The Children’s Prize team interviews the 2013 inaugural competition winner, Dr. Anita Zaidi, about implementing her million dollar life-saving project in Pakistan. It focuses on five key areas including antenatal care, skilled delivery, community care, nutrition and immunization. Read below to see how her results are leading to improved maternal and child health.

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Give us a little background on the village where you set up the VITAL Pakistan Trust. Why did you select this area?

Anita Zaidi: I have been working in the impoverished coastal communities of Karachi since 2002. Rehri Goth is a village I got to know well, where lack of access to health services for pregnant women and children, and malnutrition are responsible for large numbers of child deaths. In 2012-2013, one out of every 10 children died before reaching their 5th birthday, over half of them in the first month of life. I thought that if I win the Children’s Prize, we could make a real difference in maternal health and child survival in Rehri Goth.

What are some of the most significant changes you have seen in the community since you started your work?

Anita Zaidi: Some of the earliest changes we have started seeing are in the numbers of women seeking facility-based delivery for their births, which has resulted in a noticeable decrease in newborn death rates of about 20%.

What are some of the challenges you have encountered, and may encounter in the future, as you continue to implement your program?

Anita Zaidi: Changing behavior practiced for centuries is very hard, especially within short time spans, and we have realized that the most marginalized families need specifically tailored approaches. For example, women whose husbands are fishermen and away at sea for many weeks, and yet their wives are not empowered to make decisions regarding facility birth, or hospitalization for their infants if they become sick and need hospitalized care. We are developing and trying behavior change strategies for these situations.

Another challenge is that we under-estimated the very poor health status of pregnant women in Rehri Goth, where about 20% do not just suffer from a high degree malnutrition due to insufficient food, but also have severe anemia which puts their life in danger at the time of birth with no reserve for blood loss. We are finding women with hemoglobin levels as low as 3 mg/100 ml (normal is 12-14 for women).

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Health systems strengthening is essential towards improving public health and global health, how will your program aid in the efforts to strengthen the health systems of your community?

Anita Zaidi: We feel that improving access to skilled care at the time of birth is the most important health system change that we need to make for the women and children of Rehri Goth. This is why we have a strong focus on training local women to be midwives, and linking the community with transport and emergency obstetric services. 

Changing the legal framework of states, cities, or countries can aid in the progress toward better health for all. In Pakistan, or more specifically in Rehri Goth, what policies are enacted that compliment your work? What are some of the legal barriers that you have faced in implementing your project?

Anita Zaidi: We have not faced any legal or policy barriers in our work. What we have recognized is the serious shortage of emergency obstetric services in the city of Karachi (20 million population) that can cater to women with life-threatening emergencies at night. There are very few hospitals that offer 24/7 emergency services to poor women, and they are overwhelmed. We feel that there is not a private sector solution to this problem, because of disincentives for operative deliveries, and unless we address this issue with a public sector approach we are unlikely to see much improvement in maternal and newborn mortality rates. Pakistan has the worst maternal and newborn mortality rates in the South Asian region.

What are some the most rewarding partnerships forged through your project?

Anita Zaidi: We have been astounded by the generosity and willingness to partner with us by many organizations. I’d specifically mention Koohi Goth Hospital, for offering free delivery services, The Aman Foundation, for providing emergency ambulance services, and the Aga Khan University for offering subsidized services for newborns in need of intensive care support.

 

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About Dr. Anita Zaidi

Dr. Anita Zaidi

In 2013, Dr. Anita Zaidi was awarded the inaugural $1 million Children’s Prize for her proposed plan to save children’s lives in the Rehri Goth fishing village, one of the most impoverished communities in Karachi, Pakistan.

Dr. Zaidi was trained in United States as a pediatrician, microbiologist, pediatric infectious disease specialist, and public health professional. She left a faculty position at Harvard to return to Pakistan where she built  a child health research program in impoverished urban and rural Pakistani communities designed to find innovative low-cost solutions to saving children’s lives in resource-constrained settings. She is currently the Director of the Enteric and Diarrheal Diseases program at the Bill & Melinda Gates Foundation. Prior to the Gates Foundation, Dr. Zaidi was the Ruby and Karim Bahudar Ali Jessani Professor and Chair, Department of Pediatrics and Child Health, at the Aga Khan University in Karachi, Pakistan.

 

Photo credits: Farheen Khan