 All right, Carmel and Halima, welcome. Thank you very much. So hello everybody, I am Carmel. I'm hoping that you can all hear me. I'm one half of the Global Projects, yeah, the Global Projects team at the Royal College of Midwives. And presenting with me today is Halima. Halima, do you want to just introduce yourself? Sure, this is Halima from Bangladesh. I am the president of Bangladesh Midwifery Society and my working place is Dhaka Nursing College. My major subject is midwifery and obstetrical and I am the basic nurse's teacher as well as midwifery diploma, midwifery teacher. As you know, Bangladesh started very new midwifery. That is why nurse's teacher, nurse midwifery teacher are teaching the midwifery in Bangladesh. Still now, midwifery is not separated from our nursing. That is why we have to play a dual role. Thank you. Great, thank you, Halima. So let's get started. I can't actually see the arrows to move the presentation along. Ah, there we go, there we go, brilliant. Okay, so many of you may be familiar with twinning, but for those of you that are not, twinning is a concept and an approach to strengthening midwifery associations. It's an approach that's endorsed by the International Confederation of Midwives and it sees two or more midwifery associations for partnerships to exchange ideas, skills and learning. Partnerships can be between Northern and Northern organisations, Southern and Southern, or Northern and Southern, which is the case for the Royal College of Midwives and the Bangladesh Midwifery Society. So it's important to note that twinning partnerships are a vehicle for learning and improvement, but most importantly, that learning and improvement is bidirectional. So all the parties benefit from the twinning partnership. And as I've said, it's a partnership. It's based on mutual respect, mutual learning and importantly, collaboration. This is not about one midwifery association imposing anything on another. So how do we characterise twinning partnerships? Well, as I've said, they're collaborative and they are substantive in nature. So twinning doesn't involve ad hoc communication. It's communication with identified individuals within associations that work together on a specific and time-bound project to achieve a goal that's been clearly defined. And then finally, twinning partnerships are based on a principle of equity. So twinning. So twinning. Both partnerships have to work very hard in ensuring that the power dynamics are equal so that the learning can be bidirectional and can go both ways. So just to give you a brief history about the RCM and its involvement in twinning, the RCM has been active internationally for about six years in the context of its twinning partnerships, but it's been active internationally with regard to the work that it does with European midwifery associations for many, many years. And in the last six years, there's been a dedicated global team that has kind of formalized the RCM's approach. So we've been involved in twinning partnerships in Uganda, Nepal, Cambodia, Nigeria, Malawi, and then most recently in Bangladesh. And currently the only project that's active is the Bangladesh twinning project. And the approach that we take is to use UK midwives to undertake overseas volunteer placements to both deliver expertise, but also to learn from their Southern counterparts and bring that learning back to the UK. And we do this through both individual and organizational twinning. So the RCM is at its core, a professional association for midwives in the UK. So you may be wondering why we engage in global work. Well, it also recognizes that midwifery in the UK doesn't exist in isolation. And it's very important to be involved on an international level too, because essentially we are a community of practice of global midwives. So in the same way that there are very obvious benefits to associations in low and middle income countries, there are huge benefits to the RCM too, hence the bi-directional nature of the learning. And there are kind of two theories of change that underpin the global work and they run simultaneously. One is in relation to the change that we want to see overseas and one is in relation to the change that we want to see in the UK. And I won't talk in depth about these, but essentially the change that we want to see overseas, we do that through twinning and mentorship and organizational capacity building to strengthen the associations, to have an impact on health policy midwifery education and also to support individual midwives themselves so that they can become confident and competent midwives. This in turn then leads to safer and more effective maternity services. And further down the line, we hope to have an impact on reduced maternal and neonatal mortality and morbidity. That's our ultimate goal. There are also changes that we want to see in the UK, as I've said. So again, through twinning, mentorship and capacity building using the UK midwives, this exposes the RCM members to global midwifery. And when they come back, they report a plethora of improvements, but mainly it's to do with confidence, improved cultural awareness and also resourcefulness. And most importantly, they return as activists. They are very engaged with the RCMs work and this supports the RCMs core business because we need the members to be engaged in improving services, advocating for midwifery and being engaged in the RCM. So the benefits are many, both overseas and for the RCM. So I'm going to hand over to Halima now, who's going to talk about the context in Bangladesh. Over to you Halima. Okay. Welcome to Bangladesh Day Free Society again. And I am presenting the Bangladesh Contest Immomentality and Mortality in Bangladesh is very high. From 2000, it was in 320, but now it is reduced to 170 per 100,000 baht. Neunatal mortality is 2,024 per 1,000 baht. And previously it was more high. 90% of birth occur at home because in Bangladesh population is very high. It is not possible to all mothers delivered in the facility because our facility is not up to the level and standard and not mass space. And 32% of women are cared for by skill-bath attendants. That is skill-bath attendants, the barrettist, doctor, nurses, now at the midwifes, FW, BCSB and also paramedics. And we have the limited awareness about the role and importance of midwifery because, you know, midwifery started very short time. It was in 2010. Still, awareness is not much in the community people in Bangladesh. Give a big thanks to school. Thank you, Halima. Do you want to move on to the next slide? Brilliant. Okay. And midwifery education. Our prime minister is committed to reduce the maternal mortality in Bangladesh. And 16 world health assemblies is committed to 3,000 midwifes in produce for the reduced the maternal and infant mortality. But for this reason, in 2010, six months certified midwifes were skilled up as a skilled midwifes who have the three years diploma and one year midwifery. And then they get six months certified midwifery. Now they are working in the community, Upazila Health Complex. And 2012, from the 2010, there was 2008, the WHO and UNP Health, the Statistic Development Curriculum syllabus by the health of the Minister of Health, DZNM, and also BNNC, Bangladesh Nursing and Midwifery Council. And then 2010, November three years diploma midwifery courses started. Many diploma midwifes have not yet entered government job because they are waiting for the deployment. Every process is already completed. Only the police verification is waiting. After that, government said within two or three months they will be deployed in the union level. And today also, we have an IDM meeting that our government declared within few months they will be deployed in the community people. Next, please. Next slide, please. Kamen. You might need to move that on your screen, Halima. Yeah, yeah. Yes. Okay. Yes. And before midwifery education started, Bangladesh midwifery was founded as 2010. And at that time, 24 founding member was formed the midwifery society. Among the 24 midwifery teacher I take the TOT for six months certified midwifery course. And after that, 2000 November, six months certified midwifery course was started. And many Bangladesh midwifery society executive working as a midwifery lecturer. That I already told when I introduced myself, who are the teacher of the nurse midwifery? They are the teacher, also teacher of the midwifery because they have the previous experience of midwifery education and curriculum. That is why government and policy started the policy who are the nurse midwifery teacher, they will be the teacher of the midwifery. That is why the key message from the BMS, we have the three messages, every woman need Bangladesh midwifery. And Bangladesh midwifery society is the voice of all of our midwives. And Bangladesh midwifery society is tuning with the Royal College of Midwives. This is the key message from the Bangladesh midwifery society. Next please. Great, thank you very much for that Halima. So as the title of this presentation implies, we're going to talk to you about the twinning project that exists between our two organisations. And this project focuses on building the organisational capacity of the Bangladesh midwifery society or BMS. And this is, we're hoping to be a contributing factor to strengthening midwifery across Bangladesh. So the project itself is funded by the United Nations Population Fund or UNFPA. And it's just approaching the end of its first official year. There was some scoping that went on beforehand, but this is the first official year. And the programme is part of a wider programme to strengthen midwifery. And this involves a wide range of NGOs and other organisations in Bangladesh, which is obviously important given the context that Halima has just explained. So essentially the project aims to build the capacity of BMS to function as a strong midwifery association. And what we mean by that is to have a midwifery association that supports its members, that advocates for midwives and for midwifery services, and an association that's involved in the decisions about midwifery and helps to shape the future of midwifery in Bangladesh. So what does this mean in concrete terms? How exactly are we doing this? Well, we've been working towards firstly making BMS a more accessible and representative association. So as Halima was just explaining, a large proportion of births occur in rural areas, and many midwives work in these rural areas. But when the project started, BMS was quite DACA-centric, DACA being the capital city, and where the BMS office is located. Because previously there was no membership database, it was very difficult to know who the members were and in what context they were working, and consequently what they needed. So we've been working hard to encourage and engage the divisions or the regional branches in the society to be able to reach out to those midwives working in other areas other than the capital. We've also been focusing on advocacy and the role of BMS in advocating for better services and also raising awareness about the importance of midwives, given that there's very little awareness in the country about what a midwife does and the importance of a midwife. And so to achieve this, we've worked on developing key messages, identifying audiences, building BMS's network and using different tools for advocacy. And then most recently we've been looking at leadership. So BMS themselves have a very strong leadership in their executive board. You know, they've been around since 2010, they're very well established themselves. But we're also focusing now on the leadership of the midwives that are members of BMS. As Halima explained, the three-year diploma in midwifery only started in 2012. And so consequently the newly qualified midwives are very young for the most part anyway. So BMS has a really big role to play in developing midwife leaders and developing role models that are going to shape the future of midwifery in Bangladesh over the next 20 or 30 years. So what have we achieved? There have been so many achievements in just one year. It's been super rewarding. But the first really being establishing a partnership, this was not an organic partnership. It was basically created by the donor. And so with every interaction, we're kind of learning how to work with each other and how to put the true essence of twinning into practice because as we said, it's a concept as well as an approach. A huge achievement in the last sort of six months has been the creation of a membership database which I've kind of touched on. But this enables BMS to know who its members are and to be able to communicate with them and start to formally build a community of practice in Bangladesh. And this is also going to help with the financial stability of BMS in the future because integrated into that database is a mechanism for fee renewals. So that's using technology to really support the society. They also have employed a full-time member of staff who can support the executives with the administrative side of running a midwifery association. And my colleague Joy back in, I think it was in November, did some HR workshops with them to facilitate the recruitment process. And they've also developed an HR manual which is really important for supporting staff. We've done lots of workshops on a range of topics including human resources, as I've said. Very recently, media and advocacy, understanding the role of media as an advocacy tool and also leadership. And BMS have actually facilitated many of these workshops themselves. Most recently in Cox's Bazaar supporting the midwives working in the Rohingya refugee crisis and Helene will speak to you about that shortly. So there have been lots of workshops that have kind of been organised in response to identified need rather than being part of the project plan at the start of the project. So we've had to be very flexible. And then BMS are holding their election in a few months and we've got a new innovative online voting system which means that members can vote from wherever they are in Bangladesh. So they don't have to physically attend the election. They can vote from their mobile phone whether they're a 10-hour drive from where the election is going to be held or a two-minute walk. So it's really going to make it accessible for all the midwives that are members. And finally, because the partnership wasn't organic as I've said and because we're less than a year into the project, this year has also been about establishing baselines. So the project itself is obviously funded and this funding will come to an end. But we want to make sure that everything that we do is sustainable. So this year we've been focusing very much on establishing those baselines and working out what data we're going to use to measure the improvement both in terms of the partnership and also the project. So I'm going to hand back over to Halima to talk about the very interesting work that they did recently in Cox's Bazaar. Over to you Halima. Okay. Again, thank you so much. In March 2008 we was in visit with the international RCM delegate. We was visited Cox's Bazaar Rohingya and there was a midwife training. It's very interesting. We give many, you know, obstetric emergencies, training of them who are working in the Rohingya camp. There is a 64 midwifers working for the Rohingya camp. Many Rohingya people are living here, you know, more than 10 lakh people are coming from Myanmar and every day many delivery is conducted by our midwife and they are very much now exporting and sharing their experience with their mother and other community people. And for our government and for the NGOs people go to the visit in Rohingya camp. Everybody are giving a very praise for our midwife. They are very much happy. They said the midwife are working hard and they are very much skill about the obstetrical care. So we also visit one day. There is a one-day opportunity and give the training like bridge presentation, shoulder distribution and the cord prolapse and normal delivery, how they contact. Is there any emergency happening, how they manage? We are sharing our experience to them and they also share to us. And we give some instruction to if there is any problem, how they minimize this problem during the anti-natal, internet and post-natal. And we also sharing advocacy material. BMS are produce some materials for our midwives and we produce BMS activities and also BMS in front of July, July 14 we give the date of election for the BMS. So we also advocacy for the membership of the midwives because they are very new midwives. They are not much aware regarding the membership. So we have to advocacy to them why they need to be a member of the BMS. If they are the BMS member, the BMS will be the more stronger and feeling confident to do some activities for the BMS member if they need it. And we can help them any emergency information and not only emergency information, there is a lot of information, government and NGOs so we can share with them if they are a member of the BMS. And by this time we engage our divisional committee, Chittagang divisional committee. As already Colonel explained, previously BMS was in the national committee but now we have a divisional committee, eight divisional committee and more than six district committee. So we are trying to involve them. That is why we involve the divisional committee president and secretary to engage with the BMS and give it to committee to sharing the advocacy material and as well as training the midwives then they feel good and feel empowered for the society. So after that we talk with the midwives how they feel, how are their reaction and they said it is very good and excellent program. They need more, more this type of training because one day few hours is not possible. So they once more this type of training and last week we complete one advocacy and media training, you know. So that is why we call them and we collect the eight division midwives who are the first base midwives and second base, we collect them more than 18 students and we give them media and advocacy training and how they share their experience with others and how they talk with the communication with the news media and how they write the press release. So we hire experienced and expert media person and they give training and they feel better. We also provide the certificate for that. Brilliant, thank you so much Halima and actually one of our UK midwives went with Halima and her team to Cox's Bazaar to just to oversee the training and that was an extremely rewarding opportunity for her. So next up, I mean we've talked about the achievements and we've said it's been a very positive experience but it's very important to acknowledge the challenges too so that we can build on them. The most obvious challenge of this project has been with regard to logistics. We're working across two time zones, we're six hours apart which makes communication quite challenging at times because there's only two or three hours really in the day that we're in the office together so it makes communication difficult and it also makes planning for the project quite difficult too. It's also quite a challenge to build relationships virtually so there's nothing better than face-to-face communication when you're collaborating with someone and we've spoken about the real importance of collaboration with twinning and we have to be very creative with the technology that we use. We're really lucky to be able to use that technology but there's only so much that you can do over email and Skype and other technological platforms both in terms of the relationship building which is paramount to the success of the project but also in terms of project management too. Because of the collaborative nature of twinning neither party is making decisions for the other so all the decisions have to be discussed and when you've got limited time and you're not able to do that face-to-face it can be quite a challenge. Culture is also a challenge the cultures of the UK and Bangladesh are very different. This is the first time that we've worked together the first time that the RCM has worked in Bangladesh as well so we're not just learning from the Bangladesh Midwifery Society in terms of the reciprocal learning but we're also learning how to work with a new culture and learning new ways of interacting so it's quite a journey of self-discovery. We also have limited resources in that there's only two people in the global team at the RCM so that's me and my wonderful colleague Joy who's been typing away in the chat box. BMS executives they're not just BMS executives as Halima's explained they're also teachers so they've got their teaching commitments and BMS themselves only have one member of staff so we're a very small team delivering quite a big project. Another challenge that we come across is there can kind of be a conflict between the donor systems and the organisational systems and so for example the funding has to come from the donor it then goes to the RCM in the UK and then we make a transfer to Bangladesh. All of this can take weeks if not months and because of the donor requirements to plan activities on a quarterly basis the delay in the transferring of funds can cause delays in the activities because by the time everyone's in receipt of funds most of the quarter has been and gone so we've had to work very very hard being absolutely on top of what we're doing but also being as flexible as possible. There's also a slight conflict in that we acknowledge that twinning is a concept and it requires a lot of reflection and hard work to make sure that there is equity whereas donors of funded projects are not quite as concerned with the theoretical aspect of twinning so we understand that they have their own requirements in terms of activities and spending and reporting and we absolutely recognise the importance of that and always uphold those requirements but it can be quite difficult to find adequate time to reflect on the twinning relationship because we're very busy getting things done so we'd like to have more time not just to get things done but also to consider the methodology the methodology behind what we're doing and consider whether this is the best approach to take because ultimately as I've said we're very concerned with making sure that everything that we do is sustainable so those are the challenges what are the next steps so we're going to be focusing very heavily on leadership which is very exciting not just the leadership of BMS itself but also we've created a Young Midwife Leaders Program together with the donor and with BMS so myself and two consultants from the RCM are going to be travelling to Bangladesh next week or in a few days actually to develop a contextually appropriate and manageable programme of leadership for five newly qualified midwives and this is so exciting because the Young Midwives themselves are very enthusiastic they're very young and this is a fantastic opportunity for them but it's also a really good opportunity for the RCM and BMS to develop something very real together so this isn't a workshop it's not a specific activity it's potentially a lasting legacy of providing a framework for leadership in Bangladesh and it's also exciting from the RCM's perspective because it means that we get to test our leadership materials in a different context and begin to explore how we might adapt them and then finally as the first year comes to an end we've mentioned that it's difficult to take time to reflect on the relationship and the methodologies but as this first year comes to an end this is an ideal opportunity for us to really reflect on what's been learned and what direction the project to take in the future and how we're going to support BMS to shape Midwifery in Bangladesh so we're hoping to submit an article to the Asian Journal of Midwives on the methodology of setting up a new partnership and building the organisational capacity of the Bangladesh Midwifery so those are the next steps and it would be really great to come back next year and to update you all on everything that's been going on that's the end of the presentation thank you very much for listening and we'd welcome your questions particularly if there's anyone here that's been involved in a twinning partnership or is actively involved in one now it would be really great to hear your perspectives so thank you very much thank you so much Carmen I'm looking for questions from our participants I want to shut them such interesting work can you also, Hoima yes while I thank you so much while we're looking for questions from some of the others let me ask you both I'm curious about communication with the midwives in the very rural areas quite often when we think about communication we're thinking about online communication like this I have been to places where the midwives don't really have computers but they're doing all the communication over mobile phones what is it like communicating with the midwives in rural Bangladesh well thank you thank you so much actually now we are facing a lot of challenges in Bangladesh that in my presentation I already explained the midwives are producing and they are waiting for the deployment they are not yet giving only few of them are working under the UNEP and other organization but most of them are waiting for the job they are not yet starting any because the government already created 3000 posted but not yet deployed government deployed for the certified midwife but not yet the registered midwife so they are waiting and also our midwife facing a government because the accommodation is nurses and midwives together so they are staying same place where nurses, students are hostels because the accommodation is very few amount of student so they have to stay together many student so they are facing and also they have the classroom library facilities not adequate classroom as well as others materials education materials though UNEP are trying to give some materials and books but it is not up to the level we need to more help to regarding the materials like book, like many games and also also nurse midwife accommodation facilities so and other also after after giving the deployment still we don't know what will happen in the community because we need to more awareness create awareness among the people in community people because they still know don't know who are the midwife in city and educated people they know because from 2010 government are advocacy and we are also advocacy about the midwife but you know in Bangladesh 85 people are living in the community in village so our village people need to know about the midwives so we need more advocacy program advocacy for the midwives to take the service from the midwife to our community people because if the community people does not know who are the midwife why they need midwife then midwife cannot do anything for them so this is the challenges for our midwife to do for the service in Bangladesh Thank you Carmel I have a question for Carmel from Franca Cadet Franca is asking Carmel can you tell me something about the reciprocity side of your project Sure Yes I'm not on mute thank you Franca for your question I think it can be quite difficult to actually characterise what we mean when we say reciprocity we talk about collaboration and bi-directional learning but in concrete terms something that I have learnt personally and the global team has learnt as well from the Bangladesh Midwifery Society is that in the UK and possibly in other Western nations we seem to be so consumed with planning things really far in advance sticking to the plan following systems and processes to the letter but actually that can create situations where you miss opportunities and you miss things that come up on an ad hoc basis and what I really admire about the Bangladesh Midwifery Society is their ability to respond to an identified need as and when it comes up so for example their work in Cox's Bazaar it was never really part of the plan they identified as really important they wanted to support the midwives working in that context they wanted to understand that context a lot better and have a presence in that area too and they made it happen and it wasn't part of the plan but it's absolutely fine and it's 100% enriched the project so the reciprocal learning that I've taken from that is to just of course have a plan and try and stick to it and be open to other opportunities and be open to having other unplanned things improve your project Thank you for that Carmel there was some correspondence in the chat room asking about a Facebook page so that people could follow the project and I see that Joy Kemp has given the link to the Facebook page for the Bangladesh midwives society Yes there's the Bangladesh Midwifery Society Facebook page the RCM also has a Global Midwifery page which is a community of individuals that are interested in Global Midwifery and we often post updates in that so if Joy's still on the line if she could maybe post a link to that or I can do that afterwards that's fine but yes Facebook is such a great tool and that kind of links into what you were saying what the question that you were asking earlier Cecilia about communicating with people in rural areas I found it very very useful because it's not like email it's you know it's instantaneous if you send someone a message they can respond to you within within two seconds and I in a way find it much easier to build relationships over Facebook and that kind of technology than over more formal technologies like email thank you Carmel I want to tell people that we have all about five minutes left so any final questions Franca is saying there's also a twinning app that can be downloaded for free interesting resource thank you Franca Carmel I wanted to ask in your initial slide you talked about Bangladesh was currently the only functional the only open twinning project do you know where the others completed you considered successful and the Royal College was able to cut the cord you might say so those projects were indeed completed they were funded projects and the funding came to an end so the actual project itself is completed but the partnerships in a sense still exist because you don't need a donor to fund the partnership it's all about relationships so the most recent project that finished was the partnership in Uganda which was developing a model of midwifery mentorship and that finished in 2017 and actually one of the reasons that the Bangladesh project is the only active project currently is because we're trying to build time and space into the global team to reflect on the previous work and to get things published and to build to a body of evidence about twinning and partnerships so they were indeed finished but the cord hasn't been cut because the relationship still remains and I think that's really vital for twinning partnerships because it's not just about a project it is the relationship is really important thank you so much Carmel I see Joy has posted in the chat box her email in case people want further information one last quick question while Franca is pointing out that there are so many twinning projects worldwide not just from the international confederation and the Royal College of Midwives I know the American College of Nurse Midwives also has twinning projects with a number of nations and Halima is giving us her email if there are further questions