PHASE Program

Partnership objectives

Reduce diarrhea-related disease among school children.

In Kenya, 88% of children from participating schools washed their hands compared with 46% from non-participating schools. In Kenya, 88% of children from participating schools washed their hands compared with 46% from non-participating schools. Copyright GlaxoSmithKline

What are the health needs and challenges?

Childhood diarrhea is the biggest cause of child mortality in Sub-Saharan Africa and the second biggest killer of children worldwide. Annually it accounts for 2.2 million children’s lives, killing more under-five year olds than AIDS, malaria and measles combined.

Globally some 2.5 billion episodes of diarrhea occur in children under-five, with more than half of these seen in sub-Saharan Africa and South Asia. Rapid urbanization means that cholera and acute watery diarrhea persist in high density, poverty stricken slums including in Nairobi, Mumbai and Rio de Janeiro.

The presence of WASH facilities in school gains 272 million school-attendance days each year due to improved health. Learning achievement is increased and older girls are afforded privacy and dignity to ensure menstrual hygiene.

Description of partnership activities and how they address needs and challenges

GlaxoSmithKline's Personal Hygiene & Sanitation Education (PHASE) project is helping to reduce diarrhea-related disease by encouraging school children to wash their hands. GSK established PHASE in 1998 and has so far invested over USD 9.4 million in the program. PHASE is run in partnership with AMREF, Save the Children and Earth Institute at Columbia University, as well as national Ministries of Health and Education in countries where the program is active.

The program has had impressive results so far. For example, a study by AMREF in Kenya showed that after four years, 88% of children from participating schools washed their hands after using the toilet, compared with 46% from non-participating schools. PHASE was extended to Millennium Villages in Malawi and Senegal during 2008 and now operates in a total of 16 countries. 

GSK has a PHASE steering committee with representatives from its partner organizations to help expand the program into more countries. 

PHASE provides resource-poor teachers with child-based, relevant education materials and it is also synonymous with concurrent development of water, sanitation and hand washing facilities in schools and the ‘tippy-tap’, a highly effective, low-cost technology to provide water for hand washing particularly when the resource is in short supply. The program provides in-school education about hygiene and sanitation practices using child-friendly and context specific materials and techniques and ‘child-to-child’ or ‘child-to-family’ education promoting on hygiene and sanitation practices essential to health and well-being. 

Lessons learned

Different country programs provide their own challenges and lessons including the following:

  • PHASE, whether stand alone or integrated is not a replacement for government services. High functioning political and social acumen is required to ensure programs are perceived as complementary to existing government approaches. Without this ownership is limited and longer term sustainability becomes questionable.
  • The importance of consulting teachers and children during material design and preparation, and the value of pre-testing before roll-out to large numbers of schools.
  • A ‘standard’ national set of PHASE materials could be found inappropriate for all children. This underlines the need to consider regional differences within a country.
  • Children have a different world-view to adults. The voice of children in project meetings, design and evaluation is central to the effective adaptation and implementation of PHASE.
  • The need to create lasting relationships with key implementing partners alongside peer mentoring, study tours and networking between projects. The challenge is how to sustain these linkages and capture experiences and learning. 

Summary of impact and forward looking information

To date over 1.8 million children have been reached by the PHASE program, which extends to sixteen countries across sub-Saharan Africa, Central and South America, South East Asia and Europe. These include four of fifteen countries that globally account for three quarters of all annual child deaths due to diarrhoea – India (386,600), Bangladesh (151,700), Uganda (29,300) and Kenya (27,400); and four of thirteen that account for 83 per cent of the estimated 1.2 billion people who practice open defecation; namely Bangladesh, Brazil, India and Indonesia.

Impact of PHASE has been well documented: for example, in Nicaragua a five-fold increase in hand washing after latrine use was observed among pupils and the proportion of children reporting diarrhea in a two-week period fell from over 40% to just 13%. Similarly, diarrhea episodes reported in Kenyan schools dropped from 11% to 8% and respiratory infections from 43% to 14%. In Indonesia, at a baseline 29.1% of children had reported diarrhea during the past month, compared to only 0.7% at end-line.

In addition, a positive correlation is also reported between the presence of PHASE in school attendance, participation and academic achievement. In Bangladesh school attendance rose from 66% to 75% and school completion from 55% to 68% following the implementation of PHASE.


AMREF: Unheard Voices, PHASE Program

Partnership information

Company(ies) GlaxoSmithKline

Partner(s) African Medical and Research Foundation (AMREF), Australian Aid, Bolivia Ministry of Health, Brazilian Ministry of Health, Earth Institute at Columbia University, FIRJAN, Fit for School, Indian Ministry of Education, Indonesia Ministry of Health, Kenya Ministry of Health, Mexican Ministry of Health, Nicaragua Ministry of Health, Peru Ministry of Health, Philippines Department of Health, Pratham, Save the Children, Tajikistan Ministry of Health, Uganda Ministry of Health, US Agency for International Development (USAID), Zambia Ministry of Education

Type of Partner(s) Academia / Hospitals, Government, NGOs

Therapeutic Focus Vaccine-Preventable Diseases, Women and Children's Health, Other

Disease(s) Adolescent Health, Children's Health, Cholera, Family Planning, Sexual & Reproductive Health, General Health, Rotavirus, Typhoid Fever

Program Type(s) Prevention Programs - Awareness & Outreach

Targeted Population(s) Children, Marginalised / Indigenous People, People with low income, Teachers, Youth

Region(s) East Asia & Pacific, Europe & Central Asia, Latin America & Caribbean, South Asia, Sub-Saharan Africa

Number of Countries 16

Country(ies) Bangladesh, Bolivia, Brazil, India, Indonesia, Kenya, Malawi, Mexico, Nicaragua, Peru, Philippines, Senegal, Tajikistan, Uganda, United Kingdom, Zambia

Start Date 1998

More information PHASE in Brazil

Anticipated completion date 2020

« The range of countries in which PHASE has been implemented constitutes an extremely diverse mix of geographical, economic, political and social contexts. PHASE has been successful everywhere that it has been implemented. »

GSK-commissioned report on PHASE