Families living in rural communities within our operating districts in Malawi.
We serve rural families, particularly pregnant women, newborns, children under five and adolescents, who are likely to be reached late or lose contact with care between the household, community and health facility.
A pregnant smallholder farmer, working her fields until the day she delivers, living hours from the nearest health facility, with few transport options and a health system that waits for her to come instead of reaching her where she lives.
She is not hard to reach. She is just not who the health system was designed for.
So we built a system that goes to her, to the farm, to the household, to the community, before she knows she needs it and before it is too late to matter.
THEIR LIVELIHOOD
Smallholder
farming
They grow maize, groundnuts, and vegetables on small plots, often less than two acres. Their income arrives at harvest. During planting, there is almost none. Leaving the farm is not a choice made lightly.
THEIR REALITY
Working through every stage
Farming does not stop for pregnancy. A woman in her third trimester is still carrying water, tilling soil and preparing food. The physical demands of smallholder farming and the demands of pregnancy happen at the same time, in the same body.
THEIR LOCATION
Rural, remote and underserved
The communities Wandikweza serves are in districts where road access is limited, seasonal flooding cuts off villages and the nearest skilled health worker can be a two-hour walk across uneven terrain.
Stage 01
Before Pregnancy
A young woman farming her family's land. No one has ever visited to talk about reproductive health, nutrition or what to expect. The system has never looked for her.
Women aged 15 - 49
Stage 02
During Pregnancy
Pregnant and still farming. She may not know the danger signs. Antenatal care means leaving the farm, finding transport money she may not have and trusting a system that has not earned trust.
First trimester through term
Stage 03
Labour
& Birth
The highest-risk moment. Transport must be arranged, the facility must be reachable and the system must know she is coming. Too often, without PDC, none of these are true at the same time.
Day of delivery
Stage 04
Newborn to Age Five
Mother and child in the most vulnerable window. Breastfeeding, nutrition, immunisation, and early illness recognition — all require a system that keeps showing up long after the birth is over.
Birth through five years old
The barriers they face
BARRIER 1
Distance
The nearest facility can be two or more hours away on foot, across uneven terrain, through seasonal flooding, while heavily pregnant. Distance is a decision made against a woman every day the system does not come to her.
"She walked two hours in labour. She arrived alone. The facility was not expecting her."
BARRIER 2
Cost on a farming income
Transport to a facility can cost a day's income for a smallholder farming family. During planting or dry season, that income does not exist. A system that requires payment before access has already excluded her, without asking her to decide.
"The fare to the clinic was a week's income. She waited to see if it would pass."
BARRIER 3
Limited health
awareness
No one has visited to explain the danger signs of pregnancy. No one has taught her what to watch for in a newborn. The knowledge gap is what happens when a health system has never reached the household where she lives.
"She did not know the headache was a warning. No one had ever told her it could be."
BARRIER 4
A system built around a facility
The health system was designed around a building. It waits. It does not look for the smallholder farmer in her third trimester who cannot come. Her absence is treated as her failure, not the system's design flaw.
"The system was there. She just was not who it was built to find."
A system that requires all four conditions to be met by the smallholder farming family will only ever reach a fraction of the women who need it most. The failure belongs to the system's design not to the families it cannot reach.
THE JOURNEY OF CARE
How Care Reaches
a Family
Care that begins at home and continues when families need it
Wandikweza’s Journey of Care begins by identifying adolescents, pregnant women, newborns and children early through trusted Community Health Workers who regularly visit families at home. They provide health information, recognise risks and connect people to the care they need. Midwives on Wheels travel by motorbike to deliver skilled antenatal and postnatal care closer to families, while mobile outreach clinics bring immunisation, growth monitoring, nutrition, family planning and other essential services to hard-to-reach communities.
When clinical care is needed, families are connected to government or Wandikweza-supported health facilities and when a pregnant woman or newborn experiences a complication, the Maternity Rapid Response System coordinates timely referral and transport using an equipped ambulance. Care continues after treatment or childbirth through household follow-up, keeping mothers, newborns and children connected to preventive and routine services through a child’s fifth birthday. This creates one continuous journey between the household, community and health facility, reaching families early, supporting them continuously and connecting them to skilled care in time.
STEP 1
Health-Seeking Starts at the Household
Before a CHW arrives, a family is already deciding, whether to seek care, whether to trust the system, whether to act on what they know. The household is where health-seeking behaviour originates. The entire system is built to engage people at this point, before a complication forces their hand.
STEP 4
Community Services Reach Her
Mobile outreach clinics bring nutrition support, immunisation, and postnatal care to the community, extending the reach of the health system without requiring facility visits.
STEP 2
Found Early. Enrolled.
Followed.
A trusted Community Health Worker visits the household, identifies the pregnancy and enrolls the woman into continuous care before complications have a chance to form. From that point, the CHW returns regularly: checking in, providing education, tracking the pregnancy and watching for early warning signs that require escalation.
STEP 5
A prepared referral when needed
When facility care is needed, the family is not sent alone. They arrive with a complete clinical record, an active referral and a facility that has already been informed. The system communicates ahead on their behalf, so that when they arrive, they are expected, prepared for and received.
STEP 3
Skilled Care
Comes
to Her
A skilled midwife arrives at or near the home. Clinical assessments, ANC and skilled maternal care are delivered without the family needing to travel to a facility.
STEP 6
Emergency Response: Immediately
If a life-threatening complication arises, the Maternity Rapid Response System activates immediately, mobilising transport, clinical support and facility care without delay.