00:00:00:00 – INTRO
Welcome to What Do You Understand? Brought to you by Global Partners for Development. I’m your host, Ria Pullin, and together we’ll explore the world of philanthropy and development, confronting global disparities and the impacts of our collective efforts.
Joining me is my co-host Daniel Casanova, the Executive Director of Global Partners for Development. So, are you ready to question what you understand? Let’s dive right in.
00:00:35:05 – INTRO CONT’
Today we’re joined by Ash Rogers, the co-CEO of Lwala Community Alliance. In our conversation we’ll uncover how Lwala’s model goes beyond just healthcare delivery to foster community that’s educated, empowered, and resilient. We’ll hear about their successes, the challenges they’ve overcome and the powerful stories of the individuals whose lives they’ve touched.
00:00:55:14 – ASH ROGERS
My name is Ash Rogers and I am the co-CEO of Lwala Community Alliance, and we partner with the government of Kenya to improve health systems and achieve holistic, better life outcomes for our communities.
00:01:10:27 – RIA PULLIN
Fantastic. How long has Lwala been around?
00:01:13:06 – ASH
Lwala is now in our, almost our 17th year and was founded by two Kenyan brothers and their community in, really, response to the HIV epidemic and really maternal and child mortality associated with that pandemic and really a reaction to the injustice that they didn’t have access to health care.
And so they organized, they donated community land and resources, and they built themselves a hospital and said, we will create the health system that should be reaching us. And from there, then the organization’s built what we call our community-led health model. That starts with community organizing around health.
00:02:02:21 – RIA
Fantastic. Very cool. Are the brothers still involved?
00:02:05:05 – ASH
They are. Yeah. Our co-founders are on our board, Fred and Milton Ochieng. And they are both physicians. One is a gastroenterologist and the other one does cardiology. And so, you know, they’re all smart fellows and have been, yes, just really important supporters of the organization and founders of the organization.
And they actually, kind of different for Lwala than some other organizations, is that our founders never ran the organization. They got it up and running. They supported their community. They’ve supported fundraising and kind of early days of, like, getting it up and running and then have always wanted it to have professional leadership that was, that was separate from them.
00:02:52:03 – DANIEL CASANOVA
So, is that you?
00:02:53:17 – ASH
00:02:56:14 – DANIEL
You’re the hired gun.
00:02:57:12 – ASH
I’m one of the hired guns.
00:03:01:20 – RIA
What kind of led you to that journey to where you are now? What were you doing before Lwala? How long have you been with Lwala?
00:03:07:29 – ASH
Yeah, so, you know, started my career, I should take it before my career, in undergrad, I was
really interested in the continent. And I had an opportunity to to go to Uganda
right after I had graduated and did some work with different organizations at that time, realized like, oh, I would really love to contribute to what’s happening and met like a lot of local leaders and kind of felt the optimism of work that was happening in Uganda, which is where I was exposed to at that time, and like, oh, I don’t have, like, any helpful skills, so, I said, I should, like, go get some and like, be useful.
And so I went to grad school and then I did some internships and whatever. And then was part of a program called Global Health Corps, which was founded by Barbara Bush’s organization and had the opportunity to go back to Uganda, work with a small organization, I don’t know how helpful I was, but I certainly had the opportunity to try to be helpful.
00:04:19:28 – RIA
And you learned, I’m sure, while you were there.
00:04:22:06 – ASH
I got a lot out of it. And at that time, there was a family foundation that was just getting kind of up and running called Segal Family Foundation. And so I came on early with them and had this really cool experience of being involved with this family as they tried to lay out, like, their vision for philanthropy and which ultimately was really based on humility and then wanting to fund local leaders, wanting them to help local leaders like get more access to capital, both of their own, but also like, how can we crowd in other philanthropists to support the organizations that are just such a small percent of global financing for development.
And so, I worked with, with Segall Family Foundation as their Director of Operations and Lwala was in my grant portfolio. And so, I got to know our founders, the organization, I visited several times over that period of time. And I also got to see a really wide range of community-led organizations and kind of see the trajectories of growth, or kind of lack thereof, that was happening across that set.
And I felt like there was an opportunity, like, Lwala had some unique attributes, one being my now co-CEO Julius, who had who had been brought in about six months before I joined the organization, as well as having systems and structures, some good evaluations and good research that was like aligning with this real community-led model.
00:06:21:05 – DANIEL
And they needed a sucker to fundraise for them.
00:06:23:29 – ASH
Yeah, they needed- honestly, honestly. Like, what I can do is leverage money. And so I felt like, you know, I had this role, this real opportunity to just kind of repackage the incredible work that was already happening, but get it in front of people with more money and be able to really see a faster growth trajectory.
00:06:47:27 – DANIEL
Have you been successful at that?
00:06:50:01 – ASH
We have. We’ve had a 14 fold increase in revenue and in that almost, I think it’s like, a seven and a half year period and there’s more growth to come. And I think that a lot of that, of course, is our incredible team that’s been able to really demonstrate impact on the ground.
A lot of that is because of our ministry of health partners in Kenya and really the Kenyan government’slike increasing ambition and they’re, the real resources that they’re putting behind, universal health coverage. And that’s made it easier to sell and to be able to say like, let’s come behind a movement that’s winning, you know?
00:07:36:13 – DANIEL
And so when it started, did they start out as like, a dispensary and then go turn into like, health clinic, and then, are you like a Class IV Health Center?
00:07:44:03 – ASH
Yeah, there was-I don’t even know if we had a word “dispensary” at that time for what was happening.
00:07:52:28 – DANIEL
I mean, throughout the region, I think that’s pretty standard.
00:07:54:29 – ASH
It was standard in Kenya. Did we call ourselves a dispensary? No. We called ourselves, I think from the beginning, you know, everyone’s like, everyone’s a doctor, right? You know?
But, but no, like really humble beginnings and, you know, in the beginning, like, their stories from from Fred and Milton, you know, they were going to, to local government to, to ministry of health officials and being like, can we have some, like, drugs? You know, to run this thing, and then being like, oh you’re-
And it’s like, this is kind of a crazy idea, like, you’re still in school. Come back when you’ve, like, done something, you know, let’s see what you can get going on your own. And so it’s been an evolution of that partnership with government. And I think it’s come alongside and a real shift in, in the health sector of Kenya as well. And kind of what would that envision is.
00:08:55:18 – DANIEL
Do you feel like, so you guys must be doing things with the government then on a
policy level and stuff like, tell us about that, what that’s like? Or if you can.
00:09:03:07 – ASH
Yeah. No, this is, this is like the health moment in Kenya.
00:09:07:25 – DANIEL
00:09:08:11 – ASH
You know, we’ve had now like successive presidents who have really put their voice behind universal health coverage. And Kenya has had, you know, one of the most successful national health insurance schemes on the continent and in HIF it has challenges, but it’s a real, it’s a real kind of foundation to build UAC upon.
And, and Lwala has been working with a coalition of organizations in Kenya towards putting more resources into community health and community governance and professionalizing the community health workforce. And that has been a, an argument that we’ve been working on globally. You know, some of that, you know, WHO, USAID, Africa CDC, all of these actors are really important to that norm setting. And like what countries are able to make possible.
And so we have a global coalition that we’re part of called the Community Health Impact Coalition. We’ve been, we’ve been fighting that fight together. And then also a national coalition that’s been doing that same work and that has come together in the last couple of years where the conversation we’re really seeing see change, between what was before, literally people coming to these conferences around UNGA and saying like, oh, isn’t it fantastic, the return on investment you get from community health workers because of volunteers. It’s like bragging about their exploitation of unpaid labor.
And that’s not the conversation anymore and the-
00:10:51:11 – DANIEL
It’s going to be lo-fi and low barrier and you know, we need to like, have, you know.
00:10:57:03 – RIA
Especially because you want all the nurses to be volunteers when you go to the hospital.
00:11:00:28 – ASH
Let’s find some of the poorest, most disenfranchised people in the world and then, and get them to work 40 hours a week to solve their own health challenges.
00:11:10:13 – RIA
And not pay them.
00:11:12:12 – ASH
And not pay them, and silly arguments about how like, well if you paid them then where would their intrinsic motivation go? You know, I said, none of us are paid. We’re bringing healthcare to the community. So that argument luckily has really shifted and I think that there’s a lot more global acceptance of the idea that community health workers have to be paid.
That is also the change that’s happened in in Kenya with the Kenyan government really seeing an opportunity to achieve universal health coverage through making further investments in community health and the president with the Council of Governors have announced that they want to start doing that and that they want a scheme to have the national government match county governments for the payment of community health workers.
And so that’s on the table and kind of a big opportunity. And Lwala has been working on that with our partners for many years. Hopefully we can get some legislation that would, that would kind of codify that. And then, you know, there’s all the other pieces like,now folks need to be supervised, and do you need good digital tools, and proper training. So there’s the other building blocks to put on it.
But I think the Kenyan government’s in a really exciting moment where they’re setting a big vision and they’re bringing development partners along with them and saying like, this is going to be Kenya’s strategy and you’re welcome to support it. And so we’re excited to be in it with them.
00:12:49:02 – RIA
00:12:50:06 – DANIEL
That’s super cool. I can ask you the loaded questions now. What’s your favorite Bruce Springsteen song?
00:12:56:04 – ASH
Oh, my gosh.
00:13:05:02 – DANIEL
I wanted her not to have one.
00:13:08:08 – ASH
My favorite Bruce Springsteen song is Dancing in the Dark, like, for sure. I feel like, very seen.
00:13:13:15 – RIA
You feel very seen. Is that what you do? You like to dance in the dark?
00:13:16:24 – ASH
Yeah. No, Bruce has been a supporter. Bruce and Patti have been supporters of Lwala, really, since our, since our founding. We have become, had become early friends of Fred and Milton. They had a mutual friend who had worked for the family and it introduced them right when they were trying to get the clinic started, right when they were when they were mourning and dealing with the death of their parents and then also trying to do this crazy ambitious thing of starting a hospital and fulfilling their father’s vision and partnering with their community.
And so, so the Springsteen’s have been supporters and had been quiet supporters of the work for, really, since our founding. And then Lwala is building an endowment for the hospital. And so the, you know, the idea is that, like, the private hospitals in the US that you and I go to, like, those are endowed, the universities that folks are attending, like, those are endowed and yet we’ve gotten wild reactions to the idea of endowing a hospital.
00:14:33:07 – DANIEL
It’s contrary to like, motives of like, you know, spending down things and doing that. But yeah, I think it’s different if you’re talking about something that’s on the continent in the space, it’s a different-
00:14:44:10 – ASH
Well, the community wants it to exist in perpetuity and the continent is covered with, you know, mission hospitals that have, that have been planted and filled. And so, it seems radical for some people, but not for the boss.
He was like, he was pumped, like, Bruce and Patti are in it and they’re like, we want to do something public for you all to get more support of it. And, you know, it’s, you know, we’re backed by folks like Rick Spann who wrote this incredible article about Black-led endowments and saying that, you know, for philanthropists to put money into into an endowment like this is, like, you know, it’s the ultimate form of trust based philanthropy. And so, we’re pumped with it. And like, I feel like, there’s no better face than the campaign than Mr. Springsteen so we’re-
00:15:39:08 – DANIEL
Yeah. Well, good thing you had a song to pick.
00:15:41:20 – ASH
Yeah. Yeah. That would have been tough if I was like oh.
00:15:46:09 – RIA
Oh shoot, let me like look-
00:15:49:20 – DANIEL
We’ll add it in. Okay, well my next one would be, so, I hear you touting the line, you’re like community led, not community driven. What do you think about that? Like in terms of like, like, do you feel like, there was a moment where you would have said things were community driven historically and then now you say community led now just because it’s like, there’s like, that movement to make change or would you have always said community led?
00:16:19:08 – ASH
No, I think I would always say that these are semantics. And like, I’m not sure I know that-
00:16:24:22 – DANIEL
And I’m not I’m not trying to get you on anything. I’m curious. Sincerely.
00:16:29:06 – ASH
No, I think that I feel like we feel part of the community driven development movement.
00:16:34:20 – DANIEL
00:16:35:13 – 00:16:40:03
And community led health has been like the model, the vernacular that’s resonated and has resonated with our communities and the future of health, but I think essentially like our when we think about community driven development and the wider space, I think there’s some like tying ourselves in knots of like what actually we mean.
And I think that there is also a conversation that’s important around decolonization and we also feel part of that movement and, and they’re not exactly the same. And so I think that there’s different levels of that work that Lwala is trying to do. And one level is the program model itself.
00:17:27:24 – DANIEL
00:17:28:19 – ASH
And as a program model, our work starts with organizing communities so they can participate in the health system, that they can launch their own health initiatives at the local level, but also that they can participate in local level budgeting and strategy processes in county level legislation. Devolution in Kenya means that there’s real opportunity for democratic participation.
00:17:57:08 – RIA
00:18:00:03 – 00:18:01:25
And that’s something that is so new. Like this is a constitution that started in 2010. And so there’s a real opportunity to like, to bolster that. And so programmatically, that’s where our, our focus is. And then in the organization itself, we’re trying to practice both decolonization and, and elevate our community leaders until we have this leadership model where we have two CEOs and the other CEO is Kenyan and from the region that our community serves and all of our other- all of our U.S. based staff, including myself, are focused on leveraging money. And every other position is, is in Kenya and led by a Kenyan.
00:18:50:28 – DANIEL
You know, what’s something that you feel like you understand particularly well that like, drives you to do what you do or that’s like part of a message that like people need to know because it’s important in this time so that we can like, head in the right direction.
00:19:08:01 – ASH
I, I think one thing that I know intimately is the experience of a pregnancy and the experience of giving birth. And in particular, my first child, I was pregnant with my first child while I was interviewing for this position with Lwala. And I got the job offer while I was in labor and I was on my way to […] hospital in Nairobi.
And I took the call because I’m a crazy person, but also because, you know, having your first child is like, filled with lots of uncertainty. And I really wanted to like, know this thing before I was going to, you know, provide this miracle of creating life. So, yeah, I took the job offer and then, or I kind of heard the job offer. I told them I’d get back to them.
00:20:06:13 – RIA
After the last contraction.
00:20:07:27 – ASH
In 24 to 48 hours. And, you know, and then I gave birth to my son and immediately, you know, after giving birth, like, you’re kind of thinking this whole time, while you’re while you’re in labor, and while you’re pushing, like, I am going to have this child again, like I want to be able to hold my baby. And that was really like the prize that I was kind of visualizing. And they hand me the baby and immediately they took him away again and handed him to my husband. And then the room filled with people and I was, I was hemorrhaging postpartum, which is, it was incredibly painful.
And even the-really scary, and the lifesaving care that I provided was also, it was provided to me was also excruciatingly painful. And then when you lose enough blood, you become hypothermic. And it feels like dying, you know? And so I had this experience of really feeling like I wasn’t going to have that, that moment and kind of seeing my baby and my partner kind of fading away from me.
And, you know, the end of that story is that I received excellent care from a team of incredible Kenyan health workers, and they saved my life and my baby was fine. And I’ve had like this incredible opportunity to live after that and just really thinking about that fragile moment of motherhood and of infancy.
00:22:01:04 – RIA
00:22:02:23 – ASH
And just like, and just like, you know, the real, like, connecting of humanity, the bit that that experience provides me. And so I hope that like through my work that I can also, you know, kind of like, it’s easy to get so technical and it’s easy to get so kind of like into the day to day of running an operation and then being able to hold like, actually, that’s what this whole thing is about.
It’s like, let’s, let’s hold our humanity and like, ensure that people have that dignity in childbirth and the opportunity to raise their children.
00:22:48:26 – RIA
That’s amazing. How old are your kids now?
00:22:50:08 – ASH
So I have an eight year old. That child is eight years old. And then I have a four year old little girl.
00:22:57:12 – RIA
Is the first one the boy?
00:22:59:26 – ASH
A boy, yeah, a boy and a girl.
00:23:01:10 – DANIEL
Did you get to hold your girl after she was born right away?
00:23:04:10 – ASH
You know what’s really lovely is that I did. I had with my- I think I was just maybe this kind of like some karma, like, coming my way. But my second delivery was just so peaceful. I pushed once I was able to, I was able to cut her umbilical cord myself. Also I had like this really connected experience that I had, you know, kind of had hoped for. And so that was something really beautiful.
00:23:36:22 – RIA
I have a boy and a girl also. Yeah, they’re six and ten.
00:23:40:15 – ASH
Oh my goodness.
00:23:42:25 – RIA
But it’s lovely. Cause you know, that moment, like, you know, just bringing life into the world and, you know, things can happen. And think about the women in the rural spaces who don’t have that care. And they’re just, that’s just what happens, I think, for them, because they know they’re not going to get those interventions or they’re too far from those interventions.
00:24:03:09 – ASH
And, you know, it’s infuriating is that like, almost all of those deaths are preventable. Oh, we have the technology, we have the knowledge. Like it’s doable and achievable. And so you just have to line up the political will, the resources and the operations to make it happen.
00:24:26:08 – RIA
There you go. I know, yesterday Liev Schriber said that every NGO should find a celebrity. I was like, okay, let me just go get one in my pocket tomorrow.
00:24:34:16 – ASH
You know, maybe every celebrity needs to go find an NGO.
00:24:39:00 – RIA
There you go. This was incredible. Thank you. I loved to hear your story. That’s amazing.
00:24:46:14 – ASH
Thanks for having me. This is fabulous.
00:24:50:04 – OUTRO
At Global Partners for Development our mission is to advance community-led initiatives that improve education and public health in East Africa. We envision a world in which every East African community has the capacity to implement dynamic, sustainable solutions to the challenges they face.
To learn more, visit gpfd.org.