 In this session, I will talk about governance mechanisms for DHS2. The learning objectives is to understand why clear governance and coordination mechanisms are important to enable DHS2 as an integrated health information system and to describe the three levels of a simple governance structure and the kind of competence required at each level. We will start with the three-layered governance mechanism for sustainable DHS2 systems. So, routine health information systems is a critical part of any health system. It will need to adapt over time to new and emerging health information needs and require long-term and stable staffing arrangements for maintenance and support. And to achieve this, proper governance is crucial. So, multiple competing information needs of health programs and departments across the ministry means that coordination is important. If you manage a DHS2 system in a ministry, there are many people who want their new requirements in, their new priorities, so what should come first, etc., and having a solid governance structure can help coordinate these efforts. It's also important to ensure an operational system supporting the needs of all the different layers of the health information system from community and health facility levels through the local health administration and up to the national level. This three-layered governance model is recommended. The competing needs in terms of system scope for technical improvements in running world functioning systems, calls for prioritization processes, strong operational management to guide and monitor the technical work, and also a dedicated technical team carrying out the system improvements. There are several guidance or industry standards you can look to to structure this, but in basic ensuring that you have three sort of separate levels of a governance model is useful in order to prioritize, plan and execute what is needed to build and maintain a DHS2 system. Now I will talk about the three different layers of the governance model. We will start with the governance committee or governance body. With DHS2 playing the role of an integrated health information system addressing information needs of health programs and departments across the Ministry of Health, there will always be competing interests and needs, as well as tough decisions to remain regarding data alignment and compensation. So while DHS2 and any routine health information system is typically hosted and maintained in the HMIS or IT unit of the ministry, the system serves information needs of the whole ministry and the system's governance structure will reflect that. So on top of the coordination model we recommend a cross ministry committee bringing together key health information stakeholders across the ministry that is responsible for high level strategic decisions relating to content and scope of DHS2. This committee should have members that has competence in both technical and public health leadership and most importantly they need a clear mandate to make decisions and to meet regularly to provide continuous direction to the operational management. Next I will talk about the DHS2 operational management layer of the governance model. The operational management is responsible for implementing the priorities set out by the governing committee and a DHS2 operational lead together with security managers should be the internal government positions to secure ownership and long term sustainability. These system management roles are typically located in the Ministry of Health unit responsible for the health information systems and it's critical that this team is responsible for facilitating and maintaining an integrated DHS2 serving routine information needs of the whole ministry, health or government, not just a subsystem for example supporting a parallel system for health statistics. Typical profiles within operational management are people that has competence in project management and basic IT skills. The DHS2 operational lead should work closely with a team that's carrying out the actual technical work, provide clear guidance and plans as well as putting in place good mechanisms for monitoring in oversight and at the same time they need to work closely with the governance committee so they function sort of as a layer between those making strategic decisions and those carrying out the actual technical work. In practice you could say that the technical team and the operational management are working side by side, they're probably in the same office viewed as one team but it's important that there are some dedicated people who serve as this link between the governance committee and the technical team. And then lastly I will talk about the DHS2 core technical team. The DHS2 core technical team is responsible for day-to-day technical development and maintenance of the system. This team will be a critical component in the long term sustainability of the system and to ensure local ownership. It's critical that such a team has clear responsibilities defined and operate on behalf of the DHS2 operational leadership in the ministry. The size of this team will depend on the scope and complexity of a DHS2 implementation but typically 4 to 6 people will be needed covering aspects such as DHS2 configuration and maintenance, server administration and security. The server administration and data security functions can be generic positions in the ministry so perhaps they serve also other domains than the DHS2. They do not have to be DHS2 exclusive. DHS2 configuration and maintenance tasks will require more specialized skills and knowledge, skills that you typically learn through DHS2 academy courses and experience with DHS2 implementations. No specific background is needed to master these skills but a general understanding of IT or database systems can be an advantage. Good understanding of health information systems is more important and we recommend that at least one team member in the core technical team has public health background to better understand and implement user requirements. The IT technical complexity of DHS2 implementation is increasing with more local active elements and interoperability needs so it would be advantageous to make sure at least one team member has strong computer science background that could master things such as scripting or web app development. Countries have opted for various approaches to recruit and organize the DHS2 core technical team either internally or externally to the ministry of health and what works best will depend on the local situation. What all successful approaches have in common is a long-term contractual relationship that provides accountability and stable availability of DHS2 experts to maintain and strengthen the DHS2 system over time. Again to repeat some public health knowledge on the team is very useful. The team can be external or internal to the ministry but they really should have long-term contracts. You can learn more about this in the session called the DHS2 core team. In summary a successful adoption of a three-layer DHS2 coordination approach requires a long-term process with gradual improvements. It's also a bit of a cultural change. The ministry of health will need to establish new positions, deal with challenging recruitment of skilled IT staff and implement a long-term capacity building plan. Apart from the DHS2 specifics the standard operating procedures and skills needed for this model to function the main principles for coordination and system management processes needed here are common to all IT and information systems. Standard IT processes and governance frameworks can guide the team.