 sharing the experience of Mozambique in the development of DHS2. And we're able also to hear that Mozambique started in 2000 with the process of implementation of DHS 1.4 first and then went through several stages until it reached or they started to adopt the version to DHS2 official, which is used at the moment with different programs. So I will invite Dr. Brana. She's heading the HMIS. I think two years now, this is the second year, but she has been before going to the HMIS, she has been leading the logistics. And I think thanks to our, we are here for example, to have some logistic data which is collected using other digital bubble goods to which they are integrated in DHS2. And I will invite Dr. Brana to sit here. And also we'll be having Dr. Amelia Dupuves. She's part of the EPI program, I think is a director or deputy director of the EPI program in Mozambique. At the moment, we are supposed to have also the director here, but they started with the mass campaign, the poly campaign that started this week. That way, we also selected this topic to be shared. How are they managing the campaign, the poly campaign using DHS2? And also there are some other initiatives that came before Poly, so I will invite Amelia to also sit here. And with the different, let's say, needs of integrating data, the malaria program also decided, because they were having also challenged with regard to data, we use everything and then the component of data that was in DHS2, initial was not enough. It was only collecting the number of people that were tested, treated, and then they decided also to integrate all the malaria component, including financial data, and then we created what they call malaria data repository. So, Mariana, the silver is here to share with us the experience related to this initiative of developing malaria data repository. Because we always have, there will be maybe a need to have some translations here during the process. So, I will invite Amelia Morse, who is leading the research unit at South Digitus, also to come and sit in front. Yes. So, to start, I think Dr. Abrano will be the one starting the presentation, and then we'll conduct the whole process of implementing it. I don't know if you are going to move the slides by yourself. Okay. Thank you. And then just pass. Okay. Good morning. I'll be starting the presentation of the health information systems in Mozambique. So, Mozambique, wait, not Mozambique. What's that? I should use the next one. No, this was not for the nurse. Okay. So, Mozambique Minister of Health adopted DHIs2 as the main platform and called CISMA. CISMA means Health Information System for Monitoring and Evaluation. So, we will see how it was before the DHIs2 implementation and where we are coming from. So, during the period between 2000 and 2004, Mozambique had many attempts and many platforms, electronic platforms to improve the data management. Some of these were the CISPRO, CIM, DHIs2, version 1.2, 2.1.4, and model BASIC. But all of these electronic systems, they were not matched the expectations and the needs of the users. So, we just took the lessons from that whole process and moved to the next phase. So, let's see how it was the initial implementation. So, we had the metadata and all the data in model BASIC and this was migrated to DHIs2 database. And the implementation approach switched from server spread across the districts and provinces to a centralized approach, a central server. And some programs and areas that were not included in the beginning of module BASIC, they had the opportunity now to be included in the new version of the DHIs2 process. And the facilities were reporting, aggregated the facility level, were reporting to the district aggregate information that was able to be visible. So, we have this image just to illustrate was what I was trying to explain. So, at my left, it was model BASIC before. So, you can see that it was a very complex collection process from manual to district and then the district to province up to the central. But it took a lot of time to have this collection and to be able to see the information from the low levels. So, now, we have at my right, the current scenario, you can have the collection from, you have the collection from the health facilities, but that can be electronic or manual where there are no conditions. But once it's collected on DHIs2, you can see immediately at the central level. So, if you have connectivity, it's directly centralized in the central server. So, this is how we are currently now and we improved a lot to the visibility of our data and the health programs also increased a lot the performance of the indicators and promote use of data, of course. So, the initial DHIs2 implementation brought a lot of adventures, like I was saying. So, reduce the time taken to produce the reports. It was possible to access the data from all the facilities and for several periods, increase the quality of this data in terms of completeness, timeless. It was possible finally to have dashboards to do these monitoring evaluations performances and also simplify the process to elaborate reports for the whole country. So, to have a big picture of what was happened in all the health programs. So, how was the process from moving from aggregate to individual? So, the need of individual data came. We start to receive a lot of pressure from the health programs. They were satisfied with the aggregated data, but there was a challenge to move to the patient, individual level data. So, the inpatient and TB modules, they were the first ones to be introduced in the tracker. Then, we had the maternal neonatal mortality, auditing, and the maternity and birth modules. The success of these modules increased the demand and now we are in the process of developing new modules for routine immunization, for cancer registration and HIV. Recently, after an analysis evaluation was done in the maturity of the DHIs2 system in Mozambique. So, we still have a lot of challenges as a country, but this introduction of the individual models, it had a great impact because it was possible for the first time to have a report on the mortality and the causes of the mortality in our hospitals. So, currently, over 90% of the deaths in the hospitals are registered individual and coded with IC10, and this is possible to access these reports and this information is also available in the international platforms like WHO, UNICEF, and so on. So, it is possible now to automatically provide this data recorded and we also, through the interoperability layer, we share this information with the Minister of Justice, which will increase the registration of the civil registration process that is under justice responsibility. So, one of the modules that had a lot of impact was the electronic integrated disease for surveillance. So, this is an image of the process of the campaigns that use a lot, as my colleague will soon speak about. And this module, the surveillance module, allows to follow all the outbreaks that have come to fragile many health systems, not only Mozambique. So, we can use as timely disease detection, preparedness, and appropriate response. So, Mozambique, because it was committed to have these two developed this module with the program in the Ministry of Health, and now it's possible to have a more efficient, let's say, crisis response when you have a cyclone or overflowed or something like that. This is the tool, you have a cholera crisis, so you had COVID. So, this was the tool that was enabled Mozambique to follow what was happened in the field. So, the country started with this digitalization surveillance after the migration of the module BASIC, but was COVID pandemic that make it more visible? And we could see the potential of the system as a tool. Currently, this module evolved, and we are now looking at the management of many diseases, many program surveillance data, and we can, this system can provide real-time basis data. So, this is an example of what are the modules in the surveillance module. So, we have the notification, we have some the vaccines, and yeah, I'm going to stop here because this is the area that my colleague from the Vaccine Immunization Program is going to take over and dive you in the detail. Amelia, please come. Good morning. Thank you. My name is Amelia. I'm working at the expanded program of immunization in Mozambique. So, my presentation will be in Portuguese not only because I want to say something about Mozambique, but I want also you to learn Portuguese. So, yesterday we had a presentation with a track on Lasophony. So, I said that Mozambique is a beautiful country with beautiful people. We have a nice food and we invite you to come to visit Mozambique. I appreciate your good practice as well. Thank you. Mozambique, we adopted the DGS2 to support the country in the management of age of the campaigns. Mozambique is very beautiful, but unfortunately, it has gone through situations of disorders, of diseases that are preventable by vaccination. Mozambique, we adopted the DGS in Mozambique in order to manage the outbreak and all the health information system, but unfortunately, the country has been kind of struggling with with outbreak and disease and all these things. During COVID, it was really very difficult because we've been using paper systems and we were kind of gathering lots of data and there was a need to really use electronic systems. We already have a SISMA which stands for Health Information System for Monitoring and Development, but then during the COVID subsystem was developed in order to deal with the outbreaks. We used to collect data from all the immunization programs and the data was collected to DHS subsystem that was developed for that specific needs. This platform allowed us to have data in a timely manner. This tool allowed us to get data on time with a minimum quality that was needed during that kind of difficult time. We also used this tool to manage the health information system in DDS2. We also used this platform for the production of vaccination certificates which was a mandatory requisition in the case of travel or for approval that the person actually took the COVID vaccine. We also used this tool not only to collect data but also to issue the certificates because during this time the certificate was needed for traveling for example. The subsystem also helped us to monitor how many certificates were issued per day, per week, per month, where did these certificates were issued in the country and that was really useful tool during that time. During COVID we also had a notification with polio cases. When you have polio cases you have to really deal with that or you have to stop and deal with polio. So then we started to be engaged in the immunization campaign. The plan was to have three phases of the campaign but during the period we had many many cases so we had epidemiological kind of surveillance in order to deal with the many cases that were there during that time. As I said previously during COVID we had many cases with COVID but also we had many cases with polio and we were using a lot of papers for polio and then it was very difficult really to deal with this situation with many kind of lots of data but using paper systems. During this time with the partnership with South Egypt who is our main partner in developing these information systems for health then there was a space to develop these subsystems for polio and immunization. That was so very easy I mean the application that the subsystem that was developed was so easy and very clear for the even for the lower level of community that they can collect data and as soon as they were entering that the community level that data was accessed to the higher level of the ministry. This is an example of dashboard that was produced This is an example of dashboard that was produced the data was introduced at the lower level of the community at the provincial and the high level of the ministry that could access some real time the information that we needed. The DHS it's a very useful and very good system but because the country is really wide spread so in some cases we in some community we don't access the all data and we need really to improve because not always we have access to some of the data in very very kind of distant places. We want to implement the electronic, infant, side of the health unit and the mobile brigade thinking of us that in this way we are going to improve the quality of data that is reported and we are going to improve the access and visibility of this information that we want. So, this was long but it was very helpful. So, this was very helpful. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. So, this was long. It was very long, I think you understand. So, what she's saying is that we really need to move in order to implement fully the DHS, the platform to collect data for complete immunization, also to involve all different kind of subsystems that exist in the immunization to DHS because this is we have really access to the most important data and then we can have kind of a decision on that program. So, I want to thank you very much for this opportunity that I was given and also I reinforced that you have truly learned in Portuguese. Thank you, Amelia, for the Portuguese lesson. So, as Amelia said, the current challenge for many of the health programs is to be able to cover the community levels, the areas where we don't have health facilities near. So, the next module I'm going to talk about is the module of community health information system. That is something that is already been in the country, but in the very confined, let's say, program. So, the community health information system allows community health workers to manage patient information and the health data and to monitor what are the health trends over time. So, the implementation of a community health information system was key to ensure provision of health, primary health care, reduce the fragmentation of the community platforms that are already in place in the country, and create integrated community health information. So, like I said, we already have experience with the LEPRA, LEPRA's program. You can see in the right was a problem that we've been using this registration collection from the past years, but with the new, and here you can see some of the information that we already are collecting in LEPRA. You can see the number of cases in the last three months, four quarters, and you can see where are the areas in the country that are more endemic or have many cases, and you can follow where you need to focus your supervision and the health care support. So, now we have a new strategy for community health subsystem, and this resident strategy has a pilot with a very clear objective that is establishing high health information surveillance system and monitoring valuation of the health actions in the communities with a multi-direction flow of information. So, this new approach, this new strategy brought a lot of demand to the health information department, because we need to evolve from the LEPRA's data register to cover all other diseases and programs. So, the integrated community health information system is based in the HIS-2 as being tested and includes the digitalization of all the package of the community agents, and provides continuous follow-up on the individuals at the health hold level. These are one of the modules that the system has. You can see it allows you to follow TB, malaria, HIV, allows you to do prevention and promotion in the community, allows you to registration the births and the deaths, allows you to make a census of the household members. So, and these are the collection how it goes and also allows you to receive some notifications about the follow-up that the health community also needs to do in a daily basis. So, like I said, it's an integrated community health information system. So, all the programs are present and related, including malaria that is going to now explain us more in detail how this can be very impactful in our health care system. Now, I invite Mariana. Bondia, thank you for the opportunity. I will try to speak in English, so be patient. But I know I have backup with Dr. Emilio. My name is Mariana Da Silva and I work for malaria program in Mozambique. In the next few minutes, I'm going to present a summarize the programmatic view around the development of an integrated malaria information storage system in Mozambique. This is a bit of context. So, in 2016, a malaria surveillance assessment was conducted and noted major challenge with the data management, which includes multiple sources of data with different definitions. As you can see on my right, we have this picture with the Excel data coming from entomology, bed nets, IRS. And we also have commodities that we have the AP information coming through the HMIS. And we have supervision data and we have data quality checks data. So, because of these multiple different definitions, no standardization in terms of reporting tools and indicators, we noted that we have a poor accessibility in terms of integration of all this data. And also, we have no automated output. So, through the technical working group, there is a decision to make and to define one place where we can find all these stakeholders can find all the malaria information in the same platform. As I said, in terms of solution, a malaria data repository was created based on the HIS2 and it was developed in accordance of WHO repository guidelines. So, this malaria repository integrated all the information system that was in place, which we call CISMA with AP data and LMIS data, which allows for different electronic reporting activities not relevant for the system and creation of new forms to capture all this information, such as entomology, vector control, integrated supervision, and also to include information related to the finance. And to set it in place, we trained about 800 users all over these users with the tablets and airtime in the monthly basis to ensure that they can conduct the activities and they can report all this information on this malaria repository platform. So, in terms of the impact that we have with all these data accommodating the same platform, we saw some improvements in terms of data completeness through the validation that was created in the platform, more specific for supervision, integrated supervision and end to end to data and IRS data. We saw through this platform improvements in terms of data submission times where they can use their own tablets and submit information from the health facility and districts. Because we gathered all this information in the same repository, it is now very simple to integrate all these data collections and to do the complex analysis that was difficult before this repository was set. And we have this time-consuming considering that the data was collected through different instruments. As you can see in this picture, we have, excuse me, we have dashboards with the RDS where it is collected throughout patients. We have information coming from the LMIS with the conception of ACTs. We have even information about the stocks on the warehouse. So, now we can probably do this evaluation and it is available for all the users. We also, as I said previous, we also create a dashboard specific for financial tracking. And this was specific for global fund commodities and non-commodities. And quarterly, we collect information coming for different partners' contribution. And this is one way to involve all the stakeholders and to at least to have this finance information that you know it is sometimes very sensitive to have and to be available in the program. So, as the next steps, as I said, this is some examples that I brought here. But we have about 25 dashboards with all this information. So, as the next steps, we are working in terms of define the data use for district levels and health facility levels. And I was very excited on yesterday and some sessions with the big data extraction. I think there is a good opportunity for us to combine all these tools and to maximize the data use that we know we have a lot on this malaria repository. So, this is all that I wanted to share with you. Thank you. Okay. Again, me. So, like Mariana said, it's very important to have integrated information and have all the modules integrated in the same platform. That's why we're going to present what is the actual overview of the health information system in the Ministry of Health. So, we can see we have the aggregated module, the HISU in the middle, and we have all the modules that were developed, the hospital community health system, the malaria repository that Mariana spoke, the surveillance, and all these are connected and in the same integration, the integrated information. And we can come with a common dashboard. But there are also systems from other parts like the Ministry of Justice that have a interoperability with the inter-hospitaler. There are the logistic information system that are also integrating now with the aggregated and allows us to have the products consumption for the different programs and to follow up what are the quantification and distribution of these drugs related with the programmatic interventions. And we also have the human resources that it's now at the moment not very operational, but the layer is there. They are now doing some updates, but it's also a current process. So, this is the overview, the integration. And we are still working on to improve this integration and with the various subsystems, and the interoperability platform was implemented with the advantage of in changing the data analysis, elimination of the data duplication and redundancy, improved the set accessibility in terms of data quality, facilitates collaboration and information sharing, and also allows us to scalability and feasibility. So, there is a link there. If you want to copy and see, you can see that we are really bringing in this platform integration information. Here are all the modules that I spoke about in the previous slide. You can see that through this layer coming with the 2DHIS2 aggregation and we can see all the desegregated information there according with what you need. So, we still have challenges of course and some of these are related with the infrastructure, the Austin, the internet, the equipment, human resource training and the skills also in the IT development and so on. We have also to face the emerging tools and platforms that sometimes are not well coordinated with the MOH. We have some policies that we need to update and also we continue to coordinate all the investments that are available for H management information systems. In terms of perspectives, we would like to continue to improve the data quality, improve the interpretability with the justice for brief registration data, establish a medical record system that is very new. Like I said in the beginning, HIV is one of the programs that is now demanding to have a specific tracking module for the patients and also there is need to see what is happening with all the patients that come in in the health facilities, not only HIV but the others, how you can follow up and also bring them to the health information system with the funding to see the weight they have in the public sector. So, this is going to demand a lot of work from our side. We need to expand the community health information systems, the integrated one that I spoke previously and of course we need to improve the users support through a help desk system. It's a project that we have started to talk about because we have a very big country, people are dispersed and we need to have a support, a friendly support to provide them. So data use, we would like to bring the data from this repository, the integration platform and with the interoperability layer expansion, we are going to be able to promote the data democratization. What we want now is to be able to share all this information that we came through up to now over 10 years. We have a lot of information, many programs. It's now the time to share it and to see because if you don't use the information, you don't improve it. So now the next phase, the next challenge is really to share this information and all the stakeholders, all the programs, all the managers can see it, can advise us if we are bringing the right information of there are need of other information. So we come with a closed circle of liberation. Another perspective is in the governance. We need to lead the process of planning and financing. It's one of the key lessons we have from all these processes implementing the HICS tool. We need to invest more resources in the capacity building at all levels. We have a decentralized system now in terms of administrative in the country. So these three provinces and centers are different. So we need to bring all of them together. We need to continue to improve the data center and build the redundancy to secure the information that we have. And here there is a play with other public institutions that also come to help the minister of health. We need to continue to develop, improve and promote the standards, the policies and the strategies to be aligned. Everyone that works in the health information system should obey follow the same rules. And this is one of the weaknesses because I spoke previously in the challenge, but we are in the way of approving two policies and the strategic plan for health information system for the next five years. So another is to improve the collaboration coordination among all the stakeholders and the partners in the system, of course. So to the technical committees and technical meetings that we need to emphasize and make sure that they happen. This is it. Thank you very much for your attention and for the invitation.