ABOUT US

WE ARE DRIVEN BY VALUES AND GUIDED BY SCIENCE

Health is a human right.

We care for the people we serve.

Science is key to real change.

We focus on measurable results.

Millions worldwide need better care.

We shape scalable solutions.

People die needlessly because of the gap between knowledge and action, which creates barriers to delivering care despite the availability of affordable solutions.

 

By improving design, delivery, and data in a single model health district – soon to expand to three – we are helping those who suffer from inadequate healthcare lead themselves and their families toward healthier lives.

OUR DISTRICT-LEVEL MODEL HEALTH SYSTEM INCLUDES:

1 district hospital

15 health centers

81 community

health posts

Accessible, High-Quality Services  •  Primary Care Across the Lifespan  •  Ambulance Referral Network

Maternal & Child Health  •  Infectious Disease Prevention & Treatment  •  Patient Accompaniment

Continuously Trained Personnel  •  Dignified Infrastructure & Equipment  •  Availability of Drugs & Supplies

Designing, delivering and measuring the effectiveness of interventions can change lives.

 

Modeling scalable strategies can change the world.

WE ARE COMMITTED TO SOCIAL JUSTICE

Racism and inequity anywhere, in any form, are counter to Pivot’s core values.

We are deepening our fight for justice and commitment to diversity.

We invite you to act with us.

How are we contributing to the movement to decolonize global health?

Starting at home.

 

Our goal is to ensure that the organization’s center of gravity is where it belongs: in Madagascar.

 

This past year, we welcomed four new Malagasy members to our Board of Directors. Learn more about them here. Executive Director Tara Loyd offers more detail on our process in a Stanford Social Innovation Review article and on the Johns Hopkins School of Public Health podcast.

MALAGASY STAFF

COMMUNITY HEALTH
WORKERS

EXPATRIATE STAFF

U.S.-BASED STAFF

MEET THE PEOPLE

Dr. Tsirinomen’ny Aina

Deputy Director of Hospital Care

Dr. Barbara Vololonarivelo

Engagement Director

Bénédicte Razafinjato

Director of Monitoring, Evaluation, Research & Learning

Benjamin Andrihamihaja

Founding Board Member & Senior Technical Advisor

Eliane Solo Hery

Director of Administration

Karen Finnegan

Managing Director of Pivot Science

Laura Cordier

Executive Director

Léa Rahajatiana

Deputy Director of Biomedical Services

Dr. Lova Ratsimbazafy

Deputy Director of Partnerships

Luc Rakotonirina

Associate Medical Director

Dr. Mbola Raza-Fanomezanjanahary

Deputy Director of Primary Care

Natacha Rajaona

Director of Programmatic Support

Dr. André Andriamanday

Director of Health Policy & Systems Strengthening

Ambulance & Referral

Biomedical Services

Community Health

Engagement

General Services

Hospital Care

Monitoring & Evaluation

Logistics & Movement

Operations - HR & Finance

Operations - Programmatic Support

Primary Care

Research

Sensitization

Social Work

Benjamin Andriamihaja, PhD

Senior Technical Advisor

Bob Hower, MBA

Brittany Powell, MD

Edward Norton, JD

Development Committee Chair

Emma Uwodukunda, RN, MSN

Faramalala Rabemananjara, MSW

Jim Herrnstein, PhD

Co-Founder & Science Committee Chair

Lara Hall, MD

Luc Samison, MD

Steering Committee Chair

Manu Prakash, PhD

Mark Krasnow, MD, PhD

Matt Bonds, PhD

Co-Founder & Pivot Science Scholar

Max Herrnstein, MBA

Michael Rich, MD, MPH

Co-Founder & Senior Clinical Advisor

Patricia Wright, PhD

Robin Herrnstein, PhD

Co-Founder & Board Chair

Seheno Randriamanantena, MAcc

Stephen Della Pietra, PhD

Tahiry Raveloson, MD

Clinical Committee Chair

Tara Loyd, MPH

Executive Director

Tyler Saltiel, MBA, CPA

Finance Committee Chair

Vincent Della Pietra, PhD

Dr. Paul Farmer

In memoriam

JOIN THE TEAM

OPEN POSITIONS:

Directeur(trice) des Programmes Médicaux

Pivot cherche un(e) Directeur(trice) des Programmes Médicaux, qui veille à la mise en œuvre du plan opérationnel et plus spécifiquement, au développement et à la mise en œuvre des activités programmatiques de soins primaires et cliniques.

  • Lieu d'affectation: Ranomafana, district d'Ifanadiana, Madagascar
  • Engagement: 2 ans, renouvelable
  • Rémunération et avantages sociaux : Pivot offre des salaires et des avantages sociaux concurrentiels à nos employés et aux membres de leur famille.

Description du poste en français.

Job description in English.

       

Les personnes intéressées sont priées d’envoyer leur dossier de candidature composé des pièces ci-dessus citées, par courriel à l’adresse recrutement@pivotworks.org en précisant sur l’objet « Recrutement directeur(trice) des Programmes Médicaux » avant le 22 avril 2023 à 00h00.

Grant Writer

The Grant Writer will join the Global Support Team (GST), a small but growing cohort of North America-based staff whose collective objective is to be a resource to the in-country team – primarily in fundraising, communications, and partnerships – as Pivot expands its work. As a member of the Engagement Department, the Grant Writer will collaborate with fellow Development team colleagues as well as programmatic staff in the clinical, operations, and research domains in order to secure high-level funding partnerships to advance our 5-year strategy (see our 2023-2028 Strategic Plan to learn more).

  • Location: Remote, within US Eastern time zone
  • Start Date: November/December 2023
  • Salary Range: $63,000 - $73,500

Click here for the full job description.

To apply, please send your CV and a cover letter to Amy Donahue adonahue@pivotworks.org by November 3, 2023 and include “Grant Writer Application” in the subject line. Applications will be reviewed on a rolling basis. Candidates may be asked to provide writing samples or other materials before being invited to join a screening call and/or video interview.

 

ONGOING OPPORTUNITIES:

Pivot consistently seeks medical staff interested in mentorship positions in Madagascar.

If you hold a medical degree (doctor, nurse, or other clinician), significant field experience in low-income settings, speak French or Malagasy, and can commit to a minimum stay of at least 1-2 years in Madagascar, please send your CV and a letter of interest to recrutement@pivotworks.org with the subject line “Clinical Inquiry” to discuss opportunities with the Pivot HR team.

Pivot works with organizations across the globe, united by a common vision of health care as a human right.

We celebrate diversity and strive to create an inclusive work environment.

Pivot is an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, gender identity, age, disability or any other protected class.


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    • Molecular Diagnostics

      Pivot has partnered with the Ministry of Public Health and Centre ValBio to develop the first molecular diagnostics laboratory for COVID-19 outside of the capital city.  We additionally have partnered with the Pasteur Institute of Madagascar on novel analysis of dried blood spots from I-HOPE survey for serological analysis of measles, malaria, schistosomiasis, Hep B, and COVID-19.

       

      Learn more: 

      Integrating Health Systems and Science to Respond to COVID-19 in a Model District of Madagascar, Rakotonanahary, R.J.L., et al., 2021, Frontiers in Public Health

      Reconciling model predictions with low reported cases of COVID-19 in Sub-Saharan Africa: Insights from Madagascar, Evans, M.V., et al., 2020, Global Health Action

    • Eco-Epidemiological Surveillance

      We collate environmental surveillance data (e.g. vector surveillance) with biomarkers from household surveys (e.g. rapid tests and antibody tests from dried blood spots of participants in the I-HOPE household survey) to inform the spatio-temporal dynamics of infectious diseases.

       

      Learn more:

      Estimating the local spatio‐temporal distribution of malaria from routine health information systems in areas of low health care access and reporting, Hyde, E, et al., 2021, International Journal of Health Geographics

      Reconciling model predictions with low reported cases of COVID-19 in Sub-Saharan Africa: Insights from Madagascar, Evans, M.V., et al., 2020, Global Health Action

    • GIS (geographical)

      We use a participatory approach to map over 20,000 kilometers of footpaths and 100,000 structures. These data have been combined with high resolution data on land cover, a digital elevation model, rainfall data, and geolocated data from the IHOPE cohort (see above). These data are used to determine travel times to health care, measure geographic equity, and study geospatial determinants of disease. Accessibility modeling results are available on an e-health platform developed with R Shiny.

    • IHOPE (household-level longitudinal cohort)

      The Ifanadiana Health Outcomes and Prosperity longitudinal Evaluation (IHOPE) cohort was established in 2014 at the start of Pivot’s work in Ifanadiana District. Modeled after Demographic and Health Surveys, it tracks standard international health, demographic, and socioeconomic indicators. IHOPE has the following combination of characteristics that are novel for localized interventions:

      • True baseline
      • True representative sample
      • Sample from inside and outside of the initial catchment population
      • Collection by third party professionals at the National Institute of Statistics who collect identical data nationally
      • Tracks same individuals over time
      • Includes biomarkers such as dried blood spots used for molecular analyses

       

      Learn more: 

      Baseline Population Health Conditions Ahead of a Health System Strengthening Program in Rural Madagascar, Miller, A., et al. 2017, Global Health Action

    • HMIS and Routine M&E

      Health management information systems (HMIS) collect information on health system utilization and care provision at public sector facilities. These data are combined with additional, routine monitoring and evaluation (M&E) data to track over 1000 indicators of health system performance in Ifanadiana District, including rates of treatment and service utilization, quality of care, supply stock-outs, and human resource capacity at every level. These data are accessible via a real-time dashboard.

    • Capacity-Building

      The purpose of Pivot Science is to improve health outcomes over the long-term. Central to this goal is a new capacity building program, which focuses on both increasing research skills among clinicians/implementers, as well as helping researchers better understand and inform clinical priorities. The training includes a series of workshops on understanding clinical priorities, developing research questions, methodology, and dissemination. Trainees include a range of personnel who work within Madagascar’s health sector.

    • COVID-19 and Molecular Diagnostics

      The majority of deaths in Madagascar are due to infectious diseases and most cases go undiagnosed. The COVID-19 pandemic has underscored the need to implement new diagnostic assays in rural health districts. Pivot has partnered with the Ministry of Public Health and Centre ValBio to develop the first molecular diagnostics laboratory for COVID-19 outside of the capital city, which provides both diagnostic capacity as well as a platform for scientific innovation at the intersection of biomedicine and planetary health.

       

      Learn more: 

      Integrating Health Systems and Science to Respond to COVID-19 in a Model District of Madagascar, Rakotonanahary, R.J.L., et al., 2021, Frontiers in Public Health

      Reconciling model predictions with low reported cases of COVID-19 in Sub-Saharan Africa: Insights from Madagascar, Evans, M.V., et al., 2020, Global Health Action

    • Eco-Epidemiology & Surveillance

      There have been major advances in the science of infectious disease dynamics. But there is inadequate application of these advances at local scales to inform health interventions. We combine environmental information, spatially granular health system data, and population surveys, with mathematical models to understand and forecast local disease dynamics (such as malaria, measles, schistosomiasis, lymphatic filariasis and diarrheal disease) to improve service delivery. 

       

      Learn more:

      Estimating the local spatio‐temporal distribution of malaria from routine health information systems in areas of low health care access and reporting, Hyde, E, et al., 2021, International Journal of Health Geographics

      Reconciling model predictions with low reported cases of COVID-19 in Sub-Saharan Africa: Insights from Madagascar, Evans, M.V., et al., 2020, Global Health Action

      Towards elimination of lymphatic filariasis in southeastern Madagascar: Successes and challenges for interrupting transmission, Garchitorena, A., et al., 2018, PLOS Neglected Tropical Diseases

    • Operational Research for UHC

      Operational research provides insights into how programs are implemented with an emphasis on quality and fidelity to organizational, national, and international standards. Our operational research priority areas include UHC financing, health care quality, patient satisfaction, and health worker performance. This is a high priority area for growth across clinical and data teams at Pivot. 

       

      Learn more:

      Evaluation of a novel approach to community health care delivery in Ifanadiana District, Madagascar, Razafinjato, B., et al., 2020, medRxiv

      Rapid response to a measles outbreak in Ifanadiana District, Madagascar, Finnegan, K.E., et al., 2020 medRxiv

      Networks of Care in Rural Madagascar for Achieving Universal Health Coverage in Ifanadiana District, Cordier, L.F., 2020, Health Systems & Reform

      In Madagascar, Use Of Health Care Services Increased When Fees Were Removed: Lessons For Universal Health Coverage, Garchitorena, A., et al., 2017, Health Affairs

    • Geography & Community Health

      We are advancing new methods that combine granular health system data with a massive GIS dataset containing over 100,000 structures and 15,000 miles of footpaths in the district. This is used to identify geographic barriers and improve the design of the health system to reach everyone. To overcome geographic barriers, we have piloted a model of proactive community health for Madagascar, and are evaluating its impact and feasibility.

       

      Learn more:

      Estimating the local spatio‐temporal distribution of malaria from routine health information systems in areas of low health care access and reporting, Hyde, E, et al., 2021, International Journal of Health Geographics

      Improving geographical accessibility modeling for operational use by local health actors, Ihantamalala, F.A, et al., 2020, International Journal of Health Geographics

      Evaluation of a novel approach to community health care delivery in Ifanadiana District, Madagascar, Razafinjato, B., et al., 2020, medRxiv

    • Population-Level Impact Evaluation

      We measure the impact of our work through the analysis of a district-representative longitudinal cohort. Our quasi-experimental design allows for some of the most rigorously evaluated analysis of health systems change on population health in Africa. These analyses show improvements in nearly every major health indicator, including infant mortality, under-five mortality, vaccine coverage, access to and quality of health care services, and health equity.

       

      Learn more:

      District-level health system strengthening for universal health coverage: evidence from a longitudinal cohort study in rural Madagascar, 2014-2018, Garchitorena, A., et al. 2020, BMJ Global Health

      Early changes in intervention coverage and mortality rates following the implementation of an integrated health system intervention in Madagascar, Garchitorena, A., et al. 2018, BMJ Global Health

      Assessing trends in the content of maternal and child care following a health system strengthening initiative in rural Madagascar: A longitudinal cohort study, Ezran, C., et al. 2019, PLOS Medicine

      Baseline Population Health Conditions Ahead of a Health System Strengthening Program in Rural Madagascar, Miller, A., et al. 2017, Global Health Action

    • Data Systems

      PIVOT is fully integrated with Madagascar’s Health Management information System. By combining many kinds of data – outcomes, programmatic, geographic and more – we gain insights to inform our approaches in an ongoing improvement cycle.

    • Quality of Care

      Care is of no use to our patients’ health unless it is high-quality. We focus on bringing the best possible care to all levels of the health system, whether offered at a patient’s doorstep, at health centers, or at the hospital.

    • Supply Chain & Equipment

      Constant collaboration and integration with Madagascar’s national supply chain helps maintain adequate stocks of more than 40 essential medicines and supplies across all levels of care while steadily closing the gaps on stockout rates and saving lives.

    • Finance

      PIVOT is working with the government’s National Health Solidarity Fund to create a transparent system for patients, providers, donors, and government officials, building on success in removing financial barriers to care through patient reimbursements.

    • HR & Recruitment

      Skilled, well trained and compassionate people are the most vital components of any health system. To meet the unusual challenge of a setting where posting may be truly remote, PIVOT teamed up with the Ministry of Public Health to design and implement a joint recruitment and retention strategy.

    • Infrastructure

      A public health system needs dignified and durable spaces – a difficult task in a mountainous rainforest environment. The district’s most remote facilities are a priority, where partnership with local communities and contractors ensure that rehabilitated spaces are maintained over time.

    • Emergency Transport

      74% of the people in Ifanadiana District live more than a 5-kilometer walk to the nearest health center. Our district-wide public ambulance referral system is the only one of its kind in Madagascar, operating 24/7 since 2014 to bring urgent cases in for treatment at no cost to the patient.

    • Patient Accompaniment

      PIVOT accompagnateurs welcome people into a system that may be unfamiliar. They explain the process, assist in navigating the system,address the need for food and lodging when needed, and check on the kids back home. This service, along with the improved availability and quality of care, has helped quadruple the use of outpatient health services in Pivot’s catchment area.

    • Maternal Health

      Our programs successfully address high rates of maternal deaths among the women in Ifanadiana District, who give birth an average of seven times during their reproductive lifetime, with four in every five deliveries occurring at home. In the first two years of fully supported obstetric services, access to family planning, and facility-based deliveries, the maternal mortality rate dropped by 20%.

    • Malnutrition

      More than half of the children under 5 in Madagascar are chronically malnourished. We are piloting a national program in Ifanadiana District that combines screening, treatment, and prevention across all levels of the health system to address this major cause of child mortality.

    • Tuberculosis

      TB is so prevalent in Madagascar that there are an estimated 500 new cases in our district every year, most undetected and untreated. In partnership with the National Tuberculosis Program,  we launched a program to control TB in 2017 to upgrade basic resources and capacity, and to ensure that diagnosis and treatment are available in Ifanadiana District.

    • Child Health

      Children under 5 are those most likely to die from preventable causes like malaria, pneumonia and diarrhea. We implement protocols for the Integrated Management of Childhood Illness to guide health workers in diagnosis and treatment and to assess nutrition and vaccine status in low-resource settings.