This study was commissioned to analysethe cost efficiency and economic viability of an ethanolprogramme, for reducing disease, and protecting the forestsin Madagascar. This information is also expected to be ofinterest regionally and internationally, given that theWorld Health Organization (WHO) estimates that there arenearly two million deaths per annum globally due toHousehold Air Pollution (HAP), representing 2.7 percent ofthe global burden of disease. Of these, nearly 400,000deaths per annum due to HAP, are in sub-Saharan Africa. Withonly 20 percent of the world's population, Africasuffers a disproportionate share of around half of alldeaths from pneumonia for children under five years, forwhich HAP is a major risk factor. This study investigatesthe potential of ethanol as a household fuel in Madagascar,focusing on three main components: health benefits,financial and economic assessment, and African lessons forscaling-up a program of support for ethanol as a household fuel.