Since 2011, D-tree has worked in Malawi to keep pregnant women, mothers, and their children from falling through the gaps in the health system. The women and children we work with are not hard to reach because of geography. They are hard to reach because the system around them was not built to hold them.
Funding cuts forced us, like many others, to pause and ask harder questions. What came back was not a scaled-down version of the same approach. It was a sharper one.
The next phase of D-tree’s work in Malawi will connect health facilities and community health workers around individual patients so that care can follow the person. But a connected system is only as strong as the information moving through it. If the data crossing from community to facility is incomplete, the connection is weaker. The health worker picking up the case needs a full picture of the patient in front of them. And right now, that isn’t always what they get.
The gap at the handover
In 2022, D-tree developed the maternal and neonatal health workflows for Malawi’s national community health system. By 2023, they were live in two districts and are now in use across 10 additional districts. These workflows have recorded over 15,000 household visits to pregnant women since launch, and have stayed in use through the USAID funding pause in 2025.
The workflows work. A question we’re now asking is whether the data they collect is good enough to act on.
The answer to that is: sometimes it is, sometimes it isn’t. A community health worker sees a pregnant woman, records her fever, and refers her to a facility, but sometimes without noting whether any other danger signs are present. Fields are sent blank. By the time the woman arrives at the health facility, the health worker taking over only has a partial picture. A partial picture is sometimes worse than none. It can create an illusion of information without the substance.
Fixing it at the source
In the coming weeks, D-tree will work with Malawi’s national community health program in the Ministry of Health to fix this at the point of care. We are doing small changes: introducing more mandatory fields, clearer prompts, sharper guidance on what to record and why will mean that every handover from community to facility includes what’s needed to provide good care.
The timing is intentional and important. Malawi’s Ministry of Health is actively developing the maternal health module in Malawi’s Hospital Information System, with the goal of connecting it to the community system so that data follows a patient in both directions. When that link is live, the data flowing through it needs to be ready.
That’s what this work is building toward: not just better records, but a care loop that actually closes.
