 Okay, so it is my very great pleasure to welcome Joy, Jumu and Sharmin to the Virtual International Day of the Midwife. I met Joy talking about the twinning projects already, quite jealous really, of all her travels overseas. But let me introduce you to them first. We have Jumu, who is a midwife and vice president of the Bangladesh Midwifery Society. She's only 24 and she's been selected as a young midwife leader in the Royal College of Midwives' twinning project with the Bangladesh Midwifery Society. We also have Sharmin, who is employed by the Bangladesh Midwifery Society as project manager. And she is leading this with the support of the Royal College of Midwives. And then finally, we have Joy, who is the Global Professional Advisor for the Royal College of Midwives in the UK. She's a midwife with a background in practice research, education and international development. And she leads the RCMs international work and has specific expertise in midwifery twinning projects. So I would like to hand over to Joy to give the presentation then. Thank you very much, Linda. And I'm just trying to work out if I can move the slides on. I'm not sure if you can tell me how I can do that. Oh, I see. Yeah, there's a little thing at the bottom. Okay, great. Thank you. So good morning, everyone. It's really fantastic to meet you virtually. And thank you very much for your interest in our project and for listening in. Welcome especially to my two co-presenters, Jumu and Shamin. I don't know if we're the only presentation that's taking place today that's being presented from more than one country. But Jumu and Shamin are both in Bangladesh, which is currently five hours ahead of the UK. So trying to find a time that was suitable for all of us was a challenge. I'm really excited as well that Jumu has joined us because she's up-country, sitting in her health center where she works. And I think, Jumu, this is your first international conference presentation. And so we're really excited. And we're really grateful to Mom Tasmam, who's president of the Bangladesh Midwifery Society, for encouraging and supporting Jumu in being the person to present. So this is us. And we're very happy to see you. So Jumu, do you want to explain something about Midwifery in Bangladesh, please? Yes. Thank you very much, Joy. And thank you, Linda. Greetings from Bangladesh Midwifery Society. And on behalf of all midwives from Bangladesh, good morning to everyone and happy international Midwifery Day. I would like to talk about the Midwifery in Bangladesh. So it's 5,200 maternal deaths per year. Here, two to three deaths are preventable. In Bangladesh, 38% is home birth and home delivery. Only 42% of births have a skilled birth attendance present. Bangladesh government committed commitment was to make 3,000 midwives to achieve SDC goals. Midwifery education started in Bangladesh in 2013. Already three birth batches now qualified and more midwives in training. Currently, almost 1,200 midwives are deployed in government jobs. And most of them are working in rural areas, and especially with the Rohingya refugees. Currently, midwives targeted at rural areas, no provision for urban population. Great. Thank you. And also you can continue with this slide. Thank you, Joy. And now I would like to talk about the Bangladesh Midwifery Society. This is a professional midwives association in Bangladesh, founded in August, 2010. BMS is an ICM member, registered member. It was in April, 2011. It is also registered with Bangladesh government in May, 2011, and with South Asian Midwife Association, SAMA, in June, 2011. Bangladesh Midwifery Society's head office situated in Dhaka Nursing College. It also has seven divisional regional committees. It's set up by pioneering nurses midwives, respect to them. And before joining, there was no staff and no deployed midwives in the BMS. Now we have two more. Thank you. Thank you, Jhumu. So some of you listening might be asking what is twinning? Twinning is not an idea that came from the Royal College of Midwives or from BMS. Twinning is something which is promoted by the International Confederation of Midwives, the ICM. And they hope that midwife associations will twin with each other to strengthen each other. So according to Franca Cade, who is president of the ICM and has done a lot of work on twinning, twinning is a cross-cultural reciprocal process. That means giving and taking. It's two way where two groups of people work together to achieve joint goals. And the ICM promotes twinning so that midwife associations can build their capacity through working together and can share their ideas and their skills and can learn from each other. So it's important with twinning that it's two way. It's not one powerful organization who is leading, but it's two way. We're expecting to learn from each other. A twinning relationship makes it formal and substantive. It's something proper, something real, and it's collaborative. And as many people listening will know, ICM has three suggested pillars of a strong midwifery profession. They say that if your midwifery profession is going to be strong in your country, you need to have strong midwifery regulation, strong midwifery education, but also a strong midwifery association. And without a strong association, the profession of midwifery will be weak. So the idea of twinning is that we work together, we learn from each other, and through that partnership, we each strengthen and grow. And the Royal College of Midwives has been involved in twinning since 2012. And Bangladesh Twinning Project is our third twinning project, but we also have relationships with Uganda, Cambodia, Nepal, and in a small way with Nigeria. But Bangladesh is the one that's current and is really exciting. So we're very happy to share this with you. So, Sharmin, do you want to explain to us how BMS is hoping to be strengthened through twinning? Yes, of course. Thank you, Joy. Bangladesh Midwifery Society twinned with the Royal College of Midwife in July 2017. And the objective of this twinning is to strengthen the society, to advocate for midwifery profession and to create demand for midwifery services. The results or outcomes or outputs are midwives take leadership for advocating midwifery profession. It is in our country, it is very important project because midwifery is very new in our country. Great. And because we said that twinning is two-way, you might ask, so what is the learning that we can benefit from in the UK? What are the reciprocal benefits? So we know that when we twin it strengthens UK midwifery because UK midwives are involved in our projects and they learn new things. And when they come back to their jobs in the UK, they have a different way of thinking. They share new skills. And also in the UK, we have a large Bangladeshi population. And so when we work in Bangladesh, it gives us greater skills and cultural awareness to meet the needs of Bangladeshi women who live in the UK. Through the involvement of our members as volunteers or consultants on our projects, also that enables them to have personal and professional development. Some people have not travelled far, so the opportunity to travel is developing for them. And many people say that when they have participated in a twinning project, they understand far more about the policy aspect of midwifery because the twinning projects are working at a high policy level. Also, we know that when our volunteers, when our midwives from the UK engage with the twinning project, they become more active and keen members of their own professional association because when they go to Bangladesh, they see a new professional association that's just starting to grow. It makes them come back and appreciate their own professional association more. So we're very happy when we see them engaging more deeply with us. We also know that our members, when they come back from Bangladesh, are very motivated about global health and development. And some of them have gone on to want to study, for example, master's degrees in global health or to become more involved in the global health community. Twinning has also influenced the RCM. It's changed our strategy and we now have a new vision, which our board is taking forward for the next five years, which includes international work, which was not there before. So our twinning work has influenced our own strategy and has enabled us to spawn new partnerships, for example, with different government departments, with the global health community, with universities and others in the UK. So it has enabled us to grow our own networks and that's an important strategy for us at the RCM. It's also enabled us to do some research and to publish some articles in peer reviewed journals and gives us a platform to do presentations like this one at Virtual International Day of the Midwife at ICM conferences and other platforms where we can share our work. And that's good for the reputation of the RCM. And it also allows an opportunity for our staff to have a development opportunity. So some of our staff have been involved in visiting the countries where we've had twinning projects and that they have shared with us has been a very special experience for them and has helped them to understand the organization they work for better. So I hope that shares with you some of the reciprocal benefits. And we're going to talk more later in the presentation about the critical success factors for twinning projects. But the reciprocity and equity is a really important part of the successful twinning project. Shamin, this is for you to help us understand the activities that happened during the first phase of the project. Yes. At the first phase of the project, actually BMS was not having a very well-equipped office at the beginning, well-equipped office with important furniture and one full-time staff like me, I'm here full-time, the project manager. Earlier there was no internet connection. After the twinning project, there was a good connection set up. Then we have a database consultant and financial finance coordinator part time. Now we have a 24 hours helpline support. We have our financial policy HR policy. At the beginning of the project, there was a baseline market in July 2017. And three year strategic plan were developed. There was a stakeholder analysis and engagement, lots of divisional visits. We have a BMS office, a central office in Dhaka. And we also have seven divisional committees in seven divisions in our country. So all those divisions were visited by RCM representatives and our executives for making them more engaged to our project. Earlier there was not a lot of work, but nowadays they are very active. They are taking part in regular activities and regular meetings. So it's a really very big achievement of the project. We did three media and advocacy training last year, which provided 90 midwives received those trainings. After the media and advocacy training, midwives in root level gave the opportunity to develop documentary and interview video for advocating their profession. And they successfully developed a video documentary and the documentary was also telecasted in Gadget TV in a whole week. And it was very much appreciated. 14 midwife success stories were collected by Sarah Gregson, the RCM volunteer worked here. And those were published in Bangla and English, both English and Bangla newspapers in our country. Last year almost 21 newspapers published BMS news on midwifery and two television television covered BMS news and events. Three radios advocated for our midwifery program in three radios. We did this with our executive committee members. 15 midwives are getting continuous leadership development support under young midwife leadership program of BMS and RCM. RCM volunteers are coming for mentoring them and also we are giving some kind of grants and also mentoring and coaching support training support to these 15 midwives like Sarah Gregson and Isabelie Lamber Cooper last year visited and this year also visited for mentoring them. We have a database of our members. Currently we have 1756 registered midwives. Very few are NARS midwives. Among these 1756 only 167 are NARS midwives. So the database is you can see any data we can retrieve according to our requirement from the database like how many members from which division and how many are doing education courses. We have online education courses, 20 online education courses free for our members and our members are successfully doing the courses through our help and support and other trainings we are giving. Almost 522 members started the education courses training and 255 members completed these trainings within from last four months. We have provided 35 midwives of Rohingya CAM training support last year. We had a Makat review on the project last year in 2018 on the on what is the first baseline into 2017 and the review in 2018 Makat how we are doing. This is a picture is clear in front of us. So it was very good effectively working and we had also reviewed our strategic plan. After reviewing the strategic plan we have said subcommittees those subcommittees will work all around the year to achieve the objectives of our work plan and I would like to share with you a very very good example of this training program success it is in the year 2018 September 15. We in our country it was the first online voting system implemented by VMAs and through RCM and UNFPS support and we had at that time 1530 members among those 1530 members 717 members successfully voted from all over the country. Our donors and stakeholders supported and appreciated the election so much and also in the media they have telecasted news like this this is the first online voting in our country. So I think you can maybe and maybe now understand that how it is working in our country it's really difficult because the midwives are young and in our country we have a belief that young people are not able to work successfully but our midwives are really doing very well in the field and BMS is successfully can advocate through RCM the work of the midwives and advocating. So thank you I think Joy can do the next slide. Thank you very much Charmin. So Jumu this is a photograph of the new executive committee can you tell us something about them. Thank you Joy. Yes I can say this is the new executive committee of BMS. The election was held on last September and here we have we all most of us are very young if I introduce them should I yes from left left side her name is Shamuli Khartun she's a deployed midwife of our first best of midwife midwifery the second one is our organizing secretary Jima Khartun the third one is Runu she is an executive member and then Shamsunna her ma'am she's a teacher of midwife of midwives and the white one is sorry don't worry yes I'm sorry she's Asya she's also executive member and then our honorable president ma'am mom touch back home she's the president of BMS and after our president ma'am she's our ma'am she's also also a midwifery teacher and then we have Pinky during secretary of BMS and then it's me it's the vice president of BMS and here sitting from left side she she's also an an executive member and then Anunna she's an executive member and and then we have secretary of Kailma then we have Sanjita Talubdar here she's an executive member and then Tammi she's also an executive member thank you fantastic yeah if you allow me joy yes I would like to tell here that earlier BMS executive committee was having only the midwife sorry not midwife nurse teachers but the new committee among this 15 11 are our midwives directly working in the upajala health complexes earlier there was no midwife but after 2013 the batches received training and now we are having midwives in our committee so it it was a very big success I think for our BMS thank you yes thank you both and I agree it's a great success that midwives are now leading the midwifery association but it has been a challenge because as they have both said these midwives have been deployed in rural areas some of them are very long way away from Dhaka and so because of this change BMS has almost had to become a virtual organization and every executive member has been issued with tablet computer but it's still a challenge to communicate with each other because of difficulties with internet connection and when we do need to have a meeting they need special permission and the government order to travel and they have to travel long distances often overnight on boats or buses and so I'm just offering huge respect to Jumu and the other executive committee members for their commitment and for the incredible work that they do in really difficult circumstances so I'm going to move us on now to the evaluation because this is the the subject of this presentation at the end of 2018 we had an evaluation of the first year and a half of the project more more of a review than a formal evaluation and we wanted to use a structure for that evaluation so we looked to the work of Franca Cadet who as I said earlier is president of ICM. Franca is also in the process of completing her PhD on midwifery twinning and she is someone who has really led midwifery twinning from the very start. Franca recently published a paper last year on the critical success factors for twinning between midwives this was published in the Journal of Advanced Nursing and it's open access so you can download that article and I'm happy to send that to anyone if you give me your email address and so Franca did a Delphi study between 2016 and 2017 with 33 twinning experts from 19 countries and in that research project they identified 25 critical success factors in twinning that were grouped around these five issues equity values communication management and commitment and what Franca identified was that twinning has great potential to develop midwives power but the twinning projects that they have been have had mixed success because they haven't always been implemented correctly. Linda my screen has gone blank. Sorry we can still see it though do you want me to take the presentation that's why because she's been kicked out she will be back with us in a moment would you move I'm back can you hear me yeah sorry sorry I just lost I've just logged back in again that's quick so yes so these 25 critical success factors were identified and so we used this framework to review the success or to review the progress of our twinning project at the end of 2018 so I just wanted to tell you what that framework was I'm not able to move the slide forward Linda is it possible for you to give me that facility oh there we go thank you okay so Charmin I've explained the framework that we used so could you please explain the process that we went through yeah of course the evaluation process phase one it was done by consultant Nester Mayo Joy Camp RCM volunteer Sarah Grexton BMS staff uh present and former executive board members the workloads were appreciate appreciative inquiry focusing on what went well I know that the team visited our stakeholders and uh taken their view and interview for the review then did the market review that is membership association capacity assessment tool review did side visits strategy plan review and realignment with new executive action planning with new subcommittees we set up subcommittees according to our work plan and we disseminated the work according to the work plan to the subcommittee members now the subcommittees are actively working thank you Joy great thank you very much Charmin so it was a participatory review we did have a consultant Nesta who was ICMs technical senior technical midwifery advisor for 17 years so has a huge amount of experience to offer but otherwise except for our consultant it was a participatory review with everyone who had been involved in the project and in our twinning projects we are more and more using appreciative inquiry rather than focusing on what goes wrong and what the gaps are trying to identify when something goes well what is it that has contributed to that success and what can we do to make that success happen more frequently so that's been a useful tool for us Jumu can you talk us through this slide who is who please yeah thank you Thank you Joy this was an evaluation team here we have Nesta we have Sara Rexon and our Joy and in the below team we have previous president of Bangladesh midwifery society and previous secretary Jasmine Maim also we have a project manager here Charmin Appu and Irina Maim and our present vice president of Bangladesh midwifery society Momtas Begum lovely thank you Jumu so the results of the review we're going to talk both about the successes and the challenges I'll talk about the successes and Charmin can talk about the challenges so the review found that all the activities of the first year have led to VMS achievements and particularly the membership database and the online voting system and the election which was held in September 2018 the stakeholders said was a watershed moment and were notable successes as Charmin has said it's actually the first online vote that's happened in Bangladesh so it's caused a lot of interest it's raised a lot of interest even at government level as to whether in the future national elections and others can be done online which in a country with the challenges of communication and travel like Bangladesh enables people even in rural areas to have a voice and I have to say that when we did the election and we saw midwives coming online and voting from remote areas and having a voice in their own association for the first time it was actually a very emotional moment the review also showed that there had been measurable improvements in capacity but also identified that there had been a change in behaviors which suggested a change in mindset and values and a CAT member association capacity assessment tool score did show an improvement although only a small improvement that's due to many factors partly because it's a self-assessment tool and the people who did it the second time were not all of the same people who had done it the first time but and and we can talk more about that offline if anyone's interested in some of the issues we have with the current tools available for measuring organizational capacity and capturing that change but what we did see is that previously only one out of seven sections of the organizational capacity had been measured as adequate whereas in this review three out of seven sections so we can definitely say there has been measurable change what the team also identified is that there had been nice examples of cultural humility on both sides UK midwives Bangladesh midwives and others really trying to understand each other's perspective and showing cultural humility and that there had been definitely some successes in communication and management but there were also some challenges and shaman is going to share those with us yes joy you took the easy one which is and given me the actually I would say that the project twinning project is not at all easy it is very very difficult and from my experience I have almost 15 years of experience and the way RCM and UNFPA is handling the project is really very very much commendable I highly appreciate them sometimes when I see the challenges sometimes I feel like to give up but in our country midwives are really very important because our maternity dates are high so I then you know recollect myself and you know get the enthusiasm back to work actually people here I would say it's difficult because there is a bureaucratic system in the government they work really under a high protocol system so there is the challenge first one equity of power can be challenging at the beginning of projects twinning project when one partner is the fund holder and also the government level communication is not very easy and most of the time we try to solve our issues and problems through a good communication with the RCM and UNFPA and when RCM staff is very you know they start understanding the nature of the project then when they leave then it is also a very big challenge executive members and volunteers capacity building they are coming and it is difficult for them to go long distances and also government staffs are not allowed to give time without prior approvals so whenever they are under coaching then they need to I need to send letters to their authority for permission makes things lengthy and sometimes very challenging and the most challenging thing in this project is the mindset and culture because in our country we have especially in our government sector have a system and have a thought that seniors are seniors and they have high knowledge and we cannot you know break the protocol and midwives are new they are young so it is very difficult for RCM UNFPA BMS to get the midwives in the right forum to talk and raise their voice and also give them a chance for the training and external exposures and it's really very difficult. I'm going to move us on Sharmin because we've had a five minute warning so we need to wrap up soon. Okay. Thank you. Jhumu can you just talk us through which activities we've done so far in phase two? Yes thank you Jai. On phase two the activities are so far we analyzed the vision and mission and values on February 2019. The divisional committees are restructuring and we had monitoring and evolution workshop we have young midwife leadership development program still. We Sarah Gregson and me we developed a quality care audit tool and WHO, Delhi and Thai commission exchange trip to Cambodia recently on behalf of BMS Samina who went to Cambodia and we have e-learning system we have more than two thousand scores course online the midwives are getting the online courses and improvements to database and websites we have already improved the database system and we have all those information all the informations of the midwives here. Great thank you Jhumu. Sharmin we've only got one minute so can you go through this slide for our future plans and challenges? Yeah our future plan most our recent plans are a constitution review in June EDM in June leadership development and divisional branch strengthening build capacity of subcommittees introduce the advisory committee membership recruitment retention and organizing develop a e-learning and CPD continuous professional development platform for members more advocacy training and publication and presentations continued support and mentoring from RCM UK volunteers planning for sustainability. Great thank you and I think Jhumu will just skip through this but to say we have given some leadership awards and so just finally what's what are the challenges for us when we think about international day of the midwife 2019 and the key message from ICM that midwives are defenders of women's rights we looked at the the list of key messages from ICM and these three we felt were very pertinent for the Bangladesh Midwifery Society in 2019 women have the right to educated and competent midwives so BMS together we need to advocate that all women in Bangladesh have the right to access educated and competent midwives that midwives have the right to provide care across their full scope of practice because midwifery is new sometimes other professionals are finding it challenging to relinquish what they've been doing to midwives and some midwives where they're working are not able to practice fully so this is another key area for advocacy this year and also that midwives need safe and enabling environments to work in and the the work that Jhumu and Sarah have done and will take forward on quality care and the enabling environment is really key so we're going to be focusing on these three areas and just some appreciations of everyone who's been involved and my huge appreciation for Charmin and for Mumtaz mam the president for Jhumu and for all of others at BMS for the incredible work that they're doing the spirit of partnership that they have extended to us and it's really fantastic to be involved in this amazing project so thank you very much I will not leave without thanking Joy for the project thank you Charmin yeah and thank you all for hearing us and this is my first experience to join the ICM conference I'm very much happy thank you thank you done a great job