Systems Change

Unlocking better health through systems change

Community-led health is uniquely positioned to transform health systems in Kenya and beyond. The status quo of concentrating resources on top-down technical solutions to specific illnesses misses the root cause of poor health. We can create powerful technologies and innovations, but without justice, participation, and accountability, their impact is limited.

Underpinned by our experience and expertise, Lwala is working to change health systems at the county, national, and global levels. We advance policies and legislation that strengthen community health and accountability, develop curricula used to train Community Health Workers(CHWs) and health workers across the country, strengthen data systems to improve decision-making, and elevate CHWs and community members at policymaking tables. We work in coalition to ensure that the health systems of tomorrow are built by community needs.

National policy shifts for systems change

Nationally, we partner with the Ministry of Health to unlock better health for millions of people across Kenya, including adopting evidence-based solutions, changing policy, and packaging community-led health modules nationwide. In 2023, momentum for community health culminated with the President’s official launch of Universal Health Coverage (UHC) for all Kenyans. The President also signed two key pieces of legislation: the Primary Health Care Act, which further strengthens the role of CHWs within the formal health system, and the Facility Improvement Financing Act, which improves the ability of health facilities to direct funds toward community needs.

Advocacy from Lwala helped shape these new laws, and our work is ongoing–it’s up to partners like Lwala to translate these policies into real change for communities across Kenya.
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Digital solutions for community health

Lwala works alongside the national government to ensure that all CHWs have the tools they need to make their jobs easier. The electronic Community Health Information System (eCHIS), a new digital platform owned by the national government, was developed to digitize Kenya’s community health workforce and advance Universal Health Coverage. Using the eCHIS platform, CHWs can manage caseloads from their phones, and information can be aggregated at the local, county, and national levels to be used for decision making. Lwala was a key partner in developing eCHIS at the national level, and we are also supporting its rollout in Migori County. As of early 2024, the government and its partners have invested USD 120 million to digitally equip, train, and deploy eCHIS to over 100,000 CHWs in 42 of 47 Kenyan counties.

Now equipped with eCHIS, CHWs have access to a common community health data system and can transition from a paper-based to an electronic system. The national rollout of eCHIS is part of a much larger vision Lwala holds in professionalizing CHWs in Kenya–where they are paid, trained, supervised, and equipped with digital tools and commodities.
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Advancing community-led health across counties

Lwala was founded in Migori County in 2007–since then, Migori has become a model county for community-led health, paving the way for others. In the context of devolution in Kenya–a constitutional shift that increases county responsibility for health service delivery–neither scale nor systems change can happen through national initiatives alone. We work in deep partnership with counties and communities to design interventions that can be adopted and scaled through the formal health system.

In early 2024, Lwala expanded our community-led health model into Homa Bay and Baringo Counties. Across Migori, Homa Bay, and Baringo, we support government to strengthen the community health workforce, bolster community accountability, and improve quality of care in health facilities. We are visioning new ways to partner with government through co-implementation–we collaborate with government to develop work plans, and then the government leads service delivery, while Lwala promotes policy change, supports activities, backstops data collection and analysis, co-develops tools, and offers thought partnership. Additionally, we have forged partnerships to expand our work on obstetric emergency care in 6 counties: Migori, Homa Bay, Baringo, Kilifi, Mombasa and Garissa.
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As CHW advocate, I want to be at the table when the decisions about us and our communities are made. As the saying goes, nothing about us without us.”

-Millicent Miruka, Community Health Worker supported by Lwala

Building a movement for better health

Creating significant, system-wide change requires movement building. Lwala works through coalitions like Community Health Impact Coalition and Community Health Units for Universal Health Coverage, bringing together government officials, implementing partners, and civil society to make health systems work better for communities. Together, we test new solutions, gather community input, and change health policies, bridging the gap between communities and policymakers.

Through these partnerships, we can ensure that local solutions are translated into policies and systems that improve community-led accountability, strengthen the community health workforce, prevent maternal and child deaths, and promote the overall well-being of our communities.

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Agency, health, and wholeness of life.

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