Lwala Community Alliance

If people mistrust the health system, building a hospital is not going to bring them better health on its own. That realization built Lwala Community Alliance into what it is today, a complex, community-led health system serving nearly 3 million people across multiple Western Kenya counties. In 2007, two Lwala-born brothers who lost their parents to HIV while studying medicine on scholarships in the United States, came back home to build the community hospital their father had begun to organize with local donations of land, resources and labor. The people it meant to serve didn’t necessarily trust the health care system, especially given the hours of effort that can be involved in even getting to a clinic from remote places. It quickly became obvious that a multiplicity of factors were involved in creating a viable system, and it had to start in the heart of it all: the community itself.

Community Health Workers (CHWs) became the critical segue between the hospital and the people, as well as the most important source of information for everything Lwala did. Alongside Community Health Committees, they helped develop the 3-pronged community-led health model Lwala uses today, recognizing gaps along the way and correcting them as they went, to establish a full system that is now trusted to deliver quality care at every level of the healthcare system.

The three pillars of Lwala’s model are underpinned by data and policy advocacy. Field data from visits is integrated with university-backed research and population surveys to drive new initiatives and make informed system decisions. This results in self-determining, government supported health care relevant to the needs of each community.

The first pillar is the strengthening of Community Health Committees so they are fully representative of their population, including women and marginalized members, and trained in best practices for their task of leading initiatives and holding their local health system accountable for delivery. As Julius Mbeya, Co-CEO of Lwala Community Alliance, says, “Our organization was founded by a community coming together, not through some outside force, and there’s a power that comes from that.” Each expansion into a new community therefore starts there, with assessment, committee member adjustment if needed, training, and ongoing mentoring.

The second pillar is the professionalization of CHWs through training, supervision, and equipping them with appropriate skills, supplies, and digital tools. After many years of advocacy, the CHWs are being paid by local and national governments for the first time, and a standard curriculum which Lwala helped develop is being used for certification. This was a major win in the effort to translate community-expressed needs into transformational policy changes in the government. Traditional Birth Attendants, also known and trusted in their communities, are trained and deployed when appropriate. Since the majority of CHWs are women, their professionalisation contributes greatly to increasing gender equality. A mobile phone based digital platform for house visits has also recently been deployed to over 100,000 CHWs across Kenya, enhancing not only their effectiveness but the health system’s data collection and analysis.

These feed into the third pillar, the enhancement of care at health facilities, for which the original Lwala Community Hospital serves as a center of excellence.

A main focus area for Lwala is maternal and child health. Half of Kenyan women report challenges in accessing care, and 16 million are not the primary decision-makers in their own health care. By including them in the Community Health Committees and professionalizing CHWs and traditional birth attendants, such inequalities are changing. In turn, that cultural shift is being met with substantially improved maternal health interventions. 95% of women deliver at a health clinic, women are 2.6 times more likely to use a contraceptive, and their children are 15% more likely to be fully vaccinated. Further, an emergency maternal and newborn care initiative in 1417 facilities across 20 counties – a three-fold increase over the past two years - is supplying the training and tools needed to respond to obstetric hemorrhage, the leading cause of maternal death in Kenya. 

A fortunate confluence of sweeping government policy changes (including digitization and the payment of CHWs) and significant funding from The Patchwork Collective and ICONIQ Impact’s Maternal and Infant Health Award have allowed Lwala to expand from serving 600,000 people in 2023 to 2.85 million in 2026. Foundational investments by the government  made the grant money go further, and the grant money – unrestricted in how it’s put to use – is allowing Lwala to act on the growth plans it’s developed from years of work. It’s an excellent example of how social innovation, coupled with continual assessment and strong community/government partnership, can create portable, malleable models for successfully rolling out the programs into new areas. In the Baringo area, Lwala is partnering with and funding Dandelion Africa, a women-led organization that brings essential knowledge about the local context to the table.

“It takes years of advocacy, testing and building multiple proof points of evidence, so when a window of opportunity opens you can really advance,” says Julius. “Private philanthropy allows organizations like ours to test all those pilot programs and get them working. Their belief in the possibility of outcomes, and trust in the local organization to have the skills needed, is critical to success.”

The rewards of this work are felt personally by everyone in the organization, which is 96% Kenyan, and its many partners. Born and raised in Western Kenya, Co-CEO Julius experienced many of the same situations as the brothers who founded Lwala. “It’s very satisfying when you see a community change,” he says. “When, in the past, there was a funeral every week, including children. And now you see how a mother giving birth has been saved by healthcare workers having the necessary equipment and training to prevent her from hemorrhaging to death. That’s a very clear win.”

There’s social change, too. “Joy is created in this work. Our people can see how they’re transforming their communities for this and the next generation. They become powerful, positive influencers. They have more than a voice; they are pillars of hope in their families.”

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