Care should not depend on people reaching the health system. The health system should reach people. Early, continuously and in time.
Maternal and child deaths persist because too many families reach healthcare too late. In rural Malawi, health services remain largely facility-centred, fragmented and reactive, relying on women and children to travel long distances before receiving care. For many families, distance, transport costs, limited health information and weak follow-up mean pregnancies are identified late, danger signs go unnoticed and manageable conditions become life-threatening emergencies. Malawi continues to record 225 maternal deaths per 100,000 live births, underscoring the need for a health system that reaches families before complications arise.
WANDIKWEZA'S RESPONSE
Proactive Doorstep Care
Proactive Doorstep Care is a six-layer, government-owned system that shifts preventive, routine and follow-up care from health facilities to households while ensuring families remain connected to skilled and emergency services whenever they are needed. PDC strengthens the existing public health system by extending its reach into communities and improving continuity of care from pregnancy through a child's fifth birthday.
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.
Wandikweza believes healthcare should not depend on families reaching a health facility. Instead, the health system should proactively find families, support them throughout pregnancy and early childhood and connect them to timely routine and emergency care. This belief is the foundation of Proactive Doorstep Care (PDC), a last-mile maternal and child health system designed to bring healthcare closer to where people live.
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
Rooted in Malawi. Built with communities. Designed to stay. Since 2016.
ABOUT WANDIKWEZA
We build Health Systems
Wandikweza, Chichewa for “the Lord has lifted me up” is a Malawian health organisation building last-mile health systems through Proactive Doorstep Care. The model identifies pregnant women, newborns and children early through home visits, provides continuous support through Community Health Workers and Midwives on Wheels and connects families to facility-based and emergency care in time. It is implemented in partnership with District Health Offices and government frontline health workers.
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.
