By Azka Asif, Rotary Service and Engagement staff
In honor of Maternal and Child Health Month, Past District Governor Dr. Himansu Basu, a Rotary Foundation Cadre of Technical Advisors for Maternal and Child Health, shares about his team’s work to save the lives of mothers and babies in partnership with Rotarians, other professional volunteers, and governments.
Azka: Dr. Basu, last year you shared an update on the success of the Calmed (Collaborative Action in Lowering of Maternity Encountered Deaths) programme. Have you had any recent developments?
Dr. Basu: Calmed, started in 2013, is funded through Rotary Foundation grants, supported by hands-on efforts of volunteer doctors and Rotarians from the United Kingdom and India. Two global grants have supported six vocational training team (VTT) visits to Sikkim, with a target population of 0.7 million, and Gujarat with a target population of 2.5 million.
Our team of 12 Obstetricians has trained 39 master trainers who continue to train professionals (currently just over 250) in emergency care of pregnant women and babies. The team has also trained approximately 100 Accredited Social Health Activists (ASHA) who raise awareness about pregnancy, child care and related issues through community women’s groups.
The programme was recognized with two international awards for excellence in 2016 — Times Sternberg award and Rotary GBI Champion of Change.
AA: Have you achieved your objectives for the programme?
HB: Maternal mortality reduction programmes take time to achieve their goal – zero preventable maternal death. We are on track for improvements in access to effective care. After three years, we see a steady fall in the number of avoidable maternal deaths in all of Sikkim, our first pilot site. We are moving towards our target of zero preventable maternal deaths.
AA: What can Rotarians do to reduce maternal and child mortality?
HB: Maternal mortality is an index of development in any community – an effective project in any of Rotary’s six areas of focus will also decrease maternal and child mortality, albeit slowly. For a more direct measurable response, a comprehensive strategy based on the Calmed template aimed at reducing the shortage of trained professionals while promoting community awareness regarding childbirth and child care issues should be implemented.
AA: What advice can you offer Rotarians planning a global grant project to reduce maternal and child mortality?
HB: Create a strategic programme with vocational training teams being a key component. It’s important to have experienced project committees supported by health professionals, and public health experts. Close collaboration with motivated Rotarians and government in the project host country is essential for impact and sustainability. The Rotary Foundation Cadre of Technical Advisors can be a valuable resource in planning, implementation and the follow-up stages. Expertise is also available from Rotarian Action Groups such as the Population and Development, Health Education and Wellness, and Preconception Care groups.
A planning visit to the project area by the international partner is very important and should focus on identifying local assets and needs, partnership opportunities with local government and professionals.
AA: What advice can you offer for organising a vocational training team aimed at reducing maternal and child mortality?
Himansu: A vocational training team for improving maternal and child health should be structured to meet the needs of the community. Here are examples of scaling a project:
Scenario 1 targets several smaller hospitals or one large hospital. Two to four experienced doctors train a group of 10 to 20 doctors and nurses on emergency care of pregnant women and new-borns.
Scenario 2 targets several larger hospitals or many smaller hospitals. 5-7 experienced doctors train 20 to 25 motivated trainers who then qualify as master trainers. These master trainers go on to train others (30-40 at a time). Two return team visits should be conducted for evaluation and further training.
Scenario 3 targets a community of one million or more. This is a most effective method, but requires close collaboration with local government. A team of 7 to 10 experienced doctors undertake:
- training cascade as in Scenario 2 (above)
- training 15 to 20 ASHA trainers to raise community health awareness. The ASHAs then train women’s groups in towns and villages throughout the target area
- analysing all maternal deaths in the target area to identify preventable causes and facilitate corrective measures in partnership with local government
AA: Which scenario is most effective in your opinion?
HB: Clearly Scenario 3, but it is also the one requiring more time and resources.
AA: Thank you for sharing your knowledge and expertise! What is your vision for the future?
HB: We cannot rest on our laurels. We need to facilitate and provide support for Rotarians in many low resource countries to introduce more strategic programmes for the entire community based on the Calmed VTT template. Please contact me for further information and suggestions. Also, visit the Calmed programme website for more information.
We are in discussion to establish maternal and child health academies in partnership with governments and NGOs to provide academic support, carry out the work of vocational training teams and advocate to develop future programmes and future leaders achieve our goal of zero preventable maternal death.