2014 ROTARY INTERNATIONAL CONVENTION

CALMED –VTT Global Grant - a Collaborative Strategy for Maternal Mortality Reduction in Low Resourced CountriesModerator – PDG Dr. Himansu BasuSpeakers - 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

countriesMajority 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 framework4. 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 5300Sweden – 1 in 7800Germany – 1 in 10,600Belgium – 1 in 7500Canada – 1 in 5200Afghanistan, – 1 in 32Nigeria – 1 in 29Uganda – 1 in 49India – 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

( 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 ROTARIANSDOINGEXTRAORDINARYTHINGS Please Visit Booth # 309

SPARK A CALMED REVOLUTION

I PLEDGE TO

SAVING MOTHERS AND BABIES

THROUGH ROTARYIn My CountryPlease Visit Booth # 309

The D9800-D9550 maternal mortality reductionVTT program in Timor Leste

PDG Joanne Schilling, D9550Regional Rotary Foundation Coordinator Pt Zone 8

Trustee, The Australian Rotary Foundation TrustRI Finance Committee

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)

21May 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?

23May 2014

CALMED -AN INNOVATIVE MATERNAL MORTALITY REDUCTION STRATEGY IN A

RESOURCE POOR AREARtn. PDG DR. HIMANSU BASU ,FRCS , FRCOG , PhD

Consultant Obstetrician & Master TrainerVisiting Professor, Calcutta School of Tropical Medicine

CALMED Programme DirectorTRF Technical Coordinator on MCH

Founder Chairman , Membership Secretary, Rotarian Doctors FellowshipMEDICAL 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- BASEDON 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 TOSTRATEGIC

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

3. Advocacy– joined up approach- Rotarians, Government

undertake Needs Assessment ,Anaemia Camps,

Birthing Kits etc.

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 262591.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 ).

Dist. 3051

Dist. 3040

WE MARCH ON…………

Dist. 3140

Dist. 3240

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 ROTARIANSDOINGEXTRAORDINARYTHINGS Please Visit Booth # 309

SPARK A CALMED REVOLUTION

I PLEDGE TO

SAVING MOTHERS AND BABIES

THROUGH ROTARYIn My CountryPlease Visit Booth # 309

drhbasumd@gmail.comcalmedrotary@gmail.com

Namaskar

FUTURE VISION PLAN

Funding

Vocational Efforts-VTT

Advocacy

Measurable Output

Sustain-ability

Capacity

Building

Future is here !