In an unprecedented milestone, on December 18th, 2024, the government of Migori County launched the Birth Companion Inclusion Strategy and Guide, which will ensure that traditional birth attendants (TBAs)–caregivers who have supported women in their communities for generations—will have a place in the community health workforce. Lwala was proud to contribute to the development of these frameworks. This builds on years of work from Lwala to incorporate TBAs into the health system.
The strategy documents we launched will be implemented to improve healthcare delivery for the people of Migori County. Serving as a roadmap, they will guide our efforts in collaboration with other stakeholders and play a key role in achieving Universal Health Coverage, which is also a national priority.
-Hon. Caleb Opondi, CECM of Public Health and Medical Services, Migori County
Each year, about 600,000 women and babies around the world lose their lives during pregnancy, childbirth, or shortly after. In Kenya, many communities still face high rates of maternal deaths, with just 15 out of 47 counties accounting for nearly all of them. Migori County is one of these high-burden areas.
Since 2021, Lwala has partnered with the International Childbirth Initiative (ICI) to improve maternity care by focusing on respectful, continuous support for women during pregnancy, childbirth, and after delivery. We have trained birth companions–a role that offers mothers emotional and physical support throughout their pregnancy–drawing from a pool of community health workers (CHWs), former TBAs, midwives, and patient attendants, to provide ongoing emotional and physical support to women throughout their maternity journey. This has led to safer deliveries and improved outcomes for both mothers and babies in Migori County.
Lwala recognizes the valuable experience and wisdom that TBAs bring to their communities. For generations, TBAs have been trusted to ensure safe deliveries, making them important figures in local healthcare. However, because they are seen as competitors to skilled delivery care, their work is often criminalized, and they are isolated from the formal health system.
Research shows that a successful CHW relies more on practical experience, community trust, and a strong dedication to improving the health of mothers and babies than on formal education. Our strategy aimes to integrate TBAs into the community health workforce, giving them respected roles for the important care they provide. We work with local governments to find active TBAs and train them to become skilled CHWs. Where CHW vacancies are not available, we work with the government to train TBAs alongside CHWs and then find them other roles, including serving communities as birth companions. By bringing TBAs into the health system, we can build on their trusted role in the community and improve health outcomes. With the right training, these traditional caregivers can be the strongest advocates of facility-based deliveries.
The strategic framework put forward by Migori County officially recognizes TBAs and acknowledges their value, knowledge, and experience in improving care for mothers and newborns. This inclusion represents a powerful opportunity to bridge the gap between underserved communities and the health system. The strategy focuses on key interventions that are essential for achieving this vision; strengthening collaboration among health stakeholders, improving access to skilled birth attendance, and expanding training for TBAs to provide skilled, evidence-based support, which will be critical in ensuring that as birth companions, they are fully equipped to meet the needs of women and children. Moreover, the inclusion of robust data management and performance-tracking mechanisms will ensure continuous monitoring, accountability, and progress in the implementation of the strategy.
A Bright Future for Healthcare in Migori County and Beyond
Migori County's new Birth Companion Inclusion framework is a big leap forward—it is a significant step towards achieving Sustainable Development Goal (SDG) 3, which aims to ensure good health and well-being for all. This comprehensive approach to maternal and newborn health sets the stage for long-term improvements in health outcomes across Kenya, which has already seen big improvements in skilled deliveries over the past decade. Between 2014 and 2022, the skilled birth attendance rate rose from 62% to 89%, and we expect that incorporating TBAs into the community health workforce will drive further improvements.
Lwala stands as a proud partner with Migori County as we celebrate this significant milestone. We are dedicated to aligning with and supporting the roll-out and implementation of the Birth Companion Inclusion Strategy and Guide. We believe that recognizing TBAs is a solid foundation for a more sustainable, inclusive, and effective healthcare system. As we move forward, we are excited to see the positive impact this strategy will have on the lives of women, children, and communities in Migori County–and across Kenya.
This is truly a great moment for Migori County and Lwala is honoured to contribute to this landmark initiative. By including TBAs in the health system, we are building a stronger, more resilient foundation that will serve generations to come. We are forging a new path toward a healthier future, ensuring that no woman or child is left behind.
-Edelquinn Mumma, Lwala's Community Health Program Manager, Migori County
