An Innovative University and Non‑Governmental Organization Partnership in Global Health: Application of the Brocher Declaration to 20 Years of Collaboration in Kenya

Education and training

Over the past decade, the Lwala–Vanderbilt partnership has strategically engaged graduate‑level students across disciplines, including medicine, public health, education, and the social sciences, in service‑learning and implementation research that advances both academic training and community health impact. Through carefully structured practicum placements, faculty‑mentored field experiences, and co‑designed research projects, the partnership has served as a model for integrating graduate education with community‑identified priorities in a low‑resource setting. Between 2011 and 2025, a total of 57 graduate students have completed formal placements or immersive experiences at Lwala, contributing to 33 discrete projects and 9 peer‑reviewed publications. These initiatives illustrate how structured, reciprocal academic–NGO collaborations can foster both skill development for students and sustainable programmatic benefits for local organizations.

One key avenue for student training engagement is Vanderbilt University School of Medicine’s Global Health Immersion Course, a four‑week clinical and service‑learning experience offered to third‑ and fourth‑year medical students. Since 2011, Lwala has hosted 37 Vanderbilt medical students through this course, which introduces participants to the clinical and public health dimensions of care delivery in resource‑limited settings. The curriculum, jointly developed by Vanderbilt and Lwala faculty, emphasizes cultural humility, ethical engagement, and locally led learning. Students complete pre‑departure training in cross‑cultural communication and health systems context, followed by on‑site clinical mentorship under Lwala’s Kenyan health professionals. Each student undertakes a capstone project selected by Lwala leadership to address a defined organizational need, such as improving data management systems or strengthening maternal health counseling tools. These projects have generated actionable outputs for Lwala’s programs and highlighted innovations in community‑based healthcare delivery. Weekly reflective mentoring sessions with Vanderbilt faculty further reinforce ethical practice, self‑awareness, and applied problem‑solving during the rotation, ensuring the experience remains educationally rigorous and contextually responsive.

The partnership has also served as a field training site for students from Vanderbilt’s Master of Public Health (MPH) program and the Peabody College of Education and Human Development, hosting 18 graduate students for two‑ to three‑month practicum placements since 2012. These students have collaborated with Lwala teams on projects encompassing program evaluation, data analytics, monitoring and evaluation (M&E) system design, and the development of educational interventions. These projects have strengthened staff capacity, directly improved programming, and led to publications, which are highlighted in the “Research” section below. Each practicum culminates in a tangible deliverable such as a new data collection tool, training curriculum, or operational framework that Lwala can integrate into its ongoing programs. One illustrative example involved a 2013 MPH student who trained Lwala staff in geographic information systems (GIS) mapping and documented community water sources. Six months later, Lwala staff independently applied these skills to trace the source of a local cholera outbreak, demonstrating both the immediate utility of the student’s work and the sustainability of capacity built through the collaboration.

A third stream of engagement links Lwala to courses in the Vanderbilt MPH Program. Vanderbilt course instructors have partnered closely with Lwala, fostering a model of sustained, community‑led collaboration that stands apart from typical short‑term, student‑driven engagements. In many university programs, students are encouraged to select their own nonprofit partners for practicum or capstone projects. While this “student‑led” model offers flexibility, it often results in fragmented and transient partnerships. Projects may lack continuity, institutional memory, or meaningful local impact once the student departs. In contrast, Vanderbilt’s partnership with Lwala is intentionally structured around long‑term, community‑led engagement. Each student project builds upon previous work and lays the foundation for future efforts, creating an iterative process of refinement and shared learning. This continuity strengthens project quality, deepens institutional knowledge, and fosters bidirectional learning, while also mitigating the ethical and operational risks associated with short‑term, extractive engagements. The characteristics of this enduring collaboration spanning over a decade between a regional Kenyan health organization and a major US research university make it a relatively unique and instructive model for sustainable global partnerships.

A central component of this collaboration has been the “Essential Skills in Global Health” course. Since 2014, Lwala has served as an annual partner for this project‑based course, which uses real‑world collaboration to help students develop essential competencies in global health practice. Crucially, projects are identified by community partners rather than by faculty or students, ensuring that efforts are locally driven and contextually relevant. To date, 13 projects have been implemented with Lwala through this course, covering diverse areas such as early childhood development, organizational culture in health facilities, and men’s attitudes and practices toward gender equality and women’s reproductive health.

Through this model, students gain hands‑on experience in applied research and program design, while Lwala benefits from new analytical tools, data insights, and perspectives that advance its ongoing initiatives. The result is a mutually reinforcing partnership—one that integrates education, research, and service while demonstrating how academic institutions can engage ethically and effectively with community‑based organizations in global health.

Taken together, these educational collaborations illustrate how thoughtfully structured, reciprocal partnerships can bridge academic learning with community‑driven implementation research. The Lwala–Vanderbilt model demonstrates that when global health training programs prioritize ethical engagement, co‑design, and measurable outcomes, graduate education can simultaneously advance student competencies and strengthen local health systems—fulfilling the dual mandate of education and service central to sustainable global health partnerships.

Research

Research serves as a cornerstone of effective global health programming and policy development, yet organizational capacity for research within NGOs remains limited, particularly in resource‑constrained settings [2]. Strengthening the ability of local NGOs to conduct and apply research is essential to ensuring that evidence flows upstream from community realities to national and international policy agendas [17, 18]. Partnerships between academic institutions and NGOs can play a pivotal role in this process: while NGOs bring contextual knowledge, community trust, and implementation reach, academic partners contribute methodological expertise, analytical rigor, and access to research infrastructure [2, 19]. When grounded in equity and co‑creation, such collaborations can enhance research capacity as well as service delivery, institutional development, and policy influence [17, 20].

Within this framework, Lwala and Vanderbilt University have built a robust and sustained research partnership that has generated actionable evidence for both community programs and the broader global health field. Lwala has also invested in a team of researchers locally who have been integral to this effort. Most notable among these projects is a large, repeated cross‑sectional household survey to quantify key health metrics [21]. These findings formed the basis for the longitudinal household survey and helped build evidence for Lwala’s current expansion. The initial survey in 2017 was designed to capture health data about households in Lwala’s original catchment area. That year, a dual degree Vanderbilt MPH/MD student conducted a study of under‑five mortality in Lwala, which was published in 2018 in the journal, PLOS One [16]. Results showed that prior to a 2010 intervention by Lwala, 105 children under 5 died per 1,000 live births. By 2017, that rate dropped to 29.5 deaths per 1,000 live births. Lwala’s rates outperformed the reported under‑five mortality rates for the region, Nyanza Province (82 per 1,000), and for Kenya as a whole (52 per 1,000) [14].

Since its inception, the household survey has evolved into a 10‑year longitudinal evaluation encompassing more than 20,000 households. This project has grown alongside work with the county government to scale health and development programming and has provided both valuable baseline data prior to program implementation and a growing body of evidence for the efficacy of Lwala’s programming. Furthermore, the robust dataset has formed the basis of 12 academic publications [16, 21–31] with at least 15 more in various phases of development and serves as a training platform for emerging researchers. Between 2005 and 2025, 25 Vanderbilt trainees, including medical, MPH, and doctoral students, have conducted research projects using Lwala’s data, all in collaboration with Lwala’s Kenyan research team, which has grown from 1 staff member to 7 over this period. Using the repository of longitudinal household survey data for collaborative research is mutually beneficial for Lwala staff and Vanderbilt partners, as well as the wider community. Publications arising from this household study contribute meaningfully to regional literature, addressing critical research gaps while benefiting Kenyan students and the broader academic community. The reciprocal benefits of this research are reflected in changes in authorship as well. In a recent journal supplement (with a series of articles drawn from the household survey), 12 out of 15 have Kenyan first authors, and 2 of the 7 mentors guiding these papers are professors from local Rongo University. Building on the successful model of engagement established with Vanderbilt, Lwala is now pursuing similar partnerships with Strathmore University and Rongo University to collaborate with local students on research and training initiatives. In selecting a research question based on the type of survey data collected, the study remains focused on Lwala’s central research mission rather than the visitors’ interests. This model minimizes participant fatigue by using existing data and ensures that findings are rapidly translated into programmatic decision‑making.

Beyond the household survey, the partnership has contributed to policy‑relevant research on CHW effectiveness [32] and has been involved in international research collaborations around CHW compensation and service provision [33, 34]. This research has directly addressed knowledge gaps identified in WHO guidelines [35] and has contributed to county and national policy change in Kenya. After years of advocacy from Lwala and its partners, the Kenyan government passed a series of sweeping reforms in late 2023. First, a landmark Primary Health Care (PHC) Act formalized the role of CHWs in the health system and codified their right to payment. CHWs in 45 of Kenya’s 47 counties are now being paid, and work is ongoing to strengthen payment mechanisms and consistency. Second, the national government launched the electronic Community Information System (eCHIS), a new digital platform developed to digitize Kenya’s community health workforce and improve decision‑making. It has since been rolled out to 124,000 CHWs across Kenya. Finally, the national government distributed standardized kits to equip CHWs with supplies and medications needed for daily services. Collectively, these reforms mark transformative progress toward universal health coverage and reflect the direct policy influence of evidence generated through academic–NGO collaboration.

The Lwala–Vanderbilt partnership also fosters iterative, student‑led research continuity, where successive projects (identified as community priorities) build cumulatively on previous work. For instance, between 2007 and 2011, three Vanderbilt medical students conducted a coordinated series of studies on intestinal helminth infections in children and adults. Each project refined research questions and methodologies from the prior study, creating a quasi‑longitudinal dataset that informed targeted community interventions. Findings from this research series resulted in three peer‑reviewed publications co‑authored by both Lwala and Vanderbilt researchers, illustrating the value of continuity and co‑mentorship in capacity building and scientific productivity [36–38].

While ethical review at the beginning of the partnership was only done at Vanderbilt University, Lwala‑based research is now approved first by a local ethics review board at Kenyan universities, and appropriate research licenses are obtained from the Kenyan government. Data monitoring boards monitor all projects for negative outcomes, and these are immediately reported to appropriate boards.

Taken together, these efforts demonstrate that research partnerships grounded in co‑design, mutual capacity strengthening, and community relevance can move beyond traditional academic outputs to inform policy reform, health system strengthening, and local ownership of data. The Lwala–Vanderbilt experience underscores how research can function not only as a scholarly pursuit but as a mechanism for sustainable impact, linking evidence generation directly to the goals of education, service, and equitable global health development.

Service

Service and institutional engagement have been foundational to the Lwala–Vanderbilt partnership, translating academic collaboration into sustained community impact and reciprocal institutional growth. Since Lwala’s inception, Vanderbilt students, faculty, and staff have applied their skills and enthusiasm to support the organization’s mission to achieve health equity in rural Kenya. This service extends directly to local researchers and faculty, who receive structured mentorship throughout the research process—from study design through manuscript development—enabling them to translate that guidance into their own first‑authored publications. This mentorship builds lasting capacity: as local researchers grow their skills, they in turn become mentors themselves, extending the same guidance to students and junior colleagues at their institutions. Through these engagements, academic expertise has been leveraged to design practical solutions for local challenges while simultaneously advancing student learning in applied global health practice, creating a cycle of growth that strengthens research capacity on both sides of the partnership.

Over the course of the partnership, Vanderbilt students have developed a suite of implementation tools including survey instruments, M&E frameworks, CHW capacity assessment tools, and program scorecards, all of which have strengthened Lwala’s systems for data‑driven decision‑making and performance management.

A particularly impactful avenue of engagement has been Vanderbilt’s Global Health Case Competition, hosted by the Vanderbilt Institute for Global Health (VIGH). In 2019 and 2023, Lwala staff were invited to co‑develop case challenges grounded in community‑identified priorities [39]. The 2019 case, Improving Non‑Communicable Disease Care through Expansion of Lwala’s Health Services in Rural Kenya, focused on addressing rising chronic disease burdens in underserved settings. The 2023 case, Addressing Drinking Water Quality Issues in Rural Migori County, Kenya, built upon an MPH student’s field research testing community water sources for contaminants. In each competition, Vanderbilt students engaged directly with Lwala staff to understand contextual barriers, develop innovative solutions, and present their recommendations to panels that included Lwala representatives and board members. These interactions provided authentic exposure to global health systems and implementation realities while generating actionable insights for Lwala. As a direct outcome, Lwala launched new programming targeting non‑communicable diseases, including the creation of patient support groups, designated clinic days, and the deployment of community‑based patient ambassadors to improve prevention, care continuity, and community mobilization.

Clinical collaboration has also been central to service learning within the partnership. Vanderbilt medical students participating in the global health clinical immersion course complete rotations at Lwala Community Hospital, where they design and deliver Continuing Medical Education (CME) sessions as part of their capstone projects [40]. Guided by Lwala clinical supervisors, students identify training needs through direct observation and clinical participation, resulting in CME sessions on topics such as neonatal resuscitation, management of pediatric pneumonia and tuberculosis, HIV testing and counseling, preterm birth, and health systems delivery. These sessions provide reciprocal learning opportunities, allowing students to refine their teaching and clinical reasoning skills while contributing to the professional development of Lwala’s healthcare staff. It’s worth noting that US students don’t “train” Kenyan healthcare staff—rather, the relationship is collaborative: they share ideas, ask questions, conduct literature reviews, and occasionally introduce new tools. This exchange runs both ways, as the opportunity to teach and mentor these students also helps expand the skills of Lwala staff themselves, reinforcing the reciprocal nature of the partnership.

The partnership has also supported capacity‑building projects that help the organization strengthen staff skills and improve health outcomes. In 2017, a group of medical students worked with Lwala staff to develop a Clinical Quality Assessment tool, designed to identify gaps in protocol adherence and staff knowledge. The organization has used this tool to target future training and mentorship efforts, adapting it over time to meet evolving needs. In 2018, another student conducted a quality assessment of postpartum hemorrhage (PPH) care at Lwala and neighboring government facilities using a validated tool. She shared her findings with Lwala, which led directly to the creation of a new clinical training program on the subject. In 2021, a student supported a study tracking the implementation of Helping Babies Breathe at Lwala and other government facilities. The research led to meaningful improvements in the organization’s training approach.

Between 2013 and 2019, the partnership also leveraged technology to facilitate virtual clinical case conferences, connecting Lwala’s clinicians with Vanderbilt medical experts across specialties including infectious diseases, pediatrics, and obstetrics. These monthly discussions provided real‑time mentorship and specialty consultation during Lwala’s transition from a community health center to a full‑service hospital. This support mostly took the form of case reviews, where the team sought specialized opinions or clinical input. It was particularly valuable during periods when Lwala lacked a Medical Officer on staff, though its relevance has endured—any clinical team stands to gain from opportunities to build skills and deepen knowledge in specialized areas of medicine. Through VIGH, Lwala has access to some of the world’s leading specialized clinicians, spanning fields such as HIV, sickle cell disease, oncology, and cardiology. While the impact of this support has not been formally measured, its value to the clinical team has been consistently evident.

Beyond this technical support, the Vanderbilt community has mobilized substantial financial and in‑kind resources through fundraising events, direct donations, and sustained institutional funding. Notably, this early backing from Vanderbilt and its broader community helped build Lwala’s credibility and reputation, proving pivotal in attracting outside funding. Support from the Vanderbilt community remains particularly valuable because it comes bundled with capacity building, validation, and research and learning contributions that extend well beyond direct financial resources. This institutional engagement also extends to governance: eight Vanderbilt affiliates—four faculty and four alumni—currently serve on Lwala’s Board of Directors, while two Vanderbilt faculty members sit on the Advisory Board, ensuring strategic alignment and continuity between the two institutions.

Importantly, the financial model underlying this partnership represents a replicable best practice for other university–NGO collaborations. Since 2008, an annual unrestricted grant from Vanderbilt has provided flexible support for Lwala’s operational and research activities, including trainee supervision, infrastructure costs, and community engagement. This funding, complemented by in‑kind contributions such as shared office space, offsets the real labor, time, and logistical investments required of Lwala staff to host students and facilitate research. Too often, partnerships rely on in‑kind contributions from local organizations without compensation, creating structural inequities. By contrast, Vanderbilt’s approach explicitly acknowledges and funds the effort expended by its partner, setting a precedent for ethical cost‑sharing and institutional accountability in global health education and research. Future university partnerships seeking to model this approach should consider incorporating formal financial arrangements that value the local partner’s expertise, ensure equitable resource flow, and promote long‑term sustainability. While Vanderbilt once represented the majority of Lwala’s overall funding, Lwala has since diversified its funding base, and this source now represents a smaller share of the organization’s total support. Additionally, Lwala as an organization is not dependent on Vanderbilt. While student opportunities do depend on the partnership, this dependency does not put Lwala’s other work at risk. Both partners benefit from the relationship, and Lwala’s contributions actively enhance Vanderbilt’s offering to its students. Lwala provides a valuable service; that service strengthens what Vanderbilt can offer its students; and student tuition, Vanderbilt’s endowment, and government grants represent sustainable, diversified funding streams that stand independent of the partnership itself.

A critical factor contributing to the longevity and success of the Lwala–Vanderbilt partnership has been the continuity of leadership and key relationships on both sides. From its inception, Lwala’s founding and early leadership included 2 Vanderbilt alumni, and the organization has undergone only 1 executive leadership transition in its 20‑year history, an uncommon level of stability among community‑based NGOs. This continuity has allowed for sustained trust, institutional memory, and alignment of shared goals over time.

Similarly, at Vanderbilt, the ongoing engagement of key faculty and staff, some of whom have been involved for more than a decade, has provided a foundation of relational consistency and organizational learning. These long‑term connections have facilitated the ability to build upon prior projects, navigate challenges collaboratively, and maintain mutual accountability. Beyond its functional success, the partnership appears to have served as a source of professional identity and pride for those involved, fostering a sense of belonging and purpose that distinguishes it from the more transactional, short‑term engagements often seen in university–NGO collaborations. This sustained, trust‑based continuity underscores the importance of relational stability as a core determinant of partnership resilience and impact.

Collectively, these initiatives illustrate how sustained, ethically grounded partnerships can integrate education, research, and service to promote both institutional strengthening and community health outcomes. The Lwala–Vanderbilt collaboration demonstrates that equitable global health engagement extends beyond short‑term student experiences to long‑term capacity exchange and is one that builds shared expertise, mutual accountability, and measurable community benefit.