be adapted to the targeted population. It is a long and intensive process to develop new materials, test it, choose pertinent activities… Secondly, PHAST requires the community workers, called facilitators, to have specific skills (listening, observation, facilitating discussions), to be very well trained and to master objectives.

23. Introduction to PHAST approach & Field’s applications in Vietnam Hanoi School of Public Health, 11 th of March 2009 23 5. PHAST advantages and disadvantages 5.2. Disadvantages (2/2) PHAST implementation can be a long process. Therefore it can be time-consuming and difficult to implement in areas where people have a very high workload (agricultural work). PHAST can be seen as too simple for some communities. M&E of PHAST outputs is difficult. How to assess the behaviors and mentality changes? In Viet Nam it seems difficult to implement PHAST approach without a hardware component (infrastructures construction) within the programme.

24. Introduction to PHAST approach & Field’s applications in Vietnam Hanoi School of Public Health, 11 th of March 2009 24 Activity 1 : Mapping

25. Introduction to PHAST approach & Field’s applications in Vietnam Hanoi School of Public Health, 11 th of March 2009 25 Activity 2: Health problem in the community

26. Introduction to PHAST approach & Field’s applications in Vietnam Hanoi School of Public Health, 11 th of March 2009 26 Activity 3:Good and bad behaviors

27. Introduction to PHAST approach & Field’s applications in Vietnam Hanoi School of Public Health, 11 th of March 2009 27 Activity 4: Investigating community practices

28. Introduction to PHAST approach & Field’s applications in Vietnam Hanoi School of Public Health, 11 th of March 2009 28 Activity 5: Diseases transmission

29. Introduction to PHAST approach & Field’s applications in Vietnam Hanoi School of Public Health, 11 th of March 2009 29 Activity 6: Blocking the routes

30. Introduction to PHAST approach & Field’s applications in Vietnam Hanoi School of Public Health, 11 th of March 2009 30 Activity 7: Selecting barriers

31. Introduction to PHAST approach & Field’s applications in Vietnam Hanoi School of Public Health, 11 th of March 2009 31 Activity 8: Tasks of men and women

32. Introduction to PHAST approach & Field’s applications in Vietnam Hanoi School of Public Health, 11 th of March 2009 32 Activity 9: Choosing improved hygiene behaviors

33. Introduction to PHAST approach & Field’s applications in Vietnam Hanoi School of Public Health, 11 th of March 2009 33 Activity 10: Choosing new infrastructures

34. Introduction to PHAST approach & Field’s applications in Vietnam Hanoi School of Public Health, 11 th of March 2009 34 Activity 11, 12, 13: Planning for change

35. Introduction to PHAST approach & Field’s applications in Vietnam Hanoi School of Public Health, 11 th of March 2009 35 Activity 14: Preparing M&E