Village microfinance participants for clean air initiative

Tackling the silent “killer” in the kitchen: household air pollution

Household air pollution impacts three billion people who rely on solid fuels, making the simple act of cooking a major health hazard for more than a third of the world's population.

Household air pollution impacts three billion people who rely on solid fuels such as wood, charcoal or animal dung burned in inefficient stoves for heating and cooking. Preventive action could have massive, population-wide health benefits, particularly for women and children who share the majority of domestic burdens, and help to meet number 7 of the UN’s sustainable development goals: access to affordable, reliable, sustainable clean and modern energy for all.

Putting household air-pollution on the global agenda

“Our current work is building on 20 years of research,” says Professor Daniel Pope who currently leads the Institute of Population Health research group, Energy, Air Pollution and Health, at the University of Liverpool. “Our group co-led the first ever randomised control trial of an improved cooking stove in Guatemala, which proved hugely influential helping put household air pollution on the global public health agenda.” Indeed, household smoke is estimated to kill almost 4 million people every year – more than TB, HIV/AIDs and malaria.

To tackle the problem, the focus has been on burning biomass more cleanly using improved cookstoves. However, the work of Pope and his team has identified that in lower and middle-income countries (LMICs) such stoves fail to achieve reductions in smoke anywhere near WHO safe guideline levels. In 2014, WHO guidelines for indoor air quality, led in development by the group through Liverpool’s Professor Nigel Bruce, had the explicit recommendation for LMICs to rapidly adopt clean household energy like gas and electricity. Based on this work the group produced a REF2014 case study rated in the top 20 out of 7000 for UK research having a global impact by UK-CDS.

Research that evaluates effective behaviour change strategies

So how can a population-wide transition to clean household energy be achieved? In 2016 Pope’s group launched a programme of community-based research in Cameroon, working alongside the government in its commitment to scale adoption of clean cooking with liquified petroleum gas (LPG) from 18% to 58% of the population by 2030 through a National LPG Masterplan.

Among strategies evaluated by the group were microfinance loans managed by village banking systems, the use of pressure cookers to reduce the amount of LPG needed to cook traditional food, and in-depth community participation using photography to identify barriers and enablers to using LPG. Public engagement was a crucial component of the work where findings were communicated to policy makers involved in implementing policies related to the masterplan.

CLEAN-Air Africa - NIHR

The group is now researching how best to help populations switch from polluting fuels to LPG or ‘cooking gas’, working with the governments of Ghana and Kenya that also have ambitious targets to scale up LPG use, as well as Cameroon. This research is supported by the National Institute for Health Research (NIHR) through a £2M Global Health Research Group award, entitled Clean Energy Access for the prevention of Non-communicable disease through clean Air in Africa, or CLEAN-Air Africa, launched in November 2018.

The group has uncovered important empirical evidence on barriers to ‘exclusive’ use of LPG, which cause households with LPG access to continue using polluting fuels.

The CLEAN-Air(Africa) research programme has identified practical interventions, including increasing the density of LPG cylinder retailers in peri-urban communities to decrease travel time and associated costs, and promoting multi-burner LPG stoves to provide families the ability to prepare multiple dishes concurrently, saving time. These findings underscore the importance of convenience and fuel savings to the end consumer, which must be addressed if they are to abandon using their traditional cooking fuels.

Woman cooking with wood at home, smoke filled kitchen

Cooking with wood

Woman cooking with lpg at home

Cooking with LPG

The University of Liverpool’s Dr Rachel Anderson de Cuevas is the qualitative lead for CLEAN-Air Africa and describes its three-pronged approach of research, health system strengthening, and public and stakeholder engagement as key to its success. She explains:

We raise community awareness of household air pollution as a health and environmental problem and identify solutions within the community for addressing the issue through adoption of clean household energy. Importantly we then engage with the health sector to empower physicians and community health workers to communicate these messages and give communities a direct voice to policy makers through public and stakeholder engagement.

Training community health workers

The project group, working alongside national health ministries in partner countries and WHO has implemented domestic health programmes incorporating training in the prevention of household air pollution.

In Kenya, 130,000 community health workers are being trained in household air pollution, health and prevention through a new training initiative developed by the group that has been adopted by the Ministry of Health as part of 2021 Universal Health Coverage. Health workers will work across the whole country to educate and support communities to adopt cleaner fuels and cooking technology, reducing the exposure to harmful smoke.

Professor Dan Pope said: “We have demonstrated that rapid transition to clean cooking with LPG in sub-Saharan Africa meets an immediate public health priority with climate, gender and environmental co-benefits”.

“While we are researching future green options for domestic energy, including electricity and bio-LPG, these solutions are unlikely to achieve the scale needed to meet SDG7 on time. More effort is needed to support clean cooking with LPG in countries where the infrastructure required for cooking with electricity or renewable fuels will not be available in the short-term. Our research has shown the benefits of both financial and technological innovation in assisting a rapid, equitable transition to clean cooking fuels”.

Examining the impacts of COVID-19 lockdown on energy access

The group has evaluated the impacts of COVID-19 lockdown on income, food and energy security in urban communities in Kenya and Cameroon.

The longitudinal analyses have uncovered the exacerbation of socioeconomic and gender inequities resulting from COVID-19 lockdowns. For example, households consuming less LPG prior to the COVID-19 pandemic were more likely to report a decline or cessation of income during lockdown. Additionally, women were more likely to lose their incomes during lockdown resulting in reduced use of clean cooking fuels and transition to polluting kerosene or wood.

CLEAN-Air(Africa) is generating empirical evidence to demonstrate how increasing LPG affordability can enable households to direct more of their limited income toward food and jointly address food and energy insecurity.

Innovative technologies to scale up clean cooking

Working with a commercial partner in Nairobi (Paygo Energy), our group has assessed the ability of ‘pay-as-you-go’ smart meter technology to assist resource poor households uptake LPG for clean cooking.

Our evaluation uncovered the ability of PAYG LPG (pay-as-you-go LPG) to increase households’ resilience to income shocks resulting from the COVID-19 pandemic by enabling incremental fuel payments using mobile money. This is one example of the ways in which CLEAN-Air(Africa) is generating evidence to promote the use of innovative consumer finance mechanisms to help reverse the trend of increasing energy insecurity due to the pandemic.

Beyond COP26

CLEAN-Air Africa is now working with with the UK FCDO Modern Energy Cooking Services (MECS) Programme and commercial partners such as KopaGas in Tanzania and MGas and PayGo Energy in Kenya to rapidly accelerate the transition from wood and charcoal based cooking to modern, clean, low carbon energy-efficient energy with a focus on electricity and gas.

Dr Elisa Puzzolo, Co-Director for the Group, explains the latest evidence about LPG climate credentials: “LPG burns very cleanly in simple devices such as household cooking stoves and has a low carbon emission profile due to its high efficiency. Replacing biomass fuels with LPG reduces black carbon and methane emissions and preserves trees from being harvested for fuel. While it should be considered a transition technology towards fully renewable household energy, it has the potential for being increasingly decarbonised through adoption of bio-LPG generated from municipal solid waste and agricultural residues.”

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