 And now without much ado, I'd like us to welcome Pragati Sharma who will be making her presentation this morning on midwifery leadership as a strategy for workforce development. Pragati is a nurse midwife public health consultant working for the improvement of maternal health. She's currently working with WHO headquarters to provide technical and coordination support for the ninth WHO ICN ICM triad meeting. Her most recent role has been with the Office of Chief Nurse, WHO to build and sustain the virtual nursing and midwifery global community of practice focusing mostly on the midwifery aspect. Prior to that she was with WHO India as an assistant program director for midwifery leadership program where she supported a 12 week training on midwifery leadership for state leaders. In India, she also supported the national midwifery initiative and other in country projects around midwifery education and services. She is passionate about quality, equitable and respectful care for maternal and reproductive health, particularly midwifery and has a wide range of experience in public health in the SRNNCAH area in India and abroad. She's an advocate for midwifery services for normal labor and birth. Last few years of her work has been around midwifery education, services and leadership. So welcome Pragati Sharma. Thank you Caroline. Thank you so much for that lovely introduction. So Pragati I'll make you into, I need to make you into Pragati. I need to make you a presenter. Are you able to scroll the slides Pragati? Not yet Caroline. Can you see the arrows here Pragati? Not yet. Okay Pragati. Can I start Caroline? Yes please. Yeah, thank you so much. Thank you so much Caroline and good morning, good afternoon and good evening to all our listeners and viewers who have joined in from different parts of the world. I'm going to talk specifically about the midwifery leadership program in India that I was part of and I was very lucky to have contributed to. It was an honor working with Government of India and other senior midwifery leaders in the field. And I'm going to just talk briefly about that and just talk about how leadership can be a strategy for policy change for midwives and for midwifery in general. So in the last two years we've had two big reports being launched, one by World Health Organization, Strategic Direction of Nursing in Midwifery, which has a five year strategic priorities that our member states would follow and then implement in the country context. And here another big report launched by UNDP in collaboration with other partners like International Confederation of Midwives, WTO, Con State of World Midwifery Report 2021. So both these reports are the global strategic direction for nursing and midwifery presents evidence based practices that are interrelated to a set of policy priorities. So in total it has four strategic directions and 12 policy priorities out of which leadership is one of these strategic direction and has two policy priorities. So basically it talks about providing and giving opportunities for midwives to be trained as midwifery leaders so that they can have a speak at the policy table and they can keep their viewpoint representing midwifery workforce at the policy table. The other one is creating program and opportunities for midwives for enhancing and empowering themselves at midwifery leaders and WTO basically endorses for government positions for midwifery leaders and chief nursing officers present at the Ministry of Health. The State of World Midwifery Report also has similar priorities and sets out recommendations for what can be done to enhance the capacity of midwifery workforce to enhance the leadership capacities. So this is just to give a background on how leadership has been important in the midwifery workforce and this is the way forward. So starting with the India program and what was the India program about it was I'll start with giving a bit of a context on how government of India launched the midwifery initiative. So the government of India's midwifery initiative was launched in 2018 and it aimed in training midwives who were called nurse practitioner and midwifery to become registered midwives who would practice on their own. And they also had a program separately to train midwifery educators who could educate the midwifery practitioners when they were in training period. So this happened the policy decision was taken in 2018 and the implementation started in 2019. And as and when the implementation started there was a need was felt by the government and by other stakeholders that midwives will benefit and the country will benefit moving towards universal health care and achieving the SDGs in empowering midwives and giving them a table at the policy making giving them a place at the policy making table. So this is how the midwifery leadership in India came into you know came into being that's how it was conceptualized to begin with. So this began as a pilot program coordinated by the Major Country Office for India and was announced on 8th March 2021 International Women's Day. And that is very apt because 93% of the midwifery workforce is women and I think most of us who are present today are women as well and no offense to our main counterparts but I think majority of the midwifery workforce women. So it's a very interconnected gender interconnected space as well and I think it was very apt to be launched International Women's Day. So I was very fortunate to co-facilitate the program alongside Jane Salvage who was program director. Jane Salvage is an independent consultant and she's from the UK and we also had guest faculty from WHA headquarters. Miss Elizabeth Iroh who is the chief nurse at WHO and Miss Fran Mekhon who is midwifery advisor at World Health Organization. And the program ran over 12 weeks and we had 21 participants from all over the country as a pilot program. So this is just to give a view to the global audience on where all the participants came from in India. They came from 7 states, 6 states and the national capital and we had 3 participants from each state. The reason to specify this is because the way midwifery is stationed in India, the program is stationed in India is we have involvement of both private and public health facilities and both private and public educational institutions. So the center of excellence for midwifery, the first one is not for profit organization Fernandez Foundation in Telangana and they are the first one who started training the midwifery educators and the midwifery practitioners. And even for this program we had representation from 3 different pillars of midwifery, one from the council, one from the education and one from the private sector. So when we had these representation we made sure that midwifery as a policy priority in India got percolated to every sector and every stakeholder in the state. So that they had a wide network amongst them to collaborate and when their leadership capacities enhanced they could also help other counterparts to enhance leadership capacity. And also another stretch they could as a trio advocate for midwifery to the government, to the parliamentarians and even to the community as because this is beginning in India just in last one and a half year. The program aimed to reduce maternal and newborn mortality and morbidity and improve the quality of care and specifically the leadership program aimed at by supporting the state level midwifery and nursing leaders to implement the government of India's midwifery initiative. The program objectives were to support and plan for sustained implementation of government of midwifery initiative. So this leadership course was specifically designed around the government of India midwifery leadership. And now it's being taken into account to build a global standard document which focuses on a standardized training module for midwifery leaders all across the globe which then countries can standardize based on the local context. So now WHO is implementing this in another five countries after it was done in India. So it was the second objective was to build the individual and collective leadership capacity of senior nurse midwives. And that's when we had a session that focused on their individual capacity and their capacity also as three years like three people from one state. And also it was to advocate and evaluate the program in six states of India like I mentioned earlier. So the long term output of this leadership program was to have an active state leadership team who could advocate for midwifery in general and to have a current maternal and newborn health action plan so that they could have an action plan ready and then they could start implementing them in another one, two, three years. However it was possible and then in going along with time they keep advancing and prioritizing and amending their action plan based on how the state is moving in maternal health indicators in midwifery training where the state is positioned. The program also when we began the program we wanted the senior midwifery leaders to connect with each other and talk to each other from different states about what they are doing. We had examples while we were in the training from a state who met the health minister and then that was so inspiring that other states also wanted to do that and they had it began in the state as well. So this is sort of how to initiate our policy dialogue among our wider audience, specifically one who specifically stakeholders are political influence within their own state. So I think this program helped them a lot in that and eventually to have them also connect to other global midwifery leaders through a dedicated platform which I'll be talking about it in some time. The participants we had very senior nursing and midwifery leaders. I say nursing and midwifery leaders because currently India has just started a midwifery leadership program and we don't have midwives yet who have come out from the government of sector but the existing nursing midwifery, nursing midwifery partner in India, both nurses and registered midwives. So that's why I'm calling that nurse midwives just to give a bit of context to our listeners. So we had directors of state nursing councils participate midwifery society presidents, principals of nursing colleges from both private and government sector. We had hospitals, attendance and nurse practitioner and midwifery who had just recently come out of the training program, the government of India midwifery training initiative. As I already mentioned the program was planned for over 12 years. We had each participant join as a trio on one week or one day of the week and as an individual in another day of the week and they had four dedicated hours for that day. And then for remainder of the week they would work on the assignments on collecting data, triangulating data and working on the evidence around midwifery. So we also had an evaluation and it was done by South East Asia region office and hopefully it will be published soon and you will all be able to do what it says. And the next step is the fight for leadership program, which is underway, which I mentioned about and to have the midwifery leadership training program standardized so it will pull it up to the level. So presently, I can also share the link with you in the chat box there or and I think the slide will also be available to all the listeners and viewers on the platform. So when we finished this program, we got a lot of interest from the midwifery leaders to connect among each other to learn from each other. So they had set up a WhatsApp group and they would meet every second Wednesday of every month, even after the training program was over. So we thought they would benefit from having a platform where they could interact with other midwifery leaders in different countries. So this is just the initiation and WHO headquarters under the leadership of Elizabeth I with the Chief Nurse has initiated this project. It is a virtual platform created for nurses and midwives to come together and connect and network among themselves. It is called the Nursing and Midwifery Global Community of Practice. The link is hyperlinked in the text where I have written nursing and midwifery global community of practice. So it is open to all nurses and midwives and even other stakeholders who are closely connected with nursing and midwifery policies in the countries and states. So for this group of midwifery leaders in India, we have a private group created for them. And in the in time where the five country program gets started and then we have programs in other countries, most of them from other countries will also be added and they'll have a wider network where they could share and connect about their midwifery learnings, the challenges they are facing because even though we are different in geography, but actually the challenges would be very much similar and the way to success would also be of similar path. So just to end this on a very happy note, we had unsolicited feedback from all the midwifery leadership program participants in India after the program ended and they all found it very, very beneficial. These are two of our very active midwifery leaders from the state of Assam and from the state of Telangana and they would actually take forward much of the work they did in their action plan while they were training to take that forward in the state. And I just wanted to say happy international day of the midwifery to all of you and thank you so much for listening. I'd be happy to answer if you have any questions. And thank you Caroline. Thank you very much. Thank you very much Purgati. That was an awesome presentation. This is a very great initiative and I'm sure that it's something that will really benefit other midwives, midwife leaders from other countries and I hope that this program, many of the people on this platform will be able to join the community of practice. So just see what it is all about and just to further engage and interact with other leaders from India and across the globe. Just a quick one from me from what I've gathered. I want to believe that the training used training of trainers approach so that they could be able to cascade the knowledge to the other team leaders in their places of work and organizations. And that way you create a critical mass of trained leaders who will cascade the knowledge downwards instead of just the 21 who come in for this particular program. Thanks. Thanks Karen for your question and to answer that. Yes, the training is intended for them to share their knowledge, but they were not trained as trainers as such. Because at the context of the program that this MLP, the Midwifery Leadership Program was built was a little different than how other leadership programs are. So we wanted leaders to be attached to the National Midwifery Program so they could push for the program in a different state. And in India because health is a state subject, the federal government, the central government cannot interfere much. So we wanted them to be flag bearers of what happens in the state. So although, although the expectations are there in the soft capacity to train the counterparts in the states, but not as a formal approach, a more formal approach will be taken, hopefully by the government of India and taking this forward in the next budget, budget slide. All right. Thank you. Thank you very much. The floor is open for any questions and I can see we have resources slide there where we can see the reports that have been mentioned and the links are there with us. Any questions from the floor kindly put them in the public chat and we'll be able to pick them up. Any questions? I can see someone is typing. Somebody's typing. We have several thank yous. There's a very good feedback. The presentation amazing work. It's a good initiative to have me twice. Thank you. Thank you. Thank you, Catherine. Yeah. This is a good initiative because, like Catherine has said, it's good to have them on the table. Because you'll be able to negotiate when it comes to policymaking, you'll be able to look at the policies that are there, are they relevant to the work that you're doing and you're able to, you know, make any changes or absolutely include areas in which we know have not been covered probably by the policymakers when they're passing some, you know, making these policies and strategies. Absolutely. Yeah. Now it's started to change, but I think in the past when midwifery policies were made in most instances there were no midwives as part of the technical team or the primary group or the task force. So it was all done by people who were not midwives, but the policy was being framed from advice. So I think the top down approach is not changing, but needs to be more changed as well. So I think this could be one of the steps for India and, and I mean, as a change, I would not directly, you know, connect that to this program as a change. You can see that midwives are about the task force initiative in India and they have like an industry council, the Society of Midwives in India, they all come together. There are bigger meetings for midwifery policy decisions and they are being heard and slowly it's begun and midwives are being empowered and we all have a say in the policies that have been framed for us. Okay. A few more minutes for a few more questions. Someone was typing.