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.
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.
RESEARCH
Evidence in action
Explore Pivot’s body of academic work
Behind our healthcare model is a foundation of peer-reviewed science. Check out these academic studies to explore the rigorous research and data-driven insights that prove health systems strengthening works.
Recent publications:
BMC Pregnancy and childbirth
Ihantamalala, et al.
MALARIA JOURNAL
Randriamihaja, et al.
REPORTS
Our complete archive
2014-present
Q3-FY26 Impact Report
April 1-June 30, 2026
.This quarter, Madagascar’s Ministry of Public Health (MoPH) took a decisive step forward on a frontier that is core to Pivot’s ethos: the professionalization of Community Health Workers (CHWs).
While Pivot’s field teams continue to anchor community health delivery in Vatovavy, this period marked a notable acceleration at the national level. In May, the MoPH participated in the World Health Assembly and soon after made their first formal statement in support of CHW professionalization across Madagascar. They committed to writing CHWs into national law as recognized, paid cadre comprising…
Past Quarterly Reports
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2025 Impact Report
October 1-September 30, 2026
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.
