Pivot

The Mission

High-quality healthcare for all.

How It Works

Community health workers, clinics, and a district hospital are conceived as a unit. Protocols and training are established for every position. Care is optimized at each level, and referrals happen smoothly. A unified supply chain assures that providers have what they need. Well-conceived data and supervisory systems keep things on track throughout the district.

The Dream

The Pivot model is adopted and replicated throughout Madagascar.

Why We're In

We desperately need models for effective public healthcare in settings like Madagascar. Using rigorous methods, Pivot demonstrated a 30% drop in child mortality in their original district—and that was before their rollout of professional community health workers. They recognized that their initial model was too expensive, though, and they did a thorough redesign in advance of their expansion into two new districts. Whether a country as poor and shambolic as Madagascar can scale this up is an open question, but no model has a better shot—and worst case, what Pivot learns will be very useful to peer organizations over a broad geography.