Made-to-Measure in Madagascar

With an “almost obsessive focus on data,” a group mapping out an overhaul of Madagascar’s broken health system is hoping to avoid a common weakness of global health pilot projects: measuring impact.

Tracking 860 indicators to reveal what works and what doesn’t, PIVOT wants to build a replicable model health system.

In 2 years, PIVOT researchers reported that under-5 mortality in their pilot area dropped nearly 20%; neonatal mortality fell 36%. But success is a delicate balancing act: Madagascar’s biggest health hurdles—like malaria and diarrhea—are individually simple to treat, but myriad and interconnected. “The second one piece breaks, you are done," says co-founder Robin Herrnstein.


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