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Gold Standard

Methodology to Estimate and Verify Averted Mortality and Disability

Adjusted Life Years (ADALYs) from Cleaner Household Air

Draft 0.1

November 2, 2016

Funded By

Table of Contents




Section I: Source and Applicability7


1.2Overview of Methodological Approach9

Section II: Methodology for Characterizing Exposure10

2.Project boundary10

3.Pollutants included in this methodology11

4.Baseline scenario monitoring12

4.1Baseline scenario definition12

4.2Household survey13

4.3Personal exposure monitoring13

4.4Notation of special circumstances15

5.Project scenario monitoring15

5.1Project scenario definition16

5.2Household survey16

5.3Personal exposure measurement16

5.4Technology usage monitoring (drop-off)16

5.5Carbon monoxide (CO) monitoring for charcoal-based interventions17

5.6Notation of special circumstances17

6.Monitoring guidelines17

6.1Timing of first monitoring17

6.2Personal exposure monitoring17

6.3Technology usage monitoring (drop-off)19

Section III: Methodology for Converting to ADALYs19

1.HAPIT methodology and inputs19

2.Schedule for HAPIT maintenance and updating22

Annex 1: Recommendations for applying the methodology23

Annex 2: Household survey and PEM monitoring guidelines25

Annex 3: Stove use monitoring (SUMs) use guidelines35

Annex 4: HAPIT methods and assumptions37

Annex 5: Key elements of conservativeness and non-conservativeness48


Several organizations and individuals have contributed to the development of this methodology.

Sincere thanks to:

ClimateCare: Tom Owino

SNV: Jason Steele

Independent Consultant: Matt Spannagle

Global Alliance for Clean Cookstoves:Sumi Mehta

Berkeley Air Monitoring Group:David Pennise

UC Berkeley:Ajay Pillarisetti, Prof. Kirk R. Smith

World Bank:Rutu Dave, Tamer Rabie

World Vision Australia: Tim Tempany

Nexleaf SolutionsNithya Ramanathan, Jake Shual-Berke

Rollins School of Public HealthProf. Thomas Clasen

The Author Team:Susan Anenberg, Prof. Patrick Kinney, Ken

Newcombe, Vikash Talyan, Abhishek Goyal, Owen Hewlett

Gold Standard gratefully acknowledges the pioneering work of Prof. Kirk Smith and his team, including developing and piloting approach upon which this methodology is based.

We would also like to thank our funding partners Goldman Sachs, World Bank, Department of Foreign Affairs and Trade (Australian Aid) and World Vision-Australia for their support.

Enquiries should be directed to the Gold Standard at:


ADALYAverted disability-adjusted life year (also called DALY Averted)

ALRIAcute lower respiratory infection

AFAdjustment factor

CO2Carbon dioxide

COPDChronic obstructive pulmonary disorder

DALYDisability-adjusted life year

GBDGlobal Burden of Disease

GHGGreenhouse gas

IERIntegrated Exposure Response

IHDIschemic heart disease

IHMEInstitute for Health Metrics and Evaluation

ISOInternational Organization for Standardization

HAPITHousehold Air Pollution Intervention Tool

LPGLiquefied petroleum gas

PEPersonal exposure

PEMPersonal exposure monitoring

PM2.5Particulate Matter less than 2.5 microns average diameter

RAMRoom area concentration monitoring

SUMsStove use monitoring

YLDYears of life with disability

YLLYears of life lost

VERVoluntary emission reduction

WHOWorld Health Organization

Methodology to Estimate and Verify Averted Mortality and Disability Adjusted Life Years (ADALYs) from Cleaner Household Air

This methodology is relevant to Sustainable Development Goal 3 Ensure healthy lives and promote well-being for all at all ages

Draft Version 0.1, November 2, 2016


The development of this methodology was strongly informed by decades of evidence and experience from household air pollution exposure monitoring and epidemiological studies[footnoteRef:2], a proposed methodology for quantifying a saleable health product from household cooking interventions[footnoteRef:3] based on field work in Laos[footnoteRef:4] developed by UC Berkeley and Berkeley Air Monitoring Group, and the World Health Organization Indoor Air Quality Guidelines[footnoteRef:5]. [2: Smith KR, Bruce N, Balakrishnan K, Adair-Rohani H, Balmes J, Chafe Z, Dherani M, Hosgood HD, Mehta S, Pope D, Rehfuess E, and others in the HAP CRA Expert Group, Millions dead: how do we know and what does it mean? Methods used in the Comparative Risk Assessment of Household Air Pollution, Ann Rev of Public Health, 35: 185-206, 2014.] [3: Smith, K.R., A. Pillarisetti, L.D. Hill, D. Charron, S. Delapena, C. Garland, D. Pennise. (2015). Proposed Methodology: Quantification of a saleable health product (aDALYs) from household cooking interventions. University of California, Berkeley, and Berkeley Air Monitoring Group (funded by World Bank). Available at:, Accessed August 23, 2016.] [4: Hill L, Pillarisetti A, Delapena S, Garland C, Jagoe K, Koetting P, Pelletreau A, Boatman M, Pennise D, Smith K (2015) Air pollution and impact analysis of a pilot stove intervention: Report to the Ministry of Health and Inter-Ministerial Clean Stove Initiative of the Lao Peoples Democratic Republic, University of California, Berkeley, and Berkeley Air Monitoring Group. Available at:, Accessed September 28, 2016.] [5: World Health Organization (2014) Indoor Air Quality Guidelines: Household Fuel Combustion. WHO Guidelines for Indoor Air Quality. World Health Organization, Geneva, Switzerland. Available at:, Accessed August 23, 2016.]

This methodology uses exposure to fine particulate matter (PM2.5) as the best indicator of household air pollution. PM2.5 exposure causes negative health impacts, such as cardiovascular disease, respiratory disease, and lung cancer, all of which can end in premature death. It is considered to be the dominant contributor to the overall burden of disease from air pollution, no matter what the source.

The methodology focuses on measurements of personal exposure of households since measurements of pollution in particular places, such as the kitchen, are often poor indicators of actual exposure levels.

Section I: Source and Applicability


This methodology is applicable to project activities that introduce technologies and/or practices for household thermal energy requirements and lighting that reduce household air pollution exposures and associated risk of harmful health impacts as compared to the baseline situation. These are termed cleaner in the rest of this document.

Projects that lead to verifiable reduction in PM2.5 exposure levels via a change in household energy use and/or emissions for cooking, heating, lighting are eligible under this methodology. Projects shall include cleaner cooking devices, fuels, or practices (e.g. improved application of eligible technologies, a shift from solid fuel or kerosene to biogas, etc.).

In addition to the cooking improvements which are required to be eligible for this methodology, the project may also include technologies such as solar lighting that lead to additional PM2.5 exposure reductions and count these exposure reductions in the health benefit calculation. Projects that improve/enhance ventilation of indoor air only (i.e., there is no improvement in technology, fuel, or practices) are not currently eligible.

Throughout the methodology, the term technologies is used to refer to both new technologies, fuel, and practices surrounding the use of the new technology.

Examples of eligible technologies include cleaner cookstoves (including biomass[footnoteRef:6], biogas, ethanol, other biofuels like plant oils and dimethyl ether derived from 100% renewable feedstock, and other modern fuel stoves such as LPG, natural gas, electric stoves, and electromagnetic induction cookstoves, etc,), space and water heaters (solar and otherwise), heat retention cookers, solar cookers and safe water supply and treatment technologies. Projects that involve a fuel switch to coal, charcoal, or kerosene are not eligible. Projects leading to greater efficiency in use of coal or kerosene compared to the baseline are also not eligible for this methodology.[footnoteRef:7] However, projects leading to more efficient use of charcoal compared to the baseline are eligible. Safe water supply and treatment technologies are only eligible if in the baseline situation solid fuels are burned to treat drinking water (e.g. boiling water). [6: Unprocessed biomass and biomass briquettes produced from agricultural waste such as coconut shell, sawdust etc or derived from dedicated biomass feedstock are eligible.] [7: These fuels are discouraged by the World Health Organization. World Health Organization (2014) Indoor Air Quality Guidelines: Household Fuel Combustion. WHO Guidelines for Indoor Air Quality. World Health Organization, Geneva, Switzerland. Available at:, Accessed August 23, 2016.]

These eligibility criteria reflect what is currently known of the potential benefits of different technology and various interventions. Additional types of


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