A rights-based approach to indoor air pollution

Household indoor air pollution from open-fire cookstoves remains a public health and environmental hazard which impacts negatively on people's right to health. Technologically improved cookstoves designed to reduce air pollution have demonstrated their efficacy in laboratory studies. Despite the tremendous need for such stoves, in the field they have often failed to be effective, with low rates of long-term adoption by users, mainly due to poor maintenance of the stoves. In poor, rural, isolated communities, there is unlikely to be a single behavioral or technological "fix" to this problem. In this paper, we suggest that improved cookstoves are an important health intervention to which people have a right, as they do to family planning, vaccination, and essential primary care medicines. Like these other necessary elements in the fulfillment of the right to health, access to clean indoor air should be incorporated into state health strategies, policies, and plans. State infrastructure and health systems should support public and private sector delivery of improved cookstove services, and ensure that such services reach all communities, even those that are poor, located remotely, and likely not to be served by the market. We suggest that community health workers could play a critical role in creating demand for, implementing facilitation and delivery of, and monitoring these cookstoves and related services. Through this approach, improved cookstoves could become an appealing, available, and sustainable option for the rural poor. In this paper, we adopt a human rights-based approach to overcome the problem of indoor air pollution, and we use Nepal as an example.