Designing and piloting a program to provide water filters and improved cookstoves in Rwanda

• Published in: PloS one 2014-03, Vol.9 (3), p.e92403
• Main Authors: Barstow, Christina K, Ngabo, Fidele, Rosa, Ghislaine, Majorin, Fiona, Boisson, Sophie, Clasen, Thomas, Thomas, Evan A
• Format: Article
• Language: English
• Subjects: Air pollution; Air Pollution, Indoor; Air quality; Carbon offsets; Community involvement; Community relations; Cooking; Design; Design criteria; Diarrhea; Drinking water; Earth Sciences; Ecology and Environmental Sciences; Emissions; Energy industry; Engineering and Technology; Environmental health; Environmental monitoring; Family Characteristics; Filters; Health aspects; Health promotion; Households; Humans; Hygiene; Indoor air; Indoor air pollution; Indoor air quality; Indoor environments; Intervention; Maternal & child health; Medical personnel; Medicine; Medicine and Health Sciences; Mortality; Nonprofit organizations; Outdoor air quality; Pneumonia; Poverty; Profits; Public health; Public-private sector cooperation; Rwanda; Sanitation; Social Sciences; Systematic review; Teaching methods; Technology; Tropical diseases; Water filters; Water purification; Water Quality; Water treatment; Workers
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0092403

In environmental health interventions addressing water and indoor air quality, multiple determinants contribute to adoption. These may include technology selection, technology distribution and education methods, community engagement with behavior change, and duration and magnitude of implementer engagement. In Rwanda, while the country has the fastest annual reduction in child mortality in the world, the population is still exposed to a disease burden associated with environmental health challenges. Rwanda relies both on direct donor funding and coordination of programs managed by international non-profits and health sector businesses working on these challenges. This paper describes the design, implementation and outcomes of a pilot program in 1,943 households across 15 villages in the western province of Rwanda to distribute and monitor the use of household water filters and improved cookstoves. Three key program design criteria include a.) an investment in behavior change messaging and monitoring through community health workers, b.) free distributions to encourage community-wide engagement, and c.) a private-public partnership incentivized by a business model designed to encourage "pay for performance". Over a 5-month period of rigorous monitoring, reported uptake was maintained at greater than 90% for both technologies, although exclusive use of the stove was reported in only 28.5% of households and reported water volume was 1.27 liters per person per day. On-going qualitative monitoring suggest maintenance of comparable adoption rates through at least 16 months after the intervention. High uptake and sustained adoption of a water filter and improved cookstove was measured over a five-month period with indications of continued comparable adoption 16 months after the intervention. The design attributes applied by the implementers may be sufficient in a longer term. In particular, sustained and comprehensive engagement by the program implementer is enabled by a pay-for-performance business model that rewards sustained behavior change.