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Impact Assessment of CDM Health Intervention in Rwanda

This case study evaluates the impact of a health intervention in Rwanda that reduces emissions through improved cooking and water filtration methods. The study assesses fuel and emissions savings, health outcomes, and economic effects of the program.

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Impact Assessment of CDM Health Intervention in Rwanda

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  1. SD Impact Assessment Case Study African Regional NAMA Workshop – Kigali, Aug 17th-19th, 2015

  2. CDM – Health Intervention that cuts emissions • EcoZoom • Dura • Compared to Open Fire… • 39% - 54% Fuel Savings • 55% - 72% Emissions Savings • LifeStraw Family 2.0 • Ultra-filtration • Up to 20 nanometer Removes bacteria, viruses, and parasites • No boiling

  3. Public Private Partnership • Further GoR Collaboration • Rwandan National Police • Product Delivery • MINALOC • Project Beneficiary List – Validation of 2012 “Ubudehe” Categories • Local Authority support • Product Storage and Distribution Sites • District Community Health Desks • Separate agreements with each District • District-wide selection and training of 850 Community Health Workers

  4. Program Design - Meeting Health Targets • The leading causes of death for children under 5 in Rwanda are ALRI (16%) Diarrhea (9%) • There are over 22,000 deaths a year of children under 5 in Rwanda (UNICEF 2014) • The Environmental Desk in the Maternal and Child Health (Department?) in MoH has set targets to reduce waterborne diseases and respiratory illness through upgrading household infrastructure

  5. Data Collection for Impact Assessment

  6. CHW Baseline Survey: Sept-Dec 2014

  7. DelAgua Rwanda Dashboard Recipients Household Size Water Source Baseline Stove Treatment? Fuel Type Treatment Method Cooking Location

  8. CHW Follow Up: Feb-Apr 2015 Analyzing changes in the household Baseline > Follow Up • Primary Cooking Location • Primary Fuel • Primary Drinking Water Source Adoption & Uptake • Reported Use of Stove and Filter • Water in the filter • Cooking now

  9. Carbon Emission Reduction Verification • Verification Survey • Longer survey which collects data necessary for CDM. Rigorous and requires 3rd party validation. • Metrics that can track potential economic effects of program in households • Head of Household Education Level • Primary Source of Income • Household Commodities:Have electricity? Bicycle? Mobile Phone? • Land or Livestock Owned Kitchen Performance Test Weigh household fuel usage, record fuel gathering practices Potential to investigate impact of intervention in terms of time-savings

  10. Health Impact ResearchPhase 1 – 15 Villages • 3-Village RCT was carried out in first 5 months • Water quality testing of input water, and water taken out of filter as compared to water consumed in control villages • Collected PM 2.5 and CO measurements in homes, as well as personal exposures • RCT in 9 different villages carried out one year after the distribution, in two rounds, lasting a year • 79% Reduction in faecalbacteria • 3.7 times more likely in control arm to have contaminated water • Under 5’s had a 27.7% reduction in exposure to particulate matter

  11. Clinical RCT • All families in UBD Categories 1&2 are provided with free government health insurance, for which cards are issued with unique identification numbers. • Health insurance ID numbers collected for every family with a child under 5 by CHW’s during baseline survey • This number is registered at health facilities when treatment is sought, and research implementers collaborate with MoH to track clinical data • Advantages of this research: • Objective health data/no bias from self-reporting • Ability to investigate a wide variety of health outcomes potentially related to water contamination or HAP

  12. Village Level RCT • Enrolled 1,582 households in 174 villages with children under 5, equally distributed between intervention and control arms. • Diarrhea is assessed using self-reports and respiratory illnesses are assessed using WHO guidelines for pneumonia case identification in children • Sub-set of 2 households per village undergo extensive health and exposure evaluation, including… • Blood pressure measured with blood pressure monitor cuff • Measurements are taken of cumulative personal exposure to particulate matter for both mother and child between 1.5-4 years, using a wearable pump/filter with a light sensor to assess time-specific location and compliance • Blood samples taken at baseline and second follow-up round to investigate biomarkers and immune system function This study has the potential to contribute to health research regarding the relation to specific diseases and exposure to contaminated water and HAP

  13. Sensor-based study • Purposeis to compare objective usage data against reported data in CHW and Verification surveys • Filter sensors measure volume of water poured into filter and taken out, as well as backwashing • Stove sensors monitor every time stove is used, combustion temperature, and duration • An alternate blinded RCT is being used to study behavioral effects of sensors

  14. Thank You!

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