At Lwala Community Alliance, 2025 was defined by both challenge and growth. Across the communities we serve, we witnessed resilience in action–and learned lessons that continue to shape how we move forward together.
Time and again, we saw what happens when communities are trusted to lead. Community groups stepped forward to uncover challenges, advocate for better services, and hold health systems accountable. Professional community health workers (CHWs) across Kenya reached more households than ever before, ensuring that health care is consistent and close to home. These moments reinforce a simple but powerful truth: lasting change begins within communities themselves.
Real transformation needs more than strong programs–it requires systems that endure. This year, we deepened our work with county and national governments to strengthen primary health care. As a result, the national government delivered 100% of CHW payments to all 47 counties, and county governments have added CHW payment to their annual budgets. Additionally, as we scale emergency maternal and newborn care across 15 counties, new research reveals that our approach leads to a 29% decrease in deaths among women who experience obstetric hemorrhage.
In 2025, the end of USAID and shifts in foreign aid created uncertainty across the world. In the face of these disruptions, communities could not afford to wait. Lwala moved quickly alongside government and partners to identify shortfalls in essential commodities, and we raised $2.6 million to fill the gap. This led to a 32% reduction in stockouts across our three counties. It also reminded us that we can solve seemingly intractable problems with creativity, flexibility, and partnership.
Taken together, these lessons underscore a deeply held belief: that resilient health systems must be built by and for the people they serve. We are profoundly grateful to the communities who lead, the governments who partner with us, and the supporters who stand with us. You make this work possible.
In solidarity,
Lwala is partnering with government to expand community-led health–we are professionalizing CHWs, improving community accountability, and supporting health facilities.
Lwala is strengthening emergency maternal and newborn care–including training health workers and equipping facilities with lifesaving tools like the non-pneumatic anti-shock garment.
Lwala is bridging gaps between communities and policymakers, ensuring that local solutions are translated into policies that transform the health system.
Lwala is working with coalitions and leading universities to contribute to the global body of evidence and fuel advocacy toward health for all.
This year, Lwala Community Hospital earned a SafeCare Award for Outstanding Commitment to Quality of Care and achieved our highest score ever–receiving a Level 5 certification, the top rating possible. This recognition reflects years of investment by Lwala in systems, staff training, and continuous improvement as we set a standard for hospitals across Kenya.
Lwala is walking alongside the Kenyan government as they professionalize CHWs–changing policies to improve payment and supplies, creating standardized training, and building digital systems. We are also protecting the role of women in the workforce and championing the inclusion of traditional birth attendants. Together, we are creating a reality where CHWs are paid, trained, supervised, and equipped to deliver the care communities deserve.
CHWs are their own best advocates–their voices strengthen policy and improve health care for their communities. Lwala has trained more than 2,800 CHWs as advocates to represent the needs of frontline workers, joining the global movement for professional CHWs.
In 2025, Bernard Otieno, Migori County’s CHW Advocate Lead, was elected to serve on Community Health Impact Coalition’s Advisory Board. Here, he represents his fellow CHWs around the world and informs the coalition’s global strategy on research, policy change, and professionalization.
After attending the National Mental Health Conference, CHW Grey Odero came home with new ideas. She worked with her local facility and supervisor to build a referral plan for community members who need mental health support. She is excited that the national government is also adding mental health screening to CHWs’ digital tools.
Millicent Miruka is a passionate advocate for CHWs on the global stage, speaking alongside former Irish President Mary Robinson on a panel focused on gender equity in the health workforce. She also helped develop the World Health Organization's global curriculum for CHWs, which will help governments around the world equip and train CHWs.
CHW Regina Odour is a leader in Baringo County's advocates forum, mobilizing her peers to influence the county budgeting process and prioritize timely CHW payments. Thanks to her active participation, the county paid 100% of its CHWs in 2025.
Lwala works within existing government structures, like community health committees, to rebuild trust with the health system. We strengthen the capacity of these groups to transform health care and hold government accountable, and we elevate women’s leadership.
Kenya’s rainy season always brings challenges–it displaces families, destroys crops, and makes roads difficult to pass. Extreme flooding also spikes the spread of diseases like cholera by contaminating water sources and straining already limited sanitation infrastructure. But a strong community response helped contain Migori County’s most recent outbreak.
“We are ready to be called upon during these moments,” says John Bogie, the Community Health Committee Lead in Kehancha Subcounty. “We have an important role to play in the larger health system.”
Across the 19 villages affected by the outbreak, community health committees worked alongside CHWs and government teams to identify hotspots, trace contacts, and design solutions that reached places they were needed most. Committee members helped translate technical public health guidance into practical action, reaching more than 50,000 people with targeted outreach. They also helped guide the response in high-risk environments like gold mining areas, where overcrowding, frequent travel, unsafe water sources, and limited waste management increased vulnerability to the disease.
“This coordination between government, partners, and communities meant that no alarm went unheard, and no family was left behind,” explained Pius Ondiek, the Water, Sanitation, and Hygiene Coordinator for Kuria West Subcounty. Together, they helped identify and refer nearly 500 people who had been in contact with the 53 confirmed cholera patients.
Cholera outbreaks usually spread quickly across the county. This time, a focused, local response kept the disease contained to just a few wards—and within 11 weeks, cases were back to zero.
“In the past, there wasn’t as much coordination. This time, community committees, CHWs, and the health system worked together closely. We focused on hotspots, shared clear messages, and made sure resources reached the right places. Because of this, we detected cases early and acted fast.”
–Pius Ondiek, Water, Sanitation, and Hygiene Coordinator, Kuria West Subcounty
“Centering women’s voices in decision-making is essential to building a health system that works for girls and women... their perspectives help ensure that the issues affecting them most are prioritized and addressed.”
Dr. Kezia K’Oduol, Lwala Director of Primary Health Care
Lwala supports youth in Migori County, showing what’s possible when young people are not just beneficiaries but leaders in the health system. We deploy a cadre of young people to serve their peers, support health facilities to offer youth-friendly services through a range of access points, and leverage community leadership to change norms, policy, and behaviors.
Now we’re on a mission to support county governments across Kenya to center youth decision-making and improve access to sexual and reproductive health services. We’re using what we’ve learned through our partnership with young people in Migori to change national policies and scale our youth-led model nationwide.
When the U.S. government abruptly halted foreign assistance in early 2025, Kenya's health system experienced widespread stockouts of essential medicines. Lwala moved quickly. Working alongside government partners in Migori, Homa Bay, and Baringo Counties, we conducted facility audits, identified critical gaps, and helped redistribute supplies to where they were needed most.
These donor funds are unlocking new, sustainable revenue. A key first step is enrolling households in Kenya's new social health insurance and helping facilities claim reimbursements. Then, as facilities provide donated commodities, they receive payment and insurance reimbursements. Facilities reinvest this money in purchasing new commodities, creating a self-sustaining supply cycle. Additionally, Lwala worked with county governments to increase budget lines for essential health commodities.
We know that crises can present an opportunity to build back better systems–and Lwala is using this moment to strengthen insurance systems and grow domestic budgets, reducing dependency on foreign aid. We are also ensuring that communities across Kenya have the medicines they need, no matter what.
