How PDC
Works in Practice
Six interconnected layers each serving a distinct function, each depending on the others. From the household to emergency response, the system stays connected at every stage.
THE SIX LAYERS
Layer 1: Foundation of the system
Households, Families & Caregivers
Health-seeking behaviour originates at the household. Before a CHW arrives, a family is already making decisions about whether to seek care, whether to trust the system and whether the journey is worth making. PDC begins by engaging families at this layer, before any clinical need has arisen.
Layer 2: First and most continuous layer
Community Health Workers
Community-selected CHWs providing trusted doorstep visits, household enrollment, structured health education, danger sign identification and referral initiation. The CHW is the visible face of PDC, known by name, trusted by the household and the first person called before a situation becomes a crisis.
Layer 3: Skilled care at the household
Midwives on Wheels
Skilled midwives deployed on motorbikes for proactive, scheduled maternal assessment, reaching remote households that outreach clinics cannot easily serve. Deployment is planned from the household register. Midwives arrive briefed, knowing the woman's history before the visit begins. Every enrolled woman in her third trimester receives at least one midwife visit before 36 weeks.
Layer 4: A clinic that comes to the community
Mobile Outreach Clinics
A scheduled, site-based temporary health facility, arriving on a published date at a known community point. The clinic brings the full range of maternal and child health services directly to the community: pharmacy, point-of-care laboratory, ANC and PNC, advanced family planning, HIV testing and counselling and a porridge feeding programme for pregnant women and children under five.
Layer 5: Skilled Care
Midwives on Wheels
Health facilities are the institutional anchor of the PDC system. A woman identified early by her CHW, visited by a Midwife on Wheels, and seen at an outreach clinic arrives at the facility prepared, with a completed birth preparedness plan, a full clinical record and a referral that has already been communicated. The facility does not receive a stranger presenting in crisis. It receives a known patient, expected, with her history. Integration means active referral pathways and a feedback loop, the facility communicates the outcome of every PDC referral back to the CHW within 48 hours.
Layer 6: Coordinated emergency response
Maternity Rapid Response System
It is a coordinated obstetric emergency response infrastructure, comprising a communication protocol, pre-established transport, first-responder capacity at community level and facility pre-notification. When activated, it collapses the time between complication and care. The standard is an emergency coordination system that the DHMT owns, the CHW or Midwife can activate, the facility expects and the community trusts.
PDC engages here through
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Community introductory visits before enrollment
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CHW living in and known by the community
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Health education before pregnancy, not only during
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Birth preparedness planning at the household level.
What a CHW delivers
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Scheduled household visits every month
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Structured health education at every contact
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Danger sign assessment and documentation
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Birth preparedness planning at 28 weeks
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48-hour postnatal visit for every delivery
Clinical scope at the household
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Full ANC assessment: BP, weight, fundal height, FHR
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High-risk condition identification and same-day referral
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Birth preparedness review and confirmation
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Postnatal maternal and newborn assessment
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High-risk women visited fortnightly
Full service package
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Full ANC and PNC examination
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Pharmacy — medicines dispensed on site
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Lab: Hb, malaria, HIV, syphilis, urinalysis
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Advanced family planning including implants
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HIV Testing and Counselling with same, day results
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Porridge feeding for pregnant women and under-fives
Care delivered
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Facility pre-notified before every referral
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Household record travels with every patient
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Named facility contact for all PDC referrals
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Feedback to CHW within 48 hours of every referral
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Facility staff oriented to PDC protocols
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Handles advanced care that can not be handled at community level.
Integration standard
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Antepartum or postpartum haemorrhage
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Eclampsia or imminent eclampsia
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Cord prolapse or malpresentation at term
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Prolonged labour with no facility access
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Equipped ambulance dispatched within 30 minutes
The MRRS is a complete protocol: community first-responder activation, dispatch coordination, 30-minute dispatch standard from household notification to ambulance departure and quarterly simulation testing that validates the chain before a real emergency occurs.
What PDC looks like
for one family
From the moment a pregnancy is identified, a family enters a connected system that stays with them through every stage, from before the first antenatal contact to the child's fifth birthday.
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A family is found - Layer 02: CHW
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Enrolled early - Layer 02: CHW
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Skilled care arrives - Layer 03: Midwives on Wheels
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The clinic comes to her - Layer 04: Outreach
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Referred with support - Layer 05 & 06 : Facility & MRRS
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Followed home - Layers 02 - 04 · Postnatal
HOW WE BUILD IT
Three Building Blocks. One Lasting System.
Proactive Doorstep Care rests on three interdependent building blocks. Together they constitute the full architecture of a last-mile health system. Separately, each one is insufficient and the absence of any one of them is the most common reason health programmes fail to endure.
BUILDING BLOCK 1
Last-Mile
Infrastructure
The physical and operational hardware that makes care delivery possible in the places that are hardest to reach, in the communities where smallholder farming families live, on terrain that facility-centred systems were not designed to navigate.
This is the hardware of the system.
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CHW networks deployed at community-selected density
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Motorbike fleet for Midwives on Wheels deploymen
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Mobile Outreach Clinic schedules and supply chains
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Household registration and tracking systems
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Active referral pathways to government health facilities
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MRRS emergency coordination infrastructure
Without it: There is nothing to connect communities to. Care cannot arrive, regardless of how much trust exists or how much government endorses it.
BUILDING BLOCK 2
Community
Relationships
The trust, social bonds and reliable care relationships that determine whether communities use what has been built. Community trust is non-negotiable. it is what decides whether every other investment is used or ignored.
This is the software of the system.
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Community-selected CHWs living among the families they serve
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Reliability standards - visits happen on the day they are scheduled
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Village headmen as active health system champions
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Male partner and decision-maker engagement
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Traditional birth attendant integration as referral partners
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Continuous health education across the full lifecycle
Without it: Infrastructure exists but goes unused. Outreach clinics arrive to empty community points. CHWs are not welcomed into households.
BUILDING BLOCK 3
Government Co-Ownership
The formal mandates, budget lines, supervision structures and sustainability plans that give the system permanence beyond any funding cycle. Government co-ownership is the only mechanism that gives a last-mile health system a future beyond the organisation that built it.
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Ministry of Health alignment and national policy integration
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District Health Management Team co-management
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Government budget integration and co-financing
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Community Based Maternal and Child Health-led supervision structures
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PDC data in DHIS2 - government data systems
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Milestone-based sustainability and exit planning
Without it: The system works while Wandikweza is present and funded. It collapses when the funding ends, because there is no government mandate, no budget and no supervisor to keep it running.
Government Co-Ownership first. The District Health Officer must be formally engaged before the first community visit or CHW is recruited. Every component built before government engagement must later be handed over.
Community Relationships before infrastructure is useful. An outreach clinic that arrives in a community where CHWs have not enrolled households and leaders have not been oriented will be attended by very few people. Build the relationship layer second.
Infrastructure builds on the foundation of trust. The CHW is simultaneously the first infrastructure layer and the first relationship layer. These are built through the same people and the same actions.
Community trust is non-negotiable. A system that communities do not believe in will not be used, no matter how well it is built. We invest in trust as deliberately as we invest in anything else.
WHAT THIS ACHIEVES AT FACILITY LEVEL
Decongesting facilities by meeting families where they are.
By shifting preventive, routine and follow-up care into communities, the model is designed to decongest health facilities, reserving the health centre for complex, referred and specialised cases that genuinely require facility-level care.
A woman who receives four ANC contacts through outreach clinics and two midwife visits at home does not need to occupy a facility ANC queue for routine care. Her facility contact is reserved for the moment it is clinically necessary and when that moment comes, the facility knows she is coming.
This is the logic of the six layers working as a system. Each layer handles what it was designed to handle. The household layer builds trust. The CHW layer enrolls and follows. The midwife layer provides skilled assessment at home. The outreach clinic delivers routine care in the community. The facility receives referrals, not queues.
TWO MODELS. ONE DIFFERENCE
Facility-Centred versus Proactive Doorstep Care
The Facility-Centred Model
X Waits to be reached
The system is inside a building. It serves the families who can arrive. It does not look for the ones who cannot.
X Identifies pregnancies late
Women present when they feel something is wrong, often at 28 weeks or later, after the first trimester window has closed.
X No continuity between contacts
Each facility visit starts from scratch. No one is tracking whether she came last month or what happened at her previous contact.
X Referral means a note and a direction
She is told to go to the facility. No transport is arranged. The facility is not called. She navigates alone.
X Reactive - responds to emergencies
Care is available when a complication has already formed. Prevention and early identification are not built in.
WITHOUT PDC
WITHPDC
Proactive Doorstep Care
Goes to the household first
The CHW visits every enrolled household on schedule. She does not wait to be called. She comes because it is time.
Identifies pregnancies in the first trimester
Enrollment happens at the household, ideally before 12 weeks, when early intervention has the greatest impact on outcomes.
Continuous follow-up across every layer
The household record travels with the woman, from CHW to midwife to outreach clinic to facility. No contact starts from zero.
Referral is an active handover
Transport confirmed. Facility pre-notified. Someone accompanies her. She arrives expected, with her record, to a facility that is ready.
Proactive prevents emergencies
By the time a complication becomes life-threatening, the system has already visited the household six times this pregnancy.