by Bénédicte Razafinjato, Luc Rakotonirina, Mathilde Hutchings, and Karen Finnegan
In Madagascar, where geographic barriers can hinder access to healthcare, community health workers (CHWs) provide essential health services to remote communities (1). Community health is an essential strategy used to achieve Madagascar’s goals of a strong health system which is accessible to all. The roles and responsibilities of the Malagasy CHWs are diverse and include promotional, preventive, and curative activities; public health and epidemic surveillance; participation in emergency responses; support of the basic health center (BHC); solidarity actions to improve access to healthcare, water, sanitation, and hygiene; and vital events registration.
Pivot, a non-governmental organization, is currently working with the Ministry of Public Health (MoPH) to create a model district health system at all levels of care (community, basic health center, hospital) in the Ifanadiana district. The Pivot model combines clinical services, system strengthening and readiness, and data collection and usage. In this article, we describe how Pivot and the Madagascar MoPH applied the Community Health Worker Assessment and Improvement Matrix (CHW AIM tool) to inform the design, implementation, and research agenda for a community health program in a single district of Madagascar, and how this process helped to strengthen and adapt care.