Seven Districts
by 2030
Every district Wandikweza enters tests the replication blueprint in a new geography, a new cultural context, and a new government relationship. Each one adds to the evidence base that governments, funders and health system builders across sub-Saharan Africa need to answer the same question: what does it actually take to build a last-mile health system that stays?
HOW WE SCALE
The same four phases. Every district. Every time.
Every PDC district moves through the same four phases:
1. Government First
2. Community Entry
3. System Built
4. Government Owned
In the same order, governed by the same three convictions. These are four functions that any functional last-mile maternal and child health system for smallholder farming families must deliver, designed in each district to fit the geography, the season and the community it serves.
PHASE ONE
Government first
No community activity begins before government endorsement. The DHO is the first relationship and a co-designer from the start.
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DHO formal engagement and endorsement
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MoU signed with DHMT
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Government Focal point identified
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PDC included in district work plan
PHASE TWO
Community entry
Village headmen are engaged before CHW selection begins. CHWs are nominated by their communities. The community shapes the system from the inside from day one.
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Headman and community leader engagement
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Community CHW nomination process
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Household registration begins
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First outreach clinic schedule published
PHASE THREE
System built
All six PDC layers are established in parallel. The PDC Assessment Tool measures system functionality quarterly. No layer is considered operational until it meets the 4.0 minimum standard.
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Proactive household presence established
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Skilled clinical reach established
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Active referral established
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Emergency response tested
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PHASE FOUR
Government owned
The exit standard is not determined by a funding timeline but by a demonstrated government co-ownership trajectory: DHMT co-management and supervision, budget integration, DHIS2 reporting, and co-financing above threshold.
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Government co-financing at threshold
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DHMT leads supervision independently
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PDC in district health budget
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Wandikweza steps to advisory role
GROWTH & SCALE
Building a Multi-District Health System
Wandikweza is systematically building a scalable, government-integrated health system. Each district strengthens the model, builds the evidence base and brings us closer to a seven-district system serving 3 million people by 2030.
Each entry year marks the launch of a new district and the next layer of national coverage. By 2029, seven districts will be carrying the full six-layer PDC system, with the earliest districts progressively transferring to independent government operation.
Since 2016
Dowa
2023
2025
2026
Mangochi
Salima
Mchinji
2027
Nkhotakota
FLAGSHIP
Model development & proof of concept. Where Proactive Doorstep Care was born and proven.
EXPANSION
First replication district. Proving the model adapts across geographic and cultural contexts.
SCALE
Standardized PDC system delivery. Full framework operating at district level.
SCALE
Multi-district rollout accelerating. Operational blueprint being replicated systematically.
SCALE
Fourth expansion district. Nkhotakota extends Proactive Doorstep Care into a lakeshore context, testing the model's adaptability to fishing communities and seasonally inaccessible terrain along Lake Malawi.
2028
Kasungu
2029
Dedza
2030
Seven Districts. One System
SCALE
Fifth expansion district. Kasungu brings PDC into a large, predominantly agricultural district, deepening Wandikweza's evidence base across diverse rural economies and strengthening the multi-district operational infrastructure.
SCALE
Sixth expansion district. Dedza completes the pre-2030 scale push, operating as the final proving ground before the full seven-district system is declared operational. Positioned along the Mozambique border, it extends reach to cross-border populations facing compounded access barriers.
2030 GOAL
What began as a single model in Dowa in 2016 is now a functioning, government-integrated last-mile health system operating across seven districts in Malawi. Proactive Doorstep Care reaches 3 million people, pregnant women, newborns, adolescents and families, continuously and in time. This is not the end of the work. It is proof that the system can be built, that it can scale and that care reaching people where they are is not an aspiration. It is an operational reality.