This Accra convening serves as a pivotal moment—not only for sharing results, but for galvanizing deeper cohesion, cross-pollination, and alignment across country teams.
This reporting period demonstrates how collaborative science, participatory engagement, and North–South research partnerships can transform WASH from an infrastructure challenge into a driver of public health, climate resilience, and social equity.
In Uganda, the PROMISE team successfully advocated for the utilization of decision support tools in hygiene and sanitation to be included in the National Sanitation and Hygiene Policy of Uganda.
Further, PROMISE team activities have deepened the understanding of hygiene behaviors, institutional performance in healthcare facilities (HCFs), and pathogen flows from unsafe sanitation systems.
A sub-study explored patient involvement in promoting hand hygiene (HH) among healthcare workers in Mukono and Kagadi districts. Interviews with patients revealed barriers such as fear of negative reactions from health workers, low self-confidence, and limited HH knowledge. Facilitators included health talks, strong patient–provider rapport, and infection awareness campaigns. The findings underscore that empowering patients to reinforce hand hygiene requires addressing social hierarchies and cultivating supportive communication within care settings.
Another substudy, a process evaluation of the WASH FIT intervention in Amuru and Nwoya, demonstrated how structured risk assessments, stakeholder participation, and improved governance can transform facility performance. However, heavy workloads, limited technical capacity, and insufficient inter-departmental collaboration hindered sustained uptake. Tailoring WASH FIT to local contexts and strengthening leadership structures were identified as critical enablers.
The ComPASS Uganda Pathogen Flow Study—underway in Mulago III and Kamwokya—maps pathogen movement along the sanitation chain. Transect walks and environmental sampling (55% progress) reveal valuable data on exposure points and contamination pathways. Regular team reflections and adaptive planning have helped resolve fieldwork challenges and improve sampling efficiency, informing future sanitation investment prioritization across urban Uganda.
In Ghana, PROMISE moved from training to field execution. More than 60 Environmental Health Officers and Field Coordinators were trained in the SaniPath Tool across four municipalities: Accra Metro, Korley Klottey, Weija-Gbawe, and Awutu Senya East.
Preliminary findings reveal a critical gap between hygiene knowledge and behavior. Although 99% of households recognize handwashing prevents disease, only 89% practice it consistently before cooking or eating. Over 56% report pests in cooking areas, and 80% rely on street food, though 55% believe it is only “sometimes safe.” Even with 87% aware of foodborne illness risks, 85% remain dissatisfied with vendor hygiene.
These findings underscore persistent food safety risks and the need for targeted hygiene messaging in markets—65% of respondents observed no such messages. PROMISE Ghana is recommending behavioral nudges such as handwashing prompts, vendor signage, and improved storage practices to reduce fecal–oral transmission in food environments. These results have led the Ministry of Local Government, Chieftaincy and Religious Affairs to engage the study team to revise the standard operating procedures for food safety and hygiene for environmental health officers in Ghana. This study provides crucial insights for urban public health and food safety governance.
In Bangladesh, the project achieved several milestones, including a national stakeholder meeting and a partnership MoU with WaterAid to inform planned WaterAid investments. Scoping was completed in Paikgacha, Khulna, followed by training of government and research staff on SaniPath deployment.
Behavioral surveys (n=220) and environmental testing (n=51) uncovered widespread contamination: E. coli detected in 80% of samples, with 100% positivity in floodwater, raw produce, and surface water; 77% of drinking water and 87% of street food samples were also contaminated. Behavioral data revealed frequent exposure, as 72% of children and 69% of adults use surface water more than 10 times monthly, while only 21% treat drinking water.
These findings reveal the intersection of flooding, unsafe sanitation, and foodborne exposure, providing critical evidence to shape climate-resilient water and sanitation strategies and inform planned Wateriad investments and Bangladesh’s national hygiene and health policies.
Across all PROMISE countries, the reporting period illustrates how group science—anchored in strong North–South partnerships and South–South peer learning—has accelerated innovation, enhanced data quality, and deepened the real-world impact of sanitation research.
PROMISE’s multi-country framework enabled shared research design and comparative analysis across diverse contexts. By connecting northern institutions such as Emory University and University of North Carolina, Chapel Hill with southern research bodies, government agencies and think tanks, the Consortium forged a networked science ecosystem that balances rigor and relevance. This partnership improved field and lab protocols , ensuring that locally collected data meet global scientific standards while informing municipal planning and policy reforms.
South–South knowledge exchanges among PROMISE teams have become crucial forms of learning. Uganda’s WASH FIT experience informed Senegal’s hospital assessments. Uganda’s Compass experience informed Zambia and Kenya approaches. Ghana’s SaniPath experience informed Tanzania's adoption and approach to implementation. These peer collaborations have allowed teams to troubleshoot challenges collectively, replicate best practices, and adapt tools to local realities.
Joint training programs, joint research funding proposals, co-supervised research, and student exchanges have developed a mature team of WASH researchers and practitioners. North–South collaboration links from Emory University and UNC Chapel Hill and LMIC partner country teams, ensuring equitable skill transfer. This distributed capacity now supports national systems in partner countries, where ministries are adopting PROMISE tools for routine sanitation and hygiene monitoring for policy and planning and investment.
The group-science model has amplified PROMISE’s influence in regional and global dialogues. Data generated across multiple contexts are informing city sanitation strategies, donor investments, and health sector policies. Dissemination through joint publications, conferences, and regional forums will ensure that lessons from one setting accelerate progress in another—demonstrating the value of science conducted together.
