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 the barriers to delivering care despite the availability of affordable solutions.

 

By improving design, delivery, and data in a single model health district, 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.

 

Continuing that process to inform models 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 decolonizing global health?

Starting at home.

 

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

 

In the latest step forward, we’ve welcomed four new Malagasy members to our Board of Directors this past year. Coming from a diversity of professional backgrounds, this growing cadre of leaders share a passion for transforming their country’s national health system until it reaches every last one of the island’s 26 million people with quality, accessible care. Learn more about them here!

 

Check out Executive Director Tara Loyd’s article in the Stanford Social Innovation Review and from her guest spot on the Johns Hopkins School of Public Health podcast to learn more about the ongoing initiative.

223

MALAGASY STAFF

175

COMMUNITY HEALTH WORKERS

8

EXPATRIATE STAFF

4

U.S.-BASED STAFF

MEET THE PEOPLE



Dr. Aina Tsirinomen’ny

Deputy Director of Hospital Care



Dr. Alishya Mayfield

Senior Health and Policy Strategist



Bénédicte Razafinjato

Director of Monitoring, Evaluation, Research & Learning



Benjamin Andrihamihaja

Senior Technical Advisor



Eliane Solo Hery

Director of Administration



Dr. Giovanna Cowley

Medical Director



Dr. Herinjaka Andriambolamanana

Deputy Director of Community Health



Justin Haruna

Technical Advisor



Laura Cordier

National Director



Léa Rahajatiana

Deputy Director of Biomedical Services



Dr. Lova Ratsimbazafy

Deputy Director of Partnerships



Luc Rakotonirina

Associate Medical Director



Mathilde Hutchings

Director of Partnerships



Matt Bonds

Co-Founder & Scientific Director



Dr. Mbola Raza-Fanomezanjanahary

Deputy Director of Primary Care



Natacha Rajaona

Director of Programmatic Support



Tara Loyd

Executive Director





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

Nominating Committee Chair

Benjamin is the Founder and Executive Director of the Madagascar Institut pour la Conservation des Ecosystèmes Tropicaux (MICET). He has served as the head of the Department for International Relationships for the Madagascar Ministry of Higher Education and Scientific Research and was the first Coordinator for the Ranomafana National Park Project.



Bob Hower, MBA

Bob is a co-founder of G20 Ventures, a venture capital partnership that connects technology start-ups with established technology pioneers. He is also a general partner at Advanced Technology Ventures, and has extensive experience in marketing, product management, and sales. Bob serves on the non-profit boards of the New England Venture Capital Association and Cambridge Community Foundation.



Brittany Powell, MD

Brittany is a General Surgery Resident at Brigham and Women's Hospital in Boston, MA. She has previously worked for Partners In Health in Malawi, Rwanda, Boston, and San Francisco. Her research is focused on surgical systems strengthening, surgical site infections, and national strategic planning for surgery, obstetrics, and anesthesia service expansion. She has a BA from Harvard College and an MD from Stanford University School of Medicine.





Edward Norton, JD

Development Committee Chair

Ed is an environmental lawyer and the founding President of the Grand Canyon Trust, the founding Chair of the Rails-to-Trails Conservancy, and the founding Chair of the Conservation Lands Foundation. He lived in China and Indonesia for more than a decade working on terrestrial and marine conservation projects.



Faramalala Rabemananjara, MSW

Faramalala received her MSW in Social Development Sciences from the University of Tulear in 2015. While preparing her MSW, she began working with PIVOT as a social worker. She served as a social worker and later as the Social Work Manager from 2014-2019. Fara has always been passionate about social work activities and humanitarian work because it touches people's daily lives. Her greatest pride is to see the impact that social support can have on a person in need. She is always ready to help people in need.



Jim Herrnstein, PhD

Science Committee Chair

Jim has a PhD in astrophysics from Harvard University and currently co-manages the General Research Group at Renaissance Technologies. He is a founding board member of Stony Brook University’s Global Heath Institute, and founding Chair of the Center ValBio Advisory Board. Jim is a co-founder of Pivot and a founding member of the Pivot board.





Lara Hall, MD

Lara is a physician who served as Pivot’s Medical Director from 2015-2017 in Madagascar, where she lived with her husband and two sons. She has also worked in Haiti as the HIV and Tuberculosis Program Director for the Centers for Disease Control and Prevention (CDC) and as a Peace Corps Volunteer in the Republic of Congo. She currently practices family medicine at Cambridge Health Alliance in Boston, Massachusetts.



Luc Samison, MD

Luc has been Director of the Centre d’Infectiologie Charles Mérieux Madagascar at the University of Antananarivo since 2011 and he is the Past Dean of the Medical School at the same University. He got his diploma of professeur agrégé in 2007. Since 2000, he has worked as a hospital surgeon, and has been the head of patient care units and of training and research activities at the Hospital Joseph Ravoahangy Andrianavalona. He was also coordinator of the research files at the Faculty of Medicine of Antananarivo and is a permanent member of many research organizations.



Manu Prakash, PhD

As Assistant Professor of Bioengineering at Stanford University, Manu is a physicist working at the molecular scale who builds and designs tools to uncover how and why biological systems so often outsmart us. He is the co-inventor of the Foldscope, a paper microscope that costs less than a dollar. Prakash earned a PhD in applied physics at MIT, and is 2016 MacArthur Fellow.





Mark Krasnow, MD, PhD

Mark is a Professor of Biochemistry at Stanford University School of Medicine and a Howard Hughes Medical Institute Investigator. Dr. Krasnow's current research interests include lung development and stem cells, neural control of breathing, lung diseases including lung cancer, and new genetic model organisms for medicine. He has been working in Madagascar for about a decade, is Chair of the Advisory Board of Centre ValBio, and is a close scientific partner to Pivot. He has a Ph.D. in biochemistry and an M.D. from the University of Chicago.



Matt Bonds, PhD

Matt, one of the co-founders and the Scientific Director of Pivot, is an Assistant Professor of Global Health and Social Medicine at Harvard Medical School. There, he leads the Bonds Ecology of Poverty Lab, a team of interdisciplinary researchers who explore the intersection of ecology, poverty, and disease. Matt has spent his career as an academic-practitioner working on health systems and sustainable development in Sub-Saharan Africa. He holds PhDs in Economics and in Ecology from the University of Georgia.



Max Herrnstein, MBA

Max is a Managing Director and Head of Global Media-Comms Investment Banking at Morgan Stanley. He is Treasurer and on the Board of Trustees at Learning Spring School and is on the Dwight School Foundation Board of Trustees. Max has an AB from Harvard College and a MBA from Harvard Business School.





Michael Rich, MD, MPH

Michael is an Associate Physician at the Division of Global Health Equity at Brigham and Women’s Hospital, an Assistant Professor at Harvard Medical School, and a Global Health Physician for Partners in Health. He was the Founding Director for Partners in Health Rwanda. Michael is a co-founder and Senior Clinical Advisor for PIVOT and a founding member of the PIVOT Board.



Patricia Wright, PhD

Pat is a professor of Anthropology at Stony Brook University and is considered one of the world's foremost experts on lemurs. She was the driving force behind the creation of Ranomafana National Park, a 106,000-acre World Heritage Site in Madagascar. She is the Founder and Executive Director of Centre ValBio, a modern research campus located just outside the park.



Paul Farmer, MD, PhD

Paul is chief-strategist and co-founder of Partners In Health (PIH). He is the Kolokotrones University Professor & Chair of the Department of Global Health and Social Medicine at Harvard Medical School. Paul is Chief of the Division of Global Health Equity at Brigham and Women’s Hospital and serves as UN Special Adviser to the Secretary-General on Community Based Medicine and Lessons from Haiti.





Robin Herrnstein, PhD

Board Chair

Robin has a PhD in astrophysics from Harvard University and currently serves as president of the Herrnstein Family Foundation. She is a co-founder of the Global Health Institute at Stony Brook University and a member of the Center ValBio Advisory Board. Robin is a co-founder of Pivot, and received the 2016-17 Blackwell Alumni Service Award from Furman University for her work in Madagascar.



Seheno Randriamanantena, MAcc

Seheno holds a Master's in Accounting and Finance from a private institute in Antananarivo. She dedicated her career to working with international NGOs. She has more than ten years' experience in the finance and administration of NGOs working in child protection, agriculture, biodiversity conservation and health related programs in Madagascar. She served as the Finance Manager for Pivot from 2017 to 2019. She now serves as Finance Manager at Operation Fistula in Antananarivo, where she lives with her family.



Stephen Della Pietra, PhD

Stephen has a PhD in mathematical physics from Harvard. He has held positions at the Institute for Advanced Study and IBM’s Thomas J. Watson Research Center. He currently co-manages the General Research Group at Renaissance Technologies. Stephen is co-founder of the Della Pietra Lecture Series at Stony Brook University.





Tahiry Raveloson, MD

Tahiry is a Malagasy physician who served as manager of PIVOT’s hospital programs at Ifanadiana District Hospital from 2015 to 2018. He started his career as a humanitarian physician working on maternal and child health projects for Médecins Sans Frontières (Doctors Without Borders). As of 2020, he is working as a Peace Corps Medical Officer in Madagascar’s capital city, Antananarivo, where he lives with his family.



Tara Loyd, MPH

Tara has a master’s degree in Public Health from the Bloomberg School of Public Health at Johns Hopkins University. She came to PIVOT after serving as the Project Manager for Partners in Health in Malawi. Prior to her time in Malawi, Tara lived and worked in Lesotho as a Peace Corps Volunteer, co-founded of a safe house and outreach program for children orphaned by HIV, and volunteered for PIH Lesotho.



Tyler Saltiel, MBA, CPA

Tyler is the Director of Finance at Splash International and has an MBA from the Haas School of Business at the University of California, Berkeley. Previously, Tyler led audit engagements at Deloitte and volunteered for Partners In Health in Malawi before serving as the Global Controller for Partners In Health, leading accounting and finance teams at the organization’s headquarters and international sites.





Vincent Della Pietra, PhD

Vincent has a PhD in mathematical physics from Harvard. He has held positions at the Institute for Advanced Study and IBM’s Thomas J. Watson Research Center. He currently co-manages the General Research Group at Renaissance Technologies. Vincent is co-founder of the Della Pietra Lecture Series at Stony Brook University.



JOIN THE TEAM

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 country, please send your CV and a letter of interest to jobs@pivotworks.org with the subject line “Clinical Inquiry” to discuss opportunities with the Pivot HR team.

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

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.