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
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 setting for understanding 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.
Mothers
Women who last delivered in a health facility
Children
Children <5 moderately or severely stunted
Water
Population with access to safe drinking water
OUR REACH
Covering >540,000 people with strengthened healthcare services

Pivot supports:
1,567
Community Health Workers
47
Primary Care Centers
3
Referral Hospitals
OUR REACH
Covering >540,000 people with strengthened healthcare services

Pivot supports:
1,567
Community Health Workers
47
Primary Care Centers
3
Referral Hospitals
OUR REACH
Covering >540,000 people with strengthened healthcare services

Pivot supports:
1,567
Community Health Workers
47
Primary Care Centers
3
Referral Hospitals










