2013 Environment and Health - Basel
What determines the adoption and continued use of advanced clean cookstoves?
Background: Household air pollution is thought to be a top environmental health risk globally, and recent assessments suggest that it is the overall leading cause of DALYs in South Asia. Despite this burden of disease, solutions remain elusive. Household adoption of clean energy systems is a necessary condition for successful policies to address this problem.
Aims: We set out to assess determinants of stove use, including individual, household, and village level characteristics, and analyzed potential benefits of home encouragement visits by community health workers.
Methods: We distributed high-efficiency forced draft stoves to 200 women in seven rural villages, in the context of the India Newborn Stove Study Pilot in the SOMAARTH surveillance site, Haryana, India. Using stove use monitors (SUMS), we tracked stove use for a period of at least six months by logging the temperatures of the stoves every ten minutes. We sought to encourage stove use with periodic visits by community health workers (known locally as Accredited Social Health Activists - ASHAs). For about half of the households, randomized at the village level, ASHAs received a small payment for each stove use visit. In the other households the ASHAs were asked to visit, but were given no financial or other incentive to do so.Results: We report the results of modeling that estimates the relative influence of a range of household and demographic factors on stove use. In addition, we found that in incentivized villages ASHA workers started by making about 96% of expected visits, which fell to 83% over the course of the study. In non-incentivized villages, ASHAs only made 32% of expected visits in the first period, and by the end of the study visits had dropped nearly to zero.
Conclusions: SUMs offer a valuable tool understanding determinants stove adoption, and the value of the data they provide increases with tracking duration. Cookstove interventions that rely on community health workers to encourage stove use should consider incentives or other strategies to secure their long-term participation.