Medical Director Madagascar

PIVOT, 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 (a USA NGO that works in collaboration Harvard University and The Division of Global Health Equity, Brigham and Women’s Hospital), and modelled after its health system strengthening activities in sub-Saharan Africa and Haiti, PIVOT collaborates directly with the Madagascar Ministry of Health (MoH) to strengthen the MoH health centres and district hospital as well as community health. PIVOT also benefits from strategic partnerships with Centre ValBio of Stony Brook University.  In addition to providing health care, PIVOT engages in poverty-alleviation initiatives, conducts monitoring and evaluation of health system strengthening activities, 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 a Ifandaiana district, adjacent to Ranomafana National Park with pop 185,000, 19 health centres and one district hospital.   We are currently working in the four health centres nearest Ranamofana with the intention to expand to seven health centres and the district hospital in Year 1. By the end of Year 3 we hope to be functional across the full Ifanadiana district.

Job Description

The Medical Director is expected to lead PIVOT’s medical programs through 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 medical programs.  PIVOT’s medical programs span three essential levels of intervention including the community, health centre, and hospital levels.  The Medical Director will work in tandem with the Site Director who has administrative control of the site to lead PIVOT’s operations at site level.  The Medical Director will be under the direction of the Country Director whose time will be split across Ranamofana (the site), Antananarivo (capital), and Boston (headquarters).


  1. Serve as a clinician.  The first responsibility of our Medical Director is to be a strong, compassionate, committed, and present doctor.  In order to lead real change in the access to and quality of clinical care in Ifanadiana, the Medical Directory should spend approximately 50% of the time working alongside his or her staff and the Ministry of Health clinicians at health centres as well as attending referrals and rounding on hospitalized patients.
  2. Serve as a mentor and support to PIVOT clinicians.  As we expand the Malagasy clinical team and bring on interns, residents, and volunteers from the international medical community we want our Medical Director to serve as chief mentor to the PIVOT clinical team showing through compassionate action and excellent teaching what it means to embody the philosophy “whatever it takes” to prevent stupid deaths (as named by PIVOT Board Member Dr. Paul Farmer).
  3. Develop strong clinical relationships with Ministry of Health clinicians.  The first step to success at the health centres and hospitals is to know and work alongside the MoH clinicians.  We want to understand the barriers to staff retention at rural facilities so that we may address them as well as the barriers to quality care for patients.  This can only come through true accompaniment of the government clinicians.  This may require sleeping at rural health centres to understand the full cycle of care during a typical day or week.
  4. Lead PIVOT community health program.  Reporting to the Medical Director is the Community Health Manager charged with developing a community health program to address access to care, acceptance of the health facilities, and general population level interventions.  The community health team will include a network of community health workers and their supervisors (already exists in Madagascar but needs strengthening) as well as the possibility of mobile clinics and outreach campaigns.  The community health team works closely with the social support team headed by two PIVOT social workers.
  5. Lead MESH initiative.  Central to PIVOT’s NGO Action Plan is the implementation of the Monitoring and Enhanced Supervision model successfully used by PIH in Rwanda.  Here the Medical Director would ensure didactic training modules are brought to Ifanadiana medical staff and that after the trainings the MoH staff are accompanied at the bedside to put their new skills to practice ensuring the equipment they need to do so is available at all times.
  6. Lead PBF initiative.  Also central to Action Plan is the implementation of the Performance-Based Financing initiative meant to provide personal and facility-level incentives to clinicians to provide quality care, meet agreed-upon benchmarks, and create centres of clinical excellence for the rural poor.  PBF will also be used with the community health workers as a method to earn the month’s stipend through meeting benchmarks and ensuring patients in the CHW’s catchment area are well-supported and able to access needed care.
  7. 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 centre or from the health centre to the hospital. The ambulance is outfitted with basic life saving equipment and the 3-person referral team staffs the referral line 7 days a week. The ambulance network will be expanded by two additional vehicles shortly.
  8. 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.
  9. Supervise monitoring and evaluation efforts and be aware of research agenda.  Reporting directly to the Medical Director is the Manager of Monitoring and Evaluation charged with designing and implementing strong M+E for programs and operations as well as working closely with the government data collection systems.  Over time, the research agenda of PIVOT will become more developed and the Medical Director will be required to understand it and provide broad support. 
  10. Work well with partner organizations especially as foreign aid returns to Madagascar. We expect the Medical Director to have strong working relationships with our direct partners such as CVB and SBU as well as to have an evolving understanding of the landscape of aid in Madagascar and specifically Ifanadiana District.  This takes close coordination with the Site Director who represents PIVOT at meetings and with partners as well.

Job Requirements:

  1. Medical Degree.  The Medical Director must be a doctor.
  2. At least three years clinical experience in a resource-poor international setting similar to the working conditions in Ifanadiana.
  3. At least two years clinical management/leadership experience in an international setting, preferably rural, resource-poor setting managing a cross-cultural medical team.
  4. 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.
  5. Malagasy language ability considered an extraordinary asset, as is any substantial experience in Madagascar or working with the Malagasy public health system.
  6. Long-term commitment to living and working in Madagascar– minimum of two years. The role requires relocation to Ranamofana full-time.
  7. Experience as a relationship builder. The MD 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 PIOVT and MoH staff to high-level partners.  Most essential is building a well-working, committed, and supported team.
  8. Ability to oversee work in multiple domains. The MD 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.
  9. Demonstrated commitment to global health and social justice. It is critically important that the MD believe strongly in the work we do, advocate on behalf of our patients, and truly enjoy working to fulfil the PIVOT mission.

Job Duration: Indefinite

Job Type: Full-Time

Required Travel: 10-25%

Contact Person: Sophie Ortel

Email Address:

Apply Here

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