The Problem: A Broken Health System in Madagascar
In Madagascar, access to quality healthcare remains deeply unequal and often out of reach for rural communities. Nearly 90% of the population in regions like Vatovavy live in poverty, and many are forced to walk hours just to reach the nearest health facility—only to face medicine stockouts, untrained staff, or unaffordable fees.
Most global initiatives in health equity fall short when it comes to transforming entire public systems. Pivot is proving that transformation is possible.
The Solution:
Pivot is proving that a better system is possible—and it starts with doing the hard, often overlooked work of making public healthcare actually function.
Launched in partnership with Madagascar’s Ministry of Public Health, Pivot doesn’t build a parallel system. Instead, it strengthens the one that already exists—renovating crumbling clinics, hiring and training local staff, restoring medicine supply chains, and making sure care is free at the point of use.
The model is comprehensive. It spans everything from ambulance fuel and social worker salaries to maternal waiting homes and advanced medical training. And it’s working: in 2023 alone, Pivot supported over 334,000 patient visits and began scaling its model across three districts—aiming to reach nearly one million people.
A cornerstone of Pivot’s approach is the professionalization of community health workers—most of them women, many serving isolated villages where no doctor has ever set foot. Pivot doesn’t just train them; it fights for their inclusion in national health strategy, ensures they’re paid, and uses real-time data to help them deliver better care.
The Impact
Outputs
443 clinical personnel supported (71 hospital doctors, 173 primary care providers, 199 CHWs)
70 new community health posts built by local residents
334,039 patient visits supported in 2023
4 maternal waiting homes constructed for women in remote areas
Outcomes
56% of births now happen in health facilities—up from 33% in 2015
97% antenatal care coverage for pregnant women
82% of TB patients cured through Pivot’s integrated care approach
92% adherence to care protocols by CHWs trained with mobile tech
100% survival rate for mothers delivering in health centers and hospitals
This is what true health system strengthening looks like: fewer child deaths, safer pregnancies, better disease management, and lasting government ownership.
The Opportunity
Here’s what your donation can do:
Provide a new mother support kit with essentials like diapers, blankets, and food
Fund a routine expedition to three isolated health centers
Cover one month of support for a community health worker
Sustain a nurse or midwife at a rural health facility for an entire year
Build a community hygiene station to stop the spread of infectious disease
Fully rehabilitate a rural primary care clinic to serve thousands
To learn more or contribute to Pivot’s expansion, contact us at [email protected].
Images by Rijasolo. Madagascar, 2019.