How We Deploy Proactive Doorstep Care
We deploy Proactive Doorstep Care (PDC) through an integrated, community-anchored approach that ensures essential health services reach the people who need them most, right at their doorstep. We work in close partnership with communities, local health facilities, and district health authorities to identify gaps, mobilize trained Community Health Workers and Nurses on Bikes, and deliver care that is timely, culturally sensitive, and lifesaving. Our model is built on proximity, prevention, and people-centered care, bridging the gap between underserved families and the formal health system through trusted, trained local health providers.
It is deployed through the lens of Engage, Build, and Strengthen. The process includes:​
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1. Engage: Communities, Public Health Facilities, and Local Leaders
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At the heart of the PDC model is meaningful community engagement. We begin by working closely with community members, traditional leaders, District Health Offices (DHOs), and frontline health facility staff to understand local needs, priorities, and barriers to care. Through dialogue sessions, household visits, and health forums, we create space for communities to shape the way care is delivered, ensuring that services are culturally appropriate, locally accepted, and truly responsive.
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We also engage local health facility staff from the outset to align the Community Health Workers, mobile clinics, and outreach activities with government health priorities. This coordination avoids duplication and ensures smooth referral pathways between community-based services and clinical care. We establish trust and accountability structures at the local level, such as health committees and CHW supervision groups, to ensure that communities are not just recipients of care, but active partners in health delivery.
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2. Build: Local Capacity for Sustainable Health Delivery
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Once community engagement is in place, Wandikweza moves to build local capacity for long-term impact. We recruit CHWs directly from the communities they serve, ensuring strong cultural understanding and trust. These CHWs are trained in maternal and child health, nutrition, immunization tracking, first aid, mental health support, and more. We equip them with tools (such as referral forms, growth monitoring cards, and mobile phones for reporting) to deliver care confidently and consistently.
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In addition to CHWs, we build capacity among Nurses on Bikes (NoBs) and clinic-based providers to work as an integrated team. We also train local volunteers in health education, hygiene promotion, and porridge program management, creating community-owned solutions. Our model emphasizes continuous learning, with regular refresher training, field mentorship, and peer learning sessions to ensure skills remain sharp and relevant.
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3. Strengthen: The Health System from the Ground Up
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Finally, the PDC model aims to strengthen the broader health system by addressing gaps in access, data, and service quality. Our CHWs and NoBs serve as critical links between households and the formal health system, bringing care to the doorstep while feeding data and referrals back to local health facilities. This helps decongest facilities and improve health-seeking behavior, especially among vulnerable populations like pregnant women, newborns, under five children and adolescents.
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We support data collection and reporting that aligns with HMIS, strengthening health system visibility and responsiveness. We work with District Health Offices (DHOs) to coordinate outreach activities, support vaccine campaigns, and jointly plan for community-level interventions. We strengthen health information systems, referral linkages, supervision structures, and emergency response in order to contribute to a more resilient, equitable, and responsive health system, built from the ground up.
Health Inequalities Necessitating Proactive Doorstep Care (PDC)
In Malawi, and many low-resource settings, health care access is not equal, it is determined by where a person lives, what they earn, and whether they are visible to the system. Rural and ultra-poor households face a web of barriers that prevent them from receiving timely, quality health care. Long distances to clinics, lack of transport, high out-of-pocket costs, understaffed facilities, and low awareness of health services all contribute to widespread health inequalities, especially for women, children, and adolescents.
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These inequalities have real and devastating consequences. Many women still give birth at home without skilled attendance. Children die from preventable causes like malaria, pneumonia, or malnutrition because care did not arrive in time. Adolescents lack access to reproductive health education and services. Natural disasters further intensify these vulnerabilities, isolating communities and disrupting already fragile health systems.
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Proactive Doorstep Care (PDC) was developed as a direct response to these systemic inequalities. Instead of waiting for people to come to the clinic, PDC brings care directly to the doorstep, prioritizing prevention, early detection, and referral. It ensures that no one is left behind due to poverty, geography, or circumstance. The PDC delivers integrated, community-based health services through trained local health workers, thus it helps close the gap in access and builds a more equitable and resilient health system from the ground up.
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​​​​​Below are the key health inequalities that necessitate PDC:
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Geographic Barriers
Inequality: Rural and remote areas often lack healthcare facilities, making it difficult for women and children to access essential services like antenatal care, immunizations, and emergency obstetric care.
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Impact: Women in rural areas are more likely to experience delays in receiving care, leading to higher rates of maternal and neonatal mortality.
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PDC Solution: By delivering services directly to households, PDC addresses physical barriers to care, ensuring that even the most isolated populations receive timely and quality health services.
Socioeconomic disparities
Inequality: Poverty significantly limits access to healthcare due to the inability to afford services, transportation, or related costs.
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Impact: Low-income families often delay or forego healthcare, resulting in preventable complications and poorer health outcomes for mothers and children.
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PDC Solution: PDC provides free care at the doorstep, reducing financial burdens and enabling equitable access for economically disadvantaged communities.
gender inequities
Inequality: Societal norms and gender-based discrimination often restrict women’s autonomy in seeking healthcare.
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Impact: Many women rely on male family members to make healthcare decisions, leading to delayed or denied access to critical maternal health services.
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PDC Solution: PDC engages directly with women and involving families in health education. It empowers women to prioritize their health and seek timely care.
health literacy gaps
Inequality: Low levels of health literacy prevent individuals from understanding the importance of maternal and child health services or recognizing warning signs during pregnancy and early childhood.
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Impact: Poor health literacy contributes to underutilization of preventive services and delays in seeking care for complications.
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PDC Solution: PDC emphasizes health education as a core component, equipping families with the knowledge they need to make informed health decisions.
disparities in quality of care
Inequality: Even when healthcare services are available, their quality often varies based on location, socioeconomic status, or marginalized status of the community.
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Impact: Women and children in underserved areas frequently receive substandard care, contributing to preventable mortality and morbidity.
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PDC Solution: PDC ensures standardized, high-quality care through well-trained Community Health Workers, Nurses on Bikes, Mobile Clinics and consistent monitoring of service delivery.
ethnic and cultural inequities
Inequality: Minority and indigenous populations often face discrimination and cultural insensitivity within the healthcare system.
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Impact: Cultural barriers discourage these groups from seeking care, further exacerbating health disparities.
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PDC Solution: PDC incorporates culturally sensitive practices and engages community leaders to build trust and acceptance within diverse populations.
limited access to emergency care
Inequality: Delays in accessing emergency obstetric and neonatal care disproportionately affect rural and low-income communities.
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Impact: Such delays are a leading cause of preventable maternal and neonatal deaths.
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PDC Solution: PDC identifies high-risk cases during routine visits and facilitates timely referrals to emergency care facilities.
weak health system infrastructure
Inequality: In many districts, inadequate health infrastructure and staffing shortages result in limited service availability.
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Impact: Overburdened facilities and lack of continuity in care widen the gap in health outcomes.
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PDC Solution: PDC supplements weak health systems by providing decentralized care and reducing the demand on overburdened facilities.
