Pediatric Clinical Mentor (MD required, Madagascar) - PIVOT Works, Inc.

Title: Pediatric Clinical Mentor
Reports To: Director of Medical Programs / Country Director
Location: Ranomafana, Madagascar
Percentage Effort: Full-time
Key Words: Global health, clinical mentor, medical training
Start Date: February 2019
Expected Commitment: Minimum of 2 years

Organizational Profile 

PIVOT ( is a global health care NGO guided by the principle that all people have intrinsic worth and deserve to live healthy and productive lives. As a social justice organization working in a setting of extreme poverty and disease, PIVOT’s core objective is to address social inequity by advancing universal access to quality healthcare, while creating a health care system that can serve as a model for the country of Madagascar. Since 2014, PIVOT has partnered with the government of Madagascar to strengthen the health system and create a model health district in Ifanadiana district, adjacent to Ranomafana National Park and 11 hours from the capital. The district has a catchment area of 200,000 people, more than 75 percent of whom live in extreme poverty.

PIVOT collaborates directly with the Madagascar Ministry of Health (MoH) to strengthen a district hospital, 21 health centers, and community health programs. The model is advanced across three major components: 1) horizontal readiness (e.g. infrastructure, supply chain, personnel), 2) vertically integrated clinical programs (e.g. maternal and child health, malnutrition, tuberculosis), and 3) data systems and research. Currently, PIVOT is a 187-person organization with 6 international staff in Madagascar, and a United States-based headquarters.

Position Overview

PIVOT provides a combination of direct patient care and health systems strengthening programs at the community, health center and hospital level.  The clinical mentor is expected to improve quality of clinical care through excellent patient care, supportive mentorship, design of program and clinical protocols, and educational initiatives. They will work closely with, and under the umbrella of, the Director of Medical Programs to help improve the medical programs.  They will work directly with the Infanadiana district hospital medical teams, referral and social workers, as well as MoH staff in all three levels of intervention:  

Community: PIVOT supports networks of community health workers who serve as liaisons between the rural villages and the health centers, often more than a day’s walk for our patients. Our community teams train the nationally mandated, locally selected volunteers, providing supplies and support to their relationship with the health centers. Community activities include integrated care for children under five, urgent direct patient care, screenings and referrals for tuberculosis, sensitization of the population, and tracking of family planning / reproductive health cases. 

Health centers: PIVOT supports twenty-one health centers in Ifanadiana District through medication reimbursement, training, infrastructure and personnel. In several key health centers, PIVOT staff directly support malnutrition programs, integrated care for children under five, tuberculosis care, family planning and reproductive health.

Hospital: PIVOT works with MoH partners to transform the district hospital into a dignified life-saving facility by improving the quality of staffing, equipment, facilities and training on procedures and processes. As a result of this strong collaboration, PIVOT and the district hospital have established an action plan for reproductive health and strong governance systems.

Referral system and ambulance network: One of the first of PIVOT’s clinical programs was the establishment of an ambulance referral system for the first time in Ifanadiana District. Currently, the three-ambulance system moves patients in critical need from the community to the health centers, or from the health centers to the hospital. 

The PIVOT medical team is comprised of Malagasy doctors, nurses, midwives, and pharmacy professionals, plus social workers, ambulance drivers, and a handful of internationally trained clinicians. The PIVOT medical team works side by side with the Malagasy staff of the Ministry of Health.


·       The first responsibility of the clinical mentor is to be a strong, compassionate, and committed physician, spending substantial time (80%) accompanying clinical staff at the district hospital with patients, emergency room consultations and health centers, while ensuring a teaching spirit (primary base of operations will be the District Hospital).

·       Support the conception, implementation and ongoing activities in the area of pediatrics with a focus on under 5 children at the three levels of the health system described above.

·       Integrate and engage on the broader Maternal and Child Health (MCH), primary care and district hospital health care. 

·       Lead health system strengthening (HSS) in the following areas:

         - Impatient pediatric care at the District Hospital;

         - Neonatal care at hospital and health centers;

         - Health center program of Integrated Management of Childhood Illness (IMCI)

         - Community-based IMCI;

         - Malnutrition care program at both the district hospital (inpatient care) and health center (outpatient care).

·       Supports clinical capacity building initiatives as part of continuing education: the clinical mentor will work with PIVOT’s Clinical Team Leader and Hospital Manager – to organize trainings for all staff at the district hospital, including interns, medical students, and volunteers.

·       The clinical mentor must demonstrate a great pedagogical capacity in sharing the latest medical and scientific updates.

·       Involvement and leadership in regular meetings of clinical staff, and other clinical case presentation forums and scientific discussions.

·       Support the quality of care of District Hospital clinical services by performing clinical supervision and regular quality of care assessments in the various departments of the hospital, in close collaboration with the clinical referent. Analyze the monthly reports of the clinical team and design a quality of care plan in partnership with the director of the District Hospital, the PIVOT District Hospital manager and the Director of Medical Programs.

·       Provide input in the design of medical programs and clinical protocols: PIVOT supports MoH protocols for the care of hospitalized patients. The clinical mentor will work closely with the medical team to create (if needed) and implement clinical protocols.

·       Participate in the planning of activities and adjustments of the Action Plan. The clinical mentor will work closely with PIVOT’s National Director, Director of Medical Programs and the other team members on the Action Plan for the District Hospital and the ongoing training of PIVOT and MoH clinicians.

·       Optimize the reference and counter-reference systems, working closely with the PIVOT reference manager, clinical referent, and District Hospital manager. Discuss cases to be referred to Fianarantsoa University Hospital. Implement a system tracking references and counter references and ensure continuity of care.

·       Work with the monitoring & evaluation team, to elaborate key performance indicators and activities, as well as to analyze the resulting data.

·       Contribute to the reporting structure on a monthly, quarterly and annual basis, including the analysis and interpretation of the results of the program in presentations to the senior management team and the national director.

·       Support the other medical programs as need arises, particularly peripheral health centers.

·       Participate in periodic meetings at the main PIVOT office in Ranomafana.

·       Assure the confidentiality of all patient medical information.   


·       MD in Pediatrics or Family Medicine.

·       At least seven years of clinical experience in a hospital or health center setting.

·       At least three years of experience in a resource-poor international setting similar to the working conditions in Ifanadiana.

·      French language proficiency required including reading, writing and conversing. The office and medical team in Madagascar operate in French. Candidates with basic to conversational French may be considered if they are willing to commit to becoming proficient in the first 6 months of the job.

·      English language proficiency is preferred, but not required. The headquarters operates 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 rural Madagascar, minimum of two years. The role requires a full-time presence in the Ifanadiana District.

·       Clear capacity to efficiently contribute to the planning and implementation of clinical programming. Strong interest in clinical nursing and education.

·       Proven aptitude for working well with a culturally diverse team and to demonstrate personal diplomacy and interpersonal competencies.

·       Demonstrated commitment to global health and social justice. It is critically important to believe strongly in the work PIVOT does, to advocate on behalf of the patients, and truly enjoy working to fulfill the mission of the organization.

This is an excellent opportunity for a dynamic, driven and passionate individual to be part of an exciting global health organization that links access to quality health care to research in an ecologically important context.

To Apply 

Please submit your CV (including a full list of peer-reviewed publications) and letter of interest to [email protected] before December 21, 2018. Please refer to the job title in the title of your email. 

For more information on PIVOT, please visit our website at

PIVOT Works, Inc.
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