Cleaning up the stack: Evaluating a clean cooking fuel stacking intervention in urban Kenya

There are a growing number of market-based providers of clean cooking solutions in sub-Saharan Africa that rely on use customer fuel sales to subsidise upfront cost of equipment. These business models can widen access to clean cooking but are undermined by the continued use of polluting fuels, known as “fuel stacking”, which limits provider revenues whilst perpetuating the negative impacts of cooking with traditional fuels. This study aimed to design and test a fuel stacking intervention with commercial pay-as-you-go LPG customers in Kisumu, Kenya. It consisted of three main phases: developing and testing a survey tool for diagnosing drivers of stacking (n = 99); using an intervention design framework (the Behaviour Change Wheel) to design an intervention consisting of the bundled provision of a pressure cooker, chapati pan and training; and testing the intervention in a small (n = 19) pre-post study. There was high uptake of the intervention, with the pans being used by all participants on roughly two-fifths of days. Target foods were cooked more frequently on LPG in the intervention phase, resulting in a significant increase in PAYG LPG use and an insignificant decrease in charcoal use. A third of participants stopped cooking with charcoal altogether, but some residual charcoal usage continued amongst the remainder. The results show that targeted stacking interventions can simultaneously promote sustained use of clean fuels and dis-adoption of polluting ones, resulting in commercial gains for clean cooking fuel providers. This could address the wicked problem of fuel stacking and accelerate progress towards Sustainable Development Goal 7

Modelling the cost-effectiveness of essential and advanced critical care for COVID-19 patients in Kenya

Background Case management of symptomatic COVID-19 patients is a key health system intervention. The Kenyan government embarked to fill capacity gaps in essential and advanced critical care (ACC) needed for the management of severe and critical COVID-19. However, given scarce resources, gaps in both essential and ACC persist. This study assessed the cost-effectiveness of investments in essential and ACC to inform the prioritisation of investment decisions. Methods We employed a decision tree model to assess the incremental cost-effectiveness of investment in essential care (EC) and investment in both essential and ACC (EC +ACC) compared with current healthcare provision capacity (status quo) for COVID-19 patients in Kenya. We used a health system perspective, and an inpatient care episode time horizon. Cost data were obtained from primary empirical analysis while outcomes data were obtained from epidemiological model estimates. We used univariate and probabilistic sensitivity analysis to assess the robustness of the results. Results The status quo option is more costly and less effective compared with investment in EC and is thus dominated by the later. The incremental cost-effectiveness ratio of investment in essential and ACC (EC+ACC) was 1378.21 US dollars per disability-adjusted life-year averted and hence not a cost-effective strategy when compared with Kenya’s cost-effectiveness threshold (908 US dollars). Conclusion When the criterion of cost-effectiveness is considered, and within the context of resource scarcity, Kenya will achieve better value for money if it prioritises investments in EC before investments in ACC. This information on cost-effectiveness will however need to be considered as part of a multicriteria decision-making framework that uses a range of criteria that reflect societal values of the Kenyan society

Assessment of the action plan and of regional instruments [SaferAfrica D3.1]

Executive Summary According to the Global Status Report on Road Safety 2015 of WHO (WHO, 2015),“road traffic injuries claim more than 1.2 million lives each year and have a huge impact on health and development”.Using WHO classification of regions, there has been a further deterioration in road fatality rates in the WHO Africa region from 24.1 fatalities per 100,000 populations in 2010 to 26.6 fatalities per 100,000 in 2013. Over the same period, there was a further improvement in road fatality rates in the WHO Europe region. Road trauma in Africa is expected to get worse, with fatalities per capita projected to double over the period 2015‐2030 (Small and Runji, 2014). SaferAfrica project aims at establishing a Dialogue Platform between Africa and Europe focused on road safety and traffic management issues. It will represent a high‐level body with the main objective of providing recommendations to update the African Road Safety Action Plan and the African Road Safety Charter, as well as fostering the adoption of specific initiatives, properly funded. The main objective of work package 3 is to assess the implementation of the Action Plan 2011–2020 (AU‐UNECA, 2010). This assessment has been supported by SWOT and PESTEL analysis completed at different geo‐political scales (continental, regional economic communities/corridors and country). The second main objective is to define some initiatives for different topics designed to foster the implementation of the Action Plan. The initiatives will be based on the outputs of WP3, WP4, WP5 and WP6 and will address technical, administrative and economic concerns. The aim is to prepare turnkey project for the Dialogue Platform Management Board. The objective of Task 3.1 on which is based this deliverable is the Assessment of the implementation of the Action Plan and of regional instruments. The analysis has been realized at different spatial levels, country, corridor and continental levels. For the continental levelthe choice is made to focus the analysis on the recommendations issued from the mid‐term review of the African Road Safety Action Plan (ARSAP) (AU‐UNECA, 2015a, 2015b) and on SWOT and PESTEL approaches by pillar of the Action Plan. For the country level, 5 countries are chosen for a detailed evaluation: Burkina Faso, Cameroon, Kenya, South Africa and Tunisia. For these countries the analysis is based on results of the country on each of the five pillars and on results and knowledge of partners in charge of these countries, for example through Capacity Reviews realized in WP5. Regional analyses are made on Corridor Abidjan‐Lagos, involving 5 countries: Ivory Coast, Ghana, Togo, Benin and Nigeria. Data has been collected through questionnaires distributed by WP4 and international databases (mainly WHO data). A specific process of data validation has been proposed and realized by partners in order to reinforce quality of the information and of the analysis. Based on those data and methodological choices, results allow us to highlight recommendations that were proposed by mid‐term review of the ARSAP and which are still reliable and new recommendations which seem important in order to improve Road Safety in Africa. These recommendations will be discussed through the dialog platform