Clean Cooking and Public Health in Uganda 20 th August 2015 Kampala Meeting Report 1
Table of Contents Overview and Objectives...3 Participants...3 Agenda...4 Summary of Key Discussion Points...5 Next Steps...6 2
Overview and Objectives On August 20, 2015, the Global Alliance for Clean Cookstoves (Alliance), the FRESH Air Uganda Collaboration (FRESH Air), and the Ugandan National Alliance on Clean Cooking (UNACC) convened a half day workshop in Kampala, Uganda on Clean Cooking and Public Health followed by a networking luncheon. Financial support for this meeting was kindly provided by the Netherlands Enterprise Agency and the Global Alliance for Clean Cookstoves. Intended to create active partnerships between the clean cooking and public health implementation communities, the workshop was designed to highlight recent research and public health efforts in Masindi district, as well as the momentum to scale up clean cooking in Uganda. Key stakeholders participated in the workshop, including government and business leaders, implementers, and public health practitioners interested in promoting the adoption of clean cooking to improve public health. Participants Fifty five people, including public health researchers and implementers, clean cooking entrepreneurs, members of civil society and nongovernmental organizations, local and national government representatives, and representatives from development agencies participated in the workshop. The public health research community was well represented by colleagues from the FRESH Air Uganda project, as well as others from Mulago Hospital, The Uganda Thoracic Society, and others. A diverse group from the clean cooking sector was present at the workshop, including representatives from enterprises promoting improved biomass stoves, advanced biomass stoves, ethanol, and LPG. Civil society representatives included groups such as Living Goods and Kiboko Enterprises who are actively engaged in the distribution of consumer goods and durables, as well as PATH, an international organization focused on scaling up innovations to save lives. Local and national government representatives, notably several district leaders from Masindi, participated in the workshop. In particular, the presence of the Chairman of Masindi district, the Secretary of Health of Masindi district, the District Health Officer of Masindi district, the village leader of Bulyango, and several other local FRESH Air collaborators and stakeholders should be noted. While the Kampala city authority sent a public health representative, despite several outreach attempts, no one from the National Ministry of Health attended the workshop. Several NGOs and development agencies committed to scaling up access to clean energy were also in attendance. See Table 1. Table 1. Summary of Workshop Participants Public Health Clean Cooking Researchers and Enterprises Implementers FRESH Air Uganda Collaboration African Clean Energy Civil Society and NGOs Global Alliance for Clean Cookstoves Government Representatives Masindi District Local Government, including District Chairman and Health Officer Lung Consortium Philips Energy Explorerz Uganda Ministry of Education and Sports Development Agencies Netherlands Developmental Organization (SNV) Netherlands Embassy Mulago Hospital AES Sustainable Energy for All (SEFA) Uganda Ministry of Energy and Mineral Development GIZ / ENDEV 3
PATH Smart Cook Energy BEETA Kampala Capital City Authority (KCCA), Public Health Swedish Embassy Makerere University Awamu Biomass Center for Research in Energy and Energy Conservation (CREEC) Uganda Thoracic Society Biolite Wana Energy Solutions Global Village Energy Partnership (GVEP) Uganda National Alliance for Clean Cookstoves (UNAAC) Living Goods Kiboko Enterprises Ltd Agenda The agenda for the workshop is reproduced below. In addition to the scheduled presentations, a representative from the Ministry of Energy and Mineral Development made a brief presentation to highlight the national government s awareness of the issue, with a focus on the need for clean cooking in institutional settings. Dr. John Turyagaruka, the District Health Officer of Masindi district and Wilson Isingoma, the Chairman of Masindi district, provided brief remarks emphasizing their trust in the FRESH Air coalition, and commitment to continued support in future collaborations. The Chairman also emphasized the need for affordable and clean cooking technologies. 8:30 9:00 Welcome and introductions 9:00 9:15 Workshop overview, and objectives Dr. Sumi Mehta (Alliance) 9:15 9:45 Air pollution and health in Uganda Dr. Frederik van Gemert (FRESH Air Uganda) 9:45 10:15 New health evidence and action in Masindi Dr. Bruce Kirenga (Mulago Hospital) 10:15 10:45 The state of the clean cooking sector in East Africa Daniel Wanjohi (Alliance) 10:45 11:00 Scaling up clean cooking in Uganda Micheal Ssemwogeree (UNACC) 11:00 11:00 Tea Break Interactive Discussion and Strategy Session 11:30 12:30 Clean cooking awareness campaigns: opportunities to include public health messaging 12:30 1:30 Integrating clean cooking as a preventive strategy for children s health 1:30 3:00 Networking Lunch Workshop presentations will be available online by the end of September. 4
Summary of Key Discussion Points Clean cooking awareness campaigns: opportunities to include public health messaging Key topics of discussion included: How can clean cooking be effectively defined and communicated to community members? o There was an in depth discussion about the progress underway to clearly define clean, informed by the WHO Indoor Air Quality Guidelines, as well as the ISO international standards for cookstoves currently under development. The need to link the technical standards with the design and implementation of simple, informative labeling for consumers based on these standards was actively discussed. o There was also a discussion about how to describe clean and dirty cooking in a way that resonates with users, i.e. emphasizing smokeless kitchens or showing how much soot is currently in homes. Who are the best messengers of information on public health? This message is best delivered by the public health community, not clean cooking enterprises or implementing agencies. For example, the pediatric society has provided guidance on the public health benefits of LPG. Beyond technology, what simple behavioral messages should be communicated? This discussion emphasized the need to also address ventilation, fuel drying, reducing personal exposure (especially for small children), reducing time spent cooking close to the fire, and advocating for cooking outdoors where possible. In addition to individual behaviors, a focus on community level approaches to promoting clean cooking was emphasized. Public health has not traditionally been considered a driving factor to encourage adoption of clean cooking. At the same time, the Masindi experience suggests that this could be a result of low public health awareness, in general. When the public health risk of household air pollution is understood, the Masindi experience suggests that this can be a major because public health awareness remains relatively low. Beyond public health benefits, what other impacts would be attractive to consumers / community members? Time savings, cleaner kitchens and cooking vessels, and aspirational aspects of cleaner cooking were discussed. A case study on ethanol also emphasized the potential nutritional benefits of scaling up clean fuels. Given cost constraints, particularly for the cleanest available technologies and fuels, what are potential financing options to be considered? Mobile and internet-based options for making payments were discussed. In general, there is a need to learn from other players who have introduced other technologies. Local community leaders must be actively engaged in the process of raising awareness. Specifically, the FRESH Air team s approach to involving members of the district health office as well as village leaders can serve as a model of integrating local, social and healthcare systems to raise awareness. The critical role of the community health worker was appreciated, while acknowledging the need to consider competing health worker priorities. Finally, there was widespread agreement about the need to have clean cooking awareness campaigns that were not limited to a single technology and/or enterprise. Consumers must be given the opportunity to make informed choices about the available stove and fuel options. In addition, given the range in stove/fuel performance and pricing available, it would be important to support a market-based approach to scaling up clean cooking. 5
Integrating clean cooking as a preventive strategy for children s health Key topics of discussion included: Making clean cooking a priority within public health awareness campaigns. Changing cooking behavior is as important as clean cooking stoves. A lasting solution depends upon active participation of the community. The community has to be convinced of the benefits of clean cooking, and design strategies and alternatives to replace existing traditional cooking methods. This underscores the importance of individual- and community-focused approaches to behaviour change communication. What is best way to ensure stronger engagement from key government agencies, especially the Ministry of Health? Ministries of Health need to clearly understand their role in addressing the health impacts of non-clinical public health interventions like clean cookstoves and fuels. Health Ministries have a very clear mandate to raise awareness about public health risk factors among the public health community and at the community level. In addition, including household energy as part of routinely collected health intake forms can further raise awareness about the issue while generating useful data on population-level risk factor prevalence. What is the best way to further generate public awareness about the health risks of traditional cooking? It is important to focus on women (mothers and cooks), as well as other members of the household. This would ensure that household members with the agency to make decisions are actively engaged, particularly in cases where a women s economic agency to purchase clean cooking solutions may be low. Emphasizing the future of the children was also thought to be a useful approach. In addition, awareness needs to be raised more broadly in the community, among politicians, midwives/birth attendants, educators, youth, and religious leaders as well. Here too, the need to apply successful approaches from other sectors was emphasized. What can we learn from previous efforts to prevent illness by promoting the scale up of public health interventions in the WASH and malaria sectors? Experiences shared by PATH were particularly insightful here. Next Steps This meeting was an important first step to facilitate conversations between the public health and clean cooking implementer communities. The high volume of participation from public health practitioners, implementers, clean cooking entrepreneurs, members of civil society and nongovernmental organizations, local and national government representatives, and representatives from development agencies reflects the appetite for a more focused approach to fostering active partnerships in order to 1) raise awareness about the public health benefits of scaling up clean cooking and 2) facilitate the adoption of clean cooking. Workshop materials will be delivered to the Ministry of Health to ensure that they remain informed about the progress within this arena, and to encourage them to actively participate in future workshops. As opportunities to raise awareness and promote the scale up of a range of clean cooking technologies unfold, it is hoped that the brief introductions and connections made during this initial workshop will develop into pragmatic and strategic partnerships. In addition, several topics discussed could be explored in more detail in future meetings, with active collaboration and leadership from different groups in attendance as appropriate. 6