Our Recommendation
We highly recommend Pivot Madagascar for support because they consistently measure appropriate outcomes to understand if their work is successful.
Pivot Madagascar meets the requirements for 4 of our 4 key criteria:
✔ Understand the Social Issue
✔ Ultimate Outcome Goals (Life Changes)
✔ Evidence of Success
✔ Counterfactual Impact
Their Vision
People die needlessly because of the gap between knowledge and action, which creates barriers to delivering care despite the availability of affordable solutions. By improving design, delivery, and data in a single model health district (Ifanadiana) and expanding to the regional level (Vatovavy),we are helping those who suffer from inadequate healthcare lead themselves and their families toward healthier lives.
The Problem: A Broken Health System in Madagascar
Across the United States, millions of individuals exit prison each year only to face the same forces that led them there—addiction, poverty, homelessness, and lack of opportunity. These systemic challenges make it difficult to truly start over, particularly for those with lengthy criminal records and histories of substance abuse.
The Solution
Pivot is proving that a better system is possible—and it starts with doing the hard, often overlooked work of making public healthcare actually function. Launched in partnership with Madagascar’s Ministry of Public Health, Pivot doesn’t build a parallel system. Instead, it strengthens the one that already exists—renovating crumbling clinics, hiring and training local staff, restoring medicine supply chains, and making sure care is free at the point of use.
The model is comprehensive. It spans everything from ambulance fuel and social worker salaries to maternal waiting homes and advanced medical training. And it’s working: in 2023 alone, Pivot supported over 334,000 patient visits and began scaling its model across three districts—aiming to reach nearly one million people.
A cornerstone of Pivot’s approach is the professionalization of community health workers—most of them women, many serving isolated villages where no doctor has ever set foot. Pivot doesn’t just train them; it fights for their inclusion in national health strategy, ensures they’re paid, and uses real-time data to help them deliver better care.
A Sample of Their Outputs (2023)
- 443 clinical personnel supported (71 hospital doctors, 173 primary care providers, 199 CHWs)
- 70 new community health posts built by local residents
- 334,039 patient visits supported
- 4 maternal waiting homes constructed for women in remote areas
A Sample of their Outcomes (2023)
- 56% of births now happen in health facilities—up from 33% in 2015
- 97% antenatal care coverage for pregnant women
- 92% adherence to care protocols by CHWs trained with mobile tech
A Sample of Their Impacts (2023)
- 82% of TB patients cured through Pivot’s integrated care approach
- 100% survival rate for mothers delivering in health centers and hospitals
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