The learning agenda is built into the work.
Each new district asks the same questions Dowa answered first and answers them again in a new geography, with a new government relationship and a new community.
What does it actually take to build a system that reaches every family and then keeps reaching them after the organisation that built it has stepped back? This is the question every district adds evidence to.
EVIDENCE & LEARNING
Three questions.
answered district by district.
Each one answered a little more precisely every time. None of these questions are answered once and closed. Every active district contributes to all three and every new district entry is a chance to test what the last one taught.
COMMUNITY TRUST
What it takes to build trust in a new geography
What does a community need to see before it begins to rely on a system it has not yet tested?
Trust is not transferable between districts, it has to be built again, every time, from the first conversation with a village headman to the first community-nominated Community Health Worker beginning her rounds. But the conditions that make trust possible are not random. Four districts in, patterns are visible: how headman engagement sequences against CHW selection, how quickly households enrol once the first outreach clinic arrives on the day it was scheduled, and what reliability has to look like before a community stops testing the system and starts using it.
Each district adds to an evidence base not just about whether trust can be built in a new geography, but about how long it takes and what accelerates it, evidence that shapes how Wandikweza enters a new district and every district after it.
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Headman engagement sequencing
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CHW nomination timelines
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Household enrollment rates
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Reliability thresholds
GOVERNMENT CO-OWNERSHIP
The milestones that predict long-term sustainability
Which early milestones predict an accelerated path to government ownership and which delays are recoverable?
District trajectory toward a government handover moves through identifiable stages: DHMT orientation, joint supervision, a first co-financing conversation, a formal budget line. Districts move through the same stages at different speeds and the differences are themselves data.
This is the evidence that turns "government co-ownership" from a conviction into a measurable, replicable pathway, identifying which milestones, reached early, predict a faster trajectory and which signal that a district needs a different kind of support before it can move forward.
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DHMT supervision trajectory
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Co-financing onset
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DHIS2 integration timing
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Budget line confirmation
SYSTEM DESIGN
Which elements of the system must stay exact and which can adapt without breaking it?
The most common failure in replication is copying a program's specific form instead of the logic underneath it. Wandikweza addresses this directly by separating every element of Proactive Doorstep Care into two categories: what must travel into every district unchanged and what is free to take a different shape depending on geography.
What cannot change: Three convictions, a government-first sequence, a single exit standard and proactive care delivered at the household. Every district is built government-first, every Community Health Worker is community-nominated, every district is measured against the same standard and every household enrolled is visited continuously, before a need becomes urgent, without exception, four districts in. The household is where the model's strength sits. Everything else is built around making sure the system reaches it.
What can change: The number of layers, the transport mode and the clinic schedule. None of these are fixed requirements, they are Dowa's specific answers to Dowa's geography, free to take a different shape wherever the core is rebuilt.
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Household presence held exact
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Form free to adapt by geography
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Exit standard unchanged
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Adaptable elements identified
From the field
to the blueprint
Here is the path every answer to these three questions travels, from a CHW's quarterly visit record to a change in how Wandikweza enters its next district. This is the path that keeps the Replication Blueprint a living document.
01
Measured
The Assessment Tool is administered quarterly in every active district, co-administered with the government DHMT focal point, across all 18 indicators and three building blocks.
02
Compared
Each district's results are set against its own trajectory and against every other district at the same stage, district Year 1 against another districts's Year 1.
03
Documented
Findings are written into quarterly and annual reports and significant patterns are documented as evidence in their own right.
04
Applied
The Replication Blueprint is updated. The next districts, Nkhotakota, then Kasungu, then Dedza, enters with a sharper version of everything learned before it.
The Assessment Tool and the Replication Blueprint are where this evidence lives operationally. The reports archive is where it is shared publicly, quarter by quarter, district by district.
Built for Wandikweza.
Shared with the sector.
This evidence exists to be used by anyone asking the same questions Wandikweza asked in 2016.
How do we ensure that the families living furthest from care are reached before it is too late?
Governments
Designing community health strategies, CHW policy frameworks or last-mile referral systems and wanting to know what a realistic co-ownership trajectory looks like, milestone by milestone.
Funders
Evaluating what sustainable last-mile investment looks like in practice and wanting evidence that an exit standard is real, measured and has already been met once before.
Health System Builders
Across sub-Saharan Africa, asking the same questions Wandikweza asked in 2016 and wanting to know what worked, what did not and how long it actually took.
EVIDENCE & LEARNING
A Learning System
Every district Wandikweza enters generates evidence about what it takes to build community trust in a new geography, about the government co-ownership milestones that predict long-term sustainability, about the point at which a CHW network becomes self-reinforcing. That evidence is structured, documented and made available to governments, funders and health system builders across sub-Saharan Africa who are asking the same questions Wandikweza asked in 2016. The learning agenda is built into the work itself.
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01
Outcome Evaluation
Rigorous assessment of maternal and newborn outcomes across supported districts measuring the real-world impact of Proactive Doorstep Care on mortality, morbidity and care quality.
03
District Learning Systems
Real-time data collection and learning loops built into every district operation ensuring the system continuously improves based on frontline evidence from CHWs and midwives.
02
Learning Agenda
A structured research agenda asking the most important questions about last-mile system design, CHW performance, mobile outreach effectiveness, and scalable delivery models.
04
Data Systems & Technology
Digital platforms supporting household tracking, CHW supervision, referral management, and impact measurement, designed for low-connectivity rural settings across Malawi.
WHEN THE ROADS CLOSE
Care that does not stop when the floods come
Flood Response Continuity
When floods cut roads and displace communities, Wandikweza maintains doorstep care through pre-positioned CHWs, adapted delivery routes and household continuity protocols that were in place before the crisis began.
Household Continuity Protocol
Even in emergencies, enrolled families remain connected to CHWs. The care relationship that was built in normal times maintains continuity when it matters most preventing complications from going unnoticed.
Emergency Referral Pathways
Rapid escalation protocols ensure obstetric emergencies are identified early, transported to appropriate care within critical time windows and tracked through the full referral chain.
A pregnancy at thirty-four weeks does not pause for a flood. A danger sign does not wait for the water to recede. For smallholder farming families in Malawi's rainy season, the weeks when roads are impassable are often the weeks when the need for skilled care is highest and when a facility-centred system is least able to respond.
Proactive Doorstep Care is built for this. The season that breaks every other model is the season PDC was designed for.
Maternity Rapid Response System
When an obstetric emergency arises, every minute determines the outcome. The Maternity Rapid Response System is Wandikweza's (sixth layer of the PDC model) emergency coordination infrastructure, ensuring that when a life-threatening complication occurs at the household, the right care is mobilised immediately, ambulance is dispatched, the receiving facility is pre-notified and a woman in crisis is never left to navigate that moment alone. At any hour. In any season.
THE CASE FOR SUPPORT
Invest in something that Outlasts You
Wandikweza has built a maternal and child health system that works, proven across multiple districts, co-owned by government, continuously tracked through evidence and on a defined pathway to reaching three million people by 2030.
This is a functioning system awaiting the investment to go further. Fund the system. Not the program.
10 Years
Proven Track Record
Operating since 2016, with a replicable model proven across four districts in diverse geographic and cultural contexts.
96%
Measurable Outcomes
Skilled delivery rates that demonstrate real-world impact with rigorous data systems tracking outcomes continuously across all districts.
3M
Clear Scale Pathway
A defined, costed, government-aligned pathway to reach 3 million people through seven districts by 2030. The blueprint exists. The system works. Funding accelerates it.
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.