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.
IN 3 COUNTIES, we are partnering with government to expand community-led health–this includes professionalizing CHWs, improving community accountability, and supporting health facilities to deliver high-quality care. We will reach 5 counties by 2028.
IN 6 COUNTIES, we are strengthening emergency obstetric care. By training health workers and equipping facilities with lifesaving tools like the non-pneumatic anti-shock garment, we can ensure that every mother delivers in a facility prepared to save her life. We will reach 15 counties by 2028.
IN KENYA, we advance community-led health in policy and practice. We bridge the gap between communities and policymakers, ensuring that local solutions are translated into policies that transform the health system. We work through coalitions, including Community Health Units for Universal Health Coverage (CHU4UHC), which Lwala co-founded to fuel collective action for community-led health.
GLOBALLY, we lend our voice and expertise to the movement for universal health care and CHW professionalization, working with groups like Community Health Impact Coalition (CHIC). We also partner with our communities and leading universities to conduct rigorous research, evaluate our impact, and uncover insights that contribute to the body of knowledge worldwide.
All community health workers get new digital tools
More than 106,000 CHWs across all 47 counties in Kenya were trained on the electronic Community Health Information System (eCHIS). This tool was developed by the national government, Lwala, and partners like Medic and Living Goods, and it enables real-time data collection and more standardized care at the community level.
Lifesaving technologies made available across Kenya
After years of innovation, evidence gathering, and technical assistance on use of the non-pneumatic anti-shock garment (NASG) as part of a bundle of interventions designed to save the lives of mothers, we celebrated the addition of the NASG and other lifesaving commodities to Kenya’s Essential Medicines List. This addition will make them more available to women across Kenya.
400,000 youth take control of their reproductive health
Lwala mobilized 591 youth peer providers across all of Migori County to provide information and services to young people. As a result, there has been a 118% increase in new family planning users in places where Lwala has worked for more than a year.
Community-led health comes to Homa Bay and Baringo
Alongside county government and partner Dandelion Africa, Lwala has trained 4,440 CHWs across these two new counties. Throughout the year, we’ve seen increases in CHW home visits, immunization, and skilled delivery rates.
Lwala CHW takes the global stage
Lwala supports CHWs to advocate for their profession and their communities. CHW Maureen Wauda attended the World Health Assembly in Geneva to speak about CHW professionalization–and to launch a BBC Storyworks documentary featuring her work alongside our partner, Medic.
National CHW curriculum gets a revamp
Lwala supported revisions to the national CHW curriculum, including new modules on eCHIS, commodity management, climate resilience, disability access, and gender equity. This new curriculum has already been used to train 15,000 CHWs across Kenya.
Migori County tackles stockouts
Lwala, VillageReach, and the county government are working to close gaps in commodities for community health. Together, we developed the Migori County Supply Chain Strategy–the first in Migori, and the second in Kenya.
Community-led health increases skilled delivery
A new study, which analyzes data from Lwala communities and control sites, found that Lwala’s interventions led to significant increases in skilled delivery rates relative to the control.
People with disabilities redesign health care
With leadership from people with disabilities, Lwala and the Missing Billion Initiative launched a pilot to empower CHWs to care for people with disabilities. We developed a curriculum and trained 395 CHWs, who are reaching 3,600 people with disabilities.
Government pays CHWs nationwide
Our advocacy through Community Health Units for Universal Health Coverage, a coalition we co-founded, helped fuel national momentum for CHW payment. We are now tracking payment and continuing to advocate for budget allocation from government.
Traditional birth attendants claim a formal role
Migori’s newly launched Birth Companion Inclusion Strategy will ensure that traditional birth attendants–caregivers who have supported women for generations–will have a place in the health workforce. This builds on years of work from Lwala to incorporate traditional birth attendants into the health system.
Lwala has scaled community-led health across three counties–we reached every community in Migori and expanded into two new counties, Homa Bay and Baringo. This expansion increases our reach from 600,000 in 2023 to 2.8 million people in 2024.
We target counties with disproportionately poor health outcomes. Just 15 of Kenya’s 47 counties contribute to 99% of maternal deaths. In Kenya’s devolved health care system, we cannot make change working at the national level alone–we must partner with counties experiencing the highest burden of loss to create and implement community-led solutions.
Across Homa Bay and Baringo, we’ve trained CHWs and their supervisors, equipped them with digital tools, and supported them to register all the households within their community. To strengthen community accountability, we’ve conducted assessments of existing community governance and started to train community health committees to hold government accountable. Additionally, we’ve ensured that health facilities are equipped to respond to obstetric and neonatal emergencies–so far, we’ve reached 28% of facilities in Homa Bay and 21% in Baringo.
Community health workers (CHWs) are the caregivers of their communities. Lwala is committed to creating a professional CHW workforce, where every CHWs is paid, trained, supervised, and equipped with commodities and digital tools. Professionalizing CHWs unlocks the door for more accessible, higher quality health services. It’s also an issue of gender equity–73% of CHWs in Kenya are women. The Kenyan government has made great progress toward professionalizing CHWs, and now we have to ensure that women are protected in these roles.
In late 2023, the national government launched a series of reforms–which Lwala helped vision and develop–aimed at transforming Kenya’s CHWs into a professional workforce. But policies are only as strong as their implementation. Through Community Health Units for Universal Health Coverage, a coalition Lwala co-founded to advance community health, we began to strategize with the Ministry of Health on key questions: how do we ensure that all counties have the financing mechanisms in place to receive and disburse payment for CHWs? How do we integrate community health commodities into supply chains? And how do we digitize the entire community health workforce?
By the end of 2024, CHWs in Kenya have seen big changes. The national government is now making payments to CHWs in all 47 counties, while 38 county governments have made at least one payment to CHWs. Lwala developed a tracking tool to give visibility into where payments have been made–or where they’ve stalled–in our 3 focus counties, and we’re working to ensure that counties allocate funds to meet their commitments. We are also monitoring women’s representation in CHW cadres, as women’s experience and voice are essential to the delivery of maternal, child, and reproductive health–currently 75% of CHWs in our 3 counties are female.
Additionally, 106,000 CHWs have been trained and equipped with digital phones since the launch of the electronic Community Health Information System, reaching nearly every community in Kenya. And finally, Lwala is supporting counties to develop supply chain strategies that include community health commodities so that CHWs consistently have the supplies they need. Together, these changes are strengthening Kenya’s frontline health workers–and bringing the country closer to health for all.
Traditional birth attendants have provided health services to communities for generations, supporting women to deliver at home when facility-based births were inaccessible. Research shows that when incorporated into the community health workforce, transformed traditional birth attendants can be effective champions of skilled delivery, antenatal care, family planning, and other health services–yet they are often isolated from the formal health system.
Lwala has developed strategies to transform traditional birth attendants and find formal roles for them within the health system. This includes an assessment tool that helps county governments identify active traditional birth attendants and upskill them as CHWs.
Across our 3 counties, we have mapped 1,306 traditional birth attendants. This December, we celebrated when Migori County passed the first-of-its-kind Birth Companion Inclusion Strategy and Guide, which will ensure that traditional birth attendants have a place in the health workforce.
Lwala teamed up with the Missing Billion Initiative to answer a central question: how can we best equip CHWs to identify, treat, and refer patients with disabilities? We brought together CHWs and people with disabilities to design a training curriculum based on their lived experience and the challenges they face in accessing health care. The training was then cascaded to 395 CHWs, with 10 people with disabilities and 10 health workers serving as co-trainers. Immediate results show a 16% increase in CHWs’ confidence in providing care for people with disabilities. Already, more than 3,600 people with disabilities are being reached by trained CHWs.
Lwala and the Missing Billion Initiative plan to replicate and expand this work, and we’re working to create a movement for disability justice in community health–1.3 billion people around the world live with a disability, and trained CHWs are a key to unlocking better, more equitable care.
*In places where Lwala has worked for more than one year.
A breakdown of trust is at the root of poor health–when communities don’t trust the health system to provide high-quality care, they are less likely to seek care. Lwala works within existing government structures, like community health committees, to rebuild trust. We strengthen the capacity of these groups to transform health care and hold government accountable, and we elevate women’s leadership–when women are represented on these committees, they can ensure that health services reflect the needs of women and girls.
At Lwala, our vision is that every community has a trained community health committee (CHC) to represent their needs and hold the health system accountable. In Migori County, we recently achieved this vision–308 CHCs representing 100% of communities now have the skills and resources to plan, execute, and evaluate health initiatives.
Lwala assessed the functionality of these committees, and the results reveal other progress: 48% of committee members are women, 95% of committees hold monthly review meetings with community health workers, and 81% of committees create annual work plans to direct their work.
As we expand community-led health, we’ve begun to replicate this work. So far, Lwala has trained 111 CHCs in Homa Bay (covering 40% of the population) and 20 CHCs in Baringo. We also completed Homa Bay and Baringo’s first countywide assessments of CHCs. These assessments found that many committees in remote areas lack training or knowledge of their roles and responsibilities.
When people receive high-quality, dignified care, they are more likely to return again and again for lifesaving services. Since Lwala Community Hospital’s founding, it has served as a center of excellence in quality improvement, a training ground for health providers, and an innovator of new ideas. We also support hundreds of health facilities across six counties to improve their quality of care, especially for women and newborns. Together, this work rebuilds trust in the health system.
Lwala Community Hospital, which started as a two-bed clinic and an uphill battle against health inequity, now sees 88,000 patients a year. What’s remained constant since our founding is our community’s involvement in directing and improving health care. The hospital hosts frequent forums and annual community dialogues, where we heard a clear request from our community–hire a full-time doctor to provide more services and reduce referrals to other facilities. Dr. Chadwink Ochieng Omondi, who grew up a stone’s throw from Lwala Community Hospital, joined in late 2023. Over a year later, monthly patient referrals have dropped by 62%.
Under his leadership, Lwala Community Hospital also instituted a weekly high-risk pregnancy clinic, where women with pre-existing medical conditions, repeated miscarriages, or other complications can receive specialized care. Since the program’s inception, it has supported 95 high-risk mothers–and many women who had never before carried to term have delivered healthy babies.
“One story that stays with me,” says Dr. Chad, “is of a woman named Joyce*, who came to our clinic after 11 previous miscarriages. We were able to closely monitor her pregnancy and provide a specialized care plan, and she successfully gave birth to her first child earlier this year.”
*Client name has been changed to protect patient privacy
In Kenya, obstetric hemorrhage, or excessive bleeding during childbirth, is the leading cause of maternal death. Through our work on emergency obstetric care, Lwala is training and equipping health workers to respond. We’ve championed a bundle of protocols and tools that can treat obstetric hemorrhage–it relies on lifesaving supplies like uterotonics, the uterine balloon tamponade, and the non-pneumatic anti-shock garment (NASG), to stop bleeding.
Lwala is also working to ensure that emergency obstetric care is adopted throughout the country. For years, we have collected evidence of the impact of NASG and other lifesaving tools, and we partnered with government to update the national training curricula, so that every health worker entering the workforce will be trained to respond to obstetric emergencies. This year, we celebrated the addition of the NASG and other essential commodities for emergency obstetric care to Kenya’s Essential Medicines List, which will make them more available to women across Kenya.
Our vision is that every mother in Kenya gives birth in a facility that is well-equipped to save her life. To date, we’ve trained 4,620 health workers across 426 facilities in 6 counties, including Migori, Homa Bay, Baringo, Kilifi, Garissa, and Mombasa. Over the next few years, we will expand this work to a total of 15 counties.
For many years, Lwala has partnered with government and youth to improve access to sexual and reproductive health services. We deploy a cadre of young people to serve their peers, and we promote high-quality comprehensive sexuality education in schools using age-appropriate curricula. We also provide information and access to a range of modern contraceptive methods, delivered through government health facilities and other youth-friendly access points.
At the center of this work is the leadership and knowledge of young people.
Lwala has now expanded this model across all of Migori County, reaching more than 400,000 young people. We recruited and trained 591 youth peer providers, aged 18 to 24, who provide information to their peers on sexual and reproductive health, as well as distribute condoms, oral contraceptive pills, and emergency contraceptive pills.
As a result of this work, we’re reaching more young people than ever with the sexual and reproductive health services they deserve–unlocking the door for better health and gender equality.
