WHERE WE WORK
Madagascar
Known for its extraordinary biodiversity and unique evolutionary history, Madagascar is unlike anywhere else on earth. But beyond its natural wealth lies a complex landscape of geographic isolation, climate vulnerability, and persistent poverty that shapes the lives of millions of people across the island.
Home to some of the world’s most biodiverse ecosystems alongside some of the lowest development indicators, Madagascar is an island of extraordinary contrasts.
5th
largest island in the world
35M
people live across 23 regions
90%
of rural Malagasy live >1 mile from the nearest paved road
183rd
of 192 countries on the Human Development Index (UNDP)
25%
tree cover lost since 2000
A CRUCIBLE FOR GLOBAL HEALTH
Where global forces converge
The challenges shaping the future of global health are already unfolding across Madagascar.
The island’s unique combination of biodiversity, climate exposure, geographic isolation, population growth, and development challenges makes it a critical place to understand how environmental, social, and health systems interact.
The challenges we’re facing here are already generating lessons to inform the questions the rest of the world will soon be asking.
VATOVAVY REGION
We start where the gaps are widest
Across Madagascar’s 23 regions, Vatovavy’s population health outcomes are among the poorest.
Vatovavy spans from the rainforests of Ranomafana – home of Pivot’s HQ office – to the island’s eastern coastline. The region’s geography is defined by the steep mountainous terrain that spans all three districts.
Its steep terrain, disbursed river systems, and limited transportation infrastructure have created some of the most significant barriers to healthcare access in the country.
Maternal health
19%
Women who delivered last baby in health facility
Child health
68%
Children <5 moderately or severely stunted
Water access
18%
Population with access to safe drinking water
The majority of Vatovavy’s 900,000 residents live in extreme rural poverty, facing heightened health risks and persistent barriers to care that our approach is specifically designed to dismantle.
OUR REACH
Covering >540,000 people with strengthened healthcare services
Pivot supports:
1,567
Community Health Workers
47
Primary Care Centers
3
Referral Hospitals
