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

The Sanitation and Hygiene Applied Research for Equity (SHARE) Research Programme consortium is a programme funded by the United Kingdom Department for International Development (DFID) that aims to contribute to achieving universal access to effective, sustainable, and equitable sanitation and hygiene worldwide. The capacity development component is an important pillar for this programme and different strategies were designed and implemented during the various phases of SHARE. This paper describes and reflects on the capacity-building strategies of this large multi-country research consortium, identifying lessons learnt and proposing recommendations for future global health research programmes. In the first phase, the strategy focused on increasing the capacity of individuals and institutions from low- and middle-income countries in conducting their own research. SHARE supported six PhD students and 25 MSc students, and organised a wide range of training events for different stakeholders. SHARE peer-reviewed all proposals that researchers submitted through several rounds of funding and offered external peer-review for all the reports produced under the partner’s research platforms. In the second phase, the aim was to support capacity development of a smaller number of African research institutions to move towards their independent sustainability, with a stronger focus on early and mid-career scientists within these institutions. In each institution, a Research Fellow was supported and a specific capacity development plan was jointly developed. Strategies that yielded success were learning by doing (supporting institutions and postgraduate students on sanitation and hygiene research), providing fellowships to appoint mid-career scientists to support personal and institutional development, and supporting tailored capacity-building plans. The key lessons learnt were that research capacity-building programmes need to be driven by local initiatives tailored with support from partners. We recommend that future programmes seeking to strengthen research capacity should consider targeted strategies for individuals at early, middle and later career stages and should be sensitive to other institutional operations to support both the research and management capacities. Electronic supplementary material The online version of this article (10.1186/s12961-019-0478-2) contains supplementary material, which is available to authorized users.


Introduction of SHARE programme and capacity-building component
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 mindto 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, researchinto-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.
Capacity-building during SHARE phase I 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.

Capacity-building during SHARE phase II
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 investmentmid-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.

Research Fellows
The four Research Fellows have been involved directly in their institution's research programme, whilst also being encouraged to develop their own research agenda. A specific terms-of-reference document was designed for each of them with the aim that they would mobilise resources for sustaining their position. Each fellow had a personal development plan, to the value of £6000, that could be utilised for training, attending conferences and network meetings, among others. All the Research Fellows have been participating actively in their research programmes and have been helping to develop the capacity of other students and research staff within their institutions. All of them have been actively involved in developing their careers and in participating in workshops and conferences inside and outside their countries. In Table 2, we summarise key activities involved and show specific examples of where they have been working to ensure the sustainability of their positions within their institutions. In order to motivate Research Fellows to apply to different funding opportunities, a monthly rota for sharing funding opportunities was created among them. The opportunities were shared with all the SHARE members, and Research Fellows were encouraged to share within their institutions.

Capacity development plans
Each partner developed their own research capacity plans by identifying several small capacity gaps that needed to be addressed. All the activities mainly aligned across five topicsincrease in WASH sector capacity; increase in contribution to scientific evidence; increase in dissemination and use of evidence; increase in clinical/technical or administrative skills within the institution; and improved access to technical and information technology software and tools. The capacity development manager role supported partners to organise and execute these capacity development plans. Table 3 describes the different capacity development outcomes and inputs planned by each partner.
SHARE LSHTM members and other researchers from the Environmental Health Group at LSHTM, provided continuous and responsive capacity development to all SHARE partners. This support aligned directly with partner capacity development plans and other changing needs arising during project development. Planned technical support for SHARE research partners included the following: -Point-of-use support: Provided, usually remotely, by the SHARE Finance Officer, Administrator and Chief executive officer when difficulties were encountered by partners in the submission of financial, management and resources data support. -Mentoring: Provided to cover specific needs, especially for senior research and management staff as well as junior academics. Mentoring was usually organised by the capacity-building manager and provided remotely by Skype or during field visits by SHARE staff or researchers from the environmental health group and responded directly to the needs of SHARE partner staff. Mentoring focused on the following topics: scientific skills such as writing academic papers or conference presentation or using referencing software, methods of analysis of scientific data, research uptake, grant management support and advice about career development. -Support for outcome mapping and research-into-use: Each of the partners was supported to create outcome mapping documents to guide the implementation, monitoring and evaluation of their research-into-use work. This included identifying stakeholder outcomes across seven key groupsnational government, local government international agencies, non-governmental organisations and civil society, national research institutes, donors, and research participants [24]. For each stakeholder group, partners developed specific indicators defining the desired change in stakeholder behaviour as well as generating a list of research-into-use activities to influence stakeholders. Progress was followed through quarterly tracking and reporting tools.
SHARE partners were required to report on progress against their planned capacity development activities in their quarterly reports to the monitoring officer. Data was used to measure progress towards the overarching objectives of the capacity development work stream through a programme-monitoring logframe.

Discussion and reflections
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 middlecareer 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 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 programmeas 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 skillset 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 selectionthe 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 agendaswhile 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 networkingnetworking 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].

Conclusions
Global health partnerships and international research collaborations have enormous potential to improve the WASH situation and policy in Africa and Asia. A good capacity-building component should be included in all collaboration programmes; such an approach is more likely to help the sustainability of these institutions and to generate long-term changes in policy and practice that make real and sustained improvements with regard to sanitation and hygiene issues. Trusted long-term, high-income country collaborations that understand the context and needs of the region can teach agenda-setting skills and assist in agenda development [31], but LMIC researchers should be the leaders who dictate research agendas in their countries [29], as has been the case in the SHARE programme.