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System Readiness

System Readiness

Health system readiness requires each of the following elements present and functioning at all levels of care. PIVOT’s readiness activities aim to ensure facilities in Ifanadiana district are ready and able to provide high quality care to all patients:


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In Ifanadiana District, the public health system is comprised of three levels:

COMMUNITY HEALTH: Community Health Workers (CHWs) provide treatment for children under five and pregnant women including routine malnutrition screening, treatment follow-up, and support to discrete community-based health campaigns such as immunizations. Our program increasingly professionalizes CHWs through training and compensation to support a variety of community-based clinical interventions, such as TB care and family planning. Community Health Workers cover and treat village clusters of approximately 250 households each.

HEALTH CENTERS: They are the focal point of primary care where the majority of preventative and treatment services reach patients. Health centers provide ante- and postnatal care, deliveries, family planning, integrated management of childhood illnesses, immunizations, and malnutrition and emergency care, as well as serve as diagnostic and treatment centers for infectious disease. There are 20 health centers in the district, each serving between 10 and 25,000 people.

DISTRICT HOSPITAL: PIVOT is transforming the district hospital into a model hospital for the country of Madagascar, one capable of providing secondary care for curable diseases, emergency treatment, cesarean sections, and other urgent surgeries. The district referral hospital serves the whole of the population of 200,000 in Ifanadiana.

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