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.

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. Global Burden

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. 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. 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. Why is it
important ?

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. Why Mothers Die ?
OUR SOLUTION –
Obstetric Emergencies – Task Shifting -
More “First Aiders” are needed

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. 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. Doctors and pregnant
Women are in the
wrong places !

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. Failure of Global
Efforts
1.Relies on a mainly Medical
Model.
2.Very few examples of Multiple
Intervention Strategy
Programmes.

14. If Rotary is to realize its
proper destiny, it must be
evolutionary at all times,
revolutionary on
occasions……………
Paul Harris,1930

15. Rotary’s Future Vision Plan
Opportunities
for Change

16. FUTURE
VISION
PLAN
Funding
Vocational
Efforts-VTT
Advocacy
Measurable Output
Sustain
-ability
Capacity
Building
Future is here !

17. ORDINARY
ROTARIANS
DOING
EXTRAORDINARY
THINGS
Please Visit Booth # 309

18. SPARK A CALMED REVOLUTION
I PLEDGE TO
SAVING MOTHERS AND BABIES
THROUGH ROTARY
In My Country
Please Visit Booth # 309

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. Timor Leste - Location

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. Maternal and Child Health
Midwife upskilling in East Timor
D9800 – D9550
A TRF Global Grant project for
VTTs initially over 3 years
22

23. Questions?
23
May 2014

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. C ollaborative
A ctions in
L owering of
M aternity
E ncountered
D eaths

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. COLLABORATION

28. Rotary International
in Great Britain & Ireland
Our Collaborators add Strength

29. ACTIONS- BASED
ON MEDICAL /PUBLIC
HEALTH /SOCIETAL-
CULTURAL ISSUES

30. STRATEGY

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. ACTIONS
RELATED TO
STRATEGIC
COMPONENTS

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. 2013 RI CONVENTION
1.VTT – “Training The
Trainer” Model

35. 2.VTT Raises Awareness through
ASHA – Women’s Group
Health Education,Nutrition
Awareness , Family
Spacing
Empowerment

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. 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. We were invited to the
foothills of the HIMALAYAS!

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. CALMED VOCATIONAL TRAINING
TEAM (VTT) – Protecting Mothers’
and Babies’ Health

41. Site Visits in India – DG funded

42. Rotary Foundation GG VTT 26259

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

53. 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.

54. OUTCOME

55. 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).

56. 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

57. 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.

58. 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 ).

59. WE MARCH
ON…………
Dist. 3140

60. 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

61. ORDINARY
ROTARIANS
DOING
EXTRAORDINARY
THINGS
Please Visit Booth # 309

62. SPARK A CALMED REVOLUTION
I PLEDGE TO
SAVING MOTHERS AND BABIE
THROUGH ROTARY
In My Country
Please Visit Booth # 309

63. drhbasumd@gmail.com
calmedrotary@gmail.com

64. Namaskar

67. FUTURE
VISION
PLAN
Funding
Vocational
Efforts-VTT
Advocacy
Measurable Output
Sustain
-ability
Capacity
Building
Future is here !