PIVOT catchmentIfanadiana district (PIVOT catchment+RoD)
Health centres
Total Ifanadiana: 13
PIVOT catchment: 4		(1) Infrastructure renovations, provision of medical and non-medical equipment; implementation of IMCI and malnutrition protocols for every child under-five
(2) Staffing of health centres above MoH norms; frequent trainings for medical staff
(3) Joint MoH-PIVOT training and supervision to improve HMIS data quality
(4) Supply chain management and reduction of stock-outs
(5) Essential medicines and consumables provided free of charge to all patients
(6) Close collaboration with district health managers for the planning and implementation of activities		(1) Provision of medical and non-medical equipment
(2) Staffing to bring all health centres up to MoH norms; trainings for medical staff
(5) Basic package of health services free of charge for children under-five and pregnant women
Community health
Total Ifanadiana:
195 fokontany
PIVOT catchment:
21 fokontany		(1) Construction of 21 community health posts by community, with PIVOT support; implementation of IMCI and malnutrition protocols for every child under-five
(2) Training and on-site supervision of community health workers by mobile teams of trained nurses every 2 months (six nurses for ~40 CHWs)
(3) Joint MoH-PIVOT training to improve HMIS data quality
(4) Monthly provision of MNCH medicine stocks to CHWs and follow-up of medicine stock use
(5) Cost of MNCH medicine stocks fully covered by PIVOT and provided free of charge to patients; financial incentives to CHWs for stock management and attendance to supervisions (~$4 per month); no fees charged to diagnose patients
(6) Community engagement and participation		(1) Provision of non-medical equipment and supplies
(2) Training every year; monthly performance evaluation at health centres; on-site coaching by technical assistants (one for ~15–35 CHWs) every 2 months
(4) Provision of a free initial stock of products and medicines (subsequent stocks are purchased by CHWs)†
(5) CHWs make a profit from a small margin in the sale of medicines (except those in PIVOT catchment who obtain them for free)†; no fees charged to diagnose patients

  • *Building blocks of HSS: (1) service delivery; (2) health workforce; (3) health information systems; (4) medicines and supplies; (5) financing; (6) leadership and governance.

  • †Exceptionally, these two interventions only happened in RoD, since PIVOT substituted the medicine provision and financial incentives to CHWs.

  • CHW, community health worker; HMIS, health management information systems; HSS, health system strengthening; IMCI, integrated management of child illness; MNCH, maternal, newborn and child health; MoH, Ministry of Health; RoD, rest of the district.