A Regional Workshop on Household Energy, Air Pollution and Health was held on 9-10 May 2002 in New Delhi, India. The two-day event provided a forum to exchange information on the latest research, share experiences in mitigation strategies and strengthen commitments to future action programs amongst various stakeholders from fifteen countries. The workshop was linked to the completion of a multisectoral study, India: Household Energy, Air Pollution and Health, undertaken by the World Bank with the support of the joint UNDP/World Bank Energy Sector Management Assistance Programme (ESMAP) and the Government of Norway. The World Bank and the Tata Energy Research Institute organised the workshop in collaboration with several agencies of the Government of India, including the Planning Commission, Ministry of Non-Conventional Energy Sources, Ministry of Environment and Forests and the Indian Council of Medical Research. The workshop was co-sponsored by the World Health Organisation (WHO), United States Agency for International Development (USAID), United Kingdom Department for International Development (DFID), Clean Air Initiative-Asia and the Shell Foundation. This issue -- the last in this newsletter series -- reports the highlights and recommendations of the workshop. Regional Workshop on Household Energy, Indoor Air Pollution and Health, 9-10 May 2002, New Delhi, India The Challenge Ahead international agencies reinforced the growing commitment and interest of the key decision makers and other F acilitating improvements in household energy use for stakeholders to address the indoor air pollution problem. two billion poor households worldwide that rely on "The development challenge we confront today lies not in solid biomass fuels for cooking and heating is a daunting what we do, but in how we think about what we do", said task. But development experts and practitioners around the Mieko Nishimizu, Vice-President of the South Asia Region world now accept that addressing the problem of household of the World Bank. Her keynote speech pointed to the need energy and related health and environment impacts should for developing an effective Indoor Air Pollution (IAP) become an integral part of poverty eradication and mitigation strategy, which is based on the understanding of development efforts. The Regional Workshop in New Delhi the needs and preferences of rural women, empowers brought together over 150 experts, government officials and communities, includes a variety of interventions ranging non-governmental representatives from India and several from economic and social policies to stove technologies, and other countries (e.g., Bangladesh, China, Indonesia, Kenya, promotes synergy among the possible benefits such as Mongolia, Nepal, South Africa, Sri Lanka, Thailand and health, gender development and environmental impacts. Vietnam) to brainstorm mitigation strategies and the Strategies, policies and investments for human underlying research agenda required to achieve the development must be holistic, looking beyond health and maximum health and environment benefits of better education sectors to energy, rural livelihoods and household energy services. The overwhelming support for environment issues, emphasised Ms. Nishimizu. In terms of the workshop by several Government of India and cost per reduced incidence of illness and death, better household energy services can be just as cost-effective in protecting the health of the rural poor as common medical interventions, such as treatment for childhood diarrhoea, or public health interventions, such as provision of clean water and sanitation. Addressing the inaugural session of the conference, Dr. K. C. Pant, Deputy Chairman, Planning Commission of the Government of India, stressed the need to Ms. Mieko Nishimizu, Vice-President, South Asia Region, World Bank, addressing the inaugural session of the design effective health, Regional IAP Workshop. Seated (left to right) are Mr. Richard Ackermann, Sector Director, South Asia Environment energy and rural and Social Development Unit, World Bank, Dr. R. K. Pachauri, Director-General, TERI and Dr. K.C. Pant, Deputy Chairman, Planning Commission, Government of India. development programs to address IAP. He pointed out that the shift to clean fuels Energy Sources, Government of India, emphasised in would involve not only the provision of alternative sources his valedictory address that rural energy strategies of energy but also additional income generating should combine sustainable production and use opportunities. Local micro-credit services for meeting the of traditional energy with appropriate technological upfront costs would have to be provided to low-income and policy support for promoting cleaner forms households to accelerate the transition. Furthermore, of energy. improved biomass stoves and better ventilation conditions are likely to be most cost-effective options for alleviating Multisectoral Approaches indoor air pollution in the near to mid-term. to IAP Prof. Kirk Smith, a leading expert and long-time advocate Given the multidimensional nature of IAP, there is no of mitigating the adverse health impacts of traditional single intervention that can make a substantial impact in household fuels, noted that acute respiratory infection isolation. In a speech on multisectoral approaches, (ARI) is the leading cause of death and lost years of Dr. R. K. Pachauri, Director-General of TERI, provided a healthy life in the developing world. ARI is strongly comprehensive picture of the linkages between IAP, associated with exposure to smoke from fuel burning and household economy and energy development. He said mainly affects children under five. Highlighting the link that an integrated technological approach, enhanced between IAP and poverty, he stated that public health is local capacities to implement energy supply decisions, the art of making people healthy before they are wealthy. financial arrangements, and greater involvement of government and non-government agencies can help to Dr. Dieter Schwela, World Health Organisation, Geneva, solve the IAP problem. stressed the importance that WHO attaches to IAP as a major risk to child and maternal health. He We are dealing with one of the vicious said WHO would support activities to reduce child problems of poverty. The ultimate mortality and related answer lies in improving the livelihood risk factors to create of the poor and ensuring that they have options in safe and supportive terms of how they spend their time and also in environments for respect of the incomes they are able to generate. children. Unless technology can give us some of the answers to this problem, the poor will remain beyond the pail Mr. M. Kannappan, Shri M. Kannappan, Minister of State for of economic possibilities. Minister of State for Non-Conventional Energy Sources, Government of India, addressing the R. K. Pachauri, Director-General, TERI, New Delhi Non-Conventional valedictory session. 2 Increased International Commitment and Support Towards IAP Mitigation Multinational and bilateral development agencies are increasingly concerned about the problem of IAP. Apart from the strong support for the Regional Workshop on Household Energy, Indoor Air Pollution and Health, the growing commitment and interest of the donor community is evident from the variety of activities being implemented worldwide. Together, these activities are expected to create a solid basis for addressing IAP in the long term. Within the World Bank, increased attention to IAP is reinforced by a sharpened focus on poverty reduction and commitment to achieving Millennium Development Goals. IAP is considered a priority issue from the perspective of three different sectors ­ energy, public health and environment. The joint UNDP/World Bank Energy Sector Management Assistance Programme (ESMAP) has supported several initiatives in India, China, Mongolia, Guatemala, Nicaragua, Kenya and Sub-Saharan Africa. These efforts have focused on a range of issues, such as assessment of the health impact of household fuel use, sustainable use of biomass, commercialisation of improved biomass or coal stoves, and development of community-based holistic IAP mitigation strategies that may include housing improvements, several fuel options and new income opportunities. WHO considers IAP a top priority in its programs on air quality and health, and child health. The key focus of the indoor air quality programs of WHO includes fostering knowledge of burden of disease due to IAP, developing health-based air quality guidelines for indoor pollutants including biological agents, establishing proactive partnerships and supporting training for health risk assessment and management. WHO has also prepared a report for the Commission on Macroeconomics and Health, calling for strengthened donor coordination and support to scale-up IAP mitigation measures. The United States Agency for International Development (USAID) has added IAP to its environmental health agenda. It also supports Environmental Protection Agency (U.S. EPA) in conducting an international program on Integrated Environmental Strategies (IES) to promote the analysis of, and develop implementation plans for, integrated solutions that provide local and global benefits, such as health improvements, air pollution reduction and greenhouse gas (GHG) mitigation. The United Kingdom Department for International Development (DFID) actively supports interventions in the energy-poverty nexus, such as its Rural Livelihoods Program in India, and IAP as its part. As part of a broader Sustainable Energy Program, the Shell Foundation, in collaboration with the Chinese Centre for Disease Control and some Chinese universities, is undertaking a comprehensive assessment of the Chinese Improved Stoves Program to apply the lessons learned to the next generation of rural energy programs in China and other countries. The World Bank Study on Household Energy, Air Pollution and Health in India has reinforced the following set of Unless we are prepared, mentally at least issues and needs for combating the health impacts of IAP and preferably in real life, to squat down in a holistic manner: next to a choking fire to cook and feel that rasp in our throats, we may just piece together a The need to have better information on exposure levels wrong strategy ­ for the energy, environment, and and related health risks for population sub-groups, as health sectors. Indeed, we may piece together an well as to be able to assess the effectiveness of various entirely wrong development strategy. interventions in reducing these risks; Mieko Nishimizu, Vice-President, South Asia Region, The need to find ways to deliver effectively better World Bank, USA energy services (cooking fuels and methods) to rural households, including the poor; An Agenda for Action The need to adopt multiple mitigation strategies that Reflecting the need for multisectoral solutions, the would include a range of technical options and their Workshop explored a variety of IAP-related issues, such as combinations--such as cleaner fuels, better stoves, exposure and health assessment, gender and community improved kitchen ventilation and housing types-- development, promotion of improved stoves, policy targeted at different population groups; framework for improving modern energy services in rural The need to involve various actors in mitigation areas and global co-benefits of addressing IAP. efforts--for example, to clarify responsibilities of Drawing lessons from the experiences of the different government departments at different levels, provide countries represented at the workshop, as well as the findings the right incentive framework and business of the World Bank Study on Household Energy, Indoor Air environment for the private sector, and empower Pollution and Health in India, the workshop participants communities, especially women, to improve the ways formulated an extensive set of recommendations for policy, in which daily energy needs affect their lives; research and action in each of the following working groups: The need to raise awareness of the problem and cost- Improved stoves, cleaner homes, healthy villages effective solutions among all actors and stakeholders. Moving up the energy ladder: kerosene and LPG 3 WHO's key activities in IAP include a Improved stoves, cleaner homes, comparative evaluation of experiencies healthy villages in different settings with a view to (Specific recommendations) developing concepts for effective Promote commercialisation of improved stoves (i.e., biomass interventions and supporting policies or coal stoves having higher efficiency and lower emissions) Dieter Schwela, Air Pollution Scientist, WHO, Geneva and low-polluting processed solid fuels, as a critical factor to achieve the sustainability of these IAP mitigation options. Exposure and health research Develop innovative ways of delivering services to the poor. Addressing IAP through gender and community While it should be possible to retain targeted financial support development for stoves to the poorest of the poor families (with clear and Integrating local and global benefits of IAP mitigation. broadly accepted identification of eligible beneficiaries), it must be accompanied by operation and maintenance support. Overall recommendations of the workshop are Combine dissemination of stoves with interventions to summarised below. Specific recommendations improve housing design and behavioral change so as to of the working groups are summarised in separate boxes minimise exposure, particularly by children. (for the full text of the recommendations see Support research and development to increase the websites ­ http://www.worldbank.org/cleanair/caiasia or effectiveness of improved stoves to reduce indoor smoke. http://www.teriin.org/indoor/iap.htm). Key areas of R&D include design of low-emission stoves, piloting financing mechanisms for local entrepreneurs, The magnitude of health effects assessment of exposure and health impact of improved from traditional household energy stoves, research of `software' issues (e.g., cooking practices, diet and habits) and better stoves for space heating. use calls for immediate action While there are research gaps and uncertainties about the People were given options. We maximised exact levels of exposure and specific health outcomes, decision-making by drawing on there is sufficient evidence that the health impacts of indigenous knowledge and local traditional household energy use are significant enough technologies considering a combination of to justify immediate action. Economic development and sustainable options rather than any single option. poverty reduction are among the key factors for Some women decided to have chimneys, some to have improvements in household energy use, environment, windows and some to have eaves on the walls. Justin Nyaga, Special Projects Manager, and related health effects; however, the links are Energy Program, International Technology Development complex, multidirectional and with significant time lags Group (ITDG), Kenya at the household level. Thus, certain measures to prevent the death of young children and improve the health of Improved biomass stoves (and cleaner biomass-based rural women can and should be undertaken before a fuels) will thus continue to be an option for reducing change in the economic status triggers better health exposure for a large majority of the rural poor. In those indicators. Furthermore, better health, especially of countries where coal stoves are extensively used for women and children, is not only an outcome but also a heating such as China and Mongolia, improved coal stoves critical input to economic growth and poverty (and better, processed coal) are an important option to eradication; thus, addressing the health impacts of improve the health impacts of household energy use. household energy and IAP should now be an integral part of poverty eradication efforts. Improvements in cooking and heating technology need to be complemented with simple housing improvements, Support a range of mitigation such as kitchen configuration and ventilation conditions, options in a holistic manner which could be among most cost-effective measures to Switching completely to cooking with clean fuels, such as reduce exposure. Facilitating behavioral changes among LPG or biogas or electricity, is the most certain way to women, children and other household members offers lower exposure to indoor air pollution dramatically. another opportunity to reduce exposure and alleviate the However, the incremental costs of switching over to associated health impacts. Improving the status of modern and superior fuels are prohibitive for many rural women can be one of the most effective means of households. For example, in India, the economics of LPG promoting markets for better stoves and other household service, with its relatively high operating cost, are not energy use services. favorable to the rural poor who cannot afford to pay for An effective IAP mitigation strategy should include all refilling an LPG cylinder every month or two. these options and attempt to match specific interventions 4 (and/or their combinations) with the right segments of the Moving up the energy ladder: market. Such a strategy should also take into account the kerosene and LPG multidimensional nature of household energy use and (Specific recommendations) promote synergy among a variety of possible benefits, such as health, gender development and impacts on the Promote a fair, transparent and competitive market for local and global environment. petroleum fuels. This would enable better quality services to be provided to larger number of customers at lower costs. Mainstream IAP and related issues Experiment with small size LPG cylinders using a market- in national/state policies based approach. Small size cylinders could enable poorer and programs households to purchase LPG more regularly, especially in rural areas where cash income is less reliable. However, One of the central issues is to facilitate integration of IAP international experience with small cylinders is mixed: issues in health, energy, infrastructure and rural negative aspects include a much higher cost for cylinder development programs. For example, it is important to management and hence higher LPG prices on a unit weight integrate indoor air pollution into the existing maternal basis, and the need for households to refill more frequently. Therefore market forces, and not government policy, should and child health programs as well as to address IAP in guide the size of cylinders to be made available on the market. other home-related health programs (e.g., hygiene, water Re-evaluate the need for, and the delivery mechanism of, and sanitation). There are already some examples of the LPG price subsidy, which vastly benefits better-off urban successful household energy initiatives integrating IAP residents. Attempts to design an alternative targeted subsidy with projects and programs in agriculture, forestry, should take into account the lessons of evaluating the nutrition, family planning and empowerment of women. Deepam scheme in Andhra Pradesh (India) that highlighted the challenges of promoting the use of LPG amongst the rural National energy policies and planning should include poor in low-income countries (see IAP Newsletter No 6). specific household energy goals as well as recognition of Examine effectiveness of alternative subsidy schemes for the importance of gender-sensitive participation processes kerosene. The supply of low-cost kerosene for use by the in formulating household energy programs. These need to poor should receive more attention considering: (a) the ease be reflected in institutional frameworks for integrated of distribution and delivery compared to LPG; (b) its stakeholder participation in household energy policy at the importance as an energy source for lighting in rural areas; national, regional and local levels. and (c) its potential as an intermediate fuel between biomass and LPG. Areas of further research include different subsidy Combine market-based approaches delivery mechanisms to reduce the currently high level of diversion to the automotive sector and more work on with effective government kerosene stove design to lower emissions. interventions The government has an important role in guiding and nor result in greater participation by the poor in stove facilitating actions that alleviate the problem of indoor air programs. LPG price subsidies are heavily biased pollution. To ensure a sustained effect of mitigation towards more affluent urban households and result in measures, there is a need to promote market mechanisms diversion of LPG intended for household use to the for distribution of improved stoves and commercial fuels. commercial sector. There is a clear need for developing Programs that disseminate improved stoves on a new and more effective strategies to reach the poorest, commercial basis enjoy greater financial sustainability and complementing market-based approaches to service respond better to user demand, including the production of delivery. more durable stoves. Similarly, a liberalised market for Among other areas for government intervention commercial fuels with a level playing field for all operators highlighted by this workshop are: with proper regulations would lower costs and increase the quality and availability of service to consumers. Therefore, Paying greater attention to the health dimension in government interventions should be reoriented towards programs that disseminate improved cooking stoves creating a sound regulatory framework and incentive and cleaner fuels (as well as programs that provide structure that works with, not against, the market. other rural infrastructure services, such as housing, water and sanitation); One critical area for government interventions is the design of innovative incentives and mechanisms to Establishing quality assurance programs for services deliver better energy services (and housing) to the and products delivered by LPG retail outlets; poorest of the poor customers. For example, there is Considering innovative financing schemes that evidence from India that large subsidies for stoves do not combine housing finance with improved kitchen ensure increased and sustained use of improved stoves, and/or stove design; and 5 Exposure and health research (Specific recommendations) Develop rapid and robust methods for exposure assessment, focusing on three main objectives: Estimating exposure to indoor air pollution by national/state/local level monitoring of exposure levels and health risks. Assessing the impact of interventions on exposure levels and health risks for cost-effectiveness analyses. Using health studies to strengthen links between exposure levels in rural settings and health end-points. Improve understanding of key linkages between health and IAP While there seems to be sufficient evidence on the linkages between IAP and acute respiratory infection, lung cancer (from coal only) and chronic obstructive pulmonary disease (COPD), stronger evidence through additional research is required for health outcomes, such as asthma, heart disease, tuberculosis and infant mortality. Strengthen intervention and operational research in the following areas: The effectiveness of IEC (information, education, communication) activities, e.g., use of mass media. Exposure reduction and health benefits (effectiveness) of various mitigation strategies involving behavioral and/or technological changes, or a combination. Economic, institutional, regulatory and socio-cultural feasibility of IAP-related interventions to improve health, in addition to mere technical feasibility. Increase support for priority areas of immediate policy relevance While gaps in research should not be used as an excuse to delay action, there are some critical areas mentioned above, where better knowledge is needed to help design effective interventions. Given that household fuel-related IAP research was significantly under-funded in the past, these priority areas warrant an increased level of support by local governments and donor agencies. Upper respiratory infection in seven associated costs and benefits. Specifically, it could include counties of China is as high as 81 per the following topics: cent in children under five. Chronic Different fuel options; headaches are very common among middle age women, possibly due to high indoor concentrations of Cleaner use of biomass (improved stoves, as well as carbon monoxide. improved biomass-based fuels); Linhong Wang, Deputy Director, Women and Children's Pollutant emissions from different stove types using Health Centre, Peking University, Beijing, China the same fuel (for example, kerosene wick stoves are polluting but pressurised kerosene stoves which Actively supporting R&D in several multidisciplinary gasify kerosene are considerably cleaner) and areas related to IAP that are critical for designing more different fuels (for example, gaseous versus liquid effective programs and interventions, including versus solid fuels); and exposure and health research in priority areas. Incremental costs and benefits of cleaner options (LPG Increase public awareness versus kerosene and wood, kerosene versus wood, wood versus other biomass, improved biomass stoves One of the most important elements of a strategy to versus traditional stoves). mitigate IAP is to facilitate behavioral change, including greater demand for cleaner cooking. This Facilitate involvement of requires awareness raising among rural families about communities and energy the health impacts of traditional household energy and providing specific information on the range and users, especially women effectiveness of mitigation options. Various methods ­ Effective implementation of household energy programs from including IAP issues in basic hygiene education by requires extensive involvement of end-users from the primary schools and health centers to mass media ­ design stage to implementation. No central scheme ­ should be utilised. Improving knowledge of the IAP whether at the national or the state or provincial level ­ can problem and possible solutions among all major do justice to what communities and individuals really need and stakeholders, including the medical community, is as want. Women are the mainstay of household energy important. programs and it is, therefore, important to empower women The awareness campaigns should provide a balanced to make the choice and influence household decisions overview of a number of options, pointing to the regarding the use of fuels. Activities to target women for 6 Addressing IAP through gender and community development (Specific recommendations) AddresslivelihoodandpovertyneedsofruralcommunitiesinIAP/householdenergyprograms.TomakeIAPreductionseffective, household energy programs should address a range of livelihood and poverty needs of both women and men, for example, by providing opportunities for income-earning for women, as well as for men, in stove-building, in tree nurseries or other activities. Empower women to make household fuel choices. In the Indian stoves program, even though women were never the focus except as a market segment, there is evidence to show that programs in which women were involved in stove-making and dissemination fared better. Empowerment is needed in some places to effectively disseminate improved stoves but in areas where women are already reasonably empowered, other barriers need to be addressed. Undertake research to understand and facilitate the role of gender in energy programs. The barriers and constraints faced by men and women in adopting certain technologies arising from cultural habits and traditions need to be much better understood and factored into program design. Coordinate and expand support by If we use the number of stoves the donor agencies disseminated as an indicator of health, there is no room for gender and community Given the multisectoral nature of IAP, there are development. If we start looking at the per cent of different sectoral avenues for addressing the problem stoves maintained or replaced, per cent that is used and providing external support (see Box on Page and whether the type of use is hygienic and of low 3­Increased International Commitment...). Nonetheless, emissions, this is where the gender and community the donor assistance allocated to IAP and household development issues come into the picture that will energy remains miniscule compared to the amount ultimately deliver the health output we want. spent on other rural energy programs, such as Elizabeth Cecelski, Director of Research and Advocacy, Energy, promotion of photovoltaics for rural electrification. To Environment and Development (EED), The Netherlands maintain the momentum of these new initiatives and achieve maximum benefits from the activities by training, capacity and skill building to use and maintain various agencies, there is a need for a more coordinated better stoves (using improved biomass, kerosene or gas), as effort. The workshop pointed to the importance of well as for awareness raising of the detrimental impacts of establishing a common agenda for the near to medium traditional energy, should be strengthened. Innovative term, which could serve as the basis for effective financing schemes (e.g., micro-credit) should also be partnerships that are built on comparative advantages explored to support local entrepreneurs, both female and of different donor agencies. A working group with male, as well as communities in the manufacturing and representatives of a number of agencies to guide and dissemination of stoves and other suitable technologies. facilitate the process is one option. Integrating the local and global benefits of IAP mitigation (Specific recommendations) Attach priority to local health benefits. Given the magnitude of the health impacts, household energy strategies in poor countries should be driven by local health benefits. Explore synergies to develop win-win strategies, such as promotion of more efficient coal stoves or high combustion efficiency stoves using processed gaseous biomass, for example, biogas. It is further recommended that the Inter-governmental Panel on Climate Change (IPCC) consider creating a sub-committee to explore the co-benefits of interventions in terms of global warming and local health benefits, including (but not limited to) household energy options. Assess, and where possible, tap opportunities provided by international climate change financing for cleaner household energy. Win-win strategies could help local governments mobilise additional international financing for the benefit of global environment and local users. For example, the World Bank helped Mongolia prepare a project where the GEF supports market development for more efficient coal stoves that are expected to reduce exposure and improve the health of users. The GEF also supports activities involving gaseous biomass. While assistance should be provided to local governments to develop the capacity to use existing international financial mechanisms for household energy, attempts to obtain GEF or other "global" financing should ensure that transaction costs are not excessive relative to possible financial support, and that the attention of local institutions is not diverted from the main local health and development issues. 7 From the Newsletter Team With the completion of the World Bank study on Sri Ramachandra Medical College and Research Household Energy, Air Pollution and Health in India, Institute, Chennai, India. this is the last issue in this newsletter series. The P. Mahapatra, K. Satish Kumar, P. V. Chalapati Rao, team hopes the newsletter helped raise awareness of N. Srinivasa Reddy, Institute of Health Systems, the health risks of cooking and heating with Hyderabad, India. unprocessed solid fuels that is prevalent in rural settings of developing countries; highlighted a web A. B. Sharma, S. Tiwari, S. Dutta and K. Cherail, of linkages between household energy and health, Winrock International India, New Delhi, India. gender, environment and development objectives; P. Malhotra, Jalajakshi C. K., S. N. Srinivas, D. Palit expanded a worldwide network of professionals and N. Hazarika, Tata Energy Research Institute, concerned about the IAP issue; and facilitated New Delhi, India. commitment to take action. We look forward to all of us ­ together ­ continuing to work in this area to S. Rajakutty, V. Madhava Rao, K. Jayalakshmi, achieve better health and environment for millions of P. R. Reddy, S. Chandra, V. Annamalai and families that still have no choice but to rely on A. Nagaseshnna, National Institute of Rural traditional biomass and coal to meet their daily needs Development, Hyderabad, India. in food and shelter. The team is thankful to the publisher of this newsletter: The World Bank team working on the newsletter included: macro graphics.comm pvt. ltd., New Delhi, India. Kseniya Lvovsky, Task Leader, klvovsky@worldbank.org Indoor Air Pollution Newsletter Series: Sameer Akbar, Co-task Leader, sakbar@worldbank.org 1. Health effects of IAP. Priti Kumar ­ Managing Editor of the Newsletter and Study Coordinator, pritikumar@mantraonline.com 2. Reports of two international conferences in India related to IAP - on respiratory illness and household Douglas Barnes, Technical Adviser, improved stoves, energy. dbarnes@worldbank.org 3. Women and energy. Masami Kojima, Technical Adviser, petroleum fuels, mkojima@worldbank.org 4. Household energy and poverty. Uma Balasubramanian, overall support, 5. Review of the India's National Programme of ubalasubramanian@worldbank.org Improved Stoves. Sadaf Alam, overall support, salam@worldbank.org 6. Evaluation of an LPG promotional program--the Deepam Scheme--in Andhra Pradesh, India. The newsletter benefited from the contributions by many people and the findings of many studies. Special gratitude 7. Assessment of exposure to IAP and its determinants in goes to the dedicated study teams from several partnering Andhra Pradesh, India. institutions in India and a US university: 8. Report of the Regional Workshop on Household K. R. Smith and S. Mehta, Environmental Health Energy, Indoor Air Pollution and Health. Sciences, University of California, Berkeley, USA. If you would like to obtain an electronic copy of any of K. Balakrishnan, S. Sankar, J. Arnold, D. Venkatesan, these newsletters, please email to Sadaf Alam at A. Anand, R. Padmavathi, D. Bhuvaneswari, salam@worldbank.org, or the same can be obtained off the R. Ayyappan, and B. W. C. Satyasekaran, internet at http://www.worldbank.org/sar/sa.nsf. This newsletter is part of a World Bank study in India, Household Energy, Air Pollution and Health, and is supported under the joint UNDP/World Bank Energy Sector Management Assistance Program (ESMAP). The material used in this newsletter does not necessarily represent the views of the World Bank.