AMBULANCE REFERRAL SYSTEM
In the remote areas where PIVOT works, lack of emergency transportation to health facilities is a critical issue. PIVOT has established a network of ambulances in Ifanadiana District that is available via a 24-hour emergency hotline for health centers and hospitals. The ambulances carry a nurse and essential medicines so that treatment can begin en route.
COMMUNITY HEALTH WORKERS
Community Health Workers (CHWs) are on the front lines of health delivery in the rural areas where PIVOT focuses. They are often the first to encounter vulnerable patients and can be critical for overcoming barriers to health care. PIVOT bolsters the existing system of CHWs through a Community Health Team that ensures: adequate numbers of CHWs; an enhanced system of CHW training, reporting and supervision; and regular home visits.
HOSPITAL MEDICAL CARE
PIVOT is working closely with the Ministry of Health to transform the district’s sole public hospital, improving the quality of care, offering financing and social support for patients, renovating and equipping facilities, and providing effective treatment for curable diseases and access to emergency care, C-sections and other urgent surgeries.
PIVOT works alongside the Ministry of Health in health centers and hospitals to ensure quality medical infrastructure, equipment and services. These include clean facilities, adequate staffing, beds, reliable power, lighting, clean water, examination and delivery tables, the ability to sterilize equipment, and basic diagnostic equipment.
PIVOT finances positions at the health centers and the hospital to staff up to norms and ensure all health facilities in the district are at least open.
INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS AND MALNUTRITION
PIVOT is implementing a national initiative in the district, applying the principle of continuum of care, working with community health workers, health centers, and the district hospital. IMCI stands for Integrated Management of Childhood Illness, a systematic approach developed by UNICEF and WHO that guides healthcare providers in low resource settings to assess, diagnose and treat illnesses and assess nutrition and vaccine status in children under 5 years old, the age group that bears the highest burden of deaths from common childhood diseases.
PIVOT is conducting training and collaborating with the United Nations Population Fund on this theme.
ESSENTIAL MEDICINES AND SUPPLIES
In Madagascar, though the Ministry of Health covers overhead and consultation fees, patients are required to pay for the most medical supplies and medicines out of pocket. In Ifanadiana district, where 75% of the population lives on less than $1 per day, these user fees are prohibitive. Starting in October of 2014, PIVOT piloted a new program, where it covers the costs of more than 40 medicines and 25 supplies, on behalf of patients, which effectively eliminates user fees for the majority of outpatient consultations. This has resulted in a doubling of total health center utilization at an average cost of $.75 per patient.
TRAINING AND JOINT SUPERVISION
PIVOT develops and finances joint training and supervision systems with the Ministry of Health in emergency obstetrics, Integrated Management of Childhood Illness, and malnutrition screening and treatment, and jointly supervises staff to provide feedback and mentoring.
WATER, SANITATION, HYGIENE (WASH)
PIVOT is implementing hygiene and waste management at health facilities and working with Community Health Worker (CHWs) at the community level.