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Community health workers preventing household air pollution in sub-Saharan Africa

Household air pollution (HAP) is a significant global health concern, particularly in low- and middle-income countries as most of the population cook and heat their homes using polluting solid fuels such as wood, charcoal, and kerosene in open fires and inefficient stoves – equivalent to burning 400 cigarettes in 1 hour.

Challenge

Exposure to this HAP has been causally linked to many health issues, including respiratory diseases, cardiovascular problems, and adverse pregnancy outcomes. HAP exposure is estimated to kill 741,000 people in sub-Saharan Africa (SSA) each year.

While health education programmes have shown great promise in raising awareness and promoting behaviour change, there is inadequate public awareness on HAP with most of the SSA population not understanding HAP, its links with health or how to prevent it. Community health workers (CHWs) have an important role for health promotion in many SSA countries yet have not yet been tasked with addressing non-communicable disease burden from HAP.

Solution

The NIHR CLEAN-Air Africa Research Unit is combating HAP related disease burden through research, awareness raising and advocacy in Kenya, Cameroon, Rwanda, Tanzania and Uganda.

By measuring air pollution in homes and schools, CLEAN-Air(Africa) has demonstrated that switching from polluting fuels to clean cooking with liquid petroleum gas (LPG) has positive impacts on health, gender equality, the environment and education. 

The CLEAN-Air(Africa) programme has successfully integrated a comprehensive three-day training module on HAP, health and prevention for CHWs into Kenya's Ministry of Health national curriculum. This initiative includes specialised advocacy materials which deliver clear messaging to households.

Training has been implemented across all 47 counties, with 2,500 trainers trained and the Ministry aiming to rollout training to all 130,000 CHWs as part of Kenya’s Universal Health Coverage.

In 2023, CLEAN-Air Africa partnered with the Office of the First Lady and Kenya’s 'Mama Doing Good Foundation'. Together, they developed a special training program for women’s table banking groups, a nationwide credit initiative delivered by the trained CHWs. Using innovative training materials and personal narrative advocacy, CHWs are now training table banking groups on HAP, health and prevention through clean energy.

Affordability has been shown to be the greatest barrier to adopting clean energy. To reduce access barriers, the table banks have integrated a credit initiative enabling women to purchase equipment for clean cooking, heating and lighting to facilitate a transition to cleaner fuels.

Impact

The CLEAN-Air(Africa) programme is tracking impacts through mixed-methods research from training 2100 table banks across one county of Kenya. Early evaluation has demonstrated significant positive benefits for households.

50% of the trained women have stopped using wood and charcoal and now use LPG, ethanol, biogas and electricity for clean cooking reporting health messaging as the main driver for change.  In addition, for every trained woman, a further 5 households are reached with positive messaging from the training.

In Rwanda, the Community Household Air Pollution Prevention Programme (CHAP-PP) was translated and launched by the Ministry of Health in June 2024. This adaptation is now set for national rollout, supported by a dedicated government task force involving ministries, Rwanda Biomedical Centre and WHO.

Uganda has adapted the CHAP-PP programme to its context and is delivering training using a digital platform developed by our UK Digital Partner, the625. This version is currently undergoing pilot testing with Village Health Teams, Uganda's equivalent of CHWs.

Recently, the CHAP-PP programme was translated and approved by the Ministry of Health in Cameroon and is now being piloted at the national CHW training centre in Central Cameroon.

Based on an impact case study from this work, Nancy Chebichii, the CLEAN-Air(Africa) Health Systems Strengthening Lead was nominated for a NIHR Impact Award for her role on the CHW programme for which she received the Highly Commended Award – being the only NIHR impact winner from outside the UK.

Watch our film below to find out more about carbon monoxide poisoning in African homes and our Community Health Worker training programme.