Building Malawi’s Last-Mile Health System
Wandikweza is a last-mile health systems builder. We strengthen how healthcare reaches families, starting at the doorstep, linked to facilities, aligned with government priorities, and powered by real-time learning. Our work focuses on preventing avoidable maternal and child deaths by ensuring women and children are reached early, not late.
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We do not run standalone projects. We build the community-to-facility system that delivers care every day, for mother, newborns, underfive children and adolescents.
The Building Blocks of Our Approach
Proactive Doorstep Care (PDC) is Wandikweza’s core delivery model. It shifts health care from being primarily facility-based to being anticipatory, continuous and household-centered.
Through PDC:
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Care is delivered before complications arise, not only in response to emergencies
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Households are actively followed, rather than waiting to seek care
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Services are continuous across the life course, from pregnancy through adolescence
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Trusted Community Health Workers and Midwives on Wheels provide preventive, promotive and referral services directly at the household level, ensuring early identification of risk and timely linkage to facilities.
Doorstep-First Care
We start where risk begins: at home.
Our teams conduct proactive household visits to identify pregnancy, newborn, child and adolescent risks early, before complications escalate. This is continuous care, not one-off outreach.
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Outcome: early detection, faster action, fewer emergencies.
A Professionalized community workforce
We treat community care as skilled work.
Community Health Workers (CHWs) are selected from the communities they serve and supported as a reliable frontline workforce through defined roles, supervision and performance tracking.
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Outcome: consistent coverage, accountability, and quality care at scale.
Continuum of Care and Referral Readiness
We connect households to skilled care without delay.
We strengthen linkage and referral pathways so families can move smoothly from home-based support to skilled services, with follow-up after facility visits to ensure continuity.
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Outcome: timely referrals, reduced delays and safer maternal and newborn outcomes.
Government-Embedded Design (CBMCH-Aligned)
We strengthen the health system that must last.
Our model aligns directly with Government of Malawi Community-Based Maternal and Child Health (CBMCH) priorities, supporting the continuum of care, community-facility linkage and sustainable workforce structures.
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Outcome: long-term viability, scalability, and stronger public systems.
Data-Driven Delivery at the Frontline
Data is generated where care happens—and used immediately.
Using offline-capable tools and routine field reporting, supervisors and teams track progress, identify gaps and respond quickly. Data is not just for reporting; it is for decision-making.
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Outcome: faster course correction, improved quality and measurable results.
District-Level System Building
We scale by district, not by isolated activities.
We implement at district level because that is the unit of planning, accountability and replication in public health. Each district package includes workforce, supervision, referral strengthening and monitoring.
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Outcome: replication without dilution and stronger health system performance.
Sustainability through Prevention and Efficiency
Prevention is the highest return investment in health.
We reduce avoidable complications, decongest facilities and improve the efficiency of scarce health resources by detecting risks early and supporting families close to home.
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Outcome: lower long-term costs and better outcomes per kwacha invested.