Building Malawi’s Last-Mile Maternal and Child Health System
Women and newborns in rural Malawi are dying of preventable causes. The issue is proximity to care.
For smallholder farming families in rural Malawi, maternal and child healthcare remains fragmented, facility-centred and doorstep-blind. The system is built to provide care when families reach facilities. Yet the greatest opportunities to prevent death occur long before a woman arrives at a clinic or hospital. They occur at the household level, where pregnancies can be identified early, danger signs detected sooner and referrals initiated before complications become emergencies. Maternal and child deaths persist because healthcare reaches families too late.
WANDIKWEZA'S RESPONSE
Proactive Doorstep Care
Proactive Doorstep Care (PDC) is Wandikweza's answer to the reach crisis in maternal and child health. It is a six-layer, household-centred health system that shifts preventive, routine and follow-up care from facilities to households, ensuring care reaches families early, continuously and in time before complications arise.
The model is built on a simple insight: most preventable maternal and child deaths occur because care does not reach families in time. PDC reverses the traditional flow of healthcare. Instead of waiting for families to travel long distances to seek care, the system proactively reaches them where they live.
The six layers work as one connected continuum. It is designed to find risks early, respond proactively, and ensure families receive the right care at the right time and in the right place. The PDC transforms maternal and child health from a reactive system into a proactive one.
WHAT HAPPENS WHEN FAMILIES ARE
FOUND EARLY
Reach changes everything
When care reaches people at the household, before complications arise, before the journey to a facility becomes necessary, outcomes change. These numbers reflect what happens when a health system is built to find people where they are, before they need to find it.
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of women of reproductive age (15-49
years) with access to modern
contraceptive method
of pregnant women register in their first trimester and receive syphilis testing
of births are attended by a skilled health professional
of children with symptoms of malaria, diarrhea, or pneumonia are assessed within 24 hours
When care reaches people early, continuously and in time, outcomes improve. The PDC model demonstrates this at district level, with results that are repeatable and scalable.
Outcomes tracked across Dowa, Mangochi, Salima and Mchinji districts through continuous data systems
Rooted in Malawi. Built with communities. Designed to stay. Since 2016.
ABOUT WANDIKWEZA
We build Health Systems
Wandikweza is a Malawian organisation building last-mile maternal and child health systems that reach smallholder farming families continuously, at the household and before complications arise, from before the first pregnancy to the child's fifth birthday.
We build the system that delivers care early, continuously, and in time. We scale it through government, so that what outlasts us is a health system the Government of Malawi owns and runs.
WE DO NOT BUILD ALONE
Building Systems
through Partnership
Proactive Doorstep Care does not work in isolation. The government co-owns it. Communities shape it. Funders make it possible. Researchers strengthen its evidence base. Frontline health leaders carry it forward. Each partnership is structural, one that is built into it. Without government co-management, the system has no mandate. Without community trust, it has no reach. Without sustained funding, it has no continuity.
Government Partnership
Integrated with Malawi's Ministry of Health at district level ensuring the system is sustainable, government-owned and aligned with national health strategy.
Global
Funders
Supported by global health funders committed to building last-mile systems that scale, endure and generate evidence that shifts how the sector thinks about rural health delivery.
Research Partners
Academic and research collaborators generating evidence that informs both practice and policy, building a global knowledge base for last-mile maternal and newborn care systems.
Community Leadership
Every district system is designed and operated with communities, from village leadership to CHW networks, because systems that do not belong to communities do not survive them.
The future of health systems is reaching people where they are.
