Published: 08 November 2021
How CLEAN-Air Africa is tackling the hidden killer of household air pollution
Around the world, smoke from domestic fuel causes more premature deaths and illness than malaria and HIV combined. The NIHR-funded CLEAN-Air Africa project, a partnership between UK researchers and health authorities and institutions in Kenya, Cameroon, and Ghana, is working to address the threat of household air pollution, improving health and reducing the harmful impact on the environment.
In sub-Saharan Africa, around 900 million people rely on polluting fuels such as wood, charcoal and kerosene for cooking, lighting and heating their homes. Smoke exposure from burning these fuels is the largest environmental cause of global disease, responsible for approximately 3 million premature deaths annually. Burning solid fuels also contributes to climate change, deforestation and the poverty cycle, disproportionately affecting women and children.
The NIHR Global Health Research Group: Clean Household Energy for the Prevention of Non-communicable Disease in Africa (CLEAN-Air Africa), led by the University of Liverpool, aims to address the burden of disease from household air pollution through a programme of policy research and capacity building of health systems.
Since 2018, the group has shown significant health and gender equity gains achieved by scaling liquefied petroleum gas (LPG) (also known as bottled gas) for household energy, as well as benefits for the environment from reduced solid fuel reliance and harmful climate emissions of pollutants from traditional fuel burning.
Community health workers key to clean fuels transition
Working with national health ministries in partner countries and the World Health Organization (WHO), CLEAN-Air Africa has implemented domestic health programmes incorporating training in the prevention of household air pollution. These goals were developed to increase the population breathing in clean air in line with WHO Air Quality Guidelines. Further, CLEAN-Air Africa will help many sub-Saharan African governments achieve their targets to expand access to LPG as a clean fuel, given its potential for rapid scale, to meet the United Nations’ Sustainable Development Goal 7.
The Group has already realised substantial impact across a number of different areas. A national community health worker training initiative developed by The University of Liverpool for CLEAN-Air Africa in primary prevention of air pollution related disease was officially ratified by the Kenyan government in November 2021 under its Universal Health Coverage directive. At the Grand Launch in Nairobi attended by the Directorships from Kenya’s Ministries of Health and Energy, the Director General for Health, Dr Patrick Amoth, and Head of Public Health at the Ministry of Health, Col. Susan Mutua, stated “In Africa, Household Air pollution is among the leading contributors of burden of disease accounting to 18% of all deaths... We want from now on to protect our children and also our elders from this kind of pollution. The launch of this initiative is therefore welcome news”. Immediately following the launch, implementation of training workshops for community health volunteers was initiated across 17 of Kenya’s 47 counties through a collaboration between the Ministry of Health and CLEAN-Air Africa. Ultimately the training will reach Kenya’s 130,000 strong community health workforce as it is rolled out across all 47 counties with tracking of impact managed through a new digital health surveillance system developed by the group for the Ministry of Health. CLEAN-Air Africa plans to adapt this community health capacity building program to its other focus countries over the next 24 months.
National Launch of Kenyan Community Health Worker Training Initiative, Nairobi November 2021
In recognition of the important health promotion role played by community health workers as advocates for their communities, Professor Dan Pope, Director of the NIHR CLEAN-Air Africa Global Health Research Group, said: “Empowering community health volunteers with the information they need for primary and secondary prevention of household air pollution is crucial to achieving Sustainable Development Goals for both health and equity. The universal reach of CHVs across all communities can help scale transition to clean household energy displacing reliance on polluting and inefficient fuels”.
To achieve universal access to clean household energy, SDG 7, Dr Elisa Puzzolo, Co-Director of CLEAN-Air(Africa) explains:
“We have demonstrated that rapid transition to clean cooking with LPG in sub-Saharan Africa meets the immediate public health priority with climate, gender and environmental co-benefits.”
“While we are researching future green options for domestic energy, including electricity and bio-LPG, these solutions are unlikely to achieve the scale needed to meet SDG7 on time. More effort is needed to support clean cooking with LPG in countries where the infrastructure required for cooking with electricity or renewable fuels will not be available in the short-term. Our research has shown the benefits of both financial and technological innovation in assisting a rapid, equitable transition to clean cooking fuels”.
Partnering with leading clean energy innovators
In 2019 through a UKRI/MRC Fund Newton grant, CLEAN-Air Africa partnered with Moi University and the International Agency for Research in Cancer to understand how reliance on polluting fuels has contributed to an epidemic of oesophageal cancer in western Kenya.
In Ghana, CLEAN-Air Africa was asked by national authorities to lead evaluation of its pilot efforts to distribute LPG under a Branded Cylinder Recirculation Model to increase safety and accessibility across the national territory. In Cameroon, close to 5,000 beneficiaries have adopted clean cooking as a result of a pioneering microfinance programme co-developed with UK researchers and aligned with the Government’s aspiration to transition 58% of its population to clean cooking with LPG by 2030.
Recognising that clean energy access and affordability are key obstacles for achieving large-scale, equitable and sustained transition to clean fuels at the household level, CLEAN-Air Africa is partnering with leading clean energy innovators such as CircleGas and its subsidiaries. Receiving UK FCDO funding through the GSMA Mobile for Development Utilities Programme, this partnership will foster the expansion of clean cooking with smart metered pay-as-you-go LPG among the resource poor.
Covid-19 in Africa: a pandemic with multiple burdens
With the first cases of Covid-19 emerged in sub-Saharan Africa in March 2020, CLEAN-Air Africa rapidly undertook research to understand the impact of the pandemic, and measures designed to control transmission through community lockdowns, on economic, food and energy security for households in resource poor settings. Their research identified significant reductions in income, declines in nutrition and a regression to reliance on polluting fuels in Kenya’s informal settlements. The group also found the utility of the pay-as-you-go LPG model in cushioning the effects of economic instability induced by the pandemic with households using the technology in the same communities continuing to cook cleanly with LPG during community lockdown. The research attained significant global interest and was featured by the World Health Organisation in a case study of how the technology could promote health equity during Covid-19.
In July 2021 Kenya re-imposed VAT at 16% on LPG for domestic use in response to fiscal pressures following the pandemic. CLEAN-Air Africa partners (University of Liverpool and Moi University) teamed up with colleagues from University College London to research the effects the tax had on energy usage in the country. The results were clear - the tax is negatively impacting on Kenya’s aspirations to transition the country to clean cooking under SDG7 with a significant proportion of households switching back to polluting solid fuels. Teaming up with Directorships from the Ministries of Energy and Health in Kenya, CLEAN-Air Africa developed an action policy brief stressing the importance of returning the zero-rating for VAT on LPG to realise the health, climate and gender co-benefits of scaling clean cooking under SDG7. As of February 2022, the brief is being leveraged by the Ministries to petition the Kenyan treasury.
Looking ahead - beyond COP26
The group is assessing the positive impacts on the UN Sustainable Development Goals for health, energy access, gender and climate. This programme, including KopaGas in Tanzania and MGas and PayGo Energy in Kenya, was launched at the Kenyan Tech Hub in 2020 by then international development minister Alok Sharma, and is linked to the UK FCDO Modern Energy Cooking Services (MECS) Programme to rapidly accelerate the transition from wood and charcoal based cooking to modern, clean, low carbon energy-efficient energy with a focus on electricity and gas.
The CLEAN-Air Africa Group is the public health voice for MECS and have recently completed a policy review of the Cameroon cooking energy sector, also presented on 4 November at an African Union Development Agency event at the UN Climate Change Conference (COP26).
The group is also engaged with the UN Foundation Clean Cooking Alliance and Stockholm Environment Institute conducting global climate and health modelling of LPG transition at scale building on their quantification made for Cameroon. The climate neutrality of LPG have been recognised in the latest IEA World Energy Outlook report.
Dr Elisa Puzzolo explains the latest evidence about LPG climate credentials:
“LPG burns very cleanly in simple devices such as household cooking stoves and has a low carbon emission profile due to its high efficiency. Replacing biomass fuels with LPG reduces black carbon and methane emissions and preserves trees from being harvested for fuel. While it should be considered a transition technology towards fully renewable household energy, it has the potential for being increasingly decarbonised through adoption of bio-LPG generated from municipal solid waste and agricultural residues.”