 Today, we're going to understand what is standards-based configuration in DHIS-2 and how does it relate to the WHO routine health data toolkit, identify how standards-based configuration supports health programs who use DHIS-2, and understand key considerations for implementation and use of the WHO routine health data toolkit. The first part of the presentation will cover standards-based configuration, including a number of examples. The WHO collaboration on the DHIS-2 toolkit for routine health information systems is a part of a collaborating center agreement between the University of Oslo HIST Center and the WHO. Implementation tools are used to improve data quality analysis and use in national systems. The WHO serves as a subject matter expert to provide guidance on standards for measurement, including core indicators and recommended metadata, as well as data quality metrics. The WHO provides a number of recommended dashboard analyses that help to improve programs use and analysis of their routine data. DHIS-2 provides a toolkit of configuration packages, implementation guidance, and other tools to support programs to uptake these standards for analysis and use into their national systems. The design of this toolkit is based on an integrated health information systems platform. It contains a number of program-specific modules, but all of these are designed in a way to bring the data together into an HIS so that countries can take advantage of the data available across both programs for improved analysis and use. WHO guidance and recommendations for data analysis are used to promote best practice DHIS-2 design and configuration. Recommended dashboard analyses are provided at national and subnational levels. These take advantage of core functionality within DHIS-2 for analyzing and displaying data and dashboards at the level that is most appropriate to the user. As part of our collaboration, the global DHIS-2 team models core indicators with standardized definitions as proposed by the WHO and included in strategic information guidelines. Packages also include recommended data variables for data collection and disaggregation of key indicators. These help countries to map what types of data elements are included in their paper forms and be able to identify any gaps in those data collection tools. Lastly, data validation rules and data quality tools are used to promote data quality analysis and standards. Data validation rules and data quality tools further support programs to improve their ability to do program analysis by ensuring that data quality analyses can be made, and these include a number of core DHIS-2 apps. An important component of the toolkit is its modular design. Countries can select modules based on the maturity of the health system and also what public health interventions are most appropriate to their context. In this way, the different modules of the WHO routine HIS toolkit can be selected according to local needs. It's also important to understand that the modules are rarely adapted exactly as is. Localization for local contexts, customization to local workflows is an important part of this process that we will cover in the implementation considerations. A core product of our collaboration is the recommended dashboard analyses that are included in the core HMIS packages. These packages are designed and optimized for integrating program data into a national integrated HMIS system. These may include dashboards and data visualizations that show the different standard indicators recommended by the WHO in order to help programs to analyze the performance and improve their programming. The data use and analysis guidance that is developed by the WHO is incorporated into the configuration where available, for example, by making data analysis recommendations available through the dashboard. Analytical components can be installed and mapped to existing data entry forms and variables in a country's HMIS. This means they might already be collecting routine malaria service delivery data, but by importing a set of standardized indicators and the dashboard, they are able to then map and understand the gaps within their system and improve their alignment with the global recommended indicators. Data entry forms and standard data variables are also very useful if a country is redesigning or improving their data collection processes. These data entry forms can be referenced as new program data collection tools are developed to ensure all of the key variables are being captured to be used in the analysis. Tracker packages are used for individual level data collection and case-based data collection. These enhance data analysis by making individual level data available and enhancing the person-centered approach for program management. The DHIs2 tracker model is used to uniquely identify and track a person or an entity over time. Tracker can be used to support basic clinical level decision-making and can also generate highly granular data for enhancing the analysis. This can be very useful for indicators such as dropout rates or other longitudinal metrics over time, where paper-based reporting can be difficult to manage. Typically, we develop a set of program indicators based on the individual level data that aggregates the data coming from this tracker, and then we can map it to the core indicators contained in the HMIS modules to ensure that the individual level data can be aggregated, pushed and shared to the HMIS dashboards for improved accessibility analysis and use. In sum, the workflow for developing standards-based configuration tools is to start with the global normative guidance that is developed by WHO, often with UNICEF and other subject matter experts. The DHIs2 toolkit is a combination of downloadable metadata packages, design guidance, technical installation guides and implementation guides that support the use and uptake of WHO's analysis standards into the HMIS. The third part of this process is customizing and adapting these modules for the national context. In this next section, we will give you a few examples of the standards-based configuration toolkit for different health programs in DHIs2. Here's an example of the WHO standards-based toolkit for malaria. The guidance manuals developed by the WHO include monitoring and evaluation and surveillance for burden reduction and elimination settings. This is then contained in multiple dashboards for burden reduction or elimination that can be installed into the HMIS according to context and epidemiology. Data quality analyses and coordinator definitions are provided by the WHO as well as recommendations for triangulating various aspects of programmatic data. For example, this may include malaria service delivery metrics that can be compared with facility stock reporting. In DHIs2, we model this guidance as a series of dashboards to support programs to design and develop dashboards that can be used for their program analysis. These can be installed into an existing DHIs2 system or they can be implemented from scratch if a country does not yet have malaria or another health program integrated into their HMIS. Lastly, a series of training materials include guidance and training exercises that allow program staff to understand how the DHIs2 dashboards can be used to make some programmatic decisions. The malaria toolkit contains several components. The core HMIS module is all about program analysis. The data here typically includes service delivery data, including IPTP and ITN distribution from health facilities. There is a data quality dashboard that is tailored to the malaria program to ensure the completeness of variables and as well as outlier analysis and detection. The package also supports facility reporting of essential malaria stock items and allows this to be triangulated on the dashboards against health service delivery numbers. A series of tracker packages have been developed for malaria surveillance and elimination settings. These include an elimination dashboard that can pool the data from these various trackers and combine them with other data such as population at risk to understand how to operationalize response measures in elimination settings. The two tracker programs cover case notification investigation and classification workflows, as well as a tracker that allows the identification and mapping of FOSI, investigating those FOSI, linking them with the cases notified, classifying them and recording the response. Lastly, a series of entomology and vector control modules have also been developed in order to take advantage of the use of DHIs2 for entomology monitoring, bringing together these data with service delivery numbers and also planning interventions such as ITN campaigns. The TB modules for HMIS support case notification, outcomes drug resistance, and co-morbidity monitoring between TB and HIV. New components have been added in order to analyze TB prevention activities such as contact tracing, as well as bring in aggregated lab data from laboratories. This package also supports facility reporting of essential TB stock items and these can be analyzed on a dashboard. The TB case surveillance module is developed with DHIs2 tracker. This case-based tracker allows linking of the case record with laboratory results within DHIs2 to improve the monitoring of case surveillance indicators and outcomes over time, as well as recording multiple sets of lab results to understand TB drug resistance. A complementary module has been developed for drug-resistant surveys. The reason this was developed is because so many countries are to use TB for their case-based tracking and can use the TB tracker module to also conduct specialized drug-resistant survey tools. Lastly, a new set of modules is being developed to support TB prevention activities. For example, this includes active contact tracing based on an index case that may be recorded into the TB case surveillance tracker. These data are then aggregated and presented in dashboards at the HMIS. HIV core HMIS modules include cascade analysis, including newly diagnosed persons with HIV, ART retention, and viral load suppression. A number of prevention indicators as well as the integration of STI indicators is a major focus of our joint work in the coming years. This product also supports facility reporting on essential HIV testing and treatment stock items like the other program-specific modules. The HIV case surveillance tracker is developed to support longitudinal person-centered monitoring guidelines. The HIV case surveillance module supports longitudinal person-centered monitoring using the DHIs2 tracker. This allows to track each case over time as part of a comprehensive national case surveillance database. This case surveillance tracker can be further optimized by countries to incorporate elements of patient monitoring and follow-up. However, it was initially designed to have fidelity to the core series of HIV case surveillance indicators that would be necessary for program managers to understand the epidemiology of HIV in their country. The community health modules were developed in collaboration with the WHO as well as UNICEF as part of the Community Health Workers Strategic Information Guidelines. This comprehensive set of modules covered 21 community health interventions. A key part of this work was to harmonize the recommended community health worker indicators that are reporting on service delivery in the community with those service delivery indicators that come through the facility data. As part of an integrated harmonized HIS, these indicators must be harmonized in order to present to health programs and other users a comprehensive picture of service delivery at both community and facility. This module supports the integration of community data into the HMIS to improve the availability at district and higher levels. Data quality tools are an important component on the pathway to improve data use. The data quality tools employed as part of the DHIs2 toolkit are aligned to WHO's data quality review framework. These support annual and routine data quality reviews at national and subnational levels. Data quality dashboards by program may include aspects of reporting completeness and timeliness as well as completeness of specific data variables, consistency over time and also consistency between data variables that may come from various packages and health programs. We have also worked quite closely with the WHO to build out core DHIs2 functionality that is needed to perform adequate data quality analyses using the tools available in DHIs2. This includes the incorporation of data quality analyses into the dashboard to bring data quality issues closer to users as well as provide more enhanced analyses and calculation power in tools such as outlier analysis. The last part of this presentation will cover implementation considerations for operationalizing the standards-based toolkit in country information systems. The toolkit is developed in a modular way to allow ministries of health to select the various modules and packages based on their needs. Selection of modules is based on MOH and national program priorities for strengthening the routine HIS. In addition, system maturity assessments are referenced to understand the country's readiness for moving towards electronic individual level data collection and management which will be important for any country looking to adopt one of the tracker or case-based modules. The system maturity assessment is also used to identify key gaps in data analysis and use, which may be identified at various levels. This can be used to inform what aspects of the packages might be implemented and where they might be used. For example, national programs may have well-designed dashboards for data analysis and yet the districts have not yet implemented such dashboards. In this case, a country might choose to focus their modules on making sure that subnational level data use and dashboards are available. Lastly, the packages often relate to public health interventions that may be appropriate for different epidemiological contexts. In this way, engagement with the national programs as well as guidance from WHO and other subject matter experts helps to support the selection of packages for certain geographies. For example, the burden of malaria should be low enough for countries to implement elimination surveillance. Even in this scenario, they also need to choose which geographies or which provinces are ready to move to case-based reporting. Other examples may include whether the country is experiencing a more generalized HIV epidemic or if they would like to focus more on prevention indicators where there is a concentration of the burden in key populations. We rely on subject matter experts and national programs to help inform the selection of these packages as appropriate for their context. Operationalizing the WHO Toolkit in countries is a partnership between HISP experts, core HMIS teams at the Ministry of Health, as well as health programs. The process starts when the country begins a TA request to the HIS network for certain installation of packages or other aspects of the implementation that they wish to approve. Joint TA planning with the Ministry of Health program and the core HIS unit is conducted to understand which packages should be installed, what is the starting point in the HIS design, and what types of system maturity aspects need to be considered in order to ensure a successful implementation. Typically, his groups were joined for an in-country meeting with program staff and they will work on a number of things together in a workshop type format. These may include the HMIS unit working hand in hand with the M&E focal point for the health program to map standard indicators to the existing configuration in DHIS too, understand if there are gaps in the data collection tools used, and also to be able to modify and customize dashboards according to national program needs. At the end of the mission, it is hoped that the package will be installed in a development environment and receive approval across the various stakeholders. A training of trainers is conducted to ensure at least at national level that the in-country partners at MOH through the program and the core HIS team are prepared to continue with scale-up activities and other implementation activities. This may include, for example, a training of trainers so that districts can be trained on the use of the new dashboard. Prior to debrief and exit, the HIS groups will work with the MOH core HIS unit as well as the programs to define any remote support needed or a follow-on mission if further support is needed. Post-installation, it is the country's responsibility to carry forward the operationalization and the implementation of these modules. It is always our goal that the HIS groups work hand in hand to share and grow the capacity of the national programs over time so that at the end of the mission, the country itself feels confident to maintain their system and continue to train other users. The implementation of packages and WHO modules does have an impact on project budgets. Customizing, adapting, and implementing the configuration packages in DHIS 2 typically means considering budget lines for technical assistance to cover readiness assessments, package customization and configuration support, implementation planning, training, and technical support. End-user training should be planned for new modules. For example, if a new dashboard is introduced, training may need to be conducted at the national level but also cascaded to districts who also use these dashboards to ensure that the programs are functioning at the subnational level and can provide support to the facilities in the communities within their area. New tracker implementations should refer to the tracker budget guidance in the implementation considerations section. In some cases, a new tracker program will require substantial resources in terms of training and possibly devices in order to make this program operational. However, sometimes a country may already have an operational tracker package, safe for TD case surveillance, and rather they would choose to use their support for using some TA at the central level to improve the configuration or improve specific aspects of that configuration, such as to integrate lab data. Some costs will be recurring and these need to be planned. These costs relate to HMIS upgrades, routine data quality assessments, and other types of reviews. In summary, supporting standards-based configuration with DHIS-2 is a multi-level process. At the global goods level, the DHIS-2 implementation team partners with subject matter experts at the WHO, UNICEF, as well at country level to develop a toolkit that promotes best standards in DHIS-2 configuration as well as WHO recommendations for data quality analysis and use. The toolkit is modular and customizable and allows countries to choose which modules and which packages are most useful and most needed to improve their national HIS. These tools are available for many core health programs, but they are designed in an integrated way to support harmonization and integration with a national health information system. Programs should consider country readiness assessments, national context, and national program priorities for the selection and implementation of WHO approved modules as part of the health data toolkit.