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

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

DelAgua Rwanda Health Ltd. Rwandan Ministry of Health Tubeho Neza 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

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 Program Design - Meeting Health Targets

Low Detail: CHW Baseline Survey Follow-Up Survey Moderate Detail: Verification Verification Survey Kitchen Performance Test Extensive Detail: Health Impact Research Water/Air Quality Measurement Blood work: Diarrhea & Respiratory Illness Product Uptake: Sensor- based study Clinical RCT Data Collection for Impact Assessment

CHW Baseline Survey: Sept-Dec 2014 Village-level authorities assisted Tubeho Neza CHW teams in visiting every beneficiary household On average, 165 CHWs in 15 Sectors performed 1100 household visits six days a week At the peak, 500 CHWs in 30 Sectors performed 1500 household visits in a single day

Treatment Method Treatment? Water Source RecipientsHousehold Size Baseline Stove Fuel Type Cooking Location DelAgua Rwanda Dashboard

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

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 Carbon Emission Reduction Verification

3-Village RCT was carried out in first 5 months o Water quality testing of input water, and water taken out of filter as compared to water consumed in control villages o 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 o 79% Reduction in faecal bacteria o 3.7 times more likely in control arm to have contaminated water o Under 5’s had a 27.7% reduction in exposure to particulate matter Health Impact Research Phase 1 – 15 Villages

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: o Objective health data/no bias from self-reporting o Ability to investigate a wide variety of health outcomes potentially related to water contamination or HAP Clinical 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 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 Village Level RCT

Sensor-based study Purpose is 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