By Julia van den Bergh, BBF Director of Strategic Initiatives

Nurses on Bikes visit patients in remote regions on motorcycles, as vans and cars are often unable to transverse mountainous areas. | Photo courtesy of Wandikweza 

Every two minutes, a woman dies from preventable causes related to pregnancy and childbirth. For every woman who dies, 20-30 will experience injuries, infections, or disabilities. Maternal health challenges are particularly severe in Sub-Saharan Africa, which represents 70% of maternal deaths worldwide. Faced with the sobering fact that Malawi has the 25^th highest maternal mortality ratio globally, BBF and Wandikweza joined forces to deliver essential antenatal care to women across the country. 

Wandikweza, a locally founded and led organization, prevents maternal and infant mortality by bringing health care right to the doorsteps of women in remote Maternity Drylands. Maternity Drylands have no health facility providing maternal and childcare services, no public transport, no functional referral system for emergency obstetric care, no nurse/midwife, and are five kilometers from the nearest health facility. Antenatal care is often avoided or delayed in Malawi. The World Health Organization recommends that women receive eight antenatal care visits, starting in the 1^st trimester. Only about half of women in Malawi receive four antenatal care visits, with ~3/4 initiating care after the 1^st trimester. 

Wandikweza’s proactive model for maternal and child health rests on five pillars: 1) the Health Center in Madisi, Dowa, 2) Mobile Health Clinics, 3) Nurses on Bikes, 4) Community Health Workers, and 5) Strategic Planning with Village Health Committees. 

Nurses on Bikes visit women at every stage – before, during, and after pregnancy – until the child is five years old. Equipped with motorcycles, the nurses can reach women unable to come to the Health Center or Mobile Health Clinics. Since 2019, Nurses on Bikes increased the number of women receiving antenatal care during the 1^st trimester from 40%-76%, with a goal of 90%. 

Despite this remarkable achievement, Wandikweza’s reach is limited to two districts: Dowa and Mangochi. During a program development meeting with Wandikweza’s Executive Director, Mercy Chikhosi Kafotokoza, the organization stood out as an ideal partner for BBF’s USAID Development Innovation Venture (DIV) program. BBF’s model for sustainable development is driven by local partners, many of which face substantial barriers when applying for US funding. We can help overcome these hurdles through market research, project management, and collaborative grant writing. 

USAID DIV provides funding to global innovators through four stages: 1) Pilot New Ideas (funding up to $200,000), 2) Test and Position for Scale (funding up to $1,500,000), 3) Transition to Scale (funding up to $15,000,000), and 4) Evidence Generation for Scaled Solutions (funding up to $1,500,000). 

In June 2024, BBF and Wandikweza applied for a Stage 2 USAID DIV grant to run a randomized and controlled trial, designed and implemented by a local university based in Malawi. The study will demonstrate the impact of Nurses on Bikes in new areas of Dowa, such as Msakambewa or Dzoole. If we secure the Stage 2 grant and produce positive results, we plan to apply for a Stage 3 grant. This would enable Wandikweza to expand Nurses on Bikes across Malawi, increasing the number of nurses from 14 -300, serving ~1,000,000 people in 10 new districts. 

We hope Nurses on Bikes will be the first of many successful projects in BBF’s USAID DIV program as we continue to invest in locally-led development. 

“Thank you so much for all the work you have done during this process… We could not have done it without you.”

Mercy Chikhosi Kafotokoza, Wandikweza Executive Director