2014 ROTARY INTERNATIONAL CONVENTION
CALMED –VTT Global Grant - a
Collaborative Strategy for Maternal
Mortality Reduction ...
Global Burden
Maternal Mortality – MDG
5 , a TRF Area of Focus
Three Pregnant Women and 20 Babies
die every minute !
60 Other Women are ...
Global Efforts
1.Governments, Global Bodies
including WHO, World Bank
,Philanthropists like Gates are all
involved
2.There...
Global Efforts
3. Main efforts have been focused on
Training Professionals in emergency
care –task shifting ,workforce gr...
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 7...
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 t...
Maternal Mortality is not a
Disease ;it is not only a
Medical problem ,but also a
Public Health ,
Societal/Cultural Issue
...
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
EME...
Failure of Global
Efforts
1.Relies on a mainly Medical
Model.
2.Very few examples of Multiple
Intervention Strategy
Progra...
If Rotary is to realize its
proper destiny, it must be
evolutionary at all times,
revolutionary on
occasions……………
Paul Har...
Rotary’s Future Vision Plan
Opportunities
for Change
FUTURE
VISION
PLAN
Funding
Vocational
Efforts-VTT
Advocacy
Measurable Output
Sustain
-ability
Capacity
Building
Future is ...
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 Founda...
Timor Leste - Location
Timor Leste – some
statistics
Timor Leste
Major infectious diseases
Hep A, Diarrhoea, Typhoid (water borne)
Malaria, Dengu...
Maternal and Child Health
Midwife upskilling in East Timor
D9800 – D9550
A TRF Global Grant project for
VTTs initially ove...
Questions?
23
May 2014
CALMED -AN INNOVATIVE MATERNAL
MORTALITY REDUCTION STRATEGY IN A
RESOURCE POOR AREA
Rtn. PDG DR. HIMANSU BASU ,FRCS , FRCO...
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. PRO...
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
Sa...
ACTIONS
RELATED TO
STRATEGIC
COMPONENTS
C.A.L.M.E.D. CASCADE
Monitoring
&
Evaluation
Evaluation
Training the
Trainers – VTT -
Fast Track Skills
Transfer
Rotarians...
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.
Ambul...
Evidence Base for Actions
 Emergency Obstetric and Neonatal
Care Training – reduces Maternal
Mortality by 35 to 40 %, New...
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....
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...
Some Quality Issues
 Pre- and Post- Training Assessment
of knowledge and skills ,confirming
statistically significant imp...
OUTCOME
Pre- Post Test Results
• The initial group of master
trainers had significant
improvements in both clinical
scenarios and ...
Monitoring and Evaluation- 12 Months
 No Trained – Master Trainers – 13
Trainees – 124,increasing
 Women’s Groups – 8 ,i...
And so to CALMED ………..
1. CALMED VTT is a comprehensive
strategy for protecting mothers and
babies health.
2. A TRF Global...
And finally ………..
4. Initial monitoring and evaluation
have shown promising results
 LOWERING OF MATERNAL DEATHS RATIO
 ...
WE MARCH
ON…………
Dist. 3140
Interested ?
1. Please visit Projects Fair, and our
Display Area (# 309) for leaflets,
video, contact,Pledges
2. U –Tube V...
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 ...
CALMED VTT Global Grant: Maternal Mortality Reduction
CALMED VTT Global Grant: Maternal Mortality Reduction
CALMED VTT Global Grant: Maternal Mortality Reduction
CALMED VTT Global Grant: Maternal Mortality Reduction
CALMED VTT Global Grant: Maternal Mortality Reduction
CALMED VTT Global Grant: Maternal Mortality Reduction
CALMED VTT Global Grant: Maternal Mortality Reduction
CALMED VTT Global Grant: Maternal Mortality Reduction
CALMED VTT Global Grant: Maternal Mortality Reduction
CALMED VTT Global Grant: Maternal Mortality Reduction
CALMED VTT Global Grant: Maternal Mortality Reduction
CALMED VTT Global Grant: Maternal Mortality Reduction
CALMED VTT Global Grant: Maternal Mortality Reduction
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
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.

Published in: Health & Medicine, Business
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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
    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.
    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
    First delay - in reporting to TBA, delay in decision by the TBA,or reluctance on account of cost.
    Second - transport difficulty ,costs or delays
    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.
  • I would like to cover 5 areas
  • CALMED VTT Global Grant: Maternal Mortality Reduction

    1. 1. 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
    2. 2. Global Burden
    3. 3. 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
    4. 4. 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.
    5. 5. 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
    6. 6. Why is it important ?
    7. 7. 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
    8. 8. Why Mothers Die ? OUR SOLUTION – Obstetric Emergencies – Task Shifting - More “First Aiders” are needed
    9. 9. “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
    10. 10. Maternal Mortality is not a Disease ;it is not only a Medical problem ,but also a Public Health , Societal/Cultural Issue Three Delay Model
    11. 11. Doctors and pregnant Women are in the wrong places !
    12. 12. 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 !
    13. 13. Failure of Global Efforts 1.Relies on a mainly Medical Model. 2.Very few examples of Multiple Intervention Strategy Programmes.
    14. 14. If Rotary is to realize its proper destiny, it must be evolutionary at all times, revolutionary on occasions…………… Paul Harris,1930
    15. 15. Rotary’s Future Vision Plan Opportunities for Change
    16. 16. FUTURE VISION PLAN Funding Vocational Efforts-VTT Advocacy Measurable Output Sustain -ability Capacity Building Future is here !
    17. 17. ORDINARY ROTARIANS DOING EXTRAORDINARY THINGS Please Visit Booth # 309
    18. 18. SPARK A CALMED REVOLUTION I PLEDGE TO SAVING MOTHERS AND BABIES THROUGH ROTARY In My Country Please Visit Booth # 309
    19. 19. 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
    20. 20. Timor Leste - Location
    21. 21. 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)
    22. 22. Maternal and Child Health Midwife upskilling in East Timor D9800 – D9550 A TRF Global Grant project for VTTs initially over 3 years 22
    23. 23. Questions? 23 May 2014
    24. 24. 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
    25. 25. C ollaborative A ctions in L owering of M aternity E ncountered D eaths
    26. 26. 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
    27. 27. COLLABORATION
    28. 28. Rotary International in Great Britain & Ireland Our Collaborators add Strength
    29. 29. ACTIONS- BASED ON MEDICAL /PUBLIC HEALTH /SOCIETAL- CULTURAL ISSUES
    30. 30. STRATEGY
    31. 31. 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
    32. 32. ACTIONS RELATED TO STRATEGIC COMPONENTS
    33. 33. 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
    34. 34. 2013 RI CONVENTION 1.VTT – “Training The Trainer” Model
    35. 35. 2.VTT Raises Awareness through ASHA – Women’s Group Health Education,Nutrition Awareness , Family Spacing Empowerment
    36. 36. 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
    37. 37. 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
    38. 38. We were invited to the foothills of the HIMALAYAS!
    39. 39. 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
    40. 40. CALMED VOCATIONAL TRAINING TEAM (VTT) – Protecting Mothers’ and Babies’ Health
    41. 41. Site Visits in India – DG funded
    42. 42. Rotary Foundation GG VTT 26259
    43. 43. 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
    44. 44. 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.
    45. 45. OUTCOME
    46. 46. 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).
    47. 47. 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
    48. 48. 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.
    49. 49. 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 ).
    50. 50. WE MARCH ON………… Dist. 3140
    51. 51. 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
    52. 52. ORDINARY ROTARIANS DOING EXTRAORDINARY THINGS Please Visit Booth # 309
    53. 53. SPARK A CALMED REVOLUTION I PLEDGE TO SAVING MOTHERS AND BABIE THROUGH ROTARY In My Country Please Visit Booth # 309
    54. 54. drhbasumd@gmail.com calmedrotary@gmail.com
    55. 55. Namaskar
    56. 56. FUTURE VISION PLAN Funding Vocational Efforts-VTT Advocacy Measurable Output Sustain -ability Capacity Building Future is here !

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