Our Most Remote Work Yet
At the beginning of 2018, PIVOT coordinated an emergency response throughout areas of Ifanadiana District most affected by Cyclone Ava. In so doing, directors had their first opportunity to visit Ambohimanga du Sud (ADS), one of the district’s most isolated communities. Seeing the reality patients were facing with the state of the health system there galvanized our commitment to prioritize the urgent needs of those in need of care at the last mile.
This June, after many months of strategic planning to optimize clinical operations and work to majorly improve facility infrastructure, PIVOT officially launched primary and community-based care activities in ADS. This expansion represents a major opportunity to bring care to some of the most remote communities of Ifanadiana District.
Unlike the first six health centers to receive PIVOT’s full package – which includes technical, financial, and infrastructural support, and integration into our data system for quality assessments and feedback – ADS is located too far from the district’s paved road to be accessed by car. Getting there requires an 8-hour, 65-kilometer trek by moto, foot, and river raft. This presented a new set of geographical challenges for both clinical and operational staff to get activities off the ground.
(Read more about that challenge here.)
Our teams demonstrated true dedication to bringing care to those at the last mile, motivated by the much harsher reality that patients in ADS were facing. Despite its chronic understaffing, inadequate facility infrastructure, equipment, and supply chain, tens of thousands of people in ADS and neighboring communes were relying on it as their only option for primary care. Too often, they were forced to grapple with a near-impossible decision: either make a multi-day trek, while sick, to access adequate health care services elsewhere, or take the risk of staying put and seeking treatment at all.
Below, the top two photos show the state of the health center’s maternity ward before PIVOT’s renovation, and the bottom two show what it looked like on the day of its grand re-opening.
(Read more about the previous state of maternal health in ADS here.)
As of early June, we have begun activities to serve those most vulnerable in ADS’s population, focusing programmatic efforts on child and maternal health. Capacity-building is underway both at the community level, at newly-constructed health sites staffed by community health workers, and at the health center, staffed with a full-time doctor, nurse, and midwife.
Below and to the left, the community health workforce in ADS receives training from PIVOT clinical staff malnutrition screening protocol. Below and to the right, the health center’s chief doctor welcomes visitors to the new pediatric ward during the inauguration.
During the community-wide event organized to celebrate the health center’s official inauguration, the district medical inspector delivered a speech to those gathered saying “PIVOT is the only NGO to do what it is doing in support of health centers and patients in Madagascar,” reinforcing a sense of confidence in the community that the health center would now be the place they can get the care they need.
In the coming months and years of work to transform Ifanadiana District into a model health system, it is our aim to transform the health center in ADS into a hub for quality primary care and select specializations for the northern population. We look forward to continuing our partnership with the Ministry of Health and the community of Ambohimanga du Sud to provide a true model for a public health system that serves the most vulnerable.