 So in this session now and the next one I will talk about some fundamental principles for DHIS2 planning and also some tools that we have available that can help you to plan and assess your DHIS2 projects. So first I want to start us off with a small mentee exercise. You can open mentee and you can keep it up because there will be another question at the end. So just keep just open your mentee your mentee link with this code. Oh the code again sorry sorry 4993-6401 is the code. Everybody in? One moment okay it's early in the morning so we have to switch on our computers and our brains. Okay but some of us can get started so so the first question I have to you we will talk about planning today. How do you plan your DHIS2 system? So the first question I have to you is if you're planning a large dinner with your family and friends you're going to invite a lot of people maybe in your countries a lot of people it's a lot of people more than in Norway but you will do a huge dinner with your family and friends. What do you need to plan for? What do you need to think about for this to be a success? Okay there are many good questions here you have to think about the menu what diets people may follow who you will invite their culture where they come from food preferences place variety quantity quality ambience that's a good one suitable day who will pay very good one okay oh you had a lot of good ideas involvement of all the stakeholders who are that the husband and the wife and the everybody yeah okay good no this is great did anybody think about paying the electricity bill so you can cook your food you just assume that's there right you you just you you guess that's the oven is working yeah and that you have some knives and some pots and some pans I guess you just assume that's in place as well I see some of you here have said that you need to know the preference of the people who are coming so maybe there is some religious preferences some is vegetarian maybe some wants a kosher meal not mixing milk and meat I don't know so there are many things to think about so the purpose of this was just to think that it's not just what you will serve but there are a million things to think about okay now the next question so to plan a DHIS to implementation what do you need to think and plan for you think I will of course talk about it but what do you think you need to plan for you need to know something about the user requirements that's good indicators infrastructure that all stakeholders are on board who to train resources and capacity number of trainings budgets stakeholder identification and mapping yeah power yeah power information is power data is power for sure or power or the electricity power okay both both the types of powers are important internet buy-in coverage yeah many good inputs here logistics the central team okay so I see here who is the father of the work okay so this is like who is owning it maybe or who is driving it that's important okay great a lot of good a lot of good points here how to bring the UIO team or his the his team into the project great thanks so we will talk about many of these things now today so I will give a little bit of an introduction now in this first hour and then many of these topics will be going into depth later today and tomorrow like more in details I would just give high level intro and then myself and other colleagues will dive deep afterwards so I will talk about today some key principles for planning as I said and then some evaluation and assessment tools so after this session I want you to remember three things so firstly I want you to remember that's a health information system that we have been talking about this whole week is what we call a socio-technical system does that mean anything to you a socio-technical system anyone no one yeah it means something to you maybe it means the interaction and the interconnection between the closer to the mic I think some people can hear you maybe the means the interaction between the stakeholders and the community need or the diversity of the people who are working on design the system because you are talking about change management and behavior issue rather than that entry yeah so it's a social process maybe that's a that's a good point so an information system is not just the technology it's all the people around it that are using it that are deciding that we should have it it's the people entering the data routines roles incentives to report and use data etc so working with information systems like the HS2 you need to think about the whole package secondly we need to build and plan for systems that will last for several years so doing in the HS2 now I'm going to use the word project but then I say you should not use the word projects it's not a project it's not something that starts in January and it ends in December it's a very long-term continuous work and the last one is to assist the theme of this whole course or this academy is to encourage integrated health information systems so where possible you should aim to share data expertise resources etc and there will be a very small quiz at the end just yes there is very very small not great it okay so I will talk about some basic principles of the HS2 planning so one of them is that as I said it's a long-term continuous process and you need to make sure that you plan for that so this means that you should think about a gradual expansion of scope like of users and of the data that you collect you cannot maybe do everything at once so it can be good to start little bit small and then master that make that work and then gradually expand maybe you include more facilities because you have more resources for infrastructure or you add another dataset or another program on board in your DHS2 journey so don't think that you will do everything at once you can start small and build on it but then again not too small because you want to get some attention and some traction of your of your DHS2 work requirements are changing over time so what is the right thing to do in year one might have changed in year three so just make sure that you iterate and revisit your plans and your assumptions at the HS2 we release our software at least yearly or twice a year I'm looking at the back now it's between one and two times a year where there is lots of new functionality coming so it's also good to revisit stats and get the latest updates so you have the latest versions of DHS2 it's not a static product and another key principle of planning your DHS2 system is that a stable core system is based on a robust core design so you do not want to add very fancy things on top of something that is not stable and I will give some examples sometimes it can be quite attractive to plan for big advanced projects and then we see sometimes that countries or organizations can forget the basic things underneath like to pay the electricity bill or to buy knives and pots and pans if you're making the dinner so make sure that you do that and also to invest in what we call common building blocks that all programs using DHS2 will benefit from so invest in infrastructure and skilled staff connectivity etc and these are sometimes overlooked or invisible parts of your of your DHS2 system but nevertheless very important so here is a house would you like to live in this house yeah and what if the what if the owner of the house is contracting you to build they want a huge balcony on this house on the side like here here they would like a big balcony on the side would you advise that maybe not the best idea in reality this is what happens yeah yeah yeah maybe they just started with like one of the pallets at the bottom there to have something to sit on and then it grew yeah who knows so you can say that the system on top here information system maybe that wasn't the best the best term but it it can be for example your one of your DHS2 programs and the stuff on the bottom that's the invisible things that nobody wants to pay for nobody says oh I would really like to pay for one of these pallets at the bottom but it's your job is managing these projects to say that we need someone to pay and work with these things that makes the house stable so on the picture here this is the framework that we use in Hispnow to assess whether a country has a mature DHS2 system I'm not sure is it readable from afar if not you can see it on Moodle we say that we have some foundational pieces on the bottom these are sort of equivalent to the polls that this house was standing on these are things that it doesn't matter if you're collecting TB data or immunization data or individual data at each clinic you need to think about and take care of these things on the two top layers we have aggregate systems so aggregate HMS data aggregate TB data aggregate EBI data and the list could go on we've just asked some questions for each of these and then tracker which is individual level data so we use this as a tool and I've linked in the Moodle I've linked the tool we call it our maturity profile the tool is in the Moodle so you can review that later so this is a list of question that just gives you an indication of how is it really going with DHS2 security and compliance in country X is everything in place do they have the people the tools and processes in place to handle security privacy for example or are they room for improvements so the point of showing this is that we should really focus on these foundational pieces I'll talk most about this today and in the rest of this course some of them will be separate sessions later I put some arrows here let me just put the next slide so you can read better so we will talk about leadership and governance after this session we will talk about training end users or capacity building afterwards we have something on security and compliance on the core team and on infrastructure later in the course but really these are areas that needs to be focused on so this was all part of building on the foundations having a solid foundation before you expand another important principle is to have in-country teams to support national systems we work with 50 60 countries through 70 countries through the Hisp network sometimes we can experience that somebody wants to sort of pay for something that is finished and ordered and just delivered to the door like your finished bread like we would like a bread please give it to me and from experience that doesn't work very well I mean you have a very nice bread in day one but then after a year that bread is very moldy and doesn't it's not so nice anymore so we really really advise that each country doing DHS to has a strong local team a committed local team to work with DHS to and this local team must drive the process they must be the owners and drive this process the whole way and they must be involved in every step so of course new countries and also older DHS two countries then they need help technical assistance from from our network the Hisp network and that is perfectly normal and okay but we strive to always work in a way that the people that are helping are working together with the team so we try never to just sort of do the work and leave but do the work next to somebody from the local team so that next time you can do it by yourself another important thing is to plan for data use there is uh I believe there is another session on designing for data use isn't there sure it's later I'm not sure sorry always from the triangulation okay fine fine yeah so plan for data use so whatever data is that you plan to collect I think we all I also did the exercise on day one with the registers I personally actually hadn't done that before and it was very eye-opening I think for many of us so thinking about whatever data that you decide to collect what kind of decisions will be made on the basis of this data there are a lot of nice to have data points but can you do something about this data at some point in time can something be done differently if you know this have this information sometimes it's interesting to know something about every single patient a lot of detail about every single patient but will you as a health manager in this region can you make any decisions and change how you run your health system based on that data so these are just thoughts that needs to go through to enable that or to make sure that we reduce the the data collection burden on people and make it simpler for everyone another principle here is to make the chance to relevant for users if the people entering the data can feel that this is useful for them can it perhaps save them time is it easier to make check if they have reported everything that they should report like give everybody in the chain some benefit and value the value shouldn't just come to the person on top who has said that we need really good TB data in country X like it's also good for that TB nurse who is entering data to have some sort of benefit so think through that in your projects and also like DHS2 is part of the larger health system strengthening initiatives the plan the DHS2 plan it should be fully owned by the Ministry of Health and reflect their priorities so as we say here it's not the donor plan it's not Gavi's plan it's not CDC's plan it's not UNICEF's plan it's not WHO's plan it's not the UIO plan or the HIS plan it's the Ministry of Health plan so a lot of people can come and say and tell countries oh you should do this you should do that we want this data we want that data but it really should be the Ministry of Health plan sometimes this means that to get everybody on board in the ministry you need to fast track certain activities and make everybody happy so that's a bit of a trade-off but make sure it's the Ministry's plan another principle is to encourage what we call financial coordination we want to try to align partners and the Ministry local governments to align around one common DHS2 plan so it doesn't really matter if you have a TB program wanting TB data you have the EPI program wanting EPI data try not to fund these in silos so you have some money going to the EPI some money going to the TB some money going to this other program if you can sort of bring people together around one DHS2 strengthening plan that will be useful so this picture here is from a from a big park in the city center in Oslo if somebody has been there the frangneparken yeah been in Oslo so I really liked it I thought it was like a good illustration of like having a lot of people carrying the same thing instead of everybody standing with their own garden hosts and spraying each other down so pooling of resources as well if it's possible to use the same tablets in the same facility to report different data sets quite often we see that you come to visit a facility and you see a health worker having four different tablets and you ask what is this used for oh this is for reporting the EPI data this tablet is for reporting this this tablet is for reporting that this paper register is for reporting this so if you as a ministry or as decision makers can try to pool resources together you will save money and yeah it reduces some fragmentation and it's if you're able to have a good plan that one plan that many people can chip into I think it's also easier to get things funded we work me and my colleagues many of us we work closely with actors such as Global Fund, Gavi for example those big ones a lot closely with the WHO and we see that the better a country is at having and showing that we have one plan for DHS2 it's easier also for others to chip in and contribute towards that because it will benefit everybody hmm yes point number four please I think if we are talking about the sustainable system with the HHSC in the countries we need to have the budget as item from the government or MOH budget should be allocated for the HHS2 yes and the fund from the donors is the extra budget but we have we need to have it as a national budget yeah that's a very good point yeah it needs to be in your national budgets huh it's a line item data is expensive sometimes people think that data is just appearing out of the sky but it's very expensive to train and equipment and everything yeah very good point it should be in the national budget yeah but sometimes sometimes still external funding is coming in to strengthen so I'm not saying that all the money is coming from outside but yeah yeah good points so when we do these maturity assessment exercises with countries we started this year using this framework and I won't go you can read the details in this excel sheet that I that I put in them in the middle we've done it now in 40 plus countries the his groups around the world so they have worked closely with ministries of health sitting together with them the IT department ministry of health saying okay let's talk through your DHS2 system and try to sort of score a little bit how things are going afterwards they write a report where it starts with what is the ministry's objectives or priorities so for example a ministry of health can say oh we our main priority is to revise the HMIS tools we want to scale TB individual level TB data to the whole country and we want to do case-based surveillance for example and then based on the results that we have here it's easier to give an opinion together with with the ministry team to say that okay this seems like a good idea we would maybe wait a little bit before embarking on this project or if you want to do this we advise that you do this first so it's a tool to plan again I think I talked about this how to get this one plan funded we see that there is quite a lot of interest around having this one plan concept that many people are buying into World Bank, WHO, UNICEF have all expressed interest, Gavi Global Fund and of course many countries here are very self-funded and have all the money over the government budgets as you say so that's great for those countries that are more reliant on external funding from these big partners to have their health information systems running UIO and the HIST network we have some technical assistance funding available through both Gavi and Global Fund but we see that most of the money is coming through the technical assistance grants that are going to countries and having these showing that you're planning holistically is also a way to influence that grant making process then I will spend a little bit of time talking about audits and assessments so sometimes your plan looks like the top line there like you want to go from A to B and you have your bike and everything is fine and good to go and you made a plan how to get there but the reality can be quite different so first of all it's it's good to know like am I ready to start do I have everything in place to start and then once you start your journey stop at some point say stop at some points along this journey and see what actually happened now where am I at now what's ahead of me and what should we plan for next and we have some tools we have some tools within DHIs too that we can help you to assess it can be for assessing the quality of your implementation your security setup if you have comments or questions just give them to me as I speak that's fine so this picture here this shows some different tools that we have to help assess you along the way so the picture in the middle you have seen before now this is what we call the DHIs to maturity profile if a country is using DHIs to this can be a useful thing to revisit like at some regular intervals maybe every second year or something just to see where we at we have more in-depth tools as I said metadata assessment that has to do with how clean or messy is your DHIs to implementation so that is scripts that you can run on your system to ensure am I collecting the same data element wise am I collecting data that's not used in any indicator or dashboard for example um we have tools for mapping capacity needs and training plans so different things we can advise on and then we also have a tool that we've called the DHIs to readiness assessment that might be relevant for some of you who have not yet started with DHIs to which is a set of questions that can help highlight some gaps or things you need to think about before you get started so we are based at a university university of Oslo is where this whole organization or a network originated from so we also have a lot of focus on research we educate a lot of PhD students master students and we conduct research so it's also possible to dive deeper into your implementation to really understand a specific phenomena together with students and and academics the last thing I will mention is that we have in many countries now during COVID and I guess the same as for most of you sitting here there have been quite big investments in information systems the past three years suddenly everybody understood that data is important maybe more than they understood before oh we need to make sure people are vaccinated because they cannot travel for example so this might be a good point in time to try to leverage some of these investments so for example a lot of countries have done COVID surveillance now is maybe the time to work again getting the COVID surveillance and strengthen routine surveillance systems many people have worked on COVID vaccination this is a good opportunity to strengthen routine immunization programs yeah we also see that there has been big investments into infrastructure in countries a lot of new tablets computers access points etc have been invested in so also try to leverage that if the equipment is there can you use it for something different than COVID yes see something related to COVID-19 yes as the supervisor of the COVID surveillance in Palestine during the pandemic I think one of the challenges we had the data entry from all the users they are suffering because they need to search for the case and the data entry for the lab and for the the investigation form for the management done for the patient after it's been positive I think we need to think how we can enter the data in such a situation it's a difficult yeah it's a difficult so we worked with a lot of countries during COVID supporting with surveillance and vaccination I think overall we can see that we have not seen one country really except some small island states that have managed to keep up with COVID vaccination data in particular it's been very difficult to have this very high load of data entry happening real time across many different sites when you're in a rush so I think we have all learned a lot from that both on for example we talked about performance on day one is the system does it have good performance somebody asked that question we solved some performance issues during that time but I think also a lot of countries have learned what it takes to enter real time data for every single patient so we are quite hesitant I work a lot with countries together with Gavi on immunization for example many countries they want to do immunization tracker tracking every child so Rwanda has done it but it's very challenging it's impressive what Rwanda has done but it takes a lot of effort to have every because you need like from the infrastructure you need a device and a tablet available at every site and that tablet has to work when the patient is there not next week because then you have a huge backlog so for COVID for example we have seen examples of to keep up with data entry there have been countries that have used the army to enter data they just deployed a huge battalion of the army to sit down and punch vaccination data there have been examples of volunteers entering data also when I got to get my vaccination in in Norway you can say oh they're far ahead with digitalization everything but at every vaccination point there was one person giving the shots and one and one person entering the data so what country has that kind of resources for routine immunization no one or very few I would guess so these are things that you need to think about when you're planning your your projects be it DHIS2 or another software it doesn't it doesn't have anything to do with DHIS2 it's any information system but plan what kind of resources you have okay mini quiz time meant on mentee okay one quick question or comment from Shumbo yeah just it's one just to talk about what my colleague was talking about one of the ways I have seen that maybe was semi-efficient when it was during the pandemic we had a huge workload at the airport and we decided to have a kind of safe registration so you understand that not everyone in our population is able to have that kind of skills for safe registration but at least that part of population which is able to safe to get safe registered yeah they were using that option of safe registration and the vaccination of testing site was just to use the unique ID and add the results but the registration of profile was being done by themselves using the option of safe registration yeah the way it's possible they can adopt that that that's part of safe registration configuration I think that's a very that's a very good point and and we'll talk more about that I think the session is tomorrow um when you're when you're starting a digital project like this is uh the maybe the easiest thing is to just put we have an Norwegian expression I'm not sure if it's in English but to power to put power to paper so you have your paper form and then you just make it into a digital form but everything stays the same it's the same people entering the data the data flow is exactly the same but doing things digitizing or digitalizing um a data flow or a system it gives you opportunities to think new like maybe it's not that person who needs to enter that data maybe the people can do it themselves on their phone and then submit and it can be picked from somewhere so it's a good opportunity to think new okay so uh mini quiz time on mentee how'd I go to the next one can you name some key principles of dhs2 planning now did you learn anything from what I was talking about it doesn't have to be word by word but what did you learn from the session what will you think about when you're planning your dhs2 implementations okay great look it looked like uh my message was going through that's good very good the next session that we have uh I think we have another half an hour or so uh it's on governance um Olaf your name is also up there but I can speak but if you want to join your yeah thumbs up I see that you're busy in the back there okay but I think that you really uh you really got many of the key points readiness are you ready to do what your plan is day to use moh involvement budgeting ownership that's great okay I think seeing that we started a bit late I will just uh run straight into the governance session so we also have time to have tea and cakes which is wonderful in this hotel I will move straight to the session here called governance just give me a second okay so we'll now talk a little bit about governance in the next 20 minutes or so so first of all I want to I think I'll just jump straight to um to um the mentee actually new mentee new mentee code six two two seven six six eight two you're getting good at mentee now so this is easy okay I will start by this question six two two seven six six eight two six two two seven six six eight two can you see should I find the big number again or it's okay six two two seven six six eight two okay so here I'm wondering because governance is one of those very fluffy words that can mean nothing and everything to people so I want to understand what does this word mean to you when you hear governance what is it what are you thinking about when you hear governance in the in the in connection to information or health information systems policies and procedures leadership ownership accountability political will those who will make sure the system needs requirement implementation is on track connecting all strategic planning yes policy makers clear roles and responsibilities make roles coordination of digital activities by providing leadership many good answers here okay I think we're we're talking about the same thing which is good always good to check before you start that things are done in a legal fashion rules and norms that shape roles and responsibilities incentives tools and processes yeah many very good answers here