Edwine Okwach was working the night shift alone at Waridi Health Facility* when a woman arrived, already far along in labor. As Edwine prepared the patient for delivery, he saw that the umbilical cord had dropped through the cervix first–a life-threatening emergency that cuts off oxygen to the baby and often requires an emergency cesarean section.
Edwine sprung into action. He called for emergency referral and positioned the mother to relieve pressure on the cord, buying precious time. With no ambulance nearby and the mother fully dilated, Edwine relied on what his Lwala-trained mentor had taught him. He did a simple procedure to guide the baby out and prevent further compression. When the baby was born, she wasn’t breathing. Edwine was ready, using Helping Babies Breathe tools and protocols to manually assist her breathing with a bag and mask. The room sighed as the baby let out her first cry.
Just one month earlier, this same facility lost a mother to postpartum hemorrhage. The only nurse on duty was new, and it had been years since she had received refresher training on emergency obstetric and newborn care. The death shook staff confidence. Alongside the health facility management team, Lwala facilitated a review of this death that focused on system gaps rather than individual fault–helping staff rebuild skills, trust, and readiness for the next emergency.
Lwala works alongside facilities like Waridi to strengthen emergency maternal and newborn care so skilled providers have the training, tools, and systems they need to save lives. We’re scaling this approach to make moments like Edwine’s the norm.
Confidence that saves lives
Saving mothers and newborns depends on a prepared health workforce–one that is trained, supported, and equipped to act in critical moments. Kenya’s 2024 Report on Maternal and Perinatal Death Surveillance and Response echoes this reality, finding that 17% of preventable maternal deaths at health facilities across the country are linked to a lack of skilled providers. Edwine and his Lwala-trained mentor, Susan Akinyi, are one example of how Lwala helps build more confident and competent health workers.
“I’ve always wanted to specialize in reproductive health. But I really got to grow this passion through Susan’s mentorship. It’s something I want to keep passing on to my colleagues and continue to build their confidence as well.”
- Edwine Okwach, Nurse
Edwine meets regularly with Susan during her monthly facility visits. Together, mentors and mentees review emergency care protocols, stock management, and modules from the national emergency maternal and newborn health curriculum–which Lwala helped develop. This mentorship model builds more than technical skills; it builds confidence to act decisively in emergencies.
Training alone is not enough if providers lack tools to act. Lwala pairs skills-building with access to lifesaving supplies, including championing the use of the non-pneumatic anti shock garment (NASG) to stabilize women experiencing severe bleeding during birth. What began as a pilot has since grown into nationwide scale up: Lwala led the first countywide rollout, supported NASG inclusion in the national curriculum and essential commodities list, and trained thousands of health workers in its use. After years of advocacy and building evidence, we are now seeing the garment move toward availability in every Kenyan county and formal inclusion in national procurement through the Kenyan Medical Supplies Authority.
Through training, mentorship, and equipment, Lwala is helping to build a health workforce that is ready to save a mother's life when every second counts. In 15 counties, we have supported 7,100 health providers across 1,050 facilities to deliver emergency maternal care and equip facilities with the non-pneumatic anti-shock garment.**
Across Migori and Baringo, where we implement our full community-led health model, over 80% of health facilities are trained and equipped to respond to emergency obstetric care.
Care before, during and after birth
Lwala goes beyond emergency response to strengthen maternal and newborn care–we also build the conditions to prevent maternal emergencies in the first place. Lwala partners with counties to expand access to maternal services and reinforce positive health-seeking behaviors, such as hosting regular maternity open days to familiarize expectant parents with the services offered at facilities. At these events, we work with facilities to provide roving ultrasound and laboratory services, so providers can identify high-risk pregnancies early and connect women to specialists equipped to support safer deliveries.
As services expand, we work with counties to protect quality through routine facility assessments, stronger governance, and better use of data. Facilities establish work improvement teams and open dialogue with community members, renewing a shared ownership of maternal and newborn health outcomes. A key part of this work is supporting facilities to routinely monitor maternal deaths and near misses–bringing together providers, staff, and community members to identify gaps and assign clear actions to prevent recurrence. Learning from every delivery helps facilities move closer to safer care for every mother and baby.
Through this integrated approach, Lwala rebuilds trust in the health system–making lifesaving moments like Edwine’s possible long before an emergency unfolds. Community health workers, traditional birth attendants, and community health committees play a pivotal role by spreading news of improved services and strengthening links with health facilities. As a result, Lwala-supported communities see improved skilled delivery rates and pregnant women are 14% more likely to attend 4 or more antenatal care visits. Waridi Health Facility once averaged just three deliveries each month. Today, monthly deliveries range from 12-23, signaling rising confidence in facilities that are prepared, responsive, and accountable for every mother and newborn.
All hands on deck
The mother and baby that Edwine helped deliver were discharged two days later; both are healthy and safe today. Their story represents just one stride along an entire continuum of care. At Lwala, we walk alongside women to ensure every woman has access to high-quality, respectful care at every step of her journey to motherhood.
Scaling positive maternal and newborn health outcomes requires more than expanding programs–it requires building solutions that government can own and sustain. Lwala works with county and national governments to identify gaps in care, test practical solutions, and embed what works into health systems. As a trusted training partner for emergency maternal care and newborn care, we're bringing our expertise to new areas, working with government to further expand access to obstetric ultrasounds and institutionalize maternal death reviews.
Improving maternal and newborn health is not the work of any single organization, government, or health care worker —it requires all of us, working together, with urgency and shared accountability. Women are seeking care. Communities are engaged. Solutions are within reach. What’s needed now is sustained investment in trained health workers, reliable supplies, continuous learning, and systems that support the highest quality of care at every level.
*Facility name has been changed to protect individual privacy
**We extend our reach through strong local collaboration, implementing this work alongside our partners:
- Dandelion Africa
- Catholic Medical Mission Board
- Kisumu Medical Education Trust
- Liverpool School of Tropical
- Medicine
- MOMENTUM
- UNICEF
- Redtribe
- Ministry of Health
