PIVOT aims to create a model evidence-based health system and to improve our understanding of how health system strengthening can break cycles of poverty and disease. PIVOT believes that strong Monitoring and Evaluation (M&E) is necessary for responsive health system strengthening. In addition, we promote implementation research of interest to the Ministry of Health that can inform health programs or produce data for replicating and scaling-up of the model. Finally, we recognize that human health outcomes are the consequence of complex relationships between socio-economic and environmental factors, and therefore embrace a holistic understanding of human health that reinforces a broader agenda for conservation and sustainable development.
Monitoring & Evaluation
M&E programs use high quality data—with an emphasis on improving existing Ministry of Health systems of information—for program monitoring and evaluation, while documenting intervention characteristics, mid-course changes in implementation, processes, outputs, and impact. Rigorous Monitoring and Evaluation activities inform and complement the research agenda while generating information for dissemination on best practices in global health delivery.
The purpose of implementation research is to directly improve health care delivery programs and to provide data useful for replicating or scaling the model. A focus of most implementation research projects will be testing effectiveness of PIVOT/MoH health programs. While we have medical knowledge and technologies to address most of the causes of morbidity and mortality in the catchment population, many open questions remain about how to implement and deliver best practice. Our implementation research projects will include small-scale specific interventions as well as broader level questions at the commune or district-level.
Examples of implementation research questions include: incentivizing quality health care delivery through performance-based financing; measuring effectiveness of training programs for medical staff ; rigorous methods for identifying vulnerable patients; measuring effects of removing financial or geographic barriers; evaluating effectiveness of malnutrition programs; testing models of community health worker compensation; and much more. Additionally, a core objective will be to measure effects of the healthcare model on the entire population, such as changes in mortality rates, measures of disease burden, or economic outcomes.
The map below shows the sampling frame used in the Baseline Assesment of Health and Economic Conditions in Ifanadina District (PI: Ann Miller). Areas shaded in green denote sampled communes located within the initial PIVOT catchment area. Areas shaded in blue represent those communes sampled from the remainder of Ifanadina district.
Credit: INSTAT, Department of Demographie et des Statistiques Sociales
Basic Scientific Research
Health outcomes are a manifestation of complex relationships among social, economic, and environmental drivers that, together, comprise some of most pressing challenges for the 21st century: the persistence of extreme poverty and endemic disease, recurrent threats of disease emergence, and the loss of biodiversity. The ecological context of the region in which we operate presents particularly special opportunities for exploring drivers of disease at the human-environment interface. We deliver healthcare to a population along the border of the Ranomafana National Park, a UNESCO World Heritage Site, and we partner closely with Centre ValBio of Stony Brook University, a biological research station with an infectious disease laboratory. Many infectious diseases, which are the leading cause of morbidity and mortality in the district, have critical stages outside of the human host, in insect-vectors or free-living stages in soils or water. These include endemic pathogens, such as malaria, diarrheal pathogens, and soil-transmitted helminthes, as well as emerging or episodic diseases, such as plague. Research on the effects of ecological processes on disease dynamics or emergence, human health and poverty more broadly is also encouraged.
In order to promote research in the areas outlined above, PIVOT actively encourages research projects and collaborations within our catchment area. Our guiding principles are outlined in our Research Manifesto.