Staff Spotlight: Jeannot Andriamanantena

Staff Spotlight: Jeannot Andriamanantena

“In a nutshell: being a driver [with Pivot] means always being on time,” says Jeannot Andriamanantena. This, of course, is a task much more easily said than done in the context of a busy healthcare NGO operating across a rural district where geography is one of the greatest barriers to accessing care. And that’s Jeannot’s favorite thing about his job: “accomplishing my mission on schedule […] makes me proud; to drive all of the staff on my daily roster to where they need to be, without delays or problems.”

But being a Pivot driver, as Jeannot knows better than anyone, means many things in addition to punctuality. It means having a front row seat to not only Pivot’s goings-on, but also having a finger on the pulse of the population who you’ll inevitably interact with in that day’s movements. It often means serving as a host and tour guide one minute, and a mechanic the next. Fundamentally, it means being flexible, responsive, and creative. These qualities are key for navigating the challenges that come with traversing the roads of Ifanadiana District every day – for all those times you get stuck in the mud en route to a health center and have no cell service to call for back-up, and other such common occurrences.

Since 2016, Jeannot has been doing all of that and more as a driver on Pivot’s movement team. 

Jeannot remains in good spirits amid efforts to get a Pivot vehicle unstuck from muddy terrain.

For many years prior to joining Pivot, Jeannot worked as an educator, mostly teaching English at local Malagasy schools. Before that, he received training in environmental education and conservation in Kenya, and subsequently held a programmatic role at Friends of Madagascar, an NGO which focuses on those same issues in Ranomafana.

Through his wealth of experience, Jeannot has valuable perspective to impart about the role Pivot plays in Madagascar, and ideas for the organization about everything from efficient transport to expansion of services – a true humanitarian. Jeannot innately understands what the late Dr. Paul Farmer, who passed away in late February, taught us – that every single member of our organization has a critical contribution to make toward advancing our mission.

“Whenever I suggest promotion (which inevitably happens at the end of every long drive together),” says Executive Director Tara Loyd, “he always declines; he says being a driver is right where he wants to be. The contribution is clear and the stress stays confined to the day’s job.”

When asked to provide a quote for this piece, Executive Director Tara Loyd reached for several photos from many long drives spent together. “I trust Jeannot to the end of the earth and back – with our organizational mission, with my children, and with truly showing up for everyone we exist to serve as an organization.” Remembering the many 11-hour drives they’ve made together between Ranomafana and Antananarivo, Tara recalls one trip in which Jeannot insisted on stopping for a break every time her 6-month-old daughter started to cry. “His patience is genuine and his accompaniment is such a joy. We all look forward to seeing him each visit and sharing adventures.”

Jeannot during travels with Tara Loyd and her family (husband James and daughter Zoe).

Over the course of his six years with Pivot, Jeannot has crossed paths with every cadre of person who might intersect with our work, from patients and practitioners to government officials and international funders. One of the things that makes Jeannot so uniquely good at his job is his empathic nature. When asked which of Pivot’s organizational values he holds most dear, he names humility, because “when faced with a person, you always have to put yourself in their place in order to better help them.” And, indeed, he is uniquely gifted when it comes to making genuine human connections.

His personal experience throughout the pandemic has only deepened those qualities in Jeannot. “As a vulnerable person,” he said, “COVID scared me a lot in terms of stress and health.” But he was among the 93% of our staff who volunteered to be vaccinated first against COVID-19, setting an example for fellow colleagues and community members alike.

Jeannot flashes his COVID-19 vaccination card.

Despite the job of a driver being “just as busy and overwhelming” as previous jobs on some days, Jeannot says it makes him “proud and happy” to work with Pivot. His heart for humanitarian work is consistent with his belief in the importance of “social peace” and stability; he regards Pivot as an agent of such work. “Pivot is an organization that supports the community [both] medically and socially,” he says, emphasizing the latter; he names social and psychological support as the two things that he believes make Pivot’s health system strengthening work uniquely impactful in Ifanadiana District.

Jeannot takes his role within the Pivot community seriously, not only as part of the logistical team, but also as an engaged colleague and friend. “Since working at Pivot, I have been given special names like ‘Uncle Jeannot’ or […] ‘big brother.’ I guess it’s because everyone feels comfortable with me and we’re always happy to be together.” National Director Laura Cordier confirms, “It’s a pleasure to work with Jeannot. He is dedicated to his work and always ready to address any problems, even if it falls outside of his daily tasks.”

Beyond being satisfied with his professional life, Jeannot loves the life he has built in Ranomafana with his wife Antonine and their four children. Outside of work, he is a huge fan of “DIY” projects, and is presently occupied with expanding his own home to serve as a rentable apartment to locals and/or tourists. As an added bonus for anyone who gets to be his houseguest: he is a self-proclaimed amateur comedian, and has an infectious laugh to match.

Jeannot’s favorite phrase is a Malagasy proverb that speaks perfectly to the warmth he brings to every relationship: “Ny fanahy no maha olona,” which means “Nothing is more important than the soul.”

 




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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.