Process evaluation and assessment of use of a large scale water filter and cookstove program in Rwanda

Abstract

BackgroundIn an effort to reduce the disease burden in rural Rwanda, decrease poverty associated with expenditures for fuel, and minimize the environmental impact on forests and greenhouse gases from inefficient combustion of biomass, the Rwanda Ministry of Health (MOH) partnered with DelAgua Health (DelAgua), a private social enterprise, to distribute and promote the use of improved cookstoves and advanced water filters to the poorest quarter of households (Ubudehe 1 and 2) nationally, beginning in Western Province under a program branded Tubeho Neza (“Live Well”). The project is privately financed and earns revenue from carbon credits under the United Nations Clean Development Mechanism.MethodsDuring a 3-month period in late 2014, over 470,000 people living in over 101,000 households were provided free water filters and cookstoves. Following the distribution, community health workers visited nearly 98 % of households to perform household level education and training activities. Over 87 % of households were visited again within 6 months with a basic survey conducted. Detailed adoption surveys were conducted among a sample of households, 1000 in the first round, 187 in the second.ResultsApproximately a year after distribution, reported water filter use was above 90 % (+/−4 % CI) and water present in filter was observed in over 76 % (+/−6 % CI) of households, while the reported primary stove was nearly 90 % (+/−4.4 % CI) and of households cooking at the time of the visit, over 83 % (+/−5.3 % CI) were on the improved stove. There was no observed association between household size and stove stacking behavior.ConclusionsThis program suggests that free distribution is not a determinant of low adoption. It is plausible that continued engagement in households, enabled by Ministry of Health support and carbon financed revenue, contributed to high adoption rates. Overall, the program was able to demonstrate a privately financed, public health intervention can achieve high levels of initial adoption and usage of household level water filtration and improved cookstoves at a large scale.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3237-0) contains supplementary material, which is available to authorized users.

Socio-Cultural Reasons and Community Perceptions Regarding Indoor Cooking Using Biomass Fuel and Traditional Stoves in Rural Ethiopia: A Qualitative Study

“…Like other rural areas in different developing countries, biomass was the only fuel option in the community. Previous studies also reported that nearly all rural communities used biomass fuel for cooking [ 8 , 11 , 18 ]. However, our finding regarding not using charcoal as a fuel source by the community for either cooking or heating was inconsistent with other findings reporting its continuing use by many in rural communities [ 19 , 20 , 21 ].…”

“…There have been global and local initiates and interventions including The Global Alliance for Clean Cook Stoves, to alleviate the problem of HAP due to solid fuel by supporting adoption of clean and safe household cooking solutions [ 4 , 5 , 6 , 7 ]. However, different research findings indicate the existence of resistance to accept some technologies and/or failure of achieving the desired objective in preventing the health problems in some communities [ 5 , 6 , 8 ].…”

Study design of a cluster-randomized controlled trial to evaluate a large-scale distribution of cook stoves and water filters in Western Province, Rwanda

“…Repair and replacement of products is managed by DelAgua through district level facilities with problems being reported primarily through a dedicated call center phone line and communications with local officials. Further details of the delivery of the interventions and associated program activities are contained in a separate process evaluation paper [5] .…”

Quantifying Averted Disability-Adjusted Life Years as a Performance Indicator for Water Quality Interventions: A Review of Current Methodologies and Challenges

“…Coverage and use of household-level interventions are typically assessed using surveys and observations. However, a variety of studies have noted a poor correlation between self-reported and observed practices when evaluating the use of environmental interventions [70,72,91], and bias in self-reported outcomes is particularly likely when self-reported behaviors are perceived to be desired by evaluators or the wider community. The process of data collection itself can impact behavior, as individuals change their practices in response to the knowledge that they are being monitored, which is a phenomenon known as reactivity or the Hawthorne effect [92].…”