Our Impact

When communities lead, health outcomes improve

Since our founding, we have tested and adapted our community-led health model and generated evidence to support its impact. Our research has revealed how strong community health systems improve health outcomes—our communities have achieved a 99% skilled delivery rate, Lwala-trained and supported CHWs are 5 times more likely to be knowledgeable of danger signs in pregnancy and early infancy, and women in the communities we serve are 2.6 times more likely to use modern contraception.
Read our 2023 Annual Report

Agonyora–Breaking the Shackling Power of Harmful Norms Evaluation: Interim Report


An evaluation of the expansion of Lwala’s family planning and social norms change work across Migori County (the Agonyora Project) was conducted by Laterite Kenya Limited with the support of Children’s Investment Fund Foundation (CIFF). The evaluation sought to assess the program’s impact on family planning usage among young people, the cost of family planning services, and shifts in social norms around adolescent sexual and reproductive health. The evaluation discovered that:

  • Since the start of the intervention in early 2023, young people aged 15 to 24 received 37,478 additional family planning visits, reflecting a 57% increase over modeled expectations. 
  • Residents of Migori County received 96,310 additional couple years of protection (CYP), reflecting a 55% increase over modeled expectations. Uptake of implants was notable, accounting for 76% of CYP. 
  • In Rongo Subcounty, where Lwala has targeted norms change around sexual and reproductive health for young people, respondents reported more progressive attitudes toward youth access to contraceptives, compared to respondents in comparison subcounties.
Laterite. (2023). Agonyora – Breaking the Shackling Power of Harmful Norms Evaluation. Nairobi, Kenya.
READ THE REPORT

Training and experience outperform literacy and formal education as predictors of community health worker knowledge and performance


Common selection criteria for CHWs–such as literacy tests and formal education requirements–risk excluding women, traditional birth attendants, and other marginalized groups. A new study from Lwala and our partners at Vanderbilt University explores predictors of CHW performance in Lwala-supported communities and comparison communities. It found that:

  • Professionalization and experience were more reliable predictors of CHW knowledge and performance than formal education and literacy   
  • Children supported by professionalized CHWs were 15% more likely to be fully immunized 
  • Pregnant women supported by professionalized CHWs were 14% more likely to attend 4 or more antenatal care visits
Ash Rogers et al., "Training and experience outperform literacy and formal education as predictors of community health worker knowledge and performance, results from Rongo sub-county, Kenya," Frontiers in Public Health 11 (April 2023): doi: 10.3389/fpubh.2023.1120922.
READ THE STUDY

Predictors of Under-Five Healthcare Utilization in Rongo Sub-County of Migori County


A peer-reviewed study examined the health seeking behaviors of households in Lwala-supported communities and comparison communities. It found:

  • Households in Lwala-supported communities were 3 times more likely to seek care for a child with a fever.
  • Households visited by community health workers were 2 times more likely to seek care for a child with respiratory symptoms.
  • The percentage of children with a fever being tested for malaria increased from 24% to 88% following the implementation of a community health worker-led initiative.
Ash Rogers et al., “Predictors of Under-Five Healthcare Utilization in Rongo Sub-County of Migori County, Kenya: Results of a Population- Based Cross-Sectional Survey,” Pan African Medical Journal 41 (Feb 2022): doi: 10.11604/ pamj.2022.41.108.31618.
READ THE STUDY

Labour conditions in dual-cadre community health worker programmes

Around the world, many community health programmes are organized into a dual-cadre system, where paid and unpaid CHWs work alongside each other. Through joint research with Community Health Impact Coalition, we found that more than half of volunteer CHWs in dual cadre programs experience labor exploitation. These findings will be used to advocate for proCHW labor laws, fair contracts, and international funding that does not exploit women’s labor. 

 

Ballard M, Olaniran A, Iberico MM, Rogers A, Thapa A, Cook J, Aranda Z, French M, Olsen HE, Haughton J, Lassala D, Carpenter Westgate C, Malitoni B, Juma M, Perry HB. Labour conditions in dual-cadre community health worker programmes: a systematic review. Lancet Glob Health. 2023 Oct;11(10):e1598-e1608. doi: 10.1016/S2214-109X(23)00357-1. PMID: 37734803.
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Childhood mortality and associated factors in Migori County, Kenya

A cross-sectional survey by Lwala explored trends in under-five mortality in Migori County, which has historically had high rates of childhood illness and death. Study findings include: 

  • Across surveyed sites in Migori County, the under-five mortality rate was 32.3 deaths per 1,000 live births, which is lower than recently available estimates for Kenya (41 deaths per 1,000 live births). 
  • In areas where Lwala has implemented community-led health the longest, the under-five mortality rate was 21.5 deaths per 1,000 live births, compared to 32.2 deaths per 1,000 live births across all sites. This is also lower than the Sustainable Development Goal of 25 deaths per 1,000 live births. 
  • The study found that short birth spacing–less than 18 months between children–was associated with higher under-five mortality, pointing to the importance of contraceptive access. 
  • Parental contribution to the National Health Insurance Fund (NHIF) was a protective factor against under-five mortality.

These findings will serve as a baseline for future program evaluation as part of a 10 year study design. 

 

Starnes JR, Rogers A, Wamae J, Okoth V, Mudhune SA, Omondi A, Were V, Baraza Awino D, Lefebvre CH, Yap S, Otieno Odhong T, Vill B, Were L, Wamai R. Childhood mortality and associated factors in Migori County, Kenya: evidence from a cross-sectional survey. BMJ Open. 2023 Aug 22;13(8):e074056. doi: 10.1136/bmjopen-2023-074056. PMID: 37607788; PMCID: PMC10445361.
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Prevalence and determinants of contraception utilization over time in Migori County, Kenya

A cross-sectional study led by Vanderbilt University examined factors that influence the use of contraception in Lwala intervention and control sites finding that:

  • In the sites where Lwala has implemented community-led health the longest, we saw the highest use of contraceptives at 70%, compared to 55% to 69% in other areas.
  • We saw the most significant increase in contraceptive uptake in East Kamagambo, following the implementation of Lwala’s community-led health model–from 59% in 2018 pre-intervention to 66% in 2021.
  • Contraceptive implants have become the most commonly used type of contraception, increasing in uptake from 48% to 61%, while use of injectable contraceptives and condoms declined.
  • We still have work to do in increasing access to contraception: in Migori, unmet need among women aged 25 to 29 is 31%, while the national average for the same age group is 12% for married women and 17% for unmarried women (KDHS 2022).
Andria N. Li, Joseph R. Starnes, Alyn Omondi, et al. Prevalence and determinants of contraception utilization over time in Migori County, Kenya: Repeated cross-sectional household surveys, DOI: 10.29063/ajrh2023/v27i6.2
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Family centered early childhood development: a case of Rongo Sub County, Migori Kenya

A study from Kenyatta University reveals the impact of Lwala’s community-led delivery of nurturing care for early childhood development, which brings together 5 interrelated conditions children need to survive and thrive–good health, adequate nutrition, safety and security, responsive caregiving, and opportunities for learning. Community health workers delivered nurturing care through household visits, group parenting sessions, and facility-based education sessions. In sites where nurturing care has been implemented since 2021, research found that:
  • CHWs were effective at reaching households with nurturing care information: 93% of respondents in the intervention area reported they had received advice from CHWs, compared to 43% to 84% in other areas
  • There was a significant increase in caregiver’s knowledge of child rights and abuse in the intervention area
  • More children under 4 had play materials available to them, increasing from 69% to 86% of children in the intervention area
  • 91% of children in the intervention area had been breastfed and introduced to complementary foods according to the best practice, compared to 79% to 84% in other areas
Mwoma T, Omondi P, Mudhune S, et al. Family centered early childhood development: a case of Rongo Subcounty, Migori Kenya. Pregnancy Child Birth. 2023;9(3):86-96. DOI: 10.15406/ipcb.2023.09.00284

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Under-five mortality in Rongo Sub-County of Migori County

A peer-reviewed study of under-five mortality was published in 2018 in the journal PLOS One. Results show that prior to Lwala’s intervention 105 children under 5 died for every 1,000 live births. From 2012 to 2017 that rate dropped to 29.5 deaths per 1,000 live births.

Lwala’s rates outperformed the most recently reported under-5 mortality rates for our region, Nyanza Province (82 per 1,000) and for Kenya as a whole (52 per 1,000). Lwala is within reach of the Sustainable Development Goal of 25 deaths per 1,000 live births.

To build on this study, we are partnering with Vanderbilt Institute of Global Health to conduct a quasi-experimental program evaluation. We are collecting repetitive cross-sectional survey data across ~7,000 households, tracking key indicators, including under 5 mortality.

Joseph R. Starnes et al., "Under-five mortality in Rongo Sub-County of Migori County, Kenya: Experience of the Lwala Community Alliance 2007-17 with evidence from a cross-sectional survey," PLoS ONE 13 (Sept 2018): doi:10.1371/journal.pone.0203690
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Knowledge of Obstetric and Neonatal Danger Signs among Community Health Workers

A recently published peer-reviewed study compared Lwala professionalized CHW’s to status quo CHW’s. It found that the professionalized cadre was:

  • Trained twice as frequently
  • Retained 40% longer
  • 5 times more likely to be knowledgeable of health danger signs

Importantly, formal education level was not a predictor of CHW knowledge.

Lwala is leveraging this and other evidence to support policymakers to design more effective community health systems in Kenya and beyond.

Sarah A. Heerboth et al., “Knowledge of Obstetric and Neonatal Danger Signs among Community Health Workers in the Rongo Sub-County of Migori County, Kenya: Results of a Community-based Cross Sectional Survey,” African Journal of Reproductive Health 24 (March 2020): doi:10.29063/ajrh2020/v24i1.13.
READ THE STUDY

Determinants of Modern Contraceptive Prevalence and Unplanned Pregnancies

A peer-reviewed study of contraceptive prevalence used regression analysis to identify factors associated with increased contraceptive use. The study compared Lwala communities alongside four similar locations and found that living in a Lwala community significantly increased the odds of using a contraceptive method. Importantly, this study also gives Lwala and the Kenya Ministry of Health more insight on how to target our most vulnerable populations, especially younger people.

Troy D. Moon et al., “Determinants of Modern Contraceptive Prevalence and Unplanned Pregnancies in Migori County, Kenya: Results of a Cross- Sectional Household Survey,” African Journal of Reproductive Health 25 (Feb 2021): doi: 10.29063/ajrh2021/v25i1.4.
READ THE STUDY
  • Household Visits

  • Childhood Immunization Rate

  • Health Facility Assessment Scores

Why CHWs are so important

Jane, a new mother, knew something was wrong with her month-old son. He wouldn’t stop crying, and it seemed he was struggling to breathe. While Jane was pregnant, she had attended a parenting class led by community health workers (CHWs), and she remembered these as danger signs of illness in infants. 

Jane spoke with her mother, who agreed it was best to call their CHW, Rose. CHWs are trained to counsel families on newborn care, recognition of danger signs, and the importance of prompt care-seeking during household visits. This training enabled Rose’s swift response when she visited Jane and her baby. Rose assessed the newborn, and knew she needed to refer him to a health facility, where he was diagnosed with pneumonia and treated. Rose followed up during household visits to support the treatment regimen recommended by the nurse.

Jane and her baby offer us hope for the care CHWs can provide–the baby is now fully recovered from pneumonia. “As a young mother, I was concerned about making the wrong choice for my baby’s health,” Jane says. “That’s why CHWs are so important–because of the health messages they spread and the care they give. They offer solutions that are possible for my family.”

Agency, health, and wholeness of life.

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