Every pregnancy deserves care
In rural Malawi, many women face preventable risks during pregnancy due to poverty, long distances to health facilities, and delayed access to information and care. These barriers often lead to life-threatening complications, especially where skilled health workers and emergency services are limited.
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Wandikweza addresses this gap through Proactive Doorstep Care, identifying pregnant women early through home visits and providing continuous antenatal and postnatal support. Community Health Workers and Midwives on Wheels deliver essential assessments, health education, birth preparedness, and timely referrals—ensuring women are supported from pregnancy through childbirth and recovery with dignity, compassion, and continuity of care.
Proactive Doorstep Care across the Pregnancy Journey
Pregnancy Identification (0–12 weeks)
Goal: Early identification of pregnancy to initiate timely and continuous care.
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Key Actions:
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Community Health Workers conduct routine household visits.
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Pregnancy is identified through self-report or CHW-administered testing when necessary.
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The woman is enrolled in Wandikweza’s Pregnancy Register and linked to a designated Midwife on Wheels.
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Immediate health education begins, covering the importance of early antenatal care, proper nutrition, hydration and recognition of danger signs.
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The CHW supports the woman to attend her first antenatal care visit at a health facility.
First Trimester (0–13 weeks)
Goal: Establish continuous care and provide foundational health education.
CHW / Midwife on Wheels Visits: 1–2 home visits
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Key Actions:
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Support and confirm attendance at the first antenatal care (ANC) visit.
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Assess nutrition status, mental well-being and available social support.
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Provide targeted education on early fetal development, safe medication use, management of morning sickness and avoidance of harmful substances.
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Facilitate or refer for essential services, including iron and folate supplementation, malaria prevention (IPTp where appropriate), and HIV testing and counseling.
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Initiate birth planning discussions, including delivery location and identification of support persons.
Second Trimester (14–27 weeks)
Goal: Ensure ongoing monitoring and birth preparedness.
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CHW / Midwife on Wheels Visits: At least one visit per month (minimum of two visits)
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Key Actions:
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Continue focused health education on danger signs, nutrition using locally available foods, rest and stress management, and postpartum family planning.
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Encourage attendance at second and subsequent antenatal care visits.
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Monitor maternal and fetal well-being, including blood pressure, fetal movement, weight gain and early signs of complications.
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Develop or review a birth plan, confirming the delivery facility, emergency contacts and transport arrangements.
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Support practical birth preparedness, including essential maternal and newborn supplies.
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Engage partners or family members to strengthen maternal support and shared decision-making.
Third Trimester (28–40 weeks)
Goal: Ensure delivery readiness and anticipate potential complications.
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CHW / Midwife on Wheels Visits: 2–3 home visits, spaced every 2–3 weeks
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Key Actions:
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Finalize birth preparedness and reinforce the importance of facility-based delivery.
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Confirm transport arrangements and notify the health facility if risk factors are identified.
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Screen for and monitor high-risk conditions, including pre-eclampsia, preterm labor, malaria in pregnancy, and maternal mental health concerns.
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Provide education on signs of labor, breastfeeding preparation, newborn danger signs, and essential items to bring to the facility.
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Activate emergency and referral plans promptly if complications or high-risk indicators emerge.
Delivery Support (40 weeks ±)
Goal: Ensure safe, facility-based delivery with skilled care.
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Key Actions:
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Activate referral or community transport when labor begins.
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Support timely arrival at the designated health facility or hospital.
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Maintain communication with the family and facility staff, accompanying the woman when needed.
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Coordinate with facility nurses and midwives to respond promptly if complications arise.