In 2010, Kenya made a bold commitment to gender equity, enshrining equal opportunity for men and women in its constitution. Since then, policies have aimed to close economic gaps, increase political representation, and reduce gender-based violence–but progress hasn’t reached everyone equally. In the counties where Lwala works, women still face limited autonomy over their health– maternal mortality rates remain disproportionately high, contraceptive needs go unmet, and 40% of women report distance to a health facility as a barrier. Social norms in western Kenya often require women to seek permission from male family members to access care, and when preventable deaths persist, trust in the health system erodes–keeping women sidelined from essential services.
At Lwala, we believe that improving women’s health improves health for all. Yet in Kenya, too many women remain on the margins of the health system. Tackling maternal mortality and other threats to women’s health requires confronting gender inequity head-on—from who delivers care, to who designs it, and who holds the power to change it. We aim to build a gender-equitable and community-led health system that meets the unique needs of women and girls–where women aren’t just patients, but leaders shaping healthier communities for all.
To do this, Lwala embeds gender equity across every pillar of our model: professionalizing a predominantly female cadre of community health workers to deliver high-quality care, equipping health care workers and facilities to manage maternal health emergencies with compassion and excellence, and ensuring gender-equitable community health committees lead decision-making and accountability. Our strategy leverages people, practice, and power to help build and sustain gender equity within the health system itself.
People: professionalizing health workers to save lives
Community health workers (CHWs), remain the primary touchpoint between women and care. CHWs walk alongside women, supporting them with family planning, antenatal care, safe deliveries, postpartum wellness, and raising healthy children. Yet, only 14% of CHWs in Africa are salaried. In Kenya, 70% of which are women–and in spite of government commitment to pay CHWs, inconsistent payment exacerbates gender and wealth disparities.
Strengthening the health workforce isn’t just about employment, it’s about unlocking women's power within the system. Our community-led health model professionalizes CHWs, ensuring they are paid, trained, equipped, and supervised to bring quality care to patients' doorsteps. To date, we have trained 8,300 CHWs across Migori, Homa Bay, and Baringo. Kenya’s 2023 landmark legislation was a huge step forward for paying over 107,000 CHWs nationwide, but as this movement takes hold, female CHWs who have long served their communities as volunteers risk being pushed out by men entering the workforce.
“It’s our job to recognize the labor and experience of women who have long upheld our health system,” explains Christine Mugambi, Lwala’s Policy & Advocacy Specialist. To do this, Lwala is supporting the government to build a secure registry of all CHWs to help plan, budget, and mobilize resources for the community health workforce–protecting women from unjust termination that undermine their contribution as a cornerstone of care.
Education and literacy requirements have often excluded women from the community health workforce based on privilege, not potential–shutting out trusted caregivers like traditional birth attendants. Lwala breaks down those barriers, advancing policies that value experience and create pathways for women into the professional workforce. So far, we have trained and professionalized 508 traditional birth attendants across the communities we serve, expanding their roles as birth companions and community advocates for safe delivery. With Lwala’s support, Migori County also launched the Birth Companion Inclusion Strategy and Guide in 2024, an unprecedented framework and significant step towards a more inclusive workforce.
“It’s our job to recognize the labor and experience of women who have long upheld our health system,”
- Christine Mugambi, Lwala Policy & Advocacy Specialist
Practice: empowering providers to protect every mother
Despite national progress, maternal deaths remain high in Kenya–with just 15 of 47 counties accounting for 99% of deaths. Postpartum hemorrhage, the leading cause of maternal death in Kenya, results in an estimated 5,000 maternal deaths each year.
Maternal mortality is not just a health indicator–it’s a barometer of how much a society values women’s lives. In response, Lwala has worked with national and county governments to transform how postpartum hemorrhage is managed across Kenya since 2018. Through our Obstetric Hemorrhage Initiative, we train, mentor, and equip health care workers to respond confidently to emergencies through a bundle of protocols and tools, saving lives and ensuring that women access skilled, dignified care in facilities. As a training partner to the Ministry of Health, we are working with national and county governments to scale this work to 15 counties by 2028–so far, we have trained 6,282 health workers and 940 health facilities, and established formal partnerships with 12 counties. In Migori, preliminary data from a study led by the University of California, San Francisco evaluating our intervention shows a 49% decrease in maternal mortality.
Central to this work is ensuring that these practices are included in government policies. After piloting this initiative and pioneering the first countywide rollout of lifesaving tools like the non-pneumatic anti-shock garment, we helped update Kenya’s national training curriculum so every new health worker learns to respond to obstetric emergencies. We also helped drive the inclusion of priority maternal health products in Kenya’s 2024 Essential Medicines List. Now, Lwala is working with the Ministry of Health, Kenya Medical Supplies Authority, which manages national procurement and distribution of medicines, and other partners to ensure consistent supply and nationwide access.
Power: positioning women as health leaders
Recognizing women’s contributions to the workforce is essential, but realizing their full potential means shifting power. Lwala positions women as leaders in health decision-making spaces, addressing the male dominance that often shapes governance and health priorities.
A key lever is gender representation in community health committees, ensuring women’s voices shape decisions and no longer slip through the cracks. In the communities where we work, women represent half of all committee members. With Lwala’s support and training, these committees hold government accountable, advocate for increased health spending, and influence county planning and budgeting to reflect women’s and girls’ needs. In July 2025, Lwala successfully advocated to integrate a gender lens into the Ministry of Health’s new community health committee assessment tool. The tool will now track performance, collect gender-disaggregated data, and generate evidence of how gender representation strengthens local health governance nationwide. By working hand in hand with government to turn policy into practice, we’re creating comprehensive tools and action plans that drive measurable change.
We also host targeted interventions–like integrating gender equity curriculum in committee trainings and male-focused forums for sexual and reproductive health–to invite men as changemakers in their communities and challenge harmful norms.
“We challenge each other, learn from each other, and are able to come up with better solutions to the health problems in our community. Gender equity isn’t about taking space from men—it’s about creating space, together.”
- Caleb Jackoyo Jatelo, Kanyasa Ward Community Health Committee Member
When women are trusted as caregivers, trained as professionals, and supported as leaders, they don’t just access better care–they shape it. In partnership with Community Health Impact Coalition, Lwala has trained a growing cadre of 1,566 CHW advocates to represent the needs of frontline workers in decision-making spaces and steer policy change at county and national levels. These advocates bring their voices to high-level forums like county and national government assemblies, the World Health Assembly, and Skoll World Forum, driving the global agenda for community health investment and political commitment.
Internally, Lwala holds itself to the same standards: 96% of staff are Kenyan, 67% are hired from the communities we serve, women make up 53% of all staff, and women hold 64% of senior leadership. Our female-chaired board is similarly representative, with women holding 54% of our board seats. Our team mirrors the communities we serve, and that connection enhances both trust and impact.
Shaping systems that serve women
Lwala is not only improving health outcomes–we are building a health system where women and girls are decision-makers, community voices shape accountability, and every level of care reflects dignity. We are proving that when women lead, health systems work for everyone.
