 So welcome back for the last session of day one in this DHS2 annual conference in Asia-Pacific region. So we have two more countries yet to present for the day one. So may I invite the Ministry of Health Maldives, Ms. Sharma, who is present here. There's been a lot of progress in implementing DHS2 in Maldives over a very short span of time and we are really excited to hear. So please come and present all the interesting stories. Assalamu alaikum and a very good evening. So just to begin off after the tea break, we are going to look into DHS2 implementation in Maldives. So just to begin to give a little bit of background on which country Maldives is, we are actually a very small country in contrast to most of the countries here. So we are very small in scale. So we have a population of only about 560,000 people, and this includes around 300,000 Maldivian. So we have a mix of foreigners and locals living in our country. So Maldives is what you will know as an archipelago, like we are made of a lot of islands, and then we are distributed into different administrative what we call it atolls. So the equivalent of atolls in other countries would be districts. So whenever I talk about an atoll, I'm talking about a district. So we have about 186 inhabited islands and our health system is based on tertiary facilities and a mix of public hospitals and private facilities including clinics as well. So to begin our journey with DHS2 actually began very recently in 2019, just few months shy of COVID-19. So the first time we implemented DHS2 was to find a solution to get timely reporting of the aggregate data that is being reported to ministry. So these are what we call as the monthly statistical reports. I think a practice which is done in many countries where you ask the health facilities to report to them about their outpatient statistics, inpatient statistics, how many surgeries they did, how they made laboratory and diagnostic tests, did they run, how many, what is their health workforce, and also what is the bed count. So these are the things we actually wanted to get. It was being practiced in Morris, but at that time it was very excel based and it's very hard, especially a country like Morris which is very distributed and we are at the center and then asking people to, you know, report to us. So we thought maybe we should change it, we should try to utilize DHS2 so that at facility level the reporting can happen. And at the center level we can do the, we can just monitor how much they are doing it. And the beauty of doing that is now we know places which are doing pretty well. There are atolls which are at 100% reporting rate and we have two colleagues today with us, Lifa and Suma. They are from two districts which has 100% timely reporting and that's the reason why they have been invited to participate in this conference from Morris side as well. The data that we generate from DHS2 based on this aggregate is linked with our statistical output. The main statistical report that in Morris is called Morris Health Statistics and the book that you see there, majority of the chapters are based on the data we get out of the DHS2 implementation. And I will just show you an example of how we try to utilize the data visualization expect of DHS2 to facilitate or make the process easier for the staff who are who are involved with the compilation and the report writing of our statistical series. So this graph shows exactly how it will appear in our next 2021 statistical report of the distribution of health professionals. So in Morris we like to group the health workforce into nurses, non-medical staff, doctors, allied health professionals and other staff. But in reality, when we collect data, it's more granular in nature. We have 42 data elements in DHS2 that people enter data into. But at the statistical report, we don't want to write everything, you know, at the granular level. We need to have a way that policymakers or the public, a layman can understand and utilize the data. So one thing we did was we are going to make our process easier for the staff by ensuring that we will do the categorizations in DHS2 in a way they can optimize and generate these kind of tables. So in this one, if you look at the legend, we do exactly the same as the state book, we have allied health professionals, doctors, non-medical staff, nurses, other staff. So no other manual regrouping has to be done by the staff at the end of the day. And we also thought maybe we are doing at facility level, the most lowest level we are collecting data. So there's options for us to utilize the same data in different formats, like we have the national spatial plane, where we categorize more this into regions, we have three regions. So in DHS2 itself, automatically, once they feed the data at the health facility level, we can generate an output like this where we see the distribution in regions. And at a glance, we can really easily see the most of the health workforce is based on region two, which is central and it makes sense because the greater mother region, the capital city region is based in central. So most of the tertiary facilities are there as well. But we can also go deeper as well, because we again thought ownership is important as well. There are private facilities, public facilities and their joint partnership facilities as well. So we can look at human resource through DHS2 again with the way that we have categorized them into public, private and government facilities as well. But in that way, like we know, in public sector, there is a lot of human resource there, but we see that the HR doctors are still a little bit lower in terms. And we can also again look into local expect rate as well. So now we can see exactly where our local capacity in human resource needs to be filled, because if you look at the locals, what we see is that the blue one is the doctors. And there are more expect rate doctors compared to local doctors. Again, giving us information that can assist in future human resource capacity building works or things that is happening. So this is just one example of how we started our journey with an aggregate module. And then we thought there is also potential for us to go into more, more into individual based information as well. We are a small country. We should leverage what we can do as well and also we already had people been trained. COVID happened, people were used to entering data into systems. So it was the high time. We try something to solve an issue that is already at the ground level. The problem with Morris is that most of the births happens in the central level where they give, oh, sorry, I have five minutes remaining. The problem of Morris is that most of the birth happens in the center, but they will go back to their islands and they will continue the next dose. There are two vaccines that is given at birth, happy and BCG. But when they go back to another island to continue that facility does not know whether they have been given vaccinations at the center, because they will not be monitored unless and otherwise they carry their manual childhood record book. So this is an issue the facilities were dealing with and they were they really wanted a solution where we can track the vaccinations across multiple facilities and that's how the concept of the electronic humanization registry came in place. And we rolled it out in October 2020 so only one year since we rolled out. So what's the progress so far? Morris is very small. So our births are also very small. But if you look at the figure 5293, that is the number of children who are registered this year and their births, their vaccinations are already being updated on a regular basis that is 96% of our live births, including the birth that had been reported from abroad as well. And that's a very, we are very proud to say is a collective effort that we have been doing is a pretty good achievement. So we hope percent to capture hopefully shall we do that. And we started in October last year, already 10 months has been passed but at present we have 86% of last year births already in the system and the vaccination records also up to date as well. So I'll go to the next thing we did. So very recently, we rolled out what we call as the primary healthcare registry which is based on screening for noncommunicable diseases that according to the package of essential noncommunicable diseases there are particular NCDs that we have to closely monitor. So the beauty of this registry is that we calculate a risk core based on heart's package for people age 40 years and above. And we also have a locally adapted risk core for people age 18 years and above. So at the moment, 18 years and above is who the group that we are targeting. So this is any some statistics we get from the one at all or district in mold is called Faf at all, where the primary healthcare demonstration is happening. So it's a very important site. So based on the information we have 94% of all the eligible people living in that at all is already empaneled and among them 97 close to 98% of them has done their initial screening. So the idea behind the primary healthcare registry is to keep our community healthy by having a more active role by the health facilities because we are the people who has the knowledge to guide people so why should we wait until a person gets sick and they come. But what if we actively engage with them. So there's the whole concept behind this. So, once we filter the whole population, we identify the high risk people. So if you look at the remaining the smaller graph, initially when we rolled out in March, we had to focus a lot on enrollment, employment and initial screening. But as the days went by, the focus is more on follow ups, the red bars are the follow ups, because they're already there and we are only focused on screening the highest people now. And what we have identified is that based on this we can really drill down again into different diseases like this one is showing the diabetes and from the graph we are able to see that the red one. There are 10 people in this island who are diabetic diagnosed to be diabetic, but not on treatment. Why. And also there are 96 people who are saying who are on treatment, but they're still not controlled. So this 96 plus 10, this is the group that they are planning to make changes because they have behavior has to be changed or the concept of a disease is beyond just purely based on their biological issues but the social determinants of health plays a role in when a person has. So the whole concept behind this primary health care is to think beyond just clinical care, think about their ways to promote their health and continue to keep them healthy. All right, so the next one that we have is the National Cancer Registry. And this is also something we are doing very recently I have only like one less than one minute remaining. So the National Cancer Registry is based on can range and we have recently rolled it out as well. And this is also providing a lot of information even with one facility that is currently implementing this we see that there are more females who has diseases and the breast cancer is one of the leading ones that we face as well. There are so many things that we are doing at the background to ensure compliance to ensure that the data entry users are really involved with us. That is like providing really good user support as well. So I think, given the time I'm going to stop here. But maybe if you're interested maybe I'll touch on the training parts and the user support parts later on as well. So thank you for listening. Thank you so much. Now this is a challenge right when you have too many exciting stuff new stuff. There is no time not enough time to present. So we have time just for one question. It's only one question I will make it big thank you for the for the team on your work and it's not a question. Just it's a reflection, quick reflection about utilizing the details to be like a public health intervention tool rather than capture. And really this is a smart design and smart application of public health interventions by using the details to rather than capturing the routine statistics. And this is part of the data utilization and data use. It's not only just to present the data and to visualize the data. So what you presented recently, this is the applied public health science. So thank you for that. Thank you. Yes, actually, that's the thing that we are promoting in more this context. So the concept of healthy, healthy life expectancy health. So there's a difference between life expectancy and health. So in more this we have a very high life expectancy now which is close to 80. But when people become bedridden at the age of 50 years or 60 years we are losing a lot of quality adjusted life years. So a project like something like this primary healthcare, most of the time what we know is people with lower health seeking behaviors are the people who have a negative health outcome as well. So the 10 people that is not taking the medication and the 96 people who are saying they're taking medication but they are not improving. Potentially these are the people whose diabetes situation will continue to aggravate. So the tertiary prevention side will be really affected by that as well. So that's the reason why we are really working on this primary healthcare registry. Thank you so much. I know like there are so many questions from all this, please. Yeah, you can meet here with the breaks and even tonight. I will tell more about what will be happening tonight before we all leave but before that, we have one more one final presentation. Country presentation for the day. So Ministry of Health Indonesia. Yes, please. Okay, good evening. Yes, good evening everyone. I will present the HIS to implementation in Indonesia. Yeah, here's the HIS to roll over the years in Indonesia. I think it's just the same with another countries that around 2012 and 2013, Yon came to every country to introduce the HIS to. I see another presentation also the same. Yeah, so in Indonesia there are two types of implementation of the HIS to we divided in national scale and sub national scale. This is the implementation of the HIS to in national level. We call it ASDK application or one health data application. In this application we provide monitoring and data quality assurance we use variables of completeness consistency time consistency data and outliers for the priority indicators. In this application we the data collection we made by API and it's covering 61 priority indicators of health programs. We collecting more than 700 data elements. And we also already provide video tutorial that get user using the HIS to properly. And there is an issue in this implementation of ASDK, there are too many metadata that not using as essential need to be need to be cleaning. And we found that sometimes there are data differences from data be query to ASDK. This is the flow of data transfer in ASDK. So the data from the existing health information goes to the national data warehouse or be query and then goes to the HIS to in the HIS to use as a dashboard analysis and data quality assessment. Another implementation in national level also we use the HIS to in malaria system information and there will be another ongoing implementation for MNCH dashboard and analysis. And this is the implementation of the HIS to in sub national level. We use in several districts like in Maros, then Pasar, Makasar, NTB, the tower housing from Jakarta and Cologne Progo. We use also the HIS to in support education and digital laboratories in undergraduate and postgraduate program in one university. And this is the problems, not problems actually challenge that challenges that we found in implementation of the HIS to the first challenges is that now we use the HIS to for data quality assessment. So the challenges in that implementation first, the WHO quality, the key quality tools app on the HIS to needs to be updated to suite the HIS to version. After the HIS to has been updated to version 2.4, the WHO Decay tool app cannot be set. The second we use the WHO data quality tools to assess several parameters of routine health data. Unfortunately, when the HIS to updated to latest stable version, the WHO data quality apps cannot be used. There was some personal issues on the apps. The three challenges. Second step of the Decay data is verification to the health facility. In here in the field we compare data from health facility to the data that has been reported to higher level. And the result of verification is verification factor. And we asked to developer of the HIS to facilitate this step because now it's not facilitated. For challenges, data entry is needed for system monitoring evaluation in Decay tools, but to be able to use it, the user must be a super user. So this is a problem for us because all these things we have given them as a super user. So it's ridiculous. Five, we also need to upload supported document for the system monitoring assessment. Also, we need support for this. This is another, I have, I have, I bring here too many problems, sorry. Another, how to manage different instances to keep up with standard. Second, update the HIS to at each national and sub national level instance every six months release the latest version of the HIS to since we implemented in separate instances. We need also interoperability of this is also several problem found interoperability of individual service data with fire standard to start to say that we have we have application name Satose had. So we need how to connect individual data that already use the HIS to connected to the Satose application. We found problem in this also. And this application usage requires adapting to the latest the HIS to version such as the WHO data quality tools. This is another challenges. I'm sorry. Then another challenges we have limited resources in supervising the HIS to implementation, including the DKI roll out. There are, there is also a technology constraint. Yeah, some pictures in the HIS to such as the WHO quality tools might no longer under maintenance, but this morning we talked to Austin. Oslo University will do something to it. And yeah, no obligation to you in Indonesia. There is no obligation to utility utilize the HIS to including conducting the key through the HIS to For that we have future initiative that we want to develop national regulation to enhance the use of the HIS to particular for the gate, the key. We also want to expanding the HIS to for the key a focus from province to help us a little Apple and creating a DKI high quality dashboard within the HIS to platform. Thank you very much. All right, thank you so much. I especially like those challenges but so there was some concrete issues that she has highlighted I think some of these were also raised during the internal workshop we had two days back. Okay, so I think how much time we have probably we definitely have time for questions to questions. That's all. Any questions or comments for Indonesia. So I think all of you heard what I said so there will be a separate session on that. So I encourage all of you, please attend that session. And we really like it if we can maintain the sessions very interactive so it's been really good so far. The country presentations today have been very engaging. We want the next two days also to maintain the same momentum. Any more questions. No. Right I think you all are a bit too tired probably so we are coming to towards the end of the day but of course we have one more session. So, yeah. So, let me explain what will happen next. So we have now one more session where we will have breakout. So we will have the session on data governance, which will be happening and at this venue, the grand crystal ballroom, and then the next session, which will happen at the same time is on toolkit implementation, which will be at the Gregory Hall so that is downstairs on the same complex. Right. So those are the two sessions pending for the day. What I encourage you to do decide like what is a session you like more. Whether you want to be on data governance session or to toolkit implementation sessions. So if it is the toolkit implementation you need to go to the whole the Gregory Hall which is downstairs. Right. But before you leave, I have some announcements related to logistics. So today evening, we are having the gala dinner. So the dinner will be happening at cinnamon lakeside hotel so it's a different hotel which is located about around 1.5 to kilometers from here so you can of course walk, but we have arranged transport for all of you. So what we are requesting you to do is to be at the Taj Samudra hotel lobby at 6.30pm. Right. So we have arranged transport. So there are some vans which will be leaving at 6.30. Right. Because we only have four to five vans. We will not be able to accommodate all of you at one go. So they will be coming back and collecting the remaining participants because the thing is it's a different venue. So the dinner will be held on a boat. Right. So and it will be sailing. Yes, it will be sailing for two hours. So we really want all of you to be in that cinnamon lakeside hotel by 7pm. So we kindly request all of you to be at the cinnamon at the Taj Samudra lobby at 6.30pm shop. One final announcement. Again, like those of you who have not collected your conference package, please go to the registration desk. So your conference package is there and there are some very useful items which will come really handy, especially during this rainy weather since Sri Lanka. Yeah. Okay. Anything else or. Thank you so much. It's not. We are not done for the day. So please the governance people who are participating for the governance session. Stay here. The toolkit implementations downstairs. Yeah. Thank you.