Experiences of capacity strengthening in sanitation and hygiene research in Africa and Asia: the SHARE Research Consortium

Basic toilets (facilities that safely separate human waste from human contact) and good hygiene practices are essential for the prevention of different diseases. A total of 2.4 million deaths could be prevented annually if everyone practised appropriate hygiene and had good, reliable sanitation and drinking water [1]. These deaths would be mostly among children in developing countries who suffer from diarrhoea and subsequent malnutrition, and from other diseases attributable to malnutrition [2]. Recent estimates suggest that, despite great progress, 2.3 billion people still lack even a basic sanitation service [3]. The dearth of this basic human right can have a profound effect on individuals’ health, wellbeing and livelihoods, and this is reflected in the priority given to “adequate and equitable sanitation and hygiene for all” as part of Sustainable Development Goal 6 ‘Clean water and sanitation’ [4]. Progress towards achieving universal access to this basic right is slow due to different political and economic reasons, but understanding evidence-based information of approaches and interventions that are the most effective in each setting are also crucial to achieve this progress.

The Sanitation and Hygiene Applied Research for Equity (SHARE) consortium was established in 2010 with exactly this purpose in mind – to contribute to achieving universal access to effective, sustainable and equitable sanitation and hygiene by generating, synthesising and translating evidence to improve policy and practice worldwide. The SHARE research consortium is led by the London School of Hygiene and Tropical Medicine (LSHTM) and started as a 5-year programme running from 2010 to 2015 with £10 million of funding from the United Kingdom Department of International Development. Throughout phase I, SHARE focused its activities on working closely with national sector partners from low- and middle-income countries (LMICs) to define research priorities and supported the generation of rigorous and relevant applied research. It also worked to enhance the uptake of new and existing research in accordance with the main research themes developed throughout the inception period (equity, health, markets and urban sanitation).

In late 2014, the Parliamentary Under-Secretary of State approved a £6 million cost extension, taking the programme through to December 2018. Phase II focused on four sub-Saharan African countries – Malawi, Kenya, Tanzania and Zambia. The extension was geared towards maximising the value for money of phase I, by securing the legacy and sustainability of phase I investments and furthering the research agenda in four thematic research areas in a more concerted manner (Water, Sanitation and Hygiene (WASH) and complementary food hygiene, WASH and pro-poor urban sanitation, WASH and routine immunisation, and WASH and undernutrition). Throughout phases I and II, the SHARE programme has achieved its goals with a pioneering approach that focuses on four core activities, namely sanitation and hygiene research, research-into-use, capacity development, and monitoring and evaluation.

Capacity-building has been an important and solid component responsible for the success of the SHARE programme. The gap in research capacity strengthening has been widely recognised as a major barrier for development in LMICs. Although there has been remarkable progress over the past two decades, it has been said that “research capacity in the South remains one of the world’s unmet challenges” [5].

The capacity-building goal of the SHARE programme was to strengthen the capacity to sustain global sanitation and hygiene research by LMIC researchers and institutions. The research capacity-building activities of SHARE were aimed at maximising individual and institutional research capacity development by using different strategies. As such, the consortium worked with its research partners and other key sector stakeholders to support them in conducting research, interpreting research findings and applying these to their work. The aim of this paper is to summarise the capacity-building strategies conducted in this programme during phase I and II and highlight the lessons learnt that could be useful for future programmes.

SHARE’s capacity development activities focused on increasing the capacity of individuals and institutions to convene stakeholders, to conduct relevant and rigorous research, and to use evidence to inform hygiene and sanitation programmes and policies. The SHARE consortium’s approach to capacity-building involved strategically designing research projects to build capacity within collaborating organisations. This was achieved through action research with advisory support from LSHTM, WaterAid, the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) and the International Institute for Environment and Development for collaborating partners.

In terms of specific training activities, the approach to capacity-building and strengthening comprised (1) structured mentoring integrated into the research, administration, financial management and communication activities; (2) specific training to address immediate gaps in skills; and (3) a PhD programme designed to build lasting research capacity within LMIC institutions (including non-governmental organisations and universities).

The structured mentoring has been an on-going activity in support of proposal development. To further strengthen the consortium’s research capacity, we included external peer review of the research protocols by independent researchers not involved in the proposal development. This critical review helped researchers in refining and shaping their research proposals. Examples of other forms of mentoring included advisory consortium members supporting in-country partners in areas of training, project costing, financial management and procedures. During this period, SHARE encouraged the different research groups to have a balanced authorship contribution of authors from high-income country and LMIC institutions in publications resulting from their work. One strategy used was to request that each research group had to prepare a list of publications before the start of each project with a discussed and agreed authorship contribution.

SHARE funded six PhD students who were selected based on the quality of their suggested research and experience in research in their countries of origin (India, Malawi, Bangladesh, Kenya, Ghana and Nepal). The topics of research selected by the students were all related to sanitation and hygiene (described in Table 1) and mentors from LSHTM were selected to direct or co-direct their Theses. All the students completed their PhD within the duration of the programme and, so far, have published 17 open access peer-reviewed papers from their work. Another output is that, since then, SHARE phase I PhD students have formed networks among themselves in the WASH sector, which has resulted in different collaborations on new projects, an idea birthed during the London PhD training period.

SHARE also supported 25 MSc students and facilitated 26 training courses and 52 knowledge-sharing events. It provided peer review for 48 research proposals submitted to different funding rounds and offered external peer review for the national platforms’ research outputs.

Phase II constituted a transition from phase I and aimed to increase SHARE’s focus on building capacity in the target countries – Tanzania, Malawi, Kenya and Zambia. More specifically, phase II aimed to develop sector capacity with the view to ensuring the legacy of SHARE investments. In practice, this has required a transition away from investing in PhDs and MScs towards more established mid-career scientists from within SHARE partner institutions. This move aims to enhance the retention of skills and knowledge within leading national WASH institutions while also maximising the reach of investment – mid-career scientists themselves offer capacity development and support to PhD and MSc students.

In order to achieve this purpose, two main strategies were used, namely (1) a Research Fellow was appointed and supported for 24 months in each of the four targeted institutions (£52,500) and (2) all four national research partners were awarded £40,000 to implement their own capacity development plans.

The research capacity-building activities of SHARE were aimed at maximising individual and institutional research capacity development by using different strategies. The main strategies that yielded success were learning by doing (supporting institutions and postgraduate students on sanitation and hygiene research with different activities), providing fellowships to appoint mid-career scientists to support personal and institutional development, and supporting tailored capacity-building plans.

In phase I, SHARE’s capacity development activities focused on increasing the capacity of individuals and institutions, whilst phase II constituted a transition from phase I and aimed to increase SHARE’s focus on building capacity in higher research and education institutions from four target countries to ensure the legacy of SHARE. There was a clear transition from investing in PhD and MSc to more established middle-career scientists, with a specific budget invested in retention of skills and knowledge within leading partners institutions. A key goal for sustainability of any African institution is to ensure that research staff are advancing in their career progression and consolidate their research skills. Barriers to this, such as poor funding and lack of protected time for research pursuits, have been a common complaint from African researchers [25], which is why the Research Fellows scheme was a key success of the SHARE programme. Investing in postgraduate and doctoral studies in phases I and II was also an important achievement of the SHARE programme, as the need to provide more support for postgraduate training in health sciences in African universities is globally recognised [26, 27] if we are to increase the capacity of institutions. In both phases, locally driven research agendas were a priority. It has been seen from other programmes that externally dictated agendas have resulted in inappropriate projects unrelated to local research needs, which derived conclusions that did not have any direct local benefit [28, 29].

The SHARE consortium has managed to meet most, if not all, of its goals in the complex field of WASH. All phase I projects were completed and phase II projects are on their way to completion. The consortium projects have generated, synthesised and tested practice on current critical issues in the WASH sector. In the first phase, this included sanitation technology assessments; understanding gender and sanitation issues; the socioeconomic dynamics of sanitation to water use; and food hygiene in various contexts of LMIC settings. The second phase saw the consortium focus on supporting work on WASH and complementary food hygiene; WASH and pro-poor urban sanitation; WASH and routine immunisation; and WASH and undernutrition. Through these projects, a wealth of experience has been developed, with 114 peer-reviewed manuscripts published in international journals (Additional file 1: Table S1). Deliberate strategies were applied to distribute authorships between members of high-income countries and LMIC partner institutions; these achieved a good balance of authorship, in contrast with other programmes where power-imbalanced relationships resulted in more published work led by high-income country researchers [28]. Perhaps most importantly, SHARE will leave a legacy through its support for sustainable capacity development that will live on decades after the consortium is closed. Formation of a peer network of researchers was the pivot of success of the SHARE programme – as a result nine networks were created during phase II of the project (Additional file 2: Table S2). At the end of this 8-year programme, SHARE has effectively managed to roll out the capacity-building programmes for these nine networks (Tables 2 and 3), all aiming to orientate early- and middle-career researchers towards WASH research and equipping them with the necessary skill-set needed to carry out scientific research.

The capacity-building strategies from SHARE have been successful at meeting programme goals because of three important factors that were considered during the programme. First, strategic national partner selection – the partners selected within Africa and Asia were all established and had the required basic systems and structures in place to allow for the projects to run effectively. Thus, the SHARE project was an addition to bolster and support work within their mandates. Second, locally driven research agendas – while the partners’ projects were invited to respond to a broad call, the research agenda was driven based on local needs and partner aspirations. Third, dedicated technical support and networking – networking activities were lined up throughout the SHARE programme. Structured milestone reporting on progress helped the projects identify areas of weakness early on and find mitigating solutions in good time.

The SHARE programme faced some administrative challenges in the implementation of its research and capacity-building activities. Different sets of administrative regulations across the institutions led to complications and delays in starting or sustaining certain capacity-building activities.

Another challenge for the appointed Research Fellows was to balance their work burden as they were involved in the programme research activities as well as the training and support for their institutions and their own development. A mitigation strategy for future programmes is to create an appropriate work plan that should be always agreed on and monitored by their line managers.

The approaches described above focus on individuals and provides relatively quick and quantifiable training outputs; these approaches serve as the backbone of human resource development for national research systems. However, without a coordinated national plan and a strong enabling environment to support trained scientists, brain drain is still likely to occur [30].