 Welcome, everyone, to our session on community health management information systems. Now, oh, I need to stand near the camera so everybody on line can see. So you may be wondering, why is the analytics product manager talking about community or leading a session on community health information systems? Well, the answer is, before I became a product manager, I was a DHS2 implementer. And I started my career in Zambia now 10 years ago working on community health information systems. And it's still a use case that is very much near and dear to my heart. And because I always like to think of community health information systems as the most complicated information system that you can build. Because at the community, every single thing is happening. There's health services being provided. There are different kinds of community groups. There are, they're doing agricultural campaigns. They're doing water and sanitation campaigns. They're doing all the different health services, or most of the health services that are being provided at a facility have some community component. And you have different stakeholders. So you don't just have clinicians and in-charges. You have community health workers, maybe different types of community health workers. You have community leaders, chiefs, chiefs, religious leaders, village leaders, mayors, governors, and all of these people will have to somehow work together to make community health work programs operate. And so from an information systems perspective, to me, it's much more fascinating, but also a lot harder, much more challenging than just building a reporting system that just goes from health facilities, okay? But the reality of it is that we have to have good functioning community health information systems because we know that community health workers in most countries are the very front line for healthcare. They're receiving the patients before they get to the hospitals. They're receiving a lot of the patients that may never even go to clinics. And they are capturing a lot of data that needs to be, that needs to be integrated into the HMIS. In many countries, we actually have seen that for different diseases, community health workers can represent about 30% of the case burden. So that means that 30% of the malaria cases are coming from the community health worker. So if we are only counting the malaria cases that come from the health facility, we could be missing a large proportion of the actual cases in the country because many people don't end up going to health facilities. They only go to the community health worker. So that's why community health information systems are really important. And in this session, we're going to just have three different presentations other than my own. So I'm going to give a little bit of an update on some of the resources and partnerships and upcoming events that we have related to community health information systems. And then we have Dr. Mania joining us from Kenya. He is going to present on their continued development of the community health information system there and specifically in how they're actually looking at that community level data and ensuring quality. Then we have a very interesting presentation from Ali Chibwe and Blessings Kamanga. They are joining us from Malawi and they have been integrating their ITIS, Integrated Community Health Information System, to cover all of their universal health coverage. And then finally, we have the last presentation from Angola. We have Yohkem Hamilton and he is going to be talking about their continued development of a integrated community health information system in Angola. It's been a really interesting project to follow for the last couple of years and some really incredible innovations have come out of it. Before I hand it over to Dr. Mania, the first thing I want to point it out is there is a tremendous amount of information and resources now out there on how to build community health information systems. We have been working very closely with WHO and UNICEF to make sure that DHIS-2 is integrated and a part of these different guidance materials. There's a brand new document out. It's called the WHO CHW Guide on Strategic Information. That's going over all of the new indicators that are available. WHO has actually made a standard indicator set for community health workers. That's an extremely useful tool. There's training materials there on the second bullet. There is a roadmap to CHIS implementation. This is also brand new. This is a really good and thorough document to help you go through the process of actually making a CHIS if you don't already have one and some best practices as well. Then of course, we have all of our different metadata packages, something you may have been familiar with, but we have been developing over the last several years different preconfigured metadata packages for DHIS-2. This means all of your indicators, datasets, data elements already preconfigured that you can just download and install into your DHIS-2 instance from our website. These also cover community health as well. The last two points is we still have our DHIS-2 Community Health Information System guidelines. This book here, I don't think we have any more physical copies. This is the last physical copy of it. Oh, you have a box. Oh, we should have brought them. All right, well, we'll give you one later. Just come find me. Kristen had a magic box stored away just for this moment. But anyways, back in 2017, which I know seems like a long time ago now, we got together many different stakeholders in countries and wrote a fairly comprehensive guide, kind of A to Z, on how to use DHIS-2 as a community health information system. Even though it was 2017, the vast majority of this is still very much relevant and useful. Some of the technology needs to be updated. We have better apps. We have better things that we can do with our cell phones now. But still, the vast majority, 95% of this is still very good. So we have this. We also have it online as well. And it's also in French. The English version is 200 pages. The French version is nearly 300 pages. So that's what happens with French. And then finally, the last thing I wanted to mention is that we have an upcoming CHIS Academy. So if you want to understand how to use all of these different materials and even our book here, we have an Academy coming up last week of June of 25 to 26. Some debate on when it starts. Sorry. Yes, June 26 to July 1st. You don't have to show up on the 24th unless you just want to hang out with us. You're more than welcome. So it's going to be in DAR. There's a link to it here. And we're still, I think, if you're quite keen and interested, I think you can still probably register for that. So that'll incorporate everything. So now, Dr. Mania, I will hand it over. Yeah, good afternoon. I want to make a small presentation on assessment of community health units. One of them is that the, sorry. Yeah, I'll just, I'll do the usual introduction methods and then I'll give some discussion. And I think Scott has said very clearly the importance of community units in our country. They actually form the first level of health care. We have level one up to level six and level one is the community. And the people who manage these are what we call community health volunteers. And in real sense, they are not paid. So they visit households. They help you with some data. They ask you if you have finished your ART, whether you are on you're taking your children to immunization and the quite, and for some, they've started giving them some kids. For example, maybe my later if it's possible, but they still a lot of problems that we should actually empower them to treat. So that is the bulk of the work they do. But as they do this work, they also collect data. And this data is normally aggregated and put in our DHS. So the motivation of this data, this evaluation was that we actually noticed that the data that is in the DHS, it's just like maybe Nora, you come from the south. So the data in the DHS is just from the south and north pole. They're not really connected between what is available on the ground. So it made us start thinking what could be the problem with this variant. It's quite too huge. And so we did we did our data quality audit. And it was supported by AMREF. And so you will find that when it comes to the sampling of the counties, it may not be scientific. It was based on where AMREF is supporting. So that is part of science in the village because whoever pays you have to work only in that area. So we compared data that is available in the big books at the community level with what was actually available in the DHS. And we were just looking at the accuracy of it. So we looked at whether it's complete and the idea is just to see whether we can make anything out of it. We did a cross-sectional study design just a snapshot because we didn't follow them up. And as I put it, it was just a purpose of sampling for the administrative counties, which were actually supported by the supporting team. And in each county, we selected around 10 community units, which we called them in a meeting and we sat with them and counted the data. And we actually chose a specific timeframe for that is October, November, December for 2022 so that we can compare the data plus the one which is in the system. And during the quality data quality audit, we actually documented the availability of the tools because the national level sometimes prints these big books and gives them there. So we wanted to find whether these books are actually there. And when they were there, we also looked at whether they were well-filled. Some people had gaps, some didn't have gaps. And during the work, we used ODK to collect data and it hit a bit of challenges because ODK was prepared by the donor, the AMREV. So meaning we were sinking data down there, we don't know what happened beyond that. But those are some of the limitations that you've been given up already prepared and that is okay. But after that, they gave us some of the data and we used Excel to just compare the data. I just want to show you, this is during the data collection. I think the only interesting thing that we used a very big vehicle to visit people who don't even have, so maybe we would have used that money to buy them lunch. But the important of this is that if you are very keen, you may find that the books are different. Some of them have what they call files. You don't even see any register available. But this is what we call their documents now, what they use. And some of them were saying, our papers, sometimes if my husband finds that he wants to write something, the easiest place to plug is on this one. I'm saying husband because during the research, I realized that actually the ratio between the volunteers was nine to one, nine women to one. So very few men were willing to volunteer this work. So most of them were ladies and the books, they carried the books home. So they have the books, they work with it, they go with them at home. And sometimes when you call them for meetings, that's when they start looking for the resources, where are the books. So during this verification, it was very difficult to find it coming up very clearly. And so a quick finding incidentally, we find out that 65 of the people who evaluated actually had the reporting tool. So they were not of the same version, which is quite good. And 64% were well-filled properly. And in terms of timeliness, at least the report came in time in the DHS. We also found they were doing very well. So at least the few books which were there were there and they were well-filled. And I put there sometimes, at least since it's significant, we realized the tools which were very well done was Nairobi. Nairobi, I think, maybe it's near where the source. I don't know, no reasons. Trucana, Steve comes from those sites. Somehow they had very good books there. Maybe it's related to donors. There are many donors there, and also Homer Bay and Machacos. And in some counties, we just found the CHBs used very old versions and they just improvised their own books. And so this is what we found. The other research shows that on accuracy, the data that was over-reporting, at least more than 50% of what was in the DHS was not anywhere on the local reporting tool. That was quite interesting. And when we went further and asked them some of the area, they realized that there was no supportive supervision. And some of the CHBs actually did not understand the indicators very well. So that means there was a problem there. And they also, the idea of motivation in terms of payment came up repeatedly. That you see, we can't keep coming here if we are not even paid anything. So that came up repeatedly and we think maybe that could have been a problem. So while we discuss, we realize this focus primarily on the accuracy of data and that particular assessment. And as we realize, there's quite a lot of variation between the systems and the primary tools. And actually, this is not new. It's been found in most health information systems. We still have data quality of accuracy. So this is just in keeping with what we think we know. And also the findings point to the lack of appropriate collecting tools. At least the remaining, they were not there. And also the indicate training, supportive supervision. And also this could have been the cause. And an interesting finding was that despite all this fact that they are not paid, they continuously kept on coming to work. And that really, I think I put it very quietly, that it calls for inquiry into understanding their resilience in the community work. So we are very commendable. They carry books home, they work very hard, they have inaccuracies, but they still keep coming. And that is really commendable that we have people, a team of people who can still do work without much payment and still carry very heavy data from their families. And they also keep, of course, community secrets. They know how many people are on air, they know quite a lot. And that is a team that is very important. So we conclude that data from the CHUs are of questionable quality, considering the variance between primary and the DHS. But we think if we print tools and disseminate to them, it would be useful. We, training came up very important. Training, mentorship and on-job training would be very useful. And we could also pay them. I think some of the people who are paid, some of the few who are paid, they were very happy about it. And we also need to initialize mechanism for data verification to be able to verify that data before it's actually put in the DHS. We need to have somebody who can say, maybe this is correct and that's not correct. And this could also be like if you could have meetings with them, supportive supervision. And we could also finally think of the electronic community health information system. Just in conclusion, actually, as we talk, the government has insisted that they want to launch the electronic community health information system. And they actually wanted to launch this June. And so we hope we are going to work and train these people from carrying heavy books to carrying a tablet. And that is the way forward. And of course that's another, it's a story for another day. Today was just to recommend, because we had problems with the physical tools, we can, of course, quietly say, listen, let's go electronic and hope for the best. Thank you for listening. And yeah, so Uganda is asking about the possibility of going paperless. It's a really, I don't know that's a question or it's something for discussion. When we started even the DHS, at one point we thought we would be paperless. 10 years on, we still have both paper and that. So I think in my opinion, and really, this is what sometimes I advise the government when they ask me, I say, let's take things as they come. Because there are areas you won't even have internet. We have left the, our DHS is very high because it's at the subcounter or the district level where we have everything. We still have problems. But now you've really gone to the lowest where we don't even have some places they don't have internet. And these tablets you are saying they are not being managed by the community health volunteer, it will be by the grandchild when the grandchild is available. So we still have a lot of issues down there. So to me, I would say we recommend the use of electronic where possible but it would really be an ambitious plan to think starting from the word go to purely paperless. It's a process of, yeah, he's asking whether we've done any assessment on the, for what to use in electronic community. Actually the truth is we have and it's very high, we've developed it. It's at a very high level. What is actually remaining, it is to make the tablets and then give it to them and also look for some money to pay the volunteers because one big reason we said you cannot give somebody a tablet and not pay the person. So we'll have to select a few people, pay them so that they do their work and then be able to implement. So we've done at a very high level the system developers have done very well but it's not remaining for us to implement us to train people and be able to implement it. Thank you. Thank you, Manio. One more clap for Dr. Manio here. Oh, and are you gonna use DHS too? Of the platforms, are you gonna use DHS too? On the tablets? The question was, have you done any assessment of the platforms? And you said you've already selected a platform. Is it DHS too? No, no, no, no, it's not. It's not? Okay. We'll be back in a minute. We'll be back in a minute. Okay. All right, hello everyone. So my name is Ali Chibwe from Malawi. Here with a big team of ours, together with our leader, the madam director who is sitting there, Dr. Mandazwo from the investor of Malawi and we also have Joseph on top there from Look International. So our presentation is basically to say concretizing the foundation of universal health coverage. That is in the case of development and implementation, progress of Malawi's integrated community health information system. So I think our background might be the same. We're exactly with Dr. Manio here from Kenya. All those problems that he has mentioned, we also have the same problems to do with paper-based system. But fortunately, we went further ahead and then implemented the integrated information, community health information system using DHS too. So that's basically the case that will be presenting here. Okay, is this working? Okay, I'll use the clicks. Okay, fine. Yeah, so here with the introduction, we are saying this is a national wide system designed to track individual level data at the community health care service. So it's exactly what we're doing as Dr. Manio has also mentioned that it's a system designed to work at a community, the lowest level, that is the community level, tracking and then capturing also individual level data. Okay, so the system was basically designed to develop based on the national community health strategy as well as the digital health strategy that the ministry has, okay? All these aligning together to the strategic goals and objectives of the minister of health Malawi, okay? And this system, we are calling Aikis, is the main custodian of this system are the community health service section, that is the CHSS and also the digital health division. We've got a division within the minister of health that looks after all the systems to actually provide technical implementation support. And then also we've got the center for monitoring and evaluation, SIMED, that looks after the data itself. Moving forward, so development of this system, actually we got technical support in development from the University of Malawi, that is Unima Chansa College to be specific. And the implementation actually began way back in 2021, okay? And the plan is to roll it out to all the districts. Okay, so the way we do our development and then rolling out, this is the model. We do, we start with the planning and then after planning, a module goes into development. After one module has been developed, we go out to test it. So we take it out to the users, we take it out to the communities or the facilities down there to test the modules. After that, we get feedback. As we get feedback, we go back to the development sprints where we go and do refinements according to the feedback that we've gotten from the users. From there, the cycle goes around like that. At the same time, as development is happening on the other end, we've got deployment and support teams that actually are developing modules to help with the user support, maybe user manuals to do with that particular module at the same time, okay? So these two things go consecutively, actually in the same time, and then we roll out that particular module, okay? On that side is the actual screenshot taken from the application that we have, the gestures to capture with all the modules outlined on that particular screen. Now here are the highlights. This is essentially some of the highlights that we've, the milestones that we've gone through in Malawi. As of 2023, as we speak right now, we have rolled out this system in seven districts. So in Malawi, we've got essentially 29 districts, is it? 29 districts, so we've just done seven of them. This is of course based on the funding that we usually get. So as we get the funding, we do the development as we get the funding, we also do the deployments and training stuff like that. That is almost covering five million people in the communities with these seven districts and also over 1,800 healthcare workers, the HSAs. We've trained them on the system. They know how to use it and they're actually capturing data on production instance. Okay, so that data is almost mounting to 1.5 million patient level data or records that we have in the system at the moment. Okay, yeah. And here's the progress in terms of modules that have been developed already in the system and also where we are going. We've got registers. These are to do with personal, I mean individual level records registers. We've got a community register that is fully developed and working. Household register and then personal register as well. In terms of aggregate reports in the same system, we've got monthly, quarterly, semi-annual and then annual reports that are developed, working, fully tested and we've got a lot of data in those modules. And we also have program specific modules. That is the integrated community case management system, ICCM and expanded program on immunization, the EPI program. We've got those modules developed and fully functioning at the moment. In development, we've just gotten funding to do with the development of EIDCR. Also modules like family planning, community birth, I mean CBMNH and also supply chain. We are very excited to hear the development that the Android team had to present on the supply chain developments in DHS2. We're very excited. Hopefully we're going to use the same in that module. All right, talking of the high level architecture of those modules that I was talking about. Here's a picture that will give you a quick overview of how all these modules relate to one another. We've got the household registers. So in terms of households or the households that we have in the community, go into that register. Below that, within that, the details within that register, we essentially get the environmental health data of those households in that register. We've also the community register where all the villages, we're registering all the villages in Malawi. In those districts that we've already rolled out, we're registering in the community health register. Within that, the details that we collect there is to do with all the secondary schools that are within those villages, the community-based childcare centers, sputum collection, village details, and then also if that particular village has a village health committee or not. So all the details go into that register. In the personal register, that's where you also have the program-specific modules. That is like Nutrition, TB. Not all those have been developed yet. Only those that I showcased in the earlier slide have been developed. The rest of them, it's a matter of where we've got in the funding, how much we've got in. And then the funding goes in this way. There's one we can get, maybe, partners can give us funding to do with development alone or else they can also give, some other partners can come on the same module to say, okay, fine, we're going to hand or maybe implementation, because we know implementation is very expensive, issues to do with the procurement of the gadgets and stuff like that. So that's how partners are actually helping us in terms of progress with this system. This picture right here shows the high-level architecture of how our system is laid out. We've got the base, the DHSU system down here, where we've got all those modules, the ITS modules, community register, household register and the rest that we explained up there. All of these can be accessed in two ways. There's the web application, the Android application. We've got the Identifiable Data Listing, okay? We're also very excited to hear about the line listing application, the new one that they showcased in the auditorium. That's very useful as well. It will be very useful in our system as well. Individual-level data and then high-level data as well. We can analyze all this data that we're capturing down here in all those dashboards that we have in DHSU. Moving on, we've got some of our funders that have actually funded us to reach this at this point here. We've got UNICEF that initially was, I think this was the initial fund of the development of the system to start with. The University of Malawi, very crucial as well. They are the developers of the system. Last May house has been very crucial in terms of funding us in implementation, procurement of gadgets and stuff like that. GIZ just came in recently to say, okay, fine. I think we are going to give you, we're going to hire developers to help you in developing some of the modules that you'll be developing. We could save the children. These are helping us in a few districts in terms of implementation, trainings, deployments, and also procurement of gadgets as well. They did not procure any gadgets. So actually what we advised them, they were using some old phones in which the system was lagging a lot. So we advised them to say, okay, fine. These gadgets are not good enough. I think we need to update. We need to buy more. So we've got standards that we said at the Digital Health Division that if a partner, any partner wants to buy any particular gadgets, there should be of these standards. So we advise those to do that. We could look international that also has been very helpful since they start way back in the planning sessions of this particular system. We've got UCEDD who also gave us recently support in terms of labor. They gave us, they've hired, I think some developers to help us in development of the system as well. We've got one DQAZA. It's one particular organization in one district in Malawi where they said, okay, fine. If you want to implement this in our districts, we are going to do everything on our own. You just come in, we're going to buy the gadgets. We're going to fund the trainings and everything like that. So they're also doing a great job. And that's the end of the presentation. Thank you, Kwanbiri. And that's our presentation. Thank you a lot. We should be able to finalize with all the module development. What should remain now is the scale up. And we say we are not going to do the whole country at once. We are just going to be like facing, in like faced approach. Like maybe we take 10 districts, we implement it and you move to the other districts because you cannot just implement this. It's a very, very expensive. So partners are coming in. They are bringing us here, 70 programmers. It's not so unima. Chancellor College has been supported by a layer of programmers like from the USID, from the other organization like AMRIF, and we expect that we have more so that we build a technical specialist to be in that area. So we say if we have got more specialists that can do more to look at that platform, to say, I think this can be like the new departments, we welcome all of them to come to support the country. Thank you. And I've actually been to one of your technical working groups. You didn't know who I was, but I sat there in the back. No, but it's really impressive. Many countries don't have such well-developed technical working groups that helped kind of steer the development of this. That was fantastic. Any one last question? Any questions? No, everything's clear. Maybe just to add one thing. I think she raised a very good question to say, are you ready to go paperless and stuff like that? That's the goal, of course. But then during implementation, I think it helps to have both lines working together, both the paper system and the electronic system. So maybe you can have proper measures in data quality so you can compare. You can come back to, okay, fine. Let's compare these two. Let's look at the data that we've captured using electronic, and then we compare it with the data that has been captured using the ordinary paper system. So that's what we're doing in Malawi. We let the HSAs capture data in their paper registers, and then later they transfer the same information into the electronic system. It helps us a lot to do data quality decisions. I mean, supervision, as you say, supportive supervision. So we say, okay, fine. How come you have 10 records in the register and you have 20 records in the electronic? Where are they coming from? So that's how we do in terms of data quality checks as well. Thank you. That's for the people online. For knowledge, in Malawi, we have got frontline health workers that are going to manage this. So they are actually in the community, in the community where the people are. So these community health workers are government salary. So the government made a board step to say, we are going to hire this them and put them on government salary. So they are paid up community health workers that are there in the community all the time. And these are the ones that we have targeted for the first time. So, but in the near future, we are also going to be training the community midwife assistants, the environmental health officers, and also the who has pressures, the community health nurses, because these are community health workers. But for the community health volunteers, we have to make a decision because they are supporting the work of the HSAs because they are working hand in hand. Are they going to have the same tablet or we are going to give them another gadget because they are supporting them because they are helping out in the implementation at the village, at the household level. Yes. They're not paid yet. Yeah, they're not paid yet. They're not paid yet. How do you do with them? How do you bring them into the system? Yeah. Because it's a challenge. Yeah. We're supposed to decide do we give them tablets or else. Do they still capture their data on the paper and they send it to the HSAs? The HSAs enter the data in the system. It's a very big challenge. But they do help a lot. That's a really good point. It's a serious challenge. One thing that I would suggest, and there's quite a lot of good research on this, in chapter four of our book on the CHI and the guidelines, that book, yeah, there's a whole chapter on creating feedback mechanisms to community health stakeholders. And the research is quite clear that when you make feedback mechanisms to people at lower levels, they stay engaged, they stay motivated, even if sometimes the payment, they may be paid or they may not get paid. But they feel ownership and that's important. Do you have a question? Yeah. Excellent presentation. Now, my question is in terms of the lessons that you are learning for scale up, moving from the nine districts to 29 and looking at the data that is streaming in, the 1.5 million records. So how many people are we talking about here? How many uniquely that you've targeted so that it motivates, because you might be thinking of 1.5 million records, but you've actually captured records for only maybe 200,000 people. So before you scale up, what are you learning that motivates the scale up to 29? Maybe the uptake in the nine district is not sufficient to give you that thrust to go to 29 districts. Yeah. Anyone to help take that question? Joseph? Yes. We do have the targets. Thank you. Thank you. So just to comment, because, well, I'm supposed to talk when we are in the country, but I think it would be good to share to everyone here as well, because when we talk about the community engagement, especially with the informal sector, like volunteers or drug vendors or like the one I just discussed with the Mandan about the traditional healers. I think the key thing is to engage them and then make the information system affordable and ready for use with the lowest financial burden. So like in Malawi, we have been working on the whole reverse billing and making the WhatsApp chatbot working, the USSD, the SMS. So this would be very powerful and also the hotline. So this would be very powerful, like interactive community engagement platform or tools. So in that way, to engage with the volunteers or people in the general community, I think the key thing is for them to be able to interact with the formal health system. So they can either alert us when there is something unusual or they can access the information that they need. Yeah. So in that way, I think we will be able to enhance the whole community health in a broader sense and to really achieve the universal health coverage goal. Thank you. I think we're gonna have to end it there to save time for Angola. But let's give the warm heart of Africa one more applause. Hello, everyone. Is it okay? Can you hear? Okay. Well, today we will be doing Portuguese 101. Yes, today we'll be a lesson in Portuguese. So my name is Joaquin Augustinho. I'm here to talk about our experience implementing community health information system. Okay. Let's do it. The topics will be discussed in introduction, the Angola sees needs and assessment, integrated architecture, implementation approach and the lessons we have learned. Okay. Angola started using DHIS-2 by 2018. And by 2021, we started working with community health information system. But that work started by a number of workshops, meetings and assessments of the real needs of the country, what we had at the moment. And then a phased implementation plan was drawn based on our priorities. There we can see a few of the work we've done at that time. We have a few workshops, a few work in order to understand what we had at the moment in community services. Okay. I think there's no need to define again what are the goals of the community service. I think the earlier presentations were quite clear. And then we start talking about the assessment. Okay. In order to establish this electronic system, we needed an evaluation of ongoing community interventions, conducting seminars to identify the needs and design the real architecture. Okay. Our goal was to establish a robust electronic system and the management of community interventions. Based on that, we found that the country already had a number of different initiatives. And those initiatives were being funded by different partners with... They were independent. They were isolated islands. And for us, it was a problem because we had... I think it was said here earlier, one of our main problems is about the funding of those community agents. For us, it is also a problem that they have status of volunteers. And I think it's clear for everyone that that doesn't seem to be working very well anywhere. So, since they are volunteers, they are dependent on some partners to fund their work at some places. And the coverage isn't for the whole country. There is coverage for two provinces. There is coverage for one program. There's coverage for one disease. And during the assessment, we found that out and that's not exactly what we want. And this data, even though it's being collected at some places, most of the time doesn't reach the MOH. So the MOH can coordinate an approach based on the whole country, on the whole picture, because as was stated before also, we have in the HIS2 the data from the hospital, but we don't have the data for the community. And that is a major problem for us. Okay, during the assessment, in the previous slide, I stated two initiatives that are the most notable for malaria and for HIV. Okay, in here you can see how it was working. At the bottom, we have the community agents and then each one, each NGO has, sometimes their different system, their different methods of collecting the data. For HIV, there was an initiative that aggregated several NGOs, about 12 NGOs in five provinces and was reporting to the National HIV Institute. And for malaria, there was another initiative using Kobo Collect, an Android tool. They had cell phones for those agents and they are reporting to the cloud and sometimes not always that data was going to the Ministry of Health. Okay, after all of that, it was designed an architecture that we believe would be the ideal model for us. That architecture would establish a fully autonomous because a community system based on the HIS tool, allowing data management and harmonized tools. The existence of an integration environment for the incorporation of data from all the community-based systems and the continuous integration of that data into the main the HIS tool. So as you can see in the picture, our goal is to have only the community system and the health information system, the DHS tool. Okay. On a more technical level, you can see what is working for us. And as I stated, this is the first lesson of Portuguese. You can see there is a lot of Portuguese in there and that you learned today. So we have, as I said before, the malaria initiatives using an Android app and the TB and HIV initiatives. Those two work in parallel and our goal with the platform we want and the system we want to work with is having them from this side but in the other side, we have the National Community Health Information System. So, however, initiative there is that pre-existed our National Community Health Information System, we developed a platform for interoperability so that wherever it is, it can be transferred to the National Community Health Information System. So from there, it goes into the main DHS tool system, the National HMIS. And then the data can be analyzed and can be used for better decision making. Okay. Our approach is focused on sustainability and governance, inclusion, interoperability, community health workers data and a multi-sectoral system. It was very important for us because all those initiatives, unfortunately, some of them aren't sustainable. Sometimes there is a project, there is a funding that comes for two years, three years, four years, but after that, what happens? Where goes the data? So the sustainability was a top priority for us. And then the governance, it's important for the MOH to take hold of the project, to take hold of the data, because if not, it won't be very good for us, it won't work. And then we have inclusion, interoperability. We didn't want to leave anyone behind. We already had projects that started a long time ago that had a lot of data and we couldn't just bring another thing and discard all of that data. But the goal here is to include them, include all the data, work together. Okay. The architecture was a broader ecosystem of a different health information system instead of the isolated systems that used to be there before. With this, we have a system based on the HIS-2 and we believe it will be sustainable for us. Okay. We have local and national supervisors with simplified data visualization, health workers with data validation, community service delivery, tracking and decision support, and development community agents with integrated information related to the community. Okay. There is a dashboard that shows what we already have in that platform. In here, we have malaria, monitoria da synchronization data. This is a dashboard that reflects the data synchronization daily. And we can see for, since the beginning of the year to the last few days, we have the amount of data that was synchronized daily. This data is coming from a different app, is coming from the data collected on an Android app via Kobo Collect. And we have interoperability with that data so that we can bring it to our community health information system. Okay. And another dashboard is the real data and we can see the data for the community interventions. We can see the male and female distribution of cases for the current year. And on the other side, we have the distribution by gender and the places or the municipalities. So this is just a snippet to show you how it is working and what we already have. What we have learned throughout all of this process. The involvement of community partners is crucial to guarantee the successful implementation of the system. If we don't work together, it will not be possible. A horizontal expansion plan, we need to have all the collection instruments, a pattern, a single pattern. We can have each one collecting however he wants, each one having this data, collecting that data. It doesn't work very well. Okay. And the other side is a vertical expansion plan to cover all the levels of action. Okay. And then the local investment to strengthen the technical team. It is a priority. If we don't have a local technical team capable of supporting the system in a short amount of time, it will fail. It will not be possible to maintain it. So I think everyone that wants to do such work should have those three in mind. Okay. Thank you very much. Obrigado. Thank you. Okay. Yeah. Thank you. Okay. It would be very quick. Yeah. So it's fascinating to see how Angola is moving forward. So I'm quite curious in terms of the interoperability, have you like in Angola, did you adapt like open HIE framework or any sort of like high level architect design for the whole health information exchange? Thank you. All right. No. Okay. We can go just to say we have to develop from ground up. So we have encountered such things but we have to develop locally. We are available to share information later.