 So Till, what do you have for us today? So we have developed a new tool to help and support the health worker in the primary health care facility to better manage the acute illnesses in children. Such as what acute illnesses? So the acute illnesses that we cover are more or less all the more frequent infectious diseases that could happen in children. And so the one that will bring cough, fever, diarrhea. And so we help the clinician take care of the patient more than the disease actually. How do you do that? So we design a clinical pathway so it means that we have created a full algorithm that states step by step all the process that the clinician should take in order to appropriately identify the disease and give the appropriate treatment. This has never been done before? This was never been done in MSF. We were providing some guidelines that are more broadly presenting. If you reach this diagnosis, then you should give the treatment. But it was not clearly defining how you reach the diagnosis. So this is what we bring in you. We have developed, I mean, the idea was based also on what was done by WTO in this integrated management of childhood illness that already had developed some syndromic algorithm. But actually their guidelines were very ambiguous and it was not driving neither the clinician to the diagnosis. And a lot of disease we are not addressing in this algorithm. So I can see on the table you've got the algorithm which is written down on a paper format. Exactly. Because we wanted to really stress all the steps that should be taken especially also to identify which patients are severe which one should be referred to the hospital but then also to go according to the child presentation into specific guidelines or recommendations we ended up having a very complex protocols and pathways. Being a doctor is not easy. No, being a doctor is not easy. So how do you make it easier for the doctor? And how do we make it easier for the doctor was by programming now all this content into an Android application that helps the clinician navigate through all the process of the consultation. So all the content here has been created into this electronic algorithm and now the clinician will take all the steps and answer all the questions to the tablet and it helps him to reach the appropriate diagnosis. So here there is a lot of checklist like making sure that there is no severe signs no dangerous signs and if there are not then we continue and we need to register the patient. Maybe just I should mention at that point that this is not a patient file we have just designed what we call a clinical decision support system it helps the clinician treating the patient the day he comes but we haven't developed something that would allow the clinician to get this information once the child comes back. It's not an electronic medical record health information system it's simply a condition to own. But still we need to identify the patient because what we wanted possible was that when the child comes if there is a lab test to be done or if there is a more severe case coming this consultation should be posed and the clinician should be able to take another patient while waiting for the patient to come back to the lab or to take someone more severe. Dr Bognavi. Clotilde this looks excellent and can you tell us when you've used it what would have been the outcomes what's different I noticed from your poster here that there's something about antibiotic prescriptions which is obviously very important can you tell me a little bit about that? Yes one of our big objectives was to reduce the huge over prescription of drugs that happen in our context we should remember that in the primary healthcare settings or facility we work with there is a lack of qualified health worker I mean it's nurses it's sometimes community health worker that handle the consultation they have received limited training they often receive limited supervision and they work in an environment where the child mortality due to infectious disease is very high and because they have no access to appropriate diagnostic tools nor skills they often tend to prescribe an antibiotic to be on the safe side and it results in a lot of unnecessary antibiotic prescriptions and then driving antibiotic resistance so one of our objective was to help them identify the patient who need but also the patient who will not benefit from antibiotic and so this tool has been implemented now since end of 2016 in three health facilities in Central African Republic and what we saw is that we managed to reduce by two to help the proportion of consultation where an antibiotic was prescribed and if I can ask the devil if I had the difficult question then is that safe I mean have you seen more children have worse outcomes because they aren't getting treatment or because you're enabling people who aren't nurses or doctors to treat these children so has there been any adverse outcomes so currently we haven't in this project we haven't measured the clinical outcome of the patient and actually what we can say is that also when we were providing our clinical guidelines our green guide we never looked at the outcome of for the patient on the treatment that we are giving what we know because it has been measured in other settings is that giving inappropriately antibiotics do not prevent antibiotic infections and do not bring better outcome so but this is something that we are still considering trying to perform appropriate research so that we can measure this clinical outcome and show that our procedure are safe I mean for an MSF context this sounds fantastic you're expanding access you're bringing treatment closer to the people and you're doing it in what seems to be a very safe way without an overuse of antibiotics would that be a safe summary? It is a safe summary and I think what maybe I would like to add at the end is that when we looked at how it was implemented in Central African Republic we implemented it in three health facility that were already it saw its government health facility that were already supported by MSF since two years so the clinician had received some training by MSF nurses expatriate nurses that bring some clinical training and supervision but until we brought the tablets the supervisor felt that this training were not really getting translated into the consultation process and so this now the good result that we have with the use of the tool is not only the tool itself it's also combined with the training but you just see that it is a put on I mean it's potentialized like it's synergized it's just amazing how this tool can bring a difference in the consultation process now. Great, good luck, thanks very much.