Meet Pivot!

Our member organization, the newly formed nonprofit, Pivot, hosted this week’s Lunch and Learn to share information on their mission, strategy and accomplishments to date. Learn more below:

Matthew Bonds, PIVOT Chief Executive Officer, Co-Founder Department of Global Health and Social Medicine, HMS

Meg McCarty, PIVOT Assistant Program Manager Division of Global Health Equity, BWH

What is pivot?

In partnership with communities in resource-poor areas, PIVOT combines accessible, comprehensive healthcare services with rigorous scientific research to save lives and break cycles of poverty and disease in Madagascar.

  • A product of Partners in Health in Rwanda
  • Want to implement a model of intervention at a scale that makes sense
  • Issues scientific research grants
  • Located in the Ifanadiana District near Ranomafana National Park

What to know about Madagascar:

  • Population of 22 million
  • 5th poorest country in the world
  • $19 per capita spending on health verse an average of $94 in Sub-Saharan Africa and $8,600 in the US
  • 90% of the population is living on less than $2 a day
  • Human population is settled from Indonesia – the country’s population is thus mostly of Asian descent and speaks the same language
  • Hasn’t had a lot of major political conflict, however every single president has been ousted by coop
  • International institutes do not recognize governments established by coups
  • not a lot of HIV on the island
  • about 50% death rate for malaria
  • patients have to pay for everything – IV bag, gloves, gauze

Findings from a baseline population survey conducted by PIVOT and Madagascar Institute of Statistics (accounting for about 1,600 households – 185,000 people)

  • 81% of births occur at home
  • 71% of the population is living more than 5km from a health center
  • 72% of population is living in extreme poverty
  • 14% of children do not live to 5 years old
  • 47% of people had suspended work or school activities in the month prior due to illness

General Plan of attack – World Health Organization’s six blocks of Health Systems Strengthening

  1. Service Delivery
  2. Health Workforce
  3. Information
  4. Medical Products, vaccines and technologies
  5. Financing
  6. Leadership/ governance

More specific strategy:

  • House of ‘yes’ – try to do everything and tackle whatever issues they may encounter along the way – stay non-static and being nimble
  • Participate in government accompaniment and strengthening the public health sector
  • Work in all health system levels (community, health center, district)
  • Balancing HSS (heath system strengthening) with disease specific programs
  • Strengthen the national platform for data and evaluation
  • Put equity at the center of HSS
  • Marshal the needed resources to make the work sustainable
  • Promote good partnerships

Year One Accomplishments:

  • Infrastructure improvements
    • Health center renovation
    • Built toilets and showers
    • Built accommodations for patient accompaniers
    • Reworked the waste and sanitation management systems
    • Stocked and renovated the pharmacy
  • Joint personnel hiring, training, and supervision
    • Comprehensive training in Maternal Child Health Protocol for representatives in all 19 health centers in the district
  • 40 essential drugs in each health center
  • Launch of ambulance referral network
    • 2 ambulances fully outfitted and 2 more on their way
    • mapped out all passable roads in district
  • Monitoring and evaluation
    • Pay very close attention to patients treated, their demographics, their diagnoses, and how they fared