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 level. We advance policies and legislation that strengthen community health and accountability, develop curricula used to train 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.

Our catalysts for systems change

Data

Through digital tools, university-backed research, and population-level surveys, Lwala works with government and communities to explore solutions to health problems.

Policy & Advocacy

By leveraging evidence, experience, and community voice, Lwala advances policy change to strengthen the health system and improve care for communities across Kenya.

National policy reforms for community-led health

Lwala has long been committed to strengthening the health system, professionalizing CHWs, and enabling community accountability to improve health. After years of advocacy and collaboration with partners, the national government passed a series of sweeping reforms in late 2023. First, a landmark Primary Health Care Act formalized the role of CHWs in the health system and codified their right to payment. CHWs in all counties are now being paid, and work is ongoing to strengthen payment mechanisms and consistency. Second, the national government launched the electronic Community Health Information System, a digital platform developed to digitize Kenya’s community health workforce. And finally, the national government distributed standardized kits to equip CHWs with the supplies and medications needed for daily services.

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.

Digital solutions for 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) 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 supported its rollout in Migori County. The government and its partners have digitally equipped over 100,000 CHWs across all 47 counties.

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.

Transforming TRADITIONAL BIRTH ATTENDANTS into champions of skilled delivery

Our research shows that a successful CHW relies more on practical experience, community trust, and a strong dedication to improving the health of mothers and babies than on formal education. Traditional birth attendants (TBAs) have provided health services to communities for generations, but they are often blocked out of CHW cadres by discriminatory literacy and education requirements. Equipped with this evidence, Lwala aims to integrate TBAs into the community health workforce, giving them respected roles for the important care they provide.

We work with governments to map TBAs so that we can understand how many women are actively providing maternal care to which communities. Then we partner with community health committees, CHW supervisors, and local leaders to identify vacant CHW posts that could be filled by a local TBA–and we give TBAs the support and training they need to take on those roles. In late 2024, Migori County government launched the Birth Companion Inclusion Strategy and Guide, structured by a framework for TBA Inclusion co-developed with Lwala.