64509 Improved Cookstoves and Better Health in Bangladesh Lessons from Household Energy and Sanitation Programs Final Report June 2010 Improved Cookstoves and Better Health in Bangladesh Lessons from Household Energy and Sanitation Programs Final Report June 2010 @2010 The International Bank for Reconstruction and Development/The World Bank 1818 H Street, NW, Washington, D.C. 20433 USA Disclaimer This volume is a product of the staff of the International Bank for Reconstruction and Development/ The World Bank. The findings, interpretations, and conclusions expressed in this paper do not necessarily reflect the views of the Executive Directors of The World Bank or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. 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Designed and Printed by Macro Graphics Pvt. Ltd. www.macrographics.com Contents Acknowledgments vii Abbreviations and Acronyms ix Executive Summary xi Study Objectives and Approach xi Health Impacts of Indoor Air Pollution xii Experiences from the Household Energy Sector in Bangladesh xii Experiences from International Improved Cookstove Programs xiii Experiences from the National Sanitation Program xiii Way Forward xiv Conclusions xv Indoor Air Pollution in Bangladesh 1 Health Impacts of Indoor Air Pollution 1 Health Impacts for Bangladesh 2 Health and Indoor Air Pollution: Unanswered Questions 3 Bangladesh Scenario 4 Clean Energy Initiatives in Bangladesh 6 Objectives of this Review 7 Structure of the Report 8 Review Methodology 9 Detailed Review 9 Conclusions 13 Household Energy Initiatives in Bangladesh 15 BCSIR: Improved Cookstove Program, Phase II 15 GTZ: Sustainable Energy for Development Program: Improved Cookstoves Component 21 Contents | iii USAID: Reduction of Exposure to Indoor Air Pollution through Household Energy and 24 Behavioral Improvements BCSIR/LGED: Biogas Program 27 IDCOL/SNV: National Domestic Biogas and Manure Program 30 IDCOL: Rural Electrification and Renewable Energy Development Program 32 Conclusions 37 Lessons from Household Energy Initiatives in Bangladesh 39 Institutional Arrangements 39 Awareness and Motivation 42 Development and Promotion of Technologies 44 Financial Aspects 47 Conclusions 50 Review of International Cookstove Programs 51 Brief Overview of International Improved Cookstove Programs 51 Lessons Learnt from International Improved Cookstove Programs 57 Conclusions 62 Lessons from Sanitation Initiatives in Bangladesh 63 Bangladesh’s Total Sanitation Campaign 63 Comparison of Sanitation Programs in Bangladesh 66 Institutional Arrangements 67 Awareness and Motivation 71 Development and Promotion of Technologies 73 Financial Aspects 74 Conclusions 77 Summary and Recommendations 79 Status of Improved Stoves in Bangladesh 80 Lessons from Successful Programs 81 Way Forward 88 Conclusions 91 Appendix 1: Summary of Literature Reviewed on the Health Impacts of Indoor Air Pollution 93 Appendix 2: Rapid Review Programs 106 Bibliography 109 References 109 Other Relevant Source Items 112 Personal Communications 115 iv | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 Boxes Box 1.1 Bangladesh’s Renewable Energy Policy Objectives 8 Box 4.1 Evaluating Household Energy and Health Interventions: Catalogue of Methods 41 Box 4.2 Awareness of Health Impacts 43 Box 4.3 Carbon Finance: An Emerging Opportunity for Household Energy 49 Box 6.1 Community Engagement Process 72 Box 6.2 Moving Up the Sanitation Ladder 73 Box 6.3 Financial Mechanism in the National Sanitation Program 74 Box 7.1 Conclusions of the WHO Cost–Benefit Evaluation for Household Energy and 85 Health Interventions Figures Figure 1.1Energy Use and Expenditures in Rural Bangladesh, 2004 4 Figure 1.2Factors Contributing to Environmental Health Risks 5 Figure 2.1Review Process 10 Figure 3.1Institutional Diagram: BCSIR Improved Cookstove Program 20 Figure 3.2Institutional Diagram: GTZ Sustainable Energy for Development Program 23 Figure 3.3Institutional Diagram: USAID Reduction in Indoor Air Pollution Program 25 Figure 3.4Institutional Diagram: BCSIR/LGED Biogas Program 28 Figure 3.5Institutional Diagram: National Domestic Biogas and Manure Program 31 Figure 3.6Institutional Diagram: Rural Electrification and Renewable Energy 33 Development Program Figure 6.1 Reasons for Not Installing a Latrine: Results by Division, Bangladesh 64 Figure 6.2 Progress in Sanitation Coverage (October 2003 to June 2008) 66 Figure 6.3 Integrated Institutional Setup: Bangladesh Total Sanitation Campaign 70 Tables Table 1.1 Bangladesh: Share of DALYs Lost by Cause and Environmental Factor 6 Table 1.2 Synergies between Energy and Sanitation Sectors 8 Table 2.1 Key Issues and Questions 11 Table 2.2 Programs Selected for Detailed Review 13 Table 3.1 Overview of Selected Household Energy Programs in Bangladesh 16 Table 3.2 BCSIR Stove Performance Data 21 Table 3.3 Price of Improved Cookstoves under USAID/Winrock Indoor Air Pollution 27 Reduction Program Table 3.4 Grants for Solar Home Systems 35 Table 3.5 Cost of Solar Home Systems 36 Table 3.6 Credit Facilities Available to Users for Solar Home Systems 36 Table 4.1 Use and Maintenance Issues for Household Energy Programs 46 Table 4.2 Cost of Technologies 47 Contents | v Table 5.1 Findings of International Improved Cookstove Program Reviews 52 Table 6.1 Change in Approach for the Total Sanitation Campaign in Bangladesh 65 Table 6.2 Comparison of Sanitation Programs in Bangladesh 68 Table 6.3 Sources of Funds in Union Parishads for Achieving Total Sanitation 75 Table 6.4 Types of Sanitary Latrines Developed by DISHARI, VERC, SEDA/NGO Forum 75 Table 6.5 Source of Funds for Entrepreneurs in the Study Area 76 vi | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 Acknowledgments T his study is a collaborative effort between on sanitation programs in Bangladesh, led by the World Bank and the government of Md. Yakub Hossain with support from Anowar Bangladesh under the overall leadership of Hossain Mollah, A. M. Hasan Rashid Khan, Md. the Local Government Engineering Department, Quamrul Islam, Subash Chandra Saha, and Samar Ministry of Local Government, Rural Development Prasad Das. Winrock International reviewed the and Cooperatives of Bangladesh. The report has also national and international household energy received significant support from several agencies programs, led by Lutfiyah Ahmed with Suman of the government of Bangladesh, including the Basnet and Wendy R. Aulakh. The team from Infrastructure Development Company Limited, the the International Centre for Diarrhoeal Disease Department of Environment, and the Bangladesh Research, Bangladesh was led by Steven Luby and Council of Scientific and Industrial Research. Abdullah Brooks with support from Emily Gurley Significant contributions from representatives of and Md. Shohel Shomik. The Center undertook nongovernmental organizations, donor agencies, a review of the health impacts of indoor air and local government agencies during the meetings pollution and designed a health-based protocol and workshops held at various stages of the study for improved stove projects. and their technical support to the study through We are indebted to internal and external peer data and information are gratefully acknowledged. reviewers, namely Sudeshna Ghosh Banerjee, The World Bank team was led by Priti Kumar and Jeremy Levin, Yewande Awe, Mark Ellery, Rokeya included M. Khaliquzzaman, Jonathan Rouse, and Ahmed, Luis Alberto Andres, and Celine Ferre from Vani Kurup. Special gratitude is extended to Douglas the World Bank, and Priyadarshini Karve from the Barnes, who made substantial contributions to this Appropriate Rural Technology Institute, India. The report and guided the team during the final stages guidance of Kseniya Lvovsky in scoping out the of report writing. Thanks are due to John Dawson for study is acknowledged. his meticulous contributions in editing the report. We would like to express our sincere appreciation Technical background reports produced by to Xian Zhu, former Country Director for Bangladesh, three organizations underpin this document. Robert Floyd, former Country Program Coordinator The Village Education Resource Center focused for Bangladesh, and Karin Kemper, former Sector Acknowledgments | vii Manager, South Asia Social, Environment and Water Fund for Environment and Social Sustainable Resources Management Unit, for their overall Development are gratefully acknowledged. guidance and support to this activity. The opinions presented here and any errors Finally, the contributions of the Energy Sector are the sole responsibility of the authors and Management Assistance Program, the Bank- should not be attributed to the individuals Netherlands Partnership Program, and the Trust or institutions acknowledged in this report. viii | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 Abbreviations and Acronyms BCSIR Bangladesh Council of Scientific and Industrial Research BRAC Bangladesh Rural Advancement Committee DALY disability-adjusted life year DANIDA Danish International Development Agency DISHARI Decentralized Integrated Sanitation, Hygiene and Reform Initiative ESMAP Energy Sector Management Assistance Program GTZ German Technical Cooperation IDCOL Infrastructure Development Company Limited KfW Kreditanstalt für Wiederaufbau LGED Local Government Engineering Department NGO nongovernmental organization PM particulate matter SEDA Sustainable Energy Development Agency SNV Netherlands Development Organization SOUL Save Our Urban Life USAID United States Agency for International Development VERC Village Education Resource Center WASH Water, Sanitation, and Hygiene (Program) WHO World Health Organization Currency Equivalents (2009) US$ 1 (U.S. dollar) = Tk 68.5 (Bangladesh takas) Abbreviations and Acronyms | ix Executive Summary T wo billion people in the developing world indoor air pollution from traditional, biomass fuels, still depend on wood, animal dung, and crop at both policy and grassroots levels. With forests residues for fuel for cooking and heating. depleting and the need to provide energy to the Although biomass fuels can be a low-cost and ever-growing energy-starved population, strategies reasonably clean fuel when burnt in efficient are urgently required for the delivery of clean stoves, traditional cookstoves are often inefficient energy services at the household level. and highly polluting. This can lead to high levels of pollution in homes. Mitigating such indoor air pollution can translate not only into improved Study Objectives and health and positive economic outcomes, but can Approach also have significant environmental and human Mitigating indoor air pollution through improved welfare benefits. cookstoves offers great advantages in terms of Bangladesh has made notable advances towards reductions in mortality and morbidity, as well as attaining its Millennium Development Goals, which savings in either money spent on buying fuels or include a two-thirds reduction in infant and child in the time required to collect them. The overall mortality by 2015. However, indoor air pollution benefits can lead to greater rural productivity still remains a major concern for 25 million and a better quality of life for many of the rural households, despite a number of initiatives aimed poor. at addressing it. Despite widespread promotional efforts and In Bangladesh, as in other developing countries, several large and small-scale initiatives, improved most households are not expected to be able to cookstoves have not been widely adopted in move up the energy ladder from using traditional Bangladesh. Reasons include the relatively high cookstoves to cleaner fuels, such as liquefied capital and maintenance cost of stoves, perceived or petroleum or natural gas, solar energy, or electricity, actual inconvenience of using improved stoves, and for some years. Even well-off households continue incompatibility with traditional food preparation. to use a mix of modern and traditional energy Further, the design of cost-effective indoor air sources. Thus there is an immediate need to address pollution reduction strategies has been hindered Executive Summary | xi by technology-focused design processes, and a Health Impacts of Indoor lack of information about impact on particulate concentrations in poor households. Data have been Air Pollution scarce because monitoring in village environments Extensive scientific research has consistently is difficult and costly. documented the ill-health effects of breathing smoke from biomass fuels commonly burned in the On the other hand, Bangladesh has achieved developing world for cooking and heating (Bruce, tremendous success with its sanitation initiative – Perez-Padilla, and Albalak 2000). The World Health the Total Sanitation Campaign. The premise for Organization (WHO 2007) estimates that as much this study is that given the similarities between as 3.6 percent of the total burden of disease in the sanitation and household energy sectors it Bangladesh is attributable to exposure to indoor air should be possible to follow the lead of the Total pollution; 32,000 children below 5 years of age die Sanitation Campaign and develop successful annually due to acute lower respiratory infections, demand-based approaches for an improved and 14,000 adults die due to chronic obstructive cookstove program. pulmonary disease. Women and children in the The objective of this study is to identify lessons for developing world are disproportionately exposed to improving cookstoves in Bangladesh through an polluted air due to use of biomass fuels for cooking evaluation of existing programs, the international and heating. experience on improved stoves, and the lessons Smoke from biomass fuels contains a large from successes in the sanitation sector. number of pollutants, such as small particulates, Bangladesh’s new Renewable Energy Policy which can compromise the respiratory tract, endorses creating a better environment for making people vulnerable to viral and bacterial renewable energy technologies and promoting infections (Gurley et al. 2008). It also contains toxic market development for improved cookstoves pollutants, including aromatic hydrocarbons and (Government of Bangladesh 2009). This study carbon monoxide. Children exposed to indoor air supports this policy direction by examining pollution have two to three times greater likelihood possible strategies to move forward the of experiencing a serious episode of acute lower development of markets for improved stoves in respiratory infection, and adults are much more Bangladesh. likely to suffer from chronic respiratory disease. There are also documented links between exposure The study consists of several components: a to indoor air pollution and tuberculosis, preterm national review of household energy programs; birth, low birthweight, and asthma. an evaluation of national sanitation programs; and an examination of improved cookstove programs from around the world, including China, Experiences from the Guatemala, Haiti, Mongolia, Nepal, and Uganda. Household Energy Sector The study is based on published literature, in Bangladesh consultations with organizations throughout Bangladesh, site visits, and structured discussions Six household energy programs in Bangladesh were with beneficiaries and other stakeholders. In selected for this review, including three improved addition, key informants, such as entrepreneurs, cookstove programs, two biogas programs, and one community mobilizers, field-level staff, and local solar home system program. Findings revealed that government representatives, were consulted improved cookstoves have the potential to alleviate through semistructured interviews. many household energy problems in Bangladesh. xii | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 However, there is a significant lack of awareness and Guatemala, subsidies were used to stimulate concerning indoor air pollution in Bangladesh, initial demand (in China) or to enable the poor to despite many years of study on the issue. There are access relatively expensive stoves (in Guatemala). examples of effectively involving communities and In Mongolia, credit was extended to users, while leveraging microcredit in some programs, and these efforts in Haiti focused on reducing the cost of provide opportunities for learning and duplication. stoves through mass production. In Bangladesh, household decisions to adopt – or Carbon-financed stove programs also presented reject – new technologies are based on a complex some interesting and useful lessons. In these set of factors, including cultural and financial. cases there was implicit focus on sustainability, Investing in cookstoves is often not viewed as a high and therefore, in addition to rigorous monitoring, priority. Household energy issues are significantly most projects made provision for maintenance of impacted by gender roles: women generally use stoves. Initiatives led by both government and by stoves, while men often control family finances and nongovernmental organizations (NGOs) have much make household decisions. There is a need to better to learn from this approach, while at the same understand, and respond to, these issues. time being highly strategic in resource allocation to monitoring and evaluation. Experiences from International Improved Experiences from the Cookstove Programs National Sanitation Program The review of international cookstove programs The detailed review of sanitation programs in provided many useful lessons for improved Bangladesh focused on four organizations known cookstove programs in Bangladesh. to have an excellent record of accomplishment in program implementation. Programs selected for Lessons from the international programs emphasize evaluation represented a range of approaches, the need for a wide range of efficient stove designs institutional arrangements, and actors, including tailored to user requirements as a prerequisite government, donors, and NGOs. The common for program success. They should have proven theme was that they all were adhering to the basic efficiency, the ability to reduce indoor air pollution, characteristics of the Total Sanitation Campaign of and good durability and safety. Further, the viability the government, which aimed to achieve 100 percent of the program in the long term often depends on sanitation coverage by 2010. The achievements strong commercial approaches to promoting stoves. of the Total Sanitation Campaign in Bangladesh Targeted marketing has also been seen to be an illustrate that considerable development advances effective strategy; stoves should be marketed to can take place at the village level with support for households facing fuelwood scarcity or high costs of technical assistance and information dissemination purchasing wood, as they would be the most likely without substantial direct subsidies for the group to benefit from improved stoves, at least in improved sanitation devices. the initial stages of a program. Several key lessons may be drawn from the success International experiences also provided various of the Total Sanitation Campaign. One is that strong examples of innovative financing techniques, national policy support for innovative action can including the use of subsidies. In some countries, dramatically transform government, partner, and such as Nepal and Uganda, users were able to meet community actions into a participatory social the full cost of stoves. Elsewhere, such as in China movement, which in this case led to more than 90 Executive Summary | xiii million people in Bangladesh gaining access to, and for testing stoves both in the laboratory and in the using, latrines in a five-year period. In this context, an field, which both play a part in the development of important aspect of policy was a consensus among effective, usable technologies. The international local and national governments to switch from the literature on improved stoves mostly agrees that previous rather unsuccessful attempts to promote laboratory tests are appropriate for assessing the subsidized toilets (which are rival and excludable) technical performance of stoves and whether to the promotion of an open defecation-free they meet certain standards, but that the real environment (which is nonrival and nonexcludable). test of performance takes place in actual homes. Other important features included the availability of Many methods exist to assist in this development a wide range of low-cost and affordable sanitation process. The role of a technical group would be hardware with the target of reaching the very poor to certify that a stove being promoted in the with targeted subsidies, and the presence of a marketplace actually meets certain standards in strong entrepreneur force for wider outreach, which terms of efficiency, pollution, durability, and safety. strengthened the commercial approach and made This should be done in a way that does not stifle products readily available locally. creativity, but ensures that the public receives an acceptable product. Once certified, the stove could Way Forward qualify for government assistance through loans, marketing, and dissemination, or even some form The review of the status of improved stove of subsidy. There also needs to be more of a focus programs in Bangladesh, along with the best on understanding and addressing the significant practices from around the world, leads to several barriers to adoption that exist within the homes of recommendations for consideration. One clear the poor. message is the need for a more unified program without diminishing the creativity of the various To administer a stove program at government groups advocating improved stoves in Bangladesh. level, an institution with a commercial approach In fact, creativity and a wide variety of approaches and good field-level experience in quality-assured should be encouraged. The government’s role is technology promotion and dissemination may be not necessarily to be the main actor, but rather to well suited. One model that may be applicable to facilitate a process that promotes variety, improved the promotion of improved stoves is the program of durability, better safety, and greater efficiency of the Infrastructure Development Company Limited improved stoves. Just as government ownership (IDCOL) for household photovoltaic systems. Here, drove success in total sanitation, so leveraging an organization would provide loans and partial government support will also be a vital part of grants to NGOs, private companies, or microfinance tackling indoor air pollution. In addition, combining organizations to promote stoves. This is not a efforts to improve indoor air quality with sanitation simple process, and involves several different types and hygiene promotion may result in greater of activities, including: benefits than the sum of the parts, due to the � Qualifying and certifying stoves through complementary nature of the interventions. independent technical groups that qualify for The ultimate goal is to have a variety of improved the program; stoves for sale in retail markets all over Bangladesh. � Qualifying firms or NGOs for the program One role for the government to play in supporting on the basis of selected institutional this is the testing and certification of stoves. A characteristics and qualified staff to carry out technical group needs to be given the responsibility projects; xiv | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 � Evaluating the financial plan of the proposal use while cooking, and secondarily to promote, to make sure it is economically justified and regulate, and perhaps certify the marketing of fuel- financially viable after all program incentives efficient stoves to enable households to choose or subsidies are accounted for; options that suit their means. � Encouraging development of greater diversity of products, perhaps through Conclusions technical assistance grants or through some kind of grant competition; The future of an indoor air pollution reduction program for mitigating the ill-effects of biomass � Keeping abreast of new stoves being promoted burning requires the dedication of government worldwide, including manufactured stoves, institutions, civil society, and the private sector. and, if attractive, encouraging them to enter Entrepreneurs in particular need to be encouraged the market through local partners; and supported to develop better stoves and � Monitoring the results once the programs promote them in a conducive marketplace. are in the field by keeping track not only Although this will not be easy, the benefits of of the number of stoves but also of their improved stoves could be quite high for the effectiveness and the satisfaction of poorest populations in Bangladesh, including the consumers; reduction in the labor required to collect fuelwood for daily cooking tasks and the improved health � Establishing a proper balance between loans resulting from cleaner indoor environments. and grants in the program to ensure that the program is based on market incentives The key lessons for promoting improved stoves in rather than subsidies. Bangladesh do involve significant changes in the handling of household biomass energy problems. The possible program described above should not This obviously means that the government will involve any type of prohibition on the private sector have to establish an agency that will be responsible or NGOs developing their own programs with their for administering a program to promote improved own financing. In fact, the grants and loans should stoves. The responsibility of the agency would be be available to all who qualify, and the technical to work with qualified private firms, NGOs, and agency could verify the effectiveness of the stoves other organizations to develop and implement the of any agency on an as-needed basis. Such groups program in partnership with local governments. certainly will have their own technical staff to qualify In addition, there will be issues concerning the their own products. The idea is to develop a level quality of the stoves, the financial and economic playing field for those involved in the promotion incentives to develop new models, and the of improved stoves in Bangladesh and to create a loans, grants, or community funds to support the conducive atmosphere that encourages different promotion of stoves. Finally, once there are a wide organizations to develop and retail a wider range variety of stoves available to the public that are of improved stoves in the country. Thus, the overall safe, efficient, and reliable, a national publicity goal of government activities should be to promote campaign can be initiated to promote the health the development of improved stoves in Bangladesh and efficiency aspects of the stoves. to alleviate the problems caused by both indoor air pollution and shortage of biomass fuels. The future There is no reason why developing countries, cookstove program should follow the same path, including Bangladesh, should have populations with the government’s role being primarily to ensure dependent on stoves that have not changed in that no one is exposed to unsafe and inefficient fuel design for hundreds or even thousands of years. Executive Summary | xv Daily advances in other types of appliances and household renewable energy. The ideas from around the world have not reached the world’s these and other programs can be employed to poorest populations, who still depend on open change the polluting and inefficient centuries-old fires for cooking. In fact, Bangladesh has among ways of cooking for people who still prepare meals the developing world’s best programs in sanitation with biomass energy. xvi | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 Indoor Air Pollution in Bangladesh O ver 2 billion people living in rural and (Bruce, Perez-Padilla, and Albalak 2000). The ill- peri-urban areas in developing countries effects of polluted air are a major concern because still depend on energy from biomass (for so many people are exposed daily to high levels example fuelwood, animal dung, crop residues, and of pollution in their homes. The World Health other biomass fuels in open fires or using poorly Organization (WHO) estimates that 2.4 billion functioning stoves) for their daily needs, such as people worldwide (approximately 30 percent of all cooking and heating. Biomass can be a low-cost and people) rely on burning biomass fuels for cooking reasonably clean fuel when burned well; however, and heating their homes (Rehfuess, Mehta, and the continued use of traditional cooking practices Prüss-Üstün 2006). People in the developing world and inefficient stoves in closed environments leads are disproportionately exposed to polluted air due to high exposure to indoor air pollution. to use of biomass fuels for cooking and heating. A large section of the households in developing WHO reports that indoor air pollution is responsible countries are not expected to move up the energy for an estimated 2.7 percent of the global burden of ladder to cleaner options, such as liquefied disease and 1.6 million deaths, concluding that the petroleum or natural gas, solar energy, or electricity, ill-effects of indoor air pollution are more than five for a long time. Even the well-off households are times those resulting from outdoor air pollution expected to continue to use a mix of modern (WHO 2005; Gurley et al. 2008). In developing and traditional energy sources. Thus, the need countries, indoor air pollution accounts for to mitigate indoor air pollution will remain an 3.7 percent of the total burden of disease, making important issue in the foreseeable future. it the fourth most serious health risk factor after malnutrition, unsafe sex, and lack of safe water Health Impacts of Indoor and effective sanitation (WHO 2007). Exposure to polluted indoor air is typically greater among Air Pollution women (and children), who due to their gender roles Extensive scientific research has consistently and household responsibilities are most exposed to documented the ill-health effects of breathing smoke. Acute respiratory infections from indoor air smoke from biomass fuels commonly burned in pollution kill an estimated 900,000 children under the developing world for cooking and heating 5 annually in developing countries (WHO 2005). Indoor Air Pollution in Bangladesh | 1 Smoke from biomass fuels contains a large number levels of biomass smoke they are exposed to are many of pollutants, such as small particulates, which can times higher than acceptable standards for indoor compromise the respiratory tract, making people air quality. Standards for air quality published by vulnerable to viral and bacterial infections (Gurley the United States Environmental Protection Agency et al. 2008). It also contains toxic pollutants, including (EPA 2006) state that 24-hour average levels of PM101 aromatic hydrocarbons and carbon monoxide. of 150 micrograms per cubic meter (µg/m3) are Children exposed to indoor air pollution have two acceptable. One study in Bangladesh found that to three times greater likelihood of experiencing household levels frequently reached 300 µg/m3, a serious episode of acute lower respiratory although spikes of up to 4,864 µg/m3 were observed, infection compared to those not exposed, even and that regional levels varied (Dasgupta et al. after controlling for socioeconomic conditions 2006a). (Smith 2000). Adults exposed to indoor air pollution Globally and in Bangladesh, acute respiratory from biomass burning are also much more likely to infections are the leading cause of death among all suffer from chronic obstructive pulmonary disorder age groups combined, and among children below (Bruce, Perez-Padilla, and Albalak 2000; Ezzati and 5 years of age (Bruce, Perez-Padilla, and Albalak Kammen 2001; Smith et al. 2000). 2000; Baqui et al. 2001). Bangladesh has the highest Indoor air pollution is also reported to cause rate of tuberculosis in the world (Zaman et al. 2006; tuberculosis (a leading cause of death in the developing Begum et al. 2007). As Bangladesh struggles to world) and is associated with low birthweight and meet the Millennium Development Goals, reducing poor pregnancy outcomes (Boy, Bruce, and Delgado exposure to indoor air pollution could increase 2002; Siddiqui et al. 2005). Exposure to carbon the chances of attaining Millennium Development monoxide has been linked with preterm birth (Ritz Goals 4 and 5, which call for a reduction in maternal et al. 2000). Asthma (Azizi, Zulkifli, and Kasim 1995; and child mortality (Rehfuess, Mehta, and Prüss- Mohamed et al. 1995), stunting, and anemia (Mishra Üstün 2006). By reducing the amount of biomass and Retherford 2007) may also be associated with used for cooking and heating in Bangladeshi exposure to polluted indoor air. However, additional homes, contributions could also be made to studies are recommended to better understand the attaining Millennium Development Goal 7, ensuring relationship between indoor air pollution and these environmental sustainability (Rehfuess, Mehta, and health outcomes. Burns and scalds from burning Prüss-Üstün 2006). WHO (2007) estimates that in biomass in open fires in homes receive less attention Bangladesh alone there were an estimated 32,330 but are additional adverse health outcomes associated deaths from acute lower respiratory infections with burning biomass (Johnson and Bryden 2006). among children below 5 years and 13,620 deaths In addition to episodes of acute respiratory illness, among adults from chronic obstructive pulmonary respiratory symptoms such as cough and burning disease attributable to solid fuel burning in homes. throat have been significantly associated with This equates to 3.6 percent of the total national exposure to indoor air pollution, including in a small burden of disease in Bangladesh (WHO 2007). study in Bangladesh (Khaliquzzaman et al. 2007). According to Demographic Health Survey data, 74 percent of people in South Asia, including 88 Health Impacts for percent of people in Bangladesh, are exposed to the effects of burning biomass in their homes (Rehfuess, Bangladesh Not only are poor populations in the developing world 1 PM10 = particulate matter comprising particles with a diameter of exposed to indoor air pollution more frequently, the 10 micrometers or less.  | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 Mehta, and Prüss-Üstün 2006). Women and children in the household, and thereby reduces exposures. are thought to be the most affected because of their In laboratory tests and observational studies, domestic role in meal preparation. Studies from increased ventilation has shown promising results South Asia showed that women and children (below in dramatically reducing indoor air pollution levels 5 years of age) spent more time in the proximity (Dasgupta et al. 2006a; Still and MacCarty 2006). to fires in the home and hypothesized that this However, there have been no evaluations of increased proximity to fires was related to higher improved ventilation interventions to date. levels of indoor air pollution exposure (Balakrishnan Second, despite the vast knowledge about poor et al. 2004; Dasgupta et al. 2006b). However, another health outcomes associated with breathing biomass study from Bangladesh suggests that pollution from smoke in the home, very little is known about the fires rapidly spreads throughout all rooms of a house, best way to prevent these outcomes (Ezzati and exposing all individuals in the house to high levels of Kammen 2002). Even if interventions reduce the indoor air pollution, and not just the person who is amount of indoor air pollution, the level of reduction cooking (Dasgupta et al. 2006a). required to show health benefits is not known. In addition, the intervention that is most effective at Health and Indoor Air reducing indoor air pollution is also not known. Pollution: Unanswered Only a few studies have examined the relationship between indoor air pollution interventions and Questions health outcomes. Preliminary data from an Certain critical questions about the relationship evaluation of improved cookstoves in Guatemala, between indoor air pollution and health remain which used a randomized control trial study design, unanswered (Smith 2000). First, despite decades of showed that children living in households using intervention attempts, very little is known about the improved cookstoves were significantly less likely improvements in air quality that indoor air pollution to suffer from pneumonia not caused by respiratory interventions produce in the real world (Ezzati syncytial virus than those in households using and Kammen 2002; Smith et al. 2007). Evidence traditional stoves (Smith et al., unpublished data). of improved air quality is essential for any indoor Additionally, women using the improved cookstoves air pollution intervention. The few studies that experienced reduced blood pressure and were less actually examined the use of improved cookstoves likely to report eye soreness and headache (Diaz have shown mixed results. In some cases, levels et al. 2007; McCracken et al. 2007). For the first of indoor air pollution were reduced (Albalak et time, an experimental study design that was used al. 2001), while in other studies, interventions to evaluate an indoor air pollution intervention actually increased the levels of indoor air pollution showed improved health outcomes in intervention (Smith 2002). In one study from Guatemala, households. Evidence must show that indoor air improved cookstoves did reduce levels of PM2.5 pollution interventions are able to reduce indoor and carbon monoxide but the improvements over air pollution levels, as well as improve the health open fires were not dramatic and tended to fade of their users. over time (Naeher, Smith, and Leaderer 2000). For any indoor air pollution intervention in Bangladesh Third, currently there are few data available on to be successful, it is necessary that the intervention the seasonality of indoor air pollution. Common is effective in reducing indoor air pollution levels sense would suggest that increased heating needs during colder months might increase the amount 2 PM2.5 = particulate matter comprising particles with a diameter of of biomass burned in households or that during 2.5 micrometers or less. the monsoon people might be less likely to cook Indoor Air Pollution in Bangladesh | 3 outside in Bangladesh. Households with substantial for 44 percent of total household energy use and ventilation during the summer might, by design, 38 percent of expenditure in rural Bangladesh have very little ventilation in the winter. One study (Figure 1.1) (Asaduzzaman, Barnes, and Khandakar has examined indoor air pollution levels during 2007). Poor households spend less than wealthier the winter in Bangladesh, but measurements from households on energy, but the amount represents other seasons would be useful in determining a greater percentage of their income. The lowest- the seasonality of indoor air pollution (Dasgupta income households spend slightly more than Tk et al. 2006a). Future studies should also attempt 3,000, or 15 percent of their annual income, on to document the variation in indoor air pollution energy. High-income households spend twice as throughout the year, highlighting any potential much, but their income is more than four times seasonal opportunities or challenges to behavior higher, so it is a much smaller percentage of their change interventions. overall income. This pattern is common in other developing countries. Bangladesh Scenario With less than 7 percent forest cover and a growing population, it is becoming increasingly difficult for The World Bank’s Bangladesh Country Environment rural households to obtain biomass fuels to meet Analysis (World Bank 2006) reports that the their cooking needs. Liquid petroleum gas has majority of people in Bangladesh are poor, live in not penetrated the rural market at any scale, and rural areas, and rely on solid biomass fuels. They remains unaffordable to many even in urban areas. are consistently exposed to polluted indoor air due Only 0.3 percent of rural households nationally to traditional cooking practices. Fuelwood accounts use it (included under “Others� in Figure 1.1). Figure 1.1 Energy Use and Expenditures in Rural Bangladesh, 2004 % Average Energy Use % Average Energy Expenditures (Including Imputed Collection Values) Kerosene Electricity Non-grid electricity Others 2% 1% Others 3% 1% 0.3% Grid electricity Dung 10% 17% Kerosene 12% Firewood Firewood 44% 38% Crop residue Dung 21% 14% Crop residue Tree leaves 13% Tree leaves 15% 9% Source: Asaduzzaman, Barnes, and Khandakar 2007. 4 | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 Figure 1.2 Factors Contributing to Environmental Health Risks Agro-industrial Arsenicosis toxic waste 2% 2% Indoor air pollu�on Lack of safe water 34% and sanita�on 54% Urban air pollu�on 8% Source: World Bank 2006. Kerosene, however, is available even in rural areas, Economic losses associated with environmental risk and is used by 97 percent of the rural population, factors, such as polluted indoor air and poor water but only accounts for about 2 percent of the energy and sanitation, are estimated to be more than consumed. Prices are regulated, but the continued 4 percent of gross domestic product (GDP), and widespread reliance on biomass indicates that reduced exposure to environmental health risks affordability remains an issue. Figure 1.1 again could result in savings equivalent to 3.5 percent of illustrates this; although liquid petroleum gas and GDP (World Bank 2006). These factors combine to kerosene are used by so few households, they underline the importance and urgency of investing account for 13 percent of the energy expenditure. in cleaner, more efficient cooking technologies. As a result of international oil price increases, Over the past decade, Bangladesh has achieved households are becoming increasingly reliant on annual economic growth rates of 4–5 percent lower-grade biomass fuels, including unprocessed and reduction in population growth rate from agricultural residue and cow dung. Rises in 2.5 percent in the 1980s to 1.7 percent since international commodity prices (including food and 1990. The per capita GDP growth rate increased to fuel) can have a disproportionately adverse impact 3.7 percent in 2004, from a rate of 2.5 percent in on the poverty of the population (World Bank 2008). the 1980s. The country is on target to meet many Moves such as this down the energy ladder tend to of the Millennium Development Goals, notably for result in exposure to even higher levels of indoor infant and child mortality rates. However, despite air pollution. In Bangladesh, the estimated top five these achievements, recent studies have found that causes of disease burden due to environmental environmental health risks contribute significantly factors (Figure 1.2) include indoor air pollution. to the national burden of disease, with respiratory Indoor Air Pollution in Bangladesh | 5 Table 1.1 Bangladesh: Share of DALYs Lost by Cause and Environmental Factor Cause % Environmental factor Share of cause (%) Share of total (%) Respiratory infections 17 Indoor air pollution 30–50 5–8 and diseases Urban air pollution Perinatal causes 14 Not applicable – – Diarrheal disease 1 Low access to safe water, poor 80–90 10–11 sanitation and hygiene Injuries 11.5 Not applicable – – Nutrition/endocrine 10 Not applicable – – Malignant neoplasms  Agro-industrial toxics 5–25 0.1–0.5 Other 33.5 Arsenicosis – 0.3–0.4 Total 100 – 16.4–21.9 Source: World Bank 2006. Note: Disability-adjusted life years (DALYs) reflect a combination of the number of years lost from early deaths and fractional years lost when a person is disabled by illness or injury. infections and diseases from indoor air pollution national Renewable Energy Policy introduced by contributing to as high as 8 percent of disability- the government of Bangladesh. The new policy adjusted life years (DALYs) (Table 1.1). endorses creating an enabling environment for renewable energy technologies (Government of With Bangladesh’s largely rural population Bangladesh 2009). (85 percent of the total 140 million) and high poverty levels (36 percent of the people live on less than US$ 1 per day), the challenge of addressing indoor air Clean Energy Initiatives in pollution exposure is a daunting but important task. Bangladesh Current epidemiological understanding suggests that Bangladesh’s efforts to attain the health-related In Bangladesh, programs to address household energy Millennium Development Goals will significantly and indoor air pollution have been implemented strengthen if indoor air pollution is addressed. by various government, nongovernmental, and international organizations since the 1970s. The Mitigating indoor air pollution through improved development and promotion of improved cookstoves cookstoves offers great advantages in terms of and biogas in Bangladesh can be divided into three reductions in mortality and morbidity, as well as stages. increased economic savings. In addition to the direct health consequences of indoor air pollution, During the 1970s and early 1980s research and other benefits include reduced environmental development for efficient energy usage was started impacts due to lower fuel consumption, reduced to save trees and the environment. The Bangladesh time and financial burden of wood collection and Council of Scientific and Industrial Research purchase, reduced time savings from cooking, (BCSIR) mainly led this work. It developed and and reduced injuries arising from carrying heavy piloted different models of improved cookstoves loads. The overall benefits can lead to greater rural and biodigesters. In 1972 the first demonstration productivity and a better quality of life for many biogas plant was established at the Bangladesh of the rural poor. This is in line with the recent Agricultural University, Mymensingh campus, and 6 | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 1976 saw the establishment of the first biogas pollution. Some experts in Bangladesh suggest that plant at BCSIR. just a few percent of these stoves installed under the government program are still in use, though no one is The late 1980s and 1990s saw a marked shift away sure. Even if the number in use was known, because from saving trees to saving people’s lives and limited testing of the stoves was undertaken – improving health and welfare through programs particularly with respect to indoor air pollution – the led by BCSIR and the Local Government Engineering impact of the stoves could still remain unknown. Department (LGED) that disseminated improved cookstoves and biodigesters to thousands of The Ministry of Power, Energy and Mineral households throughout the country. These Resources of the government of Bangladesh programs were supported by local governments recently introduced its first Renewable Energy and to some extent by NGOs and community groups Policy (Government of Bangladesh 2009). The and focused on gender issues related to cooking policy endorses creating an enabling environment and fuel collection. for renewable energy technologies and supports attempts to stimulate market development for In the past few years the focus of household energy improved cookstoves. The objectives of the policy programs has progressively shifted away from are summarized in Box 1.1. grant assistance to commercial approaches. This has led to increased marketing and promotion of improved cookstoves and biogas by NGOs, Objectives of this Review private entrepreneurs, and microfinance providers. The goal of this study is to explore options for Agencies such as the Infrastructure Development improving cookstoves in Bangladesh through an Company Limited (IDCOL) and German Technical evaluation of existing programs, the international Cooperation (GTZ), and NGOs such as the Village experience on improved stoves, and the lessons from Education Resource Center (VERC), are now successful interventions of the sanitation sector. the main organizations promoting improved After all, one of Bangladesh’s greatest development cookstoves, biogas, and solar home systems in successes has been to achieve near total sanitation, Bangladesh. The recently introduced Renewable which has promising synergies with the household Energy Policy will further fuel attempts to stimulate energy sector (Table 1.2). The lessons from the Total market development for improved cookstoves Sanitation Campaign and other successful improved (Government of Bangladesh 2009). cookstove approaches employed around the world provide insights for making recommendations for Despite an increased interest in promoting the use an improved stove program in Bangladesh. of clean household energy options to decrease indoor air pollution, progress to date is far from More specifically, the purpose of this review is to meeting the needs of the people. Although about identify service delivery methods, technologies, 130 million people in Bangladesh are exposed to and financing approaches that may be suitable high levels of smoke from the burning of biomass, for large-scale improved cookstove programs for sustainable indoor air pollution mitigation. This only about 300,000 improved cookstoves and report documents the approaches taken and slightly over 26,000 biogas plants have been presents the key findings on emerging lessons. It installed. Furthermore, in the absence of a proper concludes with a series of recommendations. system for long-term monitoring of the many improved cookstove units that have been produced This report is intended for household energy it is unclear how many of these are still operational, researchers and development professionals involved much less having an impact on reducing indoor air in project development and policy formulation. Indoor Air Pollution in Bangladesh | 7 Box 1.1 Bangladesh’s Renewable Energy Policy Objectives The objectives of the Renewable Energy Policy in the context of cookstoves are to: � Harness the potential of renewable energy resources and dissemination of renewable energy technologies in rural, peri-urban, and urban areas; � Enable, encourage, and facilitate both public and private sector investment in renewable energy projects; � Develop sustainable energy supplies to substitute indigenous nonrenewable energy supplies; � Promote appropriate, efficient, and environment-friendly use of renewable energy; � Carry out training and facilitate the use of renewable energy at every level of energy usage; � Create an enabling environment and legal support to encourage the use of renewable energy; � Promote development of local technology in the field of renewable energy; � Promote clean energy in the context of the Clean Development Mechanism; � Set policy targets for developing renewable energy resources. Table 1.2 Synergies between Energy and Sanitation Sectors Energy Sanitation Women and children are responsible for fuel Women and children lack privacy and safety with regard collection and are most exposed to polluted to sanitation practices if they defecate in the open. indoor air. Lack of awareness of health risks due to exposure to Lack of awareness of health risks due to poor sanitation. polluted indoor air. Most households use low-grade biomass fuel and The poor lack access to and information on good are most in need of cleaner fuels and efficient sanitation approaches and suffer from diarrheal diseases. cookstoves. Energy technologies should be appropriately priced, Sanitation facilities should be appropriately priced, effective and sustainable to be acceptable to even effective and sustainable to be acceptable to the poorest the poorest households. households. Structure of the Report The lessons from various programs are at the center of this report and its recommendations. This report begins by describing, in this chapter, Thus, the subsequent three chapters present the background to indoor air pollution in lessons from similar programs both in Bangladesh Bangladesh, and the rationale for the review that and around the world. They include biomass led to this report. The next chapter outlines the or household energy programs in Bangladesh, methodology used for the review work, and the cookstove programs implemented in Asia, East breadth of projects considered. A description of Africa, and Central America, and the sanitation six household energy programs in Bangladesh, program in Bangladesh. The report concludes with including improved cookstove, biogas, and solar a summary of household energy and improved energy initiatives, is the subject of chapter 3. stove recommendations for Bangladesh.  | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 Review Methodology S trategies for addressing indoor air pollution 2007 to select programs for more detailed review. and adaptation of cleaner technologies to The rapid review process included consultations reduce the health toll in Bangladesh must with Dhaka-based program offices and a literature draw on lessons from best practices in the field. review where possible. The programs selected in To this effect a range of renewable household the sanitation sector are listed in Appendix 2. The energy and sanitation programs in Bangladesh, and programs had a special emphasis on a participatory international improved cookstove programs, were approach and used methodologies such as reviewed to identify their key features or innovative community-managed and demand-driven initiatives. approaches that could be used to inform a future improved cookstove program. Detailed Review The study consisted of two components: reviews The detailed review involved focus group discussions; of household energy and sanitation programs in key informant interviews with stakeholders, Bangladesh, and reviews of international improved including entrepreneurs, local government officials, cookstove programs. Winrock International and LGED engineers, and local leaders; case studies VERC undertook the reviews, with Winrock focusing of user and nonuser households; semistructured on renewable household energy programs in interviews; household-level surveys; and thematic Bangladesh and international improved cookstove round tables based on key aspects. Desk studies and programs, and VERC focusing on sanitation literature reviews were also carried out. Appendix programs in Bangladesh. 1 presents a summary of literature reviewed for The review was undertaken in two phases: health-related information on indoor air pollution. (a) rapid review of household energy and sanitation Information was collected on the following key programs; and (b) detailed review of key programs aspects: identified during the rapid review, culminating in � Institutional arrangements: exploring the the consolidation of the findings presented in this service delivery mechanism to identify report (Figure 2.1). key constraints and incentives, role of A rapid review of major initiatives in the household stakeholders, and inclusiveness with regard energy and sanitation sectors was undertaken in late to very poor households; Review Methodology | 9 Figure 2.1 Review Process SANITATION Rapid Review: Detailed Review: Output: • List programs • Selec�on criteria • Watsan review • List aspects of interest • Selec�on of programs • What can be applied to • Overview of each program • Review by sub-teams IAP pilot model? Consolida�on of review Survey instrument outputs and report HOUSEHOLD ENERGY Rapid Review: Detailed Review: Output: • List programs • Selec�on criteria • Energy review • List aspects of interest • Selec�on of programs • What can be applied to • Overview of each program • Review by sub-teams IAP pilot model? � Awareness and motivation: exploring programs, three biogas promotion programs, effective, innovative, and participatory and one solar home system program. Two of the approaches to community mobilization; programs were implemented mainly by government � Development and promotion of technologies: agencies, namely BCSIR and LGED; two by IDCOL, a identifying successful approaches to government-owned company; and two by national introducing improved cooking or sanitation and international NGOs. Some of the programs technologies, operation and maintenance were initiated two decades ago, while others were issues, and a monitoring system for user initiated only two to three years ago. feedback and quality control; The study team selected eight sites for fieldwork, � Financial aspects: identifying successful ap- based on consultation with implementing proaches to financing and enterprise devel- organizations, availability of implementation staff, opment, including monitoring mechanisms. and access to program areas. For large programs with multiple implementing partners, such as the The information collected and detailed questions National Domestic Biogas and Manure Program and concerning these issues are set forth in Table 2.1. This the Sustainable Energy for Development Program, method was employed consistently across programs the team visited the sites of comparatively large so that comparisons could be made between them, and small partner organizations to detect any highlighting their similarities and differences. differences in approaches and implementation issues. Information collected during the rapid review Household Energy Programs was verified during these discussions, and key issues Six programs selected for the detailed review identified during the focus group discussions were included three improved cookstove promotion raised and explored further. In all 142 users were 10 | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 Table 2.1 Key Issues and Questions Key issues Key questions Information collection tools Institutional arrangements Institutional setup for What are the key organizations and partners Interview with program implementation involved in this program? implementers and local Building capacity and What is the management structure? government agencies commitment of local What is the role of the local government agencies policy makers and program in promoting the use of improved technologies implementers to promote and practices? intervention Monitoring mechanisms How is monitoring and evaluation undertaken Interview with program during and after the program? implementers Awareness and motivation Awareness of benefits What awareness-raising activities are undertaken Interview with program of household energy to promote improved technologies and practices? implementers technologies How effective are these activities in promoting Focus group discussions the use of improved technologies and practices? Do these activities engage a wide range of stakeholders? Social marketing or Did the program have a specific social marketing Interview with program promotion of improved or promotional component? implementers, technical staff, technologies What messages and materials were developed? entrepreneurs, beneficiaries How were the messages disseminated? Were there synergies with other awareness- raising activities in the area? Development and promotion of technologies Adoption of improved What percentage of households is using the Interview with program technologies and practices improved technologies and practices promoted? implementers Are these households simultaneously using Literature review traditional technologies, such as stoves? Identification and How was the technology identified? Interview with program validation of suitable Was the technology tested in a controlled implementers, technical staff, technology laboratory environment and under real field staff conditions, with internationally accepted Literature review methodology? Did households test the technology and provide feedback? Was the technology adapted to meet local needs? Impact on indoor air What is the measured reduction in PM2.5 and Interview with program pollution carbon monoxide levels due to the use of implementers improved technologies and improved practices? Literature review What are some of the user-reported benefits of Focus group discussions improved indoor air quality? Review Methodology | 11 Key issues Key questions Information collection tools Access to improved What is the mechanism for getting access to Interview with program household renewable improved technologies? implementers energy technologies Is information on improved technologies and practices easily available? Financial aspects Financial and market Does the program include a market development Interview with program systems for improved component for improved technologies? implementers, microcredit staff, energy technologies What are the training needs for developing entrepreneurs enterprise development skills? Focus group discussions What are the criteria for selection of entrepreneurs? Is there special emphasis on engaging women entrepreneurs? How do entrepreneurs get access to finances for their businesses? What are the terms and conditions for loans? Do entrepreneurs have access to microcredit? Product quality control How is product quality maintained? Interview with program mechanism Is product quality tied to loans? implementers, technical staff, entrepreneurs What is the mechanism for providing technical assistance to maintain product quality? User surveys Is there any provision for refresher trainings? What is the plan for quality control beyond the program period? Access to improved What is the mechanism for getting access to Interview with program household renewable improved technologies? implementers energy technologies Is information on improved technologies and practices easily available? consulted during fieldwork, along with 41 other information. The review of country-specific technicians and representatives from organizations. programs focused on the institutional, financial, technological, and community engagement International Programs aspects. Some multicountry indoor air pollution programs, such as GTZ-HERA (Household Energy for The international improved cookstove programs Sustainable Development), were also analyzed. for review were selected based on the availability of information. A detailed review of international Sanitation Programs indoor air pollution programs was based on secondary information obtained through various Four organizations finally selected for the detailed program publications, independent evaluations, review were known to have very good expertise information available on websites, and articles. For in implementing sanitation programs by ensuring some programs, communications with program successful community mobilization towards a desired staff were carried on through e-mails for additional change. During the fieldwork, 45 users of latrines 1 | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 (both male and female) were consulted, in addition � Access of the people in the community to to 56 entrepreneurs and local representatives. basic technology options and skills, and Two focus group discussions were also held with availability of materials at the doorstep; entrepreneurs and users. The organizations have � Level of success. been quite successful in promoting latrines and behavior change by engaging the community using The programs selected for detailed review are listed unorthodox techniques, including engendering a in Table 2.2. sense of embarrassment about prevailing sanitation practices. These are at the heart of the success and Conclusions sustainability of total sanitation. The methodology of this review covers many Assessment aspects of the programs and is fairly comprehensive. The advantage of collecting information on similar The effectiveness of the approaches and scaling-up aspects of programs is that it permits comparisons of processes were assessed based on the following institutions, how the programs were financed, how framework indicators: technologies were developed and disseminated, � Ultimate beneficiary, involvement of and the response of customers to technologies and different stakeholders, aspect of governance their motivation to adopt them. The next chapter and equity, self-financing, and how the considers the most important household energy interventions address the very poor; programs in Bangladesh. Table 2.2 Programs Selected for Detailed Review Program Implementing agency Household energy Dissemination of improved cookstoves BCSIR Sustainable Energy for Development Program: GTZ improved cookstoves component Reduction of exposure to indoor air pollution through Winrock, VERC, and Concern Worldwide Bangladesh household energy and behavioral improvements (indoor air pollution program) Biogas Program BCSIR/LGED National Domestic Biogas and Manure Program IDCOL/Netherlands Development Organization (SNV) Rural Electrification and Renewable Energy Development IDCOL Program Sanitation Water, Sanitation and Hygiene (WASH) Program Bangladesh Rural Advancement Committee (BRAC) Decentralized Integrated Sanitation, Hygiene and World Bank Reform Initiative (DISHARI) Program Community-Led Total Sanitation Program VERC Community WatSan Program supported by NGO Forum Sustainable Energy Development Agency (SEDA) Review Methodology | 13 Household Energy Initiatives in Bangladesh B angladesh is a country in which there have innovation, marketing, and consumer acceptance. been many important household energy The overview of the projects indicates that some initiatives. They have ranged in scale from of them have resulted in hundreds of thousands of small to quite large, but they all contain lessons adopted products, while others have resulted in as for the development of improved cookstove few as hundreds of adoptions. Table 3.1 provides programs for the country. The programs are a synopsis of the programs that are detailed in the reviewed and compared based mostly on their following sections. institutional form, their cost structure, the technology promoted, and the acceptance of those technologies by consumers. BCSIR: Improved Cookstove Program, Phase II Six household energy programs are reviewed using a standard methodology described in the Implemented from 1988 to 2001, this government- previous chapter. The programs include the BCSIR led program had the primary objective of dissemination of improved cookstoves, the GTZ development and dissemination of improved Sustainable Energy for Development Program cookstove models suitable for Bangladesh. (improved cookstoves component), the United States Agency for International Development (USAID)/ Winrock program on reduction of exposure to indoor air pollution through household energy and behavioral improvements, the BCSIR/LGED Biogas Program, the IDCOL National Domestic Biogas and Manure Program, and the IDCOL Rural Electrification and Renewable Energy Development Program. These programs include a range of household energy projects, including cookstove initiatives, a biogas program, and a solar household photovoltaic program. The technologies are different, but they all have to deal with issues such as technology Cookstove models developed by BCSIR. Household Energy Initiatives in Bangladesh | 15 Table 3.1 Overview of Selected Household Energy Programs in Bangladesh National Rural Sustainable USAID/Winrock: Domestic Electrification and BCSIR: Energy for indoor air Biogas and Renewable Energy dissemination Development: pollution Manure Development of improved improved program: BCSIR/LGED: Program: Program: solar Program cookstoves cookstoves cookstoves Biogas Program biogas systems Implementing BCSIR GTZ Winrock, VERC, BCSIR, LGED IDCOL IDCOL agency Concern Worldwide Main partners Ansar-VDP Ministry of Power, Community groups, Union parishads, 23 partner 15 partner Bangladesh Rural Energy and Mineral technicians Department organizations organizations Development Resources (for of Agricultural including Grameen Board policy issues) Extension, Shakti and Srizony 80 partner Department of organizations Livestock Services Funding agency Government of German Federal USAID Government of SNV, KfW World Bank, Global Bangladesh Ministry for Bangladesh, Global Environment Economic Environment Facility, KfW, GTZ, Cooperation and Facility Asian Development Development Bank Duration Phase II: 2004–2010 2005–2007 1988–2003 2006–2009 2002–2012 1988–2001 Geographic Phase II: Countrywide Saidpur and Countrywide 16 districts in Countrywide 16 | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 coverage 28 districts, Dhaka Parbatipur 6 divisions and Rajshahi municipalities of Nilphamari and Dinajpur districts Achievement 300,000 improved 45,000* improved 580 improved 15,000 biogas 9,000 plants 366,000 financed cookstoves installed cookstoves installed cookstoves installed plants constructed built (as of by August 2009 for entire program 2,500 trained 27 entrepreneurs across 9 programs August 2009) Target 1 million (40,000 through trained 3,000+ engineers solar home systems Ansar-VDP and and community by 2012 Bangladesh Rural organizers trained Development Board 250 training courses with over 10,000 trainees National Rural Sustainable USAID/Winrock: Domestic Electrification and BCSIR: Energy for indoor air Biogas and Renewable Energy dissemination Development: pollution Manure Development of improved improved program: BCSIR/LGED: Program: Program: solar Program cookstoves cookstoves cookstoves Biogas Program biogas systems Sustainability Program has not Program is still Some entrepreneurs Good indications Program is still in Good indications sustained except in growing because of have survived and on sustainability implementation on sustainability some areas where financial input from households are still as most plants are phase as most systems entrepreneurs are GTZ using cookstoves and operating provided in the providing services program is slowly early phase of the expanding, which program are in use are good indications for sustainability Technology Six models: 1-pot 3-pot fixed stove 1-pot portable and Household and Two types of Solar home systems portable, 1-pot with chimney 2-pot cookstoves institutional biogas; fixed-dome semisubmerged, 1-pot fixed stove based on BCSIR, fixed and floating biogas plants in 1-pot portable with chimney and “Grihalaxmi� models 6 sizes (for sawdust), (1-pot without 1-pot fixed stove chimney) with chimney, 2-pot household/ institutional fixed with chimney Cost US$ 3–6 US$ 3–15 US$ 2.3–7.4 US$ 186–429 US$ 257–500 US$ 131–956 Subsidy Cost of stove fully No subsidies; No subsidies; loans Subsidies varied Tk 9,000 subsidy Subsidies are subsidized with microcredit as microcredit depending on for all plants provided as buy- households only available, payback available from agency. 50% user down grants of providing soil in installments local microfinance subsidy for plant; EUR 30 and capacity Local capacity institutions Tk 5,000 to farmers; development grant building Tk 5,000 as grant to of EUR 4 collaborating NGOs. Loans at 5% interest Household Energy Initiatives in Bangladesh | 17 National Rural Sustainable USAID/Winrock: Domestic Electrification and BCSIR: Energy for indoor air Biogas and Renewable Energy dissemination Development: pollution Manure Development of improved improved program: BCSIR/LGED: Program: Program: solar Program cookstoves cookstoves cookstoves Biogas Program biogas systems Approach Target-oriented Focus on identifying Focus on enterprise Focus on research Involve the Private sector development and locally acceptable, development to and demonstration private sector working with the dissemination of reliable technology create a market of biogas Quality control government and cookstoves design and for improved technology microfinance developing systems cookstoves Monitoring institutions/NGO Extensive training Dissemination mechanism component for marketing and by developing through its own partners to provide maintenance entrepreneurs is linked to off-grid electricity engineers and channeling of some NGOs in a sustainable and subsidy commercially viable manner Awareness and Extensive training Strengthening Strong emphasis Local community Community Community motivation component partner on community groups and local engagement was engagement was increased organizations mobilization user groups done by partner done by partner awareness capacity to Community were involved organizations organizations implement program management in increasing through community committees for awareness mobilization awareness raising * This figure is current for time of review; in fact the programme has expanded considerably at time of printing of this report. As per personal communication with 1 | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 GTZ, some 230,000 domestic Chulha plus 2,500 commercial stoves have now been installed as on June 2010. Institutional Arrangements responsible for the stove program and provided all necessary support to the program. At sub- The leading organization, BCSIR, received government upazila levels inspectors, technicians, and women funds and worked in extensive coordination with fieldworkers were in direct contact with the users. local government institutions and through several government partners. In total about 300,000 Local capacity building was enhanced by an improved cookstoves were disseminated through extensive training component that included training the BCSIR-led program. For the purposes of this of women fieldworkers. BCSIR trained more than report, BCSIR’s collaboration with two government 10,000 people (including a number of NGOs, local partners – Bangladesh Ansar and Village Defense clubs, unemployed youths, and staff of Ansar-VDP, Party (Ansar-VDP), and the Bangladesh Rural the Bangladesh Rural Development Board, and Development Board – is described. Ansar-VDP is a the Department of Public Health Engineering) in part-time volunteer law enforcement force working 250 training courses. The program did not have at the union and village level with direct linkages with any provision for user training, but users were the villagers. The Bangladesh Rural Development instructed on stove use and maintenance at the Board is under the Ministry of Local Government, time of installation, and given the opportunity Rural Development and Cooperatives and is the to discuss performance and usage issues during largest service-oriented institutional setup of the follow-up visits. government of Bangladesh. It is directly engaged While there was no support for entrepreneurship in rural development and poverty alleviation and development, several trainees, such as the supervisors, works with farmer cooperatives. Ansar-VDP and started their own stove-making businesses after the the Bangladesh Rural Development Board provided program ended in 2001. Program monitoring was field-level supervisors and trained fieldworkers for program-led through staff and partner organizations. motivating households and providing training to Monitoring was carried out with the help of the adopt improved cookstoves. The supervisors and upazila rural development officers. fieldworkers were on BCSIR’s payroll and received a minimal remuneration of Tk 10–20 per stove Awareness and Motivation from the households. Most of the fieldworkers were women, as it is easier for women to gain The extensive training provided through access to households. Ansar-VDP disseminated the program aided awareness raising. Other approximately 25,000 improved cookstoves3 and the Bangladesh Rural Development Board disseminated approximately 15,000–16,000 improved cookstoves4 through its extension program. Figure 3.1 shows the institutional arrangements for this program. At the upazila or subdistrict level, the team coordinated with district-level Ansar-VDP and BCSIR staff for monitoring program activities. At the upazila level, the supervisors of the Bangladesh Rural Development Board credit program were 3 Discussion with Mr. Shah Alam, Deputy Director, Ansar-VDP, Dhaka, September 2007. 4 Discussion with Mr. Rafiqul Islam, Deputy Director, Bangladesh Rural Development Board, Dhaka, September 2007. Household Energy Initiatives in Bangladesh | 19 Figure 3.1 Institutional Diagram: BCSIR Improved Cookstove Program GoB Funds BCSIR Ansar/VDP Supervisor District Supervisor BRDB Supervisor Field Officers Upazila Rural Development Officer Field Officers Sub-Upazila inspectors, technicians, women �eld workers HOUSEHOLDS Feedback on ICS design Monitoring and evalua on awareness-raising activities included local Development and Promotion of demonstrations, display centers, seminars, and Technologies radio and television spots. Local government institution representatives were encouraged to BCSIR developed and promoted (a) one-pot portable attend local demonstrations and upazila-level cookstoves; (b) one-pot semisubmerged stoves; (c) seminars. Being a government program, it received one-pot portable stoves for use with sawdust or rice special rates from the government’s media outlets husk; (d) one-pot fixed stove with chimney; (e) two- (Bangladesh Television and Bangladesh Betar pot fixed household-sized stoves with chimney; and Radio), through which a number of advertisements (f) two-pot fixed institutional stoves with chimney. and short films on improved cookstoves were Entrepreneurs, users, and other programs later disseminated. These advertisements created such modified these designs to suit local conditions. a high level of awareness that the program teams Ten in-house scientists of BCSIR carried out were inundated with requests for cookstoves. random sampling of improved stoves to test for performance. In addition, the improved cookstoves The survey team found while visiting one of the installed were listed and monitored on a monthly thana supervisors under the project in Natore basis. The performance efficiency for BCSIR district that a number of former program employees stoves was reported to be 25–28 percent (Khan had launched their own improved cookstove 2000), which reduced fuel consumption by over businesses and developed their own strategies 50 percent (Table 3.2). (including posters, demonstrations, liaising with sanitation workers) to raise awareness and to User surveys revealed that key usability issues continue to utilize the networks established by the were uncertainty about post-warranty service, lack BCSIR program to market their products. of raw materials such as fuelwood, and technical 0 | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 Table 3.2 BCSIR Stove Performance Data Fuel Carbon Carbon Stove type Efficiencya consumption monoxide %b dioxide % Saving % Improved one-pot stove 25% 1.35 kg (85 min) < 1.0 – 55 Improved two-pot stove % 1.2 kg (75 min) < 1.0 – 58.3 Traditional stove 13% 3.0 kg (90 min) 0.24 2.95 Baseline a. Efficiency values (rounded off) are based on the numbers reported in Khan 2000. b.The concentration of carbon monoxide emission in traditional stove, improved one-pot, and improved two-pot stove with chimney could not be measured as values were less than 1 percent and below the measuring range of the equipment used. difficulties such as blocked chimneys and air inlets. mud and materials, but the technicians’ fees were According to the user surveys, households changed provided from the program. Fieldworkers received stove dimensions during maintenance and, in the following fees for stoves constructed: some cases, made significant changes to stove � One-pot portable improved stove: Tk 50 dimensions, such as attaching an additional pot (US$ 0.74); hole to a two-pot stove to convert it into a three- pot stove. This is actually quite a common feature � Two-pot fixed improved stove with chimney: of low-cost stoves in other programs around the Tk 100 (US$ 1.50); world. Custom-made stoves are made from local � Two-pot fixed institutional improved stove materials, and women are used to making their with chimney: Tk 500 (US$ 7.35). own stoves, so they have no problem altering these stoves to make them more convenient for their The cookstove program was not channeled through cooking needs. This unfortunately leads to lower the credit program of the Bangladesh Rural performance in efficiency and smoke removal. Development Board because the cost of the stoves was too low at Tk 200 (US$ 3) to Tk 400 (US$ 6). Financial Aspects The program was government funded and lacked GTZ: Sustainable Energy a commercial approach. It offered direct subsidies, for Development Program: with a focus on reaching a predetermined Improved Cookstoves number of households. The program provided direct subsidy to households in the form of an Component installation fee. Indirect subsidy was in the form The Sustainable Energy for Development Program of program overhead costs (for example staff cost has been implemented by GTZ (2004–2010) with the and training). No subsidies were provided for any objective to promote improved cookstoves through stoves constructed after the program period. a commercial, sustainable approach. The program has focused efforts on identifying locally acceptable The program-appointed supervisor at upazila level and reliable technology and design, and developing managed a number of trained technicians who systems for marketing and maintenance. installed improved cookstoves in households for a fee. The program provided free molds, accessories, Institutional Arrangements and technicians’ fees for the first 200 households, who only had to supply mud for construction. For The GTZ Sustainable Energy for Development the rest of the stoves, the households provided Program supports 80 partner organizations, mainly Household Energy Initiatives in Bangladesh | 1 NGOs, as primary players in promoting three cookstove users did not receive training for using models of improved stoves throughout Bangladesh. the technology; instead they learnt by observing Partner organizations are in direct contact with their neighbors use improved cookstoves. GTZ the consumers and have a strong community has trained both men and women, but has found presence or microcredit operations through which that the men tend to go on to build more stoves, the improved stoves can be channeled to the while women tend to stop after constructing households. Figure 3.2 shows the institutional one in their home, because it is more difficult for arrangements for this program. women to travel long distances and offer technical assistance in a timely fashion. This is likely to be GTZ receives financial and policy support from the due to pervading cultural norms in Bangladesh. The German Federal Ministry for Economic Cooperation partner organizations now specifically select only and Development and the government of male technicians and entrepreneurs. Bangladesh (Ministry of Power, Energy and Mineral Resources), respectively. It supports its partner Program monitoring is led by partner organizations organizations and manufacturers in finance, and coordinated by GTZ. Currently partner training, and business development areas. These organizations, such as Palli Shakti and Grameen in turn provide finance, training, installation, and Shakti, use staff for program monitoring during after-sales support to the end user. loan collection visits (see below). Monitoring is sometimes tied in with payment collection visits Training is a key component of the GTZ program. It to those households that took loans to pay for the is needs based and provided through the partner stoves. This has been found to be a successful way organizations. GTZ has trained about 2,500 people, to build accountability into a cookstove program. including stove technicians, NGO workers and private entrepreneurs,5 who have constructed more Awareness and Motivation than 45,000 improved cookstoves to date.6 Partner organizations also engage local masons and other The program does not promote any specific interested persons to impart training on cookstove community engagement strategy, though it has construction, business development, and marketing produced posters and leaflets that it distributes to techniques. These people receive financial support its partner organizations. For example, site visits from GTZ, via the partner organizations, to set up cookstove construction or accessory businesses. The training is followed by local exhibitions at which local stakeholders, including local government representatives such as union chairpersons and members, participate. Training of users is the responsibility of the partner organizations concerned and is usually imparted after stove construction. It was observed that most 5 Potential entrepreneurs are required to have an education of at least grade 3–4 and potential trainers are required to have an edu- cation of at least grade 10–12 (discussion with Dr. Khaliquzzaman and Mr. Otto Gomm, German Technical Cooperation (GTZ), Dhaka, September 2007 and January 2008). 6 German Technical Cooperation (GTZ) Sustainable Energy for Development Program: The Killer in the Kitchen (http://www.lged- rein.org/archive_file/killerinthekitchen.pdf). Three pot improved cookstove promoted by GTZ.  | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 Figure 3.2 Institutional Diagram: GTZ Sustainable Energy for Development Program German Federal Ministry of Economic Coopera�on & Financial support Development Monitoring Financing Financing 80 Partner Training Training organiza�ons GTZ Installa�on Consumers and manufacturers Business development A�er-sales service Policy support Government of Bangladesh, Awareness raising Ministry of Power Energy & Mineral Resources showed that one partner organization, Palli Shakti, dissemination is cost-effective. Currently, GTZ is does not employ a specific community engagement supporting promotional activities by organizing approach. Instead it undertakes awareness local exhibitions and fairs for renewable energy activities that include door-to-door marketing, technologies, including improved cookstoves. distribution of leaflets and posters, and discussions with local leaders, such as union parishad members Development and Promotion of and local entrepreneurs. Grameen Shakti, another Technologies partner organization, relies on its local staff to GTZ is promoting a three-pot fixed stove with identify households that are willing to purchase a chimney, based on an earlier design from BCSIR. It is cookstove. Staff receive monthly targets for sales also promoting a one-pot fixed stove with a chimney. and disseminate information about cookstoves, Testing for efficiency and carbon monoxide emissions primarily through door-to-door marketing and by GTZ has been limited. Of the 10,000 stoves that distribution of leaflets and posters developed by GTZ has disseminated, preliminary assessment of GTZ and Grameen Shakti. only one three-pot stove with chimney has been Local government institutions participate in the conducted. This model was found to be 26–27 training aspects of the community and preside percent efficient (compared to 5–15 percent for over the training certificate ceremony. Partner traditional stoves) and saved 50–60 percent fuel. organizations are encouraged to undertake User surveys revealed usability issues such as lack community mobilization activities that are most of raw materials, technical problems (blocked appropriate for local conditions to ensure that chimneys and air inlets, as with the BCSIR program), target communities accept messages and that and uncertainty about post-warranty service. Users Household Energy Initiatives in Bangladesh | 23 reported that chimneys were difficult to install in a � Support for training and promotion: Tk traditional kitchen and if they were of poor quality 405,700 (US$ 5,966). they accumulated more dust and soot, resulting in frequent clogging. USAID: Reduction of Financial Aspects Exposure to Indoor Air The stoves promoted by this program ranged from Pollution through Household Tk 200 to 1,000 (US$ 3 to 15). Palli Shakti is selling Energy and Behavioral two varieties of the three-pot type – mud only for Improvements Tk 700 and a mud-brick for Tk 1,000 (US$ 15). No This program was implemented in the northwest direct subsidies are provided to users. GTZ allows of Bangladesh from 2005 to 2007 with the main its partner organizations to formulate financing objectives of increasing awareness of indoor air mechanisms for selling the improved cookstoves. pollution; changing household energy behavior; and The partner organizations use existing microcredit promoting and developing a commercial market mechanisms to channel funds. However, because for improved cookstoves and entrepreneurs. The the cost of the stove is low compared to the amount program disseminated 580 improved cookstoves. A of credit that is normally given for other programs, number of studies were also completed alongside the payback period is very short, usually six months. the program. Most partner organizations also allow payment in installments. Palli Shakti charges 10 percent interest Institutional Arrangements and allows payments in three installments. Due to Winrock International, VERC, and Concern Worldwide the small amount of credit required for improved Bangladesh jointly implemented this USAID-funded cookstoves, Grameen Shakti offers the loans in project. VERC led the technology component of the two installments. Fieldworkers have indicated that program. Concern Worldwide developed behavior most households can afford to pay for the improved change messages and disseminated these messages cookstoves without taking credit. The one-pot through health volunteers, ward health committees, cookstove that GTZ has started disseminating may and municipal governments. The Appropriate not require any financing mechanism as, at Tk 200 Rural Technology Institute (India) collaborated (US$ 3), it should be within the purchasing ability with Winrock and VERC and undertook improved of poor rural households. However, for very poor cookstove testing. Local municipal authorities were families, the cost can be too high to pay at once. engaged for awareness raising, and members of the As an example, the total financial support provided government’s network of health volunteers were by GTZ to Palli Shakti is Tk 700,700 (US$ 10,304), trained to promote behavior change messages for primarily for the following activities: indoor air pollution reduction and use of improved cookstoves. Figure 3.3 shows the institutional � Support for a chimney and grate manufacturing arrangements for this program. facility: Tk 95,000 (US$ 1,397); Several types of training were offered, such as � Working (seed) capital for installation of cookstove construction, enterprise development, commercial improved cookstoves: Tk 50,000 leadership and management, and kitchen (US$ 735); improvement. Thirty health volunteers were also � Working capital for installation of domestic trained in behavior change communication and improved cookstoves: Tk 150,000 (US$ 2,206); awareness-raising techniques. The users did not 24 | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 Figure 3.3 Institutional Diagram: USAID Reduction in Indoor Air Pollution Program USAID Concern Worldwide Winrock VERC Orienta�on Marke�ng materials ARTI Folk song/drama Health volunteers Tes�ng Improved cookstoves Stakeholder mobiliza�on/ Training Entrepreneurs Local governments Community Awareness raising management Kitchen improvement Improved cookstoves Installa�on and a�er Awareness raising Monitoring Monitoring sales Households/Consumers receive any training on stove construction and and (c) retail entrepreneurs, who sold improved maintenance, although catalysts, entrepreneurs, cookstove components. The program also and program staff shared this information during established a seed fund to provide initial capital to awareness-raising activities. Stakeholders and improved cookstove entrepreneurs. Toward the end entrepreneurs were involved in the monitoring of the program, refresher trainings in enterprise process. development were provided to 20 entrepreneurs Enterprise development was a key component and seven new entrepreneurs. of the program and helped improve stove construction. Trainings were geared towards Awareness and Motivation potential entrepreneurs and “catalysts� – local Concern Worldwide and VERC organized orientation women who were interested in raising indoor air sessions for local government representatives, pollution-related awareness in the initial stages of including ward health committee members, to the program. The program’s approach promoted disseminate information about indoor air pollution, private sector engagement in the manufacture, the benefits of improved cookstoves, and the supply, and installation of improved cookstoves. objectives of the program. Three types of entrepreneurs were supported: (a) manufacturing entrepreneurs, who made The program had a strong emphasis on community improved cookstove components, such as chimneys mobilization. Community-based groups were and grates; (b) installation entrepreneurs, who created and linked with local ward health committees installed improved cookstoves on a turnkey basis; to monitor activities. Local-level health volunteers Household Energy Initiatives in Bangladesh | 25 Development and Promotion of Technologies This program promoted three types of improved cookstoves: one-pot portable and two-pot cookstoves (based on BCSIR models), and the Grihalaxmi, a one-pot stove without a chimney developed from a model from the Appropriate Rural Technology Institute, with a top grate that acts as a flame concentrator and a cast-iron bottom grate. There was a strong focus on identifying stoves that were suitable for the cooking practices of the target community. With technical assistance Community mobilization in an indoor air pollution programme. from the Appropriate Rural Technology Institute, the stoves were tested using controlled cooking disseminated behavior change information. tests, 48-hour monitoring of particulate matter Thirteen community management committees (PM2.5) and carbon monoxide, water boiling tests, formed through a participatory process were and kitchen performance tests, which measured responsible for awareness raising and monitoring fuel use in real households over several days. The improved cookstove construction activities in 48-hour monitoring was conducted for improved their respective areas. These committees held cookstoves that had been in use for at least one weekly meetings where program staff, interested month. The BCSIR stoves decreased PM2.5 in the households, and local leaders gathered to discuss indoor air by 71–85 percent and carbon monoxide program progress and address any issues. by 98–99 percent. However, these results are based on tests conducted on only eight stoves, including From the outset, VERC employed the methodology two traditional stoves. for participatory assessment7 to achieve community buy-in and raise awareness. Other types of Usage issues reported included increased fuelwood awareness-raising activities included courtyard consumption, lower than required positioning of meetings for households; working with a network of the grate, and degeneration of the grate causing health volunteers and members of the community fuel to fall to the bottom of the stove. Issues of management committees; school sessions for stove maintenance included ash accumulation in students and teachers of local schools and colleges; the void beneath the chimney, decrease in chimney and film showings for the community, including diameter due to soot accumulation, and decrease local government representatives (such as ward in the diameter of the air passage from the first to commissioners), health workers, health volunteers, the second pot. and entrepreneurs. The program focused on using locally appropriate media, such as folk songs and Financial Aspects drama. Users, in general, did not make reference to The program promoted three types of improved posters and leaflets during the field study. cookstoves at project-fixed prices – BCSIR one-pot 7 The methodology for participatory assessment (MPA) is a col- portable at Tk 155 (US$ 2.3), BCSIR two-pot at Tk lection of successful participatory tools developed for the World 365–505 (US$ 5.4–7.4), and the Grihalaxmi at Tk 230 Bank’s water supply and sanitation programs. This MPA has been adapted by the Asia Regional Cookstove Program for the house- (US$ 3.4) (Table 3.3). The actual price of the stoves hold energy sector. with installation, particularly the two-pot model with 26 | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 Table 3.3 Price of Improved Cookstoves under USAID/Winrock Indoor Air Pollution Reduction Program Project contribution to Type of cookstove Total cost (Tk) technician fee (Tk) Cost to households (Tk) BCSIR two-pot: Bamboo/thatched roof 485 (US$ 7.1) 120 (US$ 1.8) 365 (US$ 5.4) Metal roof 565 (US$ 8.3) 120 (US$ 1.8) 445 (US$ 6.5) Cement roof 625 (US$ 9.2) 120 (US$ 1.8) 505 (US$ 7.4) BCSIR one-pot portable 245 (US$ 3.6) 90 (US$ 1.3) 155 (US$ 2.3) Grihalaxmi 290 (US$ 4.3) 60 (US$ 0.9) 230 (US$ 3.4) chimney, varied according to the construction material biogas dissemination from 1982 to 2004, resulting of the roof of the house, as a hole had to be made for in more than 21,000 plants installed throughout the chimney. This led to the price of each stove being Bangladesh. In its Biogas Program, BCSIR established based on estimates of local costs and negotiations memoranda of understanding with a number of between the households and the technician. organizations, including NGOs, such as BRAC for monitoring support, and government departments, Some technicians-turned-entrepreneurs sold the including the Department of Agricultural Extension, stoves at a price of Tk 230 (US$ 3.4) in their locality and at higher rates (up to Tk 500 to 600, US$ 7 to the Department of Livestock Services, and LGED for 9) in outside areas. The study team discovered that implementing the Biogas Program. For the purpose many households viewed improved cookstoves of this report the focus of the review is on LGED’s as something distributed free of cost by NGOs, dissemination program. The program, implemented but people were willing to pay very low prices for from 1988 to 2003 with the main objective of improved cookstoves if they had to. research and demonstration of biogas technology, constructed 22,100 biogas plants. The majority of program households were already taking loans as microcredit from local microfinance Institutional Arrangements institutions for various uses. Therefore, the program The union parishads, the Department of Public partnered with some of these NGOs and institutions Health Engineering, the Department of Agricultural involved in lending to provide orientation on indoor Extension, and LGED were involved in program air pollution and improved cookstoves to loan officers implementation. Through memoranda of from the NGOs and encourage them to provide an understanding, BCSIR trained a large number of additional loan of a maximum Tk 1,000 (US$ 15) for the purchase of improved cookstoves along with people in biogas plant construction, which helped some kitchen improvements, where needed. raise awareness about the project. Figure 3.4 shows the institutional arrangements for this program. BCSIR/LGED: Biogas The Department of Agricultural Extension supported the program by advising households on Program animal husbandry (the manure from which would BCSIR initiated its biogas research and development provide feedstock for the biogas plants); funding activities in the mid 1970s and implemented a motivational activities and awareness raising three-phase Biogas Pilot Plant Program to promote targeted at farmers; assisting in identifying potential Household Energy Initiatives in Bangladesh | 27 Figure 3.4 Institutional Diagram: BCSIR/LGED Biogas Program GoB Funds BCSIR MoU MoU Training Conveyance Agencies (50) DAE, Masons Na�onal banks Feedback on DLS, NGOs, UP, LGED So� loans Monitoring biogas plant Awareness raising Installa�on implementa�on HOUSEHOLDS biogas households and following up on the biogas staff and masons. Over 12,000 local-level engineers, activities of upazila agriculture officers and block community organizers, and masons were trained in supervisors; participating in the monthly meetings biogas construction, use, and maintenance from of the biogas project; and conveying decisions to 1996 to 2003. More than 3,000 users were also the upazila agriculture officers. The Department trained, but not in biogas plant maintenance. of Livestock Services was responsible for attending Following a program-led monitoring scheme, biogas coordination committee meetings and BCSIR/LGED employed engineers in every district circulating the biogas project decisions to the for monitoring plants and providing troubleshooting district livestock officer and upazila livestock officer services. Microfinance agencies, which linked to assist with biogas project implementation. The financing services to the households (see below), program agencies coordinated extensively with the helped improve the monitoring mechanism, as local government, which assisted with the program households paid the installments only if the plant through the Upazila Development Coordination was operating properly, necessitating service Committee. The Committee disseminated providers to provide continuous follow-up. information and expertise on biogas, helped identify potential biogas customers (primarily Awareness and Motivation farmers), provided administrative support for proper program implementation, and monitored The program engaged local community groups, in particular a community-based poultry association, the activities of gas stove manufacturers. to create demand for biogas among poultry The program did not have an entrepreneurship farm owners. The focus on poultry was based development focus; however, there was an on a supply chain assessment that revealed that important training component on biogas plant poultry droppings were an important raw material construction, use, and maintenance. Through a for biogas plants. Local leaders, particularly high memorandum of understanding between LGED and school principals, also advocated biogas in their BCSIR, BCSIR assisted with capacity building of LGED communities and disseminated information on the  | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 benefits of biogas. The program also involved local user groups, specifically LGED water management groups at the union level, to reach households. This approach was less costly and more locally appropriate to reaching households and is an example of using existing structures for little additional cost. As a government program, it received special rates from the government’s media outlets (Bangladesh Television and Bangladesh Betar Radio) for advertisements and short films on improved cookstove and biogas technologies. The strong training component of the program also led to local awareness-raising and capacity-building activities. Development and Promotion of The review team heard frequent complaints about masons not using good-quality raw materials during Technologies plant construction, issues with plant dimensions, Fixed-dome biogas plants were typically used in and technical problems, such as the cow dung not the program (Ghimire 2005), though the floating passing into the digester and frequent breakdown model was also promoted. Locally manufactured of the mixing device. After-sales support was not metal-framed gas stoves and lamps, popularly adequate in these instances, and households known as “hajak�, were used for cooking and stopped paying their monthly installments. Some lighting, respectively, using biogas. These also sold off their cows due to financial problems appliances were supplied by BCSIR. (for example, parts of Cholna village in Narsingdi district were affected by floods that left many Stakeholders interviewed during this study households short of cash). reported that the BCSIR/LGED models were not as efficient as the IDCOL/SNV models. Key drawbacks Trained local masons continue to provide after- of biogas technology included uncertainties about sales service to households, although they are no post-warranty services; high initial costs; technical longer associated with the program. Plant owners difficulties; and lack of feedstock given the general also contacted masons from other districts for reduction in the number of domestic animals, troubleshooting purposes. Although some poultry particularly cows. Inadequate gas production farms have closed, the local poultry association was one of the most common problems facing has continued to help households identify other biogas users. As a result of inadequate gas supply, sources of feedstock (cow dung and poultry waste households often resorted to using traditional from neighboring households). cookstoves to meet their cooking needs. Financial Aspects 8 Several different designs for biogas systems have been developed The LGED program was government funded, with and promoted in Bangladesh. The BCSIR biogas plant design was initially based on the Indian floating dome model. However, this strong support from the Ministry of Science and model developed problems and, over time, BCSIR/LGED made Technology and the Ministry of Local Government. some changes to its biogas plant design to suit the Bangladesh environment, for example having flexibility in the type of inlet and The plant cost was Tk 13,000–30,000 (US$ 186– outlet pipes. 429) depending on the size. Biogas plants were Household Energy Initiatives in Bangladesh | 29 promoted under a number of different programs, biogas in rural areas and establish a sustainable including the Sustainable Rural Energy Program. and commercial biogas sector in Bangladesh. The Biogas plants require a much higher investment program had built 9,000 plants as of August 2009. from the user and thus most programs provided some subsidy as well as linkages to financing. Institutional Arrangements Subsidies provided varied widely from a 50 percent The National Domestic Biogas and Manure user subsidy, to Tk 5,000 per plant for farmers to Program had a semigovernmental structure that motivate them. An additional Tk 5,000 was given to collaborating NGOs as a grant. took advantage of government, NGO, and private sector leverages. IDCOL worked with 23 partner The plants constructed under the Sustainable Rural organizations, which included construction partners, Energy Program were partially subsidized by LGED, lending partners, and manufacturing partners. which engaged seven NGOs in the program’s later The Biogas Steering Committee, comprising stove stages. Organizations such as Grameen Shakti and scientists and representatives from several relevant Save Our Urban Life (SOUL) installed plants and ministries, played an important role by approving also linked financing services to the households. partner organizations and annual plans and This not only made it easier for users to install the establishing standards for biogas plants and their biogas plants, but also improved the monitoring components. Figure 3.5 shows the institutional mechanism (see above). Focus group discussions arrangements for this program. among users revealed that providing loans for purchase of cattle to increase biogas production SNV provided technical assistance for establishing would have been appreciated. quality control procedures; developing standards for biogas plants, training curricula, and materials; The LGED biogas activities had a small bio slurry and providing assistance to slurry extension development component and farmers could obtain activities. IDCOL/SNV ensured that the construction loans from the local national bank, Sonali Bank, partners (the main point of contact for customers) at 5 percent interest (flat rate) repaid in monthly were constructing the plants as per specification, installments over seven years. The loan size ranged and verified the plant on site if necessary. from Tk 15,000–20,000 (US$ 220–294) per plant. Bio slurry was promoted as organic fertilizer with The lending partners provided microfinance to the support of the local government and had households, channeled grants from IDCOL, and considerable demand from tobacco growers. The were responsible for identifying participating dried slurry sold for Tk 300 (US$ 4.4) per 50 kg bag. households, approving the required amount of credit, verifying plant construction against the established standards, providing recommendations IDCOL/SNV: National for construction, and regularly reporting to IDCOL Domestic Biogas and on loan disbursement. Manufacturing partners Manure Program produced gas stoves and other accessories. The National Domestic Biogas and Manure Union parishads were primarily engaged in awareness Program, the largest biogas promotion program in raising, and local government representatives Bangladesh, was implemented from 2006 to 2009 attended local demonstrations and workshops. by IDCOL with financial and technical support from More than 2,000 people were trained, including the Netherlands Development Organization (SNV) masons, supervisors, managers of the partner and Kreditanstalt für Wiederaufbau (KfW). Its organization field offices, and users. Approximately objective was to develop and disseminate domestic 50 percent of the trainees were users. Refresher 30 | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 Figure 3.5 Institutional Diagram: National Domestic Biogas and Manure Program Government of Bangladesh SNV/KfW IDCOL Financial and technical assistance IDCOL Board Biogas Steering Commi�ee Biogas program offices Lending partners Tk 9,000 subsidy Manufacturing partners Construc�on partners Biogas households trainings and training of trainers were unique to the program supplying posters and leaflets, and program and were highly valued. advertising through the media. The study team visited selected field sites of partner organizations The program had a multilevel monitoring system SOUL, based in Narsingdi district, and Grameen whereby the Biogas Steering Committee and Shakti, in Natore district. The team found that local partner organizations monitored progress. Partner SOUL staff persons were directly promoting biogas organizations only received a grant when a household signed off on proper construction and technology. For awareness raising, Grameen staff installation of the technologies and IDCOL staff and made house-to-house visits and advertised in local the biogas program office had verified the installation. newspapers. Trained engineers advised households The program’s Biogas Steering Committee was on what type of biogas plants to acquire based responsible for monitoring overall program progress on the cooking needs of the households and the and reports to the IDCOL Board. Day-to-day number of domestic animals (cows) available. monitoring was done by the partner organizations User surveys indicated that over 46 percent of users that sold and installed the biogas systems. They learnt about biogas plants through word of mouth ensured that plants were of high quality as per from their relatives and neighbors, 18 percent got the program’s plan and that all stakeholders were information from the media (radio and television), performing their roles as per the agreement. and 12 percent from print material such as leaflets and booklets. User training had a focus on women Awareness and Motivation (of the 900 users trained, a third were women). Community engagement was the responsibility There was an opportunity for those women to be of individual partner organizations, with the employed by partner organizations, as the National Household Energy Initiatives in Bangladesh | 31 Domestic Biogas and Manure Program was planning 5 percent of biogas plants constructed under the to incorporate user training with an emphasis on National Domestic Biogas and Manure Program to training local women who could play the role of break down, according to a 2008 user survey. motivators and also be engaged as biogas masons. Financial Aspects Development and Promotion of The cost of a biogas plant was Tk 18,000–35,000 Technologies (US$ 257–500). IDCOL provided Tk 9,000 (US$ 130) IDCOL was promoting, at the time of this survey, fixed- as a one-time plant investment subsidy to dome biogas plants. The program had standardized households. Households could pay the remaining its biodigester designs and established a system amount in cash. Alternatively, households could for entrepreneur development and design and also take a microcredit loan from the lending and installation quality control. Stakeholders reported construction partner organizations at 10–12 percent that the IDCOL/SNV models were more efficient interest rate and for a maximum period of two years than the BCSIR models. However, lack of flexibility by paying a minimum 15 percent of plant cost (after in design (for example the requirement that the subsidy) as down payment. About 65 percent of inlet, digester, and outlet were all placed in one the households constructing biogas plants required straight line, which was difficult for people who did that credit support. Analysis showed the financial not have enough land; and underground placement internal rate of return (break-even interest rate) of pipes, making monitoring and leak detection very was 17 percent for a typical biogas plant with the difficult) and implementation procedures presented investment subsidy. problems for some households and entrepreneurs. The program established a biogas credit refinancing Despite these concerns, the standardization of facility (seven-year credit with a one-year grace design and implementation mechanisms and strict period and at an interest rate of 6 percent) for the quality control measures helped in scaling up biogas lending and construction partner organizations systems and developing a biogas market. Local to lend to the households. Maximum refinancing masons lacked adequate training, which resulted in that could be availed per plant was 147 euros. poor-quality biogas digesters in some areas, causing The program assumed that total investment on a biogas plant, including interest on loan, could be recovered within four to five years. IDCOL: Rural Electrification and Renewable Energy Development Program The Rural Electrification and Renewable Energy Development Program was designed to support the Bangladesh government’s objectives to provide electricity to the rural population. The program is still ongoing and is unique in the developing world as an example of the private sector working with the government and microfinance institutions and NGO partners to provide off-grid electricity in a sustainable and commercially viable manner. The study team 32 | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 Figure 3.6 Institutional Diagram: Rural Electrification and Renewable Energy Development Program IDCOL Publicity materials Monitoring Re�nancing Grants Training Opera�ons Commi�ee Technical Standards Opera�onal aspects Commi�ee Feedback on equipment Partner organiza�ons Approve (16) equipment Review product creden�als Loans Solar systems Maintenance and support Households examined the work of two partner organizations in partner organizations engage the union parishad this program – Grameen Shakti and Srizony. chairpersons and members during awareness-raising activities. IDCOL supports institutional development Institutional Arrangements of partner organizations by providing technical, logistical, and promotional training assistance The program has a semigovernmental structure to its partners through the Technical Standards and thus takes advantage of government, NGO, and Committee9 and the Operations Committee,10 private sector coordination. The program is funded by which are responsible for technical and operational the World Bank, the Global Environment Facility, GTZ, aspects, respectively. KfW, and more recently by the Asian Development Bank, and works with 15 local NGOs and private IDCOL supports its partners for software, covering organizations, known as partner organizations of 80 percent of the training costs, and conducting IDCOL. The role of the partner organizations is to training programs to build awareness among identify project areas, select potential customers, partner organization staff and the users. User install systems, provide maintenance support, and training is also conducted regularly to educate the extend loans to the households. IDCOL provides beneficiary households on how to use solar home grants and refinance, sets technical specifications systems and fix simple problems without having for solar equipments eligible for receiving grants to wait for technicians. However, during visits to and refinance, develops publicity materials, provides Srizony and Fulpur upazila, Mymensingh, it was training, and monitors partner organizations’ performance. Figure 3.6 shows the institutional 9 The Technical Standards Committee comprises members from arrangements for this program. Bangladesh University of Engineering and Technology, Rural Electrification Board, LGED, and IDCOL. 10 The Operations Committee is chaired by the Chief Executive Officer The program does not have direct linkages with the of IDCOL, and comprises members of all partner organizations and local government for implementation. However, representatives from IDCOL. Household Energy Initiatives in Bangladesh | 33 found that user training on use and maintenance Development and Promotion of of solar home systems was limited. Usually Technologies technicians from local electrical shops provide repair and maintenance services against payment. A range of solar home systems between 10 and 130 watt-peak (Wp)11 are available. Initially, the program The thrust of this program is on the development promoted systems of 30 Wp and above. Affordable of partner organizations (usually private sector 10 Wp systems, powerful enough to light one 5-watt companies or NGOs), which may be considered to compact fluorescent lamp and two light-emitting be solar entrepreneurs, who select program areas diode lamps, have recently been introduced. and potential customers, extend loans, install solar home systems, and provide maintenance support The products and components to be used in the either directly through their program staff or, as solar home systems receive a certificate from with Grameen Shakti, by training local technicians accredited testing and certification organizations. in installation and providing after-sales service. The Technical Standards Committee has also developed guidelines and a standard list of The program has a multilevel monitoring specifications for solar home system components. mechanism whereby the partner organizations only receive a grant when a household signs off on According to IDCOL, 5–10 percent of the households proper installation of the technologies and after using solar home systems face problems with verification by IDCOL staff. For Srizony, monitoring their systems. Some users tamper with the of awareness-raising activities is through regular accessories and connections, causing various staff meetings, which include discussions on inefficiencies and poor performance. The most feedback from users. For Grameen’s solar program widely reported drawbacks of solar home systems in Fulpur, monitoring typically takes place when included uncertainty about after-sales services Grameen staff visit households to collect loans. once loans are fully repaid. However, some of the Households also get an opportunity to discuss partner organizations have introduced a yearly operation and maintenance issues during these maintenance contract option with the households visits. The contract between IDCOL and its partner at marginal cost after the free service period. organizations has a provision for annual monitoring Although the IDCOL program includes a thorough of the partner organization’s work. This is a crucial training component and every system is physically component of a partner organization’s evaluation verified, many households tend to overuse the to maintain its partner status. batteries for entertainment purposes (for example television). There are also reports of linking direct Awareness and Motivation lines from the battery, which can lead to a quick discharge, and use of nonapproved batteries for Community engagement is the responsibility of charging with the solar panel. individual partner organizations. IDCOL provides promotional support, such as distributing publicity Financial Aspects materials and developing television and radio IDCOL provides two types of grants: a buy-down spots. Word of mouth and publicity are effective grant (to the households to lower costs of solar in attracting new customers. The study team observed on a visit to Paikgacha upazila of Khulna 11 Watt-peak (Wp) is a measure of power output, most often used in district that Srizony holds local demonstrations at relation to photovoltaic solar energy devices. Related units such as kilowatt-peak (kWp) and megawatt-peak are also used, and in community gathering places, including markets the context of domestic installations kWp is the most common unit and educational institutions. encountered. 34 | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 Table 3.4 Grants for Solar Home Systems Amount of grant available per solar home system per household Institutional development Item Total Buy-down grant grant World Bank funds First 20,000 systems US$ 90 US$ 70 US$ 0 Next 20,000 systems US$ 70 US$ 55 US$ 15 Next 30,000 systems US$ 50 US$ 40 US$ 10 GTZ funds 58,160 systems €38 (US$ 58) €30 (US$ 46) €8 (US$ 12) 100,000 systems €34 (US$ 52) €30 (US$ 46) €4 (US$ 6) KfW funds First 30,000 systems €38 (US$ 58) €30 (US$ 46) €8 (US$ 12) Next 35,000 systems €36 (US$ 55) €30 (US$ 46) €6 (US$ 9) Next 135,000 systems €34 (US$ 52) €30 (US$ 46) €4 (US$ 6) Next 100,000 systems €28 (US$ 43) €25 (US$ 38) €3 (US$ 5) Next 71,000 systems €22 (US$ 34) €20 (US$ 31) €2 (US$ 3) Source: IDCOL website http://www.idcol.org. home systems) and an institutional development extend credit on different terms and conditions. grant (to the partner organizations to build their The loan tenor varies from one to five years, and institutional capacity) (Table 3.4). The same the interest rate varies from 8 percent to 15 percent amount of subsidy is provided for all solar home per annum on declining balance method and 10– system sizes, allowing poor households that prefer 15 percent per annum on equal principal payment smaller sizes to pay less and still own a system. method. But in all instances, the repayment The subsidy amount decreases as more solar frequency is monthly. home systems get sold, to allow the commercial Households are required to pay a minimum sector to transition in as demand grows. According 10 percent of the system cost as down payment. to Grameen Shakti, which has sold over 150,000 On receipt of the down payment, the partner solar home systems, the decline in subsidy has not organizations enter into a sale or lease agreement affected the demand for the systems as word of (provisions of which are approved by IDCOL), mouth and microcredit schemes continue to spur install the system (mostly on credit), and make demand. electronic disbursement requests to IDCOL for Under this program, a rural household can buy a refinance and grants, as applicable. After in-house solar home system either through direct payment checking IDCOL conducts physical verification of or through credit from the partner organizations. the solar home systems installed. IDCOL releases The success of this approach is evident because the grants and refinance amount only if the about 84 percent of the solar home systems are inspection result is satisfactory. The refinance sold through a credit mechanism, according to amount does not exceed US$ 285 (equivalent in IDCOL estimates. Different partner organizations taka) per system. Household Energy Initiatives in Bangladesh | 35 Table 3.5 Cost of Solar Home Systems Watts Grameen Shakti Srizony, Bangladesh Taka US$ Taka US$ 10 8,900 131 n.a. n.a. 0 14,900 219 n.a. n.a. 40 22,500 331 ,000 324 50 27,900 410 27,000 397 65 33,500 493 n.a. n.a. 75 n.a. n.a. 34,500 507 85 42,500 625 n.a. n.a. 130 65,000 956 n.a. n.a. n.a. not applicable. Table 3.6 Credit Facilities Available to Users for Solar Home Systems Loan Down period Interest Interest Organization Options payment (months) rate type Remarks Grameen Shakti 1 25% 24 4% Flat Grameen Shakti  15% 36 6% Flat Grameen Shakti 3 15% 36 5% Flat With postdated checks Grameen Shakti 4 100% 4% discount Grameen Shakti 5 25% 1 0% Mosque, madrasa, temple, church, orphanage, etc. Grameen Shakti Micro 10% 42 No additional interest Can share system with utility rate others for a fee Srizony 15% 48 8.50% IDCOL offers soft loans of 10-year maturity with Prices of solar home systems are market driven. a two-year grace period at 6 percent interest per Table 3.5 shows selling prices of solar home annum to its partner organizations. Usually, IDCOL systems from two partner organizations of does not require any collateral or security for IDCOL. the loan, except for a lien created on the project accounts. Unless there is an event of default, Srizony Bangladesh and Grameen Shakti extend partner organizations are authorized to operate loans to the households for purchase and the project accounts on their own. IDCOL also installation of solar home systems and after-sales provides partner organizations with infrastructure service (Table 3.5). Grameen Shakti, one of IDCOL’s support (computers, motorcycles, demonstration largest partners, offers five payment options, with kits, and battery chargers) and promotional support the initial down payment of 15–25 percent, and (distributing publicity materials and developing an interest rate of 4–6 percent (Table 3.6). Srizony, television and radio spots). a smaller partner, offers 15 percent initial down 36 | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 payment and a loan period of 48 months or five the programs actually enhances the ability to years. Compared to Grameen Shakti, Srizony has a draw lessons from them. Some have extensive higher interest rate (5 percent vs. 8.5 percent). market development components, while others have none. Some stress entrepreneur training while others pay no attention to it. Thus, both Conclusions the common features and the differences permit The various programs present an interesting this study to examine some of the lessons challenge for understanding the way forward for from these programs, and this is the topic of the improved stoves in Bangladesh. The diversity of next chapter. Household Energy Initiatives in Bangladesh | 37 Lessons from Household Energy Initiatives in Bangladesh S o far, this report has examined the nature � NGO/private partnership structure: GTZ and functioning of individual programs. The Sustainable Energy for Development Program insights gained from the case studies are and USAID/Winrock indoor air pollution interesting. Technologies need to be well developed program; and accepted by consumers, and there is a need for � Led by board or semigovernmental testing, ideally by an outside, independent agency, structure: National Domestic Biogas and or at least by those implementing the program. Manure Program and Rural Electrification and In addition, there are many different institutions involved in household energy and there is a need for Renewable Energy Development Program. coordination among them. Many of the programs With regard to the institutional structures, the do not even address the issue of commercialization now defunct government-led programs of BCSIR of their household energy appliances. These and (both improved cookstoves and biogas), with their other issues are examined in this chapter, which very good linkages with the local government draws general lessons from the household energy and community organizers, were able to establish initiatives in Bangladesh. This will be done by a network for cookstove dissemination, which examining the four thematic features of each continues to be used by entrepreneurs and other program: institutional arrangements, awareness programs. However, they did not promote a and motivation, development and promotion of commercial approach and had poor management technologies, and financial aspects. practices. On the other end of the spectrum, the private programs (GTZ Sustainable Energy for Institutional Arrangements Development and USAID/Winrock), while on a much smaller scale than the IDCOL programs, did Summary of Findings not have completely streamlined management structures. Their flexible structures, however, Three types of institutional structures were found supported commercialization of household energy to exist among the six programs studied: systems by providing technology and financing � Led by government agency: BCSIR improved services under the same roof through partner cookstoves and BCSIR/LGED Biogas Program; organizations. Innovation and efficiency were Lessons from Household Energy Initiatives in Bangladesh | 39 maximized as partner organizations competed with a government body. Other advantages were easier each other to provide the most attractive services multiagency coordination, enhancing local efforts to to users. The semiprivate programs (the IDCOL-led promote program objectives across a range of local National Domestic Biogas and Manure Program government, nongovernmental, private, and civil and the solar Rural Electrification and Renewable parties; and improved program implementation Energy Development Program), with the dual as staff of local government agencies were trained advantage of government and NGO or private and program activities were implemented using the sector leverages, had the potential for creating existing institutional structures of those agencies. a long-lasting commercial approach. Both these All six household energy programs reviewed focused programs had the best management structures, with on training and capacity building for entrepreneurs dedicated program offices and clear-cut roles and or for partner organizations and staff (supply-side responsibilities. They also had rules for assignment training); user trainings (demand-side) were not a of promoters for biogas and solar devices. These strong point in most. Suitable user training means IDCOL programs could serve as best examples of that users do not need to depend on technicians institutional management approaches for large- for small repair and maintenance works. Lack of scale programs that use partner organizations and user training, especially for improved cookstove create true entrepreneurs, thus creating a market- users, has led to discontinuation of use after the driven situation based on demand and supply. programs ended, as many trainees did not continue From an institutional standpoint, it was found that with technology installation and there was a lack the NGO and private programs reviewed did not of trained people for repair and maintenance at require extensive coordination with the government. the user level. Government-led programs trained However, local government coordination needs to only government staff or those of its partnering be part of the project plan and should be linked institutions, and dedicated user trainings were not to the program objectives. Thus, programs with carried out. Users were instructed on cookstove strong involvement of the local government, such use and maintenance only during installation. as those of GTZ and USAID/Winrock, fared better The GTZ program is the only one that provides in awareness raising, as people were more likely to training of trainers as well as hands-on training for take the information and messages seriously from constructing the improved cookstoves and courses on entrepreneur development and marketing. It has even developed detailed training manuals for training of stove manufacturers and training of trainers. Among the semigovernmental programs, the National Domestic Biogas and Manure Program is the only program providing refresher training, which is highly valued among the community. Unlike the government programs, private programs (GTZ Sustainable Energy for Development and USAID/Winrock programs) laid great emphasis on entrepreneurship development, including selection of potential entrepreneurs. GTZ is providing financial support to entrepreneurs through partner organizations to set up improved cookstove or A typical kitchen in a rural Bangladeshi household. improved cookstove accessory businesses. The 40 | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 USAID/Winrock approach was to train local women and approach during implementation. For to raise awareness and thus create private sector example, basic laboratory stove testing should be entrepreneurs. The National Domestic Biogas and undertaken before technologies are disseminated Manure Program’s approach of promoting different to ensure safety and understand performance. partners for different components of biogas, such Further monitoring should be undertaken in the as financing, manufacturing, and construction, is a field to gauge effectiveness in real-life conditions. valuable model for entrepreneurship development. Evaluation is usually more of a retrospective tool. These techniques need to be carefully planned While all programs have or had some level of and geared towards the type of intervention, program monitoring and evaluation mechanism the audience for findings, and the resources for quality assurance, in the majority the program and capacity of the implementer. It is important monitoring process was not of the required to consider sampling methods to ensure standard. Government programs fared the worst. representative findings and to avoid gathering Programs used their partner organizations (for unnecessary data, thus wasting time and money. example GTZ) or stakeholders and entrepreneurs A wide range of questionnaire surveys, monitoring (USAID) for monitoring, despite their vested protocols and datasheets already exist, and many interests in outcomes. The strongest monitoring are freely available (Box 4.1). Making use of these in Bangladesh occurred in the IDCOL programs, is strongly advised, but it is vital that they be which have a multilevel monitoring mechanism carefully adapted to local conditions, including that requires partner organizations to monitor careful translation and piloting. While some the technology over the financing period in order aspects of monitoring (for example basic stove to receive full payment. An evaluation system is in testing and adoption monitoring) are feasible place where staff or other partners visit users to for most organizations, others require significant verify the effectiveness of services provided by the skills and funding (for example indoor air pollution partner organizations. monitoring), and yet others, such as health impact Monitoring is an important part of the project monitoring, require substantial skills, and time cycle, enabling feedback into project design frames ideally measured in years rather than Box 4.1 Evaluating Household Energy and Health Interventions: Catalogue of Methods This review has identified improved monitoring and evaluation of household energy programs as a key need. Many aspects of programs can be monitored, including rates of adoption, extent of market development, performance of technologies, and impacts on indoor air pollution and exposure, health, socioeconomic indicators, and the environment. This subject has been thoroughly treated in a recent report by WHO cataloguing methods of evaluating household energy and health interventions (WHO 2008). This catalogue of methods is intended to help governments, NGOs, and universities involved with household energy interventions to develop monitoring and evaluation strategies appropriate to their needs and resources. It describes a diverse range of evaluation options ranging from simple questionnaires to complex monitoring techniques, such as measurement of indoor air pollution levels through physical monitoring instruments place in the household. It also provides guidance on identifying which areas to focus on, and choosing between methods according to feasibility, objectives, and type of intervention. These techniques are fairly well established as they have been applied in a wide variety of countries. However, many programs still have minimal monitoring and evaluation systems in place, and there is a need to ensure that they are part of project and program design. Lessons from Household Energy Initiatives in Bangladesh | 41 weeks. This type of technique is more appropriate after-sales services to the technology users is for project impact evaluation. required for a successful program. In addition to assessing overall program performance � Engaging the local government is beneficial and the impacts of interventions on users’ health, for effective awareness raising, increased welfare, wealth, and empowerment, it can also be coordination at the local level, and improved useful to undertake a cost–benefit analysis. WHO program implementation. has published guidelines for conducting a cost– � Decentralization of activities can be benefit analysis of household energy and health successful as it contracts work to a large interventions (WHO 2006), as well as documents number of partner organizations, thus presenting an evaluation of the costs and benefits of generating capacity, expanding coverage, such interventions globally and regionally. Together, and ensuring sustainability. However, these different aspects of monitoring and evaluation institutional strengthening of these can enable policy makers to make decisions on partner organizations (for manufacturing, how to address household energy issues, including construction, and financing) is often technology choice, delivery method, effectiveness, necessary. and cost–benefit ratio. � Highly motivated entrepreneurs can help The review of institutional mechanisms showed that pursue program objectives beyond the the lack of a national household energy policy or program period. strategy results in disorganized and uncoordinated dissemination of household energy technologies � Training and capacity building of all by different programs, leading to variations in stakeholders, staff, and consumers (including technology standards and monitoring mechanisms use and maintenance training for women) is and duplication of capacity-building efforts. Some an important component of any program to implementing organizations also emphasized the ensure effective use of technology. importance of working with partners that share � A multilevel monitoring mechanism that similar approaches to development, and the requires partner organizations to monitor importance of keeping institutional arrangements the technology over the financing period to as straightforward as possible. The GTZ program has receive full payment can be a good model for in excess of 150 partner organizations. They find it a successful cookstove program. challenging to administer this number of separate and small contracts. Some programs with many partner organizations use an intermediary body solely to Awareness and Motivation administer contracts and reduce this burden. Summary of Findings Lessons Learnt: Institutional The programs reviewed engaged with local Arrangements communities and networks to varying degrees. While there are clear benefits to working with On the institutional arrangements, the main lessons the local community, this activity should be linked learnt were as follows: with all other key activities of the program. For � While varied institutional arrangements can example, the government programs had extensive help achieve numerical program targets, community outreach, but due to lack of financial an integrated institutional mechanism and monitoring support, local communities did not for monitoring and assurance of quality support key activities beyond the program. 42 | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 Community-based organizations can play an USAID/Winrock and IDCOL approaches are examples important role in supporting programs and of use of existing setups at incremental cost. entrepreneurs by raising awareness about the The household energy programs reviewed utilized benefits of the technologies promoted, and by a range of awareness-raising approaches. The creating stronger linkages between beneficiary USAID/Winrock program and GTZ’s Sustainable households, implementing organizations and Energy for Development Program focused more entrepreneurs, and local government institutions. on using locally appropriate media, such as folk Existing community-based organizations can help songs and drama. These methods are not only in cost sharing to cover initial installation costs for more accessible for the local audience but are poorer households and to help identify households also very cost-effective. Almost all programs that would qualify for subsidies or financial developed conventional materials, such as posters assistance, where appropriate. Community-based and leaflets. It was difficult to find information on organizations with support from NGOs and local the effectiveness of these materials. Many users government institutions can also play an important still did not fully understand the key messages role in monitoring and quality control activities. regarding proper use of their technologies – While the BCSIR/LGED Biogas Program did not improved cookstove users were often not aware have a specific focus on community engagement, it of the health impacts of exposure to indoor air did include a very strong training component that pollution, which is particularly important if they helped to raise awareness. While BCSIR’s improved are to be motivated to use the improved stoves cookstove program encouraged district supervisors exclusively in order to reduce exposure to indoor to set up demonstration centers in their homes, air pollution (Box 4.2). IDCOL’s Biogas Program utilized local LGED water user group meetings. The USAID/Winrock program Although the GTZ program has user-training used existing networks of community health components, it does not focus on women. The workers to share indoor air pollution information National Domestic Biogas and Manure Program, as a community health issue and to tap their however, has trained over 900 users, of which about already established outreach and awareness- a third are women. There are some challenges in raising activities and mechanisms. The potential to organizing women’s training. Due to their household link to these existing health networks is seriously responsibilities, women are generally not available underutilized by household energy programs. The for day-long or week-long training sessions. Women’s Box 4.2 Awareness of Health Impacts All 70 women users of improved cookstoves, biogas plants, and solar home systems consulted were asked about the various benefits of these household energy technologies. Benefits reported by 26 percent of the improved cookstoves users, the largest number of respondents, included health benefits, particularly benefits for the eyes. However, the users did not appear to be aware of other benefits, such as reduced risk of pneumonia (for children), chronic obstructive pulmonary disease, and tuberculosis. About 22 percent of the users also reported environmental benefits in terms of reduced fuel consumption. For biogas, the health benefits were significant and the users noted that cooking with biogas did not produce any smoke. Correspondingly, 35 percent of the users reported that cooking with biogas was cleaner as there was no soot production. About 16 percent of the users of solar home systems mentioned health benefits due to reduced indoor air pollution from kerosene lamps and increased cleanliness due to less smoke and soot production from kerosene lamps, and 17 percent reported environmental benefits due to reduced indoor pollution. Lessons from Household Energy Initiatives in Bangladesh | 43 stronger linkages between entrepreneurs, beneficiary households, implementing organizations, and local government institutions. � Locally appropriate awareness-raising approaches for programs are crucial for uptake of technologies. Involving community leaders and health volunteers in awareness- raising activities can increase acceptance of the technology. � Awareness of the benefits (improved health and quality of life) of technology helps create Smoke from traditional stoves cause eye and lung problems in demand, though dissemination should not be rural women. constrained by availability and affordability of technologies by the households. presence is even scarcer when developing women � User training on maintenance and use should technicians or entrepreneurs, as societal influences be extended to women, who are the main in Bangladesh do not allow women to travel too far users of the technology. from home for such purposes. Many organizations are also not keen to take on the responsibility for the safety of these women while they are on the job. To Development and address this issue, Grameen Shakti has established Promotion of Technologies a number of technology centers that also include hostels so that women can receive training while Summary of Findings living in the vicinity of the training area. For cookstove technology to penetrate households The potential role of women as entrepreneurs and across all economic strata, there is a need to have promoters of cookstoves and other household a wide range of cookstove technologies to cater to energy programs has not been tapped by the different user requirements. This is why solar home programs. Supply-side training of the end users, systems gained acceptance, as the technology is typically women, would help promote the available and affordable even to the very poor cookstoves, as it would help the users to maintain households. and use the cookstove effectively. Several models of improved cookstoves have Lessons Learnt: Awareness and been designed and promoted in Bangladesh. Motivation However, most models are some variation of a model designed by BCSIR in 1978 with the addition On awareness and motivation, the main lessons of a simple grate in the combustion chamber to learnt were as follows: increase combustion efficiency. The design was not � Community-based organizations can play the result of extensive user consultation; stoves an important role at incremental cost were designed in laboratories to technical rather in supporting entrepreneurs by raising than sociocultural and real-life specifications. awareness about the benefits of the Consequently, the designs have not really met the technologies promoted, and by creating needs of all households, which has discouraged 44 | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 use of and investment in improved cookstoves. resulting in an increase in indoor air pollution. Thus, Moreover, there is a wide range of cookstoves performance monitoring of technologies is a very with minor variations in circulation, due to the important aspect for cookstove programs. Overall, lack of a standard design. Entrepreneurs and other while limited, the various studies conducted on the programs have modified the design depending on performance of the stoves in terms of efficiency and the local conditions and availability of materials, pollution reduction potential indicate that the stoves which could impact its efficiency, ease of use, and developed in Bangladesh were technically sound. maintenance. Khan (2000) reported 25–28 percent efficiency for the BCSIR stoves, which reduced fuel consumption While a standard design for cookstoves, as with by over 50 percent. These figures are comparable biogas plants, would help in monitoring quality, to most improved cookstoves developed in other such standardization would be difficult to achieve, countries. The GTZ three-pot stove with chimney as Bangladeshi rural homes do not use standardized was found to be 26–27 percent efficient (compared pots for cooking (different sizes of pots are used to 5–15 percent for traditional stoves) and saved depending on the quantity of food cooked and 50–60 percent fuel. Similarly, the USAID/Winrock whether food is being cooked or reheated). program study also found that the BCSIR stoves Household-level research is necessary to come up decreased PM2.5 in the indoor air by 71 to 84 percent with designs that can accommodate different-sized and carbon monoxide by 98 to 99 percent, which is pots while maintaining efficiency. On the other much better than the improvements in air quality hand, standardization could lead to lack of flexibility reported by other studies done in the region. in design, which may constrain the size or efficiency However, it should be noted that these tests were of cookstoves, as reported for plants under the conducted for a total of eight stoves, including National Domestic Biogas and Manure Program. two traditional stoves. Therefore, further testing is Moreover, validating stoves for indoor air pollution required to establish statistically significant results. reduction is difficult due to lack of standard stove- As different tests have revealed varying results in testing facilities. BCSIR and Bangladesh University PM2.5 and carbon monoxide reduction potential of of Engineering and Technology could collectively stoves, there is a need for standardization of such be the institutions responsible for standardizing tests so that the effectiveness of different stoves and validating technologies fit for indoor air can be compared and evaluated. pollution reduction. There is limited information available on emissions and efficiency testing for improved cookstoves. Much of the testing was done in laboratories, and observations in the field do not always mirror laboratory test results. Also, except for USAID/ Winrock, there was no monitoring done on the health impacts of the improved cookstoves. This is an important factor if Bangladesh is to attain the health and development-related Millennium Development Goals. Poor construction, operation, and maintenance, and unapproved alterations, can result in decreased performance and efficiency of stoves over time, Lessons from Household Energy Initiatives in Bangladesh | 45 Frequent or even day-to-day monitoring (as done Lessons Learnt: Development and for IDCOL’s National Domestic Biogas and Manure Promotion of Technologies Program) is important, as households usually modify stove designs during maintenance, leading On development and promotion of technologies, to reduction in efficiency and indoor air pollution the main lessons learnt were as follows: reduction potential (Table 4.1). A key service issue � The key issues critical to technology for improved cookstoves is that current designs of performance are good design and quality chimneys are difficult to maintain and fit in all types components and basic consumer awareness of houses. Chimneys with rough inner surfaces of use and maintenance. have resulted in accumulation of soot and clogging, � The stove design should be needs based requiring more maintenance. Without adequate and suited to the local environment, training and follow-up, households do not know how to clean chimneys, and there have been reports cooking methods, and socioeconomics of of smoke backing up into the room and smoke the community. Standardization of design exiting through the pot holes. One of the project and implementation mechanism would organizations also underlined the importance help improve monitoring of quality and thus of returning to homes some months after initial customer satisfaction. installation of stoves to establish the longer-term � Performance monitoring for stoves should performance. be an important component of any improved cookstove promotion program, Post-warranty service, especially after-sales support, as information on emissions and efficiency is key to the acceptance of cookstoves. Regular testing are important for designing effective technical audits through independent organizations cookstoves. Although testing may start in the to monitor performance would help ensure quality laboratory, initial and follow-up testing in the products and components with warranties are used in building stoves. This would help build user field is vital. confidence in the product. In addition, ensuring � Reliable after-sales support and services manufacturing facilities and outlets are in place produce great confidence among in line with demand creation is also an important consumers, leading to acceptance of aspect of technology development and planning. technology. Table 4.1 Use and Maintenance Issues for Household Energy Programs Technology Use issues Maintenance issues Improved Does not accommodate small pots (two-pot stove) Chimney clogs up cookstove Difficult to clean chimneys Air inlets get blocked while cleaning Smoke production stove Chimney cap gets corroded over time Grate becomes fragile over time Biogas plant Mixer handle breaks down Cleaning gas pipe to remove water Inadequate gas production Cleaning slurry tank Solar home system Battery discharges quickly Tampering with wiring and improper Low voltage battery use 46 | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 Financial Aspects cost, rather than affordability or market research. The USAID/Winrock program initially suggested Summary of Findings prices to entrepreneurs based on cost, though later found them selling stoves for much more, suggesting A commercial approach to the promotion of they had themselves responded to the market. The improved household energy technologies was GTZ program set prices based on manufacturing lacking in the now-defunct government BCSIR costs, transport, installation cost, and a small margin programs in Bangladesh. However, commercial for the implementing organization. viability has gained ground and efforts in this direction can be seen with private programs, such Given this scenario, the cost of the stove would as those of GTZ and USAID/Winrock, that focus on be a key factor in achieving complete coverage of developing improved cookstove entrepreneurs. cookstoves (Table 4.2). The programs reviewed The semigovernmental IDCOL solar home systems promoted a wide price range (US$ 3 to 870) program promotes innovative financing by for household energy technologies, which was involving microcredit organizations and quality beneficial in stimulating a market by providing control measures to increase commercial viability. a range of options. For biogas and solar home An analysis of the correlation between wealth systems, the price range was thousands of takas. ranking and the technologies adopted by each of For improved cookstoves, the GTZ program initially the economic groups in the field visit sites showed offered a three-pot stove option costing Tk 700 (US$ 10) and has recently introduced cheaper that solar home systems and biogas were usually one-pot and two-pot models costing about Tk only owned by rich households. Medium-income 200–600 (US$ 3–9). households may own a solar home system or an improved cookstove. The poor and very poor The now defunct government-funded programs households could not afford even the improved with a greater emphasis on reaching a large cookstoves. Making cookstove technologies number of households had offered direct subsidies, commercially viable and affordable to the poor is a while IDCOL’s biogas and solar home systems major challenge. Most prices were set according to programs provide short-term and small indirect Table 4.2 Cost of Technologies Program Technology Cost in Tk (US$) Subsidy offered Dissemination of improved Improved Tk 200–400 Cost of the stove fully subsidized with cookstoves (BCSIR) cookstoves (US$ 3–6) households providing only soil Sustainable Energy for Improved Tk 200–700 No subsidies Development (GTZ) cookstoves (US$ 3–10) indoor air pollution program Improved Tk 150–500 No subsidies (USAID/Winrock/VERC) cookstoves (US$ 2–7) Biogas Program (BCSIR/LGED) Biogas plants Tk 10,000–30,000 Subsidies varied depending on agency. 50% (US$ 143–429) user subsidy for plant; Tk 5,000 to farmers; Tk 5,000 as grant to collaborating NGOs National Domestic Biogas and Biogas plants Tk 18,000–33,000 Tk 7,000 subsidy for all plants Manure Program (IDCOL/SNV) (US$ 257–472) Rural Electrification and Solar home Tk 8,000–61,000 Subsidies are provided as buy-down grants of Renewable Energy Development systems (US$ 114–872) Tk 1,250 and capacity development grant of Program (IDCOL) Tk 400 Lessons from Household Energy Initiatives in Bangladesh | 47 subsidies. However, IDCOL programs focus on with the technology and after-sales service were commercialization and incorporate microcredit more willing to make their payments. Indeed, if a grants or seed funds for entrepreneurs, as did the fault develops with a stove, some users withheld USAID/Winrock improved cookstove program. installments until it was fixed. This is another benefit of having installers collect loan payments, A number of approaches were used to finance the as it further increases accountability. The USAID/ technologies and make them more affordable to Winrock and GTZ programs motivated local, existing rural households. GTZ provides financial incentives microfinance institutions to provide loans to their to partner organizations for each stove built. members for improved cookstoves; new bespoke While this is not a true commercial approach, it facilities were not required. Most poor families demonstrates how important profit is as a motivating tend to have more than one loan and therefore factor and was also found to improve accountability have repayment problems, which needs to be kept of technicians. Providing financing options to in mind while promoting loan financing for poorer households to operate their technologies would households. be helpful in increasing cookstove acceptability. The review found that loan repayment was Carbon financing can make additional funds generally good for all the organizations providing available to support dissemination of more loans. Partner organizations for larger household household energy systems and establish a robust energy programs, such as the Rural Electrification monitoring and evaluation process and ensure and Renewable Energy Development Program after-sales services to the users, as long as the and the National Domestic Biogas and Manure carbon revenue continues to flow in (Box 4.3). Program, reported high recovery rates, while GTZ A number of carbon stove programs are being has reported some difficulties. GTZ also reduced developed at present in Bangladesh, mainly the number of repayments as much as possible building on programs formerly run by NGOs and within the capabilities of borrowers to minimize donors, including the GTZ Sustainable Energy for transaction costs. Development Program. Customer satisfaction was an important criterion A number of solar home system projects are for proper loan recovery, and users satisfied presently attracting carbon finance through the Clean Development Mechanism in Bangladesh. These are implemented by IDCOL through a network of partner organizations, and by Grameen Shakti through its own network of local offices. The World Bank has signed emission reduction purchase agreements for these projects. The projects give an indication of the scale required to make carbon finance viable: the Grameen Shakti project aims to disseminate just under 1 million solar home systems between 2007 and 2015, resulting in emission reductions equivalent to around 50,000 tonnes of carbon dioxide per annum. This scale is achieved by bundling the activities of numerous organizations or offices, enabling the projects to benefit from economies of scale. 48 | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 Box 4.3 Carbon Finance: An Emerging Opportunity for Household Energy Bangladesh is set to become one of the pioneers in securing carbon finance for a large-scale improved stove program. An international carbon finance organization has been working with partners in Bangladesh to develop a project that is now awaiting validation. It is intended to be registered as a Clean Development Mechanism project. There are examples of carbon-financed improved stove programs registered both with the voluntary and compliance (i.e. Clean Development Mechanism) markets, including in Uganda and Ghana. Other projects are under development in India. The development of a new methodology by the Gold Standard (http://www.cdmgoldstandard.org) offers a bespoke framework and methodology for developing carbon finance projects. However, the up-front investment required to develop a viable carbon finance project can be considerable (often in excess of US$ 100,000); projects usually need to be substantial to justify this, and very rigorous monitoring and evaluation is required. One of the main challenges in determining carbon savings from stoves is not only quantifying fuel savings, but understanding the extent to which fuel saved is from nonrenewable sources. Determining this alone can be a complex and expensive process. Reduction in wood derived from renewable sources is not considered to count towards carbon savings. Accurate and detailed monitoring is essential acceptability of a program. Very low cost for any carbon project: in these projects the options can help promote these technologies elaborate monitoring systems include reporting even to the very poor, sometimes without on usage based on surveys of all recipients of the the need for loans. This can be achieved solar home system. The carbon finance is being by constructing technically efficient, locally used to speed the expansion of these programs, designed, improved cookstoves built from which were established before this stream of locally available materials, which can be funding became available. Finance is used to reasonably priced to be affordable to the cover overheads, and loans are also offered to very poor. consumers to widen access. These, too, require � A variety of approaches, such as microfinance detailed monitoring and reporting to satisfy the services, loans, and financial incentives, independent assessors. can be used to finance household energy technologies to make them more affordable Lessons Learnt: Financial Aspects for rural households. On financial aspects, the main lessons learnt were � Profit (such as financial incentives to partner as follows: organizations for each stove built and seed � Subsidy-driven household energy programs funds for entrepreneurs) can be a motivating cannot be sustained beyond the program factor in adoption of technologies. period because as subsidy ends, prices � Pricing needs to be considered in light of of technologies increase, thus reducing costs as well as the market environment. demand, viability, and after-sales service as � Innovative financing, which combines a cascade effect. microcredit organizations and quality control � A diverse variety of stoves and plants with measures, can help increase the commercial a wide price range can be essential for the viability of a program. Lessons from Household Energy Initiatives in Bangladesh | 49 � Customer satisfaction is essential for loan future improved cookstove programs in Bangladesh repayments. Thus, when program monitoring need to focus on, and address, the significant is tied in with payment collection visits to barriers to adoption that exist within the homes of those households that took loans to pay for the poor. Household decisions to adopt – or reject – the stoves, it can ensure accountability in a new technologies may be based on a complex set of stoves program. factors, including cultural and financial. Investing in � Carbon finance may provide a way of funding cookstoves is generally not viewed as a high priority, further large-scale household energy both because smoke is not perceived as a major programs in the future. health issue and because biomass energy is often collected from the local environment, so there are no cash outlays to be saved from stove adoption. In Conclusions addition, household energy issues are significantly impacted by gender roles: women generally use The challenge of addressing indoor air pollution stoves, while men control family finances and make exposure in 30 million rural Bangladeshi homes household decisions. may seem daunting but it is an important task to significantly strengthen Bangladesh’s efforts to attain Large-scale certification of cookstoves and the health-related Millennium Development Goals. cookstove manufacturers would add to consumer Of all the household energy technologies reviewed, confidence in the product. The implementation improved cookstoves has the potential to be the should follow an integrated approach by gathering cheapest and easiest to implement. The ideal future all household energy programs together under improved cookstove program for Bangladesh needs one platform. There should be an exit strategy to strengthen itself in institutional and technological in place for the program implementers, who aspects. It would need to have a level of technology would generate commercial and demand-driven appropriate to the task, with a standard and approaches to sustain the viability of the program efficient design, standardized emissions and indoor in the long term. Bangladesh should continue to tap air pollution testing, efficient performance, and its existing potential as a frontrunner in microcredit compatibility with user requirements. Importantly, and community engagement approaches. 50 | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 Review of International Cookstove Programs M illions of improved cookstoves have been of households from fuel purchase for cooking successfully and sustainably disseminated and heating. Some programs also had the specific in Asia, Latin America and the Caribbean, objective to reduce indoor air pollution. and Africa. Unfortunately, successes in the South The first phase of the National Improved Stove Asia region, including Bangladesh, have been limited Program in China started with the objective of rapid and sporadic. This chapter presents the results dissemination of stoves in 860 counties through from a review of international improved cookstove subsidies to households, counties, and technical programs of selected countries (China, Guatemala, institutions to meet energy shortages in rural areas Haiti, Mongolia, Nepal, and Uganda) from different by doubling stove efficiency. In the second phase, regions of the world, based on their potential the program focused on commercialization of relevance for an improved cookstove program in stoves by reducing subsidies, giving tax and loan Bangladesh. Both published papers and informal benefits to rural energy companies, undertaking reports available on the Web were used as information training, and offering administrative support. sources. The findings of the review of programs per The third phase centered on quality control by country are presented in Table 5.1. Following this certification and standardization. is a comparative discussion of the programs under four thematic heads (institutional arrangements, In Mongolia, the project of the Energy Sector awareness and motivation, development and Management Assistance Program (ESMAP), which promotion of technologies, and financial aspects), was launched at the request of the Mongolian along with lessons learnt that could be applied to a government, aimed to introduce improved G2 stoves future improved cookstove program in Bangladesh. to the ger population1 of Ulaanbaatar, which would reduce indoor air pollution and the amount of coal consumed by households for heating and cooking Brief Overview of purposes. The objectives of the project included International Improved improving the stoves and developing retrofit kits, Cookstove Programs 1 The “ger� is the traditional tented accommodation of Mongolia. Most of the international programs were launched The ger districts of Ulaanbaatar are the poor peri-urban settle- to conserve fuelwood or reduce the financial burden ments that have sprung up on the edge of the city. Review of International Cookstove Programs | 51 Table 5.1 Findings of International Improved Cookstove Program Reviews Guatemala: Latin Haiti: Latin America and America and Mongolia: Country/region China: East Asia Caribbean Caribbean East Asia Nepal: South Asia Uganda: Africa FIS Program (1996–2001), National Improved Tezulutlán Project Energy Sector Stove Program (1999–2005), and Mirak Improved Improved space Assistance Energy Advisory Program(s)/ (1980 to late Intervida Program Stove Project heating stoves Program Project duration 1990s) (1999–2001) (1998–2009) (2003–2007) (1999–2012) (1999–2008) Achievements By the early 1990s Social Investment The first phase of By the end of 2007 Phase I was No data are and sustainability 130 million improved Fund (Fondo de this project saw the project had implemented available for the cookstoves had Inversión Social, the dissemination exceeded its goal between 1999 and first phase of been disseminated. FIS): Disseminated of 20,000 Mirak of disseminating 2006. this project. The In the late 1990s 10,000 stoves stoves, though 7,000 improved Phase II runs 2007– second phase the program was between 1996 and cost, quality, cookstoves 2012, with a total (2005–2008) aimed wound up, but the 2001. and the end of and actually budget of about to disseminate microenterprises Tezulutlán Project: promotional disseminated over US$ 60 million, 300,000 stoves developed persisted, Disseminated 4,100 activities saw sales 15,000. It was with contributions but actually and the government stoves. drop significantly in less successful, from the Nepalese, disseminated focused on providing later years. however, in Dutch, and Danish 500,000. support to these, Intervida Program: achieving its target peaked by In 2007 ESMAP governments. Total project and improving financed a new of 42,500 retrofits, disbursement = the regulatory disseminating achieving only 844. The target 52 | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 8,000 stoves in phase of the for reaching US$ 8 million. environment with project with a stove certification and first 2 years, but households with The GTZ-led this tailed off to significant focus improved biomass program continues air quality standards. just 500 in the final on building the stoves is 500,000; in Uganda; now The impact of year. capacity of small by the end of 2008 called Promotion this program has and medium they had achieved of Renewable been studied enterprises. 52,750. Energy and Energy in considerable Efficiency Program detail; information (PREEP). can be found at the University of California, Berkeley, website. Guatemala: Latin Haiti: Latin America and America and Mongolia: Country/region China: East Asia Caribbean Caribbean East Asia Nepal: South Asia Uganda: Africa FIS Program (1996–2001), National Improved Tezulutlán Project Energy Sector Stove Program (1999–2005), and Mirak Improved Improved space Assistance Energy Advisory Program(s)/ (1980 to late Intervida Program Stove Project heating stoves Program Project duration 1990s) (1999–2001) (1998–2009) (2003–2007) (1999–2012) (1999–2008) Institutional Goal: Address Goal of three Goal: Better Goal: Complete Goal: Fuel saving Goal: Initially arrangements rural energy programs: infrastructure for technical and reducing indoor for fuel-scarce crisis and later improve health energy-efficient improvements to air pollution. areas but now for on commercialize and nutritional stoves that reduce stoves, conduct By: A government reducing indoor air stoves. status, livelihood, cooking costs for additional surveys, agency (Alternative pollution. By: government and sustainable urban households test dissemination Energy Promotion By: Ministry of agencies. Managed management of and improve health strategies involving Center) coordinates Energy and Mineral by the Ministry natural resources; conditions. the private sector. with program staff Development and of Agriculture promote fuelwood By: Government. By: Jointly by the (Energy Sector GTZ program staff. with county rural saving; reduce Ministry of Ministry of Nature Assistance Program) indoor air NGOs involved in energy offices as Environment and and Environment, for policy and implementation, implementers. pollution. Bureau of Mines ESMAP, and other implementation. community Private By: Government and Energy in close government NGOs play mobilization, entrepreneurs and NGOs. coordination with agencies. major role in awareness raising, involved in Department of Baja a local consulting Mongolian implementation. trainings, and manufacturing, Verapaz, Intervida organization. Women’s Local government monitoring. installation, and (NGO) and FIS Minimal role of Federation assisted role is for (decentralized with stove trials Private companies after-sales service. NGOs. coordination only. manufacture government and household No role for NGOs. agency). Private Private companies or surveys. Local stove builders metal and charcoal Community involved manufacturers small and medium also work as private stoves. enterprises capable Households entrepreneurs. in stove construction supply stove involved in surveys, Community and operation parts (plancha, of manufacturing involved in stove Mirak stoves were stove assessments, Community-based and maintenance chimneys). and G2 stove trials. organizations construction and trainings. the key players. for community operation and Local communities extensively Beneficiaries of mobilization and maintenance engaged. this project: urban awareness raising. trainings. Review of International Cookstove Programs | 53 households. Guatemala: Latin Haiti: Latin America and America and Mongolia: Country/region China: East Asia Caribbean Caribbean East Asia Nepal: South Asia Uganda: Africa FIS Program (1996–2001), National Improved Tezulutlán Project Energy Sector Stove Program (1999–2005), and Mirak Improved Improved space Assistance Energy Advisory Program(s)/ (1980 to late Intervida Program Stove Project heating stoves Program Project duration 1990s) (1999–2001) (1998–2009) (2003–2007) (1999–2012) (1999–2008) Awareness and County rural energy Awareness-raising Extensive public Mongolian Local NGOs Local NGOs and motivation office staff carried activities by awareness Women’s and community communities carry out activities to local community campaigns Federation organizations carry out awareness- raise awareness. organizations and for awareness organized local out household- raising activities. Demonstration staff. raising, including demonstrations level awareness Awareness teams visited Women were focus on quality and surveys. raising activities – created among households. Open extensively certification. Local religious demonstrations, the students and stove design consulted under No specific role leader was competitions, children. competitions were the Tezulutlán for women or consulted trainings. Women involved held to support Project for community during project Women are as part of the outreach efforts. identifying organizations. preparation. encouraged to community, but no Communities appropriate No clear role for become stove specific role spelled participated in cookstove models. local community promoters or out. trainings and organizations. builders. Households awareness activities. involved in stove 54 | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 No special role for building with the women. technicians. Development Many designs of Plancha stove. Commercially Improved G2 metal One-, two and Rocket Lorena and promotion mud and brick Stoves were produced Mirak – charcoal stoves and three-pot mud stove for rural of technologies improved cookstoves manufactured improved charcoal stove retrofit kits. cookstove and users and metal with chimney and locally. cookstoves made metal cookstove for rocket/charcoal grate. of sheet metal with hill users. stoves for urban chimneys. users. Guatemala: Latin Haiti: Latin America and America and Mongolia: Country/region China: East Asia Caribbean Caribbean East Asia Nepal: South Asia Uganda: Africa FIS Program (1996–2001), National Improved Tezulutlán Project Energy Sector Stove Program (1999–2005), and Mirak Improved Improved space Assistance Energy Advisory Program(s)/ (1980 to late Intervida Program Stove Project heating stoves Program Project duration 1990s) (1999–2001) (1998–2009) (2003–2007) (1999–2012) (1999–2008) Materials collected Tezulutlán Project Efficiency was Mon San Co. Significant reduction 60% reduction locally and stove had provision around 30%, was the main in fuelwood in fuelwood built inside the for postproject much higher than technical partner consumption consumption. house. Commercially monitoring for one traditional charcoal for G2 stove and kit annually and smoke Room smoke available portable year to provide stoves. manufacture and levels. reduced stoves also technical assistance Stoves stove performance Stove builders significantly manufactured by and replacement manufactured by tests. trained under resulting in 21% private companies. of parts where qualified small Manufactured the program as reduction in Efficiency increased needed. and medium by private entrepreneurs, acute respiratory by 6%. Marked Stove builders enterprises entrepreneurs. ensuring quality diseases among reductions in carbon trained under with eco-label control. users. Marked reductions monoxide for both the program as for quality in carbon Periodic Local NGOs play the stoves and kits. entrepreneurs. certification. monoxide for both independent a major role in Stove builders were Periodic the stoves and kits. program monitoring quality trained by the project independent assessments carried control. After-sales service and certified for program by entrepreneurs. out. Stove builders quality. Staff carried assessments Mud stoves awarded for work out independent carried out. manufactured quality. evaluation of the Mud stoves locally using local Metal and works of stove manufactured materials. Iron charcoal stoves builders. locally using parts bought in manufactured Standards for local materials. the local market. commercially by efficiency and Metal stoves Metal stoves, private companies. emission levels were manufactured largely for hill areas, Some stove set. Random testing by private manufactured builders have also of stoves was carried entrepreneurs. by private started enterprises out. After-sales service entrepreneurs. or businesses. After-sales service by by entrepreneurs. After-sales service After-sales service Review of International Cookstove Programs | 55 entrepreneurs. by entrepreneurs. by entrepreneurs. Guatemala: Latin Haiti: Latin America and America and Mongolia: Country/region China: East Asia Caribbean Caribbean East Asia Nepal: South Asia Uganda: Africa FIS Program (1996–2001), National Improved Tezulutlán Project Energy Sector Stove Program (1999–2005), and Mirak Improved Improved space Assistance Energy Advisory Program(s)/ (1980 to late Intervida Program Stove Project heating stoves Program Project duration 1990s) (1999–2001) (1998–2009) (2003–2007) (1999–2012) (1999–2008) Financial aspects Average cost Cost around Cost: US$ 3–4 on Improved Cost US$ 4–6. Average cost estimated at US$ 13. US$ 50. average. G2 costed Users bear the of Improved On average 86% Programs highly Households US$ 50–60. Cost total cost of Rocket Lorena of the cost paid by subsidized (with purchased these of retrofit US$ 17. the improved stove US$ 6, and the users and the households paying stoves directly from The retrofit kits cookstoves. Improved charcoal rest was subsidy 10–45% of costs) to the market. were developed stove US$ 15. for the poor so Most materials provided by the make it affordable Though costlier used are locally Users bear the total government. to the poor. that it was more cost of the improved than traditional affordable through available. As a wide variety The high cost stoves, operating cookstoves. microcredit. Users pay for of models at of stoves expenses low due nonlocal materials Most materials used different prices were inhibited market to higher efficiency. Golden and stove builder are locally available. available, users development. Development Fund No subsidy. (XAC), the largest fees. Users pay for could choose models nonlocal materials according to their microfinance Demand-driven agency in approach. and stove builder affordability. fees. Mongolia, provided 56 | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 Target: for Due to low cost, initial capital. poor have also Demand-driven households that approach: could afford to pay. Future availability installed improved of credit cookstoves without thousands of rural As the subsidies mechanism is subsidy. households have were small, expected to cover installed cookstoves marketing efforts at least 50% of without subsidy. had to be effective cost. Due to significant to disseminate more benefits stoves. (13 times return on investment) of fuel saving, poor have found improved cookstoves to be attractive. conducting comprehensive surveys of households over the project period. These small and medium and stove producers, and testing dissemination enterprises continued to manufacture and sell strategies, including a program for the private more stoves after the end of the project. sector and relevant stakeholders to disseminate the retrofit kits. Lessons Learnt from In Guatemala, the three projects reviewed had International Improved a range of objectives, primarily fuelwood saving, Cookstove Programs reduction of indoor air pollution, promoting health and nutritional status, promoting sustainable Institutional arrangements livelihoods, and sustainably managing natural resources. All programs reviewed had the respective country government playing a major role, which gave The improved cookstoves component under the greater credibility to program activities, resulting in Energy Advisory Project in Uganda identified higher priority and recognition, thereby supporting areas with extreme wood scarcity. Rocket Lorena efforts to meet the national targets. A strong cookstoves, first promoted as a pilot activity, government backing (as in China and Nepal) and were scaled up later. The second phase of the an organizational structure that allows government Energy Advisory Project (2005–2008) aimed to and program staff to work in a coordinated way (as install 300,000 improved cookstoves and in fact in Nepal) is essential for success. China practiced successfully installed around 500,000 stoves during one of the most successful approaches, in a this period. program that unfolded over a period of more than In Nepal, the National Improved Cookstoves Program 25 years. The program started as a government-led started in 2000 as an activity of the Alternative program working directly with the counties (or local Energy Promotion Center and the Energy Sector governments). Capacity was gradually built and a Assistance Program, supported by the Danish more commercial approach was taken, which helped International Development Agency (DANIDA). The rural enterprises take the lead in manufacturing program aimed to install 50,000 improved stoves and installation. Cookstoves in China have now in households in the mid hills as a way to reduce evolved into a commercial enterprise across the fuelwood consumption. The second phase started country, with the government body evolving to in 2007 as a biomass energy component and aimed the role of quality controller. Lessons from Nepal to install 434,000 improved stoves in the mid hills endorse the value of an integrated institutional and Terai, disseminate 10,000 household gasifiers management setup wherein the government and 1,000 institutional gasifiers, demonstrate 5,000 closely works with key partner NGOs to provide institutional improved cookstoves, and install 50,000 integrative cross-platform energy solutions and metal improved cookstoves in the high hills. services to rural areas, thus allowing the service providers to optimize human resources. In Haiti, the project aimed to assist small and medium enterprises to develop better infrastructure NGOs and the private sector were fundamental to for the production of energy-efficient stoves that the success of a number of the improved cookstove reduce the cost of cooking for urban households programs. However, the successful China program and improve health conditions. The project goal and the innovative Haiti program had no significant was to form at least 10 competitive small and role for NGOs, while in Guatemala both NGOs and medium enterprises that would manufacture and the government were involved in implementing disseminate 50,000 high-quality Mirak stoves stove programs. Meanwhile, successes in Nepal and Review of International Cookstove Programs | 57 Uganda were attributable to NGOs as key partners Almost all programs focused on developing private in implementation. While involvement of private entrepreneurs, manufacturers, and energy service sector entities in almost all programs reviewed companies. Under the Energy Advisory Project in was as supporting agencies, such as for supplying Uganda, local persons trained as stove builders materials (Nepal and China), as technical partners became small-scale entrepreneurs by entering the (Mongolia, Guatemala, and Uganda), as commercial stove business. In Nepal, local women entrepreneurs stove manufacturers (Haiti), and as awareness have been trained as promoters to market and raisers (Mongolia), they would eventually emerge install the stoves. This empowerment has led as key stakeholders and as major players for to motivation among women to better market commercialization of cookstoves. The China model cookstoves in their communities and has resulted shows that private entrepreneurs and businesses in higher penetration. The program has created a can ultimately emerge as the key players, once niche market for small local entrepreneurs who are a program is established, by providing products capable of installing low-cost improved cookstoves and service support, and are thus an important acceptable to the users. component of any cookstove program. The only example of poor coordination of programs Working with community-based organizations and was in Guatemala, where there was limited establishing links between the government and interaction between the three stove programs, NGOs working on health and hygiene helped in which resulted in duplication of efforts in stove reducing duplication and overlapping of activities. development and dissemination. Despite this the The Guatemalan Tezulutlán Project and Intervida Social Investment Fund program, with its strong Program were the only ones that did not focus solely community support, disseminated the majority on the final product (for example the cookstove), of the 100,000 plancha stoves in Guatemala in but also paid attention to raising awareness of 1996–2002. While the review did not clearly examine health benefits and facilitating the community to the monitoring and evaluation aspects of programs, conduct their own appraisal in order to understand results showed that China at various times had strong the health issues related to indoor air pollution. program monitoring through the government, as Training and capacity building are essential did Mongolia. Monitoring entities varied from local components of such activities as awareness NGOs in Uganda to local entrepreneurs in Nepal. The creation within communities and provision of Tezulutlán Project in Guatemala offered postproject monitoring services. In China technical training is a monitoring for one year to provide technical major function of the government, while in Uganda assistance and replacement of parts as needed. The and Nepal local NGOs helped with capacity building Haiti project included a provision of supervision. and maintenance training for beneficiaries. Local Lessons learnt: institutional arrangements. From communities and community-based organizations the review of institutional arrangements, the main have also assisted with stove installation, trained lessons learnt were as follows: on stove use and maintenance, and been involved in local demonstrations and awareness-raising � An integrated institutional mechanism activities, for example in Nepal, Mongolia, and across energy solutions and intersectoral China. In China and Uganda beneficiaries were collaboration for implementation and involved in the construction of the improved monitoring are essential, and can allow cookstoves in their houses from standardized parts, service providers to optimize resources and and also received operation and maintenance help guide policy-level decisions for the trainings. programs. 58 | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 � Engaging local government has benefits in (county rural energy office) staff helped in extensive effective awareness raising, monitoring, outreach activities to raise awareness on the increased coordination at the local level, and benefits of improved stoves. As funds were limited, overall achievement of program objectives. marketing efforts had to be effective to disseminate � The role of entrepreneurs and NGOs can more stoves. Demonstration teams visited be fundamental to an improved cookstove households and open stove design competitions program as they help in awareness raising, were held to support the outreach efforts. establishing a commercial market, and Integration of the gender issue in the awareness providing after-sales services, which are key process was very helpful in Nepal, where women’s to the success of any program. organizations and women entrepreneurs were involved at the local level, which had a synergistic Awareness and Motivation effect in improved cookstove dissemination. The building of considerable social capital, While programs in Nepal have been particularly for example through awareness raising and successful in engaging women as stove promoters community-level organizational structures, was and technicians, the role of women did not appear seen in all programs reviewed. Awareness and to be explicit for the Chinese, Ugandan, and motivation aspects were handled by different Mongolian programs. entities in different countries. For the Nepal In most of the successful programs, users were program, at the user level, local community- regularly made aware of the quality, benefits, and based organizations were used for raising availability of improved cookstoves as part of the awareness and training activities. This improved awareness program. Behavioral change ensured real program effectiveness because of the rapport and sustainable improvements through investing such organizations often build with the users. in community mobilization instead of hardware, The Uganda program focused on social marketing and shifting the focus from cookstove construction efforts through extensive community mobilization for individual households to the creation of well- and raising awareness in households and children ventilated homes. It should also be kept in mind that through schools. As household awareness of the awareness and motivation go hand in hand with benefits of the improved cookstoves increased, the the marketing of a good stove that has significant program promoted easy and affordable installation advantages over traditional counterparts. of stoves by maximizing use of local materials and training local people as stove builders. This Lessons learnt: awareness and motivation. From created an environment conducive to wider stove the review of awareness and motivation, the main dissemination. Community leaders played crucial lessons learnt were as follows: roles in awareness raising in Mongolia, where � Community-based and social organizations the local religious leader was engaged in program can play crucial roles in awareness raising design, an important consideration given the role and bringing about behavioral change in the of fire in Mongolian culture. Other approaches use of energy technologies. included requiring households to participate � Awareness of health benefits and fuel in trainings and awareness-raising activities, as savings can have a significant impact on in China, or having households assist in stove creation of demand, leading to sustainability. construction, as in Uganda. Awareness-raising activities are successful One of the best examples of awareness and when heath benefits and gender aspects are motivation is from China, where local government integrated. Review of International Cookstove Programs | 59 � Investing in community mobilization assistance and replacement of parts where instead of hardware, and shifting the focus needed. In Uganda, local NGOs played a major from cookstove construction for individual role in monitoring of activities for quality control. households to the benefits of creation of Monitoring and testing in Mongolia presented well-ventilated homes, can be an important particular difficulties due to very limited laboratory factor in motivating people to buy improved and technical capacity. An evaluation highlighted stoves. the need for capacity building, and recommended that monitoring and evaluation be outsourced to Development and Promotion of an organization experienced in monitoring, with a Technologies remit to deliver training. A wide range of improved cookstoves characterize Improved cookstoves showed greater efficiency the projects reviewed, from the very simple than traditional stoves in all countries reviewed. improved mud stoves in Nepal, to the more Improved cookstoves in Nepal were estimated to sophisticated plancha stove in Guatemala, to reduce fuelwood consumption by 25–40 percent the cast-iron G2 stove in Mongolia. The choice compared to traditional stoves. In China, according of stoves introduced depended on local cooking to a 2002 survey, the average efficiency of improved practices, availability of materials, and user cookstoves was 14 percent compared to 9 percent acceptance. A number of stoves added chimneys for traditional stoves. There was a slight reduction to reduce indoor air pollution from traditional in PM413 and carbon monoxide levels. In Mongolia, stoves. This was done in Nepal, Mongolia, China, five stoves tested showed improved performances, and Haiti (sheet-metal Mirak stove). In Mongolia, with carbon monoxide emissions reduced by the program developed a stove retrofit kit that 68 percent. In Uganda the household Rocket could be used to upgrade existing traditional stove cut fuel consumption by 60 percent and the stoves. This was an innovative measure, as many institutional stove by 90 percent. Smoke levels in of the households could not afford the improved kitchens have been reduced significantly, resulting G2 stoves, which cost around US$ 50–60 while in a 21 percent reduction in acute respiratory the kits cost only US$ 17. Depending on the type diseases among cookstove users. of stove promoted, countries such as Nepal and As quality assurance needs to be visible to the Uganda use home-constructed stoves with metal users, certification of stove quality by a recognized parts purchased from local markets. In China, there institution plays an important role in convincing was greater emphasis on developing rural energy consumers to use improved cookstoves. The manufacturing enterprises to supply stove parts. certification process should be transparent and Performance monitoring is an important component regular. Eco-labeling of Mirak stoves in Haiti with of any cookstove program and was dealt with by a a quality and energy efficiency label provided variety of agencies using various methods. In Nepal consumers with quality assurance. Using public regular monitoring of stove performance was media such as radio, television, and newspapers to ensured through the establishment of renewable regularly remind consumers of the quality labeling energy test stations, leading to a high level of can be an effective strategy in scaling up use of customer satisfaction. On the other hand, in China commercially produced improved cookstoves. The the focus was on certifying the stove manufacturers Nepal program has taken the approach of certifying along with random testing of stoves. In Guatemala, the Tezulutlán Project had provision for postproject 13 PM4 = particulate matter comprising particles with a diameter of monitoring for one year to provide technical 4 micrometers or less. 60 | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 promoters rather than stoves. Training is provided the countries reviewed. Users could afford to pay to the stove builders to maintain standard efficiency for the whole cost of the stove in Nepal, Uganda and smoke levels. Quality is maintained through a (Rocket Lorena stove at US$ 6), and Haiti. The market mechanism whereby the service provider Mongolian program developed a stove retrofit kit, offers the best service to maintain goodwill and which could be used to upgrade existing traditional ensure more orders in the future. stoves. This was an innovative measure, as the ger households struggled to afford the improved G2 The lack of a central improved cookstove certifying stoves, which cost around US$ 50–60. The kits, agency in Guatemala resulted in duplication of efforts on the other hand, cost only US$ 17. This may be for stove development. Moreover, the programs did an option where the stoves, by design, are very not share valuable experiences, which could have expensive. made the stove designs more appropriate for the beneficiary households. In all programs, after-sales No financing mechanisms or subsidies are required service was provided by entrepreneurs. when cookstoves are affordable even to the poor, as in Nepal and Uganda. This resulted in a commercial Lessons learnt: development and promotion of approach to improved cookstove dissemination, technologies. From the review of development and with users bearing the full cost of the stove. promotion of technologies, the main lessons learnt Affordable cookstoves are possible when they are were as follows: built mostly from locally available materials. China � Affordable, efficient cookstove designs based used an interesting approach of initially providing on user feedback are essential for program a subsidy, with 86 percent of the stove cost on success. Locally made cookstoves are cheaper average being borne by households, and the to build and easier to repair and maintain. government, through province, county, township, and village funds, providing the rest. As the program � Performance monitoring for stoves should became demand driven, subsidies were eliminated be an important component of any improved completely from the stove itself and virtually all cookstove promotion program, as perception cookstoves were sold commercially. of reduced kitchen smoke has been shown to be a motivating factor in consumer decision The Guatemala Social Investment Fund program making. was part of a broader government community block grant program in which communities had a � Certification, quality control, and after-sales choice of using the grants for various development services are important factors for program activities, such as schools or road improvement. success. A transparent, regular certification The communities decided on the use of the block process for stoves and promoters of stoves grants based on what was most attractive to them. can be an important aspect for convincing The expensive Social Investment Fund stove gained users and generating demand. popularity and was commonly chosen for the use of these funds. Because the stoves were financed as Financial Aspects part of these block grants, in Guatemala the plancha The cost of cookstoves varied in the countries cookstoves were highly subsidized due to the high reviewed, with the cheapest in Haiti (US$ 3–4) and stove cost (US$ 75–100). On average, households Nepal (US$ 4–6) and the costliest in Guatemala paid 20 percent of the total cost of the stove over (US$ 75–100) and Mongolia (US$ 50–60). Improved a period of one year. However, Social Investment cookstoves in the price range US$ 3–6 were Fund households paid only about 6 percent of the affordable to most rural households among all total cost. Review of International Cookstove Programs | 61 For poor countries such as Haiti, it was important or their components would help develop to bring down the cost of improved cookstoves to a sustainable system whereby users were an affordable range. In the case of charcoal stoves, willing to pay the full costs and purchase this was achieved through mass production, which, cookstoves for their benefits. encouraged by general consumer acceptance of � Credit through microfinance can be used to stoves, allowed small and medium enterprises to make expensive stoves affordable to a larger operate in a sustainable manner and provide good number of households. after-sales services. In Mongolia, stove manufacturers and rural energy Conclusions service companies gave customers access to credit through microfinance by liaising them with local This review of international programs provides microfinance groups, particularly the Golden some good practices that can support the Development Fund (XAC). This was required development of new cookstove initiatives in because the stoves promoted in Mongolia were Bangladesh. While Bangladesh’s household energy for heating mainly with coal and were intended programs demonstrate some of the best practices only for poor people in the peri-urban areas of internationally, considerable learning still has to Ulaanbaatar. Under the China National Improved take place if Bangladesh is to move ahead to attain Stove Program, State funds were used for capacity its Millennium Development Goals. There are building and motivating users and there were valuable lessons available within the country, such typically no subsidies for the stove itself once the as effective community engagement approaches program became fully commercial. This resulted in and workable financial mechanisms, which can be beneficiaries purchasing improved cookstoves for easily duplicated in a new program on improved benefits other than price, creating a sustainable cookstoves. There are however still important system where all users were willing to pay for the lessons to be learnt in developing a suitable policy stoves. agenda that promotes intersectoral collaboration and integrative mechanisms across household Lessons learnt: financial aspects. From the review energy solutions. of financial aspects, the main lessons learnt were as follows: A technically sound cookstove is also essential for � Subsidies are not mandatory for a successful program success. Bangladesh needs to integrate cookstove program, if the cookstoves are and increase its efforts in developing efficient, affordable even to the rural poor. Low-cost standardized, and affordable technologies with stoves can be achieved if they are built mostly quality assurance and monitoring mechanisms from locally available materials. in place. The approach of targeting households facing fuelwood scarcity, socially marketing the � A demand-driven program resulting benefits of improved cookstoves to increase from low-cost stoves, easy availability, a their acceptability, making improved cookstoves commercialized approach, and consumer affordable by using local materials and perception of benefits can help in the success employing local technicians for construction, of a cookstove program. and strengthening monitoring are other lessons � Using funds for capacity building and to take home from the international experiences motivation rather than subsidizing stoves outlined in this chapter. 62 | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 Lessons from Sanitation Initiatives in Bangladesh T he Bangladesh Country Environment Analysis experiences of Bangladesh’s successful Total states that the health impacts of indoor air Sanitation Campaign to learn lessons for household pollution could be reduced if people were energy programs. convinced that the problem was as serious as poor While there are synergies, it must also be noted sanitation and bad hygiene practices. The Total that there are differences between these sectors. Sanitation Campaign is very focused on behavior For example, the communal health impact of open change, awareness raising, and sensitization, and defecation is more pronounced than the impact of many of the approaches used could be applied smoke in the environment. As communal impacts are to household energy programs. Both increasing at the core of engaging communities, this aspect of sanitation and reducing indoor air pollution require the community-led sanitation program possibly may the adoption of new practices, demand for latrines not translate directly to household energy programs. and cookstoves respectively, a supply chain of With the above in mind, this chapter provides a brief entrepreneurs, financing arrangements, and introduction to Bangladesh’s community-led Total local participation of communities and parishads. Sanitation Campaign and presents lessons from the Given these synergies, this chapter presents the review of sanitation initiatives for integrating into future improved cookstove programs. Bangladesh’s Total Sanitation Campaign With a population of over 150 million, an extremely high population density, and half of its population below the poverty line, Bangladesh was faced with a serious public health challenge in the sanitation sector until a decade ago. The practice of open defecation and the use of unhygienic latrines has Models of sanitary latrines developed under the Total been the cause of serious diseases, particularly Sanitation Campaign. diarrhea in children below 5 years, productivity loss Lessons from Sanitation Initiatives in Bangladesh | 63 due to sickness, and a decline in the overall quality headway. In 2003 rural sanitation coverage was only of life, with the poor being the worst affected. It 29 percent. If such a trend had continued, it would is estimated that approximately 125,000 children have taken more than 60 years for the entire country below 5 years die every year (342 children every to have safe sanitation facilities (Minnatullah and day) due to lack of proper sanitation facilities in Ahmed 2003). A nationwide sanitation survey in Bangladesh (WaterAid 2003). 2003, published in 2004 (LGD/DPHE/UNICEF 2004), revealed that for the majority of households lack Progress in rural sanitation was rather slow during of money was the key reason for not installing a the 1980s and 1990s, with a sanitation coverage latrine. Figure 6.1 summarizes the various reasons growth rate of just 1 percent per annum. Until the for nonadoption of latrines in Bangladesh. end of the 1990s, a number of sanitation initiatives were undertaken by government agencies and NGOs However, learning from these unsuccessful in Bangladesh. However, they were not sustained experiences and inspired by global development and could not bring about visible positive results, for efforts (such as the development of the Millennium a range of reasons. Technology remained the thrust Development Goals in 2000 and the World of those initiatives, with people and institutions Summit on Sustainable Development in 2002), having little or no access to and control over the the government of Bangladesh committed itself process. In addition, the institutions engaged had to achieving the Millennium Development Goal little contact with the end users (or beneficiaries) targets through a new national program called and did not consider the needs of those users, which the Total Sanitation Campaign, and took a crucial made it impossible for the interventions to make any step to eradicate open defecation by 2010, ahead Figure 6.1 Reasons for Not Installing a Latrine: Results by Division, Bangladesh 80 77.57 78.39 74.83 74.74 70 70.99 69.69 60 50 Percent 40 30 20 10 0 Baisal Chi agong Dhaka Khulna Rajshahi Sylhet Lack of Money Lack of Space Lack of Awareness Dislikes Latrines Lack of Material Source: LGD/DPHE/UNICEF 2004. 64 | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 Table 6.1 Change in Approach for the Total Sanitation Campaign in Bangladesh Past Present/future Elements of campaign Target-driven partial sanitation Community-led total sanitation Core activity Constructing latrines Igniting and facilitating process Latrines designed by Engineers Community innovators Number of designs One or a few At least 32 so far Materials Cement, pipes, bricks, etc. Bamboo, jute bags, plastic, tin, etc. Cost Higher Can be under Tk 50 Indicators Latrines constructed Open defecation ended Sustainability Only partial Complete coverage Motivation Subsidy Self-respect Coverage/usage Partial Total Source: Kar and Chambers 2004. of the Millennium Development Goal time frame. now widely used both nationally and internationally. The Total Sanitation Campaign received a positive After VERC’s pilot study, the community-led total boost at the South Asian Conference on Sanitation sanitation approach was advocated to the key sector (SACOSAN) in 2003, at which a landmark regional actors and the government of Bangladesh. Though policy towards sustainable sanitation – the Dhaka the advocacy work was well planned, it took more Declaration on Sanitation – was adopted. With than a year to convince the donors, NGOs, and the this came a commitment to focus on creating government. This work paid off, however, as it was demand, sustaining attitudinal and behavioral the commitment, support, and ownership shown by change, and encouraging wider community the government that eventually drove the success participation, thereby moving away from the top- of the program. The key difference between the down approaches common to the earlier subsidized Total Sanitation Campaign and previous sanitation sanitation programs. Table 6.1 presents the change programs was that community-led total sanitation in approach of the Total Sanitation Campaign in focused on promoting an open defecation-free Bangladesh. This initiative has led to more than 90 environment, rather than on provision of latrines. million people gaining access to and using latrines The goal remained to save the estimated 125,000 in less than five years.14 children under the age of 5 dying each year of water and sanitation-related diseases. Over the When VERC first piloted a community-led total years, the government of Bangladesh has laid sanitation approach in a few hamlets with financial emphasis on improving the situation through the and technical support from WaterAid, it was called adoption of a national policy and role creation for the “100% sanitized village approach�. Later Dr. the local governments (union parishads) and NGOs Kamal Kar (the architect of the approach) used the for the program. term “community-led total sanitation�. This name is Considerable progress has been achieved in rural 14 The 90 million people in less than five years is an estimate calcu- sanitation in Bangladesh through the community- lated by subtracting the government of Bangladesh 2003 figure of coverage from the 2008 figure, which indicates that 65 percent of led approach, with the local union parishads and the population gained access to latrines in less than five years, and NGOs playing the key role of facilitators. According assuming a conservative population estimate of 140 million (as per the 2001 census), i.e. 65/100*140 = 90 million (very conserva- to the Bangladesh National Sanitation Secretariat tively) in less than five years. the sanitation coverage in June 2008 was around Lessons from Sanitation Initiatives in Bangladesh | 65 Figure 6.2 Progress in Sanitation Coverage (October 2003 to June 2008) 100 95 90 85 80 75 70 % Coverage 65 60 City Corpora ons 55 Municipali es 50 45 Rural 40 Total in Whole Country 35 30 25 Jun-03 Dec-03 Jun-04 Dec-04 Jun-05 Dec-05 Jun-06 Dec-06 Jun-07 Dec-07 Jun-08 Years Source: National Sanitation Secretariat, 2008. 88 percent, which is an increase of about 55 percent from the baseline in October 2003. The open defecation rate reduced from 42 percent to less than 10 percent. Figure 6.2 shows the actual progress towards 100 percent sanitation coverage. A study by VERC found that investment in latrines increased from 5 percent in households of the study sample (424 households) in 2003 to 100 percent in 2006 for the study area. The average family investment for latrines increased from Tk 26.20 in 2003 to Tk 506.80 for better latrine options in 2006. Comparison of Sanitation Programs in Bangladesh Four organizations in Bangladesh, known to have excellent track records in the implementation of the Total Sanitation Campaign, were selected for the detailed review. The selected programs represented a range of approaches, institutional arrangements, and actors, including government Models of latrines in Total Sanitation Campaign are developed institutions, donors, and NGOs. It was difficult to to suit varying economic strata. distinguish differences between some aspects of 66 | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 program. The formal local government institutions involved in the process include the upazila, union, and ward sanitation task forces. The informal institutions are community organizations formed under different programs, such as the community water and sanitation action committee, water point management committee, hygiene education group, children’s group, or adolescent girls’ groups for reproductive hygiene. These groups function as task forces, and are assigned specific tasks within a range of sanitation and hygiene behavior change promotion activities. They are formed as outcomes of a process involving the facilitating NGO in collaboration with local government institution the various programs because of the similarity in representatives. the approaches. They all adhered to the principles The task forces are mainly required to undertake of community-led total sanitation supported by a needs assessment of actions and resources, the government, contributing to the success of prepare a time-bound sanitation plan at the union the Total Sanitation Campaign. The results of level, steer the overall process, and report to the the review are presented under the following immediate senior management task force for themes: institutional arrangements, awareness coordination and monitoring purposes. Thus the and motivation, development and promotion formal and informal institutions are interlinked of technologies, and financial aspects. Table 6.2 to each other for planning, implementation, provides a summary and comparison of the findings monitoring, and evaluation of sanitation activities of sanitation programs in Bangladesh. in the communities, wards, and unions (Figure 6.3 presents the integrated institutional setup of the Institutional Arrangements sanitation sector in Bangladesh). The Total Sanitation Campaign is substantially Summary of Findings supported by the Bangladesh government alone In the Bangladesh Total Sanitation Campaign, NGOs, (BRAC WASH Program), by government and donor local government institutions, and community-based jointly (DISHARI), by donor and NGO (SEDA/NGO organizations play a critical role in implementing Forum), or by NGO alone (VERC). BRAC has employed the program. The government’s primary role is its own bottom-up participation and planning to utilize its social and legal power (often its off- approach through the WASH committees formed at budget leverage) to mobilize and regulate providers the village level, whose members represent the entire and households to ensure that everyone receives a village. The union parishads together with BRAC staff basic quality of service. A secondary (and separate) guide the program in setting priorities and mobilizing role of the government is to provide services to the village committees. DISHARI involves the existing the underserved, where the government is unable administrative and local government structures and to leverage the market or social norms to do so. works by strengthening the institutional capacity of The NGOs as key players identify partners, extend the local government institutions, enabling them to technical support, and enable the partners to play a steering role. Both VERC and SEDA/NGO Forum take part in the implementation of the sanitation use the community as the entry point of their program Lessons from Sanitation Initiatives in Bangladesh | 67 Table 6.2 Comparison of Sanitation Programs in Bangladesh Decentralized Integrated Sanitation, Hygiene Water, Sanitation and and Reform Initiative Community-Led Total Community WatSan Hygiene (WASH) Program (DISHARI) Program Sanitation Program Program supported by Program (2006–2010) (2004–2010) (2000–present) NGO Forum (2004–2006) (facilitating agency) (BRAC) (World Bank) (VERC) (SEDA/NGO Forum) Coverage 150 upazilas 80 unions, 8 upazilas, 75 unions, 8 upazilas, 8 unions, 4 upazilas, 2 divisions 3 divisions 1 division Institutional arrangements Institutional management by Planning from upazila Community-based Implemented by upazila upazila linked to community- sanitation task force level organizations plan under sanitation task force. based organization. with community-based the guidance of the water Community-based Department of Public Health organizations motivating and sanitation task force organizations and Engineering for technical the community and and upazila sanitation task supporting bodies provide assistance. Monitoring by implementing the program force. They implement their support, assistance, and BRAC monitoring department. with the assistance of the own activities as per plan. program monitoring. water and sanitation task Program monitoring force. Program monitoring 32 entrepreneurs trained. by community-based by community-based organizations. organizations. Capacity building of Capacity building of the community-based community organizations organizations and local and local government government institutions. 68 | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 institutions. 10 entrepreneurs trained. 56 entrepreneurs trained. Awareness and motivation Proactively includes women Community mobilization Community water Community organization, in the program. process starts with and sanitation action the village development Hygiene education for the application of participatory committee formed through committee, formed through very poor. rural appraisal, and a participatory rural appraisal participatory rural appraisal community organization, to bring about behavior to bring about behavior Awareness activities: folk the para action committee, change. change. music, drama, exhibition is formed to bring about of short films, and publicity Campaign through Models of latrines displayed behavior change. religious and educational in front of SEDA office. on electronic media and in newspapers. Models of latrines displayed institutions. Union parishad played a in front of the upazila office Models of latrines displayed vital role in popularizing and public places. in public places. sanitary latrine models. Decentralized Integrated Sanitation, Hygiene Water, Sanitation and and Reform Initiative Community-Led Total Community WatSan Hygiene (WASH) Program (DISHARI) Program Sanitation Program Program supported by Program (2006–2010) (2004–2010) (2000–present) NGO Forum (2004–2006) (facilitating agency) (BRAC) (World Bank) (VERC) (SEDA/NGO Forum) Awareness activities: folk Awareness activities: folk Upazila introduced awards music, drama, exhibition of music, drama, exhibition of and incentives for 100% short films, and publicity short films, and publicity sanitized villages. on electronic media and in on electronic media and in Awareness activities: folk newspapers. newspapers. music, drama, exhibition of short films, and publicity on electronic media and in newspapers. Development and Sanitary latrines models and Sanitary latrines models and Sanitary latrines models Sanitary latrines models and promotion of technologies types: 1 offset model and types: 3 offset models and and type: 6 offset models. types: 3 offset models and 4 models of direct type. 2 models of direct type. Operation and maintenance 2 models of direct type. Operation and maintenance by local skilled technicians. Operation and maintenance by local masons. by local skilled technicians. Financial aspects Cost about Tk 1,000. Costs of different models Tk Cost of different models Tk Cost of different models Tk 100% subsidy to the very 30–1,400. 80–1,400. 350–3,500. poor. Revolving fund for Provision for the very poor: Provision for the very poor: Provision for the very maintenance and loans for 100% subsidy from upazila’s 100% subsidy from upazila’s poor: 100% subsidy from poor families. annual development plan annual development plan the upazila’s annual allocation. allocation. development plan allocation. Microcredit for households and latrine producers and entrepreneurs. Lessons from Sanitation Initiatives in Bangladesh | 69 Figure 6.3 Integrated Institutional Setup: Bangladesh Total Sanitation Campaign Government of Bangladesh, Total Sanita�on Campaign Policy support Union parishad /DPHE/upazila sanita�on task force Leading, coordina�ng, implemen�ng Sanita�on programs Entrepreneurs Coordina�on (BRAC-WASH, DISHARI, VERC, NGO-F) Service providers Community groups Local NGOs Implementa�on Awareness raising support Mo�va�on Awareness raising Mobiliza�on Mo�va�on Community ac�on commi�ees Monitoring Monitoring Microcredit/loans Households through their community action committees. SEDA/ and community monitoring procedures with NGO Forum works with local NGOs, involving village feedback systems are in place. Monitoring is development committees, while VERC’s approach generally a tri-party arrangement involving the focuses on community ignition and participation facilitating organizations, local governments, and processes. the community-level committees. The progress of the Total Sanitation Program is monitored from Training activities are similar across programs and upazila level through the union sanitation task force are principally provided in two broad areas – human and ward sanitation task force. The overall national skills and technical skills development. Capacity performance and progress across the country are enhancement of facilitating organizations and monitored by the National Sanitation Secretariat. capacity building of community institutions, The community organizations maintain registers to stakeholders, and catalysts is provided under document the information, decisions, plans, and the campaign. Capacity-building training on progress reviews for each activity. The facilitating participatory values and facilitation skills is provided organization maintains a flow of information for local government staff members. Training and up through the hierarchy from community advocacy interventions make stakeholders aware of organizations, to ward sanitation task force, to the issues, resources, and actors; help them explore union sanitation task force, to upazila sanitation the potential of building alliances; and clarify their task force, to district sanitation task force, and roles and responsibilities. Training is provided to finally to the National Sanitation Secretariat. masons on low-cost latrine production to ensure Strong monitoring teams comprising local community easy access to affordable latrine options. organizations and NGOs regularly monitor the Participatory monitoring assists proper planning performance of the promoters and adoption trends and implementation of activities, and organizational with regard to sanitary latrine use in program 70 | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 areas. Monitoring is done during hygiene education ensuring (through mobilizing and regulating) sessions and by the union sanitation task force to that all households under their jurisdiction ensure quality. The most important feature of the adopt safe and efficient technologies. community monitoring system is that the community action committees simultaneously monitor their own progress and impact on health. Local government Awareness and Motivation institution representatives, teachers of educational Summary of Findings institutions, members of local clubs, and other local- level stakeholders are also closely involved in the Unlike earlier approaches, in the current Total implementation and monitoring of sanitary latrine Sanitation Campaign the process of behavior use in the communities. The key issues during change is initiated without external financial monitoring are the number of households that support to households. Behavior change, which has installed latrines and whether people are using the been a key strategic area for sanitation practices, is installed latrines in a hygienic manner. measured by such indicators as the use of improved sanitation practices, reduced open defecation, safe Lessons Learnt: Institutional disposal of child feces, and washing both hands at Arrangements critical moments. From the review of institutional arrangements with One of the most noteworthy features of the regard to the Total Sanitation Campaign, the main reviewed programs is the absence of household- lessons learnt were as follows: level subsidy. Community-led total sanitation relies on the participation of every member of the � Commitment and ownership by the community. The program is based on the precept government has been critical for the success that communities can arrange cross-subsidies to of community-led total sanitation. This was make sanitation facilities accessible to weaker achieved by well-planned advocacy work. groups. This is achieved through the formation of For instance, awards for unions that had self-help groups and linking of funding sources, such achieved 100 percent sanitation coverage as microcredit schemes. However, the approach created a strong motivation for local works only if awareness is created within the government buy-in. communities of the benefits of hygienic practices. � Moving from a top-down to an integrated The awareness process consists of ensuring participatory institutional bottom-up people’s participation in all activities, and approach, where the community plays usually begins by holding an entry participatory a key role, is very effective in any large- rural appraisal session. The union parishad scale development program. Community- members, as participants of the session, prepare based multilevel participatory monitoring respective ward-level action plans for holding is essential for program success and can community-level workshops to raise awareness become an important tool for motivation. in the community in general and help in the � Decentralization of administrative roles formation of a community water and sanitation committee (Box 6.1). and actions allows the local government to manage and coordinate financial and VERC, SEDA, and DISHARI follow similar strategies administrative tasks effectively, ensuring for the involvement of village community community-level participation. This means groups. VERC starts with the community and a bigger role for the local government in simultaneously initiates sharing with the upazila Lessons from Sanitation Initiatives in Bangladesh | 71 Box 6.1 Community Engagement Process Communities are engaged through a social mapping exercise, developing a map that indicates roads, lanes, crop fields, households, water points, and installed latrines, and the location and hygiene status of institutions (religious and educational). Seasonality trends, incidence of diseases, and availability of water round the year are also determined and assessed through discussions with the community during awareness sessions. Defecation site visits and feces calculations (estimating the huge quantity of human excreta generated at an open defecation site in the community) enable the community to understand their unsanitary living conditions. A committee is then formed to lead the preparation of detailed plans of action, sharing it with the community for ratification and support, and to endorse the community’s direct involvement. Any existing institutions in the community are also brought under the sanitation initiative through discussions with the management committee. Hygiene education is imparted initially by the NGO staff for promotion and monitoring of actions and installations in the community. All its activities are documented for future reference and as a record of progress. Effectively, the community-based organizations are the prime drivers of activities under the Total Sanitation Campaign. and union sanitation task forces so that any Lessons Learnt: Awareness and success achieved can be readily shared with Motivation upazila and union forums. In the DISHARI program, this initiation process begins by holding From the review of awareness and motivation with workshops with the upazila sanitation task force. regard to the Total Sanitation Campaign, the main SEDA holds orientation sessions making use of the lessons learnt were as follows: participatory rural appraisal tools. Front-line staff � A strong awareness approach that involves members organize BRAC’s sharing sessions. active local government–partner linkages with the community as the entry point is very Ward-level committees conduct awareness-raising effective in raising awareness. activities in the form of folk music, drama, exhibitions of short films, and publicity through electronic media � The community-led approach empowers and encourages the community to analyze and newspapers, and also organize exposure visits, its own environment and sanitary conditions thematic round table conferences, and workshops. and initiate collective local action to stop The community mobilization process involves related open defecation. participatory rural appraisal tools and techniques and includes a transect walk, social mapping, well- � Awareness raising of hygiene practices is at being ranking, a seasonality trends calendar, an open the root of the sanitation program and brings defecation site visit, feces calculation, flowchart about attitudinal and behavior change, analysis, and drawing up action plans. motivating people to adopt latrines. � The people-centered approach brings To establish gender parity, both men and women are credibility to a program and can lead to actively involved. The community-based sanitation 100 percent sanitation coverage if it is approach emphasizes active involvement of women supported by low-cost technologies. in the program process. Women play a pivotal role in the community through the community-based � Gender parity is an important component participatory mechanism. They also are involved in of the sanitation program. Giving women the implementation of improvement of behavior active roles provides impetus to the program, practices, cleaning installed latrines, and improving as they can effectively impart and activate domestic hygiene. behavior change and domestic hygiene. 72 | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 Development and the fieldworkers are the front-line staff, the Total Sanitation Campaign helps to form community- Promotion of Technologies based rural sanitation engineering groups made up Summary of Findings of local individuals to develop innovative sanitation technology designs. The campaign facilitates these The Total Sanitation Campaign does not advocate a “engineers� to generate indigenous designs within single-model blueprint approach for technology. The certain technical parameters. These fieldworkers traditional approach has been to provide very few and village engineers help in the promotion of technological options, such as the concrete ring slab effective sanitation options by demonstrating with water seal. In a move away from this approach models, providing advice, and supporting people whereby a single latrine design is advocated, a wide during latrine selection and installation. Households range of hardware options have been made available hire these engineers for the construction of toilets and users can choose an appropriate model based in their premises. In addition to technological on affordability and different socioeconomic and support, the NGOs provide support for setting up hydrogeological conditions. The VERC program has village sanitation centers by the local masons, who about 30 options being used by the community. are trained in good-quality latrine construction. DISHARI is promoting indigenous low-cost options, The services of a number of skilled local technicians such as a covered pit latrine and a ventilated offset and masons, who can make sanitary latrines with pit latrine, in order to reach the very poor. The wide locally available raw materials, are available in the range of hardware options include DISHARI’s five program areas. They are skilled enough to build any models of sanitary latrines, VERC’s six models, and type of sanitary latrine in the user’s premises. The SEDA/NGO Forum’s five models, all of which have been accepted by the community. These sanitary households, in collaboration with the community latrines are so designed that all – from the very sanitation committees (which employ cleaners poor to the rich – can choose in accordance with for maintenance), are responsible for operation their economic conditions. Sanitary latrine display and maintenance of latrines. The raw materials centers have been established in program areas for making sanitary latrines are indigenous and to showcase the types and installation costs of locally available. Local entrepreneurship has been each type of latrine. Customers can select and buy developed in program areas to produce and sell sanitary latrines suitable to meet their respective accessories for sanitary latrines to the communities needs from these centers. at reasonable prices. Local innovations are actively encouraged to expand The field survey showed that householders who the range of options available. Recognizing that initially install lowest-cost latrines typically move Box 6.2 Moving Up the Sanitation Ladder A study by VERC (Saha, Kashem, and Rafi 2006) found that different strata of rural Bangladesh households moved forward on the sanitation ladder from the very low cost sanitation options to the better and more durable options by investing their own resources. A small proportion of the sanitary latrine user households in the study areas – for example around 5–7 percent of families in Manda upazila (VERC) and 10 percent in Sreepur upazila (DISHARI) – were found to receive microcredit support for upgrading from different financing organizations (for example BRAC, Grameen Bank, and ASA). The community-led approach and its in-built continuous motivation and mobilization processes motivated people to turn away from open defecation and opt for sanitary latrines to improve their quality of life, adopt better and more sustainable options, and enhance their hygiene behaviors. Lessons from Sanitation Initiatives in Bangladesh | 73 Box 6.3 Financial Mechanism in the National Sanitation Program Communities (individual households) invest in hardware installations and their repair and maintenance. Development partners (such as NGOs) invest in hygiene promotion, mobilization, capacity building, entrepreneurship development, and advocacy. Government and local government institutions invest in both hardware and hygiene promotion for the very poor as part of their safety net program. Microcredit facilities are also available for financing the entrepreneurs and for installation of better and more durable sanitation options. to better and costlier options later (Box 6.2), Financial Aspects indicating growing awareness of the benefits of using sanitary latrines. Upgrading in one household Summary of Findings often motivates others in the community to follow suit, and has been one of the key reasons behind The government of Bangladesh, particularly at the success of the sanitary latrine movement in local government level, has a safety net system whereby 20 percent of the annual development Bangladesh to date. plan allocation of the upazila parishads can be used Lessons Learnt: Development and for the very poor, providing them with 100 percent subsidy for sanitary latrines (of the three rings15 Promotion of Technologies and one slab type). In addition, the upazilas and From the review of development and promotion unions are awarded a Tk 200,000 block grant for of technologies with regard to the Total Sanitation development if they have successfully achieved Campaign, the main lessons learnt were as 100 percent improved sanitation coverage. These follows: awards, presented by the minister in person to local government representatives, have been a major � The availability of a wide range of sanitary motivational factor for local government, and have latrine technologies suited to different inspired unions and upazilas to rapidly scale up socioeconomic and hydrogeological con- and replicate the total sanitation approach. In line ditions helps reach a greater number of with the policies of the government, all reviewed households. programs allocated financial support to the very � Promoting indigenous low-cost options, such poor households to install slab latrines. Box 6.3 as covered pit latrine and ventilated offset pit lists the financial mechanisms in the Bangladesh latrine, to reach the very poor plays a major sanitation program and Table 6.3 presents the role in achieving better coverage. funds available to union parishads for sanitation. � Local innovations in design and the presence Six types of sanitary latrine models have been of locally available technicians and masons developed in the program areas, according to the are important factors for acceptance and affordability of the community (Table 6.4). The usage of latrines. highest price of the sanitary latrine is Tk 3,500 � A strong and effective maintenance approach and the lowest is Tk 30. While SEDA/NGO Forum’s is essential for continued use of the latrines in a hygienic manner, according to the 15 A ring is a part of a latrine used to make a tank or protect the pit program. where the excreta are being deposited. 74 | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 Table 6.3 Sources of Funds in Union Parishads for Achieving Total Sanitation Source of fund Type/amount Allocation from annual development 20% of annual development plan, of which 75% will be used for hardware plan and 25% for hygiene promotion. Block allocation (lump sum) Some union parishads have a special block allocation in their annual development plan apart from 20% for sanitation coverage. They keep this block allocation while they formulate the annual development plan. Gram sarkar allocation After reformation of gram sarkars, the Local Government Division allocated funds (Tk 5,000) to each gram sarkar for increased sanitation coverage. The gram sarkar was headed by the union parishad ward member, who was also head of the ward sanitation task force. Department of Public Health The Department of Public Health Engineering also distributes latrines Engineering through union parishads under the National Sanitation Program. Union parishad’s own fund The union parishads have their own revenue income from different sources (including taxation). In order to achieve 100% sanitation coverage by 2010, the government of Bangladesh suggested that union parishads spend 1% of their total income on sanitation. Prize money (block grant from Local Prize money is awarded as a block grant from the Ministry to union Government Division, Ministry parishads who achieve 100% coverage. of Local Government, Rural Development and Cooperatives) Source: VERC 2007. Table 6.4 Types of Sanitary Latrines Developed by DISHARI, VERC, SEDA/NGO Forum Installation cost (taka) SEDA/NGO Type of sanitary latrine DISHARI VERC Forum Sanitary latrine with 10 rings for soak pit, 1 slab, 1 ring (offset type) 3,500 Sanitary latrine with 5 rings for soak pit, 1 slab, 1 ring (offset type) 1,500 Sanitary latrine with 5 rings for soak pit, 1 slab, 1 ring (offset type) 1,000–1,400 Sanitary latrine with 5 rings for soak pit, 1 slab, 1 ring (offset type) 1,200–1,400 Sanitary latrine with 3 rings for soak pit, 1 slab, 1 ring (offset type) 700–800 Sanitary latrine with 3 rings for soak pit, 1 slab, 1 ring (offset type) 500–700 Hygienic pit sanitary latrine (direct) 320 600–800 Plastic pan latrine with siphon (offset) 300 Plastic vent pipe model with bend pipe, l plastic pan (offset) 300 Plastic pan pit latrine with vent pipe: local materials (offset) 140 Hygienic pit latrine: local materials (direct pit) 90 350 Motka model pit latrine with vent pipe: local materials (offset) 0 Extreme low-cost hygienic pit latrine: local materials (direct pit) 30 Lessons from Sanitation Initiatives in Bangladesh | 75 lowest-priced latrine (Tk 350) may be sustainable 32 persons as entrepreneurs in Shibalaya upazila it is costly for the poor. The lowest-priced DISHARI and 24 of them were found to be active in their (Tk 30) and VERC (Tk 80) options are the only businesses. The sanitation program promotes latrines affordable to a wider range of households. private sector involvement in service delivery by In the BRAC program, very poor households providing interest-free loans of Tk 10,000 to local received Tk 1,000 as subsidy. The remaining sum entrepreneurs for manufacturing slabs and rings. of approximately Tk 500 was contributed by Table 6.5 presents the sources of finance available the households in the form of labor and other to entrepreneurs. The table shows a high prevalence related costs. SEDA has also designed two models of self-financed entrepreneurs; the others received for richer households – a sanitary latrine with financial support from BRAC, Grameen Bank, VERC, septic tank, and a sanitary latrine (offset) with SEDA, and other sources, which provided them a soak pit of 10 rings – which cost Tk 40,000 and with seed money, or the initial working capital to Tk 3,500, respectively. establish products and services. A small percentage of the sanitary latrine user Lessons Learnt: Financial Aspects households in the study areas were found to have From the review of financial aspects with regard received microcredit support (around 5–7 percent to the Total Sanitation Campaign, the main lessons families under the VERC program, 10 percent under learnt were as follows: DISHARI, and 20 percent under SEDA). BRAC has provided interest-free loans to local entrepreneurs � A specifically targeted program that who produced 350,000 slab latrines. captures the needs of the very poor can encourage acceptance of the program, Entrepreneur development is key to the sanitation thereby helping attain goals in hygiene program and entrepreneurs are considered both as practice and sanitation. Government grants small-scale production units and catalysts that ignite and allocations made available for the very communities to install sanitary latrines. A total of poor and as incentives for local government 56 entrepreneurs were trained in Sreepur upazila institutions assist in improving outreach and under DISHARI alone, of which 45 were found to be program implementation. marketing their products. The remaining 11 were working as masons undertaking installation and � A wide range of hardware options, suiting repair of sanitary latrines. VERC trained 10 persons both the poorer and richer households, is as entrepreneurs and all of them are operating their crucial for achieving 100 percent program businesses in Manda upazila. Apart from these, coverage. 25 private latrine producers who are doing active � A strong entrepreneur development business in this field see this as an opportunity component increases availability of products for a secondary source of income. SEDA trained and services, making it easier for households Table 6.5 Source of Funds for Entrepreneurs in the Study Area Source of finance Sreepur (%) Manda (%) Shibalaya (%) Microfinancing institutions 15 24 29 Self-financed 85 76 71 Total 100% (45) 100% (33) 100% (24) Note: Figures in parentheses are the total numbers of active entrepreneurs. 76 | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 to install latrines, providing impetus to the the households by equally integrating community program. Provision of microcredit support organizations, NGOs, partners, and local government and interest-free loans to local entrepreneurs administration. Decentralization of financial and are important to the sustainability of the administrative activities further added to the program. motivation of unions. The other main aspect is active community Conclusions participation, with success achieved through meaningful leadership, coordination, motivation, Until the late 1990s sanitation in Bangladesh was and mobilization of the community by the poor, with no proper latrines and widespread community. The onus of the program is on the open defecation. Programs during this period community, providing it with ownership and were supply driven and users were not willing therefore motivation. The premise that to achieve to pay for high-cost latrines. Moreover, most of the sanitation coverage target communities have the NGOs implemented small-scale sanitation to be at the center of planning and implementation projects that made little impact. From 2003 of the sanitation programs, as advocated by onwards, successful advocacy led to government the National Policy for Safe Water Supply and ownership, and the sanitation initiative gained Sanitation (1998), has been vindicated. Following momentum. In the first five years of the Total the policy, the government has put its efforts into Sanitation Campaign the uptake of sanitary institutionalization of community participation latrines increased from 20 percent to 80 percent, through building water and sanitation committees and now more than 90 million people have access at the ward, union parishad, upazila, and district to and use latrines. Presently, although diverse levels, which has also helped towards ensuring sanitation programs are in place in Bangladesh, transparency and accountability. they have converged under the Total Sanitation Campaign of the government, which aims to Another major reason for the success of the Total achieve 100 percent sanitation coverage by 2010. Sanitation Campaign, especially with regard to The Total Sanitation Campaign is successful as the access gained by the poor, was the switch it inspires communities to undertake sanitation in emphasis by the government and NGOs programs using their own initiative and resources from the promotion of toilets (which are rival for their own good, with support from NGOs and and excludable) to the promotion of an open local government institutions. defecation-free environment (which is nonrival and nonexcludable). The sanitation program One of the most important aspects of the sanitation focuses on poor households and the emphasis program in Bangladesh is the massive policy thrust is on educating the communities that hygiene it receives from the Bangladesh government. The practices are a basic need. Increased awareness of political commitment was so strong that the Minister the benefits is achieved through a multipronged and the Secretary of the Local Government Division approach that targets households, teachers, personally traveled extensively across the country students, and community groups, and reinforces to motivate local government representatives and messages through the media. government officials. This was the key driving force and led to harmonization of activities at various The sanitation program could not have progressed on levels, from the national and local government community motivation and integrated approaches to the community. The greatest success has been were it not for the availability of a wide range of bridging of the gap between the policy makers and low-cost sanitation hardware affordable to the Lessons from Sanitation Initiatives in Bangladesh | 77 very poor. The presence of a strong entrepreneur even provide some stoves free of cost. With the force furthered the commercialized approach massive policy thrust that it is set to receive from and sanitation products were readily available the new Renewable Energy Policy (2009), the future locally. Providing subsidies to households was not cookstove program can: considered as a means for disseminating latrines � Create an integrated enabling environment in the sanitation program. Instead, the program for a policy thrust with facilitative roles for employed the approach of applying community-level the various partners; peer pressure to encourage sustained motivational change and adoption of hygienic practices. � Ensure effective communication for follow- up, monitoring, and feedback; Thus, the total sanitation program achieved success mainly through transforming government, partner, � Maximize the use of available resources and community actions into a participatory social (natural and human talent, skills, concepts); movement. The future cookstove program should � Create market opportunities and business follow the same path, with the government’s role models; being primarily to ensure that no one is exposed � Develop a wide range of models and finance to unsafe (and inefficient) fuel use while cooking, options affordable even to the very poor; and secondarily to promote, regulate, and license the marketing of fuel-efficient stoves to enable � Empower people with technical and decision- households to choose options that suit their making skills; means. The government may also need to target � Above all, propel mass mobilization through subsidies at carefully identified poor groups, or behavior change. 78 | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 Summary and Recommendations B angladesh is a country with widespread on biomass fuels of new types of stoves that are problems involving household biomass both more efficient and reduce indoor air pollution. energy. Due to the scarcity and high cost of There are existing programs in Bangladesh that firewood, over one half of its rural population is have been described in this study, but they have dependent on leaves, grass, or dung for household generally been on a very small scale and have not cooking (Asaduzzaman, Barnes, and Khandakar always been successful. The existing programs need 2007). In addition, well over 90 percent of to be supported, but a way forward is needed that Bangladesh’s rural population is involved in some expands their scope to make a real difference to the kind of fuel collection, and this is particularly true people depending on biomass for their household for women and children. The amount of time spent energy needs in Bangladesh. collecting fuel alone consumes over 150 hours of The goal of this study has been to explore options family labor, which is close to 20 days per year. In for improving cookstoves in Bangladesh through an addition, the adverse health impacts of consuming evaluation of existing programs, the international biomass fuels in the traditional stoves that are experience on improved stoves, and the lessons from being used in Bangladesh are just beginning to be successful interventions of the sanitation sector. understood. WHO (2007) estimated that 3 percent After all, one of Bangladesh’s greatest development of the national burden of disease could be attributed successes has been to achieve near total sanitation. to using solid fuels for cooking, and most of those The lessons from the Total Sanitation Campaign and deaths were caused by respiratory illnesses. other successful improved cookstove approaches There are several ways to address these household employed around the world provide insights for energy problems. One way is to promote the making recommendations for improved stoves in substitution of cleaner fuels, such as kerosene and Bangladesh. There are two ways lessons from these liquid petroleum gas, for cooking in rural areas. It programs might be incorporated to improve the is highly recommended to make these fuels more promotion of improved stoves in Bangladesh. The available for purchase in rural areas, but they are first is to examine the characteristics of successful costly and the development of markets and income programs as they apply to Bangladesh. The second to afford them will take a long time. An alternative involves how to move forward in order to achieve is to promote the adoption by people dependent the success found in the total sanitation program Summary and Recommendations | 79 and from other programs around the world. Thus, but it appears from historical evidence there in the next section, the characteristics that are is a need for greater coordination of efforts if a necessary to have a successful program on improved scaled-up program on improved cookstoves is to stoves are examined. be considered. Government agencies are not all equipped to effectively coordinate institutionally complex programs, though the experience of Status of Improved Stoves community-led total sanitation illustrates that it in Bangladesh is vital to involve them and build their capacity. In The improved stove programs in Bangladesh today addition, the success in sanitation highlights the are small and quite active. There have been many need for a willingness to learn from other sectors, different donors and NGOs involved over the years, and to transfer monitoring, financing, licensing, and the primary goal, common to many other and promotional skills between NGOs and even worldwide programs, has been to reach the poorest ministries and departments. Organizations such as households. As a result, the programs have been IDCOL are well placed to embrace the multisectoral somewhat trapped in what has been described dimensions of improved cookstoves. as the production and sale of low-cost artisan Two nonstove programs that have done very well in stoves. In addition, the programs are sometimes Bangladesh are the IDCOL household photovoltaic very output oriented due to the limited amount of program and the sanitation program. The IDCOL financing available and the short time period for institutional model does not dictate solutions to implementing them. On the positive side, these its working partners, but rather insists on good stoves at least initially do reduce fuel consumption financing, quality controls, mature technologies, and thus lead to lower indoor air pollution for and reliable partners for implementation. In families that use them. However, there are also contrast, the sanitation program seems to work well problems with this approach. These stoves need to because of the development of a variety of choices be replaced or rebuilt almost yearly, and therefore for communities, who also have been influential in require an extraordinary amount of after-sales the implementation of the program. support to succeed. This study also has found that consumers are still dissatisfied with the stoves and For issues that are important for stove programs, even modify them to meet their cooking needs. two matters still seem to be somewhat unresolved. This is not to say that there is no place for a low- One notable problem in Bangladesh is that cost stove in an overall program, but there needs to there are standards for indoor air pollution or be a greater diversity of offerings. general pollution levels, but there is no institution responsible for testing stoves to determine if they Historically, a wide variety of institutions has actually perform as claimed by those promoting been involved in improved stoves in Bangladesh. them. Claims of efficiency, pollution reduction, This is not a problem in itself, but it means and durability often are not actually tested by that the various aspects of the program can objective, outside groups. In addition, there is be fragmented. Donors and NGOs have gone no level playing field for subsidies for improved in different directions with little learning from stoves, as the level of subsidy is dependent on the mistakes or successful approaches. Some organization promoting the stoves. These problems programs stressed the promotion of particular are not insurmountable, and the next section deals stoves while others concentrated on training or with some of the practices that have contributed entrepreneur development. There is room for to the success of improved stove programs both in a variety of actors involving improved stoves, Bangladesh and around the world. 0 | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 Lessons from Successful a recent study of the difficulties encountered in the improved stove programs in India (Barnes, Kumar, Programs and Openshaw 2009). Key characteristics of successful programs reviewed include strong policy support and participation by a Institutional Arrangements wide group of actors, including community-based The programs that have been successful have organizations, NGOs, private entrepreneurs, local generally had the support of their governments. government institutions, and microfinance providers. For instance, in China the rural energy agency in the Trademarks of these programs are that they are not Ministry of Agriculture was the champion for the one-dimensional. The programs often touch on improved stove program. In Guatemala, the program such issues as demand generation, entrepreneur was implemented through a government agency to development, training, maintenance, and monitoring promote social investments funds. Thus, to facilitate and evaluation to establish a market-based approach program development and address the weaknesses for improved stoves. Generally, programs that pay encountered in existing programs, there needs to little attention to developing markets for improved be a champion for the improved cookstove program stoves can be successful in the near term, but their both at national and subnational levels, as was the long-term impact is constrained. However, it also case for the sanitation program in Bangladesh. must be realized that addressing the needs of the An integrated institutional arrangement that poorest households is quite challenging and may features central government, NGOs, community require special approaches other than exclusively organizations, and the private sector would following a market development approach. contribute to the success of a program on improved This section details the factors that might be stoves. It is true that some international agencies or necessary for establishing a cookstove program NGOs have programs that have only had marginal in Bangladesh. Four areas were considered in support from the government, but those programs examining the successful approaches of other are often isolated and dependent on grant funds for programs: continued success. � Institutional arrangements: having proper One possible approach may be to integrate the institutions to facilitate the program; promotion of improved stoves into the clean households program that has been successfully � Awareness and motivation: national strategies implemented by the sanitation programs. The for developing awareness to problems reason is that a considerable social and institutional associated with cooking on traditional stoves; network has been set up to develop sanitation � Development and promotion of technologies: benefit awareness, including sanitation committees solving the technological challenges of and other community organizations. This base may developing stoves that work well under local possibly be utilized for improved cookstove programs conditions; at only incremental effort by expanding the message � Financial aspects: ensuring that the groups of sanitation to comprehensive household health. promoting interventions are not totally However, it is sometimes difficult to promote cross- dependent on grant financing and practice sectoral programs through government agencies. financially sound business models. Training and capacity building are essential These lessons are derived from a combination of components of most successful cookstove programs. the programs reviewed in this study and also from Training can be provided to entrepreneurs, Summary and Recommendations | 1 program staff, community-based organizations, eyes and cleaner pots, but they rarely associate and end users (especially women) in technology, this with long-term health benefits. Bringing about design, maintenance, and troubleshooting. In behavior change by increasing awareness of health order to increase the dissemination of improved issues and the benefits of improved cookstoves household energy technologies and acceptance could help create a demand approach to improved by users, programs must develop strategies to stoves. Thus, one should not underestimate the provide adequate user training and after-sales importance of raising awareness of long-term service. Such a user-training component should benefits, such as better health and avoided death, lay particular emphasis on women. However, as resulting from reduction in indoor air pollution due indicated by the USAID/Winrock program in which to the use of improved cookstoves. training was a key feature, it is important to have a Communities should be made aware of other solid foundation for the training. Many of the other benefits, such as time savings due to faster cooking, successful program elements need to be in place enhancement of soil fertility by returning the crop before training can be effective. residues saved to the field, and, as a whole, the Today any program that uses carbon finance must development of the rural economy and improvement have well-established monitoring and evaluation in the living conditions of communities. If people are procedures because emission reductions must be aware of all these benefits, the willingness to pay for quantified in a standard manner. Thus, in order to and the acceptance level of improved cookstoves is monitor the progress of improved stoves, it would likely to improve considerably. As indoor air pollution be necessary to develop standards and ways to is an issue that inherently involves women and measure performance and whether stoves meet household-level cooking needs, it is very important them. This implies that there would need to be to design programs where women have an equal an institution to oversee such standards, quality voice as users, technicians, and entrepreneurs. control, testing, and validation. A monitoring This consideration needs to be included in the and evaluation program should focus on the program design process and may require getting effectiveness of the new stoves offered to the public feedback from potential women beneficiaries. One and should evaluate whether or not they adhere mechanism by which such awareness raising could to established formal or informal standards. Thus, be made possible is through existing village-level the quality and durability of improved cookstoves institutions, such as women’s credit groups or water and chimneys need to be evaluated to determine and sanitation committees. This may be particularly whether stoves actually improve efficiency, reduce beneficial in light of evidence that tackling multiple emissions, and improve indoor air quality. The health and hygiene issues simultaneously can cookstoves should be tested both in laboratories be effective, and that there is a close connection and in the field. The former is usually employed between hygiene practices, such as handwashing, early on during product development, while in- and acute respiratory infection. field investigation is invaluable for understanding The one caveat to raising awareness of the benefits the effectiveness of technologies. of improved stoves is that the new stoves or products must be effective in removing indoor air pollution Awareness and Motivation and reducing fuel consumption. In this regard, the Discussions with consumers typically indicate that monitoring of stoves in actual use by households they are not aware of the substantial benefits of for a significant period of time and having quality improved stoves. They are often familiar with the products available in the marketplace are essential fact that smoke removal leads to less burning of before embarking on a publicity campaign.  | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 Development and Promotion of of stoves, it is important to include household- Technologies level research to assist with designs of improved stoves, making them more user friendly. Many Successful programs should have the right technical insights, such as the development of stoves that design for improved stoves. One lesson from the can accommodate different-sized pots and maintain Bangladesh sanitation program is that it is better efficiency over a number of years without too much to have a variety of designs that are appropriate care and maintenance, can be gained by consulting for different social groups. Although it is important with women, who use stoves every day. to have inexpensive, locally made stove designs affordable by low-income groups, this is not always The proper use and maintenance of stoves is the right strategy for everyone. The main advantage important to maintaining the efficiency of the of locally made cookstoves is that they are less stoves. The surveys indicate that changing the costly, but as indicated in the GTZ program such dimensions of improved stoves is quite common, stoves need regular maintenance and support, and this is likely to lead to reductions in efficiency. which has not been a strong point in most programs. Improved cookstove users should be discouraged The supply of grates and chimneys was problematic from changing dimensions and designs on their in many places. own. Awareness programs are necessary to highlight the negative impacts such changes have on the The improved stove programs in Bangladesh have efficiency and indoor air pollution reduction of the been mainly centered around the artisan stoves stoves and the life of the components. User training due to their low cost, but there are new alternatives may also make the improved cookstoves partially, if that should be considered. There is no reason to not fully, self-sufficient in respect of maintenance. abandon efforts to promote affordable stoves, Maintenance at a reasonable cost is crucial for but as indicated in the sanitation program there sustainable use of improved cookstoves. In fact, a is also a need for a greater variety of choices. This good user manual combined with a durable stove was also true in China where the program quickly may be an effective way to ensure that stoves are moved from the promotion of artisan stoves maintained at a high level of performance. to assembly using manufactured parts. Today Carbon-financed stove programs differ from many some stoves are manufactured in small factories. others in that there is implicitly a stronger focus Because they require minimal installation they on sustainability, because the award of credits can be made available through local retail stores. depends on sustained use of the stove over many There are other types currently being developed, years. Therefore, in addition to rigorous frequent such as the gasifier stoves, which have higher monitoring requirements, most projects need to energy efficiency and are quite clean. Off-the-shelf make explicit provision for regular examination availability of improved cookstoves would reduce and maintenance of stoves. This helps to ensure delivery time and maintenance requirements, as that stoves continue to perform well in terms of such items are sturdier and of higher quality than fuel savings and emission reductions, and satisfy the artisan stove. user needs. Some carbon-financed stove projects Regardless of the technology of the stove, are considering making a provision to fund annual encouraging community participation in design, maintenance of stoves, mindful of the fact that implementation, and monitoring of stoves will performance can change over time without, for help increase ownership, ensuring sustainability. example, ensuring that grates remain in place and Stove designs should be based on cooking needs. chimneys remain clear. Although it can be difficult In addition to the typical laboratory evaluations and costly to incorporate such rigorous monitoring Summary and Recommendations | 83 requirements into donor-funded programs, this implicit, such as default or nonpayment of loans. level of follow-up is often required, and its absence They have also been poorly targeted, such as the is responsible for the failure of many government kerosene subsidies in Indonesia some years ago. In and NGO interventions. This degree of monitoring Indonesia kerosene prices were kept well below the and technical assistance requires a specific budget international price because the country was rich line, a skilled team, and careful organization. in petroleum resources. However, this meant that higher-income households who could readily afford Financial Aspects to pay for the fuel benefited more from the subsidy than lower-income households who often still The type of subsidies and means of financing cooked with biomass energy. Another characteristic improved cookstove, renewable energy, or sanitation of subsidies is that they have been indiscriminate, programs is covered in detail in this report. However, such as a subsidy for a quantity that is well above the issue of subsidy justification is generally not that needed by the poor or rural populations. addressed in most reviewed studies. Subsidy Finally, many subsidies become complex or difficult justification is important because in this program to administer to targeted groups, and overly review, subsidies have both encouraged success restrictive with respect to end use or technology, and sometimes led to failure of some programs. In depriving users of choices. fact, one shortcoming of many improved cookstove programs worldwide is that the organizations The effective programs in this study can generally be promoting the stoves often implement them based considered as being based on good subsidy policies. on some form of subsidy or grant given by an Of course, some countries have performed better international donor or government organization. than others, but generally all have achieved some Therefore, the stoves are available mainly through success in relation to subsidy policies. It is difficult specialized programs and are not available in the to evaluate good versus poor subsidy policies as market. This in turn limits the expansion of the it is not a one-dimensional issue. According to program and has often resulted in the promotion of most subsidy theories, several criteria need to be a single stove deemed appropriate by the financing reviewed to evaluate whether a subsidy is justified organization as opposed to that demanded by or not, including program efficiency, equity, and the public for whom the programs are intended. effectiveness (World Bank 2002), and these are Thus, the level and type of subsidy for improved applied below to promoting improved cookstoves cookstove programs can have a significant impact in Bangladesh. on the success of the program, and therefore this Program efficiency. Efficiency refers to maximizing issue warrants further elaboration. the social or economic benefits under the Some programs have experienced problems because assumption that even the best energy projects of an overreliance on subsidies. Despite laudable have an opportunity cost, raising the question: Is program objectives, subsidies have often failed to it an efficient investment for society? For this, the meet their stated goal of making services more economic rate of return needs to be calculated. For affordable to the poorest families or households. most improved cookstove projects, the economic It is no coincidence that in developing countries rate of return is positive and can be quite high. A the populations with access to high-quality recent study of the global benefits of improving energy services are the middle- and upper-income cooking practices in developing countries indicates households. Even well-intended infrastructure that the benefits include health improvement, subsidy programs can have problems (Barnes time savings, and environmental benefits, such and Halpern 2000). Subsidies have often been as avoided deforestation and carbon emissions. 84 | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 The costs involve both the retail cost of improved improved cookstove saves about 25 percent of cookstoves and the various aspects necessary to fuel and collection time, representing significant promote them if not done by a single company. annual savings. It is important to remember that For improved cookstoves WHO (2006) found the the payoff period for improved cookstoves is fairly benefit–cost ratio, including all economic benefits, short, and thus good stoves should be attractive to be about 50; so it is a highly desirable program. for purchase without a subsidy. However, the Even if some of the benefits of such programs research, promotion, and development costs of were overestimated, the programs could have stoves may be prohibitive for many entrepreneurs significant economic benefits for countries such as or microfinance organizations. In addition, the very Bangladesh (Box 7.1). poor may find it difficult to pay for an improved cookstove. Consequently, innovative approaches Because improved cookstoves require less fuel, that will enhance markets are required to make this reduces the time spent in collecting biomass stoves affordable to the very poor. Finally, the fuels or the money spent on purchasing them. An development of a variety of improved cookstoves Box 7.1 Conclusions of the WHO Cost–Benefit Evaluation for Household Energy and Health Interventions Investments in household energy and health interventions are potentially cost–beneficial and in some cases cost saving from both an economic and financial point of view. A recent WHO study evaluated both the costs and benefits of household energy programs, including improved stoves and fuel substitution. The benefits for stoves and the use of cleaner fuels were quantified by examining reduced health costs for reduction of disease, workdays saved through not contracting illnesses, reduction of costs in purchased fuel, avoided fuel collection costs due to greater efficiency of stoves, and the value of reduced fuel collection pressure on the environment. The study concluded that improved cookstoves led to the greatest overall benefit to society. This holds true particularly in urban settings where the majority of the population already pays for fuel. From an economic standpoint, making improved cookstoves available by 2015 to half of those still burning biomass fuels in traditional stoves in 2005 would result in a cost of US$ 34 billion per year, and generate an economic return of US$ 105 billion per year. The majority of costs accounted for related to fuels and stove purchase, and to a lesser extent program costs traditionally paid for by governments and donors. The economic benefits for improved cookstoves are dominated by time savings resulting from reduced fuel collection and cooking time, in excess of 70 percent for each WHO region. In some regions, avoided illness was also significant, as a local and global environmental benefit. Savings in health care were quite small and accounted for just 0.1 percent of the total economic benefits. This is because despite the significant impact of indoor air pollution on human illness among children and older adults, the illness rates are low in the main population. Thus, for a household the main benefits perceived include any cost savings for purchased fuels and avoided labor costs for collecting biomass energy. Without significant publicity of such issues, the relationship between indoor air pollution and the long-term health costs, along with the illnesses among children, is invisible to the general public. People are aware of burning of the eyes and an uncomfortable feeling when breathing smoke from fires in households, but they are not cognizant of the long-term impact that smoke has for them and their families. In addition, they probably undervalue the avoided labor costs of fuel collection, which often comprises small amounts of time spread over a week. These are issues that should be dealt with through consumer education on the benefits of improved biomass stoves or promotion of modern cooking fuels such as liquid petroleum gas. Source: WHO 2006. Summary and Recommendations | 85 at different price levels, as was done for latrines lesson is that sometimes an overconcern for equity in the sanitation program, may also be effective in leads to ineffective programs. promoting marketability. Before turning to program effectiveness, two different A complicating factor is that except for households approaches to subsidies, which are identified in that purchase fuels for cooking, the benefits of the best-practice work on adoption of improved improved cookstoves are often not in immediate cookstoves, will be reviewed. One approach is to cash benefits, which can distort the incentives promote the development of marketing for a wide for purchasing them. The saved labor is reflected variety of stoves and provide modest subsidies to as the opportunity cost of time valued at local make the stoves more affordable. Poor people do agricultural wage rates. The health costs are often have money and are willing to pay for quality stoves. avoided only years in the future. The advantages This is similar to the situation with photovoltaic of avoiding deforestation only indirectly benefits lighting systems in which subsidies of 20 percent, local people and are more of a national or regional along with affordable credit, are given to households gain. Thus, except for households that purchase for purchasing systems that cost U$ 200 (Tk 13,700) biomass fuels, many of the economic benefits are or more. High-quality improved cookstoves are distant from everyday life, even though they are likely to cost US$ 30–50, and thus in the initial stage important. of market development there could be modest subsidies that actually encourage the development Equity. In addition to evaluating economic returns, and marketing of new varieties of stoves. the equity of programs is also a consideration for choosing programs that may qualify for subsidies. Another approach to address the equity issue, which Equity refers to the efficacy of the subsidy. In other can complement the modest product subsidy and words, do the subsidies actually reach poor people market support approach, is to make high-quality who are reliant on biofuels for their everyday improved cookstoves an option for community cooking and do they have an impact on improving development programs. Programs such as the one welfare? This brings up the issue of affordability that was successful in Guatemala offered fairly and program design. expensive improved biomass stoves as one option among many different development alternatives Many improved cookstove programs have been so that included improving roads, schools, or other concerned with equity issues that they have actually infrastructure. These stoves are very durable, last caused problems in program effectiveness, as in many years, and are raised off the ground to make Bangladesh. To make improved cookstoves more them more convenient to use. Because the program accessible and acceptable to the poor many projects was not directed at the poorest of the poor, the stove have subsidized all phases of stove development option was very attractive to those communities. and dissemination. This has proved problematic In such a situation, the community has a choice for sustainability and therefore affected the overall of programs, so the stove alternative has to be a impact of the programs. The idea was to develop desirable option or product. This means that the stoves for the poorest of the poor, so that programs stove developers would have to produce a product were well targeted, but unfortunately this meant the that meets the needs of people cooking with all development of very cheap stoves that break down forms of biomass energy. This type of program is frequently and often do not perform as advertised. extremely equitable, because generally everyone in While these small interventions based on grant the community would receive the stove. Although financing have had some success, they did not result some people in the community could afford to in wide-scale adoption of improved cookstoves. The pay for the stove, which means that some of the 86 | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 targeting of the program is inefficient, it is actually problem with many of the improved cookstove those influential in the village that make decisions programs around the world that are based on on the selection of various development options. extensive donor financing. It is not that the stoves The stove is disseminated to all in the community, are not disseminated, but that the product is poorly so in a sense there is a cross-subsidy between the constructed and does not last, or does not meet more influential households and the poor because user requirements. Consumers do not repurchase of the requirement that the community grants be the stoves and thus there is very little program equally applied to all in the community. impact over the long term. Properly targeted subsidies are fundamental to To be effective, the use of subsidy incentives to the sustainability of cookstove programs. Subsidies promote stove adoption has to be done in a way often create a mindset of subsidy dependence such that the program is sustainable over the long among households. Cash income obviously is term. This means that after an initial phase of scarce among households using biomass fuels, and project development, there is a significant chance they are often willing to wait for subsidized stoves that the program will continue with modest, or despite the benefits to families. As subsidized even without, direct product subsidies. Thus, the commodities are generally limited in quantity, main approach is to provide support for institutions the spread of technology becomes self-limiting. necessary to promote the development of safe, In such a situation, subsidized supply of improved efficient and pollution-reducing stoves, with an cookstoves results in a low market demand and emphasis on the initial financing of marketing, could actually stifle entrepreneurship in the technical development of stoves, development of development of new markets. However, some standards, and other aspects of the program. This types of subsidies could help promote market will entail developing and promoting stoves for development while taking into consideration the a range of households, from the very poor to the needs of various income groups. In Bangladesh, it more wealthy. is possible to promote improved cookstoves that The successful international practices for improved combine market development with specific types cookstoves and the Bangladesh experience with of subsidies that would promote equity. sanitation services provide some interesting Effectiveness. As indicated earlier, one of the main alternatives to the high direct product subsidies that concerns around the world is that many improved have been so ineffective. In China, the approach cookstove programs have not been very effective, of a program that eventually resulted in over 100 for a variety of reasons. The main emphasis of million stoves being sold through the market and this study is on identifying the characteristics of energy agencies was to provide subsidies for effective energy programs so that insights can be the research, development, and promotion of gained from the types of subsidies used in such improved cookstoves while leaving the sale of the programs. The case studies were selected based stoves to entrepreneurs and retailers. Loans could on their overall accomplishments. The rationale for still be provided through microcredit organizations examining these best practices is that the problem for the purchase of approved improved cookstoves. programs often receive much attention, and the In the case of China, the subsidies are used for best programs often gain little consideration. market development and there are no subsidies for Nothing could be worse than pouring subsidies the stoves. The consequence is that stove retailers into a program that does not work properly even and entrepreneurs get assistance for market if it is directed at the poor. Ineffective programs development but their success is dependent on end up not benefiting anyone. This has been the consumers purchasing their products. Summary and Recommendations | 87 Another approach, reviewed above, is that An obvious role for the government to play is in the established in Guatemala, which is somewhat similar establishment of an executing agency to support to the Bangladesh sanitation program. As indicated, various aspects of improved cookstove promotion it involves the purchase of approved improved throughout the country. This would include well- cookstoves through some type of community structured loans and subsidies for qualified projects, development fund. The community purchases testing and certification of stoves, monitoring and the approved stoves from retailers. They are then evaluation to determine the effectiveness of projects distributed to most or all in the community at marked- financed, and publicity campaigns on the health down prices. In this manner market development is impacts of indoor air pollution and benefits of new not compromised, because entrepreneurs actually cookstoves. The executing agency would have well- sell the stoves to the community. defined and important activities. For example, in the case of testing and certification, the executing To summarize, these subsidy approaches go hand in agency would need to give the responsibility for hand with both market development and support testing stoves both in the laboratory and in the field for entrepreneurs. A key component of acceptability to a technical group. The international literature on is user satisfaction with the technology and after- improved stoves mostly agrees that laboratory tests sales service, due to which they are more willing are a good start to assess whether stoves meet to make the required payments. Loan financing for certain standards, but the real test is in conducting the technologies will be more effective only if there evaluations in the field. There are now techniques are a number of options to suit different clientele. available to do this, but it is not an easy process and People will only repay the financing for such stoves protocols would have to be developed that are fair if they are very satisfied with the technology and to those interested in promoting stoves. The role of after-sales service. Entrepreneurship development this technical group would be to certify that a stove can help address both the supply-side issues and being promoted in the marketplace actually meets sustainability through a commercial approach. certain standards in terms of efficiency, pollution, durability, and safety. Way Forward This should be done in a way that would not The review of the status of improved stove programs stifle creativity, but ensures that the public in Bangladesh along with the best practices from receives a product that performs according to around the world leads to several recommendations the specifications of the manufacturer or retailer. for consideration by the government of Bangladesh. Once certified, the stove could possibly qualify for government assistance in terms of loans, marketing, The overall goal is to have a more unified program and dissemination, or even some form of modest without diminishing the creativity of the various subsidy. Consumers purchasing efficient air groups advocating improved stoves in Bangladesh. conditioners in developed countries often receive In fact, the recommendations ideally should lead rebates, which is a modest subsidy to lower the to greater creativity and a variety of approaches. capital cost of efficient equipment. In a similar vein, In this sense, the government’s role is not to be for more expensive stoves, this approach could be the main actor, but rather to facilitate a process easily justified by the health and environmental that would promote greater variety, improved benefits to encourage people with modest incomes durability, better safety, and greater efficiency of to adopt improved stoves. improved stoves. The ultimate goal is eventually to have a variety of improved stoves for sale in retail To administer the program an institution with an markets all over Bangladesh. efficient commercial approach and good field-level  | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 experience in quality-assured technology promotion groups. The factors that might be considered are and dissemination may be well suited to perform the length of time the firm has been operating, some important functions in promoting improved the transparency of their accounting system, the stoves. One model that might be applicable to experience with similar programs, the ability to promotion of improved stoves is IDCOL’s program deliver on promised goals, staff that are qualified, for household photovoltaic systems. Under this and a legal and accounting system that would permit system an organization would provide loans and agreements with lending or grant-giving institutions. partial grants to NGOs, private companies, or The firm should be able to implement a program for microfinance organizations to promote stoves. improved stoves that protects consumers and the This is not a simple process, as it involves several promoting agency from undelivered promises. different types of activities. Proposal evaluation: technical feasibility and Certifying or qualifying stoves for program. One financial viability. One of the roles of the agency problem with older improved stove programs around that promotes improved stoves will be evaluation the world and even some today is that there was no of proposals to ensure that they are technically independent system to verify their performance. feasible, financially sound, and economically For example, a new stove that is custom installed in justifiable. Poor technical stove designs and a home may work quite well for a few months, but excessive subsidies have been a problem for as cracks develop in a stove and the dimensions of many improved stove programs around the world. the interior changes, the efficiency or combustion To avoid this the design of the stove program qualities of the stove may deteriorate. Thus, it should not only encourage innovative product would be beneficial to have an independent agency development, but also financial and economic or an arm of the agency implementing the stove viability. This does not mean that there should program certify that the stoves are of high quality be no subsidies, but rather that they should and will deliver promised performance under actual be structured in ways to promote the financial conditions of use. The performance criteria would viability of the program. The programs should be be both energy efficiency and smoke reduction, able to continue even if subsidies are withdrawn. along with ease of use by consumers. This could This might mean charging higher prices or finding be done by financing a technical agency to test alternative financing, but it is important that stove and certify products that would be sold under the programs do not disappear if there is a withdrawal program. This is important because consumers of subsidy support for the stove itself. should be able to purchase stoves that either have Development of diversity of products. guarantees similar to the photovoltaic programs Internationally stoves designs for poor and middle- in Bangladesh or at least be assured that they will class households have flourished. Firms such as perform as promised. It is also vital to be sure that Environfit, Siemens, and others are developing stoves are safe and will not actually increase indoor improved wood stoves, alcohol fuel stoves, and many air pollution. other designs. There are also some recent more Qualification of firms or NGOs. Just as consumers traditional stove designs available in Bangladesh. should have confidence in the performance of the At the beginning of most successful programs there products that they buy, they also should trust the will be a diversity of products that will compete organizations that are selling or providing financing for customers, and customers will chose between for the cost of stoves. Thus, firms that participate in them based on their utility. It is therefore important the program should have a track record of providing at least in the initial stages of any program to test high-quality service to consumers or consumer a diversity of stoves that address the various needs Summary and Recommendations | 89 of different types of consumers. These can include the sophisticated consumer product development both affordable and more expensive stoves. and marketing studies currently available. Recently many of the international companies involved in One way to develop a diversity of improved promoting improved stoves have begun to take stoves might be to have an improved stove grant more seriously the monitoring and evaluation of competition. This competition would award the stoves operating under actual conditions. There financing to innovative proposals to design different is now more inexpensive equipment to monitor types of improved stoves. The grants could be not energy efficiency and indoor air pollution in only for technical design of stoves, but also for people’s homes. These technical measures can be innovative ways to sell and market existing stoves. complemented by periodic consumer interviews, At present virtually 100 percent of rural households and in this way products can be refined and in Bangladesh use biomass energy, burning a wide perfected for consumers. Most private companies variety of fuels, including leaves and grass, dung, and NGOs have very little financial ability to do and wood. It will be challenging to design stoves to this kind of intensive research. Thus it would be burn efficiently for all these different types of fuels a good idea for either the firm that is involved in and there may not be any one solution. Perhaps stove certification or another local firm to carry there could be a series of competitions that address out such work. It would be necessary at least in different aspects of stove design, marketing, and the initial stages to use grant funds to complete sales during the initial phase of the program. this essential work. In this move towards diversity, it would be Proper balance between loans and grants. Many important not to reinvent what has already been programs around the world have experienced done in other countries. As indicated, there is a difficulties due to a lack of proper balance between wide variety of international approaches to stove product pricing, subsidies, and loans. The key is that development and grants might be appropriate consumers must be willing to pay for the service for local firms or NGOs to develop a cooperation that is provided by the stove. Many of the best plan to disseminate or adapt to local conditions international programs subsidize support for stove many models that are now available worldwide. programs through, for example, technical studies, Typically, this might involve a period of consumer marketing, and monitoring. However, they often testing and redesign that could be covered under do not provide subsidies for the stove itself, as in a product or business development grant. One China. In other countries with successful programs, lesson from international programs is that there there have been modest subsidies of 10 percent has been much duplication of effort because of to 20 percent provided for the stoves. The hope is poor communication between those involved with that once the initial program succeeds, then the improved stoves, and perhaps a workshop on local subsidy can be removed and the stove can be a and international experience at the beginning of commercial product. One problem with extensive the program would be warranted. subsidies is that no market development takes Monitoring of stoves in the field. In the past place for the selling of stoves, with the result that monitoring of stove performance involved most stoves are sold through the program and not specialists going out to the field, looking at through retail outlets. These programs often have whatever stoves were available, and conducting no lasting impact, because if the stoves break down informal interviews with those adopting stoves. The after the program is completed, there are no repair result was perhaps somewhat informative, but the facilities or availability of stoves in the marketplace process was rather rudimentary in comparison to for repurchase. 90 | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 Possibility of community-based grants. In technical staff to qualify their own products. The addition to the loan and grant approach, once a idea is to develop a level playing field for those variety of effective stoves are developed and in involved in the promotion of improved stoves in the marketplace, consideration might be given to Bangladesh and to create a conducive atmosphere the use of community-based funds for providing that encourages different organizations to improved stoves to whole communities, as is the development and retail a wider range of improved case with the sanitation program. Such stoves stoves in the country. Thus, the overall goal of would of course be purchased in the market and government activities should be to promote the therefore would encourage market competition development of improved stoves in Bangladesh to and the overall development of commercial alleviate the problems caused by both indoor air approaches to improved stoves. This type of pollution and shortage of biomass fuels. program should be equitable as most community grants involve projects that benefit everyone in the communities. This is the type of program that Conclusions was implemented in Guatemala, and the improved Bangladesh’s new Renewable Energy Policy endorses stoves option was popular for the use of community creating a better environment for renewable energy development funds. The stoves under that program technologies and promoting market development were relatively expensive, so the community grants for improved cookstoves (Government of were essential. Bangladesh 2009). This study supports this policy direction through examining possible strategies Publicity campaign on indoor air pollution and to move forward the development of markets for health. Once a wider variety of quality stoves are improved stoves in Bangladesh. This is not an easy in the marketplace, a national publicity campaign task as it involves many different types of forces that to publicize the health implications of indoor need to work toward achieving better success with air pollution could be implemented through a improved stoves. On the supply side, the improved chosen agency. This should not be done before stoves available in the market today are low cost, stoves that are in the marketplace are tested but have suffered from durability problems and low and certified because it would not be good to adoption rates. On the demand side, consumers publicize health issues before proper solutions still do not appreciate the long-term benefits of are available to consumers. The campaign would improved stoves and even those adopting improved provide information on health problems and the stoves alter them in ways that make them less possible ways to alleviate them. The ways to reduce efficient. No doubt there needs to be a wider variety indoor air pollution would be through interfuel of better stoves in the marketplace. substitution, proper kitchen and house ventilation, adjustment of cooking techniques, and improved In conclusions, the future of an indoor air pollution cookstoves. reduction program for mitigating the ill-effects of biomass burning requires the dedication of The possible program described above should government institutions, civil society, and the not involve any type of prohibition on the private private sector. The requirements would be to pique sector or NGOs developing their own programs the interest of entrepreneurs in developing better with their own financing. In fact, the grants and stoves, to establish a subsidy or loan program loans should be available to all that qualify, and that does not destroy market incentives for stove the technical agency could verify the effectiveness promotion, and to develop standards or an after- of the stoves of any agency on an as-needed sales service program to make sure that consumers basis. Such groups would certainly have their own are being sold products that are both reliable and Summary and Recommendations | 91 effective. Although this will not be easy, the benefits wood heating stoves has improved efficiency levels of improved stoves would be high for the poorest from 50 percent to over 80 percent and reduced populations in Bangladesh, including the reduction emissions to very low levels. There is no reason that in the labor required to collect fuelwood for daily developing countries, including Bangladesh, should cooking tasks and the improved health resulting have populations dependent on stoves that have from cleaner indoor environments. In developed had the same efficiencies and pollution levels for countries, a government certification process for hundreds of years. 92 | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 Appendix 1: Summary of Literature Reviewed on the Health Impacts of Indoor Air Pollution Author Year Journal/other Title Results Albalak, R. 001 Environmental Indoor respirable Improved biomass cookstove potentially reduces pollution exposure for Bruce, N. Science particulate matter those who cook daily with biomass fuel. McCracken, J. P. Technology concentrations from A generalized estimation equation showed 45% reduction in PM3.5 Smith, K. R. an open fire: improved concentrations for the liquid petroleum gas/open fire combination de Gallardo, T. cookstove and LPG/open compared to open fire alone. fire combination in a rural Season did not affect pollutant concentrations. Guatemalan community Plancha appears to offer best prospects among the interventions. Azizi, B. H. 1995 Journal of Indoor air pollution and Univariate analysis identified two indoor pollution variables as Zulkifli, H. I. Asthma asthma in hospitalized significant factors: sharing a bedroom with an adult smoker and Kasim, S. children in a tropical exposure to mosquito coil smoke at least three nights in a week were environment both associated with increased risk for asthma. No association between asthma and exposure to kerosene stove, wood stove, aerosol mosquito repellent, type of housing, or crowding. Balakrishnan, K. 2004 Journal of Exposure assessment for The mean 24-hour average concentration ranged form 73 to 732 µg/m3. Sambandam, S. Exposure respirable particulates Concentrations were significantly correlated with fuel type, kitchen Ramaswamy, P. Analysis and associated with household type, and fuel quantity. Mehta, S. Environmental fuel use in rural districts of Among women, exposures were highest in the age group 15–40 years, Smith, K. R. Epidemiology Andhra Pradesh, India while in men they were highest in the age group 65–80 years. Baqui, A. H. 001 Acta Causes of childhood To determine cause of death, verbal autopsy interviews were conducted Sabir, A. A. Paediatrica deaths in Bangladesh: an in Bangladesh Demographic and Health Survey. Begum, N. update Cause-specific mortality revealed that deaths due to almost all causes Arifeen, S. E. declined, though significantly only for acute respiratory infection, Mitra, S. N. diarrhea, and drowning. Black, R. E. Despite impressive decline in deaths due to acute respiratory infection, this condition remains the most important known cause of death in Bangladeshi children. Baris, E. 2004 British Medical Should interventions Risk of tuberculosis disease or mortality is increased among smokers Ezzati, M. Journal to reduce respirable and those exposed to indoor air pollution from solid fuels. The social pollutants be linked to and potential etiological links between respirable pollutants and tuberculosis control tuberculosis could provide an opportunity for integrated intervention. Appendix 1 | 93 programs? Before attempting integrated programs three important research and surveillance issues must be tackled: Author Year Journal/other Title Results � Scientific research must establish whether respirable pollutants increase susceptibility to new infections, facilitate progress to active tuberculosis, or increase tuberculosis mortality risk. � Tuberculosis surveillance should incorporate data on smoking and fuel use to quantify the correlation between tuberculosis and these risk factors. � Effectiveness of joint interventions needs to be assessed to avoid compromising existing tuberculosis programs and to select the most effective combination of interventions. Begum, V. 2007 Tropical Viewpoint: do we have Interpretation and extrapolation of existing epidemiological data of van der Werf, Medicine and enough data to estimate Bangladesh to estimate the current burden of tuberculosis is difficult. M. J. International the current burden of To enable the evaluation of progress towards the Millennium Becx-Bleumink, Health tuberculosis? The example Development Goals and to be able to assess the global burden of M. of Bangladesh tuberculosis, epidemiological surveys are needed. Borgdorff, M. W. Boy, H. 00 Environmental Birthweight and exposure Study on association with reduced birthweight, independent of key Bruce, N. Health to kitchen wood smoke maternal, social, and economic confounding factors. Delgado, H. Perspectives during pregnancy in rural Children born to mothers habitually cooking on open fires had the Guatemala lowest mean birthweight of 2,819 g; those using a chimney stove had an intermediate mean of 2,863 g; and those using the cleanest fuels (electricity or gas) had the highest mean of 2,948 g. The percentage of low birthweights (< 2,500 g) in these three groups was 19.9% (open fire), 16.8% (chimney stove), and 16% (electricity/gas). Confounding factors were strongly associated with fuel type, but after 94 | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 adjustment wood users still had a birthweight 63 g lower. Brooks, W. A. 2007 American Invasive pneumococcal Streptococcus pneumoniae was isolated from 34 pneumococcal Breiman, R. F. Journal of disease burden and patients; invasive pneumococcal disease was clinically associated Goswami, D. Tropical implications for vaccine with pneumonia (24%), upper respiratory infection (62%), and febrile Hossain, A. Medicine and policy in urban Bangladesh syndromes (14%). Overall, invasive pneumococcal disease and 13- Alam, K. Hygiene valent serotype-related invasive pneumococcal disease incidences were Saha, S. K. 447 and 276 episodes/100,000 child-years, respectively. Peak invasive Nahar, K. pneumococcal disease incidence occurred during the cool dry seasons. Nasrin, D. Penicillin, cotrimoxazole, chloramphenicol, and ciprofloxacin resistances Ahmed, N. were 2.9%, 82.4%, 14.7%, and 24.1%, respectively. Current conjugate El Arifeen, S. vaccines should substantially reduce invasive pneumococcal disease, Naheed, A. childhood pneumonia, and antimicrobial resistance in Bangladesh. Sack, D. A. Luby, S. Author Year Journal/other Title Results Bruce, N. 000 Bulletin of the Indoor air pollution in There is consistent evidence that indoor air pollution increases the Perez-Padilla, R. World Health developing countries: a risk of chronic obstructive pulmonary disease and of acute respiratory Albalak, R. Organization major environmental and infection in childhood, the most important cause of death among public health challenge children under 5 years of age in developing countries. Evidence also exists of associations with low birthweight, increased infant and perinatal mortality, pulmonary tuberculosis, nasopharyngeal and laryngeal cancer, cataracts, and, specifically in respect of the use of coal, with lung cancer. Conflicting evidence exists with regard to asthma. Indoor air pollution is a major global public health threat requiring greatly increased efforts in the areas of research and policy making. Research on its health effects should be strengthened, particularly in relation to tuberculosis and acute lower respiratory infection. Bryce, J. 2005 Lancet Child survival: countdown Recent trends in mortality and nutrition and in coverage levels for child Victora, C. G. to 2015 survival interventions were examined. The study included: � Evaluation of innovative delivery channels for scaling up population coverage with child survival interventions; � Assessment of impact of child survival interventions on equity; � Health policy and systems issues relevant to child survival; � Community participation and ownership of child survival projects; � Resource flows in child survival programs and research; � Financial protection mechanisms and their impact on access to and coverage of child survival interventions. Dasgupta, S. 2006a Indoor Air Indoor air quality for poor A stratified sample in Dhaka and Narayanganj showed that 24 hours Huq, M. families: new evidence PM10 concentrations of 300 µg/m3 or greater were common, implying Khaliquzzaman, from Bangladesh widespread health hazard. M. There are relationships between PM10 concentration and fuel choices, Pandey, K. household cooking, and ventilation practices. Wheeler, D. Exposure to dangerous pollution levels was not confined to cooking areas. Dasgupta, S. 2006b Health Policy Who suffers from indoor Investigated individuals’ exposure to indoor air pollution. Huq, M. and Planning air pollution? Evidence High level of exposure for children and adolescents of both sexes, but Khaliquzzaman, from Bangladesh particularly serious exposure for children under 5 years. M. Pandey, K. Among prime-age adults, men have half the exposure of women. Appendix 1 | 95 Wheeler, D. Elderly men had significant lower exposure than women. Author Year Journal/other Title Results Diaz, E. 2007 Journal of Eye discomfort, headache In Guatemala, the first randomized controlled trial ever performed on Smith-Sivertsen, Epidemiology and back pain among health effects from solid fuel use had the goal to assess the effect of T. and Mayan Guatemalan improved stoves (planchas) on exposure and health outcomes in a rural Pope, D. Community women taking part in population reliant on wood fuel. Lie, R. T. Health a randomised stove A high prevalence of eye discomfort, headache, and backache was Diaz, A. intervention trial found. The odds of having sore eyes and headache were substantially McCracken, J. reduced in the plancha group relative to the group using open fires for Arana, B. the follow-up period (odds ratio (OR) 0.18, 95% confidence interval (CI) Smith, K. R. 0.11 to 0.29 and (OR) 0.63, 95% CI 0.42 to 0.94, respectively). Median Bruce, N. carbon monoxide in breath among women in the intervention trial was significantly lower than controls. Continuous improvements in symptoms experienced by a substantial proportion of women may help to gain acceptance and wider use of planchas. Edwards, R. D. 2007 Indoor Air Household CO and PM The results of the indoor air quality component indicate that for nearly Liu, Y. measured as part of a all household stove or fuel groupings, PM4 levels were higher than – and He, G. review of China’s National sometimes more than twice as high as – the national PM10 standard for Yin, Z. Improved Stove Program indoor air (150 µg PM10/m3). Sinton, J. Improved stoves resulted in reduced PM4 from biomass fuel Peabody, J. combinations, but still not at levels that meet standards, and little Smith, K. R. improvement was observed in indoor pollution levels when other unimproved stoves were present in the same kitchen. Many households change fuels according to daily and seasonal 96 | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 factors, resulting in different seasonal concentrations in living rooms and kitchens. Assessing health implications from fuel use requires longitudinal evaluation of fuel use and indoor air quality levels, combined with accurate time-activity information. Ezzati, M. 001 Environmental Quantifying the effects Acute respiratory infections are the leading cause of burden of disease Kammen, D. M. Health of exposure to indoor air worldwide and have been causally linked with exposure to pollutants Perspectives pollution from biomass from domestic biomass fuels in developing countries. combustion on acute Acute respiratory infections and acute lower respiratory infections respiratory infections in are concave, increasing functions of average daily exposure to PM10, developing countries with the rate of increase declining for exposures above approximately 1,000–2,000 µg/m3. Author Year Journal/other Title Results Ezzati, M. 00 Environmental The health impacts of Summarizes the current knowledge on the relationship between indoor Kammen, D. M. Health exposure to indoor air air pollution exposure and disease and on interventions for reducing Perspectives pollution from solid fuels exposure and disease. in developing countries: Identifies knowledge gaps and detailed research questions that are knowledge, gaps, and data essential in successful design and dissemination of preventive measures needs and policies. Gauderman, 000 American Association between air Significant deficiencies in growth of lung function were found in W. J. Journal of pollution and lung function association with exposure to PM10, PM2.5, nitrogen dioxide and inorganic McConnell, R. Respiratory growth in southern acid vapor. Gilliland, F. Critical Care California children London, S. and Medicine Thomas, D. Avol, E. Vora, H. Berhane, K. Rappaport, E. B. Lurmann, F. Margolis, H. G. Peters, J. Khaliquzzaman, 2007 Indoor Air Indoor air pollution and Indoor air concentrations of volatile organic compounds, carbon M. its impact on children monoxide, carbon dioxide, nitrogen dioxide, and dust particles were Kamijima, M. under five years old in measured for 49 biomass and 46 fossil fuel users in urban slums of Sakai, K. Bangladesh Dhaka, Bangladesh. Chowdhury, Mean concentrations of carbon monoxide were found to be significantly N. A. higher in biomass fuel users, while geometric mean concentrations of Hamajima, N. benzene, xylene, toluene, hexane, total volatile organic compounds, and Nakajima, T. nitrogen dioxide were significantly higher in the fossil fuel users. Symptoms such as redness of eyes, itching of skin, nasal discharge, cough, shortness of breath, chest tightness, wheezing, or whistling chest were found to be associated with the choice of biomass fuel, with the odds ratio ranging from 4.0 to 6.3. No significant association of use of biomass fuel with respiratory diseases, eczema, diarrhea, or viral fever was observed after adjustment for potential confounders. Study suggested a significant association between the biomass fuel- Appendix 1 | 97 using population and respiratory symptoms. Author Year Journal/other Title Results Lin, H. H. 2007 Public Library Tobacco smoke, indoor air Evidence shows that tobacco smoking is positively associated with Ezzati, M. of Science pollution and tuberculosis: tuberculosis, regardless of the specific tuberculosis outcomes. Murray, M. (PLoS) a systematic review and It is also evidenced that passive smoking and indoor air pollution Medicine meta-analysis increase the risk of tuberculosis disease. These associations are less strongly supported by the available evidence. Lopez, A. D. 2006 Lancet Global and regional About 56 million people died in 2001. Of these, 10.6 million were Mathers, C. D. burden of disease and risk children, 99% of whom lived in low- and middle-income countries. More Ezzati, M. factors, 2001: systematic than half of child deaths in 2001 were attributable to acute respiratory Jamison, D. T. analysis of population infections, measles, diarrhea, malaria, and HIV/AIDS. The 10 leading Murray, C. J. health data diseases for global disease burden were perinatal conditions, lower respiratory infections, ischemic heart disease, cerebrovascular disease, HIV/AIDS, diarrheal diseases, unipolar major depression, malaria, chronic obstructive pulmonary disease, and tuberculosis. There was a 20% reduction in global disease burden per head due to communicable, maternal, perinatal, and nutritional conditions between 1990 and 2001. Almost half the disease burden in low- and middle-income countries is now from noncommunicable diseases. Undernutrition remains the leading risk factor for health loss. An estimated 45% of global mortality and 36% of global disease burden are attributable to the joint hazardous effects of the 19 risk factors studied. Uncertainty in all-cause mortality estimates ranged from around 1% in high-income countries to 15–20% in Sub-Saharan Africa. Uncertainty was larger for mortality from specific diseases, and for incidence and prevalence of nonfatal outcomes. 98 | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 The findings suggested that substantial gains in health have been achieved in most populations, countered by the HIV/AIDS epidemic in Sub-Saharan Africa and setbacks in adult mortality in countries of the former Soviet Union. The results on major disease, injury, and risk factor causes of loss of health, together with information on the cost-effectiveness of interventions, can assist in accelerating progress towards better health and reducing the persistent differentials in health between poor and rich countries. McCracken, J. P. 2007 Environmental Chimney stove The two-group comparison study showed, particularly for diastolic Smith, K. R. Health intervention to reduce blood pressure, that the chimney stove intervention reduces blood Diaz, A. Perspectives long-term wood smoke pressure. The before-and-after comparisons were consistent with this Mittleman, M. exposure lowers evidence. A. blood pressure among Schwartz, J. Guatemalan women Author Year Journal/other Title Results Mishra, V. 2007 International Does biofuel smoke The study examined the association between household use of biofuels Retherford, R. D. Journal of contribute to anaemia (wood, dung, and crop residues) for cooking and heating and prevalence Epidemiology and stunting in early of anemia and stunting in children. childhood? Multinomial logistic regression was used to estimate the effects of biofuel use on prevalence of anemia and stunting, controlling for exposure to tobacco smoke, recent episodes of illness, maternal education and nutrition, and other potentially confounding factors. Analysis showed that prevalence of moderate-to-severe anemia was significantly higher among children in households using biofuels than among children in households using cleaner fuels. Prevalence of severe stunting was also significantly higher among children in biofuel-using households. 31% of moderate-to-severe anemia and 37% of severe stunting among children aged 6–35 months in India may be attributable to exposure to biofuel smoke. Effects on mild anemia and moderate stunting were smaller, but positive and statistically significant. The study provided evidence of the strong association between biofuel use and risks of anemia and stunting in children, suggesting that exposure to biofuel smoke may contribute to chronic nutritional deficiencies in young children. Mohamed, N. 1995 Thorax Home environment Study on the relationship between home environmental factors and Ng’ang’a, L. and asthma in Kenyan asthma in schoolchildren. Odhiambo, J. schoolchildren: a case- In multivariate analysis the following factors were associated with Nyamwaya, J. control study asthma: damage caused by dampness in the child’s sleeping area Menzies, R. (adjusted odds ratio (OR) 4.9; 95% confidence interval (CI) 2.0 to 11.7); air pollution in the home (OR 2.5; 95% CI 2.0 to 6.4); presence of rugs or carpets in child’s bedroom (OR 3.6; 95% CI 1.5 to 8.5). Home environmental factors appear to be strongly associated with asthma in schoolchildren in a developing nation. Appendix 1 | 99 Author Year Journal/other Title Results Naeher, L. P. 000 Indoor Air Particulate matter and Comparisons with other studies in the area indicate that the reductions Leaderer, B. P. carbon monoxide in in indoor concentrations achieved by improved wood-burning stoves Smith, K. R. highland Guatemala: indoor deteriorate with stove age. and outdoor levels from Mother and child personal carbon monoxide and PM2.5 measurements traditional and improved for each stove condition demonstrate the same trend as area wood stoves and gas stoves measurements, but with less differentiation. Rehfuess, E. 2006 Environmental Assessing household The article discussed the results of a comprehensive assessment of solid Mehta, S. Health solid fuel use: multiple fuel use, conducted in 2005, and discussed the implications of findings Prüss-Üstün, A. Perspectives implications for the in the context of attaining the Millennium Development Goals. Millennium Development According to the assessment, 52% of the world’s population uses solid Goals fuels. This percentage varies widely between countries and regions, ranging from 77%, 74%, and 74% in Sub-Saharan Africa, Southeast Asia, and the Western Pacific Region, respectively, to 36% in the Eastern Mediterranean Region, and 16% in Latin America and the Caribbean and in Central and Eastern Europe. In most industrialized countries, solid fuel use falls to the < 5% mark. Although the “percentage of population using solid fuels� is classified as an indicator to measure progress towards Millennium Development Goal 7, reliance on traditional household energy practices has distinct implications for most of the Millennium Development Goals, notably 4 and 5. Rinne, S. T. 2007 American Use of biomass fuel is The aim of the study was to explore the relationship between biomass Rodas, E. J. Journal of associated with infant fuel, infant mortality, and children’s respiratory symptoms. 100 | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 Rinne, M. L. Tropical mortality and child health 80 households in a rural community in Ecuador were selected based on Simpson, J. M. Medicine and in trend analysis their use of biomass fuel and questioned regarding a history of infant Glickman, L. T. Hygiene mortality and children’s respiratory symptoms. Carbon monoxide and particulate matter were measured in a subset of these homes to confirm the relationship between biomass fuel use and indoor air pollution. Results showed a significant trend for higher infant mortality among households that cooked with a greater proportion of biomass fuel. Similar trends were noted for history of cough and earache among children living in these households. Author Year Journal/other Title Results Ritz, B. 000 Epidemiology Effect of air pollution on Evaluation of the effect of air pollution exposure during pregnancy on Yu, F. preterm birth among the occurrence of preterm birth in a cohort of 97,518 neonates born in Chapa, G. children born in southern southern California. Fruin, S. California between 1989 Measurements of carbon monoxide, nitrogen dioxide, ozone, and and 1993 PM10 collected at 17 air quality monitoring stations to create average exposure estimates for periods of pregnancy. A 20% increase in preterm birth was observed with an increase in ambient PM10 levels averaged over six weeks before birth and a 16% increase when averaging over the first month of pregnancy. PM10 effects showed no regional pattern. Carbon monoxide exposure six weeks before birth consistently exhibited an effect only for the inland regions and during the first month of pregnancy. The effect was weak for all stations. Exposure to increased levels of ambient PM10 and possibly carbon monoxide during pregnancy may contribute to the occurrence of preterm births in southern California. Rouse, J. R. 2004 WEDC Indoor air pollution: issues The most important driving force behind indoor air pollution reduction for Bangladesh interventions is health improvement as the evidence base grows. Other reasons for using clean household energy are deforestation, air pollution, saving people money, labor and time saving, and making people’s use of energy safer and more convenient. Many interventions failed due to the top-down nature of their implementation. Certain major gaps persist, such as the exact relationship between exposure to indoor air pollution and acute respiratory infection, and the extent to which different interventions reduce exposure to indoor air pollution. Siddiqui, A. R. 2005 Epidemiology Indoor air pollution from To identify the contribution of indoor air pollution from biomass fuel Peerson, J. solid fuel use and Low use to low birthweight in a population in Pakistan. Brown, K. H. Birth Weight (LBW) in Data were available for 941 pregnant women interviewed for a maternal Gold, E. B. Pakistan health program in Pakistan. Low birthweight, defined as a birthweight Lee, K. (measured within 48 hours of birth) of < 2,500 g, was 31%. To adjust for Bhuta, Z. A. Appendix 1 | 101 Author Year Journal/other Title Results socioeconomic confounding factors, a composite socioeconomic status variable was created using water supply, lighting source, toilet facilities, house ownership, construction, and density (occupants/room). A multiple logistic regression model showed that use of wood fuel, adjusted for socioeconomic status, body mass index, serum vitamin A levels, age, gravid status, and not receiving a tetanus toxoid injection in pregnancy, was independently associated with low birthweight. Mean levels for 24 hours for carbon monoxide were 24 parts per million (ppm) for wood use compared to 5 ppm in natural gas-using kitchens with cooking-time levels reaching above 150 ppm in wood-burning houses. Mean levels for PM2.5 were 12 mg/m3 in wood and 0.25 mg/m3 in houses using natural gas. In wood-using houses daytime average levels for PM2.5 were from 2.2 to 30 mg/m3, and during cooking, they were as high as 300 mg/m3. The increased air concentrations of carbon monoxide and PM2.5 correlated well with each other and varied by an order of magnitude by the type of fuel used. The findings of this study suggest an independent effect of indoor air pollution on birthweight, in line with findings from the few other studies available to date. This analysis also suggested the importance of assessing low birthweight in populations where pregnant women are exposed to high levels of indoor air pollution from solid fuels. Smith, K. R. 000 Proceedings of Inaugural article: national Sufficient evidence is available to estimate risks most confidently for the National burden of disease in India acute respiratory infections, chronic obstructive pulmonary disease, and Academy of from indoor air pollution lung cancer. 10 | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 Sciences Insufficient quantitative evidence is currently available to estimate the impact of adverse pregnancy outcomes (e.g. low birthweight and stillbirth). Using a DALY approach, the total is 4–6% of the Indian national burden of disease, placing indoor air pollution as a major risk factor in the country. Smith, K. R. 00 Indoor Air Indoor air pollution in Research suggested: developing countries: � Epidemiology: case-control studies for tuberculosis and recommendations for cardiovascular disease in women and randomized intervention research trials for childhood acute respiratory diseases and adverse pregnancy outcomes; � Exposure assessment: techniques and equipment for inexpensive exposure assessment at large scale, including national-level surveys; Author Year Journal/other Title Results � Interventions: engineering and dissemination approaches for improved stoves, fuels, ventilation, and behavior that reliably and economically reduce exposure. Smith, K. R. 2007 Energy for Monitoring and evaluation Monitoring and evaluation of changes in indoor air quality and stove Dutta, K. Sustainable of improved biomass fuel performance were developed and deployed in programs to Chengappa, C. Development cookstove programs for disseminate improve cookstoves in India and Mexico. Gusain, P. indoor air quality and The result showed major and mostly statistically significant Masera, O. stove performance: improvements in 48 hours indoor air pollution concentrations in those Berrueta, V. conclusions from the households using the stoves one year after introduction. Kitchen levels Edwards, R. Household Energy and of carbon monoxide reduced 30–70% and concentrations of small Bailis, R. Health Project particles reduced 25–65%. Shields, K. N. Smith, K. R. 2003 International The burden of disease 4–5% of the global least developed country totals for both deaths and Mehta, S. Journal of from indoor air pollution DALYs from acute respiratory infections, chronic obstructive pulmonary Hygiene and in developing countries: disease, tuberculosis, asthma, lung cancer, ischemic heart disease, and Environmental comparison of estimates blindness can be attributed to solid fuel use in developing countries. Health Acute respiratory infections in children under 5 years of age are the largest single category of deaths (64%) and DALYs (81%) from indoor air pollution, apparently being responsible globally for about 1.2 million premature deaths annually in the early 1990s. Smith, K. R. 000 Thorax Indoor air pollution in The studies of indoor air pollution from household biomass fuels are Mehta, S. developing countries and reasonably consistent and, as a group, show a strong significant increase acute lower respiratory in risk for exposed young children compared with those living in infections in children households using cleaner fuels or being otherwise less exposed. Acute respiratory infection is the chief cause of death in children in less developed countries, and exacts a larger burden of disease than any other disease category for the world population. Even small additional risks due to such a ubiquitous exposure as air pollution have important public health implications. Still, D. 2006 Boiling Point The effect of ventilation Concentrations of carbon monoxide and particulate matter were MacCarty, N. on carbon monoxide and monitored in a test kitchen when differing levels of ventilation were particulate levels in a test introduced to the building. These included all windows and doors kitchen closed; door open; a small hole cut in the roof; and cross-ventilation to the hole in the roof provided by a small window. Each configuration was tested three times with a constant pollution source. Increasing amounts of ventilation significantly reduced the levels of carbon monoxide and Appendix 1 | 103 particulate matter. Author Year Journal/other Title Results United States 2004 Environmental Air quality criteria for Particulate matter is composed of small solid and liquid particles EPA Protection particulate matter suspended in the ambient air, and research studies have associated Agency exposure to elevated levels of these particles in the air with damaging health effects. World Health 2005 Fact Sheet No. Indoor air pollution and Tackling indoor air pollution in the context of household energy is Organization 292 health: scope of the linked to attaining the Millennium Development Goals, in particular problem to reducing child mortality (Goal 4), to promoting gender equality and empowering women (Goal 3), to opening up opportunities for income generation and eradicating extreme poverty (Goal 1), and to ensuring environmental sustainability (Goal 7). World Health 2007 WHO Indoor air pollution: national Summary of burden of disease attributable to breathing polluted Organization burden of disease estimates indoor air. Zaman, K. 1997 Journal of Acute respiratory A community-based longitudinal study conducted in Matlab, a rural area Baqui, A. H. Tropical infections in children: in Bangladesh, investigated acute respiratory infection among children. Yunus, M. Pediatrics a community-based A cohort of 696 children under 5 years of age was followed for one year Sack, R. B. longitudinal study in rural yielding 183,865 child-days of observation. Trained fieldworkers visited Bateman, O. M. Bangladesh the study children every fourth day. Data on symptoms suggesting acute Chowdhury, respiratory infection, such as fever, cough, and nasal discharge, were H. R. collected for the preceding three days by recall. Black, R. E. To determine the type and severity of acute respiratory infection, the fieldworkers conducted physical examinations of children reporting cough and fever. The overall incidence of acute respiratory infection was 5.5 episodes per child-year observed; the prevalence was 35.4 per 100 days observed. Most of the episodes (96%) were upper respiratory infections. The incidence of acute lower respiratory infection was 0.23 per child per year. The incidence of upper respiratory infection 104 | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 was highest in 18–23-month-old children, followed by infants 6–11 months old. The highest incidence of acute lower respiratory infection was observed in 0–5-month-old infants followed by 12–17-month-old children. Among 559 children who were followed for six months or longer, about 9% did not suffer any upper respiratory infection episode and about 16% suffered one or more acute lower respiratory infection episodes. About 46% of upper respiratory infection and 65% of acute lower respiratory infection episodes lasted 15 days or more. The incidence rates of upper respiratory infection were higher during the monsoon and pre-winter periods, and that of acute lower respiratory infection at the end of the monsoon and during the pre- winter periods. Sociodemographic variables were not associated with the incidence of upper respiratory infection or acute lower respiratory infection. The study documents acute respiratory infection to be a major cause of morbidity among rural Bangladeshi children. Author Year Journal/other Title Results Zaman, K. 2006 Epidemiology Prevalence of sputum Objective of the study was to determine the prevalence of smear- Yunus, M. and Infection smear-positive positive tuberculosis in a rural area in Bangladesh. Arifeen, S. E. tuberculosis in a rural area The prevalence of chronic cough and sputum positive were significantly Baqui, A. H. in Bangladesh higher among males than females. Sack, D. A. Hossain, S. The population-based prevalence rate of smear-positive tuberculosis Rahim, Z. cases was 95/100,000 among persons aged > or = 15 years. Cases of Ali, M. tuberculosis clustered geographically. Banu, S. Islam, M. A. Begum, N. Begum, V. Breiman, R. F. Black, R. E. Zemp, E. 1999 American Long-term ambient air The association between long-term exposure to ambient air pollution Elsasser, S. Journal of pollution and respiratory and respiratory symptoms was investigated in a cross-sectional study in Schindler, C. Respiratory symptoms in adults random population samples of adults. Kunzli, N. Critical Care (SAPALDIA study). The The impact of annual mean concentrations of air pollutants was Perruchoud, and Medicine SAPALDIA Team. analyzed separately for never-, former, and current smokers. A. P. Domenighetti, Positive associations between annual mean concentrations of nitrogen G. dioxide, total suspended particulates, and PM10 and reported prevalence Medici, T. of chronic phlegm production, chronic cough or phlegm production, Ackermann- breathlessness at rest during the day, breathlessness during the day or Liebrich, U. at night, and dyspnea on exertion. Leuenberger, P. No associations with wheezing without cold, current asthma, chest Monn, C. tightness, or chronic cough. Bolognini, G. The observed associations remained stable when further control Bongard, J. P. was applied for environmental tobacco smoke exposure, past and Brandli, O. current occupational exposures, atopy, and early childhood respiratory Karrer, W. infections when restricting the analysis to long-term residents and Keller, R. to non-alpine areas, and when excluding subjects with physician- Schoni, M. H. diagnosed asthma. Tschopp, J. M. This study provided further evidence that long-term exposure to air Villiger, B. pollution of rather low levels is associated with higher prevalence of Zellweger, J. P. respiratory symptoms in adults. Appendix 1 | 105 Appendix 2: Rapid Review Programs Name of institution/ Key approach Key features organization World Bank-WSP, DISHARI Total sanitation through Capacity building of local government institution for Program upazila parishad sanitation in collaboration with national-level NGO. Safe water, environmental health and hygiene practice components being addressed in a comprehensive manner. NGO Forum Addressing safe water Implementation through partnership with local supply, sanitation, and NGOs. hygiene issues Model village development for demonstration and scaling up of the learning of water and sanitation interventions. Department of Public Health Total sanitation coverage in Implementation through alliance with local NGOs – Engineering, UNICEF upazila government sanitation committees in coordination role. Community participation in water technology installation. Local entrepreneurship development. Women and children are in key role. BRAC, WASH Water, Sanitation and Water supply and community management. Hygiene Program School sanitation and hygiene education. Sanitation and hygiene. Community management water supply and technologies. Dhaka Ahsania Mission, Decentralized total Local NGO collaboration for implementation – water DANIDA sanitation point-centered community-based organizations in key role with support from local government institutions. Water, sanitation, and hygiene behavior promotion in combined manner. CARE WatSan Program Addressing livelihood Addressing water and sanitation needs of the poor situation towards poverty and poorest in selected areas. reduction Subsidy provision for hardware supply. Hygiene education is inclusive of sanitation program. VERC People-initiated 100% As outcome of community-level entry participatory sanitation rural assessment session and initiation of mobilization – community-based organizations in lead role. Addressing poverty reduction concern through water and sanitation. Range of technology options. 106 | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 Name of institution/ Key approach Key features organization No subsidy on environmental hygiene but limited subsidy on water (in view of ability to pay analysis). Utilization of local skills and materials. Involvement of local government institutions. Women and children’s issues given special attention. Hygiene behavior change monitoring by community. Basics of sanitation technology enhanced through orientation for sustainability. Department of Public Health HYSAWA Working through the involvement of local Engineering, DANIDA government institutions. Formation of community-based organizations centering round water points. No subsidy on environmental hygiene but limited subsidy on water. Implementing NGO works under supervision of local government institution. Public place sanitation is addressed. Coastal area water and Same as above. sanitation Department of Public Health Rural piped water supply Safe water supply through pipeline in rural Engineering project communities. 20% recovery of installation cost. Payment of tariff for supply of water on monthly basis. Appendix 2 | 107 Bibliography References Baris, E., and M. Ezzati. 2004. “Should Interventions to Reduce Respirable Pollutants Be Linked to Albalak, R., N. Bruce, J. P. McCracken, K. R. Smith, and Tuberculosis Control Programmes?� British Medical T. de Gallardo. 2001. “Indoor Respirable Particulate Journal 329 (7474): 1090–3. Matter Concentrations from an Open Fire: Improved Cookstove and LPG/Open Fire Combination in a Barnes, D., and J. Halpern. 2000. “The Role of Energy Rural Guatemalan Community.� Environmental Subsidies.� In: Energy Services for the World’s Poor. Science and Technology 35 (13): 2650–5. World Bank Energy and Development Report. Washington, DC: World Bank. Asaduzzaman, M., D. F. Barnes, and S. R. Khandakar. 2007. Restoring Balance: Bangladesh’s Rural Energy Barnes, D., P. Kumar, and K. Openshaw. 2009. Realities. Energy Sector Management Assistance Cleaner Hearths, Better Homes: Improved Stoves Program, Development Economics Research Group, for India and the Developing World. Oxford: Oxford World Bank. University Press. Azizi, B. H., H. I. Zulkifli, and S. Kasim. 1995. “Indoor Begum, V., M. J. van der Werf, M. Becx-Bleumink, Air Pollution and Asthma in Hospitalized Children in and M. W. Borgdorff. 2007. “Viewpoint: Do We Have a Tropical Environment.� Journal of Asthma 32 (6): Enough Data to Estimate the Current Burden of 413–8. Tuberculosis? The Example of Bangladesh.� Tropical Medicine and International Health 12 (3): 317–22. Balakrishnan, K., S. Sambandam, P. Ramaswamy, S. Mehta, and K. R. Smith. 2004. “Exposure Boy, E., N. Bruce, and H. Delgado. 2002. “Birthweight Assessment for Respirable Particulates Associated and Exposure to Kitchen Wood Smoke During with Household Fuel Use in Rural Districts of Andhra Pregnancy in Rural Guatemala.� Environmental Pradesh, India.� Journal of Exposure Analysis and Health Perspectives 110 (1): 109–14. Environmental Epidemiology 14 (Suppl. 1): S14–25. Brooks, W. A., R. F. Breiman, D. Goswami, A. Baqui, A. H., A. A. Sabir, N. Begum, S. E. Arifeen, S. N. Hossain, K. Alam, S. K. Saha, K. Nahar, D. Nasrin, Mitra, and R. E. Black. 2001. “Causes of Childhood N. Ahmed, S. El Arifeen, A. Naheed, D. A. Sack, and Deaths in Bangladesh: An Update.� Acta Paediatrica S. Luby. 2007. “Invasive Pneumococcal Disease 90 (6): 682–90. Burden and Implications for Vaccine Policy in Urban Bibliography | 109 Bangladesh.� American Journal of Tropical Medicine E. B. Rappaport, F. Lurmann, H. G. Margolis, and and Hygiene 77 (5): 795–80. J. Peters. 2000. “Association between Air Pollution and Lung Function Growth in Southern California Bruce, N., R. Perez-Padilla, and R. Albalak. 2000. Children.� American Journal of Respiratory Critical “Indoor Air Pollution in Developing Countries: A Major Care and Medicine 162 (4 Pt 1): 1383–90. Environmental and Public Health Challenge.� Bulletin of the World Health Organization 78 (9): 1078–92. Ghimire, P. C. 2005. Final Report on Technical Study of Biogas Plants Installed in Bangladesh. National Bryce, J., and C. G. Victora. 2005. “Child Survival: Program on Domestic Biogas in Bangladesh, a Countdown to 2015.� Lancet 365 (9478): 2153–4. partnership program of Netherlands Development Dasgupta, S., M. Huq, M. Khaliquzzaman, K. Pandey, Organization (SNV) and Infrastructure Development and D. Wheeler. 2006a. “Indoor Air Quality for Poor Company Ltd. (IDCOL). Families: New Evidence from Bangladesh.� Indoor Government of Bangladesh. 2009. Renewable Air 16 (6): 426–44. Energy Policy of Bangladesh. Prime Minister’s Dasgupta, S., M. Huq, M. Khaliquzzaman, K. Pandey, Office, Bangladesh. and D. Wheeler. 2006b. “Who Suffers from Indoor GTZ (German Technical Cooperation). n.d. Killer in Air Pollution? Evidence from Bangladesh.� Health the Kitchen. Sustainable Energy for Development Policy and Planning 21: 444–58. Program. Bangladesh: GTZ. Diaz, E., T. Smith-Sivertsen, D. Pope, R. T. Lie, A. Diaz, Gurley, E., Md. S. Shomik, A. Brooks, and S. Luby. J. McCracken, B. Arana, K. R. Smith, and N. Bruce. 2008. Measuring the Health Effects of a Pilot 2007. “Eye Discomfort, Headache and Back Pain Indoor Air Pollution Intervention in Bangladesh. among Mayan Guatemalan Women Taking Part in Draft protocol. International Centre for Diarrhoeal a Randomised Stove Intervention Trial.� Journal of Disease Research, Bangladesh. Epidemiology and Community Health 61 (1): 74–9. Johnson, N. G., and M. Bryden. 2006. “Direct Edwards, R. D., Y. Liu, G. He, Z. Yin, J. Sinton, J. Contact Hazards of Cookstoves: Burns, Cuts, and Peabody, and K. R. Smith. 2007. “Household CO Scalds.� German Technical Cooperation (GTZ). and PM Measured as Part of a Review of China’s Boiling Point No. 52. National Improved Stove Program.� Indoor Air 17 (3): 189–203. Kar, K., and R. Chambers. “Keynote Speeches.� 2004. In: M. F. Ahmed, A. J. Shamsuddin, et al., Ezzati, M., and D. M. Kammen. 2001. “Quantifying eds. Proceedings of South Asian Conference on the Effects of Exposure to Indoor Air Pollution Sanitation (SACOSAN), Dhaka, Bangladesh, 21–23 from Biomass Combustion on Acute Respiratory October 2003. Dhaka: Local Government Division. Infections in Developing Countries.� Environmental Health Perspectives 109 (5): 481–8. Khaliquzzaman, M., M. Kamijima, K. Sakai, N. A. Chowdhury, N. Hamajima, and T. Nakajima. 2007. Ezzati, M., and D. M. Kammen. 2002. “The Health “Indoor Air Pollution and Its Impact on Children Impacts of Exposure to Indoor Air Pollution from under Five Years Old in Bangladesh.� Indoor Air Solid Fuels in Developing Countries: Knowledge, 17 (4): 297–304. Gaps, and Data Needs.� Environmental Health Perspectives 110 (11): 1057–68. Khan, A. M. H. R. 2000. “Development of Downdraft Wood Burning Stove in Bangladesh.� In: Energex Gauderman, W. J., R. McConnell, F. Gilliland, S. 2000: Proceedings of the 8th International Energy London, D. Thomas, E. Avol, H. Vora, K. Berhane, Forum, Las Vegas, July 23–28, 2000. 110 | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 LGD/DPHE/UNICEF (Local Government Division, Rinne, S. T., E. J. Rodas, M. L. Rinne, J. M. Simpson, Department of Public Health Engineering, and and L. T. Glickman. 2007. “Use of Biomass Fuel Is United Nations Children’s Fund). 2004. Nationwide Associated with Infant Mortality and Child Health in Sanitation Survey. Trend Analysis.� American Journal of Tropical Medicine and Hygiene 76: 585–91. Lin, H. H., M. Ezzati, and M. Murray. 2007. “Tobacco Smoke, Indoor Air Pollution and Tuberculosis: Ritz, B., F. Yu, G. Chapa, and S. Fruin. 2000. “Effect of A Systematic Review and Meta-Analysis.� PLoS Air Pollution on Preterm Birth Among Children Born Medicine 4 (1): e20. in Southern California Between 1989 and 1993.� Epidemiology 11: 5. Lopez, A. D., C. D. Mathers, M. Ezzati, D. T. Jamison, and C. J. Murray. 2006. “Global and Regional Burden Rouse, J. R. 2004. Indoor Air Pollution: Issues for of Disease and Risk Factors, 2001: Systematic Bangladesh. Water, Engineering and Development Analysis of Population Health Data.� Lancet 367 Centre (WEDC), Loughborough University. (9524): 1747–57. Saha, S. K., M. A. Kashem, and S. M. Rafi. 2006. McCracken, J. P., K. R. Smith, A. Diaz, M. A. Walking Through Sanitation Ladder: A Participatory Mittleman, and J. Schwartz. 2007. “Chimney Study on the Trends and the Drivers of Community Stove Intervention to Reduce Long-Term Wood Movement in VERC-WAB’s People Initiated 100% Smoke Exposure Lowers Blood Pressure among Sanitation Approach. Guatemalan Women.� Environmental Health Siddiqui, A. R., J. Peerson, K. H. Brown, E. B. Gold, Perspectives 115 (7): 996–1001. K. Lee, and Z. A. Bhuta. 2005. “Indoor Air Pollution Minnatullah, K. M., and S. A. Ahmed. 2003. Total From Solid Fuel Use and Low Birth Weight (LBW) in Sanitation: A Prerequisite for the Sustenance of Pakistan.� Epidemiology 16 (5): S86. Freshwater Resources in Bangladesh. Smith, K. R. 2000. “Inaugural Article: National Mishra, V., and R. D. Retherford. 2007. “Does Burden of Disease in India from Indoor Air Pollution.� Biofuel Smoke Contribute to Anaemia and Stunting Proceedings of the National Academy of Sciences of in Early Childhood?� International Journal of the United States of America 97 (24): 13286–93. Epidemiology 36 (1): 117–29. Smith, K. R. 2002. “Indoor Air Pollution in Developing Mohamed, N., L. Ng’ang’a, J. Odhiambo, J. Nyamwaya, Countries: Recommendations for Research.� Indoor and R. Menzies. 1995. “Home Environment and Air 12 (3): 198–207. Asthma in Kenyan Schoolchildren: A Case-Control Smith, K. R., K. Dutta, C. Chengappa, P. P. S. Gusain, Study.� Thorax 50 (1): 74–8. O. Masera, V. Berrueta, R. Edwards, R. Bailis, and K. Naeher, L. P., B. P. Leaderer, and K. R. Smith. 2000. Naumoff Shields. 2007. “Monitoring and Evaluation “Particulate Matter and Carbon Monoxide in of Improved Biomass Cookstove Programs for Indoor Highland Guatemala: Indoor and Outdoor Levels Air Quality and Stove Performance: Conclusions from Traditional and Improved Wood Stoves and from the Household Energy and Health Project.� Gas Stoves.� Indoor Air 10 (3): 200–5. Energy for Sustainable Development 11 (2): 5–17. Rehfuess, E., S. Mehta, and A. Prüss-Üstün. 2006. Smith, K. R., and S. Mehta. 2003. “The Burden of “Assessing Household Solid Fuel Use: Multiple Disease from Indoor Air Pollution in Developing Implications for the Millennium Development Countries: Comparison of Estimates.� International Goals.� Environmental Health Perspectives 114: Journal of Hygiene and Environmental Health 206 373–8. (4–5): 279–89. Bibliography | 111 Smith, K. R., J. M. Samet, I. Romieu, and N. Bruce. World Bank. 2006. Bangladesh Country 2000. “Indoor Air Pollution in Developing Countries Environmental Analysis, Volume I: Main Report. and Acute Lower Respiratory Infections in Children.� Social Development Unit, South Asia Region, Thorax 55 (6): 518–32. World Bank. Still, D., and N. MacCarty. 2006. “The Effect of World Bank. 2008. Poverty Assessment of Ventilation on Carbon Monoxide and Particulate Bangladesh: Creating Opportunities and Bridging Levels in a Test Kitchen.� Boiling Point 52: 24–6. the East-West Divide. Report No. 44321-BD. Poverty Reduction, Economic Management, Finance and United States EPA (Environmental Protection Private Sector Development Unit, South Asia Agency). 2004. Air Quality Criteria for Particulate Region, World Bank. Matter. Final Report (http://cfpub.epa.gov/ncea/ cfm/recordisplay.cfm?deid=87903). Zaman, K., A. H. Baqui, M. Yunus, R. B. Sack, O. M. Bateman, H. R. Chowdhury, and R. E. Black. United States EPA (Environmental Protection 1997. “Acute Respiratory Infections in Children: Agency). 2006. PM Standards (http://www.epa. A Community-Based Longitudinal Study in Rural gov/oar/particlepollution/standards.html). Bangladesh.� Journal of Tropical Pediatrics 43 (3): VERC (Village Education Resource Center). 2007. 133–7. Annual Report 2007. Savar: VERC. Zaman, K., M. Yunus, S. E. Arifeen, A. H. Baqui, WaterAid. 2003. Water, Sanitation and Hygiene D. A. Sack, S. Hossain, Z. Rahim, M. Ali, S. Banu, Promotion: A National Strategy for Economic M. A. Islam, N. Begum, V. Begum, R. F. Breiman, Growth, Poverty Reduction and Social Development. and R. E. Black. 2006. “Prevalence of Sputum Poverty Reduction Strategy Paper. Smear-Positive Tuberculosis in a Rural Area in Bangladesh.� Epidemiology and Infection 134 (5): WHO (World Health Organization). 2005. Indoor Air 1052–9. Pollution and Health: Scope of the Problem. WHO Fact Sheet No. 292. Geneva: WHO. Zemp, E., S. Elsasser, C. Schindler, N. Kunzli, A. WHO (World Health Organization). 2006. Evaluation P. Perruchoud, G. Domenighetti, T. Medici, U. of the Costs and Benefits of Household Energy and Ackermann-Liebrich, P. Leuenberger, C. Monn, Health Interventions at Global and Regional Levels. G. Bolognini, J. P. Bongard, O. Brandli, W. Karrer, Geneva: WHO. R. Keller, M. H. Schoni, J. M. Tschopp, B. Villiger, and J. P. Zellweger. 1999. “Long-Term Ambient WHO (World Health Organization). 2007. Indoor Air Air Pollution and Respiratory Symptoms in Adults Pollution: National Burden of Disease Estimates. (SAPALDIA Study). The SAPALDIA Team.� American Geneva: WHO. Journal of Respiratory Critical Care and Medicine WHO (World Health Organization). 2008. Evaluating 159 (4 Pt 1): 1257–66. Household Energy and Health Interventions: A Catalogue of Methods. Geneva: WHO (http://www. Other Relevant Source who.int/indoorair/publications/methods). Items World Bank. 2002. Rural Electrification and Ahmed, A. 2003. Experience on Sanitation in Development in the Philippines: Measuring the Social Bangladesh: The Challenge Ahead. UNICEF. and Economic Benefits. Energy Sector Management Assistance Programme (ESMAP) Report No. 255/02. Ahmed, A. 2007. Shifting Outlook: Policy Advocacy Washington, DC: World Bank. on Sanitation. WaterAid, Bangladesh. 11 | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 Ahmed, F., and M. Rahaman. 2000. Grameen ESMAP (Energy Sector Management Assistance Bank Provided USD 30 million to Install Latrines in Program). 2007. Haiti: Building a Sustainable Market Borrower’s Homes. ITN-Bangladesh. for Improved Stoves. Factsheet. Ali, M. R. 2005. “Participation and Sharing: Private ESMAP (Energy Sector Management Assistance Development Organization.� In: National Sanitation Program). 2007. Haiti: Strategy to Alleviate the for All by 2010 (in Bengali). Dhaka: Local Government Pressure of Fuel Demand on National Woodfuel Division. Resources. ESMAP Technical Paper 112/07. Appropriate Rural Technology Institute. 2007. ESMAP (Energy Sector Management Assistance Stove Monitoring Report: Reduction of Exposure Program). 2009. Improved Stoves for India and the to Indoor Air Pollution through Household Energy Developing World. Washington, DC: World Bank. and Behavioral Improvements Project. Pune, India: Government of Bangladesh. 1998. Fifth Five-Year Appropriate Rural Technology Institute. Plan (1997–2002). Bangladesh Council of Scientific and Industrial Government of Bangladesh. 2005. Bangladesh: Research. n.d. Improved Cookstove Dissemination Unlocking the Potential. National Strategy for (Phase II) Project. Dhaka: Institute of Fuel Research Accelerated Poverty Reduction. General Economics and Development, Bangladesh Council of Scientific Division, Planning Commission, Government of and Industrial Research. Bangladesh. Cowlin, S., R. Kaufmann, R. Edwards, and K. Smith. Government of Bangladesh. 2005. National 2005. Impact of Improved Stoves on Indoor Air Quality Sanitation Strategy. in Ulaanbaatar, Mongolia (http://www.esmap.org/ filez/pubs/31305MongoliaIAP090905forWeb.pdf). Government of Bangladesh. 2008. Sanitation in Bangladesh. Bangladesh Country Paper, Dasgupta, S., M. Huq, M. Khaliquzzaman, and D. SACOSAN-III. Wheeler. 2007. Improving Indoor Air Quality for Poor Families: A Controlled Experiment in Bangladesh. Government of Bangladesh. Rural Development and Washington, DC: World Bank. Cooperative Division (http://www.rdcd.gov.bd/). DFID/WEDC (UK Department for International GTZ (German Technical Cooperation). ICS Training Development and Water, Engineering and Manual. Development Centre). 1998. Guidance Manual on Helal, M., and A. Ayub. 2005. Total Sanitation: A WSS Programmes. Community Stake. Dhaka: NGO Forum for Drinking Water Supply and Sanitation. Dhaka Ahsania Mission. 2005. Sanitation for All by 2010: Strategy Options. Discussion Paper for Hurvey, P., S. Baghri, and B. Reed. 2002. Emergency Round Table in CIRDAP, July 31, 2005. Dhaka: Dhaka Sanitation. WEDC, Loughborough University, United Ahsania Mission. Kingdom. Ellery, M. 2008. An Inclusive Approach to Safeguarding IDCOL (Infrastructure Development Company the Basic Needs of the Poor. Typescript. Water and Limited). 2006. Annual Report 2005–2006. Sanitation Program, Pakistan. IDCOL (Infrastructure Development Company ESMAP (Energy Sector Management Assistance Limited). n.d. IDCOL’s Rural Electrification and Program). 2006. Project Concept Paper for Renewable Energy Development Program (REREDP). Dissemination of Improved Stoves in Haiti. Dhaka: IDCOL. Bibliography | 113 IDCOL/SNV (Infrastructure Development Saurav, K. S., R. Thapa, and K. Bajracharya. n.d. Company Limited and Netherlands Development National Improved Cook Stove Dissemination in the Organization). 2006. Implementation Plan: Mid-Hills of Nepal: Experiences, Opportunities and National Domestic Biogas and Manure Program in Lessons Learnt. Asia Regional Cookstoves Program Bangladesh. (http://www.arecop.org/zip/ICS_midhill.pdf). IDCOL/SNV (Infrastructure Development Shamsuddin, A. J. 2006. Reaching 100% Sanitation Company Limited and Netherlands Development Coverage in Bangladesh by 2010: Key Issues Organization). 2007. IDCOL Model Biogas Plant (http://www.buet.ac.bd/itn/cwp/documents/ Construction Manual. National Domestic Biogas kickoffmetnepal/AjsSanPresenNepal.pdf). and Manure Program. Sinton, J. E., K. R. Smith, J. W. Peabody, L. Yaping, Islam, S. R. 2005. “Problems of Rural Sanitation Z. Xiliang, R. Edwards, and G. Quan. 2004. “An in Bangladesh.� In: Sanitation for All by 2010 (in Assessment of Programs to Promote Improved Bengali). Dhaka: Local Government Division. Household Stoves in China.� In: K. R. Smith, et ITN (International Training Network)-Bangladesh. al., eds. Energy for Sustainable Development 2003. Sanitation Analysis: Water Supply and Volume 8 No. 3. Sanitation Research in Bangladesh. Dhaka: Social Development Foundation. 2005. Private Bangladesh University of Engineering and Financing of Public, Private and People’s Technology. Participation. Rural Piped Water Pilot of Social Kar, K. 2003. Subsidy or Self-Respect? Participatory Investment Program. Dhaka: Social Development Total Sanitation in Bangladesh. Institute of Foundation. Development Studies Working Paper 184. TRUST. 2004. Final Report on Impact Study Kristin, K., Q. Wodon, V. Foster, and J. Halpern. on Improved Cooking Stoves (ICS) Program 2005. Water, Electricity, and the Poor: Who Benefits Effectiveness. from Utility Subsidies? Directions in Development. UNICEF (United Nations Children’s Fund). Bangladesh Washington, DC: World Bank. Statistics (http://www.unicef.org/infobycountry/ LGED (Local Government Engineering Department). bangladesh_bangladesh_statistics.html). n.d. Electricity Generation from Poultry Waste: United Nations. We Can End Poverty: 2015 Muslim Mission, Faridpur. Sustainable Rural Energy Millennium Development Goals (http://www. (Comp 2.6). un.org/millenniumgoals/). Ministry of Power, Energy and Mineral Resources. United States EPA (Environmental Protection n.d. Status of Renewable Energy in Bangladesh. Agency). 2006. Air Quality Criteria for Ozone and Country Report. Related Photochemical Oxidants. EPA/600/R- REEIN (Renewable Energy and Environmental 05/004aF-cF. Washington, DC: EPA (http://cfpub. Information Network). n.d. Involvement of LGED epa.gov/ncea/cfm/recordisplay.cfm?deid=149923). in Biogas Technology in Bangladesh (http://www. USAID (United States Agency for International reein.org/biomass/lged/lged.htm). Development). 2007. Environmental Vulnerability Renewable Energy Information Network. RET in Haiti: Findings and Recommendations. USAID- Projects in Brief (http://www.lged-rein.org/ Haiti (http://www.wilsoncenter.org/events/docs/ database.php?pageid=21). Haiti_Final.pdf). 114 | Improved Cookstoves and Better Health in Bangladesh | Final Report June 2010 WHO (World Health Organization). 2004. Global Personal interviews, Dhaka, September 2006 and and Regional Burden of Disease. Geneva: WHO. January 2008. Winrock International and USAID. 2005. Islam, Formanul. Director (Legal), Infrastructure Management of Aquatic Ecosystems through Development Company Limited (IDCOL), Dhaka. Community Husbandry (MACH): Annual Report, Personal interview, January 2008. November 2004–October 2005. Islam, M. Additional Chief Engineer (Planning), World Bank. 2005. Scaling Up Rural Sanitation in Local Government Engineering Department, Dhaka. South Asia: Lessons Learned from Bangladesh, Personal interview, January 2008. India and Pakistan. Water and Sanitation Program- Khaliquzzaman, Md., and Otto Gomm. German South Asia. Technical Cooperation (GTZ), Dhaka. Personal World Bank. n.d. Mongolia: Heating in Poor, interviews, September 2007 and January 2008. Peri-urban Ger Areas of Ulaanbaatar. Final Draft. Asia Sustainable and Alternative Energy Khan, Hasan Rashid. Former Project Director, Program, Sustainable Development Department, Institute for Fuel Research and Development, World Bank. Bangladesh Council of Scientific and Industrial Research. Personal interview, January 2008. Personal Communications Nuruzzaman, A. K. M. Manager Operations, Palli Aktaruzzaman, Kazi. Director, Bangladesh Council Karma Shahayak Foundation (PKSF), Dhaka. Personal of Scientific and Industrial Research Laboratories. interview, January 2008. Personal interview, Dhaka, January 2008. Rahman, Mahbubur. Grameen Shakti, Dhaka. Bajgain, Sundar. Technical Adviser to NDBMP, Personal interviews, September 2007 and Netherlands Development Organization (SNV). January 2008. Bibliography | 115