Designing and Piloting a Program to Provide Water Filters and Improved Cookstoves in Rwanda

• Type of Material: Article
• Authors: Christina K. Barstow, University of Colorado; Fidele Ngabo, Ministry of Health; Ghislaine Rosa, London School of Hygiene and Tropical Medicine; Fiona Majorin, London School of Hygiene and Tropical Medicine; Sophie Boisson, London School of Hygiene and Tropical Medicine; Thomas Clasen, Emory University; Evan A. Thomas, Portland State University
• Language: English
• Date: 2014-03-27
• Publisher: Public Library of Science
• Publication Version: Final Published Version
• Copyright Statement: © 2014 Barstow et al.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1371/journal.pone.0092403
• Title of Journal or Parent Work: PLoS ONE
• ISSN: 1932-6203
• Volume: 9
• Issue: 3
• Start Page: e92403
• End Page: e92403
• Grant/Funding Information: All funding for this study was provided by DelAgua Health Limited www.delaguahealth.com) through a sponsored research grant to Portland State University and the London School of Hygiene and Tropical Medicine.
• Keywords: Multidisciplinary Sciences; RESPIRATORY-INFECTIONS; Science & Technology - Other Topics; KENYA; DEVELOPING-COUNTRIES; QUALITY; CHILDREN; INDOOR AIR-POLLUTION; MODEL; Science & Technology
• Research Categories: Engineering, General; Health Sciences, Public Health

Abstract

Background: 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. Methods and Findings: 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 onl y 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. Conclusion: 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.