In this study, we analyzed data from communities served by Lwala and comparison sites to understand the factors associated with skilled birth attendance and the effect of Lwala’s community-led health model on maternal health outcomes. We found that: 

• Lwala’s community-led health interventions improved skilled delivery rates. Rates of skilled delivery also increased in comparison sites, but a difference in differences analysis found that the gains in Lwala-supported communities were significantly higher.  
• The highest rates of skilled birth attendance were in North Kamagambo, where Lwala has implemented community-led health the longest–95.5% of women in 2019 and 98.2% of women in 2021 delivered with a skilled provider. 
• Skilled birth attendance was significantly associated with attending 4 or more antenatal care visits, underpinning the important role community health workers (CHWs) play in connecting women to services. Higher education status, marriage, and wealth were also associated with skilled delivery. 

These results demonstrate how community-led health improves maternal health outcomes–CHWs monitor pregnancies and encourage women to deliver at facilities, health providers are trained and equipped to provide high-quality care, and community groups hold the government accountable. Armed with this evidence, we will continue to advocate for policies and systems that advance community-led health Kenya.

Read the study here.

Common selection criteria for CHWs–such as literacy tests and formal education requirements–risk excluding women, traditional birth attendants, and other marginalized groups. A study from Lwala and 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.

Read the study here.

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.

Read the study here.

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.

Read the study here.

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. Note: At the time of the study, NHIF was Kenya's national health insurance scheme. It has since been replaced by the Social Health Authority (SHA).

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

Read the study here.

A recently published peer-reviewed study compared Lwala professionalized CHWs to status quo CHWs- who have historically been unpaid, under-trained and under-equipped. 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.

Read the study here.

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.

Read the evaluation here.

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).

Read the study here.

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.

Read the study here.

A cross-sectional survey by Lwala identified factors associated with interpersonal violence among women across Migori County, Kenya. The survey found that IPV prevalence in Migori is high, pointing to the need for interventions that address social and gender norms that perpetuate IPV. This study can guide policy interventions and community level response. Other findings include: 

• In Migori County, Kenya the lifetime prevalence of interpersonal violence was estimated to be 36.7%. This is 1.2 times higher than the global average (27%), 1.12 times higher than the average in sub-Saharan Africa (33%) and similar to Kenya’s national average (38%) in 2018. 
• Interpersonal violence was more prevalent among women who had been widowed/divorced/separated, exposed to interpersonal violence in childhood, and were experiencing severe depression.
• Women who had experienced interpersonal violence were less likely to attend 4 or more antenatal care visits or have a skilled delivery, which may lead to poor maternal health outcomes.
• Infants of women who have experienced interpersonal violence were at higher risk for preterm birth, low birth weight, and neonatal death.  

Read study here.

This peer-reviewed study examined the long-term impact of teenage pregnancy on women's health and economic wellbeing in western Kenya. Using data from 6,089 mothers in Migori County, researchers compared adult outcomes among women who became mothers as teenagers with those who first gave birth as adults. The study found that:

• Nearly 47% of women surveyed became mothers during adolescence. Of this group, 31% had one child and 14% had two or more children before age 20.
• Compared to adult mothers, teenage mothers had significantly lower educational attainment. Women who had two or more children during adolescence were half as likely to complete primary school.
• Teenage mothers were more likely to experience financial hardship in adulthood, including taking out loans to meet household needs, experiencing food insecurity, and living in less wealthy households.
• Children of teenage mothers experienced worse health outcomes. Women who had two or more children during adolescence were 4.5 times more likely to have experienced the death of a child compared to women who first gave birth as adults.
• Teenage mothers also reported poorer mental health and were more likely to experience short birth spacing, increasing risks for both mothers and children.

The findings highlight the lasting consequences of adolescent pregnancy and reinforce the importance of expanding access to contraception, youth-friendly reproductive health services, and support systems that enable young mothers to continue their education and thrive.

Read study here.

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.

Read the study here.

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 three times more likely to seek care for a child with a fever.
• Households visited by community health workers were two 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.

Read the study here.

This study reveals the impact of Lwala’s community-led delivery of nurturing care for early childhood development, which brings together five 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% - 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-four 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% - 84% in other areas.

Read the study here.

Neonatal infections–including sepsis, meningitis, pneumonia, and diarrhea–are a leading cause of death. From November 2020 to August 2021, Bill and Melinda Gates Foundation-supported partners in Ethiopia and Kenya implemented community-based treatment of possible serious bacterial infection (PSBI) when referral to a higher facility is not possible. Implementation research found:

• In Kenya, community health workers assessed more than 10,000 newborns for danger signs in the study period, representing an 81% coverage rate. Of newborns assessed, 12% had signs of PSBI and were referred to the nearest primary health facility. 
• An increasing number of infants were assessed by CHWs and treated at primary health facilities over the course of the study: from July 2021 to June 2022, the study found a 51% increase in assessments and a 49% increase in treatment of sick young infants. 
• This work was associated with the strengthened oversight of county health systems over community and primary-level services, as well as improved linkages between CHWs and health facilities.
• Critical barriers remain, however, including lack of community trust in the health system and a shortage of supplies essential in delivering PSBI services.

Read the study here.

A study from Kenyatta University reveals the impact of Lwala’s community-led delivery of nurturing care for early childhood development, which brings together five 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% - 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-four 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% - 84% in other areas

Read the study here.

A 2024 report by The Bridgespan Group highlights Lwala in answer to a question shared by many funders: what community-driven change approaches have lasting and equitable impact? One of the report’s case studies highlights our community-led health model and how it builds ownership and improves health outcomes. The report emphasizes Lwala’s strengths in:

• Strengthening local leadership to foster community-led health solutions–translating into improved health outcomes.
• Facilitating a shared vision and collective ownership through local decision-making platforms like community health committees. 
• Integrating equity into program design–such as our advocacy to remove discriminatory recruitment practices for community health workers and uplifting youth-led sexual and reproductive health.

Read the report here.

A 2024 article by The Nation highlights the work of Community Health Units for Universal Health Coverage (CHU4UHC)–a coalition Lwala helped co-found in 2020–and our efforts to catalyze community health throughout Kenya. In partnership with the Ministry of Health, CHU4UHC has been at the forefront of driving CHW professionalization and the launch of the electronic Community Health Information System (eCHIS), as well as creating an enabling environment and policies to advance high-quality community health services.

Read the article here.