 Okay, so we'll start the session like it's more about the TV. So what we'll talk about like people already know both who are here and also, you know, people who are joining us virtually. DoubleHR have released the TV package a long time back and they have kept on modifying and including new tools, new module inside the DHS as a package so that the country can actually install it. They have lots of changes what happened from the previous version and now. So there are new things that have been added. I'll just go through what we can actually get from the DoubleHR package. And after that one, like we'll talk about the effort which we've been doing with the Global Fund and IOM on the regional TV migrant process. This has been one of the key topics in many of the places where how best we can try to share the data from one country to the neighboring country. There are lots of also challenges. In Southeast Asia, its challenges is also a bit more because like none of the Southeast Asia countries speak the same language so we touch on that one. And after that one, like we have a presentation from Pakistan who will talk about the TV initiative in Pakistan. So this is the bit overview. So let me just like start with the presenting the Global Package. So as you all know, like we have this DHR to metadata package which means like we are for each and these programs like from EPI, HIV, malaria, COVID, disease surveillance, TB, RMNCH. So you have all these packages which is basically DHR to metadata which can be installed in your country implementation when you're starting fresh. This was the concept like happened long time back that every country were designing or creating the same data element and it was very different. Some places they called ANC-1, some places ANC-1. So it was very hard to share the data across. And also some of the key fields were missing. So people were just like when the malaria package was released the GD9 was completely missed and also when TB packages was released and the country said, oh we don't have this data element, why are we not collecting the gene experts and all the other things were missed. So when the people are designing this country TB system so they could know this is the reference statement, the reference where they can actually look at what all the different data fields, indicators and everything is there. In the metadata package for all these things we have three types. One is for analytics. It's not only about data entry. It's more about how best we can try to analyze this data, how much data for our own needs. So that was also focused on. And then we focused on two things. One is on aggregate data where they can collect the aggregate data especially for TB is usually quarterly data which is collected across all the places. TB is quite structured in all the country compared to if you go from one country to other place like you just see it's exact same thing. So this was actually very good to just see like, okay people know how TB systems are but if you go for other programs it's very different but TB was well structured, at least in most of the countries what we've seen. So they have aggregate data and now we are also moving down to the tracker. So then like most of the places they say they started with the aggregate and then they say no like now we want to use the DHS to tracker to collect the case-based surveillance data. So I'll go through both the aggregate and as well as the case-based and then I can quickly show a few dashboards the online resources where you can try to play around with. So in the TB aggregated package, so these are all the different modules of the TB has been included. So before this was very new, very latest, when we started the long time back not all these things were there. There's only case notification, outcome, a second line, the stock wasn't there, our MDR TB was there, household contact wasn't there, that was also newly added, laboratory wasn't there, COVID-19 impact, that was also not there. So those are the few things where University of Oslo and WHO team are working together to build up all this aggregate package so that like country can actually use on this one. And these are all for the older course what they've been trying to do with. So this again is still an aggregate what we are talking about. We have like TB case notification which is basically quarterly and yearly where you have all the treatment histories, new and replers, laboratory database of details, TB and HIV activity, and then like the treatment outcome, the second line, and then the MDR. So these are again, it's an aggregate data which we've been trying to collect across all the places. From the WHO packages what they have done is they have all these materials including the documentation, the design work and everything which are available both in English and in French. Not quite sure how many Asian countries are using French, but at least we have it, which is widely used in African other places but in Asia it's usually English and some of the places has been translated into the local language, but at least we have these guidelines. And this is the other module which they had, the household contact tracing. When we first started, this is the aggregate module, not the tracker module. They are still we're focusing on the aggregate module to try to identify all these things where they also have the other module which can be included. We're not going to go into detail of each and every section. I'll show you where you can actually go and access these places and also the demo site where you can use, try to do the data entry, do the analysis at all. So that can come to you a bit later. This one after the COVID impact assessment, this was also the application, the framework which was applied into the TB because there were quite a lot of description. Especially during the COVID, lots of service got hampered on because they could not come around, they could not reach. So this was also something they want to try to include up just to diagnose and see what all the different countries was reporting up. Even in Vietnam when they tried to deal with, even though it was a lungs hospital. So that was also the places where they're dealing with the COVID and also the TB. Other key important, this one is the tracker, but like this TB laboratory, this is an aggregate data set. But in the platform you have a tracker to aggregate push. That I'll talk to you a bit later, but this is a TB laboratory data where people can enter the laboratory details. So then like you have all the things what is needed to solve the TB one. Now I'm focusing on case-based surveillance part. So this is basically patient tracker or the TB course, the health program things. It's the TB case surveillance itself. Then like we have TB case surveillance plus lab integrated so that like you are your registered patient and the lab people will enter the lab details. So it is completely different. It's not the same person. The health worker are doing all the TB things and then the lab people are actually accessing the case and updating the lab details. Then again the drug resistance, I think that's also something which has been already there that's also a tracker program. And then TB case surveillance plus the lab and household contact, that's coming up. Many other countries they have actually started combining or not combining, but they have two program. One was case surveillance and contact tracing. When we did the COVID, they have been also using it. But like as a global package, they have been working on so that like when the country want to have the case surveillance, TB case surveillance, they also can use the contact tracing. But I know many countries have used contact tracing also and they have customized and they have customized the DHRST to meet their own need. So this was the basic system design. All these materials are also there online. I'll show you where you can try to find it. The tracker when you download the package, what you get is all the data field and also the program rules or the validations, all kind of indicators what you try to get, how we can try to import. So all those things are been defined carefully. So you have the tracker and then like you have also the program indicator where you can try to analyze and then also how best you can try to link the data between like when you transfer a particular patient from one hospital to other hospital, how are we going to try to deal with it? In TB, the transfer is also within the country. Each and every country are having this TB transfer form. So that's okay, but outside the country is also a problem. Inside THR is how best we can try to transfer and admit. From 229 onwards, there is a transfer module which we are again enhancing further so that like we have transfer and then the other people can accept it when they come around. Right now it's just like transfer and then like we don't really know whether it's coming or not but like it's we are actually having a relationship or the transfer module embedded so that like we can handle all these issues later on. There is also like minimum set of indicator which can be used which also has its own dashboard and other things. Again, based on the TB age group which is different from the HIV age group and then gender and the case type. So those are the dashboards and the aggregate information is already created in this package so that you can try to download it. Especially when we the one of the whole point is packages like you can download and customize it and then the countries need the programmer or the configuration person who is importing this one don't have to spend two weeks so now they can just like spend maybe one day to just like configure and set up all these things so that like the system is operational and all the key points of the system are embedded or can be used. So this is just the few of the basic structure of also again in the DHRs too. So you have an enrollment and then like you have the different stages where you can go through the treatment is the monitoring the laboratory and then the outcome. Before it was after the treatment we had the outcome we didn't have the laboratory results and now laboratory is there. Before the laboratory result was under the treatment as a section now it's a separate stage so that the laboratory people can actually just access it and enter those details but then like we don't have to worry about the other things so this is where the few changes has happened around the place. Just to go down a bit more into detail so during the enrollment you register all the the person information the person demographic details and all different kind of things and then like you have the diagnosis and the results and then the notification treatment stage, the laboratory stage and the outcome. Different stages and different sections what you can try to find in the places. Now based again based on the different country needs you can try to configure or change but like this one has at least been implemented in many places so we know it's going to it's been working and then any kind of feedback also be given to the global people it will be able to come around. These are some few additional features which has been included in the program itself in the package where you can get a real-time notification it's like case notification, poor data quality all those things has been set up and then also like inside DHS2 in the top bar we have few widgets where you can get the key information of particular patient which is relevant like data diagnosis the patient age classification details those things can be in the top bar when you log into the DHS2. Again you in DHS2 tracker you have this feedback mechanism or the feedback widget which is also configured around here in other places like what happened in many countries the aggregate and the tracker data are in the same system in some cases like in Laos the tracker are in different server aggregate is in different server so you want to actually share when the people are entering the data they don't want to enter the aggregate data here in Laos they have stopped using the aggregate system completely so now all the things are only by case surveillance and then like that data is pushed to from the faculty aggregates into a different server not even in the same instance it's in a different instance and different server that has been like actually requested many times so this has been like we already have so all the programming indicators and everything has been pushed around to the aggregate data set so that like you can have aggregate information also it is not like in many countries like you have you can say okay the northern part is well versed it has good internet it has also trained people but southern part they have the bad internet and the bad things so then like we can just say okay now the part can start doing the tracker and the southern part they can do the aggregate but then like the tracker person can do the tracker things can be pushed to aggregate so that at the country level you can see the overall country picture that was the reason like why we want to push the data from the tracker to aggregate not all the facilities will have the same kind of infrastructure or human resources so in one places you can just start with it and you can also have this list of assessment just saying okay do we have the capacity do we have the infrastructure okay if you don't have the infrastructure let's do the aggregate one infrastructure and train people then like you can do the the case but as a country as a overall you can still get the exact same result these are the few of the resources I'll share the presentation again all this presentation is already online you can get all these different details if you want to access more about the demo site itself like how you can do so this is the instance I'll just show you what all the different things are there and about each and every field and section I will also show you where you can try to find this is will be in DHS documentation metadata I will show you that one in a few seconds and if you have more queries and the things you can actually ask these two people there Yuri and Victoria they are working with the WHO team on dealing with all the things quickly let me just try to change so this is the demo I'm just like let's see if I'm logged out so demo.dhs.org slash hmis so just for the sake like how we can try to log in so these are list of all the username and password so anyone like with the different type you have French Portuguese Arabic and all different things so you can actually use that one so I'll just use the English so here these are list of all the dashboard which when you install the TB package you get all these different things you have notification all the TB drug resistance is tracker based so all the notification is aggregate based so you can actually just see because for the end user they don't really have to worry about whether it's tracker or things especially for the high level manager so they can actually just see like how things so each and every places DRS enrollment it's also the one of the things where you can just see for the last 12 months and these data are dummy data don't worry about the data itself just for the demo sake so we have created few data so that we can just see the how charts and maps can be used so if you want to try to play around with the actual the dashboard so you have all the dashboards on here and plus if you want to see actual data entry and all the things you can try to go around to that one also and plus the aggregate it's a so these are the these as we just mentioned these are all the dummy data so what we have included it and it's a law ordinance that's what we've been like now government was happy to share their structure so that like at least like a bit as we don't have to just always use the serial on database so we can try to use the loud database for all our testing and demonstration so as I mentioned before so you have the patient profile and then like you have the case reporting samples and all these different things which you can try to deal with and this was the top bar which I was mentioning about so where the key features can be actually put wrong and like you know it's already been configured most of the people who have been using that are now like they know how to configure the top widget and other things so those things are already set so we don't really have to work through it coming now to how do we find all this material so you can actually go for dhs2.org which I guess like we are all familiar with and in the documentation just go for dhs2.org documentation and then in the topics you can just say metadata and here it gets list of all different kind of things and here you have the tb and then like you can find all the design of the things whether it is the logistic the design part second say tb notification then you get the list of all the structures how it has been used what all the different fields we are using so you have all the materials wrong here so for the tb so you have logistic surveillance BRS and also so you have release node and as well as the design and how best how you can try to install this package into your dhs2. Okay any questions no questions perfect yeah so now most of us we have used this package what we want try to do is like how this package has actually helped us in not only in one country but like for the regional tb migrant so to start with we will ask you to give a background on the regional tb project and we take it forward from there yeah let's see if we can find the presentation and this is a project going on between the five countries in the so-called mecon sub region that's the countries let's just go to the next slide so we see the maps not the map but the flags so that's the five countries Vietnam one of them and then Cambodia, Myanmar, Thailand and Laos and it's based on the data warehouse it's based on the the tb package which WS tb package with John just referred to and it contains also a referral module meaning that you can refer a tb patient from one country to the other country so that's an important feature of the database and in order to develop this the data elements of course they're not the same in all countries but the data elements have been included, identified and included and so far there's no real data only test data in the database because as we will see when we come to some challenges there are some challenges around sharing of data across countries so that is something that we're working on now and how to establish data sharing agreements but also in this case I mean they're already sharing data when they're referring a patient but that's very ad hoc and not in any way secure so the political challenge is about sharing of data and the more technically is the challenges that's of course that the countries have different data sets all countries are their own kind of development trajectory which has resulted in different data sets and there's also many differences in how migrants or non-nationals are registered in the database you have some that are not using Vietnam for example initially they didn't have anything then you have to look to see if it was a non-vietnamese name in order to find out whether it was a non-national and others are just saying foreigners and other again are just having different nationalities that you can select them on and of course countries need to agree on this data standard what data to include and which data to report to the database and we are starting with what is called the TB-09 TB that's a referral form used by many countries and even that is not a real standard between countries so that's also one problem and in these five countries the special thing is that there are four different alphabets or scripts so that if I if somebody write my name in the Myanmar or Cambodia or Laos script then I will not understand it and nobody else apart from the Laos will understand it and that's of course a challenge when you make a shared database and we use English as the official language and we use the local language from the country where the data is registered meaning if you are registering the data in Laos then you use Laos language when you write the name of the patient but also English so that when you send it to Vietnam then they can understand it and there are other challenges from apart from the script etc because you have the Thai Buddhist calendar for example is 543 years more than our more Gregorian calendar and also it's a challenge that the years are ending in September so it's not only to add a number of years to do different things and this is different from the Nepal problems because you have a different calendar again so when we include this in Nepal then we will have yet another way to translate the dates so that's a challenge when we deal with cross country systems and this is an overview of the database the database the reader database receives data on non-nationals from the country's official databases so everything is about interaction with the country databases and the data on migrants that's aggregate so that we can produce dashboards and it's on the patient when we come to the referral to another country so if you look more closely into how these referrals are being carried out today I mean we have used practices from the country to design the database and if you look at how it is now John there we come just delay so this is an example of how this is Thailand and this is Laoh and if you look at how referrals are being carried out today it's being carried out in a very ad-hoc manner where they are using a line app which or whatsapp or facebook or things like that in twin hospitals where you have a longer border because it's a river and you have typically one town on the one side and another town on the other side so you have hospitals that are working together so they are just doing it as kind of a personal system so when we said that it's more secure to use secure database so far it's been aggregate you have a data sharing agreement but you are sharing data here but that's kind of ad hoc and inofficial so the point is just to get it regulated this data sharing which is actually this is another example from the border region and this is between Thailand and Myanmar in a place an area which is called Rannong between then the provincial head office and the Rannong hospitals where they organize the referrals with the twin hospitals on the other side of the border which is a Khao Tong hospital in Myanmar and from there the patients are referred to the other hospitals and other regions in Myanmar and you see that they have organized it so that all the southern parts of Thailand is going referrals is going through the provincial office and for the province itself and the town itself of Rannong where it is quite a big migrant population is organized through the hospitals so this is organized in the same way but there is an NGO there which is supporting and helping the referrals so it's very much based on their active participation and similarly in another border region in Thailand Myanmar where we have another Mesaot area and Miawadi hospital where they have similar interaction but here also it's an NGO the SMRU actually facilitating the referrals but also here it's on a paper based here they're using the paper form which the patient is carrying with them but with the help of the SMRU NGO so these are the practices as they are today and the practices that we try to then improve and make better through the database and for the example of Laow again where we have set up a kind of a test environment that tested out these different areas a proof of concept of the migrant management you see that it go from the paper register to the Laow with your TB database making it a bit more simple for us since that is already the GHIS too and we are also based on experience from the COVID-19 certificate and QR codes we are suggesting and want if there's some interest for it to have a self-hold referral card which the patient can carry themselves with the QR code if that is wanted and that's possible and maybe that's a more secure way of doing a patient hold record and then you go to the regional migrant database which is then interacting directly with the country databases and this is the step-by-step way the referrals are being carried out and one thing is of course to have regular regular export of aggregate data from the country so that we get the dashboards and an overview of the situation but when it comes to the transfer or referral of the patient itself we say that there are, we have seen other systems which are doing this and for example they have another used one place in being implemented one place in Thailand but they are just using a database which is shared you can log in from the both side of the border and then you just put the patient there and you take a telephone call and say no we have put the patient there please take it but the requirement from the governments of these five countries is that you should not have anything separated from the national TB databases that's why it must go from and to the national databases and you see here that referral in and out go from the national database and in this example where we put up a kind of test environment between Vietnam and Laos then it go concretely between these two databases and then it's transferred from one country to the regional database messages to the receiving country it can be email, it can be whatever and then they get the message and then they can receive download or they first must accept that's also part of the requirement that you cannot just send the patient wherever you must accept it and when you have accepted then you can get it and then mess it back that you have received the patient you confirm that the patient is received and then again later in the treatment treatment outcome because one problem with migrants and TB is that one thing is that countries tend not to be interested in their treatment because then that will destroy their treatment outcome indicators and this is then an effort to address that problem I think that's more or less we can have a look at should we have a look at where is that TB 09 form where was that somewhere here maybe I jumped it when I had some delay just to see yeah, that's one so this is the form we have used this paper form to design the data flow because here you have the section A with the patient demographics the diagnosis treatment and then you have a part C which is the bottom it's used because you're cutting the paper and then of course you cut the bottom of the paper first by that with C and then you send that as a confirmation that the patient is received and the B is the treatment outcome and we have designed the system based on that but this is the TB 09 as it used on the border between Thailand and Myanmar and it's different we have seen many different versions of this and every country will use it a bit differently so that's how far we are with the conceptual design and John, you wanted to show some screen shots etc actually like it what we have one of the things, this was the new form which they have been designing only between Thailand and Myanmar to transfer the data but again the problem is, when we just see from Thailand they write everything including the name and the TB unit is in Thai language which is not understood by Myanmar people so the CSOs, what is again the health worker they will fill this one, the hospital will fill this one up and the CSO will make the bracket and just transfer all their Thai language into Myanmar and then the patient they escort the patient to the border and then it is admitted in the Myanmar region one of the biggest problem with this form is the language and the address where they are going, so in here we don't even know, okay this person is transferred but where is he going so whether he is going into Myanmar or Vietnam or other things, so those were the few additional changes what we try to request, they say how best we can try to deal with it and then we all agreed that English would be a common language for people to transfer so when a person is transferred from one country to other country then there will be two additional fields will be required which will be filled by the person who is referring, so either by them or either by someone else before they can send that data to the regional database so in the country database, like all the country database, all the data from one particular country resides in there only the person who has been transferred outside the country, that information will be only transferred, so it's also because like we don't want to take the entire country database and put it to regional database only those people who are like transferred out of that particular country can like just like push the data, okay these are the different things and these are different fields which have been required and then they will also push the data with the ID during the assessment of all the five countries TB system that every country has their own online software where they have a TB ID for each and every hospital and every person has a TB ID so when they transferred so what they transfer is the TB ID of that particular country when they import it into regional database regional database will create a one more ID called regional ID but user can actually search by whether the regional idea or the local ID and if a person is accepted into let's say Thailand person is sent to Vietnam and Vietnam accepts it then Vietnam people have to update what is their Vietnam national ID and they are accepted in one particular hospital so just quickly to show you I will go to higher level first how the I'll show you the regional outcome and then the country outcome and then like we'll try to go for the details quickly so this was the the country dashboard right so like this is the this is the WHO dashboard which we exactly use it for our regional thing so that's how like we say the TB1 notification this is no change but this is only from the the law and what we have done is only migrant one we have we have not included all the notification is only the migrants so from then the TB system in law so we exported only the migrants because law started using case based surveillance so we know like how many migrants and everything were there so when we discuss these things with the TB people in in law they just say we don't want to over burden our people so we have tractors so we'll just like have the migrants we already have the people's nationality so based on that one we can make this one so that like we don't have to over burden our health worker based on that one we can try to do all these different things similar kind of approach also happened in in law sorry in Vietnam in Myanmar and other places this one is also like this is in law database like what we tried to do was in law just show me how many migrants you have in your database so then like we just say the Thailand was 13 the most where Vietnam China was 40 Myanmar people 49 and the others so they're like in their system like other nationality they just like I have few few places in Vietnam was only they don't collect nationality in Cambodia they collect 6 nationality in Thailand it's the list of all the nationality almost 17 nationality I guess right so they don't have the list of all the country name so at least like the key one so that it's easier for them to communicate and here is by region how many people are being migrated and then the top one was the outcome how many have been transferred out lost to follow up and all the different things so this one was like again long time back we if you just see we had the treatment details and then the referral details so this these four details were added only for the GSM country when we were trying to deal with but in the top we had the baseline lab DST and adverse treatment those were the stages from the WHO package but then like for the regional transfer so what we tried to do was transfer out preferred or transferred out acknowledgement like what we just see in the paper form and like we acknowledge this person and then one is the outcome stage whether it is cured lost to follow up replace or death so in the patient migrant also included is when we did the study we also collected all kind of documentation we had a long meeting in Singapore with IOM that like say the classification of migrant who are migrants when they say like I am migrant, you are migrant all the people who are non-Vietnamese like including Laos currently in Phukuk we are all migrants whether even for the short terms like we are also migrants so that was also the one of the things like what how they were trying to explain what is who is a migrant especially IOM and they are trying to deal with who is a migrant and like we are all documented migrant that means we have passport number and all things so then like many people who are traveling from Myanmar to Thailand it's a long border so there like they can actually I and Yon we were there we can actually cross they can just like it's a very small border we can just like it's very small edge you can even jump the smallest narrow river and then you are in other side so it's very hard there is no pass you can also get a daily pass to get in and then you don't have to come back so that's also the possibility so that's why like we just have an undocumented one and we included list of all the things temporary passport, border pass health insurance, 10 years card which is given by the village people, national ID driving license so all different kind of things and the ID and there was a lot of discussion between do we want to record all these things and just say we are from Ministry of Health our main aim is to treat patient not to check their documentation so whether they are like things so then we just say okay fine but how can we just like make sure that like cross border things works fine we just say hey that's not your problem that's your problem so it has been like challenging but like we've been like trying to just say okay you can search by different ways and the use of CSOs so there are lots of the CSOs who are helping the TB patient to track them to do the screening and then like when they are traveling around so they are actually referring that particular person to other CSOs in other other the border country so they've been like trying to import all the things so there are lots of challenges it's not all the challenges can be solved technically that was the one of the aspect from here so this was also the message so this is a patient who has been transferred from Myanmar to Laos for example so when they transfer this is the message what get this particular person is going to come around we also had a discussion on who should get it because currently what John was saying when they transfer it is from one hospital to other hospital from the neighboring countries but in NTP like what it goes like when you transfer it goes to regional database and notification will be sent to the national NTP person and also the intended province or NTP province of hospital those where the two persons who get the notification this person will come this is the intended province and this is the intended state of time and then if the person goes there it's well and good if not is lost to follow if goes there if he goes to other province the other province people can actually search this person was supposed to come around here but he went to other place and he can admit it and then a message is sent back to the country that this particular person is admitted this is the the number this is the registration number of that particular person and these are the contact of the hospital that will be sent back so those were the basic few things this was the like in covid it's also the same way because like in covid like we wanted the person to carry like how does you verify that this person is this person and he got all this information how best we can try to deal with it this was something which we were trying if we can it's possible to like have everything in the qr course which can be read into the other places and he can be put into the system but this not yet but let's just see how things works out this way are the the few few few things what we've been trying to include new innovations into them the cross-border TV and right now we are focusing on GSM countries but it's also once the concept and everything is ready doesn't mean I have to be only GMS country but it's also from other countries can be used in this way that's all from from me it's online we have got some questions because many of these countries have projects on the border with active case finding where they actually try to identify TB in migrants and how are we fitting in with it and actually we could use it in exactly the same way by registering and sending it to the national database whether it's going across the border to that database or to the migrant database and to to notify to the correct country database so it's a very multi-purpose way and we didn't say much about how to actually the interoperability is functioning from all stages from more automatic interoperability to download whatever kind of format to actually whatever if you enter them physically manually any questions thank you you talked about the patients being transferred and the pool where they get the key on waiting until they reach their destination and you talked about the search where other provinces can search the requisite patient giving that kind of an option to all the end users that's something that needs to be like it should it be done or should it not be done technically it's a good thing but patient confidentiality and all that stuff and giving open access how do you get by that actually like we didn't give the things this was the one something which we wanted to try to propose like you just say if one person is going to a particular country when they try to search you're not searching for the oldest record you're just like searching for those names but now NTP has become more strict they just say no there are only things it will come to the NTP and we in NTP national level will assign very so that's how currently the systems are but like the people CSOs actually help the non-government organization the civil service and like most of the NGOs were dealing with they are actually following the patient quite closely between two borders they are not searching in other places what we tried to do if one particular person is searching for more than what is needed it will be flagged in DHR state you cannot search and then like the cost border thing many people from Thailand many people from the neighboring countries are going to Thailand Thailand is the most people, migrant people are there compared to Myanmar, Vietnam Cambodia and Laos again like when it goes on it will be notified to that particular facility only if other person comes like it goes to other place there is a facility where just for the temporary way when they search you will just get okay this person is there so then like they have to request what we called is breaking the glass only for that particular type and like if a person breaks the glass two times then like we know okay there is something wrong happening with this guy why he is going to search for so many people if no then like we go for the next presentation that will be from Pakistan thank you so much for giving us the opportunity to present what is happening in Pakistan regarding TV over to today's topic is DHS2 TV tracker capture implementation in Pakistan in both public sector and private sector what has been happening what is happening and what we have been faced so far with the implementation of DHS2 regarding TV coming to the point that the team that in Pakistan that we have is we have substantial number of team members myself we have a national DHS2 coordinator the MISA MISO all from the public sector then in the private sector these are the technical persons that are leading the implementation Abdullah Latisha project manager Mr. Seher senior IT Upsab data visualization specialist Mosna Shahid so Naina Nawaz is there as research you see a lot of dynamic personalities there all contributing to the implementation of TV tracker and so having all these dynamic people in the team gives us flexibility to use DHS2 in a good way we have all these standard packages available in the other WHO metadata packages but having this team allows us to do customizations creating metadata packages like WHO within the country dynamics so for the public sector we started implementing in 2018 there was a DOT followed by list of trainings throughout the country Pakistan is not just a single country it has evolved into multiple provinces and each province stands alone when it comes to implementation on directions and their own implementation challenges so we started this journey in 2018 with the aggregate module before that it was Excel based reporting in 2018 with the support of HIST and University of Palslo we started our journey on the DHS2 for the aggregate module with country specific metadata again with WHO recommended dashboards and guidelines this journey took around three years and still is going on but during this process we started to work on the tracker path in 2019 we started customization of TV tracker for the mandatory case notification project this was done solely in house by the ministry and it was reflected as for the forms that were available in the country this project was carried out for two years before it was closed and the results were quite significant then again we used the tracker not the WHO metadata package but the customized tracker for multi country grant project that was for Pakistan, Afghanistan and Iran so the tracker is being used at the moment in the country for recording the patients of the TV and the technical support is ongoing at the moment and we are doing another venture similar as the one that was discussed earlier so last but not least the third implementation that we did for the tracker was the pilot in Islamabad in federal capital for the TV closest case notification TV01 that we see again this was customized in the house we tried to follow the standards but the WHO metadata package is different so we are working on that as we speak the pilot was conducted last year in 2021 and the results are still coming in and in the meantime with the support of University of Foslo Global Fund and other donors we are working on customizing the WHO metadata package for the TV tracker and we will be doing that in quarter one and quarter two of 2023 so here are some differences of the WHO dashboards that are in the national system so we have tried to use GIS as well the mapping files are there so we can plot and see what's happening, the notifications and all that so the way forward for the public sector is that we roll out the TV tracker in quarter one and quarter two of 2023 for all districts and since we are a devolved country each province has its own implementation Punjab province one of the provinces is highest burden province in the country and it has its own implementation an electronic medical record system developed by the HISTU department so we will be supporting them in the integration of that EMR with the DHIS too for the case case so we are looking forward to these two so this was for the public sector one thing that I would like to add here for the public sector we have single DHIS2 instance for tuberculosis, malaria and HIV in the country so for TV the centers that are reporting for TV and some of the centers are reporting for malaria and some of the centers might be reporting for HIV so all of the data is coming in to the national DHIS2 instance that is present at the common management unit for AIDS TV and malaria under the Ministry of Health for the private sector the private sector mainly the Mercy Corps that is supporting the country implementation for tuberculosis interventions in the country they were using their own customized information system that was designed for their need and is still being used for recording and reporting in the country but with the shift in the dynamics of the public sector as per commitment for DHIS2 rollout in the country Mercy Corps with the support of BMTF and his Pakistan is piloting WHO tracker package as per PPM requirements that's going on at the moment pilot has been completed I guess in five districts in the capital Android app is being used as the entry medium at the GP level so for public sector it's desktop that this version that's being used for the DHIS2 for private sector we are using Android app for the recording and reporting needs again I would like to add that the WHO indicator driven dashboards are being used for the tracker reporting here are some glimpses you will be seeing I guess so these are some glimpses of the tracker that's been customized and used for the case-based surveillance by the private sector the organization's units have been aligned so these are the same organizational units we have one structure that's available so public sector and private sector both are using the same organizational units here you can see the form that covers different stages diagnostics as well as treatment as well as outcome and context training and the final thing is the dashboards are being prepared so with the support of the team and the donors the DHIS2 implementation in the private sector is being rolled out the way forward for the private sector I believe the pilot results will be seen in the coming months and will be customizing the DHIS2 as per the outcome also we are expecting a rollout of tracker in 120 districts for Pakistan for the private sector in the coming months so as we talked about that Pakistan is a big country with multiple provinces and being devolved it has its own standing in every province so we are covering 157 public districts for the aggregate part reporting and 120 private districts as well so that's pretty much it from us if you have any question we are available there is one question online for you why using android for the private sector so that's a very interesting question in private sector we have DFS those are working in the field so we prefer to use the android version to capture the information rather than using the web version that's portable and allowable it's easy for us that way rather than getting a laptop they are giving them the laptop they can just use the offline one any other question online so we don't have any questions we are less people was it a big lunch okay let's just see so right now we know that we have the db has been used in multiple places the question from us we from me to you on what are the different challenges I have been facing in getting the regional tv working high level challenges and what country can do in cross border tv so it's a challenge to get countries to agree on the principle of sharing data so one approach is then to get it more down to the practical level and saying that today you are referring patient using line or email or whatsapp or facebook or things like that it's better to do it between two secure databases and then start with that that's what we have suggested to take it that instead of going to intergovernmental agreement of data sharing but I have looked it up the IOM actually have a template for data sharing which we also can suggest to use because it will focus on what kind of usage and for whom and focus on that and that should be possible to describe exactly what it's for and the restrictions and the limitations for cross border referrals and then we have this aggregate data for dashboards etc. that's more like same debate as we have when we want open dashboards and sync and how to share data to the more general public but again that's more of agreement is union and the problem of course in the region is that there are five countries not only between two and three but five countries so our approach is to take two and two and go with the three I mean actually Vietnam, Blau and Cambodia as a kind of a triangle that we can work on. Thanks. John and everything about Malaria and I will tell that and some reason they managed to get data sharing agreement even of it very difficult to see exactly the text in the photograph we have of that. In Malaria there is ministry level agreement by all the ministry from the five countries to share the data usually like what happens is by program by program there is very less effort to say now we are only talking about TB what happens then next to HIV so Malaria they already have an agreement to share the data between all the GMS country but not for TB the TB we are still struggling to get the agreement things down. I know in Indonesia we have been using TB okay now the question is can you explain how TB system is in Indonesia? Okay thank you in Indonesia we have maybe 13 form to use TB to record the TB so there's a lot of things to do to record the TB the first maybe the surveillance go to hospital maybe in no no in in hospital there is book for the register for the someone that suspect to be TBC and then they are record to the request to check the bacteriologist and then they have a card for the treatment something like that and until they are going to be surveillance like they are positive on that so there is a long process to record the TB right now maybe it's just manual you know record for us in Lebanon we have foreign worker coming to Lebanon so the first thing they have to go to the hospital and make their scan so they are confirmed cases they are sent to the cemetery for treatment then they can go back to outside and continue their treatment so since January we developed the system on DHIS we took the DHO form the original form accordingly we build the form on DHIS with different stages and since January now we are using it and now we are working on a report since we have some data now we are trying to develop the related chart like in many countries like I've seen like in Vietnam like the public facility or public ministry are also doing the presumptive screening but not in other places like in Laos it's only when you are positive you are admitted into or registered into the public health system before that one it's all maintained by NGOs or other things where they are doing the village level screening in Cambodia it's also the CSOs are actually doing all the presumptive screening and then when they are positive they are actually taken to the hospital so it's a heavy need also to include the CSOs information in the public health system and then we are facing lots of challenges saying that can we give the access of DHIS to the CSOs because they are actually doing all their data collection and some of the CSOs already have a system how best we can try to integrate their data into the national system of the TB so these are the different challenges that we are facing in many areas not only like just focus only on the national system but also try to use the other means of collections and linkages between the CSOs and right now at least like government are accepting the data from them to be included into the national system and they can they are just saying okay they can see the dashboard but we are not going to give the access to them yet so those are again the political and things issues to just to make sure can these people can also get the access at least they read only access to see these are all the things in my community so many cases has been updated and what happened after the TB treatment whether it was lost to follow up or things so those are things which we can try to share across not only the public health system but also with other partners during the assessment of the regional TB in this YGMS country we had this list of all stakeholders so each and every country when we did the study the stakeholder of TB is quite huge if you just focus only on the ministry health and things that will be very limited in Vietnam itself like the CHI is also working with the national TB system where CHI have developed a mobile system whenever they see the presumptive positive cases in Vietnam the ministry of health also recording the presumptive cases so they are sending the data from their system directly into the Vietnam national system Vietnam national system which is called VI times it's Vietnam TB information management system I just call it VI farms it's easier to like a newspaper but that system is an online system and CHI has their own local system which is used only in few provinces or the southern provinces so whenever they find any presumptive cases they are actually sending the data to VI times and then the national system is also sharing that particular location to them so this is something which is very nice to hear that like there is a linkage between national system and the CHI like in few provinces where they are actually supporting not only the case bring them to the hospital I guess like that's also some best practices what was nice to hear during the study that what we can be used in other countries also. My question is that you know when your milk is cleaning sometimes you find them negative does the tool in the DHIS TB DHIS tool already exists does it come with the negative cases or only the positive cases in the DHIS or in VI? In DHIS too like it only in Laos it's only positive cases but like in the DHIS to metadata packages and all things is again like it's only the positive cases right so at least most of the places but it has the ability to record the negative cases then they are not moving forward so the screening part usually is in other area in Laos there is an NGO called HPP who is dealing with all the screening and when there is positive that record is pushed into the the WHO TB case surveillance package positive not for screening so in Laos in DHIS they have made their own screening things yeah so again like it's the thing is not many public health system are doing the screening in Vietnam they have this five module where they start with the screening but only in few facilities there are few facilities which only focusing on treatment and there are few facilities is only for diagnosis not even a treatment so they have categorized this there the TB units as different places in Cambodia is treatment only in Laos it's only treatment so again it's depend on different countries need how best we want try to do support as a TB as a whole not only start when there is positive but also try to do the screening and like how best we can try to do it especially at the village level and can ministry of health can take this burden of screening and recording all the things because also in Malaria when they started when the case in the case is so much you don't want to record individual cases that particular time you want to just go down the case burden has to be reduced and then you are dealing with elimination for the case burden you don't have to record on all the case then you are overburdening your health worker to dealing with all different things including positive or negative again it's also the same kind of things can be implemented in TB too that like if you want to we don't want to overburden our health workers to do all the negative cases that's why like we only focus on the positive you want but can we get at least the aggregate data or all different kind of things from other places and if the CSOs are already using because if they are small they are actually maintaining all the names and everything and maybe we can just take the suspected cases into it and then start from there yeah in Bangladesh what what is done in Bangladesh we are not using the tracker for TB cases there is another software we are using but there is no screening this is actually suspected TB case so if there is any case which is suspected there is only entering the tracker and then if it is positive it is go forward if it is negative then it is stop there so that is our case protocol but for the populations population screening actually we are doing other project for other disease depends on the policy so if there is a national policy then we have to so if there is a TB elimination this might require policy but our cases the cervical cancer has elimination but it decided so we have to do the 3260 all women should be still despite of positive or negative yeah yeah it seems with Indonesia in facility health facility we have to application the RYP TB that to notify the doctor that there is a TB patient and there is a storm but TB that to track the pressure just maybe if there is any suspect they just attract and then if the contact is isn't positive so it's still like that thanks thanks for all the comments so it's good that like we share our experience about the TB so I guess like we are time for the coffee so we can break now and then we can be back at 330 to stop in this place is on the custom apps where we can know what are the different custom apps extending DHIS to for the local needs okay thanks