PROOF THE MODEL WORKS
Evidence of lives saved
In 2025, Pivot reached an organizational and scientific milestone with the publication of our landmark 10-year impact evaluation in PLOS Medicine.
The study offers rare population-level evidence that integrated district-wide health systems strengthening can reduce mortality, increase utilization, and improve equity – even in rural, low-resource settings.
KEY FINDINGS:
Over 2x increase in care-seeking for children <5
Spatial analysis over time shows a more than-two-fold increase in care-seeking for children with fever, cough or diarrhea. These improvements are seen across Ifanadiana District, even in remote corners far from health centers and the paved road.
Community Health Workers are closing the geographic equity gap
When broken out by Community Health Worker vs. health center and then additionally broken out by distance from the health center, healthcare utilization data show the increasingly crucial role of Community Health Workers in dismantling geographic barriers to care.
Mortality in Pivot-supported areas diverged from national trends
From 2013-2023, mortality outcomes across both comparison areas and the country as a whole generally stagnated or worsened. By contrast, survival rates steadily improved within Pivot’s catchment area.
Learn more about Pivot’s work:
RESEARCH
Evidence in action
Explore Pivot’s body of academic work
Behind our healthcare model is a foundation of peer-reviewed science. Read our recent academic publications to explore the rigorous research and data-driven insights that prove health systems strengthening works.
BMC Pregnancy and childbirth
Felana Ihantamalala, et al.
PLOS MEDICINE
Andres Garchitorena, et al.
MALARIA JOURNAL
Mauricianot Randriamihaja, et al.
Pivot’s 2023-2028 Strategic Plan set a clear ambition: take a decade of learnings from Ifanadiana District and responsibly replicate our impact across the entire Vatovavy Region, generating the evidence needed to inform national health system transformation in Madagascar.
Two years in, the world around us had changed. Our 2026 Strategic Refresh is not a new plan, but a refinement – a transparent update to allow partners to see how we are adapting to a shifting landscape while staying grounded in evidence and focused on our mission.
REPORTS
Our complete archive
2014-present
During a historically challenging year for global health, our teams in Madagascar not only held the line, but advanced it.
From expanding our geographic coverage in Vatovavy Region and deepening national engagement on health policy, to publishing our landmark 10-year impact study – explore the report to learn more about the milestones that shaped a year of major growth for Pivot.
Past Annual Reports
Q2-FY26 Impact Report
January 1-March 31, 2026
Past Quarterly Reports
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