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

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.

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.

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.

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.

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.”