Facilitators and barriers to the implementation of improved solid fuel cookstoves and clean fuels in low-income and middle-income countries: an umbrella review

The Lancet Planetary Health, vol. 6, pp. e601–e612

Abstract

2·6 billion people rely on solid fuels for cooking or heating. Accelerating access to cleaner solutions is crucial to reduce the negative effects of solid fuel use. Despite abundant evidence on how to implement these solutions, previous attempts have been disappointing. An overview of the evidence is missing and the translation of the evidence into practice is poor. We conducted an umbrella review using eight databases to: consolidate evidence on the factors that influence the implementation of improved solid fuel cookstoves and clean fuels in low-income and middle-income countries; weigh the level of confidence in existing evidence; and develop two practical implementation strategy tools. We identified 31 relevant reviews (13 systematic reviews and 18 narrative reviews) that covered over 479 primary studies. We found 15 implementation factors supported by the highest level of evidence. Regarding improved solid fuel cookstoves, these factors included: cost; knowledge and beliefs about the innovation; and compatibility. For clean fuels these factors included: cost; knowledge and beliefs about the innovation; and external policy and incentives. The factors were synthesised into the Cleaner Cookstove Implementation Tool and the Clean Fuel Implementation Tool. These tools can be used to optimise the implementation of cleaner cooking solutions, thereby improving health, environmental, climate, and gender equity outcomes.

Authors 9

1. Esther Adriana Boudewijns

   Maastricht University · Care and Public Health Research Institute

   Affiliation as printed

   Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands. Electronic address: esther.boudewijns@maastrichtuniversity.nl

2. Maria Trucchi Aachen

   Leiden University

   Affiliation as printed

   Leiden University College The Hague, Leiden University, The Hague, Netherlands

3. Rianne van der Kleij Aachen Department of Public Health and Primary Care

   Leiden University Medical Center

   Affiliation as printed

   Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands

4. Debbie Vermond Aachen Department of Public Health and Primary Care

   Leiden University Medical Center

   Affiliation as printed

   Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands

5. Charlotte M Hoffman

   Maastricht University · Care and Public Health Research Institute

   Affiliation as printed

   Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands

6. Niels Henrik Chavannes Aachen Department of Public Health and Primary Care

   Leiden University Medical Center

   Affiliation as printed

   Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands

7. Onno C. P. van Schayck

   Maastricht University · Care and Public Health Research Institute

   Affiliation as printed

   Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands

8. Bruce Kirenga

   Makerere University

   Affiliation as printed

   Department of Medicine and Makerere Lung Institute, Makerere University, Kampala, Uganda

9. Evelyn A Brakema Aachen Department of Public Health and Primary Care

   Leiden University Medical Center

   Affiliation as printed

   Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands