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PIVOT Data in Madagascar Is Improving Healthcare

PIVOT Data in Madagascar Is Improving HealthcareBABSON PARK, FL — Madagascar has one of the poorest healthcare systems in the world, spending $14 USD on healthcare per capita. This is well below the average of $94 USD per capita spending on healthcare in the Sub-Saharan region. The PIVOT organization has taken a data focussed approach to help improve the healthcare systems in Madagascar.

After working in Rwanda with Partners In Health, PIVOT founder Matt Bond saw the importance of statistical analysis when it comes to long term change within a healthcare system. Bond aspires to have a lasting impact on Madagascar’s health system. In addition, he develops interventions that can be implemented across the world to help improve health conditions. With the support of the Harvard Medical School, PIVOT focusses its efforts towards interventions that have significant statistical results within Madagascar’s medical system.

Madagascar’s Healthcare Challenges

PIVOT has established its goal to improve accessibility to healthcare facilities. Around 60% of the population lives more than three miles away from a medical facility. Additionally, many communities are unable to access medical treatments due to the uneven distribution of medical professionals and supplies. This issue is highlighted with the current COVID-19 pandemic. As of May 19, 2020 Madagascar has confirmed 322 cases of COVID-19. Madagascar has a Healthcare Access and Quality index rating of 29.6 out of 100. This is well below the sub-Saharan average rating of 40 out of 100. A healthcare system with such a low rating may struggle with the increased demand for medical attention. Madagascar’s government has set a strict curfew in order to reduce the spread of COVID-19, however, the healthcare system will still be challenged by the pandemic.

The Data

The initial studies conducted by PIVOT began in 2014, with 8000 subjects to be followed up with every 2 years. The study collected data on over 840 variables, from basic demographics to access to healthcare. The long term studies aim to identify changes in mortality rates and access to medical resources. In addition, this extensive study required collaboration with the National Institute of Statistics of Madagascar. The results indicated maternal mortality rates to be one in 14, twice the estimated previous national Madagascar health predictions.

Astrophysicist Jim Herrnstein, helped Bond found PIVOT and their data focussed approach to healthcare in Madagascar. Herrnstein believes that the scientific method used to back PIVOT’s interventions highlights which projects are beneficial to the overall health of Madagascar’s population. The data suggest that single-layered interventions such as providing mosquito nets are important. However, it does not offer widespread and long term solutions. Initiatives such as hiring and training healthcare workers have decreased maternal mortality rates and increased delivery care accessibility by 20%.

The data collected is not just based on Madagascar’s population; PIVOT also researches and tracks environmental factors that can affect health and well-being. These studies focus on the environmental factors that contribute to malaria rates, childhood diarrhea and access to healthcare. The environmental terrain is an obstacle itself when it comes to healthcare access. Between 60-70% of Madagascar’s people will travel between three to six miles by foot to reach medical facilities. Additionally, only 34% of the population has access to clean water, which contributes to the rates of communicable diseases.

The Results

Within the first two years of operation, PIVOT has made a substantial impact on Madagascar’s healthcare system. The data suggests that access to healthcare for fever-related symptoms has increased by over 25 percent in areas where PIVOT has established interventions. The use of maternal health services has increased by 63 percent, and the overall use of healthcare facilities by Madagascar’s population has tripled.

PIVOT has proven the importance of using data to support healthcare interventions in Madagascar. The organization’s scientific approach has allowed them to target specific elements within Madagascar’s healthcare system to most effectively improve the medical environment. PIVOT continues to track the population’s well-being and use of medical facilities to ensure their programs continue to benefit the health of Madagascar’s population. 

– Laura Embry

Photo: Flickr

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PIVOT: Health Outcomes in Madagascar

Health Outcomes in Madagascar

Off the coast of Mozambique, 80 percent of Madagascar’s population lives in extreme poverty. In these conditions, malnutrition thrives, increasing the population’s susceptibility to diseases that are no longer fatal elsewhere, like tuberculosis and diarrhea. USAID estimates that 100 children in Madagascar die daily from common preventable diseases. One NGO, PIVOT, is trying to make a difference in health outcomes in Madagascar.

Health Care in Madagascar

In 2014, Madagascar boasted the lowest reported per capita health spending in the entire world, $13.56. Even though the 1948 Declaration of Human Rights declared health to be a basic human right, 50 percent of children suffer from chronic malnutrition and one in seven children die before the age of five in Madagascar. Further contributing to poor health outcomes in Madagascar, the country’s national health policy often demands that patients locate drugs and the money to pay for all services before seeking treatment.

Such a policy, with no possibility of delayed payment, often disincentives impoverished people who need care from seeking treatment. Health policies like this, coupled with poor a transportation infrastructure, make delivery and distribution of medical care and supplies very challenging. In rural villages in Madagascar, community health clinics are often a two to 12 hour hike depending upon the village. For those struggling with illness, such a hike is often not an option.

PIVOT’s Solution

In southeastern Madagascar in the Ifanadiana district, PIVOT “combines accessible and comprehensive health care services with rigorous scientific research to save lives and break cycles of poverty and disease.”After they establish a model health system in this district, they hope to export it to all of Madagascar and eventually resource poor areas all over the world.

Located in a mountainous rain-forested area in the Vatovavy-Fitovinany region of southeastern Madagascar, the Ifanadiana district is home to over 200,000 people. In 2014, Ifanadiana’s mortality rate for children under the age of five was more than double the rate for the rest of the country — coming in at 1,044 per 100,000 live births. PIVOT selected the Ifanadiana, saying, “if we can do it here, we can do it anywhere.”

Partnered with the Madagascar Ministry of Health, Partners in Health, Centre Val Bio and Harvard Medical School, PIVOT began in January 2014 to establish a model health district in Ifanadiana. While many of these partners seem logical, dealing with humans has been a change for Centre Val Bio, formerly a biodiversity research lab who was central to establishing the Ranomafana National Park in Ifanadiana. Madagascar is known for its extreme biodiversity; species live there who live nowhere else in the world.

Targeted at improving health outcomes in Madagascar, PIVOT’s model health district consists of a clinical program within a tiered system of community health centers, regional centers and hospital care. Their clinical programs include Emergency, Patient Accompaniment, Malnutrition, Tuberculosis, Maternal Health and Child Health. Within this clinical structure, PIVOT is pursuing an aggressive data collection program. The health indicators they are focusing on are focusing on Maternal Mortality, Under-Five Mortality, Lifetime Fertility, Composite Coverage Index and the Percentage of People Covered by PIVOT.

As of 2017, PIVOT was reaching 37 percent of the Ifanadiana district. By 2018, they were covering 61 percent of the population and as of 2019, 70 percent benefited from their services. PIVOT hopes that 2022 will mark complete coverage and a total implementation of Ifanadiana as a model health district under PIVOT’s protocols. PIVOT’s own data suggests that from 2014 to 2017 they oversaw a decline in both the maternal mortality rate and the under 5 mortality rate. The maternal mortality rate declined from 1,044 to 828 and the under 5 mortality rate fell from 136 to 114.

Working with the Ministry of Health, PIVOT is helping to implement pilot fee exemption programs. According to their data, only one-third of patients accessed facilities where point-of-service fees were in place; however, with the introduction of fee exemptions the use of healthcare increased by 65 percent for all patients, 52 percent for children and 25 percent for maternity consultations. The fee exemption pilot program cost on average 0.60 USD per patient. Currently, external donor support is essential to the survival of these programs.

Due to a successful democratic election in 2014, international sanctions were lifted which in turn opened the door to increased health spending from national and international sources. PIVOT seems to be making a difference in the Ifanadiana district, and hopefully their revolutionary model health district will spread to the rest of the country reshaping health outcomes in Madagascar as a whole.

– Sarah Boyer
Photo: Flickr

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An Update on the Measles Outbreak in Madagascar

Measles Outbreak in Madagascar

Since April 14, 2019, a measles outbreak in Madagascar has killed more than 1,200 people. According to the WHO, measles is a highly contagious viral disease that remains an imminent cause of death among young children globally. This is despite the availability of a safe and effective vaccine. Organizations are aiding Madagascar to combat the outbreak. They are also educating the public to vaccinate their children to save children from further harm. The island country is located off the southeastern coast of Africa. It is the fourth largest island in the world.

How To Detect Measles

Madagascar is one of the poorest countries in the world with one of the weakest healthcare systems.

Symptoms of measles generally appear around seven to 14 days after a person becomes infected. Measles begins with a fever, cough, runny nose, a sore throat and red eyes. After a few days, tiny white spots (medically known as Koplik’s spots) begin to appear inside the mouth. Severe measles is more likely to be found among poorly nourished young children, especially those with insufficient vitamin A. They are also more likely to be found in those whose immune systems have been weakened by HIV/AIDS or other diseases.

Recent Outbreak

Madagascar is facing arguably the largest measles outbreak in its history. Only 58 percent of people on the main island received their vaccination against the disease, a reflection of the measles outbreak in Madagascar.

Dr. Dossou Vincent Sodjinou, a WHO epidemiologist in Madagascar, spoke concerning the Madagascar measles outbreak:

“The epidemic, unfortunately, continues to expand in size, though at a slower pace than a month ago. Some cases of resistance to vaccinations exist because of the influence of religion or of traditional health practitioners but they are isolated ones.”

Measles is one of the leading causes of death for children. WHO reports about 450 die each day worldwide due to the illness, according to Fox News.

The measles outbreak in Madagascar is complicated by the fact that nearly 50 percent of children in Madagascar are malnourished.

Weak Healthcare and Shortage of Vaccines

According to UNICEF, once a child is infected, there is no specific treatment for measles, so vaccination is a life-saving tool for children.

PIVOT, a partnership that aids communities in resource-poor areas, seeks to combine accessible and comprehensive health care services with rigorous scientific research to save lives and break cycles of poverty and disease.

Harvard Medical School (HMS) recently interviewed Michael L. Rich, an HMS assistant professor of medicine in the Brigham and Women’s Hospital Division of Global Health Equity and chief clinical advisor at PIVOT.

“The Madagascar measles outbreak is a particularly precarious situation because many of the districts have weak health infrastructure and systems to begin with, which is now exacerbated with a shortage of vaccines. Without a reliable supply of vaccines, strong supply chains or facilities adequately staffed with trained personnel, an end to Madagascar’s ongoing measles crisis is difficult to foresee.”

Doing more to contain the outbreak

As a result, UNICEF is issuing an urgent appeal to governments, health care providers, and parents to do more to contain the measles outbreak in Madagascar. This appeal contains:

  • explanations that not only are vaccines are safe and effective, but they can save a child’s life
  • the recommendation of vaccinating all children between the ages of six months to five years during outbreaks
  • training and equipping health workers so they can provide quality services
  • Strengthening immunization programs to deliver all life-saving vaccines.

Under the Global Vaccine Action Plan, measles is targeted for elimination in five WHO Regions by 2020. WHO is the lead technical agency responsible for the coordination of immunization and surveillance activities to achieve this goal.

By combining rights-based care delivery with strengthened public systems and a new era of science guided by the needs of the poor, PIVOT aims to help the country of Madagascar become a leader in health system transformation.

– Carolina Chaves
Photo: Flickr

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Fiction vs. Reality: How the Media Misrepresents Madagascar

How the Media Misrepresents MadagascarThe perpetual stereotype that surrounds Madagascar is that its population consists of very few people, an enormous number of animals and an increasing rate of poverty. In fact, the first page of a ‘Google Image’ search of Madagascar provides half a dozen photos of people and dozens of photos of lemurs and other animals. The ways the media misrepresents Madagascar creates a skewed image of this African country as a place populated mostly by animals and an increasing rate of poverty.

Pivot

Several organizations advocate for the population of Madagascar. One such organization, Pivot, has created a district in Madagascar called the Ifanadiana District, which focuses on providing health care benefits for Malagasy people. Its population is now 200,000.

The organization aims to transform Madagascar’s health system through rights-based care delivery, strengthened public systems and a new era of science guided by the needs of the poor. Before this organization was located in the Ifanadiana District, one in seven children died before age five. Patients also had to find and pay for all medicines and supplies before treatment.

However, there was a 19 percent decrease of under-five mortality after Pivot intervened. Pivot has built hospitals and provided vaccines and health care to enlighten the people of this impoverished country. Pivot has made an extraordinary difference to the country of Madagascar and will continue to do so until it’s health system has been completely transformed.

Halt Poverty

Halt Poverty is another organization working to reduce poverty in Madagascar. The group’s current crowdfunding campaign is to support the building of a provision of safe water in vulnerable households surrounding areas of Fianarantsoa, Madagascar. The endeavor will only cost $2,945 to serve 200 people safe water, or $14.98 per person.

Halt Poverty uses adventure tourism to advocate for the support of poverty reduction in Madagascar. By exploring the natural landscapes and villages of this country, people are able to see the nation as it truly is. These tourists will support the local economy, protect the environment, respect the local culture and participate in poverty reduction.

These programs offer a deeper cultural insight than the one offered by tourism. Over the course of the trip, tourists will get a deeper intercultural understanding of Madagascar and gain exposure to volunteer opportunities that reduce poverty.

Reality of Madagascar

The media misrepresents Madagascar by portraying the nation as an impoverished country lacking in aid from poverty-reduction organizations, but this is not the reality. Although Madagascar experiences immense poverty, the poverty rate has actually decreased in the past couple of years.

In fact, the poverty rate decreased from 77.6 percent to 72 percent between 2012 and 2018. The World Bank reported that the Malagasy economy has been gradually improving ever since the return to legal order in 2014. Since 2016, the economic growth rate in the nation exceeded 4 percent. With trends such as these, one can see that Madagascar is improving in terms of its economy and poverty at a fairly quick rate.

On the Horizon

Although Madagascar is misrepresented in the media, there is, in fact, a great deal being done to give Malagasy people a better life. However, the misrepresentation of this country in the media has caused its issues to remain predominantly unknown.

The combined efforts of organizations like Pivot and Halt Poverty suggest improvements in tourism, health systems, poverty reduction and ultimately, a brighter future for Madagascar, are on the horizon.

– Megan Maxwell
Photo: Pixabay