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?
Trust cannot be transferred from one district to another; it must be earned anew in every community. Through expansion across four districts, Wandikweza has learned that trust is built through consistent engagement with local leaders, community-led CHW selection, reliable service delivery and keeping promises. Each new district provides evidence on how trust develops, how quickly families enrol and what conditions enable communities to move from testing the system to relying on it. These lessons now guide how Wandikweza enters and scales in new geographies.
GOVERNMENT CO-OWNERSHIP
Which milestones predict sustainability?
Government ownership develops through a series of measurable milestones, including DHMT engagement, joint supervision, co-financing, DHIS2 integration and the establishment of district budget lines. As Wandikweza expands, each district provides evidence on how quickly these milestones are reached and which early indicators predict a faster path to government ownership. This learning is helping transform government co-ownership from an aspiration into a replicable and scalable pathway for sustainable health system integration.
SYSTEM DESIGN
Which elements of the system must stay exact and which can adapt without breaking it?
Wandikweza scales Proactive Doorstep Care by distinguishing between what must remain constant and what can adapt. The core elements: government-first implementation, community-nominated health workers, continuous household-level care and a common standard for success, remain unchanged across every district. At the same time, operational features such as transport models, service delivery layers and clinic schedules are adapted to local geography and context. This approach ensures the model's core logic is preserved while allowing flexible implementation in different settings.
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.
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.
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.