Applied Implementation Research for Clean Cooking: exposure, costs, and benefits of induction stove interventions

Emory University, Atlanta GA

Investigators

Abstract

The goal of this study is to design and demonstrate the effectiveness of scalable strategies for achieving increased access to and sustained exclusive use of induction-based clean cooking in low- and middleincome settings. An estimated 3 billion people use biomass fuels (e.g., wood, charcoal, animal dung, and coal) for cooking in polluting open fires or inefficient stoves. The resulting household air pollution (HAP), including fine particulate matter, is a leading risk factor for ill-health worldwide. There is recent, compelling evidence that switching to near-exclusive use of cleaner fuels such as liquified petroleum gas dramatically reduces HAP exposures. However, successful, at-scale implementation of clean cooking interventions has been limited, and few studies have evaluated the impacts of induction cooking, arguably the safest, most efficient household cooking solution. We will address these gaps by conducting the first large-scale implementation and effectiveness evaluation of induction-based cooking interventions among low-income households in peri-urban Cambodia. We will adapt and use implementation science methods and frameworks to refine, develop, and test evidence-based clean cooking interventions to establish a rigorous, transferable, and reproducible evidence base. We will conduct formative research to assess determinants of purchase and use of induction stoves and refine and rapidly prototype integrated implementation strategies for our context (SA1). We will employ a five-arm, hybrid type II cluster randomized trial to test implementation strategies to completely transition households away from biomass fuels. Trial arms will include a mix of demonstrations, direct sales, and targeted, pro-poor stove subsidies (SA2). We will measure the primary cook’s exposure to HAP before and after introducing induction stoves, providing evidence of the exposure-reducing potential of our implementation strategies. We will provide paradigm-shifting evidence of (a) the viability of induction cooking in areas that can support it, accelerating the transition towards safer household energy for billions; and (b) the cost, benefits, and effectiveness (SA2 and SA3) of these strategies to encourage uptake and sustained use of clean cooking. Our approach advances the field of implementation science by addressing established priorities, including applying a systematic approach to implementation strategy development, employing established frameworks to explain plausible mechanisms of change for these strategies, and conducting a robust economic evaluation as part of a hybrid trial design. By providing evidence of successful implementation strategies and their effects on exposure to household air pollution, this study will serve as a model and motivation for adoption and scale-up of similar programs across South and Southeast Asia and beyond.