In this two part interview, Dr. Zaidi, the 2013 Children’s Prize Winner, shares the latest from Rehri Goth, Pakistan. The first part of the Q&A can be found here

Until you established VITAL, many women, following tradition, were having home births even if they needed medical interventions. How has the VITAL helped women who needed medical care choose facility deliveries?

Anita Zaidi: We have worked with the community to raise awareness, through employing influential local men and women to promote safe deliveries. We have also linked Rehri Goth with hospitals providing quality obstetric services, and with emergency transport services, and through a charitable trust hospital, Koohi Goth Hospital, provided ante-natal services through midwives placed in local clinic.

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In your proposal you mentioned training programs for women in the community. How will these training programs save more children’s lives in the long run and how likely will it be that they remain in Rehri Goth?

Anita Zaidi: Rehri Goth had only traditional unskilled birth attendants providing birthing services in the area. We thought that an important program legacy would be to train local women to become community midwives who could then provide safe delivery to women locally going forward, and refer when needed. To increase the chances that we will retain at least some of these women locally we have built in 3 strategies. 1) to train at least 8 women, 2) to choose women who have strong local roots, preferably with a family member who is a traditional birth attendant, and 3) to provide some support for a local business establishment.

We know that you value the hard learned lessons that come with failure. What hard learned lessons have you experienced, what did you learn and how can these be valuable to others?

Anita Zaidi: The biggest lesson is that in many very poor households, even if the pregnant woman has indicated early in pregnancy she wants to deliver in a hospital, when she actually goes into labor, she doesn’t have the wherewithal to act on this desire. She either doesn’t have access to a phone to call for emergency transport, or she can’t make the decision for herself and her husband is not around. We have developed an algorithm that identifies women who are at high risk for being in this situation, and forming local neighborhood groups that can help in time.

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What advice would you give other organizations or individuals interested in implementing interventions like yours in similarly impoverished locations?

Anita Zaidi: Building a network of partners is very important. Program should be flexible with learning and modification in response to learning built in as very rapid cycles of learn-modify-act to have quick impact. So failure is an opportunity to learn, motivate, and improve, and therefore regular checkpoints (data gathering points) have to be built into the program to allow this to happen. Measurements at the end, when you can’t change anything are too late. This is a major flaw in most development aid programs.

Anita, you are strong proponent of science-based research and are committed to data. Please indicate why you believe this is important, if not necessary, for global health. More specific to the VITAL project, what is the role and significance of data in the project’s planning and implementation? What has worked? What needs improvement?

Anita Zaidi: I am very data focused because I believe measuring impact and knowing what worked and what didn’t is the only way we can scale efforts, rather than be doomed to repeat mistakes. We need to change the culture of aid to be driving for results, and if something doesn’t work, we shouldn’t consider it a failure, but an opportunity to understand why something didn’t work, and improve the design. Currently much aid, is input and process focused, rather than impact and results focused. This bothers me.

For the VITAL project, data is key to everything we do. We have a set of dashboard indicators that we measure every week (e.g. % of deliveries that week which were in a facility), or every month (neonatal mortality rate, child mortality rate). We even look at our data geo-spatially, by team, by sub-village, to identify patterns, where we are being successful, where we aren’t.

A baseline census of RG was conducted, why was this important and how would it affect your project goals?

Anita Zaidi: We wanted to set a baseline benchmark against which we would be measured. We have a very ambitious goal of 2/3rd mortality reduction in 3 years, so we wanted an external party to document what the baseline was, and the same will be done for the endline survey.

How did you target the participation from the RG community to implement VITAL’s work? What did the numbers for program enrollment look like and what did you think about these?

Anita Zaidi: We work very closely with local community elders and councilors to design and implement this program. There are about 7000 under 5 children in this community and approximately 1100 births per year that we are targeting through this program.

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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 th
e 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