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F.6 Participatory Hygiene and Sanitation Transformation (PHAST)

Participatory Hygiene and Sanitation for Transformation (PHAST) is a participatory learning and planning methodology using a step-by-step approach designed for extension workers to promote hygiene and sanitation behaviour change, particularly in rural communities.

The PHAST process involves seven steps that broadly correspond to the programme cycle: problem identification, problem analysis, planning for solutions, selecting options, planning for new facilities and behaviour change, planning for monitoring and evaluation and participatory evaluation. Each step has accompanying tools (e.g. picture sets) or interactive exercises that encourage people to conceptualise and think through hygiene problems and how they can address them. The steps should be followed in order as each step supports participants to move to the next step, enabling people to overcome the previous step’s constraints to change. The participatory approach aims to build people’s self-esteem and confidence to work together to make changes. The concept of empowerment of communities is central to the approach. Regular contact between the extension worker/hygiene promoter and each community is envisaged for at least six months. Through discussion and debate, a community-defined response to the problems is encouraged. The methods used are similar to many Participatory Learning and Action methods but the process is less open-ended and guides people towards solving sanitation and hygiene issues. The process requires trained facilitators and, whilst the tools and exercises can be learned quite quickly, skill and an attitude of respect for community capacity and knowledge. 

‘Faster PHAST’ applies the principles of PHAST to the pressures and time constraints of the emergency context, shortening the process to three or four steps and encouraging more frequent contact with communities to achieve faster change. The preparation of the toolkit and training of facilitators can take some time and it may be difficult to introduce PHAST in an acute emergency context. However, the individual tools provide useful ways to get groups talking and thinking about what they can do together to address sanitation and hygiene problems.

Tools and Methods used

  • Unserialised Posters T.19
  • Community Mapping T.7
  • Three Pile Sorting T.51
  • Pocket Chart Voting T.31
  • Transmission Routes and Barriers T.53
  • Gender Analysis T.16
  • Sanitation options
  • Question box
  • Participatory planning
  • Participatory Monitoring M.5


PHAST is more suitable for longer-term development interventions but can be adapted for use in emergencies by reducing the number of steps (Faster PHAST= ‘PHASTer’) or for use with children by using more child-focused activities. It is usually inappropriate for the acute phase of a response as significant time for preparation and training is required (unless PHAST has previously been used). Many of the tools can be used on their own for assessment or to stimulate discussion with a community or group. The tools can also be adapted and used for other purposes such as Gender Analysis T.16 and Menstrual Health and Hygiene (MHH, P.7) issues.

Main Requirements / Investments Needed

PHAST is time and resource-intensive as each facilitator is required to provide ongoing support to each community, visiting at least weekly or more depending on the urgency of the situation. The facilitators also require training and ongoing support. Context-specific materials need to be developed. The process can yield results in a few weeks but can take up to six months depending on the readiness and capacity of specific groups to take action.

Evidence of Effectiveness

A recent review of the available evidence indicated that social mobilisation and community participation methods including Community-Led Total Sanitation (CLTS, F.2) and PHAST are effective methods in promoting community hygiene and sanitation. 


  • Develop and test context-specific materials for the activities before you start

  • Encourage participants to consider and analyse their situation and enable the group to identify problems and solutions for themselves

  • Encourage participants to identify concrete actions and develop a plan; collaborate with them to Monitor [M.2] and Evaluate [M.3]

  • Ask participants to evaluate your role in the process and how you can improve your facilitation skills


  • Do not teach, direct or suggest to the group what you think they should do (unless they specifically ask)

  • Do not work with too big a group – break large groups into smaller groups where the community is large

  • Do not make assumptions about the right response to an activity

  • Do not use the activities in a mechanistic way – do not use exactly the same approach for each group

Practical Example

PHAST was used by IFRC during a cholera outbreak in Western Uganda in 2006 along with door-to-door sensitisation. Existing volunteers, who had previously been trained in the use of PHAST, employed four of the seven activities – Three-Pile Sorting T.51, Pocket Chart T.31, Transmission Routes and Barriers T.53 - and reduced the number of steps to three. Sanitation coverage increased by 12% despite challenging soils and in one district the local authority instituted bylaws to improve household sanitation. The outbreak was contained as a result of increased awareness of safe hygiene practices.

Key Decision Critria

Response Phase
Acute Response
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Protracted Crisis
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HP Component
Preconditions and Enabling Environment
Community Engagement and Participation
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Assessment, Analysis and Planning
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Social and Behaviour Change
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Monitoring, Evaluation, Accountability and Learning (MEAL)
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Target Group
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Older People
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Persons with Disabilities
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Local Leaders
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Society as a whole
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Application Level
Individual / Household
Community / Municipality
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Target Behaviour
Hand Hygiene
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Sanitation Related Behaviour
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Water Related Behaviour
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Menstrual Hygiene
Food Hygiene
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Personal Hygiene
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Environmental Hygiene
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Vector Control
Solid Waste Management
Infection Prevention and Control
Hygiene Away from Home


To empower communities to improve sanitation and hygiene behaviours and encourage community-management of WASH facilities


PHAST step-by-step guidance

Sawyer, R., Simpson-Hérbert, M. et al. (1998): PHAST Step-by-Step Guide: A Participatory Approach for the Control of Diarrhoeal Disease, WHO

Research on effectiveness of different sanitation and hygiene approaches incl. PHAST

Nzioki, M., Korir, A. (2020): Effective Methods for Community Sanitation and Hygiene Promotion in the Developing World: A Scoping Review, Africa Journal of Technical and Vocational Education and Training, Vol. 5(1). Pages 175-185

PHAST case studies from Uganda, Kenya and Eritrea

Gonzalez, L., Kabura, R. (2006): Using PHAST for In-Country Disease Outbreaks Response. Uganda Red Cross Emergency Response During the Cholera Outbreak, IFRC

IFRC (2018): Integrating CLTS and PHAST in Kenya. Case Study (Available in English and French)

IFRC (2018): CLTS and PHAST in Eritrea. Case Study (Available in English and French)

Faster PHAST cases study from the Philippines

Philippine Red Cross (2018): PHASTer Report. Participatory Hygiene and Sanitation Transformation in Emergency Response. Barangay Mangsee, Palawan