Over the past decade, Carolyne Apondi, a community health committee (CHC) member in Kanyawanga, Migori, has seen dramatic shifts in how mothers engage with the health system. “Mothers used to not value child wellness visits,” she says. “And even less so taking themselves to antenatal care.”
In many communities, decisions about health are made far from where care is experienced. CHCs are changing that—serving as a bridge between households, health workers, and policymakers to shape how care is planned and delivered.
“Nowadays, communities no longer work in isolation. We sit with leaders, CHWs, and health workers and agree on priorities together, and we are seeing CHWs identify young mothers earlier to start their antenatal care.”
- Carolyne Apondi, community health committee member
CHCs bring communities into shared problem-solving, ensuring that services reflect local realities. Lwala’s work in Migori, Homa Bay, and Baringo Counties shows how strengthening these governance structures is making health systems more responsive and accountable. 100% of communities across Migori, Homa Bay, and Baringo are now represented by a trained committee. In Migori and Homa Bay, 99% of CHCs are functional, meaning they play active roles in planning, coordination, and delivery of health care—up from 80% in Homa Bay in 2024 and 32% in Migori in 2022. In Baringo, coverage continues to expand as these structures reach more remote communities—73% of CHCs are now functional, an increase from 46% in 2024.
Because of these committees' work, 2.85 million people across these three counties now have a stronger voice in their health care.
From community insight to system response
Missed care was a recurring pattern in Kanywanga, especially for mothers. Women were delaying or missing antenatal care, leading to complications later in their pregnancies. “Care for mothers was disrupted,” says Carolyne. “The committee saw the need for a more connected approach.”
Working closely with CHWs, the committee began holding community dialogues to better understand why women were missing antenatal care visits. Two key challenges emerged: some pregnant women were not being identified and followed up consistently at the household level, while long distances to health facilities delayed care. These delays often meant that complications were identified too late, increasing the need for urgent referrals.
From these discussions, the committee focused on strengthening both follow-up and emergency transport. They worked with CHWs to improve early identification of pregnant women during household visits and tracking antenatal care schedules. At the same time, the CHC introduced a community-led motorbike referral system, where CHWs coordinate directly with riders to help pregnant women reach facilities quickly during emergencies. Across the counties where Lwala works, CHCs have community-led referral systems in place—93% of CHCs in Migori, 96% in Homa Bay, and 84% in Baringo have mobilized local referral systems to help patients reach care when they need it.
In Kanyawanga, what began as recurring challenges is now driving proactive health care—one where communities are not only identifying challenges, but leading solutions that improve care.
Community governance in action
“For a long time, families faced the same problems in health care,” says Chrispine Bolo, chair of the Nyalgosi CHC in Homa Bay. “But we never addressed them collectively.”
For years, CHCs in Homa Bay were unevenly established, and where they existed, their ability to influence service delivery was limited. This began to change with support from Lwala and the Ministry of Health in 2024, when CHCs across the county received training in governance, resource mobilization, and policy engagement. As committees strengthened their capacity, they began identifying service gaps, setting priorities, and engaging more actively in local decision-making.
This shift is reflected in stronger oversight and coordination. From 2024 to 2025, more CHCs engaged in annual work planning—rising from 81% to 94% in Migori, 62% to 88% in Homa Bay, and 22% to 55% in Baringo. This means communities are setting priorities more consistently, tracking progress, and coordinating efforts to address local health challenges. At the same time, community leadership in health governance has expanded: today, 64% of committee chairs in Homa Bay help oversee local health facilities, up from 50% the previous year. Inventory management also improved from 56% in 2024 to 81% in 2025, supporting more reliable tracking of medicines and supplies.
These changes point to growing community influence in the health system—where recurring challenges are identified collectively and addressed through coordinated action.
Rebuilding trust through community leadership
Baringo’s vast and dispersed landscape limits access to health services, leaving many women to deliver at home or travel long distances for care—often with serious, but preventable consequences.
At Maji Mazuri Health Facility, these challenges and limited resources made it difficult to provide reliable maternal services. In response, CHCs brought mothers together through focused dialogues to better understand their experiences and the barriers they faced in seeking care.
The CHCs shared what they learned with local leaders and health workers, and together they developed a successful proposal to strengthen maternal care at the facility. The county government upgraded the maternity wing with delivery beds, emergency obstetric equipment, and essential supplies—improving the quality and reliability of care for mothers and newborns.
“At first, women were hesitant to use the facility for deliveries because of past gaps in care,” says David Mwangi, a CHC chair. “But as services improved and we continued engaging the community, more women came for antenatal care and chose to deliver at the facility. That shift showed us that trust was growing.”
As CHCs become more embedded in local decision-making in Baringo, collaboration between communities and providers is improving. Joint review meetings increased from 32% in 2024 to 59% 2025, supporting more consistent coordination and shared accountability. Across all three counties, 88% of Lwala-supported CHWs report working closely with community health committees through community dialogues, joint household visits, and other local outreach efforts. As more women take on leadership roles—representing 51% of community health committee members across the three counties—decision-making is also becoming stronger and more inclusive.
“This experience changed how we see our role as CHCs,” David says. “We are not just observers, we are advocates for change. When we raise issues collectively, we can influence decisions that affect our community.”
“This experience changed how we see our role as CHCs. We are not just observers, we are advocates for change. When we raise issues collectively, we can influence decisions that affect our community.”
- David Mwangi, community health committee chair
Looking ahead: a national system for accountability
As Kenya advances its primary health care strategy, Lwala continues to advocate that CHCs are essential to how primary health care is planned, delivered, and held accountable. Our work is focused on strengthening these structures within government systems—so that community voices consistently shape decisions at every level.
In partnership with the Ministry of Health, Lwala helped develop the National Community Scorecard, which brings community feedback into structured dialogue with CHWs, health facilities, and local leaders and turns it into action. Lwala also supported the rollout of a national framework to strengthen and measure community health committees across all 47 counties, including the integration of gender-disaggregated data to track women’s leadership. Building on lessons from across our three counties, Lwala is working with national partners to conduct a nationwide CHC assessment and ensure CHCs in all counties are supported to lead. Our guiding belief is at the heart of this work: when communities lead, change is lasting.
Nearly ten years ago, Carolyne was elected by her neighbors in Kanyawanga to represent them on their CHC. Today, she is one of the leaders her community turns to with questions about health. “Now, when I attend barazas, they call on me: ‘Carolyne, how is our health?’” she says. “I share what I know, and my voice is heard.”
