 Questions from the community? Yeah, yeah, yeah. Okay. Yeah, I think you guys are going to go like this one. See you in two hours. Did you test? I think it's working out. Yeah. Good. All right. Welcome everyone to the session on the DHS to end user elimi solutions supporting supply chain and health program management. So great to have you here. We'll be recording as well. And we have some participants online. And we'll also have one presenter online. So first, my name is Brennan horse, then LMI technical lead at the his center here at the University of Oslo. And I'll be presenting with. I'm George McQuire, the elimi technical advisor working with Brennan. Yeah. So we'll be presenting then. End user elimi solution supporting supply chain and health program management. So I'll give a very quick intro just to kind of set the stage for what we're trying to propose the approach. And then we'll spend more time though on actually demoing the features and actually seeing the tools and action in the system in action. I don't want to spend too much time on slides, but I want to just give a background. We're doing actually two live demos. So we're asking for disaster, but knock on wood. It should go well. So quickly on the agenda, then I'll do this introduction before we jump into the demos and the sandbox and you'll have access to this. You can actually download the mobile app, connect to the demo server to the sandbox and then actually try these tools out on your own. And then we'll have George continuing and presenting on a transaction based stock management tool and an ICRC. So the Red Cross committee project where they've implemented this, including an integration with a, with an ERP. We'll then present, have a Philip Larson presenting on a remote temperature monitoring tool and integration with Bluetooth centers and how a pilot went in Mozambique and our plans for that tool. Per Kronselev presenting with from I plus solutions and integration project that we have ongoing in Mali with Dermadex as my solution. And then finally from the ministry of health in Malawi, a tracker based tool for managing a cold chain equipment. Due to requirements specifically related to the COVID-19 pandemic. So those will be the different presentations. And then hopefully we'll have time for the Q&A at the end. And if not, you can of course speak to us in the hallway. So first DHS to an LMIS, the big why. And for this, there's multiple reasons, but one is the synergy of DHS to where it's already implemented where you already have stock data captured within the system. And all of these implementations where you can see this from our website where it's currently implemented and being able to connect this to your supply chain management. And also being able to analyze stock and health data to improve health program management. Already having this network, both with the implementation, the support, the competence within the user base. It's a huge benefit as opposed to implementing an intense supply chain solution at a national level. The questions of cost, so cost efficiency, licensing, being a tool that's already used by ministries. It can be then used for capturing digital stock data connecting with an ERP, connecting to your supply chain management. The number of licenses that you would need for implementing a full scale solution at the facility level may be prohibitive. And this is a way of reaching that last mile of the supply chain. The question of competence where you may not have a dedicated stock or pharmacy person managing stocks at a facility. You have caregivers who are also managing stocks and trying to report this data. And this is something that they can do with an application that they're familiar with. They're using to collect health data. And then you add a stock data set with which they report or some other stock tools. And this makes it for a smoother transition and stock data capture for that user. So the what? So this is targeted tools for this facility level user. So if we just have a representation here of a national supply chain from left to right from a central to facility, we're really focusing at this end user level. We're looking at stock management tools, both report based and transaction based, and we'll show that to you later. Of course, this will be shared with you. So you have these slides available. So stock management, I think is one key. Secondly, cold chain management. So that's both remote temperature monitoring, remote cold chain equipment monitoring and life cycle management track and trace capability and quality control for products being issued at facilities. The performance management dashboards, which of course are integrated with the HS2 and available on Android, as you've seen in other presentations. And then also having a product catalog with different items, which the persons at the facilities have access to with information and we'll, we'll demo all of these. So the how, if we just quickly represent here, the health information system on the right, the pillar with the HS2 being used at multiple levels to capture and analyze health data. The way we foresee that in the logistics information pillar on the left here is you have the HS2 at this community health worker health center and hospital level at the point of care being implemented again, oftentimes by a health worker who's also managing stocks and that data is connected to a central system connected to an ELMIS or an ERP, which provides your full scale supply chain management. So warehouse management at central and regional sites, but then also providing a demand planning order management and these different functions that are very specialized for logistics, which we see better being provided by one of these specialized systems. When it comes to demand planning, they then have availability of accurate timely, accurate consumption data from the DHS2 system, which oftentimes comes in through a paper based system or another alternative solution. So now quickly I'll go through seven different points, which I mentioned before. So it's the report based stock management, first and foremost being able to report on monthly stock data using a data set configured in DHS2. We recommend using it on an Android device providing online offline capability. And this is one of the key aspects digitizing the first data mile and making data available for supply chain management. Even if you don't have the central system in place, you do have accurate data from facilities at the point of consumption. And then also there's an option for doing this first at a district level, still reporting on paper and then before moving to facility level reporting. So that can be done also at the district level in the first step. This data set we have also a metadata package, which we make available on the website. And we also have this integrated in different packages like immunization and malaria stock data package, where it's integrated with the clinical health data. And then we're able to triangulate data between health and stocks. We're also working with a transaction based stock management tool, which we hope to have integrated soon in the core that we can make it available later this year. Let's see if somebody from the Android team is here to support of course. So this is looking at real time stock management, having the ability to issue stocks and have immediate view of your stock levels. And of course, having this real time end to end visibility, which is sort of the gold standard and the objective of any advanced supply chain management system. So this is some another tool which we'll demo and you'll see how that functions in practice. Remote temperature monitoring for this for developing integration with a Bluetooth sensor, where we then have these devices connected directly to the Android capture app to both allow for alerts and analysis of cold chain of temperatures in cold chain devices and monitoring vaccines. Biomedical equipment lifecycle management. So managing from point of installation servicing all the way to end of life and having a full, a fully contained card for that specific device. GS1 data matrix. So this is the ability to scan, parse and then control the medicines that are being issued at this point of consumption. And this is something that needs to be integrated with a database, but at least the feature to be able to scan is there. And we see it being used as a quality control tool at facilities. Of course, the integrated dashboards here with a simple example showing doses administered of a BCG vaccine or sorry, yeah, for different vaccines and the stocks that have been issued. And then a simple product catalog for the end user of what they have available at their sites. So as I mentioned before, we're not looking to provide an end to end tool and end to end solution, but we're looking to focus on this facility level. So the ideal implementation would have a central system managing your supply from a central medical store down the supply chain. And then having DHS to capturing consumption level data values being shared between the two systems, both the amount shipped from a central store down to a facility and then the consumption and quantities being issued down to that last data mile, the last service mile, which is the first data mile. And then to highlight that a lot of this work in capturing this approach, developing these best practices and promoting this has been helped through this key partnership with the Stella Center of Excellence, which we have some people present here today, which is a cooperation between the University of Oslo University of Basel, Swiss TPH, and the Novartis. So we have some representatives here and we've worked together on this and they've really facilitated a lot of that work. So Fabien, Doug, Carlo, so thanks for the support. And with that, we'll go quickly to the sandbox because all of the different things which I've shown, we want to make available to you. We want you to test it, ask questions, implement it. So we'll go quickly to George who will actually show it and we'll do our best to make sure that all of the demos work as they should. Yeah, and we have the Android team lead in the room. So no pressure, right? Also the analytics team lead. So let's see if I pass the test. So until now we have been like, you know, holding meetings, giving presentations, always showing PowerPoint slides, but actually the proof is in the pudding. So we basically have created the sandbox. We are now, all of you can connect directly to DHS2 instance and check out all the applications that we'll go through very briefly. I will not explain in detail, but just for you to know what's available in the package. So this is the URL to connect to. You have the username and the password on the website. I think there's a link already on the DHS2 LMIS sub website. And for connecting to the Android, you also have the, it's a QR code. So you don't have to type the URL. So the sandbox rules is bring your own poi. So it's Android only. Charge your battery and bring your snacks. So we don't provide the toys for the sandbox. It's open around the clock. There is a detailed documentation. So there's no secrets. So the configuration of each of the tools that I'm presenting is available. I think already available as a PDF or it will be available this week. The screenshots and the screen sharing is enabled. So you can share it on a desktop computer. It's one of the Android settings. You can enter data and edit as you please. But every day the sandbox is cleaned. I think this is like the standard for the sandbox, for the sandboxes. So if anything breaks, doesn't matter. It will be reset in the night and next day, everything will be working again. And then we briefly show that the analytics are accessible also on mobile devices with a progressive web app. So you have to open it in the Chrome browser. No hacking, please be nice. We already have bad points with our system administrators. And we have to ask them to fix things. So briefly you have here on the left side, the sandbox prototypes. Everything is designed for Android because basically our concept is like to have a Swiss knife in a pharmacy in a clinic or community health worker. So it will only work on a mobile device, like entering data on a desktop computer at the district level that works well for HMS, but not really for stock management. So we have tried to use as much native functionality as possible, not to stress the developers too much. Everything can be used offline. Of course it's part of the DHS2 concept. We tried to make it a simple and user friendly for end users. We're not trying to do something complicated, just providing basic functionality, but for the end user. But it's not simplistic at the same time. So it's well thought through. We have been thinking a lot of it, feeling a lot with the details. And Kirsten mentioned the first day, stealing was the word of the day. So you're welcome to copy, to clone it, to steal it. So that's where the configuration is there. And hope to inspire you to adapt it to your own context and needs. And we are trying to also encourage best logistic practices, like minimizing the data that you need to collect. You don't need to usually collect a large amount of data. You just need to collect the right data. We are planning some more prototypes and any feedback is welcomed under the community. So I'll start with the demo of the prototypes that you have seen in the screenshot. I'll just go top down. It's maybe not very logical, logical order. So the first one is a biomedical equipment, life cycle management. So we have seen this is a need. Many people, they have different tools for alarms, for servicing, for maintenance, the functional status. And we had the idea, we all put all of it in a single tool. So the idea is that you can basically have different stages for the entire life cycle of your equipment. So this is the first icon. It's a simple tracker program. Everything is native. So first of all, you get a nice catalog. So you can click on the picture and you can see what device you're talking about. That's maybe easy with the refrigerators, but there's many different types. And in the hospital, you could have a lot of different pieces of equipment. If you click on the dropdown here, you'll have a little kind of catalog with specifications that you can customize like the PQS code, the model, the brand, the expiry date, the warranty expiring, and you can customize it to your needs. So that's kind of the product catalog, but that's just part of the actual application. And then you open the tracker program and you have these stages. So you can install the equipment. The biomedical engineer can then write the short report that it was installed, tested, commissioned, staff was trained and so on. I will not show all the details. So there's a WHO requirement that when you have an alarm on a refrigerator, normally you should be recording the reason for the alarm, what cost it, how it weathered and how it was resolved. Then the equipment status. So this is frequently asked for just is it, is the equipment working or not? Does it feature an alarm? And basically have that on the dashboard. Then the biomedical engineers can report any servicing or repair. So if they cleaned the equipment, if they repaired, if they replace any parts, and eventually if you, when the equipment comes to the end of its lifetime, you dispose of it, you can also record that. So if you wanted to report, let's say an alarm, it's the simple tracker program with the stage, you just add a new event and I will not take the time to show the details, but I guess you all know the tracker, you can enter text. And if you want to make it easy for your staff, you can also have dropdown menus like saying, okay, the alarm was resolved and I didn't report to my supervisor and just store it. So that's for the cold chain equipment or any kind of equipment, the first application. I forgot to show is that you have a list of equipment and you might have five refrigerators or 10 refrigerators in your store. So when you want to search for it, when you want to record the alarm status or the functional status, you can make a search for it. And so that you don't have to look for the equipment in the long list, you can just scan the barcode. So that's the demo effect. It's actually working. And then that's the trap. Click the search button and that equipment will actually come up. So that's the refrigerated it. So that avoids mistakes. You can also, people were asking about QR codes. You can also use QR codes or also NFCs are on the list. Okay. I moved on to the next GS1 data matrix code. So thanks to the tracker tomb. That's a great improvement. It looks like, doesn't look like anything very particular, but it's actually big. If you are in need of it, if you're a pharmacist or working in this, on these issues. So I'm just going to demo it. So I'm just going to scan a GS1 data matrix code. It's not, it's not a QR code. It's a particular code that encodes the serial number, the batch number of the medicine. So you have the barcode icon here. I'm going to scan the GS1 data matrix code. So it has to be in focus. It needs a lot of light. Actually worked. So you can see, it doesn't look like much. You have a long alphanumeric text string. And you can see that you have the product ID. You have the batch number, the serial number and the expiry date. That is all in the text string, but it's encoded in a very specific way. It's not easy to read. And you can't read it with a normal barcode reader. So you can do a lot of things with this one. I wrote it down because I actually can't, couldn't memorize it. So you could use it to scan the GS1 data matrix code. Let's see, have a vaccine to record the batch number in the registry. When you vaccinate a child so that you have a reference. If there's an adverse effect, you could also just use it for the sake of recording the batch number. So you know which child received which batch. If there's a batch recall, you can see exactly which batches are in what facility. You could use it. We envisage that you can use this. Now you have the batch number in, in a code that you can use it for batch level management. You also have the expiry date. So the next thing we're going to do is that when you scan it and the product is expired, it will give you a warning on the screen. This product is expired. Don't use it. Then if you have not heard about it, you can see this. It is expired but it is still signed. Now it's also suspended compliant with National tracking trace regulations. So this is already enforced in the US, European Union in Japan since February, 2019. And it's coming worldwide. So many countries are implementing it. So the use of this PS 1 data matrix codes will be compulsory maybe in your country one day. Then there's a big project from UNICEF, so the drug quality verification for detecting counterfeit and falsified medicines. So the idea is that you can scan the GS1 data matrix code. So every package that is manufactured by the manufacturer has its own number. So rather than having just a batch number for 10,000 packages, each and every box has its own number. And you scan it and you can then check in the database whether that product is identified as counterfeit or not. And if it's counterfeit, then you can alert the health worker not to use it. The tracking trace also requires decommissioning. So in order to have this database, maintain this database of which unit pack numbers are valid in which ones are not, you have to report whenever you remove our unit pack from the supply chain. So when you distribute it, you have to report it to the database so that if anybody else would try to use the same unit pack serialized number, you would get an alert. So we hope that we can build a tool for that. Then you can also track serialized packs, unit packs end to end. So the supply, the manufacturer is keeping a database. They know exactly when the manufacturer needs unit pack. Either you're tracing it through the supply chain up to the health worker or the immunization worker administering the vaccine. You could also combine that with geolocation. So there's one use case where you want to know if you donate medicines or the medicines are intended for use in a certain country and they turn up in another country, you could detect that. And to ultimate dream, maybe we talk about that in five years time is that if you can track the exact path of this medicine through the supply chain end to end. And if you have a record that Philip will show of all your temperature records of the refrigerators and you know exactly in which refrigerator every unit pack went, then you can have at the end the complete temperature record of your vaccine from the production line until it was injected into the arm of the child. So that would be a dream come through. So and probably there will be other applications for the GS1 data matrix code. So it's really like an enabling technology like barcodes that we'll have other, I'm sure that we'll have other uses. The healthcare product catalog, I can show it briefly. It's basically what I have already shown for the biomedical equipment. Basically the same thing, it's a kind of tracker program without any stages. So again, you can customize your catalog and you can have a picture. If you're not sure what atropine is, you can have here, for example, the WHO essential medicines list classification and a short description. We also tried to make a linked URL to a document like the MSF essential drugs guidelines. So if you want the treatment guidelines, you could link to that if you are connected to the internet. The health temperature, the temperature monitoring. So this is what we call the basic mode is instead of recording the temperature on a sheet of paper in the facility twice a day. So in the morning and in the afternoon, like minimum, maximum and current, you can do that now directly into DHIS2, which means that you have the record on the server and cold chain technician at the district level or in the capital could basically review all the refrigerators and prioritize the maintenance and repair. And then finally, the monthly stock recording. So this is what we call the basic mode where you enter, you count your stock every month, the basic enter your stock on hand and you calculate from a stock card, the stock that you have distributed and you enter it for all your items in the stock at the end of the month. Very simple, but still the idea is that you can collect it at the facility level and then have all the data on the server. Looks very simple, but to my knowledge, I don't know of any projects, probably there are some where people are actually collecting stock data at the facility and then integrating it with an upstream system. So the last one, I will not go into details just to mention that you can also do calculations. So our philosophy is that basically only collect the essential data that you really need, which is the stock on hand and the stock distributed. But if there's a need, also took a like calculator or opening balance and the closing balance, then that is also possible. Just not the PN, so okay. So that's all what I wanted to present on the sandbox. So as George said, this is available and you can access it through our site and you can play with all these tools and download the Android capture and do everything that George has showed and also contact us and give us some questions if you have. So just a big hand for George. Not too fast. Yeah, you clapped early. Sorry. You didn't clap loud enough, so I'm saying. Yeah, chocolate, okay. Right, in fact. So I'm presenting the Pharmacy Stock Management Project from the International Committee of the Red Cross. So I'll start with, unfortunately, the ICRC was not able to join today. I hope they will come next year and present, but I have been working for them for 25 years. So I guess I'm qualified to speak on the behalf. So DHIS2 has already been implemented by the ICRC for the Health Management Information System. So they use it for HMS. They also use it for the Electronic Medical Record System. And the ICT team of the ICRC has generously agreed to contribute to the code that was developed by BIOS systems that I will present briefly and make it available to the community. So it was posted on Monday. It's available on GitHub for anybody who wants to use it. You can basically download it, study the code. Only caveat is that it's not supported. I mean, the ICRC has support for its own project, but if you were to use the code, it's not supported, but we hope to have it integrated in the core and available maybe by the end of the year or early next year. So this app has been developed by BIOS systems, but in close collaboration with the HIST Center at the UIO. And also thanks to the Android team to make sure that it meets all the quality requirements, design requirements, and to make sure that it can be integrated into DHIS2, hopefully without too much re-engineering. Okay, so the International Committee of the Red Cross and this is an integration where DHIS2 is used at the facility level, as I just showed briefly, but it is actually integrated with an ERP system. So Oracle PDE is like one of the big commercial systems that are used like SAP. It's like a multimillion dollar project that took several years to implement. It's a very complicated system with like 5,000 tables and 55,000 data fields. So it's a huge system, which is one of the reasons why you're not going to use that at the facility level. So very briefly, if you have not heard about the International Committee of the Red Cross, which mainly works in conflict areas. So it's an independent neutral organization that was founded in 1863, not 1960. So if you have, provides humanitarian protection assistance to victims of war of armed conflict, has 20,000 of staff in about 100 countries, works in international humanitarian diplomacy and humanitarian law. It's mainly, it's well known for helping prisoners of wars for detainees, but also has big economic security projects for distributing food and household items. Also famous for restoring family links, providing water sanitation services, education also. And the health department supports first aid units, facilities, primary healthcare facilities, primary surgery, so war surgery and hospital services and physical rehabilitation. So the problem, I will be very brief because I think we all know the problem is the manual stock reporting at healthcare facilities. So you have the monthly stock report then you have to physically transport that record in a car, sometimes in a remote area. You have to bring it to a Red Cross office and they're usually this entered into an Excel file or maybe an access database, but in any case the written record has to be retyped. And then somebody is sitting there making the calculation based on an Excel file and their own algorithms. And the problems is that it's low because you have a delay from recording the data on the paper until you have somebody typing it in an office and you're usually sending it by email to the logistics team. You have to retype, so it's prone to error. You have very limited analysis because people often say there's a lack of data. Actually, there's tons of data, but the problem it's all in stacks of paper. So it's not accessible in a format that is useful for anybody because you would have to go through many records to find out the paracetamol, what was the consumption for the last two years. It's all there, but nobody would have time to dig out all the data. So lack of historical records in a consolidated way and you have no real monitoring. So you just have snapshots of your stock report from let's say end of May. But if you want to know what your stock report was in December, you have to go to another record and dig it out. So it's all very inefficient. So these are basically the business requirements that we had for the project that lasted 18 months after feasibility studies. So it should be very simple. The health workers are already busy. They often have many duties. You might not have a dedicated pharmacist. So the last thing you want to do is give them another two. Like the fifth app, you have to train them on and ask them to spend a lot of time entering data. So it's supposed to simplify their life. Then the offline capability, that was the main requirement. So I mean, if THR students have the offline capability, then it would not have been selected because the network connectivity, I mean, there's few healthcare facilities where you have permanent 24-7 internet connectivity. So then the requirement was that you want to collect the data on a mobile device, record it and collect it and not on paper. So the idea is that you collect it directly in the pharmacy on the shelf. You count the stock, you enter it into a mobile device and then that is synchronized with the server. So no recording on paper and then writing it. On to an electronic record. Then the requirement was real-time synchronization of data. So of course that means you need a network connection, but at least if you collect your data at the end of the month, you finish the stock count. You synchronize your data. Then after the synchronization, that data is immediately available on the server. It means it's available at the facility, but also for the logistics for the medical planner. It's available in the capital, in your logistic center in Geneva, even at the supply, you could share the data wherever you want. Then the requirement was to integrate and synchronize this system with Oracle so that you have a seamless order flow and a simple way of ordering, calculating replenishment orders for the interest level. We're not going to be kids for that. And this is quite remarkable. The storekeepers, they record only the stock on hand and the demand consumption, nothing else. So we try to keep it as simple as possible. And then for the advanced mode, the real-time mode that they will show the requirement was to have barcode scanning and speech-to-text conversion for entering values. And for the real-time mode, you basically, you record only the stock issues. So there's a single data point that you collect and not a long list of data. And multilingual, so it's available in English, Spanish, Russian, and Arabic. So why DHIS2? As I mentioned, the ISRC has already implemented an ERP system up to the country level. So Juba, Kabul, warehouse in Mogadishu, they are already running the ERP. So no need to have DHIS2 at a higher level. DHIS2 is already used as an HMS system, electronic medical record. So that means there's already in-house expertise, ICT know the system and can maintain it. There's already existing DHIS2 servers, several instances, it's user-friendly. As I mentioned, it's available as a mobile app. So Oracle is a great system, but there's no mobile app for that. It's offline functionality already mentioned. Staff are familiar with DHIS2. And again, basically you need to train the staff on the N1 tool, which is DHIS2 for HMIS, for logistics, EMR, and the other tool. We're also looking in implementing the biomedical engineering, the temperature monitoring, so it will be a kind of one-stop shop. And it's multilingual and it's free and open source, which reduces the development time. So this is basically the very simple architecture. So you have DHIS2 on the, collecting the mobile device, synchronizing with the server. It is integrated with IRIS, so IRIS is kind of user portal, web portal for Oracle GDE, where users can prepare their orders. And it's also integrated with Tableau for the business analytics, because DHIS2 has native analytics functionality, but Tableau is an institutional BI tool, so you can have data from HR, finance, logistics, operations, all in one system. So there was a feasibility study carried out, then there was an 80-month pre-pilot with the Somalia Recreation Society in Somalia, of all countries, believe it, and Somalia worked excellently. So they have been collecting data on DHIS2 since January last year, without any interruption, without any major problems. And that kind of demonstrated the feasibility to use this. There's often a lot of skepticism using mobile devices, what if they break, what if you have no network connectivity. So Somalia has proved that this is very feasible. That was used just with a default data entry form, it was not integrated, that was just to demonstrate the feasibility of using DHIS2. So the rollout is actually, technical life was last week and actually started yesterday. So it's planned in 50 facilities in seven countries to start with, and hopefully will expand. So we, this envisaged to use it in 300 facilities around the world. So only, of course, those facilities that are supported with medical supplies by the Red Cross. Already mentioned the court sharing. So just to demonstrate the simplicity, so the impressed level that is used for calculating the monthly replenishment orders that is managed by the health program managers. So the storekeepers don't have access, it's great out for them, they can still see the impressed level just for the information. And the only data that is collected is the stock that is distributed from the first to the last day of the month and the stock on hand, nothing else. So we collect exactly the same data as is collected today on paper and keep it as simple as possible. So this is basically, so should have said, so this is what it looks like on the web portal for managing the impressed level. And this is basically what the storekeeper sees on the mobile device. They have a single screen, a list of items, they can consult the impressed level and they enter the stock on hand and the stock distributed, that's all they do. It's once a month, it won't be simpler than that. You have a login screen and then they go to the screen, it will default to their facility according to the user settings in THS tool. So there's little room for error. So I will not explain that in detail, but this is the Iris interface for Oracle GDE you can see on the left side. This is what the ISAR uses worldwide as their customer portal. It's a bit designed like Amazon. So you have transportation, your order status, you have the catalog, you can check prices and of course you can make your orders. And the point is that this state is now synchronized. So this catalog, the list of these items is coming from THS tool. So you can add and remove items in the THS tool web port and it will be added. And the prices, the unit packets coming from Oracle, the impressed system is coming from THS tool and the stock on hand as well. And the stock on order. So the quantities that have been ordered but not delivered yet, those are coming directly in real time from the Oracle system. And then this user interface will automatically calculate the monthly order. You can see here. And then you have the rounded order quantities. So the calculated quantities are like result of a mathematical calculation but they will be rounded up to the next unit pack because you can't order 991 tablets, you can order only 1,000. And then the user basically everything is like a spoon fed. As soon as the storekeeper in Afghanistan or in Congo synchronizes their data, it will appear on the screen. They can reveal the data if they like it. If they want, they can still increase or decrease the order quantities. And then it's not on the screen. You press a button, create order and validate your order as any other order. So it's a seamless system. There's no copy pasting, no Excel involved. That's my life mission. Excel free world. And then we have the advanced real time all, I think. So that I will demonstrate briefly. So this was, this is the application, custom build application that was developed by Bao systems. But it is really just a user interface. It is built on a conventional native tracker program with five stages and two program rules. It's really simple. It could be set up in half an hour. And just to mention that in order to use the real time mode, you will have to have barcodes on your items. So these are not product barcodes. These are generic barcodes. Let's say the barcode that you see in the middle, that's for providone, 10% 200 milliliters. So any product from any manufacturer that is 10% and 200 milliliters can basically be managed with this barcode because managing your stocks with the product barcode, that's another story. Then you have many different barcodes for the same item and different packaging and so on. So that's a very simple system. So these barcodes are printed from Excel. You do it once, you attach it to the item and you're basically ready to go. So it takes an effort to set up your pharmacy to start with, but the picture that you see is actually from the pilot that was facilitated by Brando from the Norwegian Red Cross at that time. Sorry, at that time. And the ICERC in Yemen, in Aden, believe it. And we didn't use THS2 at that time, but it was used. We used another tool for six months. It worked really well. And after using pink cards and stock cards for 25 years, once you have a barcode scanner, I tell you, you never want to see a batch card in life again. And I finished my work with the Red Cross. So now it's tablets only. So quick, yeah, go ahead. I mean, at that it was managed without paper for six months, yes. Yes, we trained somebody for that. I forgot to show the analytics on the dashboard, but you have basically the line listing in the Progressive Web App. So if you have not tested the chocolate box yesterday, yes, you can do that any time after or in the break. So you can see, yeah. So the objective of the mobile app was to keep it as simple as possible. So you can either distribute stock, you can discard it if it is expired or if it is damaged, and you can make a stock correction if you find that the stock balance is not correct. So again, we tried to keep it as simple as possible. Initially it was only one screen. We ended up with three, but still very simple. So we select the distribution. It will default to the organization unit that is set for the storekeeper. It will default to today's date. You can predate it like five days. And all you need to do is to select the word or services, service you want to distribute your goods to. So I'll give it to the high dependency unit. So for those who have not worked in a pharmacy, basically you have the in-charge of the different departments, the operating theater, the emergency room, the pediatric ward, they will come every day or once a week or every two weeks depending on the schedule with a list of items that they want the pharmacy to provide to that order service. And then what the storekeeper is basically doing all day in and out is going and picking those items on the shelf, preparing them and delivering it to the operating theater, for example. And today, if you do that, you have to basically, every time you take an item off the shelf, you have to take up what is called the bin card, a batch card, you have to write the date, you have to write the emergency word, you have to write the quantity and sign it and put the paper back on the shelf. Somebody's smiling, you know what I'm talking about. And then you take the next item and you fill in another bin card and you do that all day. It's really boring work and it's much more fun with a barcode scan, of course. So this is replacing, it's not replacing your bin card but it's replacing your stock card at least. So you select high dependency ward, then you go to proceed and then this is basically the stock we have. So we have four different types of chocolate, very special pharmacy. You want to work in this one. So you can see that, you can see at the top of the mobile app, you can see it's in green, it means you're distributing so that you're sure that in the right place you're not discarding or correcting. You can have, you can see the organization unit, the date and you can see the facility where you're distributing to just to make sure that you don't mix up where this is going to. Now for selecting the items, here it's only four items, so it's easy. We have also the cookies, but we're out of stock. So is that if you have a long list, you have to scroll up and down. So a clinic might have 58 items, a hospital would have 300, maybe 500, up to 1,000 items. So it's very boring to scroll up and down. Also easy to make a mistake because artesonate, for example, automated comes in different strengths and you can easily mistype. So you can either, you could scroll if you wanted, you could also make a search, but that's also boring. So the key innovation, I mean, others have used it, but it's now available here is that you can scan the bar code. So I'm going to scan the yellow chocolate, right? So you can see it says chocolate yellow and it doesn't look like much, but it tells you actually how much you have in stock. So you can, it says 35, there's actually 35. And if I'm the storekeeper, I'm going to pick two. So I'll just enter two and confirm that. Then I'll take another item from the shelf. Let's say the green one. So I'll take three. And now you can do something that is called residual balance counting. So there's 33 in stock, I'll pick three. And we're not expecting the storekeeper to check each and every time to recount how much is left on the shelf because that would take a lot of time. But normally in the pharmacy, medicines come in packages like drains and catheters, bandages. Also, medicines are often like coming in and overwrap 10 packages of 10 ampoules come in 100. So when you have a round number like 30 and it's three times 10, it's easy to check. It says 30 and I can check it's three packs of 10. And if it was 31 or 29, you would see it even without having the count one by one. So this is something that has worked well in Aden. We have, for example, boxes of 2,000 masks. And it's very easy. You have three boxes, you have 6,000 masks. It says you have 4,100, you take out 100, you should be taking a big box and putting it out of the pharmacy and have two big close boxes with 4,000. If that is not the case, then you know immediately that you made a mistake in the stock count and it's easier to check it right away than to find out that the end of the month will not find the mistake. So you go on review. So you can check again, you have two yellow, three green, so that's correct, right? Trusted without my glasses. And that's basically all you need to do. You can still, you have this screen so that you can make a correction. You can remove a line, you can add a line, you can change the numbers. And if you confirm the distribution, then you just click on confirm. And basically that's all there is. You will see that there's now a small entry on the top of the list high dependency unit with the date and the time. It's just a short record that you know that you have made a delivery to this place. It doesn't give you the details. The details, you will have it in the Progressive Web App in the beautiful new line listings that was just launched fairly recently. And the line listing is basically now replacing your stock card. It's basically an electronic stock card where you have a record of all your transactions. And what happens with this data? With the web portal. So the integration that is done by iSARC with Oracle, it works for the default data entry form as well as for this one. So whenever you update your stock on hand and you go and you synchronize, I mean, this is like native functionality, you synchronize with the server, then that's current stock on hand is available to the program managers for calculating the order. So in principle, if you have a good internet connection with a permanent internet connection or let's say a connection several times a day, then you have really real-time data. So you can envisage the medical plan in Nairobi having a dashboard, checking every morning, shortages in healthcare facilities rather than waiting for somebody to call them and tell them that they're out of stock. I finished just on time, right? Are we taking questions or? All right, a big thanks for your work. Somebody has to take the chocolate because my stock is otherwise not correct and I'm not taking it back. And you will not find somebody with more enthusiasm or knowledge for logistics management than George McGuire. So you can get his autograph outside the door after the session. I wonder if we have time for just one question while we get to Philip set up with the microphone. Does anybody have a question for George on the presentation here now? Can I have a chocolate? That's what I was expecting. The answer is yes. Sorry, just temperature monitoring the earlier slides. The temperature monitoring, is there any automatic connectivity or they have to enter manually every day? So is there any option there or not? Just on Q, this is what he's presenting now. Your prayers have been heard. He has a solution. Seriously. This is just the basic mode to get you started to put it on a mobile device. But yeah, if you can, the other questions that we will let Philip go. And we didn't pay him to ask this question. Really, it was completely spontaneous. Cold chain monitoring using DHS2 capture app and Blue Maestro Bluetooth temperature sensor. Welcoming Philip Larson. Thank you so much. Hi, my name is Philip. I'm a master's student from Ithi. And together with these guys and the Android team, we've worked on a cold chain monitoring app. So yeah, vaccines are really costful and really, really important issue regarding immunization, as we know. And the solution is to improve cold chain monitoring. So we've done this by utilizing some Bluetooth sensors and Android application. So yeah, do you want to talk about? Yeah, the previous slide was mine as well, but we're still enthusiastic. I thought I'd let you go. All right, so the two use cases that were present, and I'll present just the use case quickly. And then Philip will go into the technical solution and then a pilot, which we ran a Mohsen Beek. So I think the first, he gave the problem statement, which is temperature monitoring, ensuring a proper management of vaccines. So then the first one is providing temperature alerts. So with both within a temperature threshold and providing real-time audio or visual alert, and then a next escalation alert if no action is taken. And the second is recording temperature for analysis so that you can actually have a record of how products were kept over a period of time. So those are the two main requirements. And then just a quick example of this is based on aggregate data. So the manual input is George mentioned that you can then have analytics to map where you have alerts, where you have issues with cold chain equipment, where you need to do some corrective action, improve the equipment, and then provide also some analysis and seeing it's very small type, but more or less this is showing that regions which are more remote, more rural or low resource, you have more alerts, so you need a bit more follow-up on the infrastructure. This is from Molly and Togo where this was being used with aggregate data. So then the technical solution and what then Philip will present is the automation of that, that you're not inputting manual data using thermometers, but you're actually having this digital sensor connecting to the device and then having real-time alerts and then integrated data for also supervisors at a district level. Yeah, thank you. So now over to the fun part, at least what I like. So the solution, the first part is the Bluetooth sensors and it's quite small. It's waterproof, have a small watch battery that you can change. You can also adjust, it advertises temperatures all the time and you can adjust how often it should advertise and that affects the battery lifetime. And when you buy it for approximately $35, it's no subscription or you can just use it and it's fully waterproof and working in a quite far range. So the other part of the solution is the cold chain monitoring application which I developed as a part of my master thesis. And I forked or stole the skeleton app from the DJI's to Android team which has an integration to track your capture and through Bluetooth communication, I connected to the sensor and so you can communicate it and get the temperatures it advertises and storing that in a local database. So you can see all the devices are appearing, different Bluetooth sensors. You can read the different temperature that it advertises and you can collect it and do other stuff and also set alerts and export the temperature manually in the CSV file. So you have like a backup. So yeah, basically what I talked about now it's the Bluetooth sensors advertise temperature. The Android collects it through Bluetooth and you can then upload it to DJI's two servers and visualize it in data visualizer. And also there's a link to a video. I don't have a cool live demo like George but maybe in a couple of days. So the other part was I actually have been so fortunate to pilot the application in the real settings in Mozambique. So the objectives was that we wanted to implement it in four facilities and provide tablets, sensors, mobile data, everything to the facility and then train health facility workers to use it so we ensure they report and to digitize manual reading tasks. So the South Digitus HISP group was taking care of me for about months. I worked with the implementers in Sambesa and Seferino and George Shembrano came down. And this was the current practice. The health facility workers recorded two times a day in the morning and in the evening. This chart represents a year. So after a year, they delivered it to the immunization program. And sometimes it got typed in manually to DJI's two. And when they recorded the temperature they also took the estimated vaccines of the day out in the vaccine carrier and put it outside at the vaccination station without any thermostats or anything. So you lost like the monitoring part. And when we asked if they experienced or if they have like a standardized way to handle when vaccines are spilled, they said they never had any issues with the vaccines. So over three weeks, we launched the app and implemented it at health facilities. And we only gathered the current temperature but of course we wanted to gather more. And alerts that the application supports, we didn't have time to actually test that much. And we had some issues with the Android devices. So we had to scale down to two facilities. But it went surprisingly well to implement and teach the facility levels or the health workers. And we also discovered we attended a polio campaign and they were really keen on using the sensors because they're so small, you can just have it in a vaccine carrier and they have vaccination stations out in the rural areas but it's nice to bring with them. So yeah, after the pilots, we had some learnings. Of course that it's addition to the workflow that they really appreciated not reporting manually. And it's easier to standardize practices in cold chain monitoring. And there were a big difference in the cold chain equipment, how it functioned, how, yeah. And by using the application, you also get alerts which also is a big need. Yeah, I'll just, the technical implementation, I also had some difficulties. Like I said, tablets didn't work as expected due to different versions, both in Bluetooth and Android. And we also had some issues with the internet connectivity. Like the last step when uploading to the DJI servers it could take really long time and power out just was also a common thing. Yeah, like I said, it went really well from the working with the facility workers. They were actually really keen on using it. Nevertheless, they didn't have so much experience with using technology. And they also preferred using their own device because one facility workers had three Android devices and we gave in one more. And it was like, no, he wanted the belt instead to keep all the devices. We also learned that we needed timestamps to prove that the temperature was only not captured in that day but at that exact time. So health workers didn't capture three, four times at the same time. And we also need aggregates like mean kinetic temperature to reduce the storage uploaded to DJI's two servers. And there's also a need to generalize the application further. So this is just a prototype. So hopefully somebody, yeah, you want to talk about the way forward. Right, so this was really great to show that we could have in collaboration with a master's student based here at the university develop a solution that was easily and readily implementable. So this was a minimum viable product which we implemented there. And we identified a lot of both value added for the workflow for the users that wants capturing data. And then also for the supervisors. And I think that was in a previous slide on actually being able to monitor and have data a bit more timely for their general supervision without having to visit a site or waiting for that yearly report. I'll get to a question, just one second pair. The then priority for this and of all the different tools we're showing this is the one that needs the most development. So that will be one of the top priorities is to improve this to make it more implementable expanding the implementation already in Mozambique with the team is already working on and then getting to a level where we can even apply for a PQS certification. Just one more comment, I guess. But the thing about those cold chain setups is, I mean, I don't know if you go to a given country you might have a whatever, five, 6,000 refrigerators. Freezers and refrigerators we're talking about, right? So right now these ones, there's a similar model on this. That means the companies that deliver them, they deliver, they have these RTMDs in them. Remote temperature monitoring devices. So there's certain things around it. They're very pricey, they're very costly. If you get this thing out there massively, you can break those monopolies at the cost to, and the cost to actually have those cold chains function will go vastly down because you don't have to have that specific brand out there. You can just have a function fridge. Yeah, okay. So that's, we did not pay him to say that either. Just as with Anand, this is exactly one of the points that we want to highlight. It's as George said for the other that we're looking for a simplistic but well thought through solutions that can be implemented at scale. We're not seeing solutions that can target thousands and even tens of thousands of equipment providing remote temperature monitoring with this level of functionality that can be done at a cost effective way. So that's one of the things that we're looking to target is the ability to find a good solution that works well technically but can also be implemented at scale and provide value for the users. So that's a good point. Anand, you had a question before, so. Yes, for this actually smart tag. What you will put is a blue, specific blue text but already we have 1100 pieces which have already been sent back. So how most tech would be able to do it or we have to buy each tech for the other you don't have a device in direct order experience. Yeah, so it depends on the technology. This utilizes BNE. It's Bluetooth low energy. So it's all I have really. Yeah, okay. So like the communication part is already set up and maybe eventually in the future it's part of the core and then it's so generalized that it doesn't matter which device you have as long as it's BLE it can be used through that. You have to talk to this guy. So with all of the tools. Yeah, so all of the tools you've shown are available now. A lot of them are native configuration for the transaction based stock management tool that will be later this year to early next year. And this is the one that is least developed as I said. So this is still the one that's most work in progress. It's difficult to promise you now but I would expect early next year but for the meantime, we'll be just upscaling the pilot and some of the as we make improvements to the app. Sure, I think we have time for you have one more question. I think it's just very simple ones. It's just the open source code and yes, Camel wins each share. Yes, it's open source, it's on GitHub and I'll provide it. Good, I wonder if we can maybe save some questions for the end, cause we'll move on to Pear and the iPod solutions and the Medexas CLMIS. So a big hand first for Philip. Thank you so much. Does it work now? Okay, thank you. Okay, so yeah. So I wanna start a little bit some years ago. It's actually about three years ago, started talking to Scott. That was before these guys even came on board because we got this idea of using DHIs too in the context of this LMIS. And it has turned into a concrete project now, actually hopefully two, almost two and I'll get back to that. Anyway, talking to Scott was the idea was that you got this DHIs throughout everywhere even at health and social level, at the same time there's big issues around getting LMISs to work in the countries. I'll get back to why that's an issue. So we wanted to try to combine things. That's what I wanna talk about now. This is a project, this is a very concrete project which is part of my work in Mali and it's well obviously funded by USA I think that's clear. So, yeah, let's move on. So it's about interoperability between our LMIS and DHIs too. So, okay, I do that, thank you. Yeah, I'll just do that here, sorry. So the name of the project is Kenya Sensiwale. It's a large health project. So it's not an LMIS project, it's a health project. It includes all sorts of things around these health facilities. We're a small component in it. And it's done by Palladium and we are subcontracted to Palladium. So, okay. It works, okay. So very briefly on the project itself, it includes the three most popular regions in Mali, everything around health facilities in those regions. How they manage their money, their doctors, all sorts of things. We are the supply chain part. And who are we? I think that, oh, it's coming. Well, anyway, that number of various goals, I'm not gonna begin to this. But we got people at all different levels there working with this part. And yeah, who are we? So I work with iPod Solutions and we are strictly doing supply chain work. We've got one major task which most some people know we do is we are the procurement agent for the Global Fund, as it says, for a number of commodities, we're pretty big in that one. But we also do technical assistance. We also work with systems in countries. In that respect, we're relatively small, but we have this and we have a number of different projects and we work a lot around systems, technology, how to use that. Yes. We're having this iPod Academy that's a web learning basis and we got the system called Medexis, which I will talk about now. Yeah, so now we get to the really interesting part, the challenge. So, I mean, right now we put a rule on Mars, right? We got, I mean, we've done a lot of things. You've got health facilities out there, people use mobile phones, they're on Facebook, all these things. At the same time, in big, big parts of Africa, people still have big pieces of paper like this and they fill them in and fill them in and fill them in with various information around these products. They get these papers together. Sometimes they just stay there. Sometimes they move to a district. They might even also fill them in. At some stage, it's probably punched into a spreadsheet. At some stage, the data ends up somewhere. Anybody who works for the logistics knows that that is pretty useless. The moment the data is a month, two months old, it's just too old. It's not interesting to know what was in stock three months ago somewhere. That's not interesting, but that's still the reality. Why? Well, that is, I would claim, it's got to do with cost and complexity and maybe also the whole approach has been there for a while because you can put you, the E-LMS solution has been there for at least 15 years, functioning solutions. They've been there, but they've been made based on a technology approach or a technical view on things, right? That means you make a nice system, this and that and say, okay, now we train people on this. And that's when you have hit a big problem usually because if you're going to do this in a country, okay, how many health facilities you got? 4,000, 5,000? You've got maybe 4,000 health facilities. Ideally, you should train two people for health facilities. That's 8,000 people. Now, a third of them will change jobs every year. That's normal. They don't stay that long in these jobs. So every year, then you're going to train a couple of thousand also. If you've got a relative complex piece of software, you want to train for people in rural Africa like that, it will cost a fortune. Especially USA has spent those fortunes in a few countries and they have succeeded, you could say, but it costs a lot of money. And it has actually attacked to a wide extent in many other places because the donors have pulled back from it. They say, oh, yeah, we can do the implementation, but then after that, we will not every year put in a couple of million dollars every year just to make the machine one. So that's the problem. Now, that's a challenge, right? So why are we there? This is an attempt to deal with that. I just said that. Now, so the idea is to combine DHIs to interface with a real LMIS. That's the idea. And because at George, he referred to this cost, actually. So it's to deal with this implementation cost, the maintenance cost, to make it happen. That's the whole approach, right? To deal with that main issue. Okay, so now we're in Mali. I got this project. So in Mali, the way it works in Mali is that you got, there is actually a DHIs2 is in every health facility and they report into DHIs2 every month. And they also report some simple logistics data, stock on hand consumption, expires, these kinds of things. Now, this data in Mali today is aggregated. It goes into DHIs2. It reaches a dashboard. It's called OSP Santé. And this dashboard is watched by Minister of Health, donors, kind of people. But there are some issues about it. One is that it goes in there, there are certain delays, and later on, they look at this, but there's no connection to the supply chain. The way they manage the supply chain is on paper, on the bin card, the piece of paper, you know? And then they transfer that into another piece of paper where they do the calculations, calculations, final calculation, and that one's written into another piece of paper. And then that paper goes physically to the district and then the district figures out how much to send. It's about one and a half months process. So no link between the digital flow and the supply chain flow. And then there's a lot of issues around stock outs and issues in the sense that the problem is there is actually products out there. There's products at central level, but we've got lots of problem with the supply chain at between the level of district and health facility and between the CMS store or regional CMS store and district because of this paper show, right? That's the situation there. Now, okay. So the concept, what we thought of, actually, now it's quite a while ago, it's one and a half year ago, I think, I'll get back to that, because it didn't take that long to figure it out. It's taken a long, long time to make anything happen, but what we thought of was to take that data and then take it from the DHRs to enter in and immediately put it into an LMIS, work with it at district level and then figure out how much product to send to the health facility, right? That's the idea, that's the concept. And also after that to go into incremental improvement because it's pretty obvious, the moment you make it work, you could start work with the frequency, for instance, maybe go from monthly to weekly. You could do various things. You could also actually work with, you could give them an app. You could give the workers an app and say, okay, like they've seen George showed, do that. There are a number of possibilities the moment we get started, right? So, now, okay, I'll try to do this. It can, okay. I'll go a little bit quicker. I don't know if that makes sense, but so the idea, the SESCOM, that's a health facility in Mali, it's called SESCOMs in Mali, right? The DRC, that is the district level. So, the idea is we get these, the stock position, the consumption estimate, we get that from the health facility, directly into DHRs too. It reaches Medex, this is an LMIS, E-LMIS, which we got. It could also be another one, but it's our E-LMIS. It reaches that one, and there's an integration which can be created with the help from the team here, George Brenner, so it reaches that one. And then, because then in that E-LMIS, we can do the calculations, we can do the things you do in an E-LMIS which DHRs too is not so good for. And we can, of course, create an order at the district. The district can sit and work with the E-LMIS in a proper way, do all those things. They create an order, it can be shipped to the SESCOM. And phase one, that, by the way, for the donated products, and then for the phase two is for the procured products. That's more complicated because you've got money involved. The donated products, we can do that as a push, an active push. The procured products, we can't do exactly the same, obviously, because they have to pay for it. So there, you can't just have the district deciding, now I'll send you a hundred. I mean, the guys will receive those, actually have to pay for it. That's why we have to split in two. Anyway. Now, I'll just go. Oh yeah, and the dashboard remains, right? We're not gonna touch that one because all the data goes still into DHRs too, but the dashboard picks it up so we're not touching the dashboard. And that, it's one of the learnings for dealing by this is there are certain things you should just, in life, there are things you should fight. The balance you take and balance you should not take. One of the balance you don't take is, for instance, don't try to change people's dashboards. They like them. So don't say, I'll give you another dashboard. Can do the same. It's all very interesting. Let them have the dashboard. It's much better. And that's what we do here. So it stays, they like it, no problem. And we'll get the data. Okay, so what are we gonna do short-term? Short-term. So the data goes into the DHRs too. As today, that means the health facility will have no change whatsoever. We don't have to train them anything. We just, but the difference, there's still a big difference because now we will take the data. I mean, the paper flow, the order flow to the district will stop. So we'll take the data and get into the system and we'll generate the order in there and then we ship the products. So for the health facility, there's no change. For the district, there's a substantial change and there's training and things involved. But after all, we're only talking, we're dealing with in total 28 districts in those three regions. So that's doable, right? 28 districts, we have to manage, work with 50, 60 people in total, that we can do. So we'll take that, the district will work with this and then it goes into our dysmedexes. They work with at the district level and then we generate the order. That's the short-term. Yeah, so another advantage you get is actually on the data side because right now there are problems with the data they put in there because the only reason why they put the data in there is because they're told to do so. They have to do so, right? But it's not used for anything, really. There's somebody who might make noise if you don't do it right, but it's not really used. But of course, we might get some challenges now where you realize that in the sense that what we have now is to put the wrong data in that the supply chain is not gonna work. And so now we got to get the right data in there. So it will also most likely improve the data flow. I mean, the visibility in the OSP Santé and the dashboard. The whole data needs to improve because if data in the digital side is wrong, well, the supply won't work. So everybody will have a whole new interest in making that digital data work. They have to have that. We also realize that there will be a challenge which we'll face, but it can also be seen as a big advantage that you actually have to make it work. We get simpler calculations. We get the cold chain systems on more or less the same as George was talking about. The same, same. We also gonna hook these freezes and fridges up to the system so we can monitor the cold chain. Yeah, and we'll do the informed push. That's another thing for the donated parts only, but informed push. So we're not more depending upon the sit and calculate the right number to the issue. It'll be calculated based on the stock levels. So that is the short term, but short term, no change for health facilities whatsoever means also real cheap implementation only training those districts, but a longer term. Yeah, a longer term, there's obviously some possible perspectives and somebody from, I see somebody from the project that told me, ah, be careful what you say. So I'm careful, but well, we don't have money for doing a whole lot of things, but who knows? Given we manage short term, that perspective longer term and then money maybe can be found. We realize we first have to succeed for short term. And longer term, you could obviously, for instance, the health workers, the primary health workers, you've got these, what are they called, community-based health workers going out there. Each community-based health workers today asked to fill in every month a table around their products. That table has 1,500 fields. We're talking, it's a person with a bicycle and some medicines and stuff. And she has this huge form she has to fill in, right? On paper, and this paper then goes onto the health facility who will pass it onto the district who may or may not punch it into something, right? So not into digitized too. Obviously we would like to digitize this. I mean, we could a little bit longer term, go on some mobile apps, simplify things and all these things. All this is a possibility when we get moving, given we get started with this short term stuff. So there are many nice perspectives if we get going. Yeah, where are we now? Okay, yeah, where are we now exactly right now? So actually, yeah, we got all this design done, all this and that, there's a work and the trainings and things are starting next week actually, right? But you'll be on next week anyway. So I mean, we start in next week with things. Hopefully in two months, we should be out there in a number of facilities, hopefully. Hopefully in six, seven months, we should be there for quite many districts. At least that's been promised. So we are just on the brink of rolling this out. Technically, the solutions exist now. Right now it's about putting it out there. We finally have all the signatures in place, all the meetings has been through, all the ones that need to say yes, all of that. Okay, yeah, so yeah, as I said, we are doing the pilot, rolling out, all this. We're actually starting, literally starting next week. It's process and learning, yeah. So getting the idea, well, it didn't take that long. This is talking to people and it's fun a few months and making some papers, yeah. Now, but the dialogue was different stakeholders talking to people like that. More than a year, one and a half year, more than a year, it takes a long time. There's a lot of people that has to get what you actually want to do here and want it. They have to want it, right? It's essential, obviously, to keep Minister of Health part of it. I know it's a no-brainer. I know that, but I'm just saying we also learned that. And also, I mean, Minister of Health is many things, right? There are many parts of a ministry of health. And you may think you're okay because you talk to a certain Parliamentary Minister of Health, but you forgot those guys over there. And that is not always good. So there's a whole lot of politics and things to manage within that and that really needs to be watched. There are multiple stakeholders involved also. You also have the Garvey's, the USA's, the Global Funds, all those people. And they may not have any idea of what's happening. And it's a good idea to try to keep them informed also because they actually may start new initiatives in various ways. The work with George and Beno has been very important for us because we've gotten this details to integration on this sector. I mean, it's been, well, I basically haven't managed without, I'd say that. I don't think so. So it's been instrumental. It was important to put together some technical concepts to actually show people because one thing is to put the PowerPoints up there and then they make this big piece of paper. I say, we want to do this and that, but people, they don't really believe it until you actually show them and do things like George did before. He said, okay, I have this app and do the chocolate thing. And then he said, okay, it works. You've got to do something like this before you are in front of that group of people because the ministers of health and the donor guys and those, they have all seen people who say a lot of things before, but they like, it's good to have this something to show. And then another thing, I guess, learning or evaluation after it. Sometimes it's fun to figure all this technical stuff out and do this and in your little bubble, you do things you get together. But in that work, you can tend to forget the stakeholders. And then you moved on together with your other friends in your little bubble and think, oh, now we have a great thing to do here. Or we would like to do a pilot, but then you've forgotten the stakeholders a little bit. And then you come and say, oh, we would like to do this. They're like, oh, we didn't hear from you the last five months, so now you've got something. And then they might not be so collaborative when you start wanting to do things with the health facilities without having talked to them before. So you must, when you do this fun technical stuff, it's very important to forget, to remember those stakeholders and hold their hands. That's it. I think that's awesome. Thank you. This is paper copies, you can just take them. That's why they're there. Thank you. It's been great to have success in the coming weeks. Yeah, and then by the way, we are actually hopefully, seems to be not so far from getting there, but we're good. Fantastic, looking forward to it. All right, so just to mention also that we're working with multiple ELMISs, we have the same approach integration. So we also suggest that you follow guidance on selecting an ELMIS and that we're happy to work with many of the different platforms that are there. So as the last presentation in this session, we'll go to Ministry of Health in Malawi and Blessings Kamanga, who will present a solution developed during the COVID pandemic for equipment tracking. So I will stop sharing. And Blessings, are you there? Can you share your screen and we'll follow along here? Thanks everyone. Good morning, good afternoon, good evening everyone. Blessings, can you hear us? Yes, I can hear you, can you hear me? Sorry, Blessings, just talk one more time for me. Can you hear me? Hello? Just can't hear if I can't hear you. Okay. Yeah, so good morning, good afternoon, good evening everyone. My name is Blessings Kamanga. I work for the Ministry of Health in the... Sorry, Blessings, we can't hear you. Hold on for a minute. Hello, can you hear me now? I can hear you. Ah, okay, great. So good morning, good afternoon, good evening everyone. My name is Blessings Desem Kamanga. I work for the Ministry of Health in the... Yeah, I can see that you're coming through. Just struggling to figure out why you're not coming through here. Bear with us just a minute. Okay. This is the HDMI connector. So we should be sharing over here. Literally, we did this yesterday and it's fine. There's no separate audio cable. No, no, no, there's no separate audio cable. It's just straight through the HDMI. It should come straight through the HDMI. And the configuration on the... Yeah, so what's this connected to? This is power. This is the HDMI from the lamp. The lamp's coming through. Anybody has any questions for George, Philip, here in the meantime? Maybe we can take that while we can do the specs. Question in the back? Yes, thank you very much for the question. I understand that you want to learn more about how to get out of town, how you can. Why don't you make more time to get that to be one day. They have a lot of events. They have a lot of events. And one of the other ones that you can learn is the studio. I mean, it's a PRC, it's mainly ours. And then also... I thought you wanted to... We could take the second question first, Bear, wait for the second. And then we'll take the first one. I'm trying to answer that one. The thing is that PRC is kind of not useful. It's a much larger system. It's very not suitable. But it's good when it's very costly and complicated. So it's not good to use a really neat, grand, efficient level of protection. It can be possible, but it's very costly. Right. So, therefore, the need for a solution is very difficult. There are two types of solutions. Back in a second. I don't think we want to learn that. But if you can't do it, it's very costly and costly. So we came in as a partner, having already stopped data in DHS-2, which is kind of approach, but I think that's a valid point. And then just to be clear, that we have both the aggregate data, which we can report, or transaction-based data, which is based on the Tractor data model. And that's where the PSM or the app that Georgia demo is built on top of. I don't know if I want to say anything more on that on having me. Well, I'm not sure I understood the question correctly, but basically what we're doing in mining is we have a very simple date and form. Basically, the one that's like a demo, it has five or six columns. So once a month, we're collecting data on the top of our hand, from some of the scope you see. Before date and form at the end of the month synchronizing, and that is actually directly integrated with the Redsys. And if you get back with the Redsys, then connect to the DHS to endpoints, so it's relatively easy to do the integration. Just to try to understand that, DHS, we need to get it in the EU. Very likely we've got less data on top of it, so we need to review what's going on. Well, it is collecting logistic data, collecting the stock data, so the stock on hand on some stock we see, stock in size, stock is redistributed, that is collected once a month, and it has definitely integrated with Redsys, because Redsys is doing the calculation that I showed in the summer in Morocco, some in Redsys also, it's like an automated system that we can do all together. Yeah. For a new woman... Ah, I got it. ...at least one year, at the end of the month, at least once you're gonna be able to find a way around. But basically, with time, especially for the drivers, there really needs to come to a agreement, there really needs to come to a agreement, in case it's green or experts or the manager, and there are also expenses because you have to pay license to these three users. Robert, also, I think if you can also implement that as a business, that most of the things that are being made for life, we can use this as a business. Okay. Another question. The enhancements for the transactional stop management is coming up. Will you anticipate, or will there be, like, where else the warehouse stop transfer might put you now in there? I mean, I would expect. We're looking at distribution now. So it says distribution for non-annual facilities. And then the idea would be to have. Okay. Okay. Okay. Good thing. What we show at the distribution, it's really important for the last month. Okay. Blessings. Can you hear me? Can you hear me? We can hear you. Yes, I can hear you. Okay, great. We can go ahead. Can you confirm? I can go ahead. So blessings. Can you just talk again? Sorry. Yes. I got confirmation that I'm already born. Sorry, blessings either. Okay, thanks. Hi, sorry. Sorry, we just had an issue with you connecting in the room, but we've got you now. Okay. Sorry about that. Okay. Our apologies. Blessings, but welcome. And we're ready and eager to hear your presentation. So please go ahead. Okay. Thank you Bruno. Hello everyone. My name is Blessings. I wait for the minister of health in the digital health division. As a product manager. So we'll be presenting on behalf of the project team members listed here on a use case of day chest to trucker on improving monitoring and management of quality chain equipment in Malawi. Okay. So that's the outline of my presentation. So a bit of background. So the expanded program on immunization in Malawi was established in 1979 with a small mandate of ensuring that infants or children are being vaccinated. So as of from 20, 20 annually, about 800,000 children are vaccinated. And then in order to ensure that these vaccines are delivered, the component of quality, quality chain storage is critical. So we have about 900 content storage points, which are located at different points. So we have some at national level, we have some at districts and then some are at facility level. And then with coming in of COVID-19, it added unprecedented exposure on the immunization supply chain, considering that there were some vaccines which had a short time before expiring. So there was an analysis which was done to look at the gap which was there in terms of quality chain storage. And then from the analysis showed that there's need for more quality chain equipment to ensure that the routine vaccines as well as COVID-19 vaccines are safely administered. So the genesis of the idea. So for the last 40 years, we have seen barcodes or QR codes being used in various sectors. So for instance, these are used in packages of food and consumers. So for instance, if someone goes in the shops, you see quite a number of use of barcodes as well as QR codes. So the Global Immunization Committee has also been keen in exploring the potential use of barcodes as well as QR codes in vaccine supply chains. So the intention is to show that information is extracted as quickly as possible from the treated version into an electronic format. So currently in Malawi, they use the Microsoft Excel files in managing as well as monitoring the quality chain equipment. So this comes with a lot of challenges. So for instance, it means each quality chain storage point has to maintain its own version of the Excel file. And then it's very difficult to have an analysis of like an overall picture of the whole country. And then it also takes time. For instance, if there is some breakage in the quality equipment for them to be replaced because of lack of time of communication on the same. So that's why it is essential to have a digitalized quality chain equipment that would help in making timely decisions. So the digital quality chain equipment would have various advantages. So for instance, because it will be timely reported, it will be easier to phase out all quality chain equipment as well as assessing the quality chain storage, apart from a real time tracking of breakdowns as well as other transactions for the quality chain equipment. Hence the project team intended to develop what is called an EVACS code chain guide. So this is a tracker program which is implemented on 180 surveillance platform or HSP, which is based on DHS2. So the primary objective is to ensure that the quality chain equipment inventory management system is digitalized with the use of QR codes as well as DHS2 tracker. But apart from that, this would also aid in reducing the errors that are there during data entry for quality chain equipment inventory as well as it will reduce the workload that health workers incur by introducing this new technology. And then the idea is that we'll sample some sites to ensure that this is piloted and enough feedback is gotten. So you know the idea of change management and the like, you need to ensure that the users are involved as much as possible. So the idea is to pilot in about seven sites or so. So we have one national vaccine store, one health care center and then one health care center and then one health care center as well as the about four health care facilities. And then the key activities that have been aligned, so one is finalizing the state code for the project and then we have to prepare the concept note as well as the budget and then all these other activities will follow the pilot will have to expand or roll out the project to some other facilities. So this is the information flow. So we have the various functions of the EVACs call chain guide. So we have the call chain equipments themselves as they attract the entity types and then each of those will be enrolled into the EVACs call chain guide, the tracker program. And then once that these are enrolled, there will be two stages. There are two stages. So we have one which we are calling managed CCE, call chain equipment transactions. So here basically you are looking at cases whereby some facility may be in need of the call chain equipments. So you are transferring call chain equipments from one facility to the other. So we have a receipt, dispatch, as well as rain off the call chain equipments. And then the other stage we are just looking at monitoring the operational status of the call chain equipment. So whether the equipment is a forte, it's working or it needs some maintenance and the like. And then there's also status alert notification. So we are looking at notifying the call chain technicians, the EPI officers, as well as other key stakeholders. So for instance, if some call chain equipment is not working, once the data interface updates that in the system, it should be able to send an alert to these officers to ensure that a timely intervention is done. So there's also analytics part where we're looking at analyzing data, both for the enrollments as well as for various events in these stages. And then we'll have dashboards that stakeholders as well as these filmmakers can access and make timely decisions. So in terms of the attributes that are being captured, so we have the manufacturer of a brand name, the model numbers, the serial number, equipment type, and so on and so forth. So upon receipt of each call chain equipment, a QR code is generated. And then that is used to uniquely identify each of the call chain equipment. And then the other transactions I mentioned, as I mentioned, the transaction management as well as the monitoring. Thereafter, it happens. So this is just a screenshot of the enrollment page. So if you're using a mobile gadget, you can scan the QR code. You can also use the web by entering these various tools. So others can be entered manual and in others you're able to select from the drop down list. So apart from that, there are other attributes that you can also select. So this also includes an image of the equipment. And then once all the necessary fields are entered, the call chain equipment can be rolled into the program. And then in terms of the two stages, so for the equipment transaction, call chain equipment transaction, we're looking at if you're transferring the equipment or you are receiving the equipment or if you are laying off the equipment, that has to be specified. And then for the operational status, we are looking at the operational status itself and then whether the intervention has been done. And the also name of the technician operating or looking after the equipment and so on and so forth. So these are also screenshots. So for instance, this is for the transaction. So here you are looking at a transaction whereby the equipment is being dispatched to some other facility. So this is from Bohemian Center to Kasungu District Hospital. So there are those entered there. And then this one, like now you are receiving the call chain equipment that was dispatched. And then you input there the comments on the right. And then this is also, these are also screenshots for the other stage. So here you're looking at the operational status, whether the equipment is working or it's not working. And then you can also include some comments there. And then dashboards can be created based on data that has been highlighted. So for instance, here you are looking at the equipment status, functional status at each of the site. So you are able to identify which facility have also the equipment not working. And then intervention can be done timely. And then we also have a dashboard where you are able to see the equipment that are at the facility where purchased by which donor and so on and so forth. And then apart from that, you can also have a line list of all the equipment that are available at the entire country. So this is a sample of the QR code. So basically there there is information embedded looking at what sort of equipment, the equipment name, as well as the brand, the model that uniquely identifies that equipment. So the same could be used for some other things as well, like the vaccine. So as a way forward, we're looking at ensuring that maybe the manufacturers, as they are manufacturing the equipment, they can already standardize the QR code or the bar codes so that the costs that are incurred in ensuring that the QR codes are printed out can be avoided. So we need to have some standards of what sort of information should be encoded on the QR codes. And then apart from that, based on the pilot, as well as maybe rolling out to some other facilities, get as much feedback as possible and then see how this can also be applied to some other countries. So in that case, we want to work with his center at the invest of Oslo to ensure that this can also be part of the part into metadata that can be utilized in other countries as well. So apart from that, my lab is also providing routine vaccine programs. So apart from using it for the COVID-19, we will also ensure that we use it for some other interventions. So for instance, we have routine vaccines responding to coronavirus as well as for it out of it. So you think that the evacs code can also be handy in those interventions. And finally, I would like to thank especially Yonsef Malawi for conceptualizing the idea. And then we also had the planning program on immunization, EPI, welcoming the concept. And then we also had support from the Bureau and Melinda Gates Foundation through the clinical project by its implementing partners. So we have Cooper Smith as well as Look International Norway, that's Lin. And then finally, also acknowledge is going to expanded program on immunization as well as Yonsef for the technical inputs towards the pilot. So thanks for your attention, Asante Sanna and Siba Kuh. Over to Breno. Thank you. With the mic, I will now thank all the participants and all the presenters and just say that if you can take one message away is that we're looking to build some easily accessible, implementable tools, but that meet the needs of both the ones implementing the ones at the facilities, but also the managers at facilities connecting consumption level data with central level supply. And then once we establish that foundation, we can take a next step and say, now what, what do we do with that data? And I would then recommend that you join the session tomorrow on AI Machine Learning and DHS2 where Bahid Rustami from Macarons and Elmarie Klassen from HIST South Africa will be presenting. What do you then do with this data? Once we get to the level that we have accurate and better data, what can we then do with that to improve supply chain management and health service management? So join that session as well. There's also this same session in French tomorrow. If anybody you know is interested in that in French and thank you again.