 Thank you Tish. And thanks everybody for giving us the opportunity to share this work that is called operational models for delivering healthcare in insecure settings. They want to show the strategy and the intermittent preventive treatment of children for malaria plus vaccination in Central African Republic. This work is based in one of the big challenges that MSF continues having. And as yesterday was mentioned in different presentations. How to assure access in insecure settings. So just let me go through the factors that took us to arrive to these two strategies. The one shot and the intermittent preventive treatment for children. We have security challenges for sure and we have as well in Central Africa health system constraints. Those health system constraints are taking that our teams cannot access to the population or that the population cannot access to the health services or structures. This population is as well affected by by displacement. The displacement can be different of different magnitude and different frequency. At the same time in Central Africa we have one of the big diseases that is malaria that is affecting many populations and is the first cause of morbidity and mortality for children under five years. And last we had as well that since 2013 the coverage of vaccination has been weak due to the disruption of the system. So this map show us the places where MSF works at the moment. These experiences have been developed in three of the projects we are which are Cabo, Batangafo and Endele. Just to illustrate a bit what is our usual way of working in Central Africa I want to use the chart of Cabo where we are going to see that we have the star in the Cabo village that is the city of the of the district and we have then the peripheral areas know the part of Mayansido, Basara and Farazala. So in each one of these places there are structures which MSF supports with the different components that we develop in the program that goes from pediatrics, maternity, HIV, tuberculosis, etc. Our teams support in terms of training and as well in supplies and constant presence when possible. Usually we do movements from Cabo to the periphery to do this this job as well. At the same time we have a community network through the health workers which who support the activities that we develop not to complement in terms of information and as well tracing of some patients. When we have problems of access usually is mainly in the periphery that makes that we cannot access to the periphery or the population cannot access to the town. But then what is it what is what we call the one shot and what is the intermittent preventing treatment. Let's start by the one shot. The one shot is a movement that we do quickly to the periphery when we have the opportunity. We offer the package for the most vulnerable population that we said that is going to be the children and the five the women especially as the pregnant women and if needed we are going to offer as well mental health. When we talk about the intermittent preventive treatment for children and vaccination we are talking about administration of Arte Sunat Amalia Kind for prevention of malaria, vaccination with a measles vaccine, festivator thing that for pneumococcal and pentavalent and the distribution of mosquito nets. How was it done? The one shot experience we developed in 2015 in Batangafu as an alternative for the different incidents and problems that we had in the periphery. We did or the way that it was done was through the movement to the periphery when we had the security window and using always the harm reduction principle. We was needed as well the information to the population through the health promoters that we will arrive that date. For that we needed always to keep good contact with our networking. In the case of the intermittent preventive treatment and vaccination it was done in Cabo Batangafu and Endele in 2015 at the real level and the city level. The alternative is an alternative during the high malaria transmission period and use the massive vaccination campaign format to deliver the service. For this is very important to use the community and city session in order to transmit properly the importance to participate in this campaign and how it's going to be done because we set up different sites in the periphery. So what were the results? In Batangafu in 2015 through the one shot activity we managed to do 18 movements to the periphery. In those 18 movements we covered 3,300 children with vaccination. We did 50 unit counseling sessions in mental health in five points where it was considered due as well to the incidence of the situation at that moment. 2,400 children were screened for malnutrition and those who were found with the criteria to be included in the program were therefore included. 150 cases of malaria were treated and 45 reproductive health consultations were done. 30 of them were for a pregnancy. In the case of the intermittent preventive treatment for malaria and vaccination, four rounds were done. In Averash for the four rounds we got coverage for the artesunate amodicine administration of 86 percent over the 15,300 kids that were targeted as an estimation and we distributed more than 48,000 mosquito nets. In the case of the vaccination coverage we used for the presentation measles and we got 81 percent of coverage. We refer as well some malaria cases complicated. Although we cannot go so much in detail in this presentation I just want to show with this graphic something that we keep still for analysis that we have seen a reduction in the number of cases of malaria that have been in the external consultation. In the green line is the data for 2015 and the red and blue are for 2014 and 13. The arrows are just showing the moment where we did the campaign of the intermittent preventive treatment. As conclusions we can say that for us the two strategies have allowed us not to have a delivery of service to the population that otherwise with our usual model we have not been able on that period. Then we have as well that the sexual reproductive health was a missed opportunity taking in consideration that children are taken by moms, sisters, aunties to these kind of activities and that most probably we could have been done more but the reasons given by the teams is the volume perception. The coverage of vaccination although was not fully measured we have noticed that we were able to increase more than 10 times the number of children that get in contact with the service compared with the previous year and that these strategies could be considered and be adopted wherever there is need. The challenges that we face that we continue facing for in these activities is the data registration, the difficulty to know exactly when we could do that movement because it depends as well of the security window, the way to include better these sexual reproductive health elements and the think capacity in terms of flexibility and way to adapt and react on time to adjust for the moment. The limitations for the work that I'm presenting today are mainly related to the data collection because as I said before we miss better data to present the vaccination coverage. We realize that could be interesting as well to have an individual database to see how many times the kid has contact with these kind of activities and make a better follow-up for the child and the difficulty that we had to launch the coverage survey that was planned for last year but due to security issues we couldn't do it on time. What are the next steps for us? Well we can and we are in the line of continuum to look for alternatives for this kind of context and specifically how better we could adjust and deliver the service to see as well that these strategies could be as well a need or a possibility for other emergency contexts to avoid missed opportunities in sexual reproductive health. As minimum we would like to introduce and already the teams are doing this year the vaccination of women during these strategies and to maintain the catch up vaccination as a basic in the component due to the positive results in the calendar for the kids. To improve of course the data collection system. So as acknowledgement of course we have the population and staff from Batangafo, Cabo and Endele and today I would like to mention as well in memory of our colleague from MSF Hola who was killed this week in one of these incidents a driver in Bosangua project and of course to all of you thanks for your attention.