Innovative Stoves to Help the Poor

Half of the world’s population cook with a fuel-burning stove, and this figure rises to 80 per cent of households in rural areas in developing countries. Typical fuels burned include wood, coal, crop leftovers and animal dung. The indoor pollution from smoke and carbon monoxide is a top health hazard in the developing world, ranking just behind dirty water, poor sanitation and malnutrition. The World Health Organization (WHO) estimates that 1.6 million people die each year as a result of toxic indoor air.

A landmark five-year study comparing Guatemalans cooking on open fires, to those using improved stoves, has brought more evidence forward of the damage done by indoor air pollution: “It’s been shown that children living in houses using open fires with solid fuels will have more pneumonia than children living in houses that are using cleaner fuels,” said Dr. Kirk R. Smith, an environmental health scientist at the University of California, Berkeley.

The research, combined with studies in Asia, suggests additional health problems from indoor air pollution, including higher frequency of cataracts, partial blindness, tuberculosis, low birth weights and high blood pressure. The researchers found that cleaner stoves had larger effects than reducing salt in the diet or lowering blood pressure in women, with the results published last July in Environmental Health Perspectives.

But Southern innovators are finding practical ways to curb pollution from indoor cooking and the burning of trash in slums.

In Yunnan Province, China, entrepreneur Hao Zheng Yi’s Yunnan Zhenghong Environmental Protection Co. has been selling clean-burning stoves to rural farmers. One fifth of rural China has no electricity (UN), and 80 per cent rural dwellers burn wood or straw in ovens for heating and cooking. This creates heavy indoor air pollution, damaging health.

The so-called Efficient Gasification Burning system combines traditional fuel and natural gas: a hybrid that helps low-income households to affordably use the stove and not pollute their indoor air.

The stoves are sold for a profit in Yunnan Province, and so far 50,000 have been sold. Because the ovens are sold for a profit, Zhenghong had to consult extensively with the farmers in the design phase to make sure the ovens meet their needs.

The result has been that Zhenghong ovens run for five to eight years using the same amount of wood and hay a conventional oven burns in one year.

Another source of air pollution is burning trash in slums. The lack of formal trash removal services in slums has two bad consequences: one is the pollution and poison from rotting rubbish leaching into the soil and water table; the other is ad-hoc burning of the trash to get rid of it, which pollutes the air with a toxic, acrid stench. In Nairobi’s Kibera slum – the second biggest in Africa – over 60 per cent of the city’s residents live in the slum, and are bypassed by garage collection services. Garbage is piled up along the muddy roads and paths, or hangs in the trees.

The Kenyan NGO Umande Trust, which specialises in water and sanitation projects, has developed a home-grown method to burn trash and avoid having to turn to very expensive and complicated incinerators from Europe. The sheer quantity of trash that needs to be burned in the slum means smaller solutions will not be able to handle the problem.

Its “community cooker” re-uses garbage from the community as fuel for a boiler and oven attached to it. The heat generated by burning the rubbish provides hot water and cooking facilities – and also jobs for unemployed youths who collect the rubbish and stock the incinerator. It was developed by a Kenyan architect, and it is hoped the “community cooker” will be taken up across Africa.

The community cooker’s inventor, Kenyan architect Jim Archer, took eight years to design and build it: “My thinking was how do we get rid of the rubbish and …how can we induce people to pick it up. Then I thought, well if we can convert it to heat on which people can cook…” he told Australia’s ABC News.

Similar industrial scale trash incinerators can cost between US $50 million to US $280 million (World Bank) – “…when applying waste incineration, the economic risk of project failure is high…”. The community cooker on the other hand, will sell for US $10,000.

The idea was to create an incinerator that was simple to use and repair: something that the commercially available, computer-controlled incinerators were not able to do. As the cooker gets up to speed, it will be able to burn 60 per cent of the slum’s trash.

Local youth go house-to-house collecting trash. They get money from the slum residents for this. Rubbish is then exchanged for cooking time or hot water for washing.

“The trash has started to help us a bit after the cooker came. There are fewer diseases like diarrhea and the environment has improved. … I think burning the rubbish will bring good health to this community,” said Patricia Ndunge, as she fried onions on the cooker.

And it looks like the community cooker has a future: Kenya’s largest supermarket, Nakumatt, has pledged to pay for 20 more slum cookers.

By David South, Development Challenges, South-South Solutions

Published: March 2008

Development Challenges, South-South Solutions was launched as an e-newsletter in 2006 by UNDP's South-South Cooperation Unit (now the United Nations Office for South-South Cooperation) based in New York, USA. It led on profiling the rise of the global South as an economic powerhouse and was one of the first regular publications to champion the global South's innovators, entrepreneurs, and pioneers. It tracked the key trends that are now so profoundly reshaping how development is seen and done. This includes the rapid take-up of mobile phones and information technology in the global South (as profiled in the first issue of magazine Southern Innovator), the move to becoming a majority urban world, a growing global innovator culture, and the plethora of solutions being developed in the global South to tackle its problems and improve living conditions and boost human development. The success of the e-newsletter led to the launch of the magazine Southern Innovator.  

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Cashing in on Old Wisdom

 

India’s traditional weavers, heirs to a 2,000-year-old textile industry, are turning to the ancient practice of ayurvedic medicine to make their products more appealing and boost sales. Drawing on recipes once used by weavers to the Indian royal courts, clothes are woven and infused with ayurvedic, herb-and-spice medicinal recipes to address various health problems. Strange as it may sound, the health-giving properties of the clothes have been backed up by clinical trials at the Government Ayurveda College in Thiruvanathapuram, southern India.

The college claims the trials were successful for 40 patients with rheumatism, allergies, hypertension, diabetes, psoriasis and other skin ailments. It is believed the healing properties of the herb-and-spice-infused clothes enter the skin and contribute to healing.

Modern India’s founding father, Mahatma Gandhi, championed hand-spun cloth and weaving. But India’s weavers have been hit hard by the rise in the rupee against the dollar and an inability to compete internationally. They are facing stiff competition from a flood of machine-made cheap clothing. According to Siddique Hassan of the Weaver and Artisans Rights Front (WARF), 1 million of India’s 5 million weavers have lost their jobs because of competition (Deutsche Presse-Agentur).

But rising interest in sustainability and natural healing is creating a growing global market for organic clothes – sales are set to triple to US $2.6 billion in 2008 (Organic Exchange).

Against this backdrop, local governments have turned to traditional ayurvedic medicine to help save the livelihoods of handloom weavers and develop a market niche for their eco-friendly fabrics.

In the technique called Ayurvastra, the clothes are dyed with herbal essences, infusing the cotton with the medicine. More than 200 herbs are used, mostly taken from roots, flowers, leaves, seeds and bark. Most of the clothes are made with cotton and silk, and some with wool and jute. A dress is marketed to people who suffer from hypertension. There are bedcovers, pillow covers, nightgowns, and even suits. It is believed the healing effect is best when the patient is sleeping.

The clothes are made in Balaramapuram, home to traditional weaving in Kerala, southern India, and sell for between 1,000 and 1,800 rupees (US $25 to US $45). Ayurvastra clothing is currently being exported to the Middle East, the US, Italy, Germany, Britain, Singapore, Malaysia and Jordan.

Acknowledging traditional medicine as a useful development tool goes back to the World Health Organisation’s Alma-Ata Declaration in 1978, which urged governments for the first time to include traditional medicine in their primary health systems and recognise traditional medicine practitioners as health workers. During the last 30 years there has been a considerable expansion in the use of traditional medicine across the world. Despite their ancient origins, it is still critical these medicines do meet efficacy and health standards and are proven to work.

Ayurvastra is a branch of the 5,000-years-old Indian ayurveda health system. Ayur means health in Sanskrit, veda means wisdom, and vastra is cloth or clothing. There are no synthetic chemicals and toxic irritants and the technique uses organic cotton that has been hand loomed.

“The entire process is organic,” said K. Rajan, chief technician at the Handloom Weavers Development Society in India, to Zee News. “The cloth is bleached with cow’s urine, which has high medicinal value. The dyeing gum too is herbal. It does not pollute like synthetic dye. And the waste is used as bio manure and to generate bio gas.”

Chaitanya Arora of Penchant Traders, an Indian company promoting and exporting ayurvastra cloth and clothing, tells how it works: “usage of the cloth is based on the principle of touch. By coming in contact with ayurvastra, the body loses toxins and its metabolism is enhanced.”

One clothes buyer, T D Kriplani, told Zee News, “Basically, I have read about the concept in newspapers… I was inquisitive and have also heard that it is in direct touch with body pores. I have come here after reading about it and hope it will benefit people.” It is even claimed the clothes can keep people cool.

Another seller of ayurvastra, Hitesh, is enthusiastic about its impact: “The medicinal clothes that we have launched is a new revolution in the textile industry. In there, we dye the clothes with ayurvedic dyes and the clothes have medicinal qualities, which hopefully are good for diseases.”

By David South, Development Challenges, South-South Solutions

Published: February 2008

Development Challenges, South-South Solutions was launched as an e-newsletter in 2006 by UNDP's South-South Cooperation Unit (now the United Nations Office for South-South Cooperation) based in New York, USA. It led on profiling the rise of the global South as an economic powerhouse and was one of the first regular publications to champion the global South's innovators, entrepreneurs, and pioneers. It tracked the key trends that are now so profoundly reshaping how development is seen and done. This includes the rapid take-up of mobile phones and information technology in the global South (as profiled in the first issue of magazine Southern Innovator), the move to becoming a majority urban world, a growing global innovator culture, and the plethora of solutions being developed in the global South to tackle its problems and improve living conditions and boost human development. The success of the e-newsletter led to the launch of the magazine Southern Innovator.  

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Traditional Medicine is now a Proven Remedy

Once dismissed as old fashioned, ineffective and unscientific, traditional medicine is now seen as a key tool in bringing healthcare and healing to poor people bypassed by existing public and private health measures.

Acknowledging traditional medicine as a useful tool goes back to the World Health Organisation’s Alma-Ata Declaration in 1978, which urged governments for the first time to include traditional medicine in their primary health systems and recognise traditional medicine practitioners as health workers. During the last 30 years there has been a considerable expansion in the use of traditional medicine across the world. Despite their ancient origins, it is still critical these medicines do meet efficacy and health standards and are proven to work.

In Mongolia, when the Soviet Union collapsed a decade and a half ago, new market forces meant that supplies of conventional medicines became prohibitively expensive for most of the population. With one doctor for 600 people in the rural areas – and the vast distances to be covered – medical services were virtually unobtainable in rural communities.

This situation led to a revival of Mongolia’s 2,000-year-old traditional medicine. This includes acupuncture, cauterisation, manual therapy, blood letting and therapies using mares’ milk – all integral to the rural way of life.

Research by the Japanese Nippon Foundation – the largest private foundation in Japan – explored how Mongolia’s public health care could be improved through traditional medicine. It focused on the possible use of traditional medicine alongside Western medicine, the depth of faith in traditional medicine, the affordability of traditional medicine, and the lifestyles of herdsmen living in remote areas away from hospitals. The project, launched in 2004, distributes medical kits with 12 types of traditional medicines to households in rural areas. As they use them, the households pay for them. The kits, which mostly target stomach and intestinal ailments and fever, have so far been distributed to 10,000 households (50,000 people) across the country. The Foundation found doctors’ house calls were down by 25 per cent after one year of the project.

In India, Gram Mooligai and its Village Herbs label helps bring quality healthcare to the country’s 170 million rural poor currently left out by public healthcare programmes, or who can’t afford private services. At present, the Indian government has been unable to find adequate funds to provide healthcare to all its people. Gram Mooligai uses a network of 300 women health practitioners to reach villagers who spend on average US $50 a year on health services – so far, they reach 30,000 households. It has built trust with the poor by offering herbal remedies based on India’s strong Ayruvedic heritage of herbal healing. It also draws on India’s rich biodiversity by harvesting medicines sustainably from native plant species – over 18,000 are known.

The company is owned by a network of rural growers that manufacture herbal remedies like Trigul balm for joint pain, Sugam cough syrup and Jwaracin fever reducer. Gram Mooligai combines modern heathcare with local remedies familiar to rural villagers.

The website gives a good example of this folksy approach. In answer to a villager whose daughter is complaining of pain in her legs and back, the villager is advised to give her milk and ghee (clarified butter). “Add nuts and dry fruits to her daily diet in small quantity. If she is lean, then a weekly massage with Lakshadi Thailam (which is available in the Ayurvedic shops) is very useful. Slightly warm the oil before massage and add a pinch of common salt to the oil for better absorption.”

By David South, Development Challenges, South-South Solutions

Published: September 2007

Development Challenges, South-South Solutions was launched as an e-newsletter in 2006 by UNDP's South-South Cooperation Unit (now the United Nations Office for South-South Cooperation) based in New York, USA. It led on profiling the rise of the global South as an economic powerhouse and was one of the first regular publications to champion the global South's innovators, entrepreneurs, and pioneers. It tracked the key trends that are now so profoundly reshaping how development is seen and done. This includes the rapid take-up of mobile phones and information technology in the global South (as profiled in the first issue of magazine Southern Innovator), the move to becoming a majority urban world, a growing global innovator culture, and the plethora of solutions being developed in the global South to tackle its problems and improve living conditions and boost human development. The success of the e-newsletter led to the launch of the magazine Southern Innovator.  

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Saving Water to Make Money

The world’s water supplies are running low, and according to the World Health Organisation (WHO), four out of every 10 people are already affected. But despite the gloomy reality of this problem, entrepreneurs in the South are rising to the challenge to save water.

“The situation is getting worse due to population growth, urbanisation and increased domestic and industrial water use,” said WHO’s Director-General, Dr Margaret Chan. While the WHO has adopted the theme ‘Coping with Water Scarcity’ for this year, every year more than 1.6 million people die from lack of access to safe water and sanitation. Ninety percent of these deaths are children under the age of five.

The health consequences of water scarcity include diarrhoeal diseases such as cholera, typhoid fever, salmonellosis, other gastrointestinal viruses, and dysentery.

One unnecessary waste of water is car washing. The number of cars in developing countries is growing fast, with a 27 per cent increase in sales in China this year, and South America overtaking Asia as the world’s fastest-growing regional vehicle market (Global Auto Report). And all these cars will be washed, wasting this precious resource.

The large informal car washing market in Brazil has long been known for paying low wages and avoiding taxes. On top of this they also waste water. Lots and lots of water. In Brazil, 28.5 per cent of the population (41.8 million people) do not have access to public water or wastewater services. And 60 per cent do not have adequate sanitation (Brazilian Institute of Applied Economic Research).

Started in 1994, Drywash uses a locally available Brazilian organic carnauba wax to clean cars without using water. Drywash has also developed a line of cleaning products that cleans every part of a car without the need for water. They estimate they have saved 450 million litres of water in their first 10 years of operation. From the start, they set out to change the status quo and run a business that “thinks like a big corporation,” said its international partner, Tiago Aguiar.

To do this, Drywash’s management team focused on operating an efficient and professional business. When Brazil’s government passed strict laws against informal selling of products, Drywash was well positioned to benefit, with companies preferring to work with a legal business. Customers have also been attracted to Drywash because they know the service is consistent and to a high standard. Drywash made US $2.7 million in 2005.

Drywash prides itself on operating “on the books”, and paying taxes. They are also ambitious, and have expanded outside Brazil and into other services.

And they don’t just do private cars: they also clean private jets, with Drywash Air. They have also expanded into Mexico, Portugal and Australia, on top of 50 Brazilian franchises. They also want to enter the US market.

In China, Landwasher toilets is tackling the growing problem of providing flush toilets to the country’s 1.32 billion people. As its founder Wu Hao told the World Resources Institute (www.nextbillion.net), “Assuming all of our country uses water-flushing toilets, not even the Changjiang and the Yellow Rive will be enough.”

Formed six years ago, it has patented a process using a special agent and sterilisation to dispose of human waste without using water, and very little electricity.

Hao graduated from Beijing University’s Physics Department and developed management experience working in manufacturing, securities investment and corporate management.

“On a personal level, I love the natural environment… I can’t endure the large scale waste and damage to the environment caused by the process of construction in China.”

Landwasher has seen its sales grow to 40 million Yuan (US $5.2 million), and has six sales offices covering 27 provinces.

Landwasher has just been awarded a contract to provide portable toilets to the 2008 Olympics in Beijing.

By David South, Development Challenges, South-South Solutions

Published: September 2007

Development Challenges, South-South Solutions was launched as an e-newsletter in 2006 by UNDP's South-South Cooperation Unit (now the United Nations Office for South-South Cooperation) based in New York, USA. It led on profiling the rise of the global South as an economic powerhouse and was one of the first regular publications to champion the global South's innovators, entrepreneurs, and pioneers. It tracked the key trends that are now so profoundly reshaping how development is seen and done. This includes the rapid take-up of mobile phones and information technology in the global South (as profiled in the first issue of magazine Southern Innovator), the move to becoming a majority urban world, a growing global innovator culture, and the plethora of solutions being developed in the global South to tackle its problems and improve living conditions and boost human development. The success of the e-newsletter led to the launch of the magazine Southern Innovator.  

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Taking Medicine to the People: Four Innovators in Community Health

Preventing and treating illness at home or in small local clinics makes financial sense. It also makes patients a whole lot happier.

By David South

Canadian Living (Canada), January 1993

Your health is your wealth, my grandmother used to say. It certainly is our most valuable resource – and when its caretaker, universal health care, is under attack, people take notice

Provincial health ministries across Canada are scrambling to find new cost-efficient ways to deliver health care, and community health care is an increasingly talked-about option.

“Every royal commission has suggested we need to shift resources to community care and stop focusing on institutions,” says Carol Kushner, co-author, with Dr. Michael Rachlis, of Second Opinion (HarperCollins, 1990), a blockbuster book that challenges the way we approach health care in Canada. According to Rachlis, health care nationally cost more than $60 billion in 1992 and is primarily delivered through hospitals and doctors’ private practices. Yet 20 per cent of all patients in acute care hospitals don’t belong there, and about five per cent of hospital admissions for people over age 65 are the result of improper use of prescription drugs.

One study of the Toronto Health Unit found that as many as 50 per cent of seniors residing in nursing homes who were admitted to hospitals with pneumonia had contracted it through mouth infections. If they had received regular dental check-ups in the community or at institutions, these unnecessary and costly admissions could have been avoided.

Increasing numbers of people see community health care as the way of the future. In this model, health care providers – doctors, nurses and support staff – work as a team, and users of health care are involved in making important decisions. Community-based care supplements a medical approach to illness, with emphasis on social and environmental factors like work-related stress. Its advocates say community care can wean us off our addication to expensive hospitals (where one bed costs at least $100,000 a year), drugs and surgery – and make us all healthier.

“Fee for service” encourages doctors to see as many people as possible, emphasizing quantity over quality. In community health centres, doctors are put on a salary and encouraged to give as much attention as necessary to each patient. By simply spending more time with each patient, and by taking into account factors such as illiteracy and cultural differences, community clinics can cut down on misuse of medication.

Jane Underwood, director of public health nursing for the regional municipality of Hamilton-Wentworth in Ontario, says we have reached the limit of what hospitals can do to improve health. “Other factors are now more important than a strictly medical approach, which was the foundation of the old health care system. In 1974, a Health and Welfare paper urged a behavioral approach – stop smoking, get more exercise. Now we are moving to a socio-environmental approach, looking at poverty, social isolation, and unemployment, and their effects on health.”

“Community health care is inevitable because we can now do many procedures on an outpatient basis. With the new technology, all kinds of things can be done outside institutions,” says University of Toronto professor Raisa Deber, co-editor of the recently released book Restructuring Canada’s Health Services System (University of Toronto Press, 1992).

“Just as people can work out of their homes because of computers and faxes, technology can take medical care to the home.” This trend can already be seen in the treatment of cancer. Many patients now receive their chemotherapy at home, with the help of computerized IV pumps.”

If the debate over community health care often seems confusing, it may be because of the haphazard patchwork of programs across Canada. Quebec is the only province that took community health care seriously enough to set up clinics across the province in the 1970s and make those clinics an integral part of the provincial system. Elsewhere in Canada, programs sprang up in the ’60s and ’70s at the initiative of community activists but were met with indifference or hostility from government.

The challenge for community care advocates is to educate both the public and governments. Jane Underwood admits it will be a tough struggle. “Governments are beginning to understand, but the public still has reservations. They panic when there are fewer surgeries and feel that lots of high tech will provide a safety net for health. In fact, it is more scientific to probe for the true causes of illness and not think that just taking a pill will make us better.”

Four Innovators in Community Health

South Riverdale Community Health Centre, Toronto

This fully functioning health centre opened in 1976 in Riverdale, a multicultural and economically diverse neighborhood. The staff consists of doctors, nurses, chiropodists, social workers, health promoters and a nutritionist. Innovative in taking on economic concerns of the community, the centre has set up a community food market to provide cheap and healthful food and recently started workshops with business and community members to come up with strategies to recover jobs lost during the recession. "We consider ourselves part of a movement," says executive director Liz Feltes. And this is played out in projects with local groups and citizens on a variety of issues - from wife assault, drug abuse and sexually transmitted diseases, to medication literacy for seniors. 

Victoria Health Project, Victoria

Originally started in 1988 to tackle the problem of poor communication between hospitals and community health providers, the project first targeted Victoria's large senior citizen population. Twelve programs were launched, including Wellness Centres, palliative support teams for patients dying at home and elderly outreach service focused on mental health. The project has been successful at getting local services to cooperate and eliminate duplication. "There are 500 different agencies for seniors in Victoria, so we linked up with them and increased cooperation," says Susan Lles, excutive coordinator of the project.

It was such a great success that the minister of health created the Capital Health Council to expand the program to the rest of the community. Now, for example, in hospital emergency rooms, quick response teams of nurses assess whether a patient would be better served by other services in the community or by being admitted to hospital. 

Centres locaux de services communautaires (CLSC), across Quebec

Started in 1972 as part of province-wide health reforms, these comprehensive health centres now number 158, with more than 500 satellite offices all over Quebec. Every citizen is guaranteed access to a CLSC, even in remote areas. With five per cent of the provincial health budget, they are able to serve 41 pr cent of the population. They also involve the community through elected boards. "We think it is a unique model in that it integrates health and social services in the same place - both prevention and cure," says Maurice Payette, president of the federation of CLSCs. Because CLSCs are close to the community, governments, schools, community groups and other organizations have turned to them for advice during the last five years. In rural areas, CLSCs have been crucial in reducing the number of farm accidents. 

Canadian Healthy Communities Project (CHCP), across Canada

Started in 1989, the program is aimed at municipalities and gets them to pledge that they will review all their actions with community health (including impact on the environment and economy) in mind. CHCP is part of an international movement linked with the World Health Organization's Healthy Cities movement. With more than 150 participating programs, it is an innovative attempt at getting the powers that be to plan for overall health. "We bring together community leaders to make a list of top 10 health problems and then decide what can be done with the existing budgets and staffing," says David Sherwood, project director. The city of Sherbrooke, Que., is a classic example. Facing reduced funds for road and sidewalk repairs, the city concentrated on repairs in neighborhoods with hig numbers of the disabled and elderly, thereby reducing the number of accidents. Unfortunately, funding was recently reduced dramatically by Health and Welfare Canada, but programs in Ontario, British Columbia and Quebec continue with the help of their own provincial government. 

"Taking Medicine to the People" was published by Canadian Living in 1993.

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