Worldwide, about 4 million people die prematurely each year from diseases linked to smoky cookstoves, and many more suffer from poor health. Yet most campaigns to replace those stoves with cleaner alternatives emphasize the fuel savings or technical features, not the health benefits.
Would more households adopt improved stoves if they learned just how harmful the smoky stoves are, particularly to the cooks and their children?
SNV Netherlands Development Organisation commissioned studies in Cambodia and Kenya to examine this crucial question. SNV has funded clean cookstove and fuels programmes in 20 countries, reaching more than 3 million people, and engaged SEI, which has previously helped SNV to draw insights from its stove programmes, to analyse the study results and make recommendations.
The Cambodia study, conducted in the province of Kampong Chhnang, tested the effects of positive and negative health messaging and more or less intensive health messaging. Effectiveness was measured in terms of number of stoves sold and participants’ health awareness level.
The Kenya study, in Kiambu County, tested the effectiveness of three health-based interventions: SMS messages sent on five consecutive days, graphic imagery, and the combination of personal goal-setting and measures to remove barriers to the purchase of an improved stove.
The Kenya campaign’s impact was measured in terms of willingness to pay for stoves, score on a health awareness index, and whether people had switched stoves during the study.
Both studies found that health messaging had a minimal effect on stove purchases, while price was a key factor. In Cambodia, the campaign did increase awareness of the health risks of traditional biomass cooking, but in Kenya there was little improvement, as awareness was already high.
“This is very much in line with other research which shows that health awareness is rarely a key factor motivating the adoption of health-promoting behaviours,” said Fiona Lambe, a research fellow at SEI in Stockholm and co-author of the report.
Lambe noted that the stoves used in both studies – ACE-1 in Cambodia, and a Philips gasifier stove in Kenya – are fairly advanced and unaffordable to most households. “Further research is needed to understand the potential impact of health messaging on purchase and use of stoves when the technologies are more affordable.”
The studies were also short – 10 weeks in Cambodia and five in Kenya – and realizing the benefits of clean stoves requires sustained use. This raises another key question, Lambe said: whether health messaging would be more effective in persuading households to switch stoves in the longer term, and to keep using stoves once they acquire them.
Caroline Ochieng, a research fellow at SEI in Stockholm and co-author of the report, was struck by the fact that in Cambodia, a single agent – who had deviated from the supplied script – was responsible for 24 of the 34 stove sales.
“The Cambodia study suggests that there are other key unexplored factors that could be far more influential in the adoption of clean cookstoves than health messaging,” Ochieng said. “This one sales agent was so effective that she even overcame the major barrier of stove cost.”
“A key question is, how do you exploit these individual traits and use them at a broader scale to promote wider-scale stove adoption?” she added. “It may require further research on understanding these personal traits and how they inspire people to change.”
Andy Wehkamp, managing director for the Energy Sector at SNV, said that although the results are “far from conclusive”, SNV hopes they “will add to the knowledge base required to make clean cooking interventions more effective and life-saving.”
“So far, over a million households in Africa, Asia and Latin America have acquired an improved or clean cookstove with support from SNV,” she said. “Especially women and children benefit from a less smoky, healthier kitchen every day, even if the cost and time savings and convenience are more important to them than the health benefits. SNV is committed to increasingly integrating health awareness campaigns and behaviour change communication in its current and future programmes.”
Indeed, Lambe noted, “there is a perception among clean cookstove promoters that lack of awareness of the health risks of cooking with traditional biomass is a key reason for low uptake of cleaner stoves. They believe improved health awareness could trigger people to purchase and consistently use a clean cookstove. It is important to know whether this is really the case.”
SEI continues to explore these questions through the Initiative on Behaviour and Choice and multiple projects around the world.