Clean Cooking Implementation Science Network (ISN)
This piece was originally published on the Fogarty International Center website.
The National Institutes of Health (NIH), in partnership with USAID, the CDC and the Global Alliance for Clean Cookstoves (GACC), has launched a Clean Cooking Implementation Science Network (ISN) to advance the science of uptake and scale-up of clean cooking technology in the developing world. Hosted by the Center for Global Health Studies (CGHS) at Fogarty, and supported by the NIH Common Fund, the Network aims to advance collaborative efforts and understanding among researchers and implementers to accelerate successful adoption and use of clean cooking technologies with an eye to scaling up appropriate use.
A significant challenge in the clean cooking agenda for both researchers and implementers is achieving sustained adoption, correct and near-exclusive use of appropriate technologies that reduce pollutant exposures sufficiently to achieve the sustained health and environmental benefits envisioned. In particular, we are concerned with the challenge of scaling up these technologies. The problem includes socioeconomic considerations of access to clean stoves and fuels, a relatively poor understanding of critical household behaviors and the role of environmental context, and inadequate attention to these in technology adaption and/or distribution program design.
The primary goal of the Network is to develop an implementation science platform to advance our understanding of how to improve the uptake and appropriate use of evidence-based clean cooking interventions to maximize their benefits on the health and longevity of populations in LMICs. In its initial meetings the ISN has analyzed existing Implementation Science Frameworks (Damschroder, Aron et al. 2009, Tabak, Khoong et al. 2012, Milat, Bauman et al. 2015) for the potential applicability and utility to the planning, execution and evaluation of clean cooking interventions. In that context we invited proposals for research support linked to existing funded and active clean cooking research and or implementation programs that will advance our generalizable learning.
Updated July 2016
Enhancing adoption and use of liquefied petroleum gas (LPG): an implementation science approach to understanding key determinants and impacts of local interventions to address financial constraints
The LPG Adoption in Cameroon Evaluation-2 Study (LACE-2)
Daniel Pope, Ph.D. (University of Liverpool)
Bertrand Mbatchou, M.D. (Douala General Hospital)
Building on the ongoing “LPG Adoption in Cameroon Evaluation” (LACE) study in Cameroon, the LACE-2 project will implement two interventions aimed at increasing adoption of liquefied petroleum gas (LPG) as a cooking fuel in peri-urban and rural regions of Cameroon. The first is a loan/credit intervention that will be studied via a community-level matched treatment-control study. The managed loan, which will cover the cost of the LPG start-up kit and periodic LPG refills, will be paid back in a maximum of 12 monthly installments. The second intervention is a pressure cooker intervention that aims to shorten the cooking time for preparing certain common foods. For both intervention studies, surveys, stove use and air pollution monitoring will be conducted in intervention and control households to determine the proportion of cooking carried out using LPG over the year. The project will also implement Photovoice, a qualitative participatory methodology, with the aim of understanding the societal and cultural factors that influence initial adoption and sustained use of LPG as a fuel. Lastly, the project researchers will conduct a mixed-methods evaluation of enablers and barriers to the adoption and sustained use of LPG.
Enhancing liquefied petroleum gas (LPG) use during pregnancy
Kalpana Balakrishnan, Ph.D. (Sri Ramachandra University)
Sanjay Juvekar, Ph.D. (KEM Hospital Research Centre)
Kirk Smith, Ph.D. (University of California, Berkeley)
A major transition in the life of many Indian women occurs at the time of their marriage, which for 60-80% of women is also followed by pregnancy within a year. “Enhancing LPG Use during Pregnancy” targets this important life transition as a potential moment for implementation of behavior change. Borrowing from successes in other global health areas, the project will implement a conditional cash transfer (CCT) program focusing on newly married and newly pregnant women in the northern Pune district of Maharashtra, India. A specially modified stove use monitor (SUM) called the “Pink Key” will be installed on LPG stoves, tracking stove use. When a pregnant woman brings the Pink Key to her antenatal health visits, she will receive a small cash payment for each meal prepared using the stove, thus encouraging exclusive use of the LPG technology during pregnancy. The effect of the program on stove use will be evaluated using SUMs tracking on LPG and traditional stoves, air pollution monitoring, and time-activity tracking.
Prices, peers and perceptions: opportunities for scaling up liquefied petroleum gas (LPG) adoption in Northern Ghana
Abraham Oduro, M.D., Ph.D. (Navrongo Health Research Centre)
Maxwell Dalaba, Ph.D. (Navrongo Health Research Centre)
Katie Dickinson, Ph.D. (University of Colorado-Boulder and National Center for Atmospheric Research)
The government of Ghana has set the ambitious goal of expanding LPG access to 50% of the country by 2020, but currently LPG access varies widely, with the northern reaches of the country having some of the lowest LPG adoption rates. The “Prices, Peers, and Perceptions” project is located in the Kassena-Nankana Districts of northern Ghana, where only 7% of households were using LPG as their main cooking fuel as of 2013. This collaborative implementation science project begins, first, with supply- and demand-side analyses. On the supply side, the project team will analyze barriers to LPG distribution and how they might be overcome; while on the demand side they will explore the role of PRICES (upfront fixed cost of stoves and variable cost of fuel, as well as credit and savings constraints), PEERS (information and encouragement from social contacts), and PERCEPTIONS (safety, health benefits, suitability for cooking local dishes) on LPG adoption decisions. The team will also conduct a series of experiments to evaluate willingness-to-pay (WTP) for different LPG intervention packages. In these experiments, intervention packages comprised of different combinations of cylinder refilling options (status quo vs. cylinder recirculation with home delivery); refill vouchers; and financing options (lump sum vs. payment plan) will be presented to participants. Follow-up work to measure stove use, fuel stacking, and perceptions of LPG will be used to determine the effectiveness of the interventions toward the goal of expanding LPG adoption and sustained use in the region.
Understanding household, network and organizational drivers of adoption, sustained use and maintenance of clean cooking fuels in rural India
Gautam Yadama, Ph.D. (Washington University in St. Louis)
William Checkley, M.D., Ph.D. (Johns Hopkins University)
In rural India, 80% of households continue to use biomass fuels for cooking. Despite the fact that the Government of India has committed to redesigning their LPG policy and distribution to penetrate rural communities using a combination of direct cash transfer programs, campaigns encouraging non-poor to give up LPG subsidies (GiveItUp), and smaller LPG cylinders, empirical evidence on determinants of adoption and sustained use of LPG among energy poor communities is weak and anecdotal. Located in the Chitoor district of Anhra Pradesh, this project examines factors that influence the adoption, sustained use, and maintenance of LPG cooking in below poverty line (BPL) households in rural India. Using a combination of closed-ended questionnaires, stove use monitoring, and gendered social network analysis, the project aims to a) determine the factors that distinguish LPG-adopter BPL households from non-adopters; b) among adopter households, examine how the “3 A's” – affordability, accessibility and awareness – influence use of LPG versus traditional fuels (fuel stacking behavior); and c) evaluate the influence of social networks on LPG adoption and sustained use, following the hypothesis that adopter households will have more open and less kin-based social networks that facilitate fuel switching. The project will apply the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to explore LPG use and distribution at household, community, and block levels.
Joshua P. Rosenthal, Ph.D.
Damschroder, L. J., D. C. Aron, R. E. Keith, S. R. Kirsh, J. A. Alexander and J. C. Lowery (2009). “Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science.” Implement Sci 4: 50.
Milat, A. J., A. Bauman and S. Redman (2015). “Narrative review of models and success factors for scaling up public health interventions.” Implement Sci 10: 113.
Tabak, R. G., E. C. Khoong, D. A. Chambers and R. C. Brownson (2012). “Bridging research and practice: models for dissemination and implementation research.” Am J Prev Med 43(3): 337-350.