Launched in 2014, PIVOT (www.pivotworks.org) 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. 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. PIVOT is currently a 140-person organization with 8 international staff in Madagascar, and a Boston-based headquarters. In addition to the MoH, PIVOT's mission partners include Partners in Health, Centre ValBio, Harvard Medical School, Stanford University, and Stony Brook University.