“Since our founding in Migori County in 2007, Lwala has been an agent of change, pioneering a model that centers communities as leaders and change-makers in breaking the cycle of health inequity,” says Julius Mbeya, Lwala Co-CEO. As Lwala works with government to strengthen community health systems nationally, in 2024 we scaled our community-led health model to two additional counties, Homa Bay and Baringo. This expansion increases Lwala’s reach from 600,000 in 2023 to 2.5 million people in 2024, paving the way for us to reach even more counties with community-led health.
Our expansion plans are driven by disproportionately poor health outcomes in Kenya’s historically marginalized counties. Just 15 of Kenya’s 47 counties, for example, contribute to 99% of maternal deaths. In a devolved health care system like Kenya’s, we cannot work at the national level alone–we must partner with counties experiencing the highest burden of loss to create and implement community-led solutions. But we also recognize that each county has unique health challenges that require us to adapt the approaches we’ve used in Migori:
Baringo is located in the Rift Valley and is home to 735,000 people, 89% of whom live in rural settings. Because communities are so dispersed, health service delivery can be challenging. Baringo's climate is arid/semi-arid, resulting in droughts that threaten food security, nutrition, and water supply. Additionally, some parts of Baringo face insecurity and unrest. A key strength lies in a new partnership between Lwala and Dandelion Africa, another Kenyan-led organization committed to advancing community health in Baringo.
Homa Bay is located on the shores of Lake Victoria and is home to about 1.25 million people, 84% of whom live in rural settings. The county has 16 islands, which often lack health services, and referral systems to the mainland are weak. Additionally, high rates of poverty contribute to poor health and nutrition, and malaria and HIV are prevalent. Coupled with drought and rising lake levels, many communities in Homa Bay are vulnerable to the effects of climate change. The county government has demonstrated a significant commitment to strengthening community health as a response to these challenges.
To adapt our learnings in these new contexts, Lwala is partnering with government and other like-minded organizations to implement sustainable, community-driven solutions.
A new model for implementing health solutions with government
Lwala’s work in Migori County has been key in refining our community-led model. We have learned how to partner with county governments, build trust with communities, and improve access to health care in underserved populations.
In expanding our model, we first collaborate with government to develop work plans. The government then leads service delivery, while Lwala promotes policy change, supports activities, backstops data collection and analysis, co-develops tools, and offers thought partnership. “It is important to establish trust with the government and existing partners and understand their priorities for community health,” says Steve Okong’o, Lwala’s County Manager for Homa Bay. “These partnerships helped us match our efforts to local needs and priorities, leading to better and more lasting change.”
Homa Bay: a community-led approach for sustainable health
As we expand community-led health in Homa Bay, we have found a strong and committed partner in the county government. As part of our entry activities, we worked with government to set community health priorities and undertake joint planning. A key activity was supporting CHWs in household registration, a process where every household is captured in the electronic Community Health Information System (eCHIS), a new digital platform for CHWs that Lwala and other partners helped the national government develop. Registration provides CHWs with a full client list and ensures that no family falls through the cracks of care. Because of the county government’s strong partnership and engagement, CHWs have already been able to register nearly 100% of households in Homa Bay.
Additionally, we conducted a functionality assessment to identify the key priorities for strengthening community health in Homa Bay. Our findings revealed that CHWs had not received training in a decade, meaning that they lacked up-to-date knowledge and tools to provide care. While CHWs had been trained to register households on eCHIS, they had not learned how to use the platform to document services during household visits, resulting in the loss of important data. To address these challenges, we are rolling out targeted training on eCHIS, as well as on basic and technical competencies that CHWs need for delivering services. We are also mentoring CHW supervisors and local facilities to boost data accuracy and support for CHWs, enhancing the quality of care they provide.
Through the assessment, we also identified 2,082 active traditional birth attendants, women who have been serving their communities for generations but are often left out of the formal health system. Yet when traditional birth attendants are incorporated into the community health workforce, they are transformed into champions of skilled delivery. In the coming months, we will be working with the government of Homa Bay to develop a strategy for their integration into the community health workforce.
Additionally, the assessment revealed community health committees–which are essential for holding health systems accountable– were formed but are not operational, and we intend to build their capacity to support and advocate for local health initiatives. Through our joint work plan with government, we will train 2,967 community health workers, 287 community health committees, and 244 community health assistants (supervisors), ultimately improving the quality of and access to health care in Homa Bay County.
“Our partnership with Lwala is built on a sustainable, community-focused approach, where we co-design and implement programs with clear goals. We are hopeful that this will lead to quality care for every county resident.”
- Benard Mboya, County Community Focal Person, Homa Bay County
Homa Bay has also experienced severe flooding in recent months, affecting about 16,000 people, displacing around 3,000 households, and forcing nearly 900 to seek refuge in camps. Lwala teamed up with the county government to respond. We provided sanitary supplies, mobilized outreaches to maintain critical health care, and raised funds to support displaced persons. We are using the lessons learned from our recent work with Migori County to develop a Disaster Management Strategy and working with communities to design health strategies at the intersection of health and climate.
At the national level, we worked to add a flooding function to eCHIS. When a CHW visits a household, they can turn on their GPS location and enter information about whether a household is at risk of or currently being affected by flooding. We had already deployed this tool, so it will help us map out the most recent effects of flooding (including household relocation), how it impacted access to health facilities, and whether there are correlations with trends in waterborne illness.
Baringo: advancing community-led health through partnership
In Baringo, Lwala is partnering with Dandelion Africa, another Kenyan-led organization, to strengthen community health. Dandelion applies its local knowledge to develop innovative strategies that empower community leadership, support CHWs, and strengthen health systems. At the same time, Lwala is building our own capacity to support local partners and provide financial and technical assistance. Together, we’re not just improving health care delivery in high-need areas but also creating a model for successful community-led interventions that can be replicated across Kenya.
When we began to work with Dandelion in Baringo, our first priorities were training, digitizing, and equipping CHWs. After helping Dandelion with planning and tool development, they trained 1,244 CHWs, including 40 traditional birth attendants, in a 5-day session that equipped them with the knowledge and skills they need to provide health services. As we work toward the professionalization of CHWs in Baringo, we will be conducting research in partnership with Dandelion to better understand the predictors of CHW knowledge and performance.
Additionally, Lwala and Dandelion evaluated health facilities in Baringo, identifying opportunities to strengthen emergency obstetric and newborn care services. In the next several months we’ll begin work with community health committees (CHCs) to strengthen their capacity to transform health care and improve accountability. We’ll start with a CHC functionality assessment to understand CHC coverage and their needs for training and support.
One challenge we faced was that about 200 CHWs did not receive mobile phones or commodities from the national government, both of which were distributed late last year following efforts to equip CHWs. After investigation, we found that the CHW registry, which documents how many CHWs are serving in a particular county, was not up-to-date. We supported the county government to update the registry, and now we are working with Dandelion and government to close the gap in commodities and mobile devices. The county government has been actively involved in eCHIS rollout and has provided continuous technical support. Meanwhile, Dandelion is helping to improve inventory management of mobile devices, adding barcodes to each phone and building a database for the county government to track.
A second challenge is adapting to Baringo’s vast terrain. Because the population is spread out, it was difficult for CHWs to visit and register their 100 assigned households. We adjusted our timelines and ramped up support, and we are now making steady progress toward full registration–by June, CHWs had registered 46% of households, up from 22% in April. With each challenge and opportunity that arises, we rely on the expertise of Dandelion to drive the strategy. “This new approach is a journey of growth and learning," explains Brian Ombaka, Lwala’s County Manager for Baringo. "We are adapting our model within different local contexts while leveraging local insights to optimize health care outcomes. I believe that this partnership will catalyze long lasting change in Baringo County.”
“Successful partnerships are built on shared goals, trust, and mutual support. Our collaboration with Lwala has demonstrated how these elements foster knowledge exchange and innovation. By leaning on each other's expertise, we are broadening our understanding and enhancing our ability to make meaningful impact, ultimately improving the health and well-being of the people of Baringo County.”
-Wendo Aszed, Founder & Executive Director of Dandelion Africa.
A blueprint for community-led health driving meaningful change
“Our expansion into Homa Bay and Baringo is not just about reaching more people—it's about setting a precedent for how community-led health can drive meaningful change,” reflects Julius Mbeya, Lwala Co-CEO. The lessons we are learning–supporting government to lead, championing local partners, and tailoring our approach to unique contexts–will continue to inform Lwala’s own systems change strategy. But it also goes further: “By learning from these experiences and collaborating with local partners,” says Julius, “we’re crafting a blueprint for success that can inspire and guide similar efforts across Kenya and beyond.”
