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Director of Hospital Programs
Country Director
Ranomafana, Madagascar
Full time
Global Health, Health System Strengthening
Fall 2014
Minimum 2 year commitment
Organizational Profile
PIVOT (www.pivotworks.org), a newly-formed global healthcare NGO based in Boston,
Massachusetts and launched in January 2014, has established a new health system strengthening
(HSS) effort in rural Madagascar to directly relieve unnecessary suffering and death in the
population around the Ranomafana National Park and aims to serve as a model for health system
strengthening for the rest of the country. In partnership with Partners In Health, PIVOT collaborates
directly with the Madagascar Ministry of Health (MoH) to strengthen a district hospital, health
centers, and community health programs. PIVOT also benefits from strategic partnerships with
Centre ValBio, Stony Brook University and Harvard Medical School. In addition to providing health
care, PIVOT engages in poverty-alleviation initiatives, conducts monitoring and evaluation and
supports research.
Currently PIVOT is a 60-person organization with 5 international staff in Madagascar, 44 Malagasy
staff in Ranamofana, 4 staff in the Boston headquarters office, and a 12-member Board of Directors.
Eleven hours from the capital by car on paved road, PIVOT works in the Ifanadiana district, adjacent
to Ranomafana National Park with a population of 185,000, 19 health centers and one district
hospital. We are currently working in the four health centers nearest Ranamofana with the
intention to expand to seven health centers and the district hospital in Year 1. By the end of Year 3
we hope to be functional across the full district.
Job Description Overview
PIVOT’s medical programs span three essential levels of intervention including the community,
health center, and hospital levels. The Director of Hospital Programs is expected to lead PIVOT’s
clinical programs at Ifanadiana district hospital, as well as related referral programs. S/he is
expected to provide excellent direct patient care, supportive mentorship and guidance to clinical
staff, strong relationships with government officials, using monitoring and evaluation to improve
service delivery, supporting global health research initiatives, and the driving of strategy and
implementation of the full scope of hospital-level clinical programs. S/he will work in coordination
with the Director of Primary Care, who is responsible for clinical oversight of the health centers and
community programs, as well as the Site Director, who has administrative responsibilities for the
site. The Director of Hospital Programs will report to the Country Director whose time will be split
across Ranomafana (the site), Antananarivo (capital), and Boston (headquarters).
Responsibilities:
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Serve as a clinician. The first responsibility of the Director of Hospital Programs is to be a
strong, compassionate, and committed physician, spending substantial time working
alongside other clinical staff.
Serve as a mentor and support to PIVOT and Ministry of Health clinicians, including
Malagasy clinical teams, interns, residents, and volunteers from the international medical
community. The Director of Hospital Programs should demonstrate, through action and
teaching, what it means to embody the philosophy “whatever it takes”.
Lead hospital team. PIVOT is currently looking to build a clinical team dedicated specifically
to the district hospital in Ifanadiana. The team will accompany the hospital staff to meet
minimum standards of care as a first step and then to radically exceed them over time.
Currently the hospital has relatively decent infrastructure, two operating rooms, and a
needs assessment conducted by PIVOT to guide the entry of this team. This team will be
based in Ifanadiana which is a 30-minute drive from Ranamofana and will require regular
visits and support.
Support monitoring, evaluation and research. PIVOT has a strong M&E program that has
standardized data collection of many indicators. The Director of Hospital Programs will
support data collection activities and help ensure their feedback with clinical programs.
Support MESH initiative. PIVOT is implementing a Monitoring and Enhanced Supervision of
Healthcare model successfully used by PIH in Rwanda. MESH is a system of didactic training
and structural bedside supervision of clinical staff.
Support PBF initiative. Performance-Based Financing initiative is meant to provide personal
and facility-level incentives to staff and CHWs to provide quality care and meet agreed-upon
benchmarks.
Lead referral program. One of the first outward signs of PIVOT’s clinical programs has been
the establishment of an ambulance referral system for the first time in Ifanadiana District.
Currently the 2-ambulance system moves patients in critical need from the community to
the health center, from the health center to the district hospital, and from the district
hospital to the university referral hospital.
Work well with partner organizations. In addition to existing partners, there is an evolving
landscape of aid coming to Madagascar. This requires close coordination with PIVOT
administrative leadership
Qualifications:
 Medical Degree. The Director of Hospital Programs must be a doctor.
 At least three years clinical experience in a resource-poor international setting similar to
the working conditions in Ifanadiana.
 At least two years clinical management/leadership experience in an international setting,
preferably rural, resource-poor setting managing a cross-cultural medical team.
 French and English language proficiency required including reading, writing and conversing.
The office operates in French and interactions with headquarters-based staff is in English.
 Malagasy language ability considered an extraordinary asset, as is any substantial
experience in Madagascar or working with the Malagasy public health system.
 Long-term commitment to living and working in Madagascar- minimum of two years. The
role requires relocation to Ranamofana full-time.
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Experience as a relationship builder. The Director of Hospital Programs will be perceived as
the organization’s clinical leader. Thus, a substantial component of the position is to build
relationships across a broad spectrum – from parents of patients to PIVOT and MoH staff to
high-level partners. Most essential is building a well-working, committed, and supported
team.
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Ability to oversee work in multiple domains. The Director of Hospital Programs is a doctor
as well as a leader and manager – responsible for setting direction and delivering results
across multiple programs. This requires regular meetings and accompaniment with the
medical team.
Demonstrated commitment to global health and social justice. It is critically important that
the Director of Hospital Programs believes strongly in the work we do, advocate on behalf of
our patients, and truly enjoy working to fulfill the PIVOT mission.
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This is an excellent opportunity for a dynamic, driven and passionate individual to be part of an
exciting and new initiative that links access to quality health care to research in an ecologically
important context.
Applications are being accepted on an immediate, rolling basis for Malagasy and international
candidates.
Interested candidates should send a compelling cover letter with earliest start date, CV, and list of
references to Tara Loyd at tloyd@pivotworks.org with “Director of Hospital Programs Application –
Your Name” as the subject line in the e-mail.