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.
Highlights
Contaminated air and drinking water at the household level are significant contributors to morbidity and mortality among rural populations in low-income countries
In an effort to reduce the disease burden in rural Rwanda, decrease poverty associated with expenditures for fuel, and minimize the environmental impact 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
Recipients of the technologies included all households classified as Ubudehe 1 and 2 in 70 of 96 sectors in the Western
Summary
Program description The program is branded Tubeho Neza which means to “Live Well” in Kinyarwanda. Sensitization meetings were conducted by the South African marketing agency, EXP, anywhere from 1 day to 2 weeks before the households in the community were to attend the distribution meeting to collect their products The focus of these meetings was to introduce the larger community to the program, while providing initial exposure to the water filter and improved cookstove before households received them. A follow up household visit included a brief survey to assess several adoption and programmatic metrics, repair and replacement of broken products, cleaning of the filter’s bottom safe storage water container and an education and training lesson. Ongoing behavior change activities include: CHW Cooperative Meetings – Staff provide additional educational messaging, receive updates on adoption within households and facilitate incorporation of the Tubeho Neza program into other health programs. All households, regardless of consenting to the surveys were able to retain the filter and cookstove
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