Peru Healthy Kitchen/Healthy Stove Pilot Project

This publication explores the implementation and effectiveness of a 21-month project designed to reduce indoor air pollution (IAP) among 33 economically poor indigenous communities in a rural district of Inkawasi, Peru. Field implementation of Healthy Kitchen/Healthy Stove was led by Centro de Ecología y Género (Centro ECO), a Peruvian non-governmental organisation (NGO). The report itself was produced by Winrock International under a cooperative agreement for the United States Agency for International Development (USAID).

Although the evaluation report examines all components of the initiative - including the manufacture and distribution of an improved wood stove called "Inkawasina" and the creation of an animal-based micro-loan system to facilitate sustainable, widespread community access of the new cooking technologies - the present summary focuses on the social communication campaign designed to secure local buy-in, to raise awareness about the risks of indoor smoke, and to introduce and reinforce specific behaviours as essential for reducing exposure.

To determine and demonstrate the effectiveness of the intervention, Winrock and its partners undertook monitoring of local practices and perceptions, indoor air quality, fuelwood consumption, and health symptoms using pre- and post-intervention surveys, focus groups, fuelwood monitoring, air sampling, and spirometry to detect changes in lung function. Winrock gave priority to monitoring Particulate Matter (PM4) and Carbon Monoxide (CO) to gauge project impact, followed by energy consumption. However, Winrock and Centro ECO also sought to track other impacts, such as time savings, to provide further insight into the project's success in bringing about effective and enduring changes in the cooking practices of Inkawasi families. Local training was included for each monitoring component.

As detailed here, the project worked to establish an organised cadre of promoters and other community leaders; the idea was that building formal community structures would facilitate initial community buy-in and ultimate ownership and responsibility for long-term results. On this particular element of the campaign, the evaluation finds that, "Despite the challenges of working in a cash-poor region with low literacy rates, the ECO staff and the communities of the Inkawasi district demonstrated remarkable leadership in embracing the objectives of the Healthy Kitchen/Healthy Stove project and corresponding responsibilities....Centro ECO's previous community organizing experience proved critical in motivating community leaders and creating a trusting relationship between the NGO and project promoters." Evaluators cite as crucial the fact that the lead technical engineer was born and raised in Uyurpampa and not only spoke the local language and knew many families, but was intimately familiar with daily life and customs. Having champions like him - from within the population being reached - facilitated educational household visits conducted as part of the campaign. In addition, "Pride, status, and the opportunity to learn and improve community conditions were strong motivators for promoters to become active in the project....It appears quite possible to engage indigenous rural communities from this region in volunteer work to promote projects with a social focus. Sufficient training must be provided, however, to ensure that promoters have absorbed the messages and gained the skills needed for proper management of all project components."

This community engagement was part of the larger project aim of educating families about the risks associated with indoor smoke and convincing them to adopt new practices and behaviors that reduce exposure. Evaluators assert that "During the focus groups, which consisted of members of households [in] which stoves were installed, women stressed that they were happy with their new stoves and didn't want to use open fires indoors anymore; rather, they would reserve cooking over open fire for special occasions when they needed to cook for larger groups, and they would do so outdoors. The post-intervention practices and perceptions survey showed a similar increase in awareness in the general population: in response to a question about how to avoid indoor smoke, around 51% of the interviewees suggested acquiring an improved stove, 32% recommended improving ventilation, and 15% recommended having a kitchen that is separate from the rest of the house. These responses showed marked increases over the respective 18%, 15%, and 8% of interviewees who suggested these measures during the baseline survey." Most families report they now try to keep children away from smoke as much as possible.

Centro ECO also developed a variety of materials, including 300 posters announcing the project which, with the help of promoters, were distributed widely throughout the district. Murals were posted in central locations in each of the 33 communities. Centro ECO developed 4 radio spots using both Spanish and Quechua in the same spot, and each was broadcast for one month. The first message, delivered by ECO, announced the project and invited participation. The subsequent 3 spots were formatted as a dialogue between Inkawasi residents. The 30-second radio spots were broadcast on a local station between 6:00 and 7:00 pm (the hour during which husbands and wives would typically be home together listening to the radio).

According to evaluators, "The radio messages spread initial information about the project quickly. The spots appeared to have been particularly useful in prompting several leaders of communities reached by the radio messages to approach the EHAs [Environmental Health Associations] and ask to join the project and form EHCs [Environmental Health Committees]. However...the radio spots were less influential than direct visits by promoters in raising awareness among typical households about the project and its messages, perhaps due to their limited broadcast time. Future radio campaigns should be run for at least six months, and in the local language (Quechua, in this case) for maximum impact."

To reiterate the point indicated above, "the most effective means of raising awareness appears to have been the househand village-level visits of the promoters. Centro Eco's emphasis on personal contact with the target groups helped bring about widespread interest in the new stoves." In the survey conducted after improved stoves had been installed, 54% of the interviewees reported that the family visits, women's gatherings, and village-wide visits by the promoters were the most effective techniques for raising awareness, motivating participation in the project, and prompting behaviour change.

The simple, locally oriented educational materials developed for use by the promoters were found to be useful tools for communicating key messages. Centro ECO engaged a local artist and communications expert and used an interactive process to develop the materials based on feedback from focus groups and input from Winrock. Each promoter received his/her own set of materials to use with the families. The materials depicted health effects that included coughing, runny noses, shortness of breath, and death of young children. Pictures featured the Inkawasina stove in a clean kitchen; proper operation of the stove, including covering the pots and cook holes; splitting and drying the fuelwood and lighting the stove; as well as stove maintenance, with particular emphasis on removing the ash and cleaning the chimney. Other pictures suggested opening windows for better lighting and ventilation, and finishing walls and using shelves for a cleaner and more orderly kitchen. "With no text, the pictures were particularly effective for educating illiterate community members."

A total of 22 Healthy Kitchen competitions "proved to be extremely useful in getting the attention of the communities." The purpose was to raise the visibility of the Inkawasina stove and complementary kitchen improvements undertaken voluntarily by families. The competitions were designed to spotlight role models within the communities and infuse a sense of ownership and pride in having an improved stove and creating a healthy kitchen space. The judges awarded kitchen utensils such as new pots, pans, and silverware to the 5 best kitchens in the competition area.

As indicated by the vigorous participation in these competitions, "Many families voluntarily invested time, resources, and ingenuity to improve their kitchen environments to complement the improved stove, from installing shelves to constructing completely new kitchens. This level of commitment suggests that the improved stoves are highly valued, and that this population is eager to invest in improving its living conditions."

An excerpt from the report follows:
"...The project achieved its primary objective of significantly reducing IAP among target households of the Inkawasi district. While the total number of installed stoves fell short of the target (largely due to slower than expected rates of animal breeding and loan repayment), as of August 2007 60% of the target number had been installed, with indications that dissemination would continue sustainably. Twelve-month post-intervention monitoring demonstrated the potential of this intervention for reducing indoor pollutant concentrations - there was an average IAP reduction of 84% in households where any reduction was noted (a majority of households monitored)...

During implementation, the project team and USAID recognized that the number of installed stoves was not the most telling indicator of long-term success. Indicators of the likelihood that local capacity, community organization, and financial mechanisms would endure over time were ultimately given greater weight. In this regard, the project has demonstrated success. By the end of the project, 527, or 88% of the target number of households, had acquired or committed to acquiring an Inkawasina stove (93% utilizing the micro-loan mechanism and 7% paying for the stove in cash); 68% of the original value of loans made had been recovered; and project surveys, focus groups, and anecdotal feedback indicated that a large majority of households in the district now understand the risks associated with IAP and are aware of measures they can take to reduce these risks.

The direct purchase by 36 families of Inkawasina stoves was surprising. This suggests that the IAP messages and appreciation for the advantages of the Inkawasina stove are spreading beyond the target population to an unexpected segment that both values the benefits and has the capacity to pay for the improved stoves without the assistance of a loan.

Since the close of the project implementation period in September 2007, the activities initiated in Inkawasi have continued and even picked up speed, with both increased stove demand, and increased promoter and manufacturer capacity to meet the demand. By September 2007 about 380 improved stoves had been purchased and installed and more than 400 animal modules had been distributed on loan. Since then project activities have continued without external funding. By March 2008 the Environmental Health Associations had supported the adoption of about 700 improved stoves, and loans of more than 800 animal modules. This continued success demonstrates the sustainability of the project, which relied on local organizations, developers, and community leaders influencing their neighbors and friends about the importance and benefits of the improved stoves."