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UNCLAS STATE 144739 
 
SIPDIS 
 
SIPDIS 
 
E.O. 12958: N/A 
TAGS: BC BN ET GH IV NI SENV TBIO UG UV ZA
SUBJECT: SUMMARY OF RESPONSES TO CABLE ON INDOOR AIR 
POLLUTION AND FOLLOW-ON ACTIONS 
 
REF: 2006 STATE 192623 
 
¶1. This is an action request. See Paragraph 3. 
 
SUMMARY 
 
¶2. SUMMARY: Reftel asked posts in countries where greater 
than 20 percent of the population uses biomass and coal to 
meet basic energy needs to assess host countries, commitment 
to addressing the health concerns posed by indoor air 
pollution (IAP) and to identify opportunities for 
strengthening U.S. diplomatic outreach on the issue. This 
cable provides a synopsis of the responses, identifies 
priority countries for outreach, and asks posts to encourage 
these countries to join the Partnership for Clean Indoor Air 
(PCIA), one of the public-private partnerships launched by 
the United States at the 2002 World Summit on Sustainable 
Development and registered with the UN Commission for 
Sustainable Development. END SUMMARY. 
 
¶3. ACTION REQUEST: Department asks Posts to share information 
about PCIA with relevant host government ministries and 
agencies (e.g. health, environment, energy, women and 
children, economic development) and to encourage them to join 
the Partnership. Posts may use the general comments in 
Paragraphs 12-16 and also country-specific comments in 
Paragraph 17 in developing talking points for their 
respective host governments.  Department would appreciate 
Post's consideration of hosting roundtable meetings for 
relevant civil society organizations and government 
ministries to encourage awareness about IAP, to introduce 
them to PCIA, and to encourage membership in it. 
Organizations can register to become a partner on the PCIA 
website.  Department appreciates Posts, assistance and 
support for U.S. efforts to mitigate indoor air pollution and 
improve global health.  Please contact OES/IHB,s Lindsey 
Hillesheim (HillesheimLN@state.gov or 202-647-6922) or Dano 
Wilusz (WiluszDC@state.gov or 202-647-6817) with Mission's 
response and for any necessary additional background 
information. 
 
Department requests a response by November 30, 2007. 
 
TABLE OF CONTENTS 
 
¶4. Summary (Paragraph 2) 
   Point of Contact (Paragraph 3) 
   Synopsis of Responses from 21 Countries (Paragraphs 5-9) 
   Encouraging Government PCIA Membership (Paragraphs 10-11) 
   General Background on IAP (Paragraph 12-15) 
   General Background on PCIA (Paragraph 16) 
   Country Specific Comments (Paragraph 17) 
   Further Resources (Paragraph 18) 
 
SYNOPSIS OF RESPONSES TO REFTEL 
 
¶5. Reftel asked posts in countries where greater than 20 
percent of the population uses biomass and coal to meet basic 
energy needs to assess host countries, commitment to 
addressing the health concerns posed by indoor air pollution 
(IAP) and to identify opportunities for strengthening U.S. 
diplomatic outreach on the issue.  As of June 2007 Department 
had received responses from posts in 21 countries. These 21 
countries represent approximately 50% of the estimated 3 
billion people who burn solid fuel for cooking and heating. 
While the content and depth of individual responses varied 
significantly, we were able to make conclusions in four 
areas:  host government commitment; ministry responsibility; 
public and non-governmental activities related to IAP; and 
host government interest in the Partnership for Clean Indoor 
Air (PCIA), one of the public-private partnerships launched 
by the United States at the 2002 World Summit on Sustainable 
Development and registered with the UN Commission for 
Sustainable Development. Since 2003, PCIA partner 
organizations have succeeded in influencing 1.31 million 
households to adopt clean and efficient cooking and/or 
heating practices; resulting in 11 million with reduced 
exposure to harmful indoor air pollution. The U.S. 
Environmental Protection Agency (EPA) coordinates PCIA and 
leads USG efforts within it. 
 
¶6. GOVERNMENT COMMITMENT: Host government commitment to 
reducing indoor air pollution and the negative health effects 
associated with it varied considerably.  Approximately half 
of the response cables could not identify any government 
action plan, besides further study, to address indoor air 
pollution.  Approximately one-quarter of the cables noted 
that host government officials in relevant ministries did not 
think IAP was a major problem in their country. 
 
¶7. MINISTRY RESPONSIBILITY: Government ministries responsible 
for indoor air pollution varied significantly from country to 
country.  About three-quarters of responding posts reported 
that they were referred to the Ministry of Environment and 
one-quarter to the Ministry of Health.  Approximately 
three-quarters reported that they were referred to multiple 
agencies.  It seems likely that ambiguous ministerial 
responsibility contributes to government inaction on indoor 
air pollution in some cases. 
 
¶8. INDOOR AIR POLLUTION INTERVENTIONS: Posts highlighted many 
important public and private country-level efforts aimed at 
reducing indoor air pollution from solid fuel use. 
Approximately half of the responses indicated that private or 
government projects to distribute improved cooking stoves had 
taken place in the host country.  Approximately half also 
indicated that host countries have had private or government 
projects to encourage cleaner alternative fuels.  However, it 
is important to note that the vast majority of intervention 
projects were carried out by private organizations and not by 
the host governments. Almost no responses reported private or 
government projects to educate people about the significant 
and negative health impacts due to IAP. 
 
¶9. PCIA INTEREST: Six of twenty-one host governments were 
members previously or have joined the Partnership. Another 
one-quarter said that host governments were interested in 
learning more. 
 
ENCOURAGING GOVERNMENTS TO JOIN PCIA 
 
¶10. One quarter of respondents indicated that host 
governments are interested in learning more about PCIA. 
Increased government participation in PCIA has the potential 
to raise awareness about environmental health issues and to 
increase international action dedicated to reducing the 
health effects of indoor air pollution related to solid fuel 
use.  The USG provides a substantial portion of the funding 
and human resources required to maintain the PCIA, and the 
Partnership's capacity to address the negative health and 
environmental consequences of solid fuel use for household 
energy will grow with its membership base.  In addition to 
receiving notices for grants and Requests for Proposals 
(RFPs), PCIA members also receive information about free 
in-depth technical training in community outreach and 
education, stove development and performance, market 
development, and exposure monitoring. Another benefit of PCIA 
membership is direct exchange, both regionally and globally, 
between users/cooks, researchers, entrepreneurs, project 
implementers, programs directors, and policy makers. 
 
¶11. The Department and PCIA coordinators from EPA's Office of 
Air and Radiation have used the responses to identify 
relevant government ministries to be encouraged to join PCIA, 
as well as those governments that are already PCIA members 
who we would like to deepen their involvement in the 
partnership.  Criteria for selecting these governments 
include: (1) high burden of disease from indoor air 
pollution, (2) capacity to join and benefit from membership, 
(3) willingness to partner with the PCIA, and (4) involvement 
of international donors in national indoor air pollution 
programs within that country. 
 
GENERAL BACKGROUND ON INDOOR AIR POLLUTION 
 
¶12. HEALTH EFFECTS: Indoor air pollution is caused by cooking 
and heating with wood, dung, coal and other solid fuels on 
open fires or simple stoves. IAP is a daily reality for more 
than half of the world's population and kills over 1.6 
million people each year, making IAP the second biggest 
environmental contributor to ill health behind unsafe water 
and sanitation.  The majority of those deaths occur in 
sub-Saharan Africa and Southeast Asia, where 396,000 and 
483,000 people are estimated to die from exposure to IAP each 
year, respectively. Worldwide, 1.2 million of the 1.6 million 
annual deaths due to IAP occur in just eleven countries: 
Afghanistan, Angola, Bangladesh, Burkina Faso, China, the 
Democratic Republic of Congo, Ethiopia, India, Nigeria, 
Pakistan and the United Republic of Tanzania. The smoke 
produced by solid fuel combustion in fires or stoves contains 
health-damaging pollutants including carbon monoxide, human 
carcinogens, and fine particles that penetrate deep into the 
lungs. These pollutants cause inflammation of the airways and 
lungs, impair the immune system, and reduce the 
oxygen-carrying capacity of the blood. The result is a 
significantly increased susceptibility to pneumonia in 
children and chronic respiratory disease among adults. 
Globally, pneumonia and other respiratory infections are the 
single greatest cause of death in children under five. Women 
exposed to indoor smoke are three times as likely to suffer 
from chronic obstructive pulmonary disease (COPD) than women 
who cook and heat with electricity, gas or other cleaner 
fuels. Because of gender norms in many societies women are in 
charge of cooking and, depending on the local cuisine, spend 
between three and seven hours per day near the stove. Young 
children are often carried on their mother's backs or kept 
close to the hearth. Thus indoor air pollution 
disproportionately affects women and children, and in 2002, 
is estimated to have resulted in 500,000 deaths among women 
and 800,000 deaths among children under five years of age. 
 
¶13. ENVIRONMENTAL EFFECTS: Demand for the fuel that produces 
IAP causes severe land degradation and desertification in 
many of the world's poorest countries.  For example, 
according to the Food and Agricultural Organization (FAO), 
many countries in sub-Saharan Africa have lost three quarters 
or more of their forest covers to deforestation.  Such 
resource depletion threatens food security, which, in turn, 
can upset national and regional political stability. 
 
¶14. GENDER INEQUALITY: In many countries women's domestic 
responsibilities make them disproportionately exposed to IAP. 
 Many women must spend several hours per day collecting fuel 
for cooking and heating; a recent study found that women in 
Nigeria and Ethiopia spend on average more than two hours per 
day collecting fuel.  Alleviating this time burden would free 
women's time for childcare, education, and income-generating 
activities. Women also bear the brunt of IAP-induced disease. 
 For example WHO reports that each year IAP kills fewer than 
200,000 men but over 500,000 women.  The fight against gender 
inequality is one key element of the 2002 Millennium 
Declaration signed by the USG and 188 other nations. 
¶15. ECONOMIC CONSIDERATIONS: A recent WHO report, "Fuel for 
Life", estimates that making improved stoves available to 
half of those still burning biomass fuels and coal on 
traditional stoves would save USD 34 billion in fuel 
expenditure every year, and generate an economic return of 
USD 105 billion every year over a 10 year period.  The report 
also suggests that halving the number of people worldwide 
cooking with solid fuels by 2015 would cost a total of USD 13 
billion per year but would provide an economic benefit of USD 
91 billion per year.  The majority of these costs are borne 
at the household level since donor investments are used to 
design appropriate technologies, set up local businesses, and 
put micro-credit systems in place. However, the majority of 
the benefits also occur at the household level.  Addressing 
household energy needs through the introduction of improved 
cook stoves not only reduces rates of illness and death but 
also means that household members spend less time 
recuperating from illness, caring for sick family members, 
collecting fuel, and cooking. With more time available, 
children may be in a better position to take advantage of 
educational opportunities, while their mothers could engage 
in childcare, agriculture or other income-generating 
activities as a way to break the cycle of poverty. 
GENERAL BACKGROUND ON PCIA 
 
¶16.  The Partnership for Clean Indoor Air, an Administration 
initiative launched at the World Summit on Sustainable 
Development in Johannesburg in September 2002, addresses the 
environmental health risk faced by three billion people who 
burn traditional biomass fuels indoors for cooking and 
heating. This voluntary Partnership brings together 
governments, public and private organizations, multilateral 
institutions, industry, and others to increase the use of 
affordable, reliable, clean, efficient, and safe home cooking 
and heating practices. The mission of the Partnership for 
Clean Indoor Air is to improve health, livelihood and quality 
of life by reducing exposure to air pollution, primarily 
among women and children, from household energy use. More 
information on PCIA can be found at: 
http://www.pciaonline.org 
 
COUNTRY SPECIFIC COMMENTS 
 
¶17.  The following country-specific information responds to 
points raised in the individual country response cables or 
provides country-specific information that could be useful in 
raising awareness with host governments on the health, 
environmental, economic and gender-based consequences of IAP 
and recruiting host governments to join PCIA. One upcoming 
opportunity is the PCIA Africa Regional Workshop &Measuring 
Change:  Indoor Air Pollution and Household Energy 
Monitoring8 to be held in Pretoria, South Africa October 29 
) November 2, 2007. Participants will learn about commonly 
used approaches and techniques for monitoring the impact of 
household energy interventions, and develop a monitoring plan 
for their program. 
 
** COUNTRIES NOT CURRENTLY PCIA MEMBERS ** 
 
¶A. Benin (COTONOU 186): WHO estimates that Benin's national 
burden of disease attributable to solid fuel use is 6.8%, and 
accounts for 6000 deaths per year among children under five 
years of age. GOB has expressed interest in IAP and the 
partnership, but is not currently a member of PCIA. 
 
¶B. Botswana (GABORONE 133): It appears that at least two GOB 
ministries are directly or indirectly working on IAP. These 
ministries could benefit from PCIA membership (both can 
join). The Energy Affairs Department in the Ministry of 
Minerals, Water and Energy Resources (MEWR) indicated that 
commonly-practiced outdoor cooking negated the health effects 
of IAP. However studies have shown that women and their 
children standing close to an outdoor cooking fire are 
exposed to dangerously high levels of fine particles, carbon 
monoxide and human carcinogens.  Furthermore outdoor fires 
are often inefficient, and the collection of fuel wood 
contributes to increased deforestation. WHO estimates that 
Botswana's national burden of disease attributable to solid 
fuel use is 0.40%, and accounts for 100 deaths per year among 
children under five years of age and 200 deaths total. 65% of 
Botswana's population uses solid fuels. 
 
¶C. Burkina Faso:  In 2006, EPA sponsored a regional stove 
design and performance workshop to train more than 20 stove 
makers (project managers, tin smiths, metal workers, stove 
builders, ceramists) from Burkina Faso, Senegal, Mali and 
Benin on the design and construction of household and 
institutional clean burning and fuel-efficient &rocket8 
stoves. The workshop was co-sponsored by PREDAS/CILSS the 
Promotion of Household and Alternative Energies in the Sahel 
and the Permanent Inter State Committee for Drought Control 
in the Sahel. WHO estimates that Burkina Faso,s national 
burden of disease attributable to solid fuel use is 8.5%, and 
accounts for 21000 deaths per year in children under five 
years of age. Greater than 95% of Burkina Faso,s population 
uses solid fuels. Women in Burkina Faso spend an average of 
2.5 hours per day collecting fuel, putting them at increased 
risk of gender-based violence. 
 
¶D. Cote d,Ivoire (ABIDJAN 99): GOC has indicated an interest 
in PCIA. The Center for Anti-Pollution in Cote d'Ivoire 
(CIAPOL) seems to be focused on testing outdoor air pollution 
rather than indoor air pollution mitigation projects; thus it 
may be worth reaching out to officials in health, rural 
energy, and deforestation as well. WHO estimates that Cote 
d,Ivoire,s national burden of disease attributable to solid 
fuel use is 3.4%, and accounts for 8000 deaths per year in 
children under five years of age. 74% of Cote d,Ivoire,s 
population uses solid fuels. 
 
¶E. Nigeria (LAGOS 239): WHO estimates that Nigeria's national 
burden of disease attributable to solid fuel use is 3.8%, and 
accounts for 70,000 deaths per year among children under five 
years of age and 79,000 deaths per year total. Nigeria is 
among the group of eleven nations that account for the vast 
majority of world-wide deaths caused by IAP. Greater than 95% 
of Nigerians use solid fuels for cooking and heating.  Delta 
State is a member of PCIA and the partnership would welcome 
other Nigerian states but is particularly interested in GON 
involvement at the federal level. 
 
¶F. Uganda (KAMPALA 172): WHO estimates that Uganda's national 
burden of disease attributable to solid fuel use is 4.9%, and 
accounts for 18,000 deaths per year among children under five 
years of age. In addition, Ugandan women spend an average of 
2 hours per day collecting fuel, putting them at increased 
risk of gender-based violence. The time spent gathering fuel 
wood could be used for more productive activities such as 
childcare, education and income-generation. GOU is not a PCIA 
member. Greater than 95% of Ugandans use solid fuels.  EPA 
has funded a highly successful pilot project in Kampala with 
the Urban Community Development Association, which has 
resulted in more than 8,000 homes adopting clean and 
fuel-efficient stoves. 
 
¶G. Zambia (LUSAKA 87): WHO estimates that Zambia's national 
burden of disease attributable to solid fuel use is 3.8%, and 
accounts for 8000 deaths per year among children under five 
years of age. 70% of Zambians use solid fuels. The GOZ 
Environmental Council of Zambia, as well as agencies 
responsible for health and/or house-hold energy, could 
benefit from membership in PCIA. 
 
** PCIA MEMBER COUNTRIES ** 
 
¶H. Ethiopia (ADDIS ABABA 495): WHO estimates that Ethiopia's 
national burden of disease attributable to solid fuel use is 
4.9%, and accounts for 50,000 deaths per year among children 
under five years of age. Ethiopia is among the eleven nations 
that account for the vast majority of world-wide deaths 
caused by IAP. In addition, Ethiopian women spend an average 
of 3 hours per day collecting fuel, putting them at increased 
risk of gender-based violence. Greater than 95% of Ethiopians 
use solid fuels. The GOE,s Ethiopian Rural Energy 
Development and Promotion Center (EREDPC) is a member of 
PCIA. We would like to see GOE to take a more active role in 
the partnership and in raising regional awareness for the 
health, environmental, economic and gender-based consequences 
of IAP.  EPA is in the process of awarding a grant to Project 
Gaia to introduce 17,000 Clean Cook ethanol stoves into 
condominium developments for low-middle income families 
previously living in some of the poorest and most run down, 
slum neighborhoods of Addis Ababa.  Clean Cook ethanol stoves 
will also be sold to the UNHCR for use in refugee camps in 
Ethiopia.  This program will be run in partnership with 
Makobu Enterprises PLC, Dometic AB, Finchaa Sugar Company, 
Addis Ababa City Government and the Municipal Environmental 
Protection Agency. 
 
¶I. Ghana (ACCRA 194): The Environmental Protection Agency of 
Ghana is currently a PCIA member. Wisdom Ahiataku from the 
Ministry of Energy in Ghana was a panelist during a 
PCIA-sponsored side-event at the 16th session of the UN 
Commission for Sustainable Development on May 7, 2007. WHO 
estimates that Ghana's national burden of disease 
attributable to solid fuel use is 2.2%, and accounts for 4000 
deaths per year among children under five years of age. 87% 
of Ghana's population uses solid fuels. GOG could be 
encouraged to take a more active role in the partnership and 
raising regional awareness for the health, environmental, 
economic and gender-based consequences of IAP.  EPA recently 
awarded a grant to EnterpriseWorks/Ghana to expand the 
availability of 98,000 cleaner burning wood and charcoal 
Gyapa stoves to 686,000 people living in major urban centers 
of greater Accra, in the Brong Ahafo region of Western and 
Central Ghana.  The Gyapa wood stove has documented fuel 
savings of 60% and Gyapa charcoal stove has savings of 40%. 
 
¶18. FURTHER RESOURCES: 
USG,s Sustainable Development Partnerships website 
http://www.sdp.gov 
WHO General information on IAP 
http://www.who.int/indoorair/en/ 
Fuel for Life report 
http://www.who.int/indoorair/publications/fue lforlife/ 
en/index.html 
WHO National burden of disease estimates for IAP 
http://www.who.int/indoorair/publications/nat ionalburden/ 
en/index.html 
Partnership for Clean Indoor Air resources 
http://www.pciaonline.org/resources.cfm 
RICE