 So welcome everybody to this session at the digital annual conference 2020 on immunization. Today we will hear three very interesting country stories and Gavi will also give an introduction. So immunization data is an essential component of a functioning and strong health information system and strengthening countries. Immunization data is a key focus from a global perspective and down to the health facility level. The HISP network are glad to collaborate with partners such as Gavi, UNICEF, CDC and WHO on their mission for strengthening immunization data and most importantly country ministries and health and ministries of health and national immunization programs. So HISP and DHIS2 network support this in several ways. Firstly, we develop a range of digital data packages in collaboration with WHO such as EPI dashboards and analytics down to more individual data packages that you can see in overview of here. You can find all these packages on our website both to download and to read more about. And additionally, we also support countries in country support in 54 countries currently where we're working very closely with ministries of health and immunization programs to strengthen their immunization systems and data. The community is growing and there is more and more activities around immunization. We're trying to actively build a strong community where people can have a place to share their stories and to have insight into the work that is actively being done. So I put here a link to the to the COP where you can post questions for this session specifically. We've also launched a new website for immunization related work on the DHIS2.org site so I encourage you all to go in and have a look at that. And we also have a community of practice for immunization specifically. And I really, really encourage you to go in there and to keep the discussion going and to post your questions and stories. This is how we learn from each other and to build strong communities across the globe. There are many, many people working on this topic and we can most definitely learn from each other. And then for today's session, I'm very proud and happy to introduce our speakers. So Karin from Gavi, she will give an introduction on Gavi's current work and priorities first. Second, we have Hassan Siboumana, EPI manager from Rwanda. We've been very lucky to work closely with Rwanda for the last years and they're really at the forefront of building immunization registries. So we're very interested in and hearing about their experiences. And another very important component of immunization work is supportive supervision. And we're lucky to have two country stories that will illustrate this. First, Dr. Rose Jalango from Kenya Ministry of Health will talk about how their experiences on using DHS2 for monitoring supportive supervision. And then secondly, we have Shea Adatola from Affinett in Nigeria. And he will share their experiences of conducting supportive supervision in Nigeria and what that's how that has affected the service provision, service provision and the support of supervision activities in Nigeria. So with that, I will give the word to Karin for your presentation. Okay, so good afternoon. Good morning to everyone. Let me share my screen. And thank you for confirming that you can see that. Is that okay? Yes. Okay. Thank you, Alice. Okay, so I'm very, very happy to be with you today. Of course, we are all missing to really be together. But let's take opportunity of digital to reach more people. So just quickly, I wanted to remind you some of the highlights from Gavi. Gavi is a global alliance for immunization. I just wanted to remind everyone that we are an organization that has time and under the principle of donor alignment for digital health. These are very strong principle for us. And you will see the list of priority we have so far. I just also wanted to tell everyone before we continue speaking a lot on DHS2 that Gavi and all our alliance partners and let me acknowledge them. This is UNICEF, WHO and CDC. We are all software and platform and provider agnostic. However, you know, the HIS2 is in more than 60 countries in more than 50 countries that Gavi support. So we acknowledge that and we also acknowledge the fact that Universal Overflow and the HIST network are really best positioned to provide good quality guidance and technical support to country. Yesterday for those who listened to the surveillance session at the closure, we talk a lot about, you know, all the diseases that we have to take care in what we call the vaccine preventable disease. But we're not also facing many diseases. We're also facing a lot of different data. And this big mess in that screen is really to show you that we are dealing with all sorts of data aggregates and longitudinal case-based operational data, population data, geospatial data is a huge thing. And actually in the HIS2, we have been able to collaborate with all our partner, including of the UNICEF or SLU to develop different, to support the development of different packages that correspond to different niches of immunization data type. So Anne has presented some of them. So I'll just pass quickly and I just wanted to highlight and really acknowledge the hard work of that very strong community of the HIS2 and all the country partners. And there have been a lot of great achievement. For the past two years, we supported the technical assistance in more than 35 countries by Gavi. There will be a wide adoption, very rapid of the WHO immunization module. And you can see all the numbers. We have some countries like Rwanda, who are also shifting from aggregate to longitudinal data. There's community of practice for immunization that is shaping it a little bit now. And we have some evidence that with the HIS2, there is an increased data completion, timeliness and quality and use of data. So we are, I think, on the right track and it was a quite fast track for immunization because immunization were among the latest to a kind of shift and adopting the HIS2 for immunization data. Here you can see the progress. We were quite orange two years ago. We are progressing and this is to show that gradually many countries more than 22 now among the country support have stopped parallel system. This is quite important for us. So, besides, you know, all the great achievements, we want to say that there is persistent challenge and unfinished business and this is really around the effective that I use. And, you know, people now can use the data that yes, great, they are in the HIS2. I can use those data to be used to make sure that we are taking the right decision. A good example in Nigeria will talk today as well in another topic, but a lot of progress have been made on the quality of data that is in the national platform in Nigeria. Also an highlight in Togo, huge progress on timeliness and also they started to work on the triangulation of data between the vaccine use and the number of children vaccinated. So a lot of good achievement. But now if you look forward and we have we are preparing a new approach for digital health information in Gavi, you will see at the bottom are six priority. And actually the HIS2 could be, you know, of support in all those digital health information priority. We are really, really working for looking forward. And we need all of you to work and I highlighted some area on the show special and all the effort we could do is bottleneck analysis app and identification of what we call zero those children children were never been vaccinated. We see real time monitoring of campaign data triangulation case based surveillance with talk yesterday and if I am both notification, a lot of things to move forward and encourage research. I know this is the main principle of the community of practice. I think we are going to invest more in evaluating learning from what has been working well. And actually last year I was seeing one of the area to move forward it was on supervision and I'm so glad that this year we have two papers that will be presented by Nigeria and Kenya on that aspect. So now I'll put the new topic for the year and I really, really encourage the community to really work and see how the HIS2 could support us in our mission to identify better the area with the highest number of Miss Children for Vaccination. Children will never receive vaccine. How can we use all these HIS2 power to work on that. And please let's make that the HIS2 community very, very alive for immunization and vibrance. We can never learn better than from each other. So thank you for all of you. I put a lot of heads to HISP is a wide community to the University of Oslo and the community of practice. Our partner, the WSU UNICEF CDC, all of the expanded partners that I'm raising the HIS2 agenda and of course countries and all the data users. Over to you. Thank you very much Corinne for your presentation. It was very interesting to hear about your the Gavi digital health information priorities. I think that's really a topic that we can continue in the in the COP as well to discuss how this can be solved. And also your new topic for research with reaching the children that are not getting immunized to also use the COP to discuss this further. So with that, I will give the word to Hassan to tell us about the Rwanda experience. So thank you and good afternoon. Good morning to everyone. So let me share my screen. Can you see my screen? Hello. We don't see your screen. We don't see your screen. Share screen the green button at the bottom. Now we see your screen. Wonderful. Okay. Thank you, Anne. Yeah. First of all, let me thank organizers of this meeting. It is very important for us to share our experience on immunization in trucker, which has been introduced in Rwanda last year in September. This is Rwanda profile, the overview. So we have been using DHS to since 2012 and our total population now almost 13 million. So number of health facilities we have there are so many they are increasing a lot. So in total good for the 80 hospitals, 515 health centers, and also have good private clinics. More than 300. And we have got a lot of document in which data managers and the vaccinators can use on the field, including SOPs at national district and health clinics level. They can use them. And then, as I have said, we have introduced EPA trucker last year in September. If you look at the number of children we are expecting to vaccinate, there are so many. So we have got almost 370,000 per year. And in total we have got 30 districts. So you can ask why we have chosen to use immunization in trucker. So these pictures speak a lot. And you can see this is the one of the picture taken from the health center. So where they have been keeping records of vaccinated children actually have been printing two cards. One to be given to parents and another one to be kept at the health center so that you can follow up easily the vaccinated chart. And you can see it was very challenging to keep all those cards. So we think that with immunization in trucker, we are going to improve data quality, but also we are going to reduce number of data collection tools you have been using on the field since the beginning of the vaccination program in 1980. So we think that the running costs will be reduced, but also this immunization in trucker, we think that is going to help us to reach every chart and also to track individual data, real time individual data. And then we think that we are going to solve the issue of denominator. You know, sometimes it's not only in Rwanda, it is one of the biggest issue in vaccination programs where immunization coverage, if it's not low, very low, less than 80%, it is sometimes higher than 100%. So meaning that in that case, there is so many issues, one of the issue can be denominator. So with immunization in trucker, we think that we shall be linking the system to CRVS. And then we shall solve this issue of denominator because actually we'd be sure that we are waiting a number of children to be vaccinated and this number from CRVS can be used as proxy denominator. And then we think that with immunization in trucker, we shall be keeping vaccination data for long because actually currently we're having issues with children now aged 20 and more than 20 years going to study abroad coming to vaccination program to request for their record, vaccination record. You can understand it's sometimes very challenging to make sure that we have got vaccination history of if each and every chart it is a big issue. So with immunization in trucker, so we shall solve also this issue of keeping vaccination record for every chart. And then immunization in trucker is helping us at the central level because actually from something of now we can monitor what is being done in the old district. So can you imagine in one district the chart can be vaccinated and at the same time contract the vaccinated chart using immunization in trucker. So as a background of this immunization in trucker, I have said this in September when we introduced immunization in trucker and thank you. Thanks a lot to Gavi because actually we have been having the support from Gavi because actually it requires some IT equipment to be deployed in all facilities. So with the Gavi support we have been able to procure a desktop to all health centers. And then we are trying to see how can introduce also immunization in trucker in private health facilities because actually it has been delayed by this COVID context. But we think that by the end of this year we shall be also using immunization in trucker in private clinics. So we have got also three staff training in each health facility. And then also the environment has been changed because actually people now are using IT software. So it is something really motivating health workers. So at the beginning it was very difficult because actually they have been saying that it is the overload because actually they have been, they are using it sometime in the train in trucker. But we have kept also the traditional records. So because actually you cannot change the existing system at once. So it is progressively so now we are very happy that now they are trying to understand the direction of the use of immunization in trucker. And then we are also planning to provide a tablet to all health facilities. These tablets will be helping to capture data during outreach vaccination session. This is very important because actually have got a number of children being vaccinated in the community. So they are almost 10% of the total population. So we have got so many activities ongoing to strengthen this immunization in trucker. So currently we are conducting data quality review with much focus on immunization in trucker. So this is continuous exercise. We have planned to conduct this data quality review on a quarterly basis. So what we are doing in this data quality exercise. So our staff from central level. So I go down on the field and then from the hospital they can invite vaccinators and data managers from all health centers. And then it is the time to review what they have been recording in immunization in trucker. And at the same time they are trying to compare what they have registered so that we make sure that once it will be 100% we shall remove all paper recording. And we think that by 2022 so it will be possible to remove all papers from the system. And then with immunization in trucker we think that we shall be improving the coverage beyond the current level. Actually the immunization coverage is more than 90% in Rwanda. But we think that we shall go beyond 95% of the current coverage. And then as I have said we are trying to link the immunization in trucker to CRFVS. This is very important because actually CRFVS, I mean civil registration of birth and death. People are born in health facilities. Now they are being recorded at the same time in health facility. So it is very easy now to collaborate with CRFVS so that we make sure that children registered in CRFVS system. They can use that number as the approximate denominator in vaccination program. And then we are trying also to see how can assess what have been using the whole year. I have seen that immunization trucker started in September last year. So it is almost one year. So we are collaborating with UNICEF to see how we can conduct this assessment. And also we think that we shall be publishing a paper on immunization in trucker. But also the feasibility to link it to CRFVS. And then we are also working together with HIST Rwanda. Of course we support from the University of Oslo to see how can also track vaccine stock at all levels. So we think that by the end of this year it would be deployed in all health facilities. Because actually we are at the final stage. So what is the meaning just to test it and then train people from the field so that they can start to use it. So this is very important because actually it is one of the requirements. For your information in Rwanda currently Auditor General. Now is not only focusing on public finance but also on data. So we have got this recommendation of seeing how we can digitalize also vaccine stock management. And also we are working together with HIST on AFI's module to be integrated also in immunization trucker. So what is the added value of this immunization trucker? So actually it increased the confidence in data collection because actually the whole country we are using standard variables are being collected and also standard data collection tools. Because actually we think that we shall be now publishing so many people because actually we will be confident that we have got good data. And also with immunization trucker have seen that there is a reduction of waiting time in health facilities. We have been using so many hours to make sure that we vaccinate all children. So you can imagine a parent having a small baby waiting for three or four hours. So currently we have seen that there is a reduced time. So this is also has to be evidenced with that so that we can publish everyone can understand the value of this immunization trucker. And then the data quality review also is very easy because actually with very few minutes you can go to the health center and review what they have been doing in immunization trucker. You can easily track how many children vaccinated, how many children missed, how many children plan to be vaccinated in the near future for next sessions. And also the monitoring is very easy because actually with immunization trucker we have created some dashboard. And also because actually you know it is at the same platform with DHS too so even the analysis data analysis is very easy. And then vaccination program central level is overseeing remotely the data collection from all health facilities. This is also something really very new and we think that it will help to improve the quality of data we are collecting from the health facilities. Of course there is some challenges. One of the challenges is the turnover of training staff. So I know I have said that we have trained three staff from each health center. But you know it's not very easy to maintain the staff, especially in the health center so they are always moving. So we have got this issue of turnover of training staff. And of course sometimes we have got a disruption of internet connectivity. So even though the whole one that you can use internet, but it is not easy sometimes in rural areas where there is sometimes a disruption of internet connectivity. And then use of with trucker doing outreach for extension session, which is still an issue because at very we think that it will be solved by the introduction of tablets so that people can be using also tablets and they should be connected at that time. And then we have seen that we need really a permanent technical staff to support users requests because at very She's piranha. So they are not so many, even though they're helping a lot, but they are very, very overloaded and especially during this COVID context. So it is not easy ready to To respond timely on requests from from users on the field. So with this, with this few slides. So I think I have briefly explained what we are doing in Rwanda with the position trucker. So I thank you a lot for your attention. It's over to you. Thank you. Thank you so much for your very interesting presentation. I think it's incredibly inspiring to see what you've managed to do in Rwanda and, and it really speaks to the challenge that current post with this reaching the zero Those children, I think, following this more closely going forward and how that contributes to that goal. It's very, very, very interesting. The Rwanda stories also posted on the community of practice. And this is also a great place to ask questions to the Rwanda team. And for those of you are interested in and how they have gone about working with this and the challenges they are facing and if you have any common challenges or solutions. That's a great place for that. And with that, we will move into the second part of this session, where we will talk more about the role of supportive supervision and the highest two. So with that, I will give the word to Dr. Rose. The floor is yours. Good morning. Good afternoon, everyone. I'm sharing my screen. Yeah, so I'm going to give an experience on how we've used a data to then capture application to support support is imminent support supervision in Kenya. I'm going to give a Kenyan experience. The background information of the country. So we have 47 counties that are interdependent and the use of DHS to nationwide began in 2013. So it is a main health information system where all health programs collect their data. And this is used across the country and over 12,000 facilities are using this platform. So basically the data collection is both paper based and DHS. So from the health facilities, we do use the data based form and then the data is feeding into the DHS at the sub national level. But there are some large volume health facilities that actually key in data directly into the DHS. Supportive supervision is actually a facilitative process between a supervisor and a supervisor. So as to ensure that there is joint problem solving and communication and mentorship. So this is a way to drive better use of data. So in Kenya, previously support supervision has been done at the national level sub county level and the county level using paper based. So given that we have 47 counties, we did have various forms of papers that are used by the different sub national levels. And then we had electronic platforms that were not harmonized. So what did this mean for the country? So we had very fragmented and inconsistent supportive supervision data. So it was very difficult to access historical data that was done for supportive supervision. Then again, it was very difficult to aggregate support supervision data. So hence analysis and interpretation of that data was very difficult. And therefore using supporting supervision data to make decisions has been a gap for a very long time. In that the papers that are used to support supervision are actually left at the health facilities. So at the national level, there was no disability of what's happening at the lower level after supportive supervision. So there is this DHHI-2 event capture for immunization where we decided that we are going to combine all the supportive supervision and have one consolidated checklist of immunization supportive checklist. So we have this platform that is already existing in the DHHI-2. And on this event capture platform, the staff are very familiar with it. So there is no additional training that is required because it's already existing in the system and they know what it is. And then the other advantage about the DHHI-2 event capture is that you can do offline data capture for all the facilities. And then it will synchronize once you have access to data. And then there is no need for a separate server. We are using the existing server to show the supportive supervision data. The beauty about this platform is that it's going to use the existing information that is in the DHHI-2. So for example, the name of the health facility, the organization unit, all those are already in the DHHI-2. So this tool is used both at the national, at the county and the sub-county level. And it is able to pick the geo-coordinate of every place that the supervisor is going to pick that to conduct support supervision. So the objective of this platform was actually to ensure a uniform supportive supervision checklist across the 47 counties. And again, promote supportive supervision. A platform where supportive supervision data can be used for decision making so that we can improve data-driven feedback practices. So it is an Android and web-based supportive supervision that is used to collect data. And the data can be compared over time across counties. So this allows one county, one sub-national level to compare its performance against another sub-national level. And this is over a duration of time. So it's customizable, dashboard-friendly, and allows user-friendly data visualization. So this one I'm going to highlight an example of how we use the DHHI-2 dashboard in this platform. So this is one of the counties in Kenya called Garisa County. And at the national level in the DHHI-2 system, we did realize that they have consistently high centrally coverage. That is covered above 100%. That is from the monthly routine reports. So we targeted Garisa County as one of the counties to be included for support supervision. And one of the results of the output of the support supervision was that there are new staff that have been posted to the health facility. So they did not know how to record and report immunization data. Rose, are you there? It seemed like Rose's internet connection got a bit rough. I'll give her a few more seconds to see if the connection comes back before continuing. Okay. So for now, thank you very much, Rose, for your presentation. I think I will move it over to our next presenter, Shaye from Nigeria, from Afinat. And then if Rose returns, she can finish off in the end. But I will give the word to Afinat and Shaye. Thank you so much, Han. And thank you for co-presenting. Just wanted to share my screen. You can see my screen. Yes. Awesome. I'll be talking on improving routine immunization through improving routine immunization. I like VHI through SMS, reporting through supportive supervision. And I'm going to be sharing an experience from a much part of Nigeria, a major state in August 2019. So I'm going to give this presentation on behalf of my co-presenters. My name is Aditola Shaye from African Feed Epidemiology, and this is following the outlines of the presentation. The introduction, the objectives, method, result, conclusion, and recommendation. This is a background of the country. For routine immunization coverage, data quality issues, and supportive supervision are linked with low routine immunization uptake in the country. So this necessitated the declaration of the National Emergency Routine Immunization Coordination Center, NERC. So in order to be able to improve the uptake of routine immunization in the country, there are a lot of interventions that were implemented. And one of them, it is the data and VHI through SMS and reporting and platform. And the essence of the VHI through SMS reporting platform is to generate delivery time, our SMS on the dashboard, which can enable at the national level to make a decision, instead of waiting to month ending. So all of this system actually work. And the system work with the help of the short message system, SMS. Why the edge facility are expected to send the conduct of session immediately after the finished conducting the session. And this is achieved through some literature configuration of the phone number. The phone number is configured and it's been linked with the DHS so that it can synchronize the message. And basically that is how the system work. So despite all the effort and the development was actually done in 18 priority states in Nigeria, which Niger State happened to be one of them. So low reporting data, data quality issues continue to persist despite implementation of DHS through SMS in Niger State. So the team decided to pay a super recoup receipt to Nigeria State. So why do we need to go to Nigeria State? We have two objectives to conduct data quality assessment at the local government area and the edge facility level, and also to identify key challenges. So this is the method that we actually utilize. We conduct a supportive outreach to Nigeria precisely in August 2019. Following review of its SMS dashboard and there was a cross section assessments was conducted in 12 letter LGAs based on set categories. So we picked 10 good performing LGAs and two at 10 poor performing LGAs and two good performing LGAs. And when we're talking about performing LGAs, we're talking about LGAs that are reporting rate, it's above 80%. And the low performing LGAs and LGAs that reporting rate are below 80%. And then majorly we focus on three indicators. And the three indicators are the weekly plan. We have the fixed section and the way out of the outreach section. So when we talk about the fixed section, the fixed section means the immunization services at least all antigens were given at the edge facility. Why the fixed section means the office in the section are held in a location other than a facility for which healthcare worker can go and return that same day. And the usually is held periodically, sometimes twice in a month, sometimes twice in a week, sometimes three times in a week, depending on the coverage and the target population of that particular location. All right, so after the repair and advocate visit to the state and the LGA, and we actually work with 12 LGA, like I said earlier, and for each of those LGA that we work with, we visited three at facility and to make it 36 at facility altogether. But unfortunately, because of security compromise, we're able to just visit only the five at facility. So at the LGA level and at the facility level, we conducted a data quality assessment with the app of the ODK that was used. So we went through the records and we use the ODK for data collection. So as a result of the activities that we did in Angiastate, these are the results. Three more to the view of data post-supervisory show and improvement in the number of edge facility reported weekly section plan. And with an average of it 1% compared to 51, 56% before the visit. And then the number of edge facilities that are expected to report in Angiastate are 1061 edge facility. So out of the 1061 edge facility, we recorded it 1% of 1061 edge facility, improving in the number of them submitting the weekly section plan. Similarly, the population of edge facility with a conduct of fixation increased from 30% before the visit to 19% after the visit. So in terms of the outreach session also to, in terms of outreach session too, we also recorded a great improvement from outreach session and which actually helped with other results of the supportive supervision that was conducted. Also an improvement in percentage of conduct of section supervised with an average of 46% compared to 29% before the visit. So in other area, we recorded some other improvement also to in the area, people sending wrong format messages. We recorded an improvement also in that and that is significant improvement in number of edge facility with zero reports compared to the visits to Angiastate. So I'm doing the visit. There are some findings that we observe for management of data entry and which leads to lots of data representation. Also, one entry and submission of data from tally sheets to monthly edge facility musician summary, which leads to the experiences and consistency between various data tools in most of the edge facility are visited. Also, the use of wrong format to send our SMS was observed, the use of one configure for them back to send out SMS was also available. So only few facilities have data components across the reporting tools and the platform. Lastly, in a decrease some participation by 18 so the edge facility and level. So what are the mitigation that we actually make use of. The possibility of the ad care worker were built on the following management of our data tools. They have a great feeling of the data tools using the formats to send the SMS data. We also configure the phone number of the ad care worker that we're not configured with all the precede and we provided a feedback to the state. So let me conclude. Let me just know that color of supporting supervision is key to sources of any intervention at service delivery points. Incubate in the proportion of super victory visits to the facility mentorship feedback and implementation of action. Plus, let's do number one, improve our reporting in the United States on the real time VHS to SMS reporting platform. Also increased content of fixation and how to section. So we recommend that national should support state and LGA to within the condo supportive supervision visit to the edge facility. Number one to motivate the staff to strengthen their capacity to deliver and report service provided. And lastly, to mentor and address issue in a timely manner. I would like to acknowledge the national from my health care development agency. Our US Center for Disease Control and Prevention, my justice government and African field epidemiology network. Thank you. Thank you so much for your presentation. I think this, this is a really good example of of doing studies that show the value of these interventions and how it affects affects the immunization work going on in countries. So thank you so much. We can share the abstracts on the on the COP so people can also read more about your study. I think I will give the word back to Rose. She was having some trouble with her internet connection, but she's back now so she can finish off her presentation here for her final couple of slides. Here you go Rose. Okay, thank you. So I was on that slide showing an example of how we are using data to dashboard for both supportive supervision and translating it with the national routine immunization coverage data. So this is Garita County, one of the counties in Kenya. We had some routine coverage data. The data was more than 100%. It was selected targeted for supportive supervision. And one of the findings of the support provision is that the health care workers had were doing poor recording and reporting of immunization data. So there was some training that was done on job training and mentorship. And we did see that with improved knowledge of reporting and recording, we did see that the quality of data that was being reported monthly improved over time. So the next step for the support supervision, the bit about the support provision tool is that it can be integrated with other analytics tool that are embedded in the DHS tool. So for example, the bottleneck analysis tool that is currently in the DHS tool. So this data can be translated with the support provision tool. In that, for example, if you find that they are perennial stockouts in a facility, the bottleneck analysis can be able to give us some of the reasons why they're consistent stockouts. So it could be because they are not focusing, challenges with transport, and either they are having higher stage rates. So the health facility can be able now to discuss some of the interventions that they want to do in order to mitigate these problems that they're having. And they have an action tracker module, again, within the DHS tool, that helps to monitor any implementation status of the action point. So what are some of the lessons that we have learned from the DHS tool tracker implementation is that we have the same access to data, immunization data. So we are able to monitor immunization performance over time and comparing it with other sub-national levels. Then it's very possible to identify the bottlenecks and also track the possible interventions and share feedback for immediate feedback for correction. And then the other beauty, the other thing about this platform is that it can only be used for supportive supervision in immunization, but all the other health programs using DHS tool in Kenya. So I'd like to acknowledge Gavin, the vaccine alliance, for supporting, for giving us financial support. And then we have technical assistance from CDC and AFNET, and we work with my colleagues within the Ministry of Health and also the University of Nairobi. Thank you very much. And over to you, Anne. Thank you, Rose. I'm glad that you were able to finish off your slides of your interesting presentation. So we have five minutes left before we have to close up. So I will just, I will close off with one question coming from the community of practice. And the question goes to Hassan in Rwanda. So the Pan American Health Organization, they have several Latin American countries that are interested in using DHS tool for immunization. And the question coming from the people working there are, is there anything that you didn't foresee when you started to work on your project that you have experienced out in your, in your work with developing immunization registries that you could share as an experience to the Latin American countries? Yeah, thank you, Anne. So actually, with the introduction of immunization, there is a lot of experience we can share. So first of all, you have to make sure that people are mobilized to support this initiative. Because actually, you know, people are very familiar with using paper. So if you introduce a software or a digital system, so you have to make sure that you have mobilized all of them. And also, you have to make sure that at least you can have more than 70% of internet connectivity. Because actually this is the most of the, one of the biggest issue when people have got the system and they cannot use it because of the internet. So sometimes it is demotivating. And also, you have to make sure that if you are going to introduce the system, you have got a good support from leaders because actually everything starts from them. So, and also, you have to be prepared because actually you will need more equipment, more IT equipment. There is a lot of things we can discuss, but at least where once we have started, yeah, it is good because actually people can easily understand why they're using the new system because actually what we are seeing when people get familiar with the system, there is a reduction of workload. And also, there is an advantage at all levels of using some very less resources for printing and also people are very happy because actually they are not spending some more time at the health clinic waiting to be, to get immunized, their children. So this is very important but also we have to make sure that you have defined very well the idea of client because actually what you have seen as a problem here on the feed, once the child has been vaccinated in health facility X and want to move from that health facility to another one, you have to make sure that also you have so that issue of ID. And also, because this institution itself can be linked to so many other systems like the SMS remainder we are trying to to introduce. So you have to make sure that we, you ask everyone to make sure that if you don't have a phone cell so he can at least get the one from a community worker and also we have to make sure that you are requesting people to come with the ID so that it can be very easy to identify every child being involved in the system. So there is so many we can share. So maybe we shall, I think we shall share the assessment report we are going to conduct with UNICEF and we think that it will be out by December this year. Thank you. Thank you so much Hassan. I think there's a lot to learn across countries there. I just want to end by thanking all our presenters and the people listening in. There are already some questions to the Kenya team for example on the COP on the solutions that you have that you are using and people are interested in how you've done that so I encourage you to go in and answer those questions Kenya team. So I will now leave the room over to the next session there are people knocking on the door for the next session. So thank you everybody and goodbye from the immunization session. Bye bye. Thank you. Thank you. Bye. Okay, thank you. Bye.