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The aim of this programme is to test our community health approach in fragile and supply challenged settings where longer term programming can be extremely challenging. This will help to understand what approaches are most suitable in these contexts.

Improving poor women and men’s access to essential health care is the overall aim of the community health approach. The Health Legacy (HL) programme is specifically intended to support Christian Aid to strengthen our evidence base, communicate our impact and leverage other funding through testing approaches, match funding and relationship building.

Key information


Primary: Burundi, Sierra Leone, South Sudan

Secondary: Kenya, Nigeria



September 2016 - July 2020

Programme Value::

£2.9 million

Funded By::


Ellis-Hadwin Legacy

Our approach

The programme is being delivered across three strands of work:

1. Testing and adapting

Testing and adapting our community health framework approach in supply and resource challenged settings including Burundi, South Sudan and Sierra Leone.

This means developing context-specific programmes designed to meet the challenges of working in each environment. To achieve this, we are piloting a number of initiatives, including the use of a flexible adaptive programming approach which has enabled us to apply Participatory, Vulnerability, Capacity Assessments (PVCA) for the first time in our health programming.

Read the project's theory of change

2. Integrating health programming

Exploring options for flexible funds to support countries to strengthen the integrated nature of their health programming.

In Kenya the Health Legacy (HL) is supporting integration of adolescent nutrition with sexual and reproductive health interventions in Narok county, which has the highest teenage pregnancy rates in the country (41%).

The project aims to reduce teenage pregnancy and improve nutrition amongst pregnant adolescent girls, adolescent mothers and their babies.

We are also partnering with Unilever for innovative communications on healthy diets among adolescent girls in schools.

In Nigeria, the HL is supporting the integration and scale-up of nutrition into a UK Aid Match (UKAM)  funded project that is focusing on integrated Community Case Management (ICCM) of common childhood illnesses, which include malaria, pneumonia, and diarrhoea among children under five years.

Through the HL, maternal and child nutrition education will be intensified, as well as community level screening and referral of severe cases of malnutrition.

3. Evidence and learning

The HL is allowing us to increase the robustness and credibility of our health evidence, and to examine what works and what does not. This includes developing learning and research relationships as well as developing the capacity of staff and partners.

We have identified and developed a plan to carry out research and generate learning under the following themes over the next three years:

  • Women’s economic empowerment and health
  • The extent to which the community health framework is relevant in fragile and resource constrained contexts
  • Health and resilience

Read more about our work across the three strands in Burundi, South SudanSierra Leone, Kenya and Nigeria.

Find out more in this video: Christian Aid's health work in Burundi

Crisis modifier in adaptive programming

Based on learning from Christian Aid’s resilience programmes such as BRACED, the HL is using a 'crisis modifier' approach as a way of building flexibility into the funding structure.

This will enable country programmes to proactively respond to risks that threaten the success of the project, by supporting individuals, communities and organisations to prepare and respond in a timely manner.

To date project design and inception workshops, as well as PVCAs and context analyses, have been conducted. The project implementation commenced in August 2017.

Baseline surveys are also underway in Burundi and Sierra Leone.

Key achievements

To date, we have supported 7 partners in Burundi, Sierra Leone and South Sudan reaching over 73,000 people improving health amongst vulnerable women, children and men through better access and use of health services.

In these countries, we have developed strong community structures that are driving health interventions and breaking gender inequalities in families and communities and impacting on the health and wealth of women and men. For example, women’s savings and loans groups in Burundi, Sierra Leone and South Sudan, have increased 3,500 women’s access to and control over resources, enabling them to play a more active role in decision making. 

In South Sudan, teams of community paralegals are working with communities to reduce the risk of violence against women and ensuring that survivors receive adequate support.

Families in Sierra Leone, are driving shifts in unequal power and gender relations and community care groups are promoting appropriate health and nutrition practices in Burundi.  We have increased the participation of women and people with disabilities into positions of power in communities and districts in Sierra Leone.

In addition, we are using the legacy funding to strengthen the impact of our health work in Kenya and Nigeria. We have forged an innovative private sector partnership in Kenya, helping to reduce undernutrition and teen pregnancies among 5804 teenage girls.  

In Nigeria, we are increasing the impact of our work by integrating life-saving nutrition interventions to an existing child health programme in 2 out of 4 regions benefiting 655 children.

Ellis-Hadwin Health Legacy in Burundi

Ellis-Hadwin Health Legacy in Burundi

Ellis-Hadwin Health Legacy in South Sudan

Ellis-Hadwin Health Legacy in South Sudan

Ellis-Hadwin Health Legacy in Sierra Leone

Ellis-Hadwin Health Legacy in Sierra Leone

Ellis-Hadwin Health Legacy in Kenya

Ellis-Hadwin Health Legacy in Kenya

Ellis-Hadwin Health Legacy in Nigeria

Ellis-Hadwin Health Legacy in Nigeria

Reports and resources

List Resources – by content reference (specific page match)

Christian Aid Ireland’s adaptive programme management

This paper is the product of a collaboration between ODI and Christian Aid Ireland to assess the relevance of adaptive approaches.

Want to know more? If you have any enquiries about our work, please contact us