The PROMISE Consortium: Deploying team science principles to build capacity for environmental health research and decision-making

September 18, 2024

— Story by Gillings School Assistant Professor Musa Manga

Dr. Musa Manga

An old adage says, “If you want to go fast, go alone. If you want to go far, go together.” When it comes to tackling the world’s most challenging environmental health problems, we must attain a greater depth of teamwork to ensure the effective and efficient performance of complex, compartmentalized tasks.

Rapidly growing cities in low- and middle-income countries are complex environments — often with high-density informal settlements that have inadequate water and sanitation infrastructure and services. These areas are among the most vulnerable to the risks from climate change, and residents grapple with flooding, water scarcity and heat waves. The combination of rapid growth, climate change, and aging or inadequate infrastructure contributes to an urgent health crisis in many cities worldwide and necessitates smart investments that promote health, equity and climate adaptation.

Fortunately, a group of researchers, practitioners and policymakers have come together to work on this set of issues. The Promoting Evidence-Based Investments in Sanitation for Health and Equity (PROMISE) Consortium is a seven-country partnership, partly funded by the Water, Sanitation and Hygiene strategy at the Bill & Melinda Gates Foundation. The partners first convened in May 2022 with the following question in mind: How can evidence be used to improve health and development policy and practice in a way that ensures input from local policymakers and decision-makers and builds long-term capacity among partner institutions?

Building evidence for decision-making

The UNC-Chapel Hill team (left to right: Lauren Sprouse, Dr. Musa Manga and Sarah Lebu) joined the July 2024 PROMISE Consortium workshop in Kampala, Uganda.

It is hard to overstate the value of reliable, useful information when contemplating a difficult decision. That is true for just about everyone, including researchers, industry practitioners, communities and policymakers. Often, the process of planning and implementing feasible solutions that fit the environmental characteristics and population of a city requires evidence to guide the prioritization of investments. However, few tools and resources exist to support government decision-making from a public health perspective.

Examples of tools that have been promoted to aid decision-making in water and sanitation include the shit-flow diagram, a tool for mapping the flow of human waste in a city, and SaniPath, a tool for collecting data on pathogens and their exposure pathways in the environment.

However, critics rightfully argue that the development of such tools and approaches may not happen in response to local demand. Instead, concepts are developed by organizations in high-income countries and then tested and implemented in the low-income environments for which they were envisaged. This approach to “evidence-into-policy” can, and often does, lead to limited uptake, because local needs may not align with the information provided by the tool; tool application is not integrated into the usual decision-making process; local capacity to implement the tools, manage the data, and develop integrated health and environment data systems is limited or not available, etc. In addition, governments and decision-makers may get overwhelmed with the wide array of tools available and fail to prioritize the ones best suited for their needs.

To institutionalize the use of public health tools to support environmental interventions that effectively reduce exposure to pathogens and protect human health, the PROMISE consortium partners plan to build the capacity of partner institutions. Work on one tool in development — a Pathogen Flow Hazard tool — is being led by the research group of Musa Manga, PhD, assistant professor of environmental sciences and engineering and member of The Water Institute at the UNC-Chapel Hill Gillings School of Global Public Health.

The role of team science in solving complex problems

Consortium members take a field visit to Bugoloobi Wastewater Treatment Plant in Kampala.

Complex public health tools and the difficulty of prioritizing them for decision-makers are just the beginning when addressing sanitation challenges. Integrating experts from diverse personal and professional cultures into a cohesive team presents its own set of challenges.

This is where the principles of Team Science become crucial. Collaboration, mutual respect, open communication, shared vision, accountability and leadership all help create an environment where a large, global team can work together smoothly, bringing diverse perspectives into harmony.

From research design to implementation of public health decision-support tools, the consortium facilitates cross-North-South and South-South peer partnerships. These partnerships leverage diverse expertise and shared leadership, enabling the consortium to work toward a common vision motivated by joint planning and action to achieve its goals. Manga and Jill Stewart, PhD, adjunct professor of environmental sciences and engineering at the Gillings School, lead the consortium along with Christine Moe, PhD, from Emory University’s Rollins School of Public Health. The consortium includes partners from Uganda, Kenya, Senegal, Bangladesh, Zambia, Tanzania and Ghana.

In July 2024, the consortium members convened in Kampala, Uganda, for a week-long meeting to establish their governance structure and assess the needs for capacity development among partner institutions. This participatory process culminated in the creation of a governance framework and individual country plans for implementing tools to identify pathogens in the environment. The group also developed a plan to train members in research.

Sarah Lebu, a doctoral student of environmental sciences and engineering at the Gillings School, also attended the meeting. She shared that she was particularly impressed by the active participation of all partner organizations.

“Everyone was on the same wavelength, bringing their unique skills and experiences to the table,” she said. “In our sector, it’s common for interventions, tools and perspectives to clash. Seeing this level of collaboration was a refreshing change.”

What the future holds

PROMISE Consortium members gather during the workshop in Kampala. From left to right are: Sarah Durry (Emory University), Dr. Christine Moe (Emory University), Dr. Musa Manga (UNC-Chapel Hill), Benedict Tuffuor (TREND Ghana), Habib Yakubu (Emory University), Dr. Richard Mugambe (Makerere University), Dr. Swaib Semiyaga (Makerere University), and Dr. Mahbubur Rahman (ICDDR Bangladesh).

To begin solving these puzzles, the consortium partners have identified core skills that the members need to build, including participatory grant writing and developing communication materials for advocacy. The first step is to identify partners within the group who have the skills needed, and then to create a platform for sharing that expertise with those who can benefit from it.

This capacity-building is crucial for empowering local professionals to tackle sanitation-related challenges more effectively. By strengthening these skills, institutions in low-resource settings can enhance their ability to make evidence-based decisions in sanitation policies, investments and interventions, ultimately leading to more sustainable, impactful outcomes.

“We hope that the consortium will serve as a model for developing and practicing group science in low- and middle-income countries ,” Mange reflected. “We aim to be an example of effective, equitable South-South and North-South partnerships.”

Contact the UNC Gillings School of Global Public Health communications team at sphcomm@unc.edu.