On a sleepy Sunday morning in South Kamagambo, by the shores of Lake Victoria in southwest Kenya, two dozen young women attend an outreach event to learn about family planning. “I don’t want to get pregnant while I’m in school,” says an attendee. “I came here today to ask questions about preventing pregnancy and maybe even start on family planning.”

The event was sponsored by the Lwala Community Alliance, a nonprofit founded in 2007 by community members aiming to reduce maternal mortality and the risk of HIV in Kenya’s Migori County. 

Lwala’s role in community-driven change 

The young women at the outreach event came to learn about sexual and reproductive health from youth peer providers in a Lwala platform for peer-led learning. Learning from peers has helped “reduce stigma by improving awareness around historically taboo health-care issues,” says a group leader.

Lwala Community Alliance's model is sustainable because it focuses on building community ownership of health-care services.

These peer-led learning groups are just one of the ways Lwala fosters a community-led health model, recognising the importance of community participation in developing sustained and equitable impact.

Why Lwala adopted a community-driven change approach

Lwala set out to establish a hospital for the surrounding community. At the time, there were no health-care facilities nearby. Community members supported the project by providing land, resources, labour, and knowledge. “Today, it is an important community institution,” says Robert Kasambala, Lwala’s chief of staff.  

The story of the hospital, which is staffed by many members of the community, is one that showcases how a pressing need can translate into a shared vision and collective action to improve community well-being. It also signifies Lwala’s launch into a full-scale movement for community-led health care. 

Facilitating a shared vision and collective ownership

Surrounding communities treat the hospital as their own and actively participate in decision-making, which has been instrumental in ensuring access and continued quality of health care. “The evolution of our model is informed by our own founding that saw the community come together to solve a problem,” says Julius Mbeya, Lwala’s co-CEO. 

“The community got together to do something about a problem they were facing. Without many resources, they used what they had. As we have grown beyond our founding community, we have had to ask ourselves: how can we continue to amplify and incorporate community voices in all we do? Through this we have found … structures for community engagement that we continue to strengthen and use to amplify community voices.”

Lwala’s annual planning process involves consultations and dialogues with the communities it works in to understand their needs and collaborate on solutions. The organisation believes in the importance of strengthening community representation in health-care decision-making, recognising that communities know their own challenges best.

An important differentiating aspect of Lwala’s model is its focus on strengthening existing community decision-making platforms, including government-mandated health committees (responsible for coordinating and managing community health units) and barazas (community meetings) led by traditional leaders. These forums enhance the community’s voice and participation in the planning of health initiatives and systems. 

Community health committees are elected by the communities they serve. This builds collective accountability and transparency. The committees identify challenges and bring them to the fore to shape community action plans. “[During] community dialogues, we give [the community] first priority to identify what they’re in need of, whether it is a water point or latrine or any other need, and to decide what the collective priority should be,” says a health committee member. 

Strengthening the community’s leadership and asset base

A focus on building leadership, communication, and technical skills (such as proposal writing and budgeting) among community health committee members has been instrumental in fostering community-driven solutions to collectively identified needs. 

One committee member wrote a proposal to local government to establish a water supply point. This was a shared community priority that arose from the absence of accessible and safe water, which affected sanitation and health outcomes. Today, the community owns and manages the water point, illustrating the sustained impact of community-led initiatives. 

Focusing on equity

Lwala integrates equity into its operations through community platforms and an inclusive program design. 

For instance, Lwala helped to develop a more equitable selection process for the community’s health-care workforce. Previously, exclusionary literacy and education requirements meant that traditional birth attendants were not included as community health workers. Now, traditional birth attendants are incorporated into the community health-care workforce and trained as community health workers. An assessment tool also has been created to enable community members to locate birth attendants throughout Migori County. This focus on professionalisation and the inclusion of birth attendants has led to improvements in the community’s overall health outcomes.

Similarly, young people now have access to a network of youth peer providers who educate them on sexual and reproductive health and a range of family planning options. “It is easier to engage youth, as they see us as friends,” says a youth peer provider. “We create sessions with young girls where they are educated and motivated through family planning services.”

Outcomes in communities

Lwala’s model is sustainable because it focuses on building community ownership of health-care services. There has been a 44 percent increase in community health committees that develop annual work plans and a 79 percent increase in community health committees that hold monthly meetings with community health workers to review health data for decision-making. This reflects the increasing ownership that communities have in shaping the quality of care they receive.

This community-led health model has also resulted in improved health-seeking behaviour. Children in Lwala communities are three times more likely to receive health care when sick, specifically with a fever, and 15 percent more likely to be fully immunised. “Lwala’s approach, which focuses on strengthening the community’s capacity to deliver and lead their health-care priorities, has enhanced the community’s voice in health-care planning and improved health seeking behaviour,” says Tom Odhong, the Migori County director of public health.

Half of Lwala’s staff also come from the communities they serve, which is instrumental in ensuring that the communities’ evolving dynamics and needs sit at the forefront of everything they do.