 This is our presentation, a participatory evaluation of a five-year midwifery training partnership. That will be presented by two beautiful women. Joiken is an experienced midwife. She is a global professional advisor for the Royal College of Midwives in the United Kingdom. She has had parallel careers in healthcare and international development. She has led the Royal College of Midwives International Training Partnerships for the past 10 years. And she most recently facilitated a five-year partnership with Bangladesh, which ended in the summer of 2012. She is registered with the North America Free Council in the UK. She is an experienced educator and researcher. And she has significant experiences, international development experiences across Asia and Africa. Her areas of specialty are professional, association capacity building help, professional education, education practice, global health and humanitarian response. Just to tell you that a few. She has published widely and she lived in Asia and Eastern Europe and speaks fluent Cambodian. Outside her work, she enjoys meeting, baking, working her elderly dog, swimming, and attending her local church where she plays piano. She lives in the Kent, UK now. Our other presenter is Shamin. Shamin is the Partnerships and Project Manager at Bangladesh Midwifery Society. She has a master's degree in sociology and anthropology. And she has 20 years experience also working in the development sector in Bangladesh. Since 2017, she has been working with its elected officers and which led to her to various transformations of the Bangladesh Midwifery Society. Trying to change it from a nurse led to a midwife led organization as a question. So they did a partnership with the Royal College of Midwives in the UK. Though she is not a midwife, but she is a dedicated advocate for midwives. She is the Vice President of the Feminist Network of Bangladesh and an active member of the National Gender Working Group Bangladesh. Prior to her employment with the Bangladesh Midwifery Society, she worked with USAID and Muslim Aid. She is married with two children and she lives in Dhaka. Okay, thank you so much Aisha. And welcome to everyone. Thank you Joy. It's wonderful to be with you. Trying to see. Yeah, you're welcome Joy. She has some issues with her videos but she is very much available with us. Yeah, I'm here. I'm sorry my video camera is not working. And also if you hear some strange noises. We had some freak weather here and we've had a flood in our office. So they are sorting it out. But if you hear some noise in the background, that's the reason why. Okay, so Joy you are the presenter now. So you can take over. I will stop my video and listen. Thank you everyone. Okay, great. Thank you and thank you everyone for coming to listen to our presentation. We want to present to you today about an evaluation that was recently conducted of a five year twinning partnership between the Bangladesh Midwifery Society and the Royal College of Midwives here in the UK. This is me. So you can see my photograph even if you can't see my camera. I work for the Royal College of Midwives as the global professional advisor. So I have been leading the RCMs twinning partnerships in different countries in the world for the last 10 years. Sharmin, can you introduce yourself? Yes, thank you Joy. I'm Sharmin Shabnam Joya, project manager at Bangladesh Midwifery Society. Sharmin, you're going to give us some background to Midwifery in Bangladesh. Thank you Joy. Midwifery in Bangladesh introduced in 2010 by the Honourable Prime Minister with multinational support. Midwifery education started in 2013. Midwives started working in the humanitarian sector in 2016 and in government sector in 2018. BMS was founded by the pioneer nurses in 2010. In 2017, when the project twinning project started, BMS was led by the nurses and there were no midwives in the National Executive Committee of BMS. BMS had no staff at that time and there were very few systems and very weak governance and weak voice for midwives. When the twinning project started through RCM with support from UNFPA, the project started to build capacity and support the transition to midwife leadership. And you can see here the picture of our founding president, Halima madam. She was the president from 2010 to 2018. Twinning is all about reciprocal learning and benefit. It's not supposed to be a one-way traffic. And so we also wanted in the UK to understand how we could maximize the learning from our partnership. Actually in the UK we have a 1% Bangladeshi population and we know from our maternal mortality reports that Asian women are twice as likely to die in childbirth as than white women in the UK and for black African women, for black women that is three times more likely. But the perinatal outcomes are also poor. It's similar for babies as for women. There are more stillbirths, neonatal deaths, perinatal deaths for babies of women from Asian countries. We also have few midwives from the Bangladesh diaspora. So although we have 1% Bangladesh population, we don't have many midwives of Bangladesh origin. They have a picture here of Nafisa. She is one of our British Bangladeshi midwives. She's a fellow of the Royal College of Midwives and Nafisa has been involved in supporting our twinning project. And also midwives who have black and brown skin color in the UK have worse experiences working in our health services. They have more bullying and harassment, more referral to our regulatory body. They don't seem to have the same opportunities for leadership and career development. So we can see here there are clearly some very significant potential for reciprocal learning and benefit from a partnership between the UK and Bangladesh. The Royal College of Midwives had previous experience of twinning in Nepal, in the region in Nepal. And because of that UNFPA approached the RCM in 2016 for us to support the Bangladesh Midwifery Society. So after a scoping in 2016, our partnership started in July 2017. And it was both twinning between our organizations in terms of developing systems and structures and the governance, learning from some of the RCM's experience. But also individual twinning between midwives in the UK and midwives in Bangladesh. And I can see we've got Liz joined who is one of our UK twins. And we have a number of midwives from Bangladesh. Tomim, Tamar, Fangita, Mim who are here, who were also Bangladesh twins. So it's wonderful to have you on the call. There were 10 UK midwives. You can see one here. This is Sarah Gregson, another one of the RCM fellows. And she's standing with Asma Khatun, who's president of the Bangladesh Midwifery Society. A number of RCM staff and consultants, both international and national consultants were involved. And partnership finished in December 2022. Within the partnership, there were three separate projects. And these were the UNFPA funded project and two projects from a funded by faith. And the objective were to transition BMS from a nurse-led society to a midwifery-led organization. Organizational capacity development was one of its biggest objective. It is to advocate for the midwives and for the profession and to create a demand for midwifery services in Bangladesh. To develop the systems, as I told you, there were no systems and policy procedures. Policy procedure, systems, structure and network were developed. These were also in the objective to develop midwife leaders to take the new profession forward in Bangladesh. To contribute to the global body of learning and evidence around twinning to strengthen core pillars of midwifery profession. To bring reciprocal learning, as Joy mentioned that both RCM and BMS got benefited from this project and benefit to UK midwifery and maternity care. Bangladesh Midwifery Society has a young midwife leadership program and through this young midwife leadership program, BMS provided support to 53 young midwife leaders. In this year YML program, there were also national executive committee members. You can see the picture of our leaders. All of them are Bangladeshi midwives, very young and very enthusiastic for their work. Here there is our treasurer Tania Lubna, joint secretary, education secretary Tahmina and our former executive team member and YML Sanjeda. The evillation was carried out through mixed methods and it was in a participatory way. Data was collected through internal-external documentary view. Qualtrics and survey monkey were used for data collection, semi-structured stakeholder interviews were taken, stakeholder workshop took place, observational site visits took place and focus group discussion held with young midwife leaders. Feedback collected from a huge number of national and international participants and beneficiaries. The evaluation team you can see here, there were representatives from Royal College of Midwives as well as Bangladesh Midwifery Society. There was Joy, Liz Benon, Tamara Kutpis and Dr. Gina from RCM and from Bangladesh Midwifery Society. There were the president of Bangladesh Midwifery Society, Asma Khatun, me, the secretary, Shongita Shahaprema and Arifine Happy Meen, the executive member. Here you can see the methodology very clearly from this slide. In the methodology there were impact, we analysed the impact. This is what is the difference in the, any difference made through the interventions. This was assessed, then the effectiveness was assessed, then the coherence, relevance and efficiency and the sustainability were assessed through this system. Data analysis were carried through onsite sense checking, daily reflection, identification of emerging themes and feedback to stakeholders laid by both partners, statistical and qualitative analysis of survey data, team meetings both online and face to face to agree on themes. And we used the methodology OECD and DAC and the methodologies criteria to do the analysis. So we just, we can't share with you all of the findings from the evaluation of this five year twinning project. But just briefly, in terms of relevance and coherence, the partnership was found to have been an important enabler for the further profession of midwifery in Bangladesh. People felt that it really fitted with what other actors were doing to strengthen midwifery in Bangladesh and that everyone was working to the same goals and that it wasn't overlapping with work that other people were doing. Someone described it as being a revolution. One of the BMS staff said this is the time to influence the midwives as they are young and it's the time to make the midwives as they are making our children. I thought that was wonderful. And the R-C-M midwives from the UK who'd been involved found it highly relevant to them as midwives. In terms of the effectiveness and efficiency of the project, so this means did it meet its objectives and did it use resources well? Generally, yes, people felt that it had been really effective, but not totally because, for example, in the second quote, someone from UNFPA said, the young midwife in Bangladesh is yet a member of BMS and BMS has struggled to both recruit and to retain its members. So, you know, not every objective was achieved, but they felt that the organizational capacity building, the leadership development was really significant. And one of the young midwife leaders said, now I can speak in front of people and my teachers and in a country like Bangladesh where young people don't always have a voice and it's difficult to speak up in the presence of your seniors. We felt that was really significant. And there was a lot of positive findings around how the partnership had managed to continue and also develop and change during the COVID-19 pandemic. So we used a tool throughout the project that comes from the International Confederation of Midwives. It's called the MACAT tool, so it's the member association capacity assessment tool that midwives associations can use to assess themselves in seven categories. So that's looking at the financial management, leadership, governance, advocacy, communication and network. So seven different categories that organizations can assess themselves against. And what you can see here is that the first time BMS assessed itself in 2017, it had a score of just under 30% and only was passing. That means a score of over 50% in one of those seven categories. So of the total 96 criteria, they were passing 28 of those. So there was a lot of room for improvement. And then year on year as that exercise was repeated, you can see that there was an incremental increase in scores to the end in 2022 where I can't quite see the number because it's 75 categories that were passed out of 96, a score of 75%, and actually a pass in every one of the seven sections. So there's still work to do, but really exciting to see that concrete evidence of development of the capacity of a midwives association. And in terms of impact and sustainability, I can't see the right hand side of the slide because there's icons on it. But the twinning project was felt to have empowered particularly the young midwife leaders, empowered the midwives and put them in power and in leadership. There was also evidence of quality improvement because we know that leadership and development and quality improvement go hand in hand. So when midwives have had that leadership development, they were able to then go back to the services where they were working and improve the quality. And where we conducted clinical site visits during the evaluation, all of the health service managers were very positive about the impact that midwives were making. It was a bit hard to extrapolate whether the impact was from the introduction of midwives in Bangladesh or whether that was due to the twinning partnership. But the areas where we visited, all of those midwives had participated in the Young Midwife Leader Project. And so it is likely that there was an impact from that leadership development. So for example, one manager said the midwives are now providing 24-7 care. They felt that maternal deaths had come down, although we didn't set out to measure that in the evaluation. But the civil surgeon, who is the equivalent of a district health officer in some of the countries, directly attributed the reduction in maternal death in his area to the midwives and the difference that they were making. And one of the midwives proudly said that before her quality improvement, the Caesarean section rate had been 30% and now it was down to 15%. Participants did question the timing of the withdrawal of the Royal College of Midwives from the partnership and felt that there was still more work to do. But we are happy to tell you that BMS is now partnering with the International Confederation of Midwives for the next four years. So that's really exciting. In conclusion, the partnership achieved its objectives, broadly achieved its objectives. And we found that twinning is a very powerful tool for midwifery leadership development, gender empowerment and quality improvement, and to give midwives a voice. BMS must develop new international partnerships, but also national partnerships, and it is doing that, but for its sustainability it will need to continue to grow new partnerships. And twinning programs do need a clear long-term focus and exit strategy that needs to be discussed and decided at the beginning of the program. And the recommendation from the evaluation is that the Royal College of Midwives should continue to engage in global partnerships and maximize the opportunities for reciprocal learning. And we haven't managed to do that as much as we wish to bring, actually, to bring that learning back to the UK and have an impact on our services here. So we need to maximize on that and integrate this with other work that we're doing, such as Race Matters Project, which is about equity for midwives and service users in the UK. And also we're doing a piece of work at the moment on the decolonization of the midwifery education curriculum, and we want to influence those programs through our work in Bangladesh. So that's all from our presentation. We're really grateful to you for listening, for being here in our session. Here are our contact details. I'll actually be leaving the RCM in July. I'm heading out to Bangladesh to work as an international midwifery advisor with UNFPA. So I will be continuing my work with the MS, but I've put my personal email on there because I won't be able to use my RCM email. And Sharmin's email, the Bangladesh Midwifery Society is there as well. Sharmin, do you want to say the last few words? Yes, Joy. I would like to, on this occasion of International Day of Midwives, I would like to say that I see from 2017 till now a big difference in the leadership of midwives in Bangladesh. And I would like to thank Royal College of Midwives for this project. And through this project, a lot of things were possible. And if it will continue, it will be more good. But thank you. Thank you so much. Thank you, Joy. Thank you, Joy. Thank you, Joy, for that wonderful presentation. The floor is off our discussions. Let me throw this question to you, Joy. Do you have any advice for others that will want to start a twin program? The project, what advice will you have for them, Joy? Thank you, Sharmin. Do you want to answer that first? What advice would you have for other people who want to start a twinning program? I believe that twinning was a wonderful concept for BMS. And it helped Bangladeshi midwives so well. We have our midwife executive team members here. They all agree with us. I definitely know this. So I think people who want to start the twinning project, it's a very good idea. And it's really very beneficial for the midwives in your country. I think it will prove very beneficial. Thank you, Sharmin. I agree. I think I would also add that it's important to be invited. If you want to start twinning, it's important that both organizations have a commitment to twinning and that the program is being started where there is a need, where there is a stated need, because it's always really important to be invited in. And I think one thing we learned from the evaluation is it's really important to have strong leadership, not just for the program, but that the leaders of both organizations are fully committed to the program and that will make it much easier to achieve the aims. And then as we said in the presentation, the importance of taking the long-term view. And I think understanding that expectations may be different according to different countries. So I think from the RCM's perspective, it was our organization felt this was a program that had a definite end after five years, but that maybe had not been communicated so clearly until the last year. And then for BMS, they were feeling more that twinning was something much more long-term. So I think we've learned from that that it's really important to have a long-term focus and to be very clear in communicating about the exit strategy. Thank you. Yes, I want to take a comment here from Ginger that says how can the RCM use this learning here in the UK? She's asking here in the UK, how can the RCM use this learning? Yes, thank you, Fishi. Yeah, it's a really good question. In the UK now, quite a few midwives associations from diaspora groups that are starting up. So we have the SAMA, which is the South Asian Midwives Association, which is from midwives in the UK who have South Asian origin. So I think one of the ways that we can maximize the learning from the program is to engage with those midwives associations because they have much closer connections with South Asian communities in the UK and midwives. And so having people like Nafisa, whose photo we saw earlier, that's really important. So what I hope we can begin to do is to make midwifery a more attractive profession in the UK for people from British Bangladeshi communities because it's not seen as an aspirational profession in the UK for women or young women to become midwives. Many Bangladeshi families will want their children to become doctors or engineers or lawyers, but they won't necessarily think about becoming a midwife. So I think we've got work to do there and then, yeah, and hopefully also look at how we can improve the quality of care. Okay, thank you. Arafin here is saying that the twin project was a wonderful program for her and Sanjita also said that the partnership allowed young midwife leadership to be established. This is talking about the importance to recognize that all those involved need considerable personal commitment from all the midwives as well as all the associations that need to be committed for the particular project to be successful.