CLEAN-Air(Africa) Programme of Work
The CLEAN-Air(Africa) programme consists of five distinct components: Evaluation, Intervention, Communication, Training and Health Systems Strengthening. Each component is described in detail below.
CLEAN-Air(Africa) is undertaking a program of evaluation in each of its focus countries to understand barriers and enablers to adoption and sustained use of clean household energy. Mixed-methods implementation research is being conducted working within communities to understand individual, household and community features that affect traditional use of polluting fuels (e.g. firewood, charcoal and kerosene) and transition to clean cooking, heating and lighting. Our research helps identify community derived solutions for switching to cleaner fuels/energy and using them in a more exclusive and sustained way to maximise health gain from reductions in household air pollution.
1. Community-based representative surveys
Using standardised questionnaires on domestic fuel use, household demography, health symptoms, burns and perceptions of household energy, CLEAN-Air(Africa) identifies factors associated with fuel choice and the health and social impacts of these choices. We employ state-of-the-art digital data collection methods maximising data security and accuracy. These surveys help identify areas for intervention that can inform policy on scaling adoption of clean domestic fuel.
2. In-depth interviews and participatory research
CLEAN-Air(Africa) works within communities using innovative participatory methods to understand the perspectives of people who (i) purchase/ gather and (ii) use domestic fuels. Semi-structured interviews, focus group discussions and visual participatory methods, such as Photo-Voice, help elucidate the impacts of fuel choice on women and their families’ lives and identify crucial factors that constrain and enable transition to clean household energy. These methods are a crucial feature of the two-way public and stakeholder engagement employed by CLEAN-Air(Africa) to help translate research into evidence-based policy.
3. Assessing impacts from choice of domestic household energy
CLEAN-Air(Africa) conducts detailed objective evaluation of emissions, concentrations and exposure to key health damaging pollutants associated with domestic fuel choice. The University of Liverpool has substantial expertise in the measurement and analysis of fine particulate matter (PM2.5), carbon monoxide (CO) and other products of incomplete combustion (e.g. polycyclic aromatic hydrocarbons (PAHs)) that are causally related to a range of respiratory (e.g. pneumonia, chronic obstructive pulmonary disease and lung cancer) and cardiovascular diseases (e.g. stroke and ischaemic heart disease. CLEAN-Air(Africa) uses state-of-the art equipment and methods for measuring the concentrations (i.e. in kitchens) and exposure to (i.e. for women and children) these pollutants.
The effectiveness of adoption of clean fuels for cooking in terms of reductions in household air pollution and associated positive impacts on health relies on the displacement of concurrent use of polluting fuels (so called ‘stove stacking’). CLEAN-Air(Africa) uses the latest stove use monitoring (SUMs) technology to identify multiple fuel use in households and to correlate levels of household air pollution directly to stove usage for cooking.
Household air pollution data is collected across all the focus countries for CLEAN-Air(Africa) and allows indirect assessment of the impacts on illness and premature mortality from choice of domestic fuel. This information is crucial in providing evidence to policy makers on the potential public health impacts for national strategies on scaling clean household energy.
In addition CLEAN-Air(Africa) objectively measures health indicators that are known to be associated with exposure to household air pollution. Blood pressure measurement is collected from study participants to investigate how exposure is associated with hypertension. Understanding the impacts of household air pollution exposure on restricted lung disease (e.g. Chronic Obstructive Pulmonary Disease) is assessed through spirometry. Fuel/ stove related burn and scald surveillance is also being implemented through CLEAN-Air(Africa) to understand the occurrence of this neglected burden.
With major national strategies for clean household energy being implemented through scaling adoption of liquefied petroleum gas (LPG or bottled gas) in its focus countries, CLEAN-Air(Africa) works with international experts in climate research to model the potential impacts on climate through population transition to this fuel. These sophisticated models offset emissions of short-term climate forcing emissions (e.g. black carbon or soot) and reductions in deforestation against potential increases in carbon dioxide (CO2) from scaled adoption of LPG to national target levels. These models can help put into context that the substantial health gain from population transition to clean cooking with LPG are not at the expense of climate through global warming potential. See an example of this research here.
To effectively understand the social and economic impacts of choice of household energy and potential barriers and enablers for transition to clean, modern fuels CLEAN-Air(Africa) adopts a constructivist approach using innovative visual participatory methods (e.g. Photo Voice) as well as inductive research methodology (e.g. semi-structured interviews and focus group discussions). Working closely with women, who typically bear the brunt of the burden of reliance on polluting solid fuels, and within communities, CLEAN-Air(Africa) aims to translate evidence from users of household energy to stakeholders to inform policy designed to facilitate adoption of clean fuel.
An important remit for CLEAN-Air(Africa) is to evaluate strategies that can facilitate scaling adoption and sustained use of clean household cooking, addressing barriers identified by communities. Examples of priority areas being evaluated by CLEAN-Air(Africa) include (i) implementation of microfinance initiatives to facilitate purchase of equipment/ fuel/ energy to switch to clean energy, (ii) evaluation of the potential for pressure cookers to encourage more sustained use of LPG and (ii) use of technology and innovation (for example pay-as-you-go LPG smart meters) to facilitate adoption and sustained use of clean fuels. An important remit for these interventions is that they can be scaled to benefit households at a population level. In this endeavour CLEAN-Air(Africa) works closely with both the public and private sector to describe the benefits of these interventions for populations (health and social impacts) and the potential for their scale within its focus countries.
The implementation research conducted by CLEAN-Air(Africa) is underpinned by translation of evidence into policy through knowledge exchange. Research questions are informed by both the study communities (users of domestic energy) and through consultation with national and local stakeholders. This knowledge exchange is essential in ensuring research conducted by CLEAN-Air(Africa) is policy relevant and contributes to its aspiration for informing strategies to achieve Sustainable Goal 7 “access to clean modern energy for all by 2030”. CLEAN-Air(Africa) works with ministries of health, energy and development within its focus countries in setting its research objectives and for disseminating its findings. Through its two-way public and stakeholder engagement events CLEAN-Air(Africa) facilitates dialogue between communities and policy makers, facilitated through dissemination of its mixed-methods implementation research.
Our work with the Ministry for Promotion of Women and the Family (MINPROF) in Cameroon has resulted in an annual clean cooking conference to coincide with the International Day for Rural Women. The event is attended by rural women who have a chance to engage with clinicians, environmental health experts, policy makers and stakeholders to discuss how to transition to clean cooking fuels. The conference is supported by national television (the Cameroon Radio and Television Company (CRTV)). Since its launch, we have worked closely with CRTV who have produced documentaries involving our work and raised the profile of household air pollution, health and prevention through clean cooking linked to our research.
Knowledge exchange and capacity building is a crucial focus for CLEAN-Air(Africa) and international academic and research experts in the field of household air pollution, health and prevention lead one week training events across all its focus countries to train future African researchers. Courses include:
- Measurement of household air pollution and health impacts
- Measurement and analysis of stove use monitoring data
- Quantitative research methods and data collection
- Principles of qualitative research methods
- Visual participatory methods (Photovoice and Photo elicitation).
Capacity building led by CLEAN-Air(Africa) includes an annual training event in household air pollution, health and prevention held for African health professionals, researchers and students held in each of its focus countries. The one-week course has input from some of the world’s leading researchers in the field presenting the latest research on health impacts from household air pollution and prevention strategies including clean household energy. The course includes training in (i) quantitative research methods (including household air pollution measurement and health impacts), (ii) qualitative research methods (including visual participatory methods) and (iii) research skills (including paper and grant writing). More details can be found under CLEAN-Air(Africa) Learn.