Community-based organizations (CBOs) are an important model for the care of orphans and other vulnerable children whose life and development are threatened by human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) and poverty. However, data are lacking on the challenges and solutions enabling successful expansion of these programs to the national level. This article presents some of the experiences encountered by Malawi in the expansion of their network of CBOs. Challenges addressed by CBO, intergovernmental organisation (IGO) and government leaders centred on developing a shared understanding of goals and solutions as well as on obtaining, training and retaining sufficient care providers. The implications of Malawi's experience in these areas for the effectiveness of other programs are discussed.