Judith Owano walks through her village with a smartphone in her hand and a health kit slung over her shoulder. Every week, she meets with her supervisor to review household visits and manage complex cases. Judith is trained and paid as a community health worker (CHW)–the first link between her community and Kenya’s health system. When she began in 2009, she worked as an unpaid volunteer without supplies or supervision. “I had responsibilities at home, but I also felt a duty to my community,” she recalls, a dilemma thousands of CHWs faced for decades.
That reality is now changing. Kenya is advancing CHW professionalization, built on years of advocacy by CHWs, government, and coalitions. This shift rests on paying, training, supervising, and equipping every CHW. Lwala transforms this national vision into a household reality, providing evidence, expertise, and implementation support.
Dignity of labor: securing fair pay
The passage of the Primary Health Care Act in 2023 codified CHW payment and community leadership in health, turning CHWs from volunteers into a paid cadre. For Immaculate Ambugo, payment changed her livelihood. "This income helps me to pay school fees for my children,” she says. “It also allowed me to save up enough to take a course in HIV testing and counseling, which I had wanted to do for a long time."
Lwala has played a critical role in turning policy into payment. In 2025, we supported the Ministry of Health in finalizing the national CHW registry, a centralized database that helps ensure every CHW is counted and paid on time. Together, we increased CHW validation from 60% in early 2025 to 90% by December. For the first time, the registry also tracks gender thanks to Lwala’s advocacy, revealing that nearly 70% of CHWs are women–data that will protect women who have long served their communities as volunteers and risk being pushed out as payment takes hold.
We are seeing payments improve: in 2025, national government delivered 100% of its CHW payments to all 47 counties. Over the same time period, county governments made progress on payments: 25% of payments were realized in Migori, 83% in Homa Bay, and 100% in Baringo. Migori and Homa Bay have committed to additional payments–three months and two months, respectively–to ensure CHWs receive their 2025 stipends, despite delays. Lwala takes a multi-pronged approach to strengthening county financing: in Migori, we supported a phased transition to county-led payments by engaging the County Assembly on budget allocations and facilitating learning visits with other counties. In Homa Bay and Baringo, we combined targeted engagement with health and budget leaders and worked with CHW advocates and Dandelion Africa to protect stipends from reallocation. Across all three counties, we are supporting counties to forecast their share of CHW stipends in county budgets and account for delays in national treasury transfers. This includes expanding registration in the Social Health Authority, which reimburses facilities and boosts revenue, and implementing the Facility Improvement Financing Act to expand local decision-making of facility revenue.
"This income helps me to pay school fees for my children. It also allowed me to save up enough to take a course in HIV testing and counseling, which I had wanted to do for a long time."
- Immaculate Ambugo, Community Health Worker, Suna East Subcounty
Precision at every doorstep: training and supervision
To serve as the health system’s frontline, CHWs need standardized skills and ongoing training. Lwala supported the development of Kenya’s national CHW curriculum, equipping CHWs to triage malaria cases, identify maternal danger signs, and use diagnostic tools like blood pressure machines and glucometers. We also co-developed advanced modules in the curriculum on mental health and disability, digital health, and supply chain.
In parallel, Lwala works with traditional birth attendants and trains them alongside CHWs as champions of maternal and child health. To date, Lwala has supported the training of over 8,300 CHWs across Migori, Homa Bay and Baringo counties.
For Rose Mango, the impact is confidence. “I know what to do, what to say, and when to refer,” she says. “Now, I don’t fear entering a household because I am equipped with knowledge on how to support them to make informed decisions about their health.”
Quality care also requires structured, supportive supervision, which Lwala works to standardize nationally. We helped develop national guidelines for supervising and mentoring CHWs, and we are partnering with the Kenya Medical Training College to train supervisors. As a result, 99% of CHWs reported receiving supportive supervision across all three counties in a phone survey conducted by Lwala.
“I know what to do, what to say, and when to refer. Now, I don’t fear entering a household because I am equipped with knowledge on how to support them to make informed decisions about their health.”
- Rose Mango, Community Health Worker, Uriri Subcounty
Equipped to act
This confidence from training and supervision is matched with the right equipment. Professional CHW kits–containing diagnostic tools like digital blood pressure monitors, malaria rapid diagnostic tests, and basic medicines–allow CHWs to triage cases accurately. Judith recalls identifying a malnourished child using a simple color-coded screening tape.
“We took the child to the facility,” she says. “The boy is in grade two now—a life saved because I was equipped to see what once went undetected." Without reliable equipment, even the best-trained CHW is left unable to act. To sustain this care, Lwala pushes for reliable kit replenishment nationally and works with county governments to expand and protect budget lines for essential health commodities.
Physical tools enable CHWs to act in the moment; digital systems ensure care is tracked, coordinated, and sustained at scale. For decades, CHWs kept track of their clients using a paper register. Lwala was a key partner in co-developing and rolling out the national electronic Community Health Information System, a digital platform owned by the national government to digitize Kenya’s community health workforce. 107,000 CHWs are now enrolled in the platform, standardizing care, prompting referrals for services like immunizations and antenatal care, and automatically flagging high risk cases.
“We took the child to the facility. The boy is in grade two now—a life saved because I was equipped to see what once went undetected."
- Judith Owano, Community Health Worker, Suna East Subcounty
Amplifying CHW voices
Payment, training, equipment, and supervision are essential, but realizing their full potential means shifting power into the hands of CHWs. Lwala positions CHWs as leaders in health decision-making by training them as advocates, supporting them to organize into networks that can shift policy, and amplifying the movement for CHW professionalization beyond Kenya’s borders.
Lwala has trained more than 2,800 CHWs as advocates to represent the needs of frontline workers in high-level policy spaces, joining over 10,000 trained globally with Community Health Impact Coalition. "We are not speaking for them anymore—they are speaking for themselves”, explains Christine Mugambi, Lwala’s Policy & Advocacy Specialist. “They can stand next to ministers and directors and give feedback based on lived experience."
CHW advocates are proving their impact: in Baringo, CHW advocates successfully influenced the county’s budgeting process to prioritize consistent CHW payments. CHW advocates also took to the national stage to provide feedback on regulations for the Primary Health Care Act, and contributed firsthand perspectives to the World Health Organization’s CHW Curriculum launched in December 2025. Empowering CHWs to speak out strengthens policies, improves services, and leads to better health outcomes.
Protecting gains and looking ahead
The impact of all these pillars is visible at the household level. In Migori and Homa Bay, household registration is nearly 100%, more than 70% households are visited by a CHW each month, and skilled deliveries are above 90%. In Baringo, household registration has doubled in one year–from 31% in December 2024 to 72% one year later–and household visits increased from 28% to 45% over the same time period.
Kenya has shown that when you invest in the person at the doorstep, you transform the health of a nation. By paying, training, equipping, and supervising CHWs–and empowering their leadership–Kenya is building a resilient health system that reaches every household. As Judith reflects, she is no longer just a neighbor helping out–she is a professional making Universal Health Coverage real.
