Lwala-2018-Annual-Report

2018 Annual Report
2018 ANNUAL REPORT | 1 |

04 MODEL & THEORY OF CHANGE
06 SYSTEMS CHANGE
08 CHILD HEALTH
10 MATERNAL HEALTH
12 REPRODUCTIVE HEALTH
16 HIV CARE AND PREVENTION
18 WATER, SANITATION & HYGIENE
19 NUTRITION
20 HEALTH CENTERS OF EXCELLENCE
22 EDUCATION
23 ECONOMIC DEVELOPMENT
24 RESEARCH
25 RESOURCES
26 LEADERSHIP
All names of beneficiaries and their home locations have been changed to protect individual privacy
Photo images do not represent specific narratives in this report
| 2 | 2018 ANNUAL REPORT

LETTER
FROM THE
DIRECTORS
In 2018, we took a bold step in expanding our impact, doubling the population we serve. This is part of a larger effort to build a
model county of community-led health, transforming how the 1 million people in Migori, Kenya access healthcare, and ultimately
influencing the health system at-large.
We are driven to reach more communities facing the challenges of a struggling health system by one of our core values,
neighborliness.
When our founders, Milton and Fred, got the opportunity to study in the US, it was their neighbors that sold chickens and goats
to send them to Dartmouth. And when they returned to fulfill their father’s dream of building a hospital, it was their neighbors
who oversaw the blueprints, donated land, and dredged sand to make it possible. This founding community believed that we are
each other’s keeper.
Over twelve years, we’ve built a holistic health model that is driven by the power of neighbors banding together to make change.
We have seen community committees lobby local government to connect health centers with electricity, ensuring 24-hour
maternity services in facilities that were previously closed at night. We have seen villages launch campaigns to build latrines and
declare their homes open defecation free. We have seen Community Health Workers identify sick children and treat them in their
homes. We have seen neighbors encouraging each other to try a contraceptive method or finally get an HIV test.
The relationship between communities and their health care system is changing – and with it, health outcomes are improving.
This year, we published a peer-reviewed study in a scientific journal, PLOS One, that shows a significant decrease in child death
in Lwala communities. Child mortality has decreased from 105 deaths per 1,000 live births prior to Lwala’s intervention to 29.5
deaths per 1,000 live births in the last five years.
This evidence drives us to engage more communities with our lifesaving model. This next year, we will continue to expand our
direct reach to a population of 90,000. And we’ll remain at the forefront of policy change with the Ministry of Health, to secure
health care for all.
All of this is possible through the support of our neighbors and partners, like you. Thank you for standing with us!
In solidarity,
Ash Rogers
Executive Director
Julius Mbeya
Managing Director
2018 ANNUAL REPORT | 3 |

AGENCY, HEALTH, AND WHOLENESS OF LIFE
FOUNDED BY A GROUP OF COMMITTED
KENYANS, WE ARE BUILDING THE CAPACITY
OF RURAL COMMUNITIES TO ADVANCE
THEIR OWN COMPREHENSIVE WELLBEING
Lwala believes that communities have untapped potential to solve the world’s most pressing health
challenges. We connect community innovation with university-backed research and evaluation to
create drastic improvements in health outcomes.
We leverage our community to lead in the design, implementation, and evaluation of all of our
interventions. Then, we partner with communities, government and universities to build evidence of
impact and infuse these insights into the formal health system. This bottom-up change promises
holistic solutions that are custom-built for the systems they are meant to reform.
| 4 | 2018 ANNUAL REPORT

COMMUNITIES
We start by organizing community
committees to launch their own health
initiatives around water, sanitation,
& hygiene, HIV, reproductive health,
and nutrition. We also train community
members to participate on the
governance committees of public health
centers and equip them to hold the
health system accountable.
COMMUNITY HEALTH WORKERS
We recruit, train, pay, supervise, and
digitally empower transformed traditional
midwives to extend high-quality care
to every home. Our Community Health
Workers track pregnancies, encourage
facility deliveries, ensure on-time
immunizations, test and treat common
childhood illnesses, provide contraceptives,
and connect clients to health centers.
COMMUNITY-LED
HEALTH MODEL
DATA
Real-time data, collected by our
mobile application, enables our team
and government policymakers to make
patient-centered, evidence-based
decisions. This means we’re building
systems that collect data while also
pushing analysis at all levels, from frontline
workers to government officials.
HEALTH CENTERS
We provide onsite quality improvement
support and training to government
health facilities. This support is built around
the World Health Organization’s six health
system building blocks: service delivery,
health workforce, information systems,
supply chain, finance, and governance.
Our approach emanates from our center of
excellence – Lwala Community Hospital.
2018 ANNUAL REPORT | 5 |

Systems change
DEMONSTRATING A COMMUNITY-LED APPROACH
TO TRANSFORMING HEALTH SYSTEMS
Influence
Share research & advocate for
community-led health
Advise
Expand technical assistance
across hotspots of poor health
Model County
1,000,000
Government adoption +
peer replication +
direct service
Current Population Served
90,000
Replication
150,000
Direct service
expansion
Innovation Hub
30,000
Partnership with Kenyan Government
Lwala is committed to supporting Kenya’s ambitions to achieve universal
health coverage. As such, all of our work is done in partnership with the
Ministry of Health at national, county, and local levels. In partnership with
government, we are testing innovations designed for nationwide scale.
In 2018, we are proud to have run the first county-wide pilot of our obstetric
hemorrhage initiative, supported policy change within Migori County to
begin paying Community Health Workers, and shared our joint learning in
national, continental and global forums.
Country
County
Community
| 6 | 2018 ANNUAL REPORT

Kenya
17 clinics served
by obstetric
hemorrhage
initiative
Migori
County
East Kamagambo
2018 EXPANSION
Rongo
Subcounty
North Kamagambo
2007 - PRESENT
INNOVATION HUB
Central Kamagambo
2020 EXPANSION
204
COMMUNITY
HEALTH
WORKERS
7
HEALTH
FACILITIES
143,000
PATIENT VISITS
South Kamagambo
2019 EXPANSION
2018 ANNUAL REPORT | 7 |

Significant Reduction
in Child Deaths
105
child deaths per
1,000 live births
prior to Lwala’s intervention
29.5
child deaths per
1,000 live births
in the last five years 1
CHILD HEALTH
ENSURING EVERY CHILD CELEBRATES A 5TH BIRTHDAY
Children in rural Kenya die at a rate 12 times higher than children in the United States 2 .
Nearly all of these deaths are preventable, with most children dying simply because they
receive healthcare too late.
Lwala is changing this injustice through our community-led health model. Digitally empowered
Community Health Workers enroll every child at birth, track child growth, and ensure on-time
immunizations. They provide home-based screening and treatment for the most deadly childhood
conditions, including malaria, pneumonia, malnutrition and diarrhea. Community Health Workers
also connect children to local health clinics. Lwala works with community members and government
to ensure these local clinics have the resources, training and systems to provide quality care -
making certain that no child slips through the cracks.
| 8 | 2018 ANNUAL REPORT
1
Kenya Demographic Health Survey (2014)
2
Starnes JR, et al. Under-five mortality in the Rongo Sub-County of Migori County, Kenya: Experience of the Lwala
Community Alliance 2007-17 with evidence from a cross-sectional survey. Public Library of Science. 2018:13(9).

PEER-REVIEWED STUDY SHOWS
LWALA WITHIN REACH OF
SUSTAINABLE DEVELOPMENT GOAL
A peer-reviewed study of under-five mortality was
published in 2018 in the journal PLOS One. Results show
that prior to Lwala’s intervention 105 children under 5 died
for every 1,000 live births. From 2012 to 2017 that rate
dropped to 29.5 deaths per 1,000 live births 2 .
While not directly comparable, Lwala’s rates outperformed
the most recently reported under-5 mortality rates for
our region, Nyanza Province (82 per 1,000) and for Kenya
as a whole (52 per 1,000). Lwala is within reach of the
Sustainable Development Goal of 25 deaths per 1,000
live births.
WELL-CHILD VISITS
REGULAR CHECK-UPS FOR
HEALTHY CHILDREN
11,218
LWALA COMMUNITY HOSPITAL
9,972
PARTNER FACILITIES
IMMUNIZATION RATE
PERCENTAGE OF CHILDREN WHO RECEIVED ALL SPECIFIED VACCINATIONS
MIGORI COUNTY
57% 1 94%
2016 LWALA COMMUNITIES
2017 LWALA COMMUNITIES
96%
2018 LWALA COMMUNITIES
97%
1
Kenya Demographic Health Survey (2014)
2
Starnes JR, et al. Under-five mortality in the Rongo Sub-County of Migori County, Kenya: Experience of the Lwala
Community Alliance 2007-17 with evidence from a cross-sectional survey. Public Library of Science. 2018:13(9).
2018 ANNUAL REPORT | 9 |

MIGORI COUNTY
the challenge
1
KENYA 2 3
usa
673 495
17.3
DEATHS PER 100,000 LIVE BIRTHS
MATERNAL MORTALITY
MATERNAL HEALTH
UNLOCKING THE LIFESAVING POWER
OF TRADITIONAL MIDWIVES
Central to our model is the recruitment of traditional midwives. These women have delivered healthcare
to their community for generations. But because traditional midwives have been cut off from the formal
health system, these births are often dangerous for mothers and babies.
We leverage the deep connections of these midwives and train, pay, supervise and digitally empower
them as professionalized Community Health Workers. We transform these midwives from the greatest
competitors of skilled delivery to the formal health system’s greatest champions.
Lwala Community Health Workers identify pregnant women as they proactively visit homes in their
village. Then, they link mothers to the formal health system by identifying symptoms of high-risk
pregnancies, ensuring adequate maternal nutrition and encouraging safe delivery at a facility. They also
follow-up on postpartum care, provide breastfeeding support and counsel new mothers on a range of
contraceptive options.
| 10 | 2018 ANNUAL REPORT
1
UNFPA. Counties with Highest Burden of Mortality (2014)
2
Ibid.
3
Center for Disease Control and Prevention (2013)

percentage of WOMEN WHO ATTENDED
4+ prenatal CARE VISITS
58% 1
Kenya
61%
78%
2016 2017
lwala communities
80%
2018
LWALA COMMUNITY
HEALTH WORKERS ARE
2.5X
MORE LIKELY
TO BE KNOWLEDGEABLE OF THE
DANGER SIGNS IN PREGNANCY AND
EARLY INFANCY THAN STATUS QUO
COMMUNITY HEALTH VOLUNTEERS 2
percentage of skilled deliveries
LWALA PRE-2011 - 2018
92%
96%
94%
97%
97%
97%
98%
62% 1
53% 1
47%
26%
Kenya Migori
PRE-2011
2011 2012 2013 2014 2015 2016 2017
2018
County
lwala communities
Ensuring Mothers Survive Childbirth
Obstetric hemorrhage (uncontrolled bleeding) is the leading
cause of maternal death in Kenya. Even if a mother delivers
at a health facility, this condition may require that she receive
surgical or higher level care to save her life. In an environment
with poor infrastructure and limited emergency transportation,
many mothers don’t make it to lifesaving care in time.
In response, Lwala partnered with University of California San
Francisco and the Ministry of Health to deploy the low-cost
technology of the non-pneumatic anti-shock garment. When
applied to a woman in shock, the device provides 72 additional
hours to get the mother to advanced care.
We are deploying this life-saving intervention across Migori County.
59%
REDUCTION IN
MORTALITY AMONGST
PATIENTS IN SHOCK 3
17
FACILITIES REACHED
166
HEALTH WORKERS
TRAINED
1
Kenya Demographic Health Survey (2014)
2
Heerboth S, Hennessy C, Omondi B, Moja M, Mbeya J, Rogers A, Ressler D, Davidson M, Moon T. Knowledge of Obstetric and Neonatal
Danger Signs among Community Health Workers in the Rongo sub-County of Migori County, Kenya: Results of a community-based
cross-sectional survey. 2018. (Unpublished Manuscript)
3
Mbaruku, Godfrey, et al. “Implementation Project of the Non-Pneumatic Anti-Shock Garment and m-Communication to Enhance Maternal
Health Care in Rural Tanzania.” Reproductive Health, vol. 15, no. 1, 2018,
2018 ANNUAL REPORT | 11 |

REPRODUCTIVE HEALTH
WORKING WITH COMMUNITIES TO PROMOTE HEALTHY
TIMING AND SPACING OF BIRTHS
When women and couples have the tools to choose when they get pregnant, the result is better
health outcomes for mother and child.
Lwala understands that while women and girls may have a desire to access reproductive health
services, relatives and community leaders are often the gatekeepers to these services. Thus, we
increase confidential access to services, while challenging social norms and increasing buy-in
for reproductive rights.
We start by training and empowering community committees, male forums, Community Health
Workers, and youth advocates. Each of these groups plans and launches their own reproductive
health initiatives to educate their neighbors, distribute and promote contraceptives, and confront
cases of abuse.
the challenge
Regional Average 1 Kenya 17% 2
usa 3
23% 17% 9%
Unmet need for contraceptives
Percentage of women of reproductive age who want to stop
or delay childbearing but are not using contraceptives.
| 12 | 2018 ANNUAL REPORT
1
Kenya Demographic Health Survey (2014)
2
Ibid.
3
The World Bank: Unmet need for contraception (2014)

I wanted to preserve my health and focus
my love on raising my four sweet children
– FAITH, MOTHER OF 4
Faith had tried long-term contraceptive methods, but experienced side effects and wanted a
permanent solution. Her Community Health Worker shared information on a full range of options and
Faith chose to have a tubal ligation at Lwala Community Hospital. She was so pleased with the results
that she began sharing her experience with friends and neighbors. Faith spoke at Lwala outreaches
and in community meetings, answering questions and debunking misconceptions. Thanks to Faith’s
courage and community advocacy, 12 women followed her lead and selected tubal ligations.
contraceptive prevalence rate
PERCENTAGE OF WOMEN USING CONTRACEPTIVES
58% 1
44% 2
62% 3
78% 4
Kenya
Migori county
Lwala Communities 2016
Lwala Communities 2018
Reproductive Health
Service Visits by Youth
13,300
couple years of protection
A MEASURE OF BIRTH CONTROL
PROVIDED, BASED ON THE NUMBER
OF YEARS OF PREGNANCY PREVENTION
IT PROVIDES
14,833
6,600
8,100
5,771
9,291
3,477
2016
2017
lwala communities
2018
2015 2016
2017
lwala communities
2018
1
Kenya Demographic Health Survey (2014)
2
MEASURE Evaluation Pima (2016)
3
Lwala Community Alliance Household Survey (2017)
4
Lwala Community Alliance Household Survey (2018)
unweighted data, subject to change.
2018 ANNUAL REPORT | 13 |

| 14 | 2018 ANNUAL REPORT

I’m grateful for the team that
helped me get surgery during
my strenuous labor. Without
that support, I’m afraid my
life or the life of my baby could
have been lost. – LYNN, MOTHER OF 4
When Lynn realized she was pregnant with her fourth child,
she contacted her Community Health Worker, Susan. Just
like with Lynn’s previous 3 pregnancies, Susan visited Lynn
regularly, helped her keep track of prenatal care visits and
screened her for common warning signs.
Susan is Lynn’s neighbor and before training with Lwala she
delivered babies in her home as a traditional midwife. Now,
Susan provides her clients higher quality care with the support
of a mobile application, consistent supplies for testing and
treatment, a dedicated supervisor, and a team of nurses at the
health center.
At the early signs of labor, Susan accompanied Lynn to the
health center. However, the labor was strained and the
clinician determined it was unsafe for Lynn to deliver vaginally.
Lynn was referred to a higher-level hospital and the Lwala
ambulance transported her rapidly. Qualified surgeons
performed a successful cesarean section and Lynn soon
returned home with a healthy baby girl, Mary.
Following the birth, Susan visited Lynn and Mary every week.
She tracked Mary’s growth and checked for complications,
paying special attention to signs of infection at Lynn’s incision
site. Mary is now two months old, has gained nearly 3 pounds
and has received her first round of vaccinations.

HIV CARE AND PREVENTION
BUILDING AN HIV-FREE GENERATION
Migori County is among the five counties with the highest HIV incidence rates in Kenya 1 .
Despite major advancements in HIV prevention and care in other regions of the country,
Migori County has lagged behind 2 .
Lwala’s comprehensive HIV programming empowers people living with HIV to lead
healthy, productive lives, while eliminating new infections. All HIV–positive individuals in our
communities are encouraged to join a program called HAWI (“Good Luck” in Dholuo). HAWI
groups are trained in critical health topics and community organizing. Participants provide
psychosocial support to each other and launch health initiatives in their communities. Each
participant in HAWI is regularly visited by a Community Health Worker.
| 16 | 2018 ANNUAL REPORT
1
NASCOP. Kenya AIDS Response Progress Report (2018)
2
NASCOP. Kenya HIV Estimates Report (2018)

aids-free generation
97% 99% 93%
POPULATION
TESTED
ENROLLED
IN CARE
SUSTAINED
THERAPY
The global UNAIDS target is to reach 90-90-90 by 2020.
I was terrified by my HIV diagnosis. But, through the
support of my community, I regained the bright dreams
I had for my baby. – EDNA, MOTHER OF 5
When Edna visited Lwala Community Hospital early in her fifth pregnancy, she was
shocked to learn that she was HIV–positive. She wondered if HIV was the cause of death
of her recently deceased husband and worried about the health of her unborn child. Edna
was put on HIV treatment and immediately connected to Nick, a psychosocial counselor,
and Milly, a peer mentor who had also given birth while living with HIV. Edna joined her
local HAWI support group, which helped her build a latrine, handwashing station, drying
rack and rubbish pit - important elements of a healthy home. She also enrolled in Lwala’s
nutrition program and planted a nutrient-rich garden. Edna delivered a healthy baby boy,
who recently reached 18 months old and tested HIV negative.
Only
2%
OF HIV-EXPOSED
INFANTS
SUPPORTED BY LWALA
TESTED POSITIVE FOR
HIV 18-24 MONTHS
AFTER BIRTH, compared to
8.3% in Migori County as a
whole. 1
LWALA
VIRTUALLY ELIMINATED
MOTHER-TO-CHILD
TRANSMISSION OF HIV
AMONG ITS CLIENTS FOR THE FOURTH
YEAR IN A ROW.
1
UNAIDS. Fast-track to an HIV-free generation. (2016)
2018 ANNUAL REPORT | 17 |

Water, Sanitation & Hygiene
Igniting community
action for safe water
water treatment
PERCENTAGE OF POPULATION TREATING
WATER PRIOR TO DRINKING
Water-borne illness is the number one
cause of premature death in Kenya 1 .
Improved sanitation has been shown to
reduce diarrhea morbidity by 38% 2 .
To achieve this, Lwala activates
community committees who lead their
villages in constructing latrines, building
handwashing stations, and securing water
sources. If a household is unable to build
their own latrine, their neighbors step in
to get the job done. Once villages are
declared open defecation free, we work
together to secure safe water.
46% 3
county
96% 4
lwala
communities
12
LWALA VILLAGES
DECLARED OPEN
DEFECATION FREE
BY MINISTRY OF HEALTH EVALUATORS
1,083
LATRINES BUILT SINCE 2016
| 18 | 2018 ANNUAL REPORT
1
Institute for Health Metrics and Education (2016)
2
United Nations Millenium Project (2016)
3
Kenya Demographic Health Survey (2014)
4
Lwala Community Alliance Household Survey (2017)

Nutrition
Investing in the long-term impact
of nutrition security
Maternal malnutrition has a direct correlation with increased
risk of infant death 1 .
45% of child deaths are linked to malnutrition 2 .
1,303
HOUSEHOLDS
ENROLLED IN GARDENING
AND NUTRITION TRAINING,
ACCESSING SEED INPUTS &
RECEIVING INDIVIDUALIZED
FOLLOW-UP
Adequate nutrition during the first 1,000 days between conception and
a child’s 2nd birthday is one of the best investments in a child’s health,
education, and wellness.
Lwala provides preventative support to all pregnant women and young
children, screens for vulnerability, and provides a holistic package of
support to get families on a long-term path to nutrition security.
building a ladder to nutrition security
TREATING
ACUTE MALNUTRITION
Clinical Care – Intensified clinical training,
longer hospitalization periods, designated
nutrition unit, therapeutic food
Priority Households – Community
Health Workers follow-up daily after
hospitalization, provide therapeutic
food, provide fortified flour and enroll
in long-term food security program
FIGHTING
CHRONIC MALNUTRITIOn
Food Security – Nutrition training,
gardening training, seed inputs,
fortified flour
prevention
Maternal/Child Nutrition – Screening for
nutrition, breastfeeding training, nutrition
education, vitamins (A & zinc), de-worming
1
Ehrhardt S, Burchard GD, Mantel C, et al. Malaria, Anemia, and Malnutrition in African Children–Defining Intervention Priorities (2006)
2
Black RE, Victora CG, Walker SP, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries.
The Lancet. (2013)
2018 ANNUAL REPORT | 19 |

Lwala unites community members
and health care workers to improve
health facility performance in the 6
key areas of healthcare delivery
SERVICE DELIVERY
HEALTH WORKFORCE
HEALTH INFORMATION SYSTEMS
ACCESS TO ESSENTIAL
MEDICINES AND SUPPLIES
FINANCIAL MANAGEMENT
LEADERSHIP AND GOVERNANCE
CLINICAL QUALITY IMPROVEMENT
SUPPORTING PATIENT-
CENTERED HEALTH CENTERS
The Challenge
Government health centers are tasked with
providing the majority of health services in
Kenya. And yet, these facilities experience
frequent shortages in staff, medicines,
electricity, running water, and other essential
resources. These systemic challenges reduce
the quality of care provided to patients and
feed distrust in the health system.
CONTINUE
IMPLEMENTAION
ADJUST OR
DOCUMENT
PLAN
v
v
REVIEW
OUTCOMES
v
v
FACILITY
ASSESSMENT
Community
committees, health
workers, and Lwala
clinical mentors work
together to implement
a cycle of continuous
improvement
v
IMPLEMENT
PLAN
v
DEFINE
PRIORITY GAP
v
MAKE
IMPROVEMENT
PLAN
7
HEALTH
CENTERS
SUPPORTED
11%
AVERAGE
IMPROVEMENT
IN QUALITY
ASSESSMENT SCORE
5
FACILITIES NEWLY
ESTABLISHED
24-HOUR MATERNITY
SERVICES
5
FACILITIES DEVELOPED
TRANSPARENT PHARMACY
MANAGEMENT SYSTEMS
| 20 | 2018 ANNUAL REPORT

Lwala Community Hospital
Standing as a center of excellence
accessible care
90%
OF OUR CATCHMENT
POPULATION HAS
BEEN TREATED
AT LWALA
COMMUNITY HOSPITAL
59,000
PATIENT VISITS
13
DELIVERIES A WEEK
FREE CARE
TO PREGNANT WOMEN,
CHILDREN UNDER 5, AND
PEOPLE LIVING WITH HIV
quality care
99%
OF OUR PATIENTS SAY THEY WOULD
RECOMMEND LWALA TO A FRIEND
94%
SCORE ON PEPFAR’S SITE
IMPROVEMENT THROUGH
MONITORING ASSESSMENT
QUARTERLY
CASE
REVIEWS
WITH VANDERBILT UNIVERSITY
MEDICAL CENTER CLINICIANS
12%
IMPROVEMENT
ON SAFECARE ASSESSMENT
innovative care
MUZIMA
MOBILE APPLICATION ALLOWS
DATA COLLECTION AND SHARING
BETWEEN HEALTH WORKERS
IN THE COMMUNITY AND THE
FACILITY, CREATING A SEAMLESS
PATIENT EXPERIENCE AND
HIGHER QUALITY CARE
CLIENT-
OWNED
PATIENT
RECORD
IN PARTNERSHIP WITH IBM
RESEARCH WE PILOTED A
MOBILE APPLICATION
ALLOWING PATIENTS WITH
NON-COMMUNICABLE DISEASES
TO OWN AND MANAGE THEIR
OWN PATIENT RECORD
SAFECARE CERTIFIED
2018 ANNUAL REPORT | 21 |

ECONOMIC DEVELOPMENT
TACKLING A KEY DRIVER OF POOR
HEALTH - EXTREME POVERTY
Lwala partners with Village Enterprise to implement their
cost-effective poverty graduation model. The approach
combines business training and mentorship with a start-up
grant. We are empowering the rural poor to lift themselves
out of poverty through income and savings generated from
small businesses.
458
BUSINESSES STARTED
1,381
ENTREPRENEURS TRAINED
9,160
LIVES IMPACTED
40%
INCREASE IN WEEKLY ANIMAL
PROTEIN CONSUMPTION
91%
INCREASE IN
HOUSEHOLD SAVINGS
LWALA COMMUNITY BANK
We sparked the creation of a savings
and loans cooperative, which operates
independently and provides pro-poor
financing to staff and community members.
$90,000
IN ASSETS 1 135
MEMBERS
| 22 | 2018 ANNUAL REPORT
1
Unaudited data

EDUCATION
EDUCATING GIRLS AS
A POWERFUL LEVER OF
COMMUNITY HEALTH
For every year a girl remains in school, the likelihood
of an unwanted pregnancy or HIV infection decreases.
And, studies show that children of educated moms have
better health outcomes.
We work with 13 government primary schools, partnering
with communities to launch their own solutions and
advocate within the education system.
School-led solutions include: sexuality education,
reproductive health access, provision of uniforms and
sanitary pads, linkages to secondary scholarships, and
digital access to textbooks.
And, through our Broadened Horizons program, we support
girls who have dropped out due to pregnancy to re-enroll
in school. We provide them mentorship, scholastic support,
school materials, and a small cash transfer to subsidize costs.
13
GOVERNMENT
SCHOOLS
12
SCHOOL-LED INNOVATIONS LAUNCHED
39
TEACHERS TRAINED IN COMPREHENSIVE
SEXUALITY EDUCATION
22
YOUNG MOTHERS RE-ENROLLED IN SCHOOL
406
5, 219
STUDENTS
IMPACTED
STUDENTS WITH WORLDREADER E-READERS
LOADED WITH KENYAN CURRICULUM
reaching gender parity in primary school completion rates
BOYS COMPLETION RATE
GIRLS COMPLETION RATE
63%
60%
58%
55%
54%
56%
56%
48%
49%
gender
PARITY
37%
40%
42%
45%
46%
44%
44%
52%
51%
2010
2011
2012
2013
2014
2015
2016
2017
2018
lwala communities
2018 ANNUAL REPORT | 23 |

RESEARCH AND LEARNING
EXTENDING OUR IMPACT THROUGH RESEARCH
In partnership with the Vanderbilt Institute for Global Health, we are producing peer-reviewed research
designed to inform local policy makers and build the global body of knowledge around community health.
Among other studies, over five years we are measuring Lwala’s multi-sectoral impact through a
quasi-experimental study design, collecting repetitive cross-sectional survey data to track key indicators like
child mortality. Our baseline data collection kicked off in 2017 and we are actively surveying over 4,000
treatment and comparison households using Vanderbilt’s REDCap electronic survey tool.
COMMUNITY HEALTH
IMPACT COALITION
Lwala joined 9 peer organizations
to coordinate research and catalyze
the adoption of high-impact
community health design. This
year, the coalition worked with
USAID and UNICEF to update
the Community Health Worker
Assessment and Improvement
Matrix and contributed to the World
Health Organization’s guidelines on
community health worker programs.
Together, we are leveraging
our knowledge and research for
global impact.
Lwala is
pioneering new
ways to connect
our clients and
front-line staff
with data-driven
decisions that
save more lives.
– VINCENT OKOTH,
MONITORING, EVALUATION,
AND LEARNING MANAGER
TECHNOLOGY-ENHANCED ITERATIVE LEARNING
Through our customized CommCare application, Lwala Mobile, Community Health Workers collect data and
receive decision support in real-time. With the addition of Salesforce analytics, our team and government
policy makers are empowered to make patient-centered, evidence-based decisions. Through this
system we track individual-level, longitudinal data across 12,000 households and counting.
| 24 | 2018 ANNUAL REPORT

Revenue by Year
$3,000,000
$2,500,000
$2,000,000
$1,500,000
$1,000,000
$500,000
$0
2011 2012 2013 2014 2015 2016 2017
2018
100% board giving
$500K+
$100k +
$50K+
Program partners
Ronald McDonald
House Charities
Segal Family Foundation
Deerfield Foundation
Vitol Foundation
Anonymous
The ELMA Foundation
The Tramuto Foundation
Tivity Health
Planet Wheeler
Izumi Foundation
Child Relief International
Erik and Edith Bergstrom Foundation
Stichting Dioraphte
Weekley Family Foundation
Bohemian Foundation
Vanderbilt University Medical Center
One World Children’s Fund
Health eVillages
Blood Water Mission
Partners for Equity
DAK Foundation
T&J Meyer Family Foundation
Kenya Ministry of Health
Vanderbilt Institute of Global Health
Village Enterprise
Community Health Impact Coalition
IBM Research
Marie Stopes Kenya
Miller Center for Social Entrepreneurship
Big Bang Philanthropy
Innovations in Healthcare
PharmAccess
Safecare
National Health Insurance Fund
Worldreader
World Bicycle Relief
Mighty Ally
Princeton in Africa
$20K+
$10k+
$5k+
$2.5K +
Gary and Carol Hobday
Waterloo Foundation
TB Cares
Stephen and Elizabeth Carr
Open Road Alliance
Johnson & Johnson
Gould Family Foundation
Imago Dei Fund
$1K+
Peter and Sarah Lanfer
Chris and Kirstin Hobday
Benevity
Real Medicine Foundation
Who Gives a Crap
Allison Family Fund
Imago Dei Fund
T.J. and Seran Glanfield
Ted and Karen Philip
GE Foundation
A to Z Impact Foundation
Mary Campbell
Tom and Ainin Edman
Susan Lee
Dr. Georgia Mode
Conservation Food and Health
Thrill HIll Foundation
Hearne Dry Goods
Harpeth Hall
Anonymous
Don and Linda Norman
Robert and Bonnie Miller
Felix Dowsley and Susan Douglas
Bank of America
Equifax
Lisa and David Issroff
Issroff Family Foundation
Paul and Laverne Lorenzini
Brian and Jessie Adams
Tim Ammon
Cole and Christen Barfield
Bill and Elizabeth Hawkins
Bill and Anita Cochran
Alison Kelley
Brian and Jocelyn Mason
Jad Raffoul
Kelley Barnaby
Philip and Linda Andryc
John and Sallie Bailey
Lee and Mary F Barfield
Cody and Elizabeth Davis
Doug and Beth Heimburger
Richard Higgins
Rick Majzun
Steve and Edana Nelson
Joel and Hilary Stanton
Bert and Kim Bailey
Thad and Suzanne King
Brad Thomason
Fidelity Charitable Gift Fund
Russell and Dinah Fitzgerald
Erik Wang and Brianne Johnsen
David and Jamie Sauerburger
Nic and Caitlin Glover
Melizsa Mugyenyi
Steve and Liz Janicak
Dr. Xylina Bean
Dave and Sue Pyke
Thistle Farms, Inc.
Rebecca Cook
Jeff Andrews and Michele Marston
Ash Rogers and Garett Switzer
Harry and Jeanne Baxter
Waldon and Renee Garriss
Harvey and Cheryl Major
Mark and Erin Miller
Dr. Sten Vermund and Dr. Pilar Vargas
Kristina Swenson
Brock and Corinne Kidd
David Hornsby and Emily Deschanel
Andy and Katie Friedland
Dr. Christopher Reiner and
Dr. Kathleen Kilbride
James and Jena Nardella
Frank and Ann Bumstead
Judson and Carol Burnham
Paul and Carol Caldron
Karen Callahan
Dr. William Danforth
Elizabeth Davis
Dr. Roland Eavey and Dr. Sheila Desmond
Hunter and Glencora King
Maughan Family Fund
Marilyn Paganucci
Dorothy Porter and Laurie Phelan
Keith Quinton and Barbara Fildes
Daniel and Sheila Riesel
Robert and Paulette File Foundation
Barry and Cortessa Russell
Shane/Wu Family Fund
Clay and Dorothy Sifford
John and Lorien Sites
The Skoll Foundation
David and Lindsey Toomey
Weyerhaeuser Family Foundation
Randy Brothers
Valerie Leitman
Larry and Kay Litten
Monthly Donors
Jonathan Andereck
Jeff and Melinda Balser
James Brown, III
Joanne Candela
Ross and Autumn Carper
Laura Cleveland
Yvette Crabtree
Jane Easdown
Stephanus Eman
Kristen Foery
Dionne Gayle
Cynthia Giannini
Rosemary Chege and John Gitau
Susan Glick
Ann Green
Natasha Halasa
Kevin and Kristin Harney
Anthony Janetos
Dr. Michelle Kiger
John Walker and Michelle Kingsbury
Christine Knippenberg
Nancy Liles
Benjamin Luthi
Janella Pennington & Thomas McAuliff
James Mendelsohn
James Mnookin
William and Curry Stahl
John and Julia Morris
Donald and Lisa Nehrig
Jessica Pearson
Harry Rice
Marc and Mindy Scibilia
Dr. Girija Shinde
Oran Aaronson and Shannon Snyder
Renee Tevelow
Elizabeth Torres
Pilar Vargas and Sten Vermund
Emily Warne
Ed and Elizabeth Warren
Amanda Winchester
Dr. Carolyn Woodfork-Richardson
2018 ANNUAL REPORT | 25 |

Our Team
90 full-time professionals and hundreds of
Community Health Workers bring together expertise
in global health, community development, research,
and operations management.
Ash Rogers
Executive Director
Julius Mbeya
Managing Director
Co-Founders: Milton Ochieng’ & Fred Ochieng’
Leadership Team: Daniele Ressler, Doreen Awino,
Elizabeth Owino, Robert Kasambala, Rose Adem,
Vincent Okoth, Winnie Oyugi
The Lwala Village Development Committee
(LVDC), Kenya Board and Global Board are
comprised of a diverse group of individuals
committed to wholeness of life in Lwala & beyond
Board: Thomas Glanfield (Global Board Chair),
Bonnie Miller, Chris Hobday, Dave Eilers, Elizabeth
Carr, Fred Ochieng’, Jessie Adams, Joel Stanton,
Lindsey Toomey, Melizsa Mugyenyi, Milton Ochieng’,
Susan Douglas, Richard Wamai, Gervasse Nykinye
(LVDC Chair), Shem Ooko, Charles Obong’o, David
Odwar, Perpetua Okong’o, Charles Obunga, John
Obunga, Rose Onyango, Samson Mbori, Robinson
Mbori, Musa Odhiambo
94% kenyan
52% hired from
patient population
48% women
66% women in
senior leadership
| 26 | 2018 ANNUAL REPORT

I come from this area and have experienced the struggle of
being a new mother. I like to share my knowledge with my
people. – NANCY, NUTRITIONIST
Nancy had her first child as a teenager and moved into our community to be with her new husband. She was
searching for an outlet for her talent and joined the first class of Lwala Youth Peer Providers. Nancy and her
colleagues were tasked with advocating for youth access to reproductive health services. At the time, this was still
a highly controversial topic in the community and youth contraceptive use was low. She spent her days in deep
conversations with teachers, village elders, parents, and other young people. Over the course of that year, she
witnessed a slow transformation in the community conversation around reproductive health and was proud to
watch her peers begin using contraceptives and getting tested for sexually transmitted diseases.
The training she received from Lwala on self-agency and negotiating skills also impacted her personal life. She
began talking with her husband about her dreams and he agreed to support her to go back to school.
The next year, Nancy pursued a diploma in nutrition and returned to Lwala in 2017 as an intern. From shadowing
Community Health Workers, witnessing gardening trainings, and treating patients in the hospital, Nancy identified
a need for a specialized nutrition program for our most vulnerable households. She tells of a particularly impactful
client named Naomi:
“Naomi was suffering from mental illness and her two twins were severely malnourished. I began visiting
them weekly, bringing them supplements and therapeutic food. I would spend time encouraging the mother
and listening to some of the challenges she faced. Over time, the children gained weight and the household
stabilized. Now that they are doing well, I no longer visit them as a health provider, I visit them as a friend.”
Soon, Lwala asked Nancy to join the team full-time and help us build up our nutrition program for priority
households, just like Naomi’s. Nancy now balances clinical hours and home-visits with tailoring a new nutrition
curriculum. Ask Nancy why she does what she does and she’ll tell you, “I come from this area and have
experienced the struggle of being a new mother. I like to share my knowledge with my people.”
2018 ANNUAL REPORT | 27 |

agency, health, and
wholeness of life
www.lwala.org
Lwala Community Alliance
is a tax-exempt 501(c)(3)
nonprofit
| 28 | 2018 ANNUAL REPORT