Pivot is a non-governmental organization that combines accessible and comprehensive health care services with rigorous scientific research to support the existing public health system in rural Madagascar. Eleven hours from the country's capital by car, Pivot works in Ifanadiana District, adjacent to Ranomafana National Park. The district has a population of over 200,000 people, more than 75% of whom live in extreme poverty. Pivot aims to create a district-level health system that can serve as a replicable model for the rest of Madagascar, and produce lessons in health systems strengthening for peer implementers worldwide. Pivot partners closely with the Madagascar Ministry of Health (MoH) to strengthen Ifanadiana's district hospital, 20 health centers, and community health programs. Pivot conducts research of interest to the MoH that informs health programs and produces lessons for the replicating and scaling-up of the model district. Pivot's data platform is central to adapting, improving, and scaling our model. Our team is currently comprised of 245 staff on the ground, over 97% of whom are Malagasy, and a 4-person US-based support team. In addition to the MoH, some of PIVOT's key mission partners include Centre ValBio, Partners In Health, and Harvard Medical School.