 So in this session, we will talk about how you can assess readiness for starting with DHS-2 and tools to assess the maturity of a DHS-2 implementation. In this session, we will identify tools for performing DHS-2 readiness and maturity assessments, learn about which factors are relevant for a country's readiness to start with DHS-2 aggregate systems, and understand the factors relevant for a country's readiness for DHS-2 tracker or individual data systems. We will start talking about the DHS-2 maturity framework. We have two different tools that can help you both assess whether you are ready to start with DHS-2 and to understand how mature your DHS-2 implementation is. So the DHS-2 readiness assessment and the DHS-2 maturity profile related tools. The readiness assessment is a tool to map the current situation in a country before starting with DHS-2 to ensure that the prerequisites are in place. While the maturity profile on the other hand is a tool that maps the maturity of both the foundation and programmatic topics related to an existing DHS-2 implementation in a given country. So again, a readiness assessment is something that you do before you start using DHS-2 in a country to understand whether you are ready. The maturity profile is something you can use to understand how you are doing in your already running DHS-2 implementation. You can see on the slide on the left is the topics that is addressed in the readiness assessments. These are areas such as leadership and governance, security, training of end users and infrastructure. To mention a few, we will go into detail about these areas later. On the right, you see a visualization of the DHS-2 maturity model. This will also be discussed more in detail later. But the point to show on this slide is that the topics that we address in the readiness assessments are corresponding quite closely to the foundational areas of a DHS-2 implementation. The foundational areas are topics that is important to have in place to have a solid functioning DHS-2 system in a country. And again, to summarize, the readiness assessment is the mapping of the current situation before you use DHS-2. The maturity profile is the mapping of the current situation with DHS-2. And we will now move into explaining more about both of the different tools. So readiness essentially means what needs to be in place to start a DHS-2 system. So before starting with DHS-2 in a country, it's really important to assess if the country is ready with a focus on a key specific areas, such as leadership and governance, strategy and investments, security and compliance, if there are available technical skills for a DHS-2 system to be set up, if there are people available with the right skills, if the country has a system to train end users, whether there is availability of a facility and population profile, what the situation is for infrastructure, and how the country currently collects aggregated data for the HMS. So in the next coming slides, I will go through each of these sections, the questions that is asked to understand the readiness for a DHS-2 system. It's quite a lot of text, but bear with me. So first, under leadership and governance, what we want to understand is, is there an existence of a health management information system unit within the government? Does the government have a national department or agency or coordinating body for digital health? Is there existence of leadership and political will to start with DHS-2? Does it have political support, for example? Are there existence of agreements between the Ministry of Health and other agencies for digital health implementation? So are there any kinds of agreements and coordination happening? Existence of structure for engaging key stakeholders, including other government agencies, system users, civil society, organization, funder, technical partners, implementers in the private sector? So are there any sort of formal forums or places where these conversations are taking place? For strategy and investment, we're interested in understanding whether there is a key health strategy in the country already, and if there is money set aside to work with DHS-2 over time. So again, here we assess whether there is existence of political interest and support in investing for IT for service improvements, existence of sufficient funding to support infrastructure strengthening. Often we can see that there is lack of devices, for example, in a country that will influence how a DHS-2 system can succeed over time. So is there sufficient funding to support infrastructure strengthening? We're also interested in understanding if there is a cost plan for maintaining physical and technical infrastructure in the country and human capacity of the system strengthening investments. So for example, is there a plan to replace broken devices, for example? Are there people available in the country that know how to do these replacements or repairs? And also whether there is sufficient funds to support a cost of maintenance plan. So for example, if a device breaks down, is there a plan on how to replace that device or upgraded, etc. Under security and compliance, we're interested in understanding whether the country has the policies, frameworks, laws, etc. that guides how the country, for example, addresses personal data. So we want to understand whether there are legal frameworks for data protection, if there are any laws or regulations for privacy, confidentiality and access to data information, and also if they're personal responsible for implementing e-health security policies at a senior level in the country. This is important as a lot of the DHS2 systems often contain personal and sensitive data. And you want to make sure that this is set up in a way that does not conflict with the country's regulations or laws. Or if there is none in the country, that needs to be addressed when starting up. You want to understand whether there are existence of specialized knowledge to support and maintain a system such as DHS2 in a country? Are there people available that have basic IT skills, that can do basic programming, understand databases, scripting, etc. For training the end users, it's important to understand whether there is a system in place to train both the HMIS team but also the end users that are going to use DHS2. So we want to understand the capacity and computer literacy of the HMIS team. We want to understand the mechanisms for workforce capacity developments and communication of training support. So for example, is there a plan for training people when they are newly hired? If there are new people coming in in the middle of the year, for example, if people quit? Is there a system for retraining staff? We also want to understand whether there is an existing process available for regular supervision of staff regarding data entry analysis and management. The key aspect of a DHS2 system is the facility and population profile. So an important thing to assess before starting with DHS2 in a country is whether there is a master facility list in the country. So does the country have an overview of all the facilities with associated data available to use as the basis for the DHS2 system? And you also want to understand whether the country has the ability to identify a person or a child unambiguously. So is there any kind of social security numbers or ID numbers, etc. That can make sure that you can identify a person. The key components of a DHS2 implementation is infrastructure. Before starting with DHS2 in a country, you would like to understand whether the country has stable electricity, how the internet or data access is at health facility and district level. You want to understand who has accessible computers or mobile devices to capture data. You want to understand how a country is supporting data storage and servers, how the national level capacity of maintaining hardware in the data storage center is, and whether the country has the ability to maintain and troubleshoot both hardware and software at district and health facility level. And finally, before starting with DHS2 in a country, you would like to understand how the country currently collects health data, so the availability of paper-based records. If there is enough workforce capacity to enter data or is the workforce completely overburdened, is there any existence of a regular data review process? So all of these topics that I've gone through now, we've developed in a tool called the DHS2 readiness assessments, and it scores these domains from non-existent to strong. So it's not required that all of these are in place before you start, but you should be aware of where the weaknesses are or where the gaps are before starting so that you can address them in parallel before starting and as you start a DHS2 implementation project. So once you have DHS2 already set up in a country, we have a tool called the DHS2 maturity framework. This both guides readiness for new programs. So if, for example, the country uses aggregate HIV, TB, and malaria in a country, and maybe you would like to add another program, EPI, for example, or you would like to go deeper into a tracker program, it's useful to understand what the situation is of the current DHS2 implementation. So the DHS2 maturity profile tool is a tool that assesses the maturity of DHS2, and it really supports countries to measure and understand if the country is progressing on their health information systems strengthening, but also if they're ready to go further and if there are any areas they should really address before moving to the next level. You can see here in the picture that there are some foundational areas at the bottom. This covers areas such as leadership and governance, how you train end users, security and compliance, etc. A lot of what I described in the readiness section and this is depending or it doesn't really matter which program you're building on top of it. This needs to be in place in any case and then each program is assessed by itself. Once the HIST group has done this assessment of the country, the results are compiled and aggregated and it can be displayed the way that it is here. So it gives a sort of a glance of what the situation is. And it's important that this tool can encourage investments in the core DHS2 capacities, so the foundational areas. This is really what contributes to a sustainable health information system supporting the health programs. So if all of the foundational boxes at the bottom are red, meaning that they're scoring very poorly, then the chance of succeeding with a health program at aggregate level and even more at tracker level, and I'll get back to that later, is very poor. So you're depending on a strong foundation in order to build something else on top. The results here can also help align across investments or donor interventions. So in an ideal world, you would have different partners pay for the same thing. So if everybody can chip in and contribute towards the DHS2 core team, for example, or to strengthen the security and compliance under DHS2, that's helpful for all programs. And it also helps in assisting planning DHS2 implementations and strengthening activities. It can also really identify areas in need of more in-depth evaluation and monitoring. So if an area is scoring very poorly, it also means that you would have to dig deeper and understand really what is the problem and go deeper to really understand the details of how you are to address that specific problem. Again, the tool measures maturity in three core areas. You have the foundational at the bottom, the aggregate in the middle, and the tracker on top. I've mentioned this already, but just for a quick repeat. You can see the symbols here at the bottom. You have the in-development symbol with a little tool that indicates that the program is being configured and developed, but it's not yet been implemented anywhere. Then you have the pilot sign, the wheels turning. That means that it's being tested out in a couple of facilities to see whether the configuration is sound and if then you need to do any changes. And then the arrow pointing upwards, it means that it's in the process of scaling or fully scaled. Next, I'll talk about what is important to be ready for DHS2 aggregate systems. Again, repeating to add new DHS2 aggregate programs. For example, if a country wants to add aggregate EPI, for example, to their DHS2 system, or they want to add an HIV or surveillance, we recommend that all the foundational topics that you see on the bottom, on the blue square, are at least in early progress. That would be the yellow marking in the maturity profile before starting a new program. If you have a country that is scoring reds, not yet achieved, these really needs to be addressed. You can start with a new aggregate program, but we highly recommend that you address these not yet achieved things already. And this is because if the country does not have any system for training end users, if there is no facility or population profile or the infrastructure situation is very poor, it's very hard to do even aggregate programs well. Next, I will assess the readiness for DHS2 tracker systems or individual data. So starting a tracker program is a little bit more complex than starting an aggregate system. So it's a potentially large and pretty complex endeavor with large investments in devices, personnel, etc. And hence it is very important to ensure that there is sufficient institutional buy-in and support from key stakeholders, that there is funding not only for developing the program and the start of the implementation, but you also need to have money for training of staff and continued support, being able to buy and replace devices, etc. You need to ensure that the legislation and policies for privacy, e-health and standards are up to up to dates. And if there are no policies, that's the topic that needs to be addressed carefully so that you're sure not to break any laws or do anything that is unethical in that country. We deal with sensitive data, so that's important to remember. It's important to assess the capacity and competence to plan, design, develop and long-term support tracker system. So do you have the proper DHS2 capacity in the country to start up? Is there capacity in the districts to support end users over time if they get stuck using the system, etc. And lastly, how is the infrastructure situation? Do you have enough devices? Do you have money set aside for connectivity? What is the service situation like? Do you have a system for user support? Who will pick up the phone if one of your 2000 users, tracker users have a problem? Do you have a system for that? And to match the implementation plan. So in general, the foundational domains, we recommend strongly that they are at an acceptable level before tracker programs are implementing. So this means they should score at least early progress, meaning the yellow box here, yellow color, preferably adequate when using the maturity profile tool. You should really not have any not yet achieved before starting a tracker program and security and compliance should always be at adequate level before starting a tracker program. And as with aggregate systems, when planning and budgeting implementations of new individual data domains, it's critically important that the plans also provide for strengthening the foundational areas that are in need of improvement. So when writing your budget for your system implementation, do not only write down the cost of configuring your TV tracker, for example, but also are there any activities related to these foundational issues that you should include in your budget to ensure that your system is successful over time? Lastly, I will talk about Android considerations. So readiness for implementing the tries to Android applications as a component of the aggregate and tracker systems is not something that we have explicitly covered in the maturity model tool, but it is part of assessing each aggregate and tracker system. But there are some special considerations for Android implementations, for example, if there are special implications for trainings, what kind of devices you should procure, etc. This is covered in more detail in the session on going mobile in this course. In summary, before embarking on a details to project, it is important to assess whether the country is ready or not to start and if there are things you need to fix before you start. This is especially important for projects using tracker to collect individual data, because these projects are close to clinical practice, they are in use every day and they require more elaborate planning and a higher degree of readiness and details to maturity than an aggregates project does. It's a larger investment, it's more complex and it affects more users. So here it's especially important to make sure that you are ready before start. So here's BIO, we provide various tools and frameworks that can help assess readiness and maturity for countries in details to implementations.