 All right. Okay, we're gonna start the next session really soon, since we have a little bit less time, we're already five minutes over, so if you are joining us, please sit down, and if you're not, please exit. Hi, Namdee, are you there? Hi, I'm here. I can hear you. Okay, great. I will just be sharing the slides from this end, if that's okay. Where do you prefer to do it yourself? I would prefer to do it myself. Okay. Yeah. I believe we can present her slides, yeah. Okay, thanks all for joining. Oh, hi. Thank you. Thanks all for joining. My name is Brian O'Donnell. When I'm not a outreach nurse, I'm also on the DHI's two implementation team. I work on producing implementation toolkits, including thinking about how DHI's two implementation should approach non-communicable diseases. For those of you who may be new to the subject, I'll just give a very brief background on NCDs, because DHI's two implantations have traditionally been focusing on communicable and infectious diseases, and the majority of our investments over the last 20 to 30 years have been in that area. But as the burden of disease has increasingly shifted towards non-communicable diseases, such as diabetes, hypertension, and cancers in DHI's two countries, we are now starting to think about how DHI's two implementation should be approaching this topic. So we have three very exciting speakers here today with us, or three different presentations, rather, and four different speakers. First, from Blue Square and Expertise France, we'll be presenting on DHI's two tracker for large-scale cervical cancer prevention and treatment in Burkina Faso. And we have a speaker starting here, Polonaid. Nandia, can you share your slides? Share your screen? Yes, I'm doing. Okay. Okay. As soon as you are ready, you may take the wheel. So can you see my slides? Not yet. Sorry. Maybe it's behind, yeah, here. Zoom has to go, yeah. Zoom on this slide? Yeah. Are you sharing your screen? I'm sharing it. Oh, there we are. Maybe it is, so, Nandia, how do I move this over? Because it's not... It's on one side. Okay, you can see the slides on the recording, but you cannot see it on the presentation window. So we are just trying to change the presentation window here. One second with the technical issues. Okay. Sorry, Nandia, we're going to share your slides from here as we're having some issues with the presentation. Okay, not a problem at all. So I'll stop sharing and... Okay. Thank you. Are we just completely frozen now? Oh, yeah. That's it. Parallel sessions right there. Here? That's just here. That's another one. That's another one, so. Okay. Which one is it? It's one. Yeah. That one. It's my name is... Yeah. Oh, Saja. Okay. I hope you can take it from here. Are we unmuted? Nandia, the floor is yours. Okay. Thanks, everyone. And sorry for being late with the presentation. And I'm very glad to be presenting our major work with ZHS-2 tracker for cervical cancer prevention. Next. So I'll be presenting with Apollinaire and Nandia, the M&E lead for the SUCCESS project, working on Experts' Friends, and Apollinaire was the country lead for Blue Square. So the SUCCESS project is secondary prevention, cervical cancer secondary prevention project deployed in Côte d'Ivoire, working at Faso Guatemala and the Philippines. And the idea was to be able to screen 175 women with 40% living with HIV. Through this project, we wanted to implement the ZHS-2 tracker. So the project is led by a consortium, led by Experts' Friends, and with two major partners, Jepaigo, who is the implementation lead and UICC more related to the advocacy work we're working. So we also receive heavily support, technical support from WHO, and also the NCIs from four different countries. The project is funded and supported by Unit 8. Next. So as I said, it's a cervical cancer elimination project with four major outputs. But the one that is more related to us for this presentation today is output three, where we want to implement the service delivery, integrated service delivery model for screening and linkage to treatment in four different contexts. And to do so, we wanted to have a digital tool to optimize, I would say, the service delivery intervention. Next. So, although we implemented the project in four countries, we did implement the DHIS-2 tracker in Côte d'Ivoire and Burkina Faso, but today the focus will be on Burkina Faso where it's most advanced. And in the following slide, you will see why. So can we go next, please? Yeah. And there was also a global momentum for implementing the tracker. Recently, we were part of the technical working group where the WHO really had the focus on how to collect facility-based data for non-communicable disease. And one of the conclusion was that it was, it's really recommended to implement some simple digital tools for recording, reporting indicators, but also for patient monitoring. Next. So how we did for the DHIS-2 tracker, we had methodology. Maybe can we go back to the first slide before? Sorry, before that, global momentum. Yes. So we implemented the tracker in Burkina Faso in a very specific context. So prior to 2021, the Ministry of Health did not collect routinely data on cervical cancer screening and treatment. But with the intervention of the SUCCESS project in January, 2021, we were able to help the Ministry of Health to collect facility-based indicator, but on paper-based tool that we've updated with CHAPAICO support. And also when we were implementing the project, we quickly realized that paper-based could not really help us to track longitudinally the clients given the algorithm we have for cervical cancer secondary prevention. So in response to that, we in collaboration with the Ministry of Health, we introduced the DHIS-2 tracker for two main reasons. First of all, the DHIS-2 aggregate is used in Burkina Faso as the national HMIS. So the inoperability and the indicator sharing would be easier for us. And second, the tracker was fully deployed for COVID and it was piloted for HIV and TB cases tracking. So in Burkina Faso, then so next. So we started with this methodology. We conduct a very heavy analysis of existing data system because the keyword of the success project is integration but also sustainability. So we wanted that the tool we wanted to introduce leave and remains after the project. So that's why we conducted this analysis. And then with the support, we support the MOH to update all the registers, the tools and the HMIS indicators related to cervical cancer secondary prevention. We digitized the double-h O clinical algorithm related to our intervention. And we analyzed, we conduct a platform analysis with the signed it and we created metadata dictionary. We set up the tool on DHIS-2 capture. We set up also the SMS server and the messages to be sent out with the tool. We conducted a pilot phase really to get the end users feedback and to be able to correct the tool as needed. And we did the deployment while integrating the tracker in the MOH existing environment. And all along the step, we deployed also change management really to inform, to enforce the ownership at different levels for the tool from the laboratory technicians service provider to the central MOH unit. And we continued to engage women. So the way it works patient or enrolled. And then we do the screening and lab analysis through different forms. We do results sharing by connecting the SMS server with the DHIS-2. And then we do the treatment and follow-up to treatment. Next please. So this is a clinical algorithm and you can see how complicated it could be, it can be even on paper based to do patient monitoring and follow-up. So that's why we came up with the tracker as I said. Thanks. So how it works. The tracker is used in the health center but also at the lab level because we are doing HPV DNA testing and that's not done at the same place than patient consultation and treatment. So we have the samples, the patient they come first for self-screening or provide the assist providers assisted stem sampling. And then the samples go to the lab where they are analyzed. So we came up with a tracker app that allows for communication between the lab technicians and the service provider at the sites. And then all the data entered or in the DHIS-2 instance and they are used to create dashboards that help for decision-making and patient tracking. So different dashboards were also created based on the end-users need. The lab dashboards is not the same as the service provider dashboard and it's not either the same as the district level dashboard or the MOH dashboard where data are more and more aggregated. And the DHIS-2 instance is connected to an SMS server that send SMS to the patient related to the results availability but also upcoming appointments. Next. So we have different forms, but we need to focus also on what the DHIS-2 now can do. The DHIS-2 tracker we have for cervical cancer, secondary prevention allows for tracking the patient throughout the biopsy result but it ends at the biopsy result. We, it is not cancer case tracking, but we, Apollina will tell about we want to go further with the tool we deployed in Birkin-Afaso. Next please. So this is one of the output of the data collected. This dashboard is used more at the central level but also at the national program level where we can show the cascade of care for the secondary prevention and also the screening throughout the time. Next. So I'll leave the floor now to Apollina where we'll bring you through difficulties and counter but also solutions and lessons learned. Thank you so much. Thank you very much Namdia for this first presentation. So doing this kind of work, of course you will make some difficulties. So I'm going to cite some of the difficulties we encountered during this, the implementation of this project. So first of all, it's creating uptake and encouraging by in the use of DHIS-2 tracker forms and consistent use of the application. So if a patient come like in the local health facility and we don't have two to collect the samples that may affect the inconsistency of use of the applications, in complete forms and on three of results into truck impacted turnouts, times and contributing to potential loves to follow up. So in a correct chronology of events, impacting ability to launch in our truck also, women from screening through the treatment as needed to battle out of that entry from influx of crane screening during major screening campaigns, in the country the project doesn't cover all the countries. So sometimes the minister of health try to do some big campaigns. So at this moment we have many, many women who are coming to the health facility so we have a lot of work. So we have also the migration to the DHIS version that's for several version newer, which has a number of bugs and challenge requiring time for technician to resolve. Of course we found out some solution to fix those issues. So formalizing K-Pathway for proper configuration in the HH2, joint supportive suppression visit for mentorship on correct and complete use of truck application, following initial training also, setting management rules for ensuring the chronology of events by linking the sampling form and result form in the HH2 to data quality as incentive for better data collection and also to limit inconsistency. Integration of the HH2 program within the image of the HH2 infrastructure is also a solution we give to this. So we learn also best practices and it will be good to also share lessons for those who want to implement those kind of work. So first of all is understand the contradictory health ecosystem. In what national stakeholders are at every step to involve end user in the design and testing phase, align the pilot phase with the site reporting cycle, define a change management strategy and a deployment strategy, integrated supervision with the service data manager district level that's very important to allow the district technical manager to solve certain issues and mentor users in monthly reporting. So since the start, the beginning of the project till the date we submitted the abstracts, so we trained more than 200 professional in the use of tracker. So we are all more than 30,000 women in the tools and we sent more than 14,000 SMS to the SMS server and we expect to have in the database at the end of June, more than 40,000 women. So doing this project, you have to also see how you are going to work on the ownership of sustainability and also the transition to the Ministry of Health. So to ensure ownership of the platform by the Ministry of Health, we adopted for a participatory strategy. So first of all is the selection of the dashes tracker already in use for other pathology in the country. Next is the development of the forms with the ANCD department and the HMI's unit of the Ministry of Health. That's very important. Third one is the implementation of the DHS2 tracker application and dashboards under the lead of the HMI units. And the next one is to allow you, so the Ministry of Health Surveillance Server to host the platform, including the SMS servers. This is very important to take over the process. And next, and finally to make some joint supervision with the Ministry of Health. So to conclude, the platform improves special follow-up at health centers. It's also improved the availability and quality of data for higher level decision-making. So, and we also have some perspective. So call for the HMI tracker to be adopted nationwide warehouse for indicator transfer, potential fitter use. So setting up interoperability between the servants platform and the cancer registry. And all this work is to have these smiling faces of women. Thank you to you. Thanks, maybe as we're getting the next speaker, Andreas, if you want to come up. We have some time in between for questions. If anyone has some questions for Apollonera and Nandia. Yes, Arshad. Or maybe you can just project and we can repeat the question. Or what you want. Oh, we have a microphone. Okay. This? Okay, perfect. So the name is Arshad Farzalspar. I am a scientist in the NCD department, W.H.O. at Guarte in Geneva. And thank you so much for the presentation. I really enjoyed and I learned specifically. I really liked the part that you connected the lab results to the other part, which is a very, very important and very good. The question is when you are doing the screening, not the treatment, when we don't have, when individuals coming and just for a screening, are you counting the service or you counting the individuals? And if you are counting the individuals could be the reason for, because you'll have to enter a lot of data for each individual could be one of the reasons that the facility people getting overwhelmed because of the burden of records. And I think that would be one part. And also the second question is what you have done is just limited to the primary health care setting or it's also included the secondary and tertiary. Thank you. I appreciate it. Thank you so much. Maybe I can come at, start and apple inoculate it. What we count is the patient, not the service. As I said, looking at the algorithm we have different type of services that one patient received throughout treatment and for each type of services, we have developed a form. So when the woman come, it is counted as one patient receiving different types. Of service. And we also able to capture the type of service rather than the cervical cancer because as I said, the success project is, the keyword is integration. So we provide cervical cancer services in HIV clinics, but also in gynecology services and in one site. So we are able also to capture where the woman is receiving this type of cervical cancer secondary prevention services. So the secondary prevention services starts from self-sampling or provided assisted sampling to follow up after treatment. And we deployed the tracker on 36 sites at different level, but not tertiary level because our intervention stuff that's secondary prevention. So we are from the primary care to district hospital and site and to national or university hospital. Thanks. Thanks so much. Another round of applause for... And up next we have the World Diabetes Foundation's Diabetes Compass. We'll be presenting on their initiative in Sri Lanka under as Facebook as a senior program manager from WDF and he will be sharing his slides on their work there. Can you share your... Okay. Thank you very much for this opportunity. My name is Jean-Paul Hatter-Ikmana from Hispiruanda. I'm with my colleague Mutari Jean-Paul is a senior software developer here in Hispiruanda. I hope he's on call. If he's not, he is coming. So maybe, Blaine, can I go on with my presentation? Yes, I don't think that we can see your screen from our side, unfortunately. Are you sure that you're sharing? He's sharing. You're sharing, but we just can't see it. Okay, there we are. Yeah, we still can't see it. Okay, so we'll just try to keep aligned with your slides from here then. Yeah, it's real quick. Okay, okay, thank you. Now our presentation is about the abstract we have submitted, which is about the use of DHS-2 as a digital tool to help to track the non-comcomtable diseases for early case detection and your time case management here in Rwanda. The use case is here in Rwanda and for information, the NCD tracker is now in use. So we wanted to share with you how we have collaborated, we have been collaborating with the Ministry of Health to implement this NCD tracker. Sorry, we're sharing the slides from our side here. If you can hear us now. Where there's an issue with sharing the slides. So we're doing it from our side. But please proceed. Jean-Paul, are you there? Yes, do you hear me? Yes, we can hear you, just fine. Yes, we'll just share with you about the details about the implementation of NCD program here in Rwanda. Can you be back a little bit on the agenda? Yes, and then we will discuss a little bit about the challenges the Ministry is facing in the NCD screening and treatment. Then we'll share with you about the digital solutions where we are using the chance to manage the, I mean to manage the NCD cases from the screening up to the treatment. And then we talk a little bit about the system integrations where NCD tracker has to be sharing the information with other rated systems. And then we will share with you some results we are observing and then some opportunities for collaborations next. NCD program here in Rwanda is just a program, one of the programs under the Ministry of Health. But the Ministry of Health here in Rwanda has established another institution called Rwanda Biomedical Center, which is a technical entity, which is there just to implement different policies that has been put in place by the Ministry. So through that Rwanda Biomedical Center institution, there is a program called in charge of NCD where some of the priorities are increasing awareness in the community about prevention and detection, then centralization of the management of NCD from the central level to the district up to the health centers, but also we have some services at community level. And then establishing disease registries. Here the disease registries, when it comes to NCD, we have national cancer registries, and diabetes registry, thematic heart disease registry. And then promotion of research and the development later the NCD. At this last point you are collaborating with them to measure the impact of using all these trackers. That's where comes this abstract of submitted. Next, talking a little bit about the challenges in NCD screening and treatment, there is an observed limited awareness among population about NCD and associated risk factors, where we find that even those who have the access to the healthcare, they are not really getting these screening services on time. So we found that it's a kind of lack of awareness. Then home self-check for those already have this kind of NCD, even for those who are not yet being detected positive, the self-check at home is really something which is lacking for blood pressure and the leukemia, but mainly for those already positive. Then the third one, the referral system, which is not adequate for this diabetes and hypertension, you complication emergencies, you find that if someone is in emergency condition when he gets to the hospital or when he gets in emergency condition, I've been observing that for many cases, there is a need to reinforce this referral system. Maybe we are trying to see how the system can help us to improve the referral system. Then they connected community screening, education and the follow up of NCD patient was not efficient and limited specialized equipment, staff and infrastructure. And we will see how most of the challenges are being mitigated through this digital system. Next. Yes. Now, NCD digital solution, you will see on this side where there is one of the DHS2 mobile app where it's being used to track this screening activities using this mobile app. In collaboration with the Ministry of Health in Rwanda, the Ministry has issued the Ministry of Order of how detecting NCDs through a systematic NCD screening at the community level using the DHS. And then that's where the speed one that came in goes through the Rwanda Medical Center, which is really responsible of implementing all policies. We have customized the DHS to best NCD tracker for it to be used starting from the NCD screening up to the NCD case management. And we are now tracking for NCD screening in Rwanda, the individual criteria, one of the individual criteria is that for all females starting from 35, they have to have an annual screening annual screening and then 40 and above for males, they have that annual screening. So we are tracking all those records individually starting from the screening up to their treatment. For those who are positive, of course, they are put on treatment. And for those who are screened in negative, there are events in stock there. So we have also cancer registry. Also cancer registry is a kind of NCD tracker where we have collaborated with the NCD to put in place this cancer registry. And now the cancer registry is integrated with something called the Kandegi-5. So all these trackers are for NCD a digitalization program. But for today, I think we will focus on NCD tracker next. This is a schema that shows how the screening is being done. You will see at community level, we have population which are visiting the health center and at the health center, they do the basic diagnosis screening. And once the screen is positive, the patient is referred to the hospital for further assessment. And once the hospital goes to the hospital, they are the ones which are that mandate of confirming whether a case is positive, NCD positive or not. So after the referral, the hospital, once someone is confirmed to be a positive NCD case, is put under treatment. And after being put under treatment, he is allowed in the NCD tracker. And after the enrollment, of course there is a diagnosis, a lot of meta treatment. And after the treatment is sent back to the community for follow-up. This is the flow in green for follow-up because the follow-up is being done at the health center which is the lowest health facility level. Next, I got it, yeah. This is one of the pictures that has been taken during the screening activity. Next, this is one of the screenshots taken from the system. On the other side, you will see the dashboards. Yeah, this is about the system integration, some of the systems that has been integrated just to enable this, the management of NCD records. We have integrated the national identification with CLAVAS and vital statistics and HMIS which is Loutines Formation Management. So we are tracking to enable data translation so that we can easily be able to analyze and talk with this NCD tracker. Then about the results, NCD tracker is assisting clinicians to minimize errors by providing outcomes, actions to be taken, cause after maybe to explain a little bit about this how then NCD tracker is helping clinicians to minimize errors by providing outcome and taking decision. When a case is screened for NCD, there is program, different program rules that are there to help the clinician to decide whether the screening case is positive or negative. Automatically the system will have a kind of decisions where clinicians can based on and maybe decide to not replace clinicians but it is helping assisting clinicians to decide. Then digital solution that enables follow up or positive cases, you see it helps to link it but also retention. Then come check up is annual, this is a kind of information. We are just giving clients identification with the unique code. The system has a unique code and this is eliminating the cost for screening. Sometimes when you don't have a kind of identifying the assigning unique codes, you will end up by screening one case more than one time once a year yet by policy and everyone should be screened at least once per year. So clients identification by using unique code is something good. Number of clients now screened within this fiscal year 2022-2023. There are now more than 2,500, I mean, 2,500,000. This number is above 85% of the target and your targets or population to be screened. You see that now using the system, we are able to monitor the progress towards the targets but also this will help us also to find this remaining 15% remaining to be screened. This is one of the results by using this NCD tracker next. Yeah, this map shows the coverage of NCD tracker. It's one of the best what we have developed which is helping the program to monitor the screen cases towards the target. They have a new target, they have monthly targets. Then the opportunities for collaboration. There are different opportunities remaining and available for collaboration. We think that non-NCD experiences were from the global standard test packages. In fact, we are in collaboration with the Universal Walls Law, the NCD package. It is one of the things and I think they got the information or some of the information from the one experience and said implementation. Yeah, then I'm wrapping up and the expansion of the NCD screening and I know this case is surveillance. This is a linkage to secondary and routine monitoring that use of NCD data from the test system that's on national level. Of course, there are different studies that are ongoing using this NCD tracker, NCD data. And I think there are different opportunities for different researchers that are ongoing and that would be starting soon using this data and all these are the opportunities around, we think that there will be based on the implementation of this NCD tracker. Thank you very much. This is a summary of what we would like to share with you about implementation of the NCD track in Rwanda. I think I can stop by here and I will welcome your comments, your input. I don't know where the material is on the call so that you can maybe provide some compliments if I may be forgetting something over to you. Thank you so much, John Paul. We are running low on time so I'm going to ask that we can move directly into our next presentation here. But I do also just want to quickly point out the scale of this system for NCD screening. A lot of times people think that these are pilot projects or sentinels to valence. They've managed to screen 85% of their target population over the course of one fiscal year, which I think is a really remarkable achievement and should be noticed more across the DHS2 community. So well done to your entire team on that. Can we give a big round of applause? Yeah. Andreas, could you? Well, I think you introduced me before. Yes. Previously known as, but hello, my name is Andreas. I'm from the World Diabetes Foundation. We're physically located in Denmark. That's the headquarters. But we do a lot of work across the world and we have a few region representatives. And I have the pleasure of, how do I switch the slides? Just press the keyboard. Okay, good. And thank you so much for the invitation to come speak today. And I consider myself a bit of a prelude today in the sense that we have some of our partners locally. We have some of our partners present here. We have our partners from the Ministry of Health in Sri Lanka, Health Information Unit. So I'm very happy. Maybe you can raise your hands so we can see where you are. And also we work, of course, closely with the HISP. So yeah, a prelude in the sense that I hope next year because we're still in the development and implementation phase that next year, hopefully we can invite some of all you to the stage instead of me. But let me get on with it. So we at the World Diabetes Foundation have been busy implementing a program called the Diabetes Compass Program, which with all these fancy words express that we are in a process of seeing how we can reduce vulnerabilities in not only the diabetes but also the hypertension care pathway by developing innovative digital solutions. And in this process, we support the digital transformation of health systems towards an integrated and patient-centric approach to healthcare service delivery. I think it's very academic. So I'll try to break it down and give you a bit of more of a practical idea of what we do. I think what we've learned so far since we're still a bit new at the World Diabetes Foundation, which is 20 years old, as a foundation doing a lot of health programs around the world, we're still a bit new in digital health. And we've launched this Diabetes Compass Program as an effort to try and see how we can work not only within the space of diabetes and hypertension care but how can we leverage technology into this space. And then we have this program where what we've learned so far is that we have encountered that a lot of health systems introduce individual digital technologies. And therefore we have now, together with our partners in Sri Lanka, Tanzania and Malawi, discovered that we are focusing more on the transformation of the health system, leveraging technologies to do so. And let me see here. What we really encountered in Sri Lanka was that they were in the process of developing a large digital health blueprint. And so our own conception of trying to come there and introducing technologies, you can say met a bit of not resistance, but it met a really high requirement to align with the current technologies and strategies of the country and this blueprint. And yeah, I would love to have invited, if we have more time, Dr. Palita, the director of the health information unit to talk more about this because this became pivotal for our work as opposed to coming in with a preconceived and predetermined technology. We underwent a quite long process of aligning with their digital health blueprint, which was really emphasizing the digitization, the connection and the sharing, interoperability of the health information systems landscape. So we undertook a lot of co-creation and collaborative activities in country, in the three countries where we're implementing the Diabetes Compass program. And we have different, you can say product tracks in our program. One of them is called health information. So we underwent these activities and around four problem areas, surveillance, quality, resourcing and continuity. How can you use health information across those four areas to innovate and create solutions? So that then expanded further into a solution design phase. And here we're working again with some of our partners. There's a beautiful photo of you, Dr. Palita, presenting the digital health blueprint on the top left corner. And all in all, we converted and translated all that into a journey of how data flows from the community to the to the outer right, which is the data use. So basically what we've been able to do is to together with our stakeholders in Sri Lanka, Ministry of Health Health Information Unit, NCD unit is to conceive this vision or this concept where we start from a community data capture point of view or use case where we're developing an app. I'll come back to that. That app then connects its screens individuals at the community level using a risk calculation algorithm. We can refer them to a more comprehensive screening at a facility where they're then if screened positive for diagnosis hypertension enrolled into clinic treatment, we then work more from a health data surveillance point of view in aggregating the data and ultimately focusing on data use with the relevant stakeholders across national, subnational and facility level. And as you can see at the bottom here, then there are different technology components involved in each of these different visionary steps or concept steps. So if I try to relate this back to where we all started, this was a lot of collaboration and co-creation. We had this like high level concepts that we eventually turned into a solution map which looks like this and now it gets much more technical. So what you saw from the beginning were all these more conceptual steps which is ending up with this. And this is now what we have the pleasure of working on together with the Ministry of Health in Sri Lanka. We're pretty far now I feel. And I think it being a DHHIS2 conference, what's interesting to bring out here in this room is probably that we did not go for a tracker implementation and that was a quite deliberate move together with the HIST Sri Lankan Ministry of Health. We opted instead for the raccoon in the middle that's on fire, which for really a lot of you people know here but we opted for a fire server implementation or a happy fire. In this case, a happy fire server implementation and if I'd had more time and if this was a more technical discussion we could go into depth about what is the prospect of that. But I think it's tied on one side to the fact that the community screening platform or the community health platform called OpenSRP has a strong connection to a fire server. But I think more importantly, it's to speak the language of interoperability and that as we come into this and try to collaborate with the Ministry of Health we want to of course, as everybody else wants to adopt and implement a sustainable and long-term model. A model that then our solution architecture that centers around interoperability and supports their existing concept for a national eHealth record was what we ultimately decided to try and do. And that's what we're now in the process of doing. So a lot of capacitation around fire modeling in this whole solution architecture. And we're just at the moment now getting to the interesting part of integrating the fire server with DHGIS2 and aggregating data. And that's also becoming a really interesting challenge, a resolvable challenge, but also interesting. So we learned in this process is that, I don't know if this speaks specific to Trishulanka but we've definitely felt that planning and progressing in a dynamic social political environment has been challenging, as well as navigating and increasing the complex stakeholder network. I think to put some words to that is that I think it surprised us. SWGF, we have historically mostly worked with the NCD units of a particular country. And in order for our program being also a technology program to become sustainable, we had to engage in very, very high collaboration with the health information unit or the tech side of the Ministry of Health. And now we are also faced with yet another ministerial partner. So we're actually, we're at the pleasure of doing a lot of cross ministerial collaboration and implementation. It also was interesting for us to experience the requirements to aligning with and understanding the existing digital roadmaps and policies of the country, which has also now proven as we're going to solution development and implementation to be highly advantageous. So Sri Lanka has already undertaken a lot of really, really great efforts in drafting fire models and defining guidelines for data sharing and its operability. So I think as a program that has high ambitions in terms of solution development, this was a great thing to be exposed to. It was also a strong, it was quite challenging. We've also experienced as I think was with anyone else in this room who's been dealing with implementations that there's been a converging with other, other digital health solutions being implemented. But luckily so far it's gone okay. And then our own ambition of not trying to build a massive local office has also been a requirement because as everyone knows tech projects, they can quickly get out of hand. So you wanna increase your capacity and staff up. But I think the more you do that, the more you're also facing a risk of not creating a sustainable and long-term strategy. Yeah, just as a rounding off slide, maybe just interesting for people to know that through this whole process and where we're heading, what we've learned so far and what informs our own digital health framework. So we focus on needs-based innovation, not products. We want to improve. I think especially the things around improving and integrating has been a key thing for us. We never really wanted to, we don't have our own solutions at WDF. We deliberately promote everything as open source and yeah, basically use the principles of digital adoptions. And I think fire is becoming a very key thing in our framework because it enables us to establish a whole different dialogue with our partners when we go somewhere. And I think it's also, a lot of countries are in this verge now. They need to figure out what that strategy is from a digital transformation point of view in the health systems. So I think that's really interesting. Of course, digital public goods, yeah. And then we just keep supporting local development and capacity building throughout this in the countries where we are. So yeah, I think that's it. Just trying to keep the pace high. There was a slide that says, thank you. Thank you very much everyone.