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After more than three decades of access to low-cost liquefied petroleum gas (LPG) financed by large direct government subsidies, more than 90% of Ecuadorian households cook primarily with LPG. Due to the large fiscal burden of the LPG subsidy, increases in electricity from hydropower, and other sociopolitical factors, the Government of Ecuador launched a major induction stove program (PEC) to reduce the demand for LPG. We assess the effects of the LPG subsidies and PEC using government records, interviews, academic literature, newspaper reports, household surveys, and focus groups. Household surveys, conducted in rural, northern Ecuadorian households (n=383), characterized cooking patterns and fuel access. Focus groups (n=6) were carried out with a subset of surveyed households to better characterize survey findings. The LPG subsidy was developed as part of broad social support reforms in the early 1970s, without specific aims to reduce the health impacts of household air pollution from woodfuel or provide economic benefits as part of the transition to a clean cooking fuel. Nonetheless, the subsidy has resulted in nearly all Ecuadorian households cooking primarily with LPG. PEC has generated the sale of 740,000 induction stoves since its inception in 2014, short of the goal of 3.5 million. Among the rural households surveyed, LPG use, acceptance, and satisfaction was high, however, more than three-quarters of those surveyed reported weekly woodfuel use. Induction stove ownership (17%) and use as a primary cooking fuel (1%) was low among the rural households surveyed; furthermore, households owning induction stoves reported very low satisfaction with the stoves. Here we show that nationally-representative surveys reporting only "primary cooking fuef" use may underestimate solid fuel use as a supplemental household cooking energy, particularly in rural areas where fuel availability issues play a stronger role in decisions about what fuels to use.

Replacing traditional stoves with advanced alternatives that burn more cleanly has the potential to ameliorate major health problems associated with indoor air pollution in developing countries. With a few exceptions, large government and charitable programs to distribute advanced stoves have not had the desired impact. Commercially-based distributions that seek cost recovery and even profits might plausibly do better, both because they encourage distributors to supply and promote products that people want and because they are based around properly-incentivized supply chains that could more be scalable, sustainable, and replicable. The sale in India of over 400,000 "Oorja" stoves to households from 2006 onwards represents the largest commercially-based distribution of a gasification-type advanced biomass stove. BP's Emerging Consumer Markets (ECM) division and then successor company First Energy sold this stove and the pelletized biomass fuel on which it operates. We assess the success of this effort and the role its commercial aspect played in outcomes using a survey of 998 households in areas of Maharashtra and Karnataka where the stove was sold as well as detailed interviews with BP and First Energy staff. Statistical models based on this data indicate that Oorja purchase rates were significantly influenced by the intensity of Oorja marketing in a region as well as by pre-existing stove mix among households. The highest rate of adoption came from LPG-using households for which Oorja's pelletized biomass fuel reduced costs. Smoke- and health-related messages from Oorja marketing did not significantly influence the purchase decision, although they did appear to affect household perceptions about smoke. By the time of our survey, only 9% of households that purchased Oorja were still using the stove, the result in large part of difficulties First Energy encountered in developing a viable supply chain around low-cost procurement of "agricultural waste" to make pellets. The business orientation of First Energy allowed the company to pivot rapidly to commercial customers when the household market encountered difficulties. The business background of managers also facilitated the initial marketing and distribution efforts that allowed the stove distribution to reach scale.

Health risks from poor malaria control, unsafe water, and indoor air pollution are responsible for an important share of the global disease burden-and they can be addressed by efficacious household health technologies that have existed for decades. However, coverage rates of these products among populations at risk remain disappointingly low. We conducted a review of the medical and public health literatures and found that health considerations alone are rarely sufficient motivation for households to adopt and use these technologies. In light of these findings, we argue that health education and persuasion campaigns by themselves are unlikely to be adequate. Instead, health policymakers and professionals must understand what users value beyond health and possibly reengineer health technologies with these concerns in mind.