Clinical Programs

PIVOT’s vertical clinical activities support and improve upon national programs and are integrated and delivered at all levels of the health system, from communities to health centers to the district hospital. We partner with the Ministry of Health to ensure access to quality care for all patients, maximizing our impact by prioritizing the needs of the population.

• Child Health

  

  

  Child Health

  We implement national protocols for Integrated Management of Childhood Illness (IMCI) at the community and health center levels. IMCI is a internationally-used, systematic approach that guides health care providers in low resource settings to diagnose and treat illnesses and assess nutrition and vaccine status in children under 5, the age group that bears the highest burden of deaths from common diseases such as diarrhea, pneumonia, and malaria.
• Malnutrition

  

  

  Malnutrition

  Malnutrition is one of the biggest underlying causes of death in childhood, and Madagascar has one of the highest rates of childhood malnutrition in the world, with more than half of children under 5 chronically malnourished. We are spearheading the implementation of a national program in Ifanadiana District to combat malnutrition through screening, treatment, and prevention of severe acute and moderate acute malnutrition across all levels of the health system.
• Tuberculosis

  

  

  Tuberculosis

  The national incidence of tuberculosis in Madagascar is estimated at 236/100,000 (roughly twice that of the rest of Africa and Asia) with prevalence possibly double the incidence rate. This means there are likely around 500 new cases of TB each year in Ifanadiana District, most of which are going undetected and untreated. PIVOT is partnering jointly with the National Tuberculosis Program to deliver and demonstrate comprehensive TB control in Ifanadiana District. Prior to the program’s 2017 launch, the district lacked basic capacity and systems for diagnosis and treatment. Our TB control activities are embedded in health system strengthening (HSS) activities in collaboration with the MoH, following and enhancing National TB policies.
• Maternal and Reproductive Health

  

   

  

  Maternal and Reproductive Health

  PIVOT’s Maternal and Reproductive Health program aims to reduce maternal and neonatal mortality and to support female agency, including prevention of unwanted pregnancies. Before PIVOT began, the average woman in Ifanadiana District was giving birth an average of 7 times over her reproductive lifetime, with 81% of deliveries occurring at home, contributing to a lifetime maternal mortality rate of 1044/100,000. In our first two years of intervention, this rate fell by 20%. We ensure access to quality obstetric services from pregnancy to postpartum, and dignified spaces for facility-based deliveries, creating a positive cycle of infant/child health as children become enrolled in the formal health system at birth.
• Patient Accompaniment

  

  

  Patient Accompaniment

  Understanding the complexity of barriers to care for the poor, and to to ensure patients are welcomed into and remain in the system, we provide social support and accompaniment to all patients, many of whom have never utilized public health facilities.  PIVOT accompagnateurs explain the care process, pay their bill, and support the food and lodging needs of the accompanying family member(s) in cases when they cannot provide for themselves.  Combined with increased quality of care and availability of services, the removal of these financial barriers to care has resulted in quadrupled outpatient utilization of the health system in PIVOT’s catchment.
• Emergency Transport

  

  

  Emergency Transport

  74% of people in Ifanadiana District live more than 5 kilometers from the nearest health center, primarily without road access. Since 2014, we have been implementing the country’s only public, 24/7, district-wide ambulance referral system in order to reduce geographic barriers, rapidly bring urgent cases to treatment, and establish a continuum of care across all levels of the health system.