This policy brief is based on SANDEE working paper no. 44-09 "Re-visiting the need of improved stoves : estimating health, time and carbon benefits"Indoor air pollution (IAP) is a major environmental health problem in Nepal. Most of the poor in the country cook in poorly ventilated kitchens using inefficient stoves that burn wood and other biomass fuels creating a dangerous cocktail of hundreds of pollutants. They, therefore, suffer from numerous respiratory health problems. In a recent study, Min Bikram Malla Thakuri looked at the costs and benefits of a particular indoor air pollution control initiative and found that it offers a viable and cost-effective way of dealing with IAP

Malla Thakuri, Min Bikram

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1Indoor air pollution (IAP) is a major environmental healthproblem in Nepal. Most of the poor in the country cookin poorly ventilated kitchens using inefficient stoves thatburn wood and other biomass fuels creating a danger-ous cocktail of hundreds of pollutants. They, therefore,suffer from numerous respiratory health problems. In arecent study, Min Bikram Malla Thakuri looked at thecosts and benefits of a particular indoor air pollutioncontrol initiative and found that it offers a viable andcost-effective way of dealing with IAP.The study finds that a smoke hood and simple changes to stoves canreduce the consumption of fuel, improve air quality and reduce healthcosts borne by households. These ‘anti-pollution interventions’ can alsohelp reduce emissions of green house gases. A cost-benefit analysissuggests that it makes economic sense for households (and society atlarge) to roll out the implementation of these interventions more widely.The study highlights what must be done to help make this happen.INDOOR AIR POLLUTION IN NEPALAccording to the World Health Organization, IAP from solid fuel burningis responsible for the deaths of around 7,500 people, 204,400  Disability-Adjusted Live Year (DALYs) and 2.7 percent of the national burden ofdiseases annually in Nepal. According to the Nepal Demographic andHealth Survey, acute respiratory infection contributed to 23 percent ofall deaths among Nepali children below five years of age in the year2006. Acute lower respiratory infections, Chronic Obstructive PulmonaryDisease and Tuberculosis are among the top 10 causes of death inNepal and there is strong evidence to suggest that IAP has a significantrole in the occurrence of such illnesses. (For more on the impact of IAPin the developing world, see side bar, page 2).A number of technological solutions are available to address the indoorair pollution problem. However, due to a lack of information on the costsand benefits of such technologies, their wide-scale adoption is not takingplace at a rapid pace in Nepal. This study therefore aims to help fill thisinformation gap and promote action to solve the country’s IAP problem.Number 38-09, November 2009Why Tackling Indoor Air Pollution MakesSense – A Study from NepalThis policy brief is based on SANDEE working paper No. 44-09, ‘Re-visiting the Need of Improved Stoves:Estimating Health, Time and Carbon Benefits’ by Min Bikram Malla Thakuri from Practical Action Nepal,Kathmandu, Nepal. The full report is available at www.sandeeonline.orgTHE STUDY AREAThe study is based on data fromfive Village DevelopmentCommittees in Rasuwa district,which lies about 80 miles fromKathmandu. More than 90% ofthe households in the area aretotally dependent on biomass fuelfor cooking and room heating.While most households cook withinefficient traditional stoves inpoorly ventilated kitchens, inrecent years some householdshave installed smoke hoods andmade changes or ‘anti-pollutioninterventions’ to their traditionalstoves.The new smoke hoods that areused in Rasuwa suck out smokeproduced by the incompletecombustion of fuel wood whilecooking. The hoods also radiateheat into the room, and allowpeople to cook in the way theywant, using different types andsizes of pots. Many householdshave installed the hoods with thefinancial and technical supportfrom an NGO, Practical ActionNepal. Loans were provided tohouseholds through local revolvingfund groups to put in the smokehoods.2ASSESSING INDOOR AIR POLLUTIONThe information for this study was collected through household surveysand indoor air quality monitoring. 400 households (80 of which hadimplemented anti-pollution interventions) were surveyed and datacollected on household resources, skills, energy use, income and healthstatus. The main cook in each household was asked whether they orthe household’s children suffered from any of the adverse healthsymptoms that are associated with IAP. These include coughing, wheezingand eye irritation. Information was also gathered annual treatment costsfor respiratory problems.INDOOR AIR POLLUTIONPROBLEM IN DEVELOP-ING COUNTRIESAccording to the World HealthOrganisation more than threebillion people worldwide depend onsolid fuels, including biomass(wood, dung and agricultureresidues) and coal, to meet theirbasic energy needs such ascooking, boiling water and heating.However, the inefficient burning ofbiomass fuel creates a dangerouscocktail of hundreds of pollutantsin the air in people’s homes. Ingeneral, people in developingcountries use solid fuels becauseof their availability and affordability.Studies suggest that IAP is stronglyassociated with income level. It isthe poor who rely on the lowergrades of fuel and have the leastaccess to cleaner technologies; itis therefore the people in the leastdeveloped areas that are mostlikely to experience the highestlevels of indoor air pollution.There is abundant evidencesupporting the link between IAPand health problems such as acuterespiratory infections, chronicobstructive pulmonary disease andlung cancer in women. Inhalingindoor smoke doubles the risk ofpneumonia and other acuteinfections of the lower respiratorytract among children under fiveyears of age. Women exposed toindoor smoke are three times morelikely to suffer from chronicobstructive pulmonary diseases,such as chronic bronchitis oremphysema, than women whocook with electricity, gas or othercleaner fuels. Moreover, somestudies have linked exposure toindoor smoke to asthma,cataracts, tuberculosis, adversepregnancy outcomes, heart andlung diseases and nasopharyngealand laryngeal cancers. Globally,IAP is responsible for 1.6 milliondeaths annually and 2.7 percentof the global burden of disease.Table 1:  Summary of Cost and Benefits (in Rs.)CostsCost of a smokehoodAnnual maintenance costProgramme cost (excluding supportfor smokehoods)Benefits- Treatment cost saving- Day loss due to illness saving- Annual fuel collection time saving(Rs/Year)- Annual cooking hour saving (Rs/Year)- Carbon dioxide (CO2) emissionsaving (Rs./Year)-(5000+150)x 640100 x 6402,850,870  (987+375)x 640950 x 6402000 x 640525 x 640962 x 640-5000100-9871900 (19 days)4000 (40 days)1050 (10.5 days)-PerspectivesHeadingsHouse hold(in Rs.)Societal(in Rs.)Researcher Min Malla conducting the household survey3			 		Indoor air quality was monitored to gauge the level of IAP in eachhousehold. Carbon Monoxide and particulates (PM10), two key emissionsthat are harmful to health, were measured. In 60 households (30 ofwhich used interventions and 30 that did not) PM10 was monitoredusing Buck S.S. pumps. Carbon monoxide was monitored in 203households (123 that did not use interventions and 80 that did) usingthe Industrial Scientific ISC T82 real-time single gas monitor.A cost-benefit analysis was carried out to see whether it makes economicsense for people to install smoke hoods and carry out other anti-pollutioninterventions. To do this analysis, four benefits of implementing theinterventions were highlighted and their economic values calculated.These benefits were: (i) health benefits; (ii) fuel savings; iii) cookingtime savings; and (iv) global environmental benefits due to greenhousegas reductions.THE ECONOMIC BEN-EFITS OF INTERVENTIONThe levels of IAP in the kitchens inthe households in the survey areawere very high (see Figure 1). The24 hour average PM10 level was763 µg/m3 in households that didnot use anti-pollutioninterventions. This is about 15times higher than the WHO-recommended safe level of 50µg/m3. In households that did useinterventions, the 24 hour averagePM10 level was 255µg/m3; this isstill significantly higher than WHOguideline levels, but is 66% lessthan the levels in households thathad done nothing to reduce IAPlevels. This shows that theinterventions used in the study areaare effective at significantlyreducing the level of indoor airpollution.Not surprisingly, the occurrence ofrespiratory illnesses (e.g., cough,phlegm, and wheezing symptoms)was significantly lower amongst thecooks and children of thehouseholds that used anti-pollution interventions. Theinterventions reduced the numberof sick days that householders hadto take by approximately 19 Fig.2: Particles deposited in smokemonitoring filters in with andwithout intervention householdsdays per year per household.Economically, the interventionscontributed to a reduction intreatment costs of Rs. 987 per yearto each  household.The interventions also resulted ina reduction in firewoodconsumption and saved eachhousehold about 40 workingsdays, since they did not have tocollect as much firewood. Inaddition, improved stove efficiencyand changes in cooking practicesled to a reduction in approximately84 hours per year per household.In monetary terms, householdswith interventions saved Rs. 5050per household per year because ofFigure 1: PM10 level in the kitchens (with and withoutinterventions)     Without WithFigure 2: Particles deposited in smoke monitoring filtersin with and without intervention households4This policy brief is an output ofa research project funded bySANDEE. The view’s expressedhere are not necessarily thoseof SANDEE’s sponsors.SANDEEThe South Asian Network forDevelopment and EnvironmentalEconomics (SANDEE) is a regionalnetwork that seeks to bring togetheranalysts from the different countriesin South Asia to address theirdevelopment-environment problems.Its mission is to strengthen thecapacity of individuals andinstitutions in South Asia to undertakeresearch on the inter-linkages amongeconomic development, poverty, andenvironmental change, and, todisseminate practical information thatcan be applied to developmentpolicies. SANDEE’s activities coverBangladesh, Bhutan, Nepal, India,Pakistan and Sri Lanka.SANDEE’s Policy Brief Series seek to in-form a wide and general audience aboutresearch and policy findings fromSANDEE studies.AuthorMin Bikram Malla Thakuri EditorRufus Bellamy Series EditorPriya ShyamsundarSANDEE SPONSORSSANDEE | P.O.Box 8975 EPC-1056 | Kathmandu, NepalTel: 977-1-5003222 | Fax: 977-1-5003277E-mail: info@sandeeonline.orgWebsite: www.sandeeonline.orgWomen cooking -  after the interventiona reduction in fuelwood collection and cooking time. Adding up thesevarious household level benefits, the study estimates that interventionsamounted to a savings of Rs. 7937 of annual income per year.DO INTERVENTIONS MAKE ECONOMIC SENSE?To look at the financial viability of the anti-pollution interventions, theircosts were compared with their benefits. The initial investment cost forthe interventions per household was approximately Rs.5000, plus amaintenance requirement of Rs.100 per year. Added to this are thecosts of implementing the program by Practical Action.The cost-benefit analysis shows that the anti-pollution interventions willsave households and the wider community money. For households, theestimated financial net present value from these interventions is Rs.39,281. A sensitivity analysis shows that the investment in smoke hoodsis economically viable even if there is an increase in product costs of 20percent or a decrease in associated benefits of 20 percent. Investing inincreasing the adoption of anti-pollution interventions is economicallyviable for society as a whole as well.CHALLENGES AHEADWhile it makes sense to invest in anti-pollution interventions, currentlyadoption of these interventions is rather limited. There are several reasonswhy widespread adoption is not happening. The three most obvious onesare: i) an information gap – households are not aware of the benefitsthe interventions can provide; ii) a lack of credit facilities to helphouseholds offset initial investment costs; and iii) no regular supply ofthe necessary technology, because there is no established market for it.Policy makers need to address these challenges as part of an overallprogramme to help people reduce the IAP in the homes. Such aprogramme could be based around using smoke hoods, stoveimprovement and other anti-pollution interventions and would bringhealth and economic benefits to households and to society at large.

Why tackling indoor air pollution makes sense : a study from Nepal

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Why tackling indoor air pollution makes sense : a study from Nepal

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