Proactive Doorstep Care
Proactive Doorstep Care is Wandikweza's last-mile health system model. It is a six-layer connected system that shifts preventive, routine and follow-up care from facilities to households, ensuring that smallholder farming families are reached by skilled care early, continuously and in time before complications escalate into emergencies.
The model is built for the families that facility-centred systems were never designed to reach: women of childbearing age between 15 and 49, pregnant women, newborns and children under five, living on smallholder farms in rural Malawi. It follows them through every stage, from before the first pregnancy to the child's fifth birthday, because the risks that determine maternal and child health outcomes begin at the household, long before a woman knows she needs care.
The model integrates Families and Caregivers, Community Health Workers, Midwives on Wheels, Mobile Outreach Clinics, Health Facilities and a Maternity Rapid Response System into one coordinated continuum, bringing preventive, routine and follow-up care directly to the smallholder farming families that facility-centred systems were never designed to reach.
Proactive
The system does not wait to be found. A CHW or Midwife visits because a woman is enrolled and her visit is scheduled, not because a crisis has already begun.
Doorstep
Because care starts at the home, where the family is, where the decision to seek further care is made and where the system must first show up.
Care
Skilled assessment, health education, danger sign identification and a direct connection to every layer that follows.
THE ARCHITECTURE
What the System
is built from
Each of the six layers is a distinct operational component with its own workforce, protocols, supervision structure and connection to every other layer. Together they form one coordinated system, not six separate services running in parallel, but a single continuum in which each layer depends on and feeds into the next. That is what makes Proactive Doorstep Care a system, not a program.
LAYER 1
Households, Families & Caregivers
The origin of the system. Health-seeking behaviour starts at the household, with families and caregivers making decisions before any health worker has identified them. This is the foundation of PDC. Everything else the system does is built on what happens here first.
LAYER 4
Mobile Outreach Infrastructure
A scheduled, mapped outreach system that deploys clinical teams to fixed community points on a regular calendar, bringing ANC, postnatal care, nutrition assessment, family planning and general clinical care to where populations are concentrated.
LAYER 2
Community Health Worker Network
Trained, supervised, and incentivised CHW, recruited from the communities they serve, operating to standardised protocols and supported by a tiered supervision structure that maintains quality at scale across all districts.
LAYER 5
Facility Integration & Referral
Government health facilities are integrated into the PDC system through active referral pathways, two-way communication protocols and shared patient records so facilities receive prepared patients and can communicate outcomes back to the community layer.
LAYER 3
Midwives on Wheels Programme
A cadre of skilled midwives deployed on motorbikes, equipped for community-based maternal assessment and care. Operationally distinct from outreach clinics, they go further, move faster, and respond directly to CHW escalations in real time.
LAYER 6
Maternity Rapid Response System
MRRS is a dedicated obstetric emergency coordination infrastructure, comprising equipped ambulances, trained first responders and facility pre-notification systems, designed to collapse the time between complication and care
Six connected layers carry that shift in practice
A household enrolled early, a Community Health Worker who returns again and again, a skilled midwife who reaches the home itself, a full clinic that comes to the community, a facility that receives a family it already expects, and an emergency response that closes the gap when every minute counts.
Each layer depends on the one before it and feeds the one after it, together, they form a single continuum, not six separate services.
And it is built to last. PDC rests on three things constructed together from Day 1: the physical Last-mile infrastructure to deliver care where it has not consistently reached, the Community Relationships that make care trusted and used, and the Government co-ownership that makes care sustainable long after Wandikweza steps back.
THE BUILDING BLOCKS OF PDC
The Three Building blocks of a System that outlasts us
The three building blocks are built simultaneously, because none of them works without the others. A system with infrastructure but no community trust goes unused. A system with trust but no government co-ownership collapses when the funding ends. The absence of any one of them is not a gap in the model. It is the end of it.
Each block fails without the other two. We build all three, together, in every district we enter. That is what makes it a system and not a program.
Proactive Doorstep Care rests on three building blocks, each representing a distinct and irreplaceable dimension of last-mile health system development.
Government Co-Ownership provides the mandate, the budget integration, and the institutional structures that give the system continuity beyond any external programme and beyond any single funding cycle.
Community Relationships provide the trust and social foundations that determine whether communities engage with what has been built.
Last-Mile Infrastructure provides the operational and physical capacity to deliver care where it has not consistently reached.
Healthcare should not depend on people
reaching the system.
The system should reach people early, continuously and in time.
Care Starts
at Home
Care begins where people live, not where buildings are located.
Prevents,
not Reacts
The system identifies risk before complications escalate to crises.
Connects the Full System
Community, outreach, facilities and emergency response work as one.
Designed for
Scale
Government-aligned from day one. Built to replicate across districts.