CALMED VTT Global Grant: Maternal Mortality Reduction
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CALMED VTT Global Grant: Maternal Mortality Reduction

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Learn about the causes of maternal and newborn ...

Learn about the causes of maternal and newborn
mortality and morbidity associated with childbirth and
how Rotarians are using the CALMED (Collaborative
Action in Lowering Maternity Encountered Deaths)
model to reduce deaths and improve women’s health
in India through a global grant and vocational training
teams (VTTs). Learn about continued monitoring and
evaluation and hear participants’ stories about the
long-term impact and sustainability of this and similar
projects.

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  • To work out a logical basis of long term solution ,we need to look at the reasons why mothers die. The reasons are different between developed parts of the world and less developed. Former – mostly medical reasons <br /> Latter – medical, public health, cultural/ societal issues –it should involve everyone .Fortunately , a collaborative action model CALMED has evolved – it stands for |Collaborative Action in Lowering of Maternity Encountered Deaths. <br /> I have the privilege to present our initial experience with this model ,on behalf of a large number of colleagues and collaborators.
  • So to the three dealy <br /> First delay - in reporting to TBA, delay in decision by the TBA,or reluctance on account of cost. <br /> Second - transport difficulty ,costs or delays <br /> Third ,worse, even when in the safety of hospital – not enough professionals trained in emergency obstetric care.
  • When you look at some of the statistics of countries within our Districts, you can see the importance of the Global Grant areas of focus.
  • An ongoing Vocational Training Team project by D9800, training midwives in East Timor, D9550
  •  As a Rotary Club and as a Rotarian YOU can choose to make a difference. Please do so. <br />
  • I would like to cover 5 areas

CALMED VTT Global Grant: Maternal Mortality Reduction CALMED VTT Global Grant: Maternal Mortality Reduction Presentation Transcript

  • 2014 ROTARY INTERNATIONAL CONVENTION CALMED –VTT Global Grant - a Collaborative Strategy for Maternal Mortality Reduction in Low Resourced Countries Moderator – PDG Dr. Himansu Basu Speakers - PRIP Raja Saboo - RID Mike Webb - PDG Jo Schilling - DG Dr. G. Rao
  • Global Burden
  • Maternal Mortality – MDG 5 , a TRF Area of Focus Three Pregnant Women and 20 Babies die every minute ! 60 Other Women are injured 99 per cent occur in low resourced countries Majority are preventable
  • Global Efforts 1.Governments, Global Bodies including WHO, World Bank ,Philanthropists like Gates are all involved 2.There have been considerable progress towards achieving MDG 4 and 5 in many countries, but also lack of progress in many African and South East Asian countries.
  • Global Efforts 3. Main efforts have been focused on Training Professionals in emergency care –task shifting ,workforce growth  Or Social mobilisation – women’s Groups  Or Family Planning  Or improvement of Health framework 4. Estimated cost – US $ 21 Billion in 20 years in aid plus in country spend
  • Why is it important ?
  • Life Time Risk of Childbirth Mortality Great Britain – 1 in 5300 Sweden – 1 in 7800 Germany – 1 in 10,600 Belgium – 1 in 7500 Canada – 1 in 5200 Afghanistan, – 1 in 32 Nigeria – 1 in 29 Uganda – 1 in 49 India – 1 in 170 ( in some parts 1 in 50) --www.data.worldbank.org
  • Why Mothers Die ? OUR SOLUTION – Obstetric Emergencies – Task Shifting - More “First Aiders” are needed
  • “Women are not dying because of diseases we cannot treat. They are dying because societies have yet to make the decision that their lives are worth saving ……………” Prof. Mahmoud Fathalla Past President, FIGO
  • Maternal Mortality is not a Disease ;it is not only a Medical problem ,but also a Public Health , Societal/Cultural Issue Three Delay Model
  • Doctors and pregnant Women are in the wrong places !
  • WHY MOTHERS DIE ?-Three Delay Model in Low Resourced Countries First Delay DELIVERIES OUTSIDE INSTITUTIONS Third Delay EMERGENCY SKILLS SHORTAGE Second Delay LACK OF INFRASTRUCTURE , TRANSPORT, COMMUNICATION ( Mullick and Serle ,2011 ) Tales of the Unexpected !
  • Failure of Global Efforts 1.Relies on a mainly Medical Model. 2.Very few examples of Multiple Intervention Strategy Programmes.
  • If Rotary is to realize its proper destiny, it must be evolutionary at all times, revolutionary on occasions…………… Paul Harris,1930
  • Rotary’s Future Vision Plan Opportunities for Change
  • FUTURE VISION PLAN Funding Vocational Efforts-VTT Advocacy Measurable Output Sustain -ability Capacity Building Future is here !
  • ORDINARY ROTARIANS DOING EXTRAORDINARY THINGS Please Visit Booth # 309
  • SPARK A CALMED REVOLUTION I PLEDGE TO SAVING MOTHERS AND BABIES THROUGH ROTARY In My Country Please Visit Booth # 309
  • The D9800-D9550 maternal mortality reduction VTT program in Timor Leste PDG Joanne Schilling, D9550 Regional Rotary Foundation Coordinator Pt Zone 8 Trustee, The Australian Rotary Foundation Trust RI Finance Committee
  • Timor Leste - Location
  • Timor Leste – some statistics Timor Leste Major infectious diseases Hep A, Diarrhoea, Typhoid (water borne) Malaria, Dengue Fever (vector borne) Unimproved Water 31% of population (40% in rural areas) Unimproved Sanitation 61% of population (73% in rural areas) Births / 1000 population Children born / woman Maternal Mortality Rate (MMR) Infant Mortality Rate Children under 5 underweight 34.48 births (2014) 5.11 (2014) 370 deaths / 100,000 live births (2011) 38.79 deaths / 1000 live births 45% % of Population under 15 yrs 43% Illiterate (people over 15) 42% Population below poverty line 41% Labour Force in Agriculture 64% (10% of land is arable) 21 May 2014 Sources: CIA World Fact Book and UN Population Fund (UNFPA)
  • Maternal and Child Health Midwife upskilling in East Timor D9800 – D9550 A TRF Global Grant project for VTTs initially over 3 years 22
  • Questions? 23 May 2014
  • CALMED -AN INNOVATIVE MATERNAL MORTALITY REDUCTION STRATEGY IN A RESOURCE POOR AREA Rtn. PDG DR. HIMANSU BASU ,FRCS , FRCOG , PhD Consultant Obstetrician & Master Trainer Visiting Professor, Calcutta School of Tropical Medicine CALMED Programme Director TRF Technical Coordinator on MCH Founder Chairman , Membership Secretary, Rotarian Doctors Fellowship MEDICAL DIRECTOR, ROTARIAN ACTION GROUP ON POPULATION DEVELOPMENT ON BEHALF OF VOCATIONAL TRAINING TEAM TO SIKKIM AND MANY COLLABORATORS OF CALMED PROGRAMME
  • C ollaborative A ctions in L owering of M aternity E ncountered D eaths
  • PRESENTATION GOALS 1. OUR COLLABORATORS 2. ANATOMY OF A MODEL SUITABLE FOR LOW RESOURCE SETTING 3. PREPARATORY WORK 4. PROGRAMME –VTT VISIT 5. QUALITY ISSUES 6. OUTCOME AND FUTURE TRENDS
  • COLLABORATION
  • Rotary International in Great Britain & Ireland Our Collaborators add Strength
  • ACTIONS- BASED ON MEDICAL /PUBLIC HEALTH /SOCIETAL- CULTURAL ISSUES
  • STRATEGY
  • SAVE MOTHERS AND BABIES LIVES ! Maternal Health Workforce Training Resources Reduced no. of pregnancies Make the Mother Safe for Delivery Make Delivery Safe for the Mother Satisfy unmet needs for contraception
  • ACTIONS RELATED TO STRATEGIC COMPONENTS
  • C.A.L.M.E.D. CASCADE Monitoring & Evaluation Evaluation Training the Trainers – VTT - Fast Track Skills Transfer Rotarians’ advocacy – Govt., Anaemia Camp, PPIUD , Birthing Kit Raising Awareness by Women’s Groups –Inner Wheel Two further visits at 12 and 24 months
  • 2013 RI CONVENTION 1.VTT – “Training The Trainer” Model
  • 2.VTT Raises Awareness through ASHA – Women’s Group Health Education,Nutrition Awareness , Family Spacing Empowerment
  • 3. Advocacy– joined up approach- Rotarians, Government undertake Needs Assessment ,Anaemia Camps, Birthing Kits etc. Ambulance, Smart Phone Maternal Death Review Treatment of Anaemia Postpartum IUD
  • Evidence Base for Actions  Emergency Obstetric and Neonatal Care Training – reduces Maternal Mortality by 35 to 40 %, New Born Mortality by 50 to 60 %.  Women’s groups –Social Mobilisation reduces MMR by 23% and IMR by 37 %.  Satisfying unmet needs for contraception – 29 % reduction of maternal deaths. calmedrotary@gmail.com
  • We were invited to the foothills of the HIMALAYAS!
  • Preparatory Work –GG 26259 1.Agreement between Districts 1120 and 3240 – funding, location ,humanitarian programme etc. 2.Selection of Leader and Team Members 3. Regular Communication – Skype 4. Grant Application –online – resources split between Districts 5. Preparation for Training in Sikkim
  • CALMED VOCATIONAL TRAINING TEAM (VTT) – Protecting Mothers’ and Babies’ Health
  • Site Visits in India – DG funded
  • Rotary Foundation GG VTT 26259
  • VTT unleashes the power of Rotary –Strategy is different from GSE- it is a revolution ! P rogrammed R esourced E quipped S tructured E valuative T rained, with S ustainable impact
  • Some Quality Issues  Pre- and Post- Training Assessment of knowledge and skills ,confirming statistically significant improvement.  Training The Trainer model.  Mentoring Support-VTT  Fire Drills  Maternal Mortality Survey Review (MDR) and Verbal Autopsy.
  • OUTCOME
  • Pre- Post Test Results • The initial group of master trainers had significant improvements in both clinical scenarios and the MCQ paper(P<0.01). • The second group who they subsequently trained also had significant improvements(P<0.01).
  • Monitoring and Evaluation- 12 Months  No Trained – Master Trainers – 13 Trainees – 124,increasing  Women’s Groups – 8 ,increasing  Maternal Mortality – 350 down to 150  Increase in levels of competence and confidence in tackling obstetric and new born emergency care  Focus Group Interview -Satisfaction by NRHM Staff, Doctors
  • And so to CALMED ……….. 1. CALMED VTT is a comprehensive strategy for protecting mothers and babies health. 2. A TRF Global Grant 26259 has supported introduction of this programme between Dist. 1120 and 3240 (Sikkim, India). 3. Collaboration with Inner Wheel, Government and important Global Organisations are in place.
  • And finally ……….. 4. Initial monitoring and evaluation have shown promising results  LOWERING OF MATERNAL DEATHS RATIO  INCREASE IN NO. OF TRAINED PROFESSIONALS  REDUCTION IN DEATH WITH “DELAYS” 5. The programme is being adapted and introduced in Gujarat ( Dist. 3051) and in Madhya Pradesh ( Dist. 3040 ).
  • WE MARCH ON………… Dist. 3140
  • Interested ? 1. Please visit Projects Fair, and our Display Area (# 309) for leaflets, video, contact,Pledges 2. U –Tube Video on CALMED 3. Websites- www.rotariandoctors.org 4. Rotary Showcase 5. Please join RI My Groups on MCH, VTT, International Fellowship of Rotarian Doctors
  • ORDINARY ROTARIANS DOING EXTRAORDINARY THINGS Please Visit Booth # 309
  • SPARK A CALMED REVOLUTION I PLEDGE TO SAVING MOTHERS AND BABIE THROUGH ROTARY In My Country Please Visit Booth # 309
  • drhbasumd@gmail.com calmedrotary@gmail.com
  • Namaskar
  • FUTURE VISION PLAN Funding Vocational Efforts-VTT Advocacy Measurable Output Sustain -ability Capacity Building Future is here !