The Context
In Malawi, maternal, newborn, and child mortality rates remain alarmingly high, particularly in rural and underserved communities. Despite global advancements in healthcare, many Malawian families continue to face significant barriers to accessing essential health services.
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Maternal Health Crisis
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Despite progress over the past two decades, maternal mortality remains one of Malawi’s most urgent and persistent public health challenges. As of 2020, the Maternal Mortality Ratio (MMR) in Malawi was 381 deaths per 100,000 live births, a significant improvement from 749 in 2000, representing a 49% reduction. However, while this progress is commendable, the MMR still remains more than five times higher than the global Sustainable Development Goal (SDG) target of 70 deaths per 100,000 live births. This means that thousands of women in Malawi continue to die each year from complications related to pregnancy and childbirth, deaths that are almost entirely preventable.
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The leading causes of maternal mortality in Malawi are hemorrhage (severe bleeding), sepsis (infection), eclampsia (high blood pressure complications), and obstructed labor, all of which can be prevented or treated with timely, skilled medical care. However, access to this care is often limited or delayed, particularly in rural communities. Many women begin antenatal care late or not at all, give birth at home without skilled attendants, or are unable to reach health facilities in time due to distance, cost, or lack of transportation. Moreover, weak referral systems, drug stock outs, and gaps in postnatal follow-up further endanger mothers during the most vulnerable period of their lives. These preventable deaths reflect broader systemic inequalities, where geography, poverty, and health system weaknesses converge to create a cycle of maternal risk that disproportionately affects the most marginalized women.
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Child Mortality and Malnutrition
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Malawi has made progress in reducing child mortality, but the burden remains high, especially in rural and low-income communities. 34 out of every 1,000 children die before their fifth birthday. Most of these deaths are from preventable and treatable conditions like pneumonia, malaria, diarrhea, and neonatal infections. Many children still lack access to basic services like immunization, growth monitoring, and timely treatment due to poverty, distance from health facilities, and limited household awareness.
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Malnutrition is a major underlying cause of poor child health. Over 35% of children under five are stunted, showing long-term effects of chronic undernutrition, and more than 62,000 children are at risk of severe acute malnutrition. Without early intervention, malnourished children are more likely to die from common illnesses and face long-term consequences in school, health, and future productivity.
Why so many are left behind: The barriers to health care access in Malawi
Despite the availability of free public health services in Malawi, millions of people remain without timely, quality health care, particularly in rural and underserved areas. This is not due to a single cause but a complex web of structural, economic, and informational barriers that intersect and compound, especially for the most vulnerable families.
Economic Constraints - cost
Although most basic services are technically free, the hidden costs of accessing care, such as transportation, missed work, or childcare, can be insurmountable for low-income families. A mother may have to choose between buying food or paying for a bicycle taxi to the clinic. These trade-offs lead to delayed care, untreated illnesses, and avoidable complications.
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Only 46% of Malawians live within 5 kilometers of a health facility, meaning that more than half the population must walk long distances, often for hours, to reach care. For women in labor, sick children, or elderly caregivers, this distance can mean the difference between life and death. In the rainy season, flooded roads and impassable terrain make access even harder. Geography alone isolates entire communities from care.
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Lack of Health Awareness
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Many families, especially in remote communities, lack the knowledge and confidence to seek preventive care or recognize danger signs early. Cultural beliefs, misinformation, and low health literacy contribute to late care-seeking or reliance on informal and less effective remedies. This is especially harmful during pregnancy and early childhood, when delays in care can have lifelong consequences.
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Health System Limitations
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Malawi’s health system is under strain. Chronic staff shortages, high patient-to-provider ratios, and frequent stockouts of essential medicines weaken the quality and reliability of services. Even when patients reach a facility, they may be turned away due to lack of supplies or overwhelmed providers. Continuity of care, especially for chronic illnesses, pregnancy, or postnatal follow-up. is often disrupted.
Geographical Barriers - distance
Health care closer to the people -where it is needed most
our solution
We recognize that the health system, as it stands, does not reach everyone, especially those living in rural, impoverished, and disaster-prone areas. The barriers of cost, distance, lack of awareness and weak infrastructure have left too many mothers, children, and families without access to even the most basic health services. We exist to close this gap.
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Our solution is Proactive Doorstep Care (PDC), a community-based model that brings health services directly to people’s homes rather than waiting for them to find their way to a clinic. This model is built on a strong, coordinated network of Community Health Workers (CHWs), Nurses on Bikes (NoBs), mobile outreach clinics, and facility support, all working together to deliver preventive, promotive, and curative care at the household level.
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We focus on early detection, health education, regular follow-up, and strong referral systems, to prevent complications before they become emergencies. We address the full continuum of care, from pregnancy, childbirth, and postnatal care to child nutrition, immunization, mental health, and adolescent health. Through this approach, we are not only treating illness, we are transforming the way health care is delivered.
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We work in partnership with communities, local health authorities and national systems to build an integrated, sustainable approach to health delivery that centers the needs of the most vulnerable. Every doorstep we reach brings us closer to a health system that is equitable, resilient, and truly for all.
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At Wandikweza, we do not wait for people to come to care.
We bring care to the people, one doorstep at a time.
