This piece by Annelise Gill-Wiehl and Daniel Kam­men is fea­tured in The Beam #11 – Pow­er in Peo­ple. Sub­scribe now to read more on the subject.

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“Each time [the local work­ers] vis­it, we gain strength from that. To refill [LPG cylin­ders]. To con­tin­ue on,” says Bibi Matun­da (or Grand­ma Fruit as the old woman is kind­ly nick­named) at a focus group with a few oth­er fam­i­lies in the Com­mu­ni­ty Tech­nol­o­gy Work­er Pilot Pro­gram. In Tan­za­nia, where our research is based, 96% of the pop­u­la­tion [1] relies on “unclean” fuels, and the effects of bio­mass burn­ing and indoor air pol­lu­tion con­tributes to 20,000 deaths [1]. Liqui­fied Petro­le­um Gas (LPG) is one of the tru­ly clean cook­ing fuels based on emis­sion cri­te­ria set by the World Health Orga­ni­za­tion (WHO). Although LPG is a fos­sil fuel, there is a net cli­mate ben­e­fit to a large-scale switch to LPG for house­hold fuel due to increased effi­cien­cy, as well as the ben­e­fit of tran­si­tion­ing away from the methane emis­sions caused by wood burn­ing. Despite a wave of many African coun­tries set­ting goals for increased or exclu­sive LPG use, LPG pro­grams face com­mon bar­ri­ers to adop­tion of the clean fuel, which include a lack of education/​need for house­hold train­ing, house­hold safe­ty con­cerns and the pro­hib­i­tive cost.

We looked for analo­gies in oth­er sus­tain­able devel­op­ment fields that over­came bar­ri­ers in behav­ior change and the need for com­mu­ni­ty tran­si­tions. Specif­i­cal­ly, we turned to the lit­er­a­ture on Com­mu­ni­ty Health Work­ers – local indi­vid­u­als who link their under­served com­mu­ni­ties to health systems.

Despite the exis­tence of estab­lished and proven inter­ven­tions to improve com­mu­ni­ty health, local health sys­tems are too frag­ment­ed to scale up these inter­ven­tions. This weak infra­struc­ture, com­bined with the short­age of over 4 mil­lion health care pro­fes­sion­als and the high cost of train­ing doc­tors, pre­sent­ed a need for a local work­er to fill this health care void. A Com­mu­ni­ty Health Work­er (CHW) was imple­ment­ed at the vil­lage lev­el to pro­vide indi­vid­ual care that was effec­tive, cul­tur­al­ly appro­pri­ate, and eco­nom­i­cal. The WHO defines CHWs as “mem­bers of the com­mu­ni­ties where they work, should be select­ed by the com­mu­ni­ties, should be answer­able to the com­mu­ni­ties for their activ­i­ties, should be sup­port­ed by the health sys­tem, but not nec­es­sar­i­ly a part of the orga­ni­za­tion, and have short­er train­ing than pro­fes­sion­al work­ers” [2]. The pub­lic health com­mu­ni­ty has over­whelm­ing­ly demon­strat­ed that CHWs can increase com­mu­ni­ty devel­op­ment and access to health ser­vices. We there­fore decid­ed to inves­ti­gate whether a sim­i­lar mod­el – a Com­mu­ni­ty Tech­nol­o­gy Work­er (CTW) – could be intro­duced to aid in the adop­tion of clean stoves.

This work was pilot­ed in Shi­rati, Tan­za­nia, a town of ~50,000 on the edge of Lake Vic­to­ria, near the Kenyan bor­der. Kub­wana and Michire are two sub-vil­lages in Shi­rati. Kub­wana is a larg­er, elec­tri­fied trad­ing area with the region­al hos­pi­tal, small shops, and unof­fi­cial ven­dors sell­ing veg­eta­bles, fruit, and char­coal. Michire is clos­er to the lake and has a small­er trad­ing post with­out grid elec­tri­fi­ca­tion – some shops have a sin­gle solar pan­el.  A local NGO, ReachShi­rati, helped iden­ti­fy trust­ed com­mu­ni­ty mem­bers, Mary from Michire and Nay­ome from Kub­wana, to each start with 15 house­holds. The local LPG com­pa­ny, Mihan Gas, was brought in to pro­vide a day long safe­ty train­ing to sup­ple­ment the man­u­als and expla­na­tions we pro­vid­ed on the LPG stove. The women then taught the fam­i­lies how to use the gas stove and pro­vid­ed edu­ca­tion­al and safe­ty pam­phlets in the native lan­guage that were sup­ple­ment­ed with pic­to­r­i­al con­tent for those who can­not read. They promised to always be avail­able for ques­tions or con­cerns. Mary and Nay­ome would check-in week­ly with the house­holds to con­duct a short sur­vey to gauge fuel use, but more impor­tant­ly, they con­tin­ue to pro­vide sup­port and encour­age­ment to the fam­i­lies. After a year of sur­veys and rounds of inter­views, the results show that rough­ly 80% of fam­i­lies report sus­tained, reg­u­lar refill­ing of LPG cylin­ders. This is a rel­a­tive­ly high rate of adop­tion com­pared to oth­er LPG and improved bio­mass cook­stove interventions.

 

A CTW does not remove all bar­ri­ers to gas adop­tion. Eco­nom­ic dif­fi­cul­ties and cook­ing mate­ri­als stand in the way of full adop­tion. How­ev­er, these results do sug­gest that a CTW does mit­i­gate many of the obsta­cles through edu­ca­tion and main­te­nance support.

To fur­ther bol­ster the effec­tive­ness of the CTW mod­el and encour­age fam­i­lies to refill their LPG cylin­der, we are con­tin­u­ing to con­cep­tu­al­ize with oth­er dis­ci­plines, specif­i­cal­ly eco­nom­ics and micro­fi­nance. The research is attempt­ing to expand and offer house­holds an oppor­tu­ni­ty to opt into a sav­ings bank option to pro­mote account­abil­i­ty and a for­mal finan­cial mechanism.

 

 

Our work is not the only clean cook­ing ini­tia­tive to reach across dis­ci­plines and inno­vate to reach the world’s poor. There are many promi­nent ven­tures on the hori­zon in clean cook­ing, such as pay-as-you-cook Smart­Gas from Envi­rofit and Inyeryeri’s fire­wood pel­let stove – one of the few bio­mass stoves to meet the Tier 4 Emis­sion Cri­te­ria set by the WHO. These enter­pris­es are com­bin­ing dis­ci­plines with IT & com­put­er sci­ence, mechan­i­cal engi­neer­ing, and eco­nom­ics. This cross-dis­ci­pli­nary work is cru­cial to attack the most press­ing envi­ron­men­tal and glob­al health issues. As we face a warm­ing cli­mate and grow­ing health impli­ca­tions from the burn­ing of bio­mass, it is all the more impor­tant for the sus­tain­able devel­op­ment com­mu­ni­ty to work togeth­er and lean on new ideas and iden­ti­fy proven bright spots, even those from dif­fer­ent dis­ci­plines. We can­not look for solu­tions in silos; rather, we must reach out across dis­ci­plines and top­ics to achieve a sus­tain­able future.

We must not for­get to incor­po­rate the most impor­tant aspect from both CHWs and CTWs – the human con­tact of local out­reach. In the­o­ry, reach and scale are eas­i­ly and quick­ly attain­able even with­out phys­i­cal vis­it­ing. How­ev­er, even com­pa­nies like Envi­rofit, who pur­sue large-scale cook­stove deploy­ment most­ly through IT-based com­mu­ni­ca­tion, admit that “while invest­ing in train­ing resources increas­es costs, it also increas­es adoption”[3].

The advan­tage of this mod­el for cook­ing over an IT-based solu­tion (i.e. text mes­sage edu­ca­tion or reminders) is the flex­i­bil­i­ty and resilience inher­ent to a human-led ini­tia­tive. Human work­ers can respond and adapt to the spe­cif­ic issues of the house­hold and pro­vide help­ful advice; an auto­mat­ed text mes­sage is eas­i­ly ignored and can­not adapt to spe­cif­ic cir­cum­stances. House­holds are more like­ly to adopt improved stoves if they have had pri­or expo­sure to a trust­ed indi­vid­ual or orga­ni­za­tion pro­mot­ing the prod­uct. Addi­tion­al­ly, these local train­ers could be uti­lized to solve oth­er com­mu­ni­ty prob­lems, such as water and san­i­ta­tion tech­nol­o­gy or mini-grids. An inter­dis­ci­pli­nary solu­tion can be employed to solve a mul­ti­tude of dis­ci­pli­nary problems.

The focus group reit­er­at­ed the impor­tance of com­mu­ni­ty between the CTW and the house­holds. For exam­ple, one woman said, “we have become friends, we greet each oth­er, you find out what the prob­lem is and you help. If there is a prob­lem, we find a solu­tion.” As the women of Shi­rati sup­port each oth­er with­in this pro­gram, so should the fields in sus­tain­able devel­op­ment. Beyond an expand­ed study that cou­ples this mod­el with a sav­ings bank as men­tioned above, this work could become a strong pri­vate-pub­lic part­ner­ship. Mir­ror­ing the CHWs in Tan­za­nia, LPG com­pa­nies could coor­di­nate their vil­lage LPG deal­ers with local gov­ern­ments to adopt this mod­el, empow­er their com­mu­ni­ties from with­in, and work towards clean fuel adop­tion for decades to come. Com­mu­ni­ty-based out­reach and inter­dis­ci­pli­nary solu­tions are invalu­able in the effort to pro­vide access and ensure adop­tion of clean ener­gy for cook­ing and beyond.

Sources

[1]    Clean Cook­ing Alliance, “Tan­za­nia,” 2019. [Online]. Avail­able: https://​www​.clean​cookingal​liance​.org/​c​o​u​n​t​r​y​-​p​r​o​f​i​l​e​s​/​4​1​-​t​a​n​z​a​n​i​a​.​h​tml. [Accessed: 30-Oct-2019]. [2]    G. Health, “Com­mu­ni­ty and For­mal Health Sys­tem Sup­port for Enhanced Com­mu­ni­ty Health Work­er Per­for­mance A U.S. Gov­ern­ment Evi­dence Sum­mit FINAL REPORT Con­tent,” 2012. [3]    Envi­rofit, “COOKING IN ONE MILLION KITCHENS: Lessons Learned in Scal­ing a Clean Cook­stove Busi­ness,” 2015.