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Background: Globally, 2.8 billion people rely on household solid fuels. Reducing the resulting adverse health, environmental, and development consequences will involve transitioning through a mix of clean fuels and improved solid fuel stoves (IS) of demonstrable effectiveness. To date, achieving uptake of IS has presented significant challenges.Objectives: We performed a systematic review of factors that enable or limit large-scale uptake of IS in low- and middle-income countries.Methods: We conducted systematic searches through multidisciplinary databases, specialist websites, and consulting experts. The review drew on qualitative, quantitative, and case studies and used standardized methods for screening, data extraction, critical appraisal, and synthesis. We summarized our findings as “factors” relating to one of seven domains—fuel and technology characteristics; household and setting characteristics; knowledge and perceptions; finance, tax, and subsidy aspects; market development; regulation, legislation, and standards; programmatic and policy mechanisms—and also recorded issues that impacted equity.Results: We identified 31 factors influencing uptake from 57 studies conducted in Asia, Africa, and Latin America. All domains matter. Although factors such as offering technologies that meet household needs and save fuel, user training and support, effective financing, and facilitative government action appear to be critical, none guarantee success: All factors can be influential, depending on context. The nature of available evidence did not permit further prioritization.Conclusions: Achieving adoption and sustained use of IS at a large scale requires that all factors, spanning household/community and program/societal levels, be assessed and supported by policy. We propose a planning tool that would aid this process and suggest further research to incorporate an evaluation of effectiveness.Citation: Rehfuess EA, Puzzolo E, Stanistreet D, Pope D, Bruce NG. 2014. Enablers and barriers to large-scale uptake of improved solid fuel stoves: a systematic review. Environ Health Perspect 122:120–130; http://dx.doi.org/10.1289/ehp.1306639

Approximately 3 billion people, most of whom live in Asia, Africa, and the Americas, rely on solid fuels (i.e. wood, crop wastes, dung, charcoal) and kerosene for their cooking needs. Exposure to household air pollution from burning these fuels is estimated to account for approximately 3 million premature deaths a year. Cleaner fuels – such as liquefied petroleum gas, biogas, electricity, and certain compressed biomass fuels – have the potential to alleviate much of this significant health burden. A wide variety of clean cooking intervention programs are being implemented around the world, but very few of these efforts have been analyzed to enable global learning. The Clean Cooking Implementation Science Network (ISN), supported by the U.S. National Institutes of Health (NIH) and partners, identified the need to augment the publicly available literature concerning what has worked well and in what context. The ISN has supported the development of a systematic set of case studies, contained in this Special Issue, examining clean cooking program rollouts in a variety of low- and middle-income settings around the world. We used the RE-AIM (reach, effectiveness, adaptation, implementation, maintenance) framework to coordinate and evaluate the case studies. This paper describes the clean cooking case studies project, introduces the individual studies contained herein, and proposes a general conceptual model to support future planning and evaluation of household energy programs.

Figure 1. Key dimensions and factors for LPG scaling up and sustained adoption.

Background: In 2007, the Indonesian Government instigated a national program to convert domestic kerosene users to liquefied petroleum gas (LPG) for cooking. This was primarily motivated by the rising cost of kerosene subsidies. Objective: To review the national conversion program and LPG scale up by evaluating its impacts, including assessing sustained changes in cooking behaviour and consequent reductions in exposure to household air pollution (HAP). Methods and data sources: Searches of peer-review and grey literature in both English and Bahasa Indonesian were conducted and supplemented by interviews with key informants, data from the National Statistics Agency and results from household surveys. The data were extracted and analyzed using an Implementation Science approach. Results: The main kerosene to LPG conversion phase took place in highly populated kerosene dependent areas between 2007-2012 reaching over 50 million households, approximately two thirds of all households in Indonesia. Since then the drive to expand LPG use has continued at a slower pace, especially in more remote provinces where solid fuel is more widely used. Over 57 million LPG start up kits were distributed as of 2015. Beginning in 2018, the open subsidy for LPG is expected to be replaced by one targeted at lower income households. While the main conversion phase has been highlighted as an example of effective and impressively fast fuel switching at scale, the impact on domestic biomass use remains limited. Conclusions: Addressing HAP and the health impacts associated with kerosene and biomass use was never an objective of the program. Consequently, there is limited evidence of impact in this area, and in hindsight, missed opportunities in terms of influencing cooking behavior change among biomass users, who are more at risk.