Since our founding, Lwala Community Alliance has walked alongside our neighbors on the journey to better health. But Lwala doesn’t just serve our community–we are our community. It was community members who, 15 years ago, donated their own land, resources, labor, and expertise to build Lwala Community Hospital, which now serves thousands of patients each year. The dream was simple: to ensure that every person in the Lwala community could access health care.
Over time, that dream grew into a full-scale movement to transform the Kenyan health system–so that professionalized community health workers (CHWs) reach every household, community groups drive change, and health facilities provide high-quality care informed by what their patients want. We could tell countless stories of change–this Annual Report does just that–and our data and research also tell a powerful story. In our communities today, 99% of all births are attended by a skilled provider, children under five are 3 times more likely to receive health services, and women are 2.6 times more likely to use contraception.
Over the past 15 years, we have tested and adapted our community-led health model, replicating from North Kamagambo to all 4 wards in Rongo Sub County. This year, we tripled our reach by taking on two additional sub counties, Nyatike and Awendo, where we will work with new communities to advance their health and well-being. This scale-up is part of our plan to reach all 1.1m people in Migori County with community-led health. As we support more leaders to spark change in their communities, we’re also working to change systems, unlocking better health for millions of people across Migori County and Kenya. Our vision is that community-led health becomes the norm.
As always, we thank you for walking alongside us. Your support allows us to reach further–and enables our communities to dream bigger.
Founded by a group of committed Kenyans, Lwala Community Alliance unlocks the potential of communities to advance their own comprehensive well-being. Our community-led health model underscores our central belief: when communities lead, change is lasting. We’re working to make this a government-owned model across Kenya.
Creating significant, system-wide change requires movement building. Lwala convenes coalitions of government officials, implementing partners, and civil society to make the Kenyan health system work better for the communities it serves. Together, we test new solutions, gather community input, and change health policies.
Community health workers (CHWs) are the caregivers of their communities. Yet CHWs are often under-equipped and under-supported, and only 14% of CHWs in Africa are salaried. At the same time, traditional birth attendants (TBAs), have provided health services to communities for generations, but they are often blocked out of CHW cadres by discriminatory literacy and education requirements.
Lwala is committed to professionalizing CHWs. We work with government to ensure they are paid, trained, supervised, and digitally enabled. We also incorporate TBAs into government CHW cadres.
Professionalizing CHWs unlocks the door for more accessible, higher quality health services. It’s also an issue of gender equity–more than 70% of CHWs worldwide are women.
Read the full study here.
Pass Migori County’s landmark Community Health Services Act
This legislation strengthens the community health workforce and paves the way for professionalizing CHWs.
Launch National Certification Guidelines for CHWs
These guidelines reverse eligibility requirements–like formal educational attainment and literacy–that often exclude women. We also worked to register and certify CHWs in Migori County, where approximately 90% of CHWs have undergone a assessment of their knowledge, skills, and competencies.
Develop a traditional birth attendant assessment tool
Identifying TBAs is the first step toward incorporating them into the county’s community health workforce. We used this tool to map TBAs across the Migori County.
Scale the Electronic Community Health Information System (eCHIS)
This is a new national system for collecting and using community health data. We are now working with government to roll out eCHIS across Migori County.
Professionalized CHWs–inclusive of transformed TBAs–track children’s growth, ensure on-time immunization, diagnose and treat the most deadly childhood conditions, and connect children and families to local health clinics. Lwala works with community committees and government to support local clinics to have the resources, training, and systems to provide quality care–ensuring that no child slips through the cracks.
1. Read the full study here.
Since our founding, Lwala has been committed to the holistic development of children–ensuring they survive and thrive. We implement an evidence-based approach called nurturing care for early childhood development, which prioritizes good health, adequate nutrition, safety and security, responsive caregiving, and opportunities for learning for every child.
In addition to health and nutrition services, CHWs and health facilities provide caregivers with information on how to practice responsive caregiving and provide opportunities for early learning. They also focus on the safety and security of the child, help caregivers enroll in health insurance, and ensure children are registered and have birth certificates.
Women and girls have unique health needs at every stage of their life—from contraception, pregnancy, and childbirth, to ensuring the health and wellbeing of themselves and their families. Lwala improves the health of women and girls across the life course, and we strengthen their representation in decision-making so that they receive the health care they want.
This year, more women than ever had access to high-quality maternal health care. CHWs continued to accompany pregnant women, monitor their health, and support antenatal care and skilled delivery. As more women sought care at health facilities, trained midwives conducted free ultrasounds, newly built laboratories provided comprehensive testing and screening, and health facilities opened new maternity wards to meet demand.
To address sexual and reproductive health, we delivered a full range of contraceptive options through CHWs, health facilities, and youth-friendly services. For the first time, we trained health workers to offer permanent methods–including tubal ligation and vasectomies–and we equipped CHWs to talk to their clients about these options. We also expanded access to HPV self-testing alongside training for health workers on screening and treating cervical cancer.
In Kenya, obstetric hemorrhage, or excessive bleeding during childbirth, is the leading cause of maternal death. Through the Obstetric Hemorrhage Initiative (OHI), Lwala is equipping health facilities to save mothers’ lives during birth. OHI is a bundle of protocols and tools that can treat obstetric hemorrhage, and it relies on lifesaving supplies like uterotonics, tranexamic acid, the uterine balloon tamponade, and the non-pneumatic anti-shock garment (NASG).
In partnership with government, Lwala has expanded OHI to every facility in Migori County–214 in total. Additionally, we worked with Jacaranda Health to launch a website that shows the real-time availability of blood products across Migori County, enabling health facilities to more rapidly conduct blood transfusions for hemorrhaging mothers.
Lwala is also working to ensure that OHI is adopted throughout the country. We launched a partnership with Kilifi and Homa Bay Counties, where we have begun to train health providers. And after years of advocacy, the Ministry of Health added new OHI technologies and protocols to national training tools, which will prepare health workers across Kenya to provide emergency obstetric care.
When young people have access to sexual and reproductive health services, we unlock the door for better health and gender equality. Partnering with young people in our communities, Lwala makes this a reality by:
At the center of this work is the leadership and knowledge of young people, constantly creating new ways to meet the needs of their peers.
Safe water and sanitation are the most basic of human needs–and are essential to good health. Yet around the world, billions of people lack access to clean water, the ability to wash their hands, or a working toilet.
That’s why water, sanitation, and hygiene (referred to as WASH) are integral to our community-led health model. With the right training and skills, community groups can transform WASH outcomes for their neighbors. They provide information to their communities on the importance of WASH, including handwashing, latrine use, and clean water. Alongside CHWs, they also organize action days, where community members come together to build latrines and handwashing stations and to rehabilitate water sources.
When it comes to improving health, Lwala believes that communities should be in the driver's seat. We work within existing structures, like community health committees (CHCs), and strengthen their capacity to transform health care. CHCs identify health-related challenges affecting their community, work with CHWs and health facilities on creative solutions, and hold government accountable.
CHCs are key platforms to elevate women’s leadership. When women are fully represented on CHCs, they can ensure that health services reflect the needs of women and girls.
Lwala’s vision is that every community in Kenya has a well-trained CHC equipped to represent their priorities and advocate for better health. In 2021, we conducted Kenya’s first county-wide assessment of CHCs and used the results to target training and support in Migori County. Since then, CHCs have launched initiatives to improve the quality of health care, as well as bring services closer to their community. We’ve also seen measurable improvement:
Using our lessons from Migori, Lwala worked with the Ministry of Health to develop a National Community Scorecard and CHC Curriculum, both launched in 2022. The scorecard is now a foundational tool for accountability–it jumpstarts a process where CHCs collect community input, and then share that input with CHWs, health facility staff, and local leaders to plan for change.
When people receive high-quality, dignified care, they are more likely to return again and again for lifesaving services. By rebuilding trust in health facilities, we can improve health outcomes.
Across a network of 10 partner facilities, Lwala brings together community members, facility-based health providers, and community health workers. We work with these groups to conduct biannual assessments, which identify areas of progress and priorities for improvement. Armed with this information, facility teams develop and implement improvement plans, review outcomes, and make adjustments–ultimately improving the quality of health care.
This year, Lwala Community Hospital had record patient numbers–more women and children received services like antenatal care and well-child visits than ever before. Amidst this increase, we were successful in keeping patient wait times stable–a key contributor to patient satisfaction. We also strengthened our focus on non-communicable diseases (NCDs) like diabetes, hypertension, sickle cell anemia, and epilepsy, which are often neglected in service delivery. We created NCD patient support groups, hosted designated clinic days, and deployed patient ambassadors to mobilize their neighbors and networks to seek care.
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INEQUITY IS A DISEASE,
COMMUNITIES ARE THE CURE.