 Thank you very much. And also I want to thank our keynote speaker and the previous presenters because you managed to pave the way very nicely for my talk. So this presentation is talking about data and paperwork is already now we have set the stage already, so I would just focus on Central African Republic as a context. This here is a summary how the surveillance data reports come in every week across the whole Central African Republic every health care center has to send a weekly report to the district and This is the focal point of one of the districts in in car. I would use the acronym car Central African Republic And then here this is written in French that he will write either if they arrived late or on time Or if it's blank so you can see kind of a Swiss cheese dataset model here as well so the project the MSF mission is in a district called memory Caddy and they have The whole car has surveillance system that is known by SMI are Integrated surveillance system for diseases and the acronym S. I. M. R. Is in French the technology here is Is a software called Argus developed by W. H. O. And Leon that is very simple that on the Interface of the health care center They have an Android phone that has a Graphical interface where the health care staff will just punch in the data for 20 diseases and It will be sent in form of an SMS So this is a hybrid model between having a graphical interface for an application phone application And it will be sent a form of an SMS So 20 SMS is will be sent per every report because there are 20 diseases and here It's in the district on a district level Where you have the laptop and it acts as a form of a server. It receives all the SMS's and From here, you can have all the outputs either if you want to have it as a data set to have your own data analysis Or also there is an integrated dashboard. So I'm going to show you later a snapshot of this form and MSF here has done a form of a catalyst for this surveillance system So the system has been integrated in places where MSF does not have operations and has operations It has a mission Presence This is a snapshot from The app where you have the report and you have an archive and also the health care staff They can send an alert and They have to fill in all the 20 diseases here And at the end they need to click to send it and then it will be sent in form of SMS's individual SMS's Talking about Technology again, I will refer back to our keynote speaker that you have to work with the people and you have to build a Relationship and you have the technology has to come at the very end. So we started with phase one by having Reinforcement for surveillance concepts working with them first before we introduce the technology. So we took this Project through three phases phase one we had a four days workshop with them talking about surveillance about different concepts and We tested their knowledge Before and after the surveillance and it was an increase and this is the data here showing An increase in the reporting system as well So we show we found also significant increase in the reporting system despite the challenges of the The structure of car where you have to send your reports by a motor to motorbike Motor taxi and It's the clinic that they pay for this transport. There is no budget from the government So it's basically they allocate the budget themselves the staff and Despite this we found really an increase in the reporting system So this was just after this training on the integrated surveillance Information Then we started doing testing for the technology in Among six clinics and In that in a town called berberati, which is the capital of this district memory cadet and It was a fantastic experience to see How the staff started to react around this technology and to start to really think sense of community and Not to only to focus on the trees which are their patients that you see them every day But also to think about the forest about the community around them And of course talking about mobile phones and technology we are talking about electricity So we have also installed Solar panels for the clinics to that the staff they can recharge their mobile phones and we were testing There was a question mark around the connectivity to the cell network and whether this will facilitate the SMS transmission or not So we decided to just have a couple of weeks of Testing so that was phase two now here, this is the map of the whole district The size of this district is almost equivalent to the size of Belgium, so it's a large. It's a large district and we have 21 healthcare centers The car has three major cell networks. We so we have used these cell networks on the Southwestern part of car here. There is no cell network from these Cell coverage, so we have used cell coverage from Cameroon So the SMSes were coming all the way they would be sent from here to Cameroon back to here the server is in Berberati in this capital here and in this Clinic in this one called Amada Gaza and in this one called Bambia and here these two Jomo and Gezi The staff they need to travel around 20 kilometers 20 to 35 kilometers by motorbike to find also cell coverage So then they can send the report and come back to the clinic and the rest Connectivity is is relatively good And all the SMSes will be sent on a weekly basis and the server is here Plus these clinic these health care centers are also inside Berberati on this blue dot This is the data from the pilot. So the pilot was done here and the project called PAP project alert precoce This is the French acronym We looked at the completeness of the reports WHO sets a cutoff point of 80 percent that of completeness of free ports and This is here the beginning of 2016. These are the weeks. This is the percentage of completeness This is the red zone that everything below 80 is a red zone and it has to be here above 80 as a green zone. So historically car has never reached even above 50. So Here in the end of 2015 we had the phase one intervention to train the staff on the Concepts of surveillance and since then we start to see an increase and then here we have a reduction This is the paper-based surveillance the reason of this reduction. There was a vaccination campaign so here again, we are talking about individuals that are in the limited resource settings where If there is a vaccination campaign, they are the one they will leave their clinics and health care centers to go and help in this vaccination campaign So what happened here? They were away from their clinics So there was no one to fill in the reports to send it by papers to the to the district office But when they come home on the weekends or at night, they can actually fill in on their mobile phones and send it in as an SMS So there was a lot so this is the qualitative Aspect of the study that everyone was questioning. Oh, is it because of the mobile phones? This is increasing the sorry Decreasing the the paper-based surveillance. The answer is no because the staff was away one of the health care centers Also, there was no vaccination in the area, but we haven't received an SMS or a paper Form from them and we did some investigation. What's happening? so the the health care Leader he was away for three days because his son was having a surgery and Then everyone everything kind of stopped and MSF doesn't have a presence there as well So all these little details we can see that how much the role of individuals are really important here It's about really people much more than about technology and of course we have the This is the distribution of diseases that showed up during the piloting and I will not go much into the details here But there are many sites or health care centers that have been silent all these years And now they start to show up and to be to send in the data about the diseases that are available there So we have identified areas that The Minister of Health didn't know about what's happening there MSF didn't know and the staff also They became more and more active in this because they could see that they can help on a larger scale And not only by treating their patients on a day-to-day basis So as a conclusion We have really found a significant improvement in the reporting system We have extended the pilot until the end of the year Because we want to really see on long-term and not only short-term effect how it's going to be The software has been updated Because we have also as also the nature of softwares we always see bugs in softwares So we have updated the software and then in June There will be a new version installed and We have developed GIS component as well to the software So I will show you now a peak on a snapshot of the GIS component That will be installed in a couple of weeks in the field So here you see the map of the district and then here you see the epidemiological week Here you can see the summary of cases By we on a weekly basis on this axis and then here the number of mortality the deaths as well and This red dot it's a dot that you can slide it so over the weeks So you can see over weeks how the changes visual changes happening in these areas so the this circle light blue it represents number of cases and dark blue it represents number of mortality And Finally I want to acknowledge everyone has been involved on this project because Technology alone without really the will of people will die. It has no value So that's why I want to end with this citation that it's really it's about us as individuals to make a difference. Thank you