PIVOT is working alongside the Madagascar Ministry of Health to transform Ifanadiana District into a scalable, evidence-based model health system for the rest of the country based on the integration of three key elements:
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1) “vertical” clinical programs including child health, malnutrition, tuberculosis, maternal/reproductive health, emergency transport, and patient accompaniment;

2) “horizontal” system readiness that ensures proper infrastructure, trained staff, management systems, supply chain and equipment;

3) knowledge systems that produce data to continuously improve quality of care, support scientific innovation, and share lessons for impact.
These elements are implemented and integrated across the health system from the community level, to health centers and the district hospital.
Ifanadiana District will serve as a fully functioning model health district by the year 2022, with our package of services reaching the entire district population. Ultimately, we aim to see population-level improvements in health outcomes and access, and we track progress towards these ambitious targets by our Key Performance Indicators:
