 Hello everyone. My name is Uwe. We are five minutes behind schedule, so simple introduction is enough. We will be presenting what public-private partnership is and some call it public-private integration, some call it public-private mix, some call it public-private partnership. Just a brief introduction into what exactly it is, and then we'll be moving towards presentation from two of our continuation, one is Sri Lanka and other is Pakistan. So let's quickly jump into it, what exactly it is. As Nim suggests, it's an approach where you combine the public and private sector in order to leverage the strengths of both sectors and try to provide uniform services and good quality care to people who actually need it. Particularly important when the private sector, like in Pakistan, I can give an example, most of the services are provided by private sector, let's suppose in TB, so then if they're not being reported into the national system, then that makes public-private sector implementation very important. And the other scenario is like when there are a lot of public providers but they're not reporting their data to the national system. So this is also the case when the public-private implementation becomes very important. There are the advantages. Of course, wider coverage, you successfully reach more number of people who need services and then in this comes the strength from both. Public sector have their own strengths, private sector have their own. So we try to leverage both of them and come up with some system that provides uniform services. It is effective user resources, as I suggested, strength from both, technical capacity from the public sector and the physical infrastructure from private structure. They can combine and come up with better services. Challenges are something which we have actually learned from our implementation that we have been involved in in Pakistan. Some of the discussion we will be having from public sector, from ministry and other from the private sector, we have colleagues are sitting here. So they will get more into detail but after involvement in the project, some challenges that we have seen probably not very much technical but often the technical challenges are not hard to get a hand on. So the same is the case in public-private partnership like legal and regulatory framework, which as name suggests, there has to be some MOU between both institutes so that they know who is going to be responsible for what. There are clear roles and responsibilities, plan of action, what needs to be provided at the end of the day and who will be responsible for carrying out the services. They have a sharing agreement. Of course, for the single system, it is going to be used for both public and private. Then there has to be a clear understanding that how the data will be shared between two institutes, public and the private. So this collaboration has to be there from the day one. This understanding has to be there from the day one. This is not something they can leave it for the later stages. Okay, we will deal with it later on now. It will not work. They first have to have this understanding that how they are going to manage data sharing agreements. And this is probably, I think, we have just done as well in our case. Change request management, when you are working with a single system for both, public and private, public and private both have different data flows. Private sector wants to do some extra stuff, which public sector probably not. So in that case, to make sure that data flows of the public and private sector are not being disturbed by the changes done in the system, they have to have some kind of agreement that will make sure that the changes are being done to the system are consistent. And it's not that public sector is doing changes which makes completely, which makes private sector completely unable to work on their domain or the private sector changes which makes completely unacceptable for public sector. So this communication has to be very much coordinated. And there has to be some solid framework that manage this change request. Some SOPs has to be there who is following what, who is responsible for what. And in our case, it's better to have a core team which consists of both firm public sector and the private sector. So that's one of the key that they can do in order to achieve this change request management. Some key that we have actually figured out in our project. Of course, trust is the first thing because then both sector will be having some access to the data. So probably this trust factor should be there. Political will, as I suggested, the technical issues are not the one which are difficult. It's more of the managerial stuff, access to substantial financial support and continuous material input, which is important for sustainability. They need to have a consistent source of funding. It's not like they have for two years unless they will be taken care of later on. Training for both health providers involved, establishing joint monitoring and evaluation. Like after some time, they have to evaluate that how far this has been successful. And if there are changes needed, they need to do it. Like in our case, we have pilot. We have been consistently going through the pilot evaluation through the SRs. Abdullah, my colleague will be saying more about SRs, the subrecipients. We have their inputs and we keep on changing our system for the good. He has building capacity of the private healthcare. And this is where public sector can help because they can provide capacity building, especially when they are hosting as well. Because it's a data. Data belongs to ministries. They will be holding the system. So definitely ownership is there. But they need to have capacity as well so that they can train private sector people as well if they want to work with the system. I don't have much to say now. And I think our next presentation is from Sri Lanka. Dr. I forgot the name. Hello, can you hear me? Yes, Dr. Udayanga. So we have a colleague from Sri Lanka. Shall I speak now? We have it here now. So you just carry on. Just let me know when you want to move on and I'll be moving on with it. Okay, so let me start. So good evening. I'm Dr. Udayanga, attached to the Family Health Bureau, Ministry of Health Sri Lanka. And today I'll be presenting to you about capturing maternal and newborn health data for private health sector institutions in Sri Lanka. Next slide. Oh, and the contents of this presentation will be composed of introduction, objective, case study, lessons learned, output and outcome. Next slide. Despite the childbirths occurring in both the public and private sectors, only data relevant to live births in public health sector is available. Due to the absence of a proper mechanism to capture births that are occurring in private health hospitals, 99% of the births occurring in Sri Lanka are institutional deliveries according to the annual report of Family Health Bureau, Ministry of Health and annual health bulletin of the Medical Statistics Unit of Ministry of Health. So according to the Registrar General's Department, the total number of live births for 2022 was 225, 321, which comprises of deliveries occurring in the private sector and the government sectors. Next slide. So this is the provinces of Sri Lanka. So Sri Lanka has nine provinces and from the survey conducted in 2020 by the Family Health Bureau, the data pertaining to births were obtained from the relevant provinces of the private health, private sector hospitals. The data collected reveal the private health sector deliveries from the nine provinces were as follows, but there was no proper mechanism in place to capture the number of live births occurring in the private sector. Next slide. It was identified that the non-availability of a proper system to capture the maternal childbirth data from the private sector was a drawback in the national program. So therefore in 2019, the electronic reproductive health management information system too for health institutions was launched using event capture system for health care institutions, which initiated a pilot in the major private sector hospitals of Western province in Sri Lanka. So as the initial project was a success, it was decided to expand the system island wide by 2023. Next slide. So the objective of the study was to capture all deliveries happening in private health institutions in Sri Lanka and to collect information on essential maternal newborn health indicators for the country. Next slide. So a minimal data set was identified following several rounds of focused group discussions and in-depth interviews amongst stakeholders, DHIs to base event capture system was developed based on the minimal data set, and for maternal death reporting and neutral death reporting, we used ICDCM and ICDPM classification codes were used in the system. Trainings were conducted for identified users in each private hospital on data entry and visualization, and a partnership was developed between the Ministry of Health Sri Lanka and private hospitals of Sri Lanka, which facilitated the entire process, which was mutually beneficial. Next slide please. In terms of data flow, we can see here that private sector and public sector, we obtained delivery, pertaining to deliveries that occur in the private hospitals, neutral data and maternal data from private sector. Then after we obtained the data, we give feedback to the private sector. Next slide please. And initially, the first lesson we learned was planning and preparation. So adequate planning and preparation are crucial before deploying the and here, health management information system. So it is essential to assess the needs of the healthcare facility, involve relevant stakeholders and develop a detailed implementation plan. So secondly, user involvement and training. So engaging end users from the beginning and providing a comprehensive training and planning are essential. And users should be involved in system design, testing, decision making process to ensure their needs are met. So many terms of data quality and standardization. So establishing a data quality standards and ensuring data standardization is essential for effective data management. Clear guidance should be provided to healthcare workers regarding data entry, coding and validation. So when it comes to infrastructure and technical support, sufficient technical infrastructure, including hardware, software and networking capabilities is necessary for the successful implementation of a health management information system. So adequate technical support should be available to address any technical issues that may arise. So change management and leadership, deploying a health management information system often requires a significant organizational and workflow changes. Effective change management strategies, including clear communication, training, leadership support are crucial to overcome resistance and ensures more adoption. So the sustainability and scalability in terms of sustainability and scalability consideration should be given to the long-term sustainability and scalability of the health management information system. This includes financial planning, maintenance, regular systems updates, and ability to accommodate future growth and evolving needs. So continuous monitoring and evaluation, regular monitoring and evaluation of the health management information system implementation are vital to identify areas of improvement and measure the system's effectiveness and necessary adjustments to optimize its performance. So last but not least data security and privacy. So ensuring data security and privacy are most important in the health management information system. Robust security measures including use access controls, encryption, adherence to privacy regulations must be in place to protect sensitive patient information. Next slide please. So and the outputs and outcome we found was the electronic system reports all deliveries taking place in private healthcare institutions of the Ministry of Health and it provides a comprehensive set of information for the country in order to manage a national maternal newborn health program in Sri Lanka by adhering to the national guidelines. Private sector hospitals are being benefited by training they receive from the government sectors and electronic reproductive health management information system too will play a role in obtaining a clear representation of how much the private sector represents compared to public sector in Sri Lanka. And we created dashboards based on their private sector requests are made available for them to visualize and monitor their maternal newborn health services through the system. And this next slide please. These are some dashboards we created from the private sector for the private sector and our institution. Could you click the next slide? Which is another one and there's another slide. So okay so these are some dashboards we created obtaining the data from the private sector and last but not least why we need DHIS2 as a platform to collect this data. So why DHIS2? So DHIS2 is as we all know is a free open source software that is suited for the current economy of Sri Lanka. And it's a user friendly easily customizable system to meet the stakeholders needs. And as you all know that DHIS2 is already implemented in Sri Lanka and the people in the ministry are really well organized and used to using the system. And other thing is that it's a big data warehouse which we use for research and compiling annual reports and innovation. Thank you. Thank you very much. Now we I request the public sector Ministry of Health. Sir Mustafa Jamal Ghazi are you still with us or are you left? Welcome to any questions? Thank you very much. I'm with you. Good evening everyone. Sir thank you. Let me just start the presentation. No not this one. Yes. Yeah we can ask the question at the end. Please thank you. Sir floor is yours. Thank you. Thank you everyone and good evening. This is Mustafa Jamal Ghazi. I'm a joint secretary in the ministry of health and national coordinator for common management unit funded by the Global Fund. Hello to everyone and I hope you must be enjoying the Oslo weather but here in Pakistan it's very hot. So let me introduce what I wanted to convey to all of the technical team who are into the very noble cause of this eradication and stop TV and this is what DHIS2 people are doing a wonderful job and as far as the Oslo University is concerned they are keep on engaging us and keep on asking the demands and the necessary changes with regard to the proper you know a dashboard to be generated. Next this is the current situation. Well there was a little issue with regard to the co-sharing of the government of Pakistan with regard to these three diseases but now the government of Pakistan has contributed around 2 billion rupees in order to you know more injectize the entire interventions. Next these are the present challenges. The challenges the scale of HIV AIDS TB prevention program is too low to achieve an impact and low number of people living with HIV TB are on treatment high level of stigma and discrimination weak monitoring and evaluation system lack of integrated approach across communicable diseases specifically TB and HIV. HIV is not in development or even on political agenda but now after you know global fund has invoked additional safeguard policy it has become lot of challenges we are facing and this is why we are more emphasizing that this digitalization has become more important more rational so let's show you the challenges and how to meet those challenges please go ahead next next next this is you see in every organization you need to have you know proper data to be recorded presently in Pakistan the data has become a very very difficult task and how to you know make our assessment and analysis according to the program interventions we have we have you know facing lot of challenge as far as the data actualization and authentication is in case of Pakistan next this is the whole despite global fund Pakistan co-financing this science of HTM data synergizes and coordination remain highly underutilized but this is the problem and this is what the demand of the state of Pakistan right now with the Oslo the experts who are preparing this dashboard that how it how it is presently working the patient information not digitized and encrypted lose records on papers and excel excel files are confidentially confidentially very risky and the PR and SR's data is not talking with each other this is the main cause of entire you know problem that whenever we prepare a program review or whenever we start you know judging ourselves that what to monitor where to monitor and how to monitor and how to engage ourselves to know the value for money now this part is very much missing that everyone is working under their silos and the data is not talking with each other provincial data that is the public sector and the private data that is the partners and supporters with us the both data's are not not talking with each other there is some sort of issue of authentication again there is a real-time diagnosis tracking and automated nearby referrals are impossible geo fencing of testing treatment and supply dynamics never recognized despite mapping treatment records are not digitized therefore follow-up cannot be automated automated follow-up SMS alerts are not systematized and artificial intelligence based justice that that's you know we have a practice in covert and that's a very successful story in Pakistan with regard to the covert intervention and the data was you know working in the covert operation was wonderful so here we are going to have a real-time data system to be you know talking with each other with each and every public and private interventions or interveners to work on it and again we are actually we have this problem that silos of good PR and SR work but patient data is not linked with the national database therefore state limited actions we can't judge we can't evaluate we can't monitor whatever the private interventionists are doing what are their targets and what they have achieved so far and how they have achieved so far or whether they have achieved and it has been recorded or it has an impact on the field it is it is really a big question for the state of Pakistan to tell each and everything to everyone stock and warehouse digitization only exists at the national level yes we have a stock in digitization at the federal government level but it has to be supposed to be you know digitized at the at the provincial level at the regional level uh pr and sr centric digital system rather client patient not a common platform again this is a big challenge difficult patients access to htm htm services in remote areas invisible diagnostic financial support mis data not leading to geo specific advocacy communication and uh and social mobilization therefore patients and communities are dissed at disadvantage this is the situation when you are completely unaware of what is happening around you how and where to find out those hiv or tp positive patients and what should be the mapping system so what we have done so far in order to facilitate the dh is to effectively worked on it that is we have mapped all the you know gps along with the coordinators of their locations and their areas and their districts and their places where they are working for still uh the public sectors uh interventionist or public first factors facilities are basically you know known to everyone but the private sectors facilities are you know seldomly known to anyone so now with this sort of you know uh this uh entire uh the problems and challenges faced by the government here in Pakistan we have suggested a solution uh next this is multi stakeholder accountability digital framework and cmu is committed to state multi and bilateral synergies without this it is impossible to reach the numbers to be to evaluate the targets and to see that how they have been attended how they have been taken care what are the level of they're taken care and and and how the communities are talking with each other along with the the specialists the gps and the program program and the officials are talking with each other presently this is a challenge this is a problem that nobody is here to support them in as far as the data is concerned with the inception of dhi s2 i believe i have a discussion with the uh our team here of dhi s2 in Pakistan and i have sensitized the issue of how and where to you know uh sort of engage our community in order to reach the number reach out to the maximum number of population if they are hiv or tb positive because hiv and tb are segregatedly being treated and they need to be you know integrated so this is how we believe that the ideal system of engagement with the dhi s2 should be like this that the patient data emr testing and treatment and supplies it's a facility where it is available number one number two a system of national you know database that is the nadra here in Pakistan which has you know complete database of national identification and identity cards available in the country and this is the basically the key key to this success that even if we we we've lost any patient at any point of time if we have to digitize through biometrics definitely that patient is going to be followed time and again through their notifications presently the nadra system is not in vogue and we need to create a artificial intelligence system to follow that specific person who is declared to be hiv positive we don't find any big challenge to reach out to the maximum number of population even up to the remotest area but how to reach where to reach this is the problem and how to suggest them where to go and what facilities it is nearby at at their you know location this is the challenge so the advisory role the dhi s2 is going to play in Pakistan and this is what i am you know emphasizing for this type of software or this type of interventions or digitalization of the activity should be placed on on board so that we can reach out to the maximum number of population again you can see the geo fencing and artificial intelligence to guide alert clients and providers to nearest now this is what i'm talking about if you can't have a system in the area where the awareness is very weak where the communication with the community is very weak where the where the excess of the health workers is very very very weak so in all these you know factors we need to engage as maximum as possible through these data now how to generate the data and how to achieve the data so this is this is the main issue and that is the that can only be you know a proper challenge for us so what i basically feel the diagnostic financing mrs integration system that all of them should talk with each other even the public and private as zubair at the very beginning of his own slide that he was emphasizing the public and private synergies to work it with them to work with with bilaterally working with each other and to talk with each other in this way we can effectively very very effectively you know engage our all activities according to the e diagnostic system and this could be the best possible you know system which can be found out for diagnosis services supplies network optimization is the basically need i thank you here my two slides speaks volume of you know problems and challenges and this is what and if anybody have some question please you are welcome thank you sir thank you very much we are taking question at the end and now i would like to call upon our merciful guys if you can come and i will start from where mr kazi has left the discussion about the challenges pakistan is facing especially the private sector and my topic of discussion is the use of digital system in the private sector next slide so as mr kazi has mentioned that pakistan has been struggling with the setting up the digital system for tv control program in in the country since the very beginning when the program restarted back in 2001 but in 2018 with the support of the university of oslo and his pakistan we set up a dhs2 aggregate system in the country and and with this system we actually found the solution of our problem as you know in pakistan pakistan is one of the high high burden countries and we have the incidence around 600 000 people every year and most of these people access the private sector as a first point of contact a study shows that 86 percent of the people goes to the private sector as a first point of contact and parks in pakistan the private sector is highly unregulated so engaging the private sector which is highly unregulated is very challenging and we started this with the support of his pakistan and university of oslo and bill and melinda gate foundation next slide so how we started we set up an aggregate instance for the tv control program in pakistan we started recording the case notification reports as well as treatment outcome reports and these reports have a dashboard which shows the trends and analysis of the case notification and the treatment outcome of the country next slide but these this was not enough actually because as mr kazi has mentioned that there are a lot of patients who are missed in the private sector who are also missing the public sector but some people they access the private sector and they also access the public sector so lack of intelligent data and surveillance was missing reliance on paper-based system which has its own limitation and there was no insight on what is happening in the field monitoring was not there we didn't knew that these patients what kind of drug resistance profile they have we didn't knew about their trends what what are the trends what are the seasonality trends and etc and we were not actually allocating resources based on the data which we're receiving next slide so we set up the tracker in the private sector and we used the support of call center to set up the tracker and get the notification from the field so the the the system which we are using in the private sector has step number one when the patient visits the gp in the field the gp notifies the patient to a call center and the call center gets the information some basic information about the patient and then the district field supervisors who are working with us in the private sector they visit the patient get the more detailed information and enter the system in the system entered information in the system so in this way the data is available in the cloud in the dhs2 software and this data can be accessed by the government authorities the district health authorities and the private sector as well next slide but the private sector is not only limited to the case notification we are also doing the active case finding in the country and my active case finding is the most expensive intervention which is done by the private sector so we digitalize our active case finding intervention as well we develop an app which can help support collecting the data in the field in the remote setting where there is no internet facility available but the system is there to collect the information of the individuals who are screened and then this information is used to analyze the trends in the communities in the fields so that the future active case finding activities can be planned and using the dashboards which are generated by dhs2 it really helps us to target the areas where the active case finding activities can be directed next slide we also we are also engaging the pharmacies and engaging a pharmacies who are working for business in the communities is also another challenge so what we do is actually we trained the pharmacy staff in the field and provided them with an application and that applications require them to only upload the prescription of tb patients who come come to who visit them to collect the information from them so in this way the these prescriptions are received by the national tb control program and their private partners and then they mobilize their field staff to contact them and offer them the free of cost services and the whole program package to them so this is helping us increasing our network so this information which was basically collected by the private sector the private pharmacies is now also available to the public sector as well for decision making next slide in addition to this we were also connecting the communities with the diagnostic facilities and how we were doing it actually we set up an uber kind of uber based kind of application in which the samples are transported using an application there are volunteer riders in the communities who use this application they get the jobs for example if there is a need to sample to transport the sample from one clinic to the diagnostic facility they post a job on an application the volunteer rider gets the job and then upload this and and goes to the center collect the specimen and transport it to the diagnostic center and this way we are expanding our diagnostic network to those people who do not have access to laboratories next slide now having all this information in different systems which were not speaking to each other before we are using the common system which is dhi s2 and all this information is coming in to the dhi s2 server so in this way all this information is analyzed in the real-time fashion and program is notified or informed about the timely decision-making next slide now as i mentioned in the previous slides we are not only collecting this information and storing this information in our databases we want to use this information because Pakistan is one of the high burden countries and missing a lot of people cases in the communities so we want to use this information so that we can reach to these people and and use this information to get provide them access to the quality care and diagnosis so this information which is coming in from the dhi s2 tracker capture and information coming in from the other sources other software which the private sector is using we are feeding this information to a model which is artificial intelligence based model and using a Bayesian model to analyze this information and generate the trends next slide so the model which we have set up in Pakistan is a Bayesian model artificial intelligence based model which predicts the hotspots in the communities so in the smaller communities it can tell you where there is high prevalence of TB patients and then the program can direct their resources to these areas where they are much needed we we are directing our active case finding into interventions activities to these areas we are engaging more pharmacies in these areas and we are engaging more gps in these areas to expand our coverage and get more people into our network so that's how the dhi s2 is helping us in the private sector to not only collect information from the field but also efficiently use this information for effective program implementation with this I thank you very much yes no we can have a round of question if someone wants to ask anything nothing good everything understood we tried that no one none of you sleeps but yes please so sorry I mean the difference in the background of the job is very rare even though in the digital looks like they are really quite effective I just want to understand how do you manage to really engage the private sector concretely apart from the hygiene tools that you have set up how do you manage to really give them what are their benefits in that so that they're really going to be able to start by equaling this information for the same third one in terms of policies that will take effect on I mean I just want to get more insight from your side because it's not about the tools the tools are there to support processes so what really was the change maker or really the infrastructure to change it and make it and make them involved in the process yes good question yes as I said technical stuff is already there solutions are there but it is hard when it comes to managerial problems but I think it started back in 2018 where they have this national digital health strategy 2018 to 2024 where they decided to continue with the DHS2 as a system for Dell data collection and the same time they agreed to bring private sector on board because as you mentioned most of the treatment 60 to 65 percent of the population are going towards our private sector which means that we do not have more than half of the data but no we have less more than less more than less than 50 percent of the data which makes your decision nearly incorrect so that was the like motive behind combining the private sector so they can have governance and coverage to as many as much data as possible so that decision making can be moved forward and this was actually driven by our ministry as well and it was like back in 2018 where they have agreed this MOUs and everything yes please for the next question can you wait for the mic okay so adding to what Zubair has already mentioned so in Pakistan I will share the experience of Pakistan in Pakistan there is a mandatory TB notification act which has been passed by three out of four provinces so the GPs or the private practitioners who are working in the private sector by law they are required to notify the case to the district health authorities so this is a very strong document we have in hand to convince them to get on board with the program plus I mean by getting them we tell them about the advantages to get on board with the program and the advantages are that they get the free diagnostic services so for example if a TB patient comes to them and if the patient gets a free diagnosis then that's the that's the positive advocacy done for that GP or the private practitioner who has been practicing in the field so they spread a good word in the community that this doctor is doing a test for TB which is free of cost then the drugs are provided free of cost and then the follow-ups are done free of cost because they are getting incentive from us as a program for the services which they are providing to the patients and secondly I mean in Pakistan there is a lot of control on the anti TB drugs sale in the market now because the global fund has been providing a lot of drugs to the country and the communities are using these drugs I mean the GPs that because we have engaged more than 14,000 GPs in the country so those main GPs who are prescribing the anti TB drugs are now with the program so the sale of anti TB drugs is very less so if a GP or a private hospital wants to treat a TB patient it's better for them to engage with the program and treat these patients rather than treating them on their own so these are different kind of strategies which we are using in Pakistan and it is successful so far the only challenge which we are facing is the comprehensive recording and reporting tools which are used by the TB control program in Pakistan but we have a very strong field force which are basically supporting these private practitioners to fill this recording reporting tool and as Zubair has mentioned that since 2018 this digital system has helped us a lot in getting the information from the field by digitally entering because previously it was they were using the paper-based system and this call center is now helping them to get the notification on calls only I hope I have answered your question yes so thank you so much for the presentation my name is Farzad Farzad Farzad I am scientist in NCD department W. Chauhet quarter Geneva I have two questions one is for colleagues in the Sri Lanka and Pakistan both have you done any data quality review on the what you are receiving from private sector and the second part of the question regarding the colleagues in Pakistan is how what what type of data you are collecting from the pharmacies actually the question is what is that is about the name of medicines those that they are using or is just general information that they are receiving the medications thank you so I suppose your first question is with the doctor is Dr. Dhan here yes regarding the question pertaining to data quality yes actually what you're doing is like we are obtaining data from the private sector at the same time we want to say input the data we are assessing the data inputs so so in the system what we have done is we have inputted some validation rules so if they try to input data which is say say the mother's period of amenorrhea so if the period of amenorrhea is having more than two digits like say 100 so some data entry officers may not be aware of what they are entering so in the system it will just recognize as like three digits and it will reduce to two digits but it won't exceed a certain amount which is the maximum limit for a POA so that so with the validation rules we have control that so when it comes to timeliness accuracy so the timeliness wise we are assessing the reporting rate so they are told to enter the data at the end of each month at 28th of each month so they are entering the data on time so when it comes to accuracy the data accuracy is like say we are capturing the number of newborn children and the weight of the child and the sex so when you get the feedback from their side as I mentioned in the slide it tallies with what we have so in the end it comes as all comes as aggregate data and then we compile it and the end result will be the data which we use which is collected and we use those data for action for the national program for mental health. I hope that answered your question. I wanted to be more focused on the collected data but the validity of the recorded data what you have done when you receive the amounts of the information from the private sector how do you know that this data are reliable and valid when you have when then you can you can do the planning for this part. Yes yes so when it comes to collecting the data from the private sector what we do is we perform training programs so if there's any questions pertaining to entering the data we cross check with them personally like we can call them or we have a WhatsApp group and Viber if there are any questions they have we discuss in collaboration with the private sector and we have like a manual sheet which we use to collect data so we use that so whatever the information they are sending us we get a feedback from them using the data. Should we move on to your next question that was related to something sorry can you repeat your second question? The second question was about the information that you are collecting from pharmacy what are the what are the type of the information that you are collecting? So just to briefly answer related to your first question we have the same kind of data validation mechanism in Pakistan for both public and private sectors so there are quarterly review meetings in which the data is been presented to the district health authorities where it is reviewed these activities are funded by the global fund so the private sector brings in the patient record files with them and it has been validated by the district health authority so regarding your second question for pharmacy related project the pharmacy is basically just notify the prescriptions after taking the consent from the patient of course upload the prescription in an application and that prescription contains the information about the patient name their telephone number the information related to the GP who has been treating the patient and the CNIC number is CNIC number is the unique identifier number given to them by the government of Pakistan it's the national identity card number so this information is provided to the program the district then our field staff is mobilized to contact them offer them the free services and get the detail information about their details of diagnosis for example on what test they were diagnosed what kind of treatment they are getting and etc so this information is then collected by our field staff but the pharmacies only upload the prescription they take the photo from their phone and upload it in the application i've been repeatedly asked for this group photo so yeah is there any question if not okay yeah please on the offline session we have it so please move forward towards the i don't know where exactly that is outside yeah