 So I'm going to invite Victor Ilyanes to give us the next presentation. Victor is a medical doctor, is an internal medicine specialist, which I think means everything but dermatology and hair loss. And he splits this time between clinical practice as well as being a medical reference at MSF Operational Center Barcelona Athens in Barcelona, where he works on NCDs and other issues as well. So go ahead Victor. Okay, thank you. Ten minutes. Yeah, ten minutes. Hi, thank you very much. Well, I'm here basically on behalf... You need the slides as well? Yes, I do actually. That was my job probably. No, no, no. Actually it's... I'm just doing a capella, but it would be nicer to... Well, first of all, thank you. But I'm here basically on behalf of Gazana Aziz. He's our program manager of the Health Surveillance Program in Middle East. And he was supposed to be here, but for more administrative slash immigration issues he couldn't attend. So I will be doing this presentation. I'm sorry, this is passing a lot. What we wanted to share with you is a very practical experience of the appliance of a mobile data collection tool for surveys in a setting where we consider it difficult to obtain information in MSF and how this could have some space for NCD monitoring eventually. Thank you. Well, the need comes, has been stressed during the whole presentations, but I will just use this completely non-standard word of difficult setting that for us basically means not only a place that we don't know but we don't have really local sources of information because this is probably almost everywhere. It's also where we have problems of access or the conflict might imply that movements of population make the situation change quite quickly. So in these settings, we of course need information to start with, but we probably need some information during the project development and eventually, which is something that we all like, is to have some type of measure of the impact of the interventions that we're having. In the Middle East, the Health Surveillance Program was developed that basically implies surveys that are done in a repeated manner to try to have at least a basal assessment of some conditions and then to have a follow-up in the same target population that we're looking at. So for this tool in particular, surveys were done and as you see there was an electronic device in the middle so this is part of what I wanted to show you about. Sorry about that. Basically, the software where it allowed is a flow of information from the tablet itself to as soon as it got online, the database was automatically uploaded. Sorry, I don't know how to take that out actually. The analysis could be done almost real-time so all the stakeholders could have the information very available and quite quick as soon as the survey was collected. So basically from these four stages of a preparation survey collection and encoding of data and analysis, at least we start taking out one which is the encoding because this is directly uploaded from the tablet. The survey collection, there was a pilot done in Lebanon in 2014 and what they referred is that for very large surveys where there's a lot of information compared to paper-based, they were taking like a third of the time because it's very user-friendly the application. The analysis is quick because it's immediately uploaded for everybody and the teams also referred that the training was quite easy also because it was a very structured interview. So for the moment, five surveys have been done. Only one of them has a follow-up in Iraq and they have been in different settings and for different populations. Some of them have been directed for refugee populations and for IDP population and some for general population. Do we have a space for NCD monitoring this setting? Well, basically the initial assessment of prevalence has been discussed here a bit. Of course it might imply some things in the operational side as soon as we know the population. Healthcare access is a very important one for us. Also for the initial assessment but also for the follow-up especially if we are intending to have an impact on that. Population practices and perception could be interesting to know as much as a quantitative tool can give us. And eventually we can include some potential outcome indicators like a frequency of hospital consultation for asthma attacks or the awareness of education for a community health education program. So I wanted just to show you the survey that has been done in July, the one that had an NCD component inside. That was the last one that we did in July. It was done in the south of Syria in an area that is difficult for us partly because we don't have access with expatriates to the area. So this is one of the settings that we call this remote control setting. It's in the zone of Dara which is a mixed controlled area. So we don't have access to the whole area. But in the east Dara the survey was done for the population basically the area was separated in three groups and 26 clusters were identified. And this was a time frame for the survey itself. The training was quite quick and because of this characteristic of the tool it could be actually done by Skype which was very comfortable for the situation that they had. The collection was done in five days. They could only collect 18 of the 26 clusters because of security issues. But still that meant around 1,000 households and 4,200 individuals. And this is a relatively large survey with a lot of items and information from food security, essential items, utilities to more things related to access to healthcare. And in this one besides many other things some questions regarding self-reported diseases were done regarding hypertension, diabetic asthma, asthma-like actually because the diagnosis is a bit more tricky. Then in each one of these sub-items regarding access to healthcare through control of the diabetes or the hypertensive was asked. And also in the case of asthma for example how many asthma attacks they had in the last 12 months etc. So it was quite a volume of information and it was easily available for all. So relatively quickly as soon as this was done in the end of July, all the stakeholders that were interested had this information. This 15% of the total population has some chronic illness as self-reported. 30-35% of those are hypertensive, 20% so diabetic. We could get a glimpse of what type of treatment they're receiving or needed. So for us it was very interesting to know the amount of insulin requirements of the zone, of the area. We could get a glimpse of how well or how is the control of the diabetes for example how many blood sugars in the last 30 days or how many visits in the last year to the doctor. And this outcome indicators like the one for asthma that we were talking about, the visits to the hospital for an asthma attack. So what was the response with this information? Well it's a little bit soon to know but what we can tell you about is that the fact that it was easily accessible to everybody and this survey, the first thing that has brought to discussion in the area is that our intervention was very focused on the hospital and we might need to get a better access to particular vulnerable groups like this insulin requiring patients that might need some type of primary health care response. Data of course as you all know is super important for us for advocacy so this information is supposed to go. And we, I hope that we have the luxury of some site of impact during the next assessment. The next assessment is planned in six to nine months and the idea is that trying to fill up the gaps and the next plan for the next month is going to be developed, implemented and we hope that in the next assessment we have some type of information that helps us to know if we are doing something. Vantage is basically this is from the field, the collection speed as we were saying was very fast. The encoding was completely non-existent and that implies less mistakes, less human resources eventually. The analysis is quite simplified and accessible to all the stakeholders and since the data storage is standard we actually can compare different settings eventually if we want. The cost was not analyzed but in general you even though some part of the technical side will cost more you eliminate human resources for the encoding and everything so at least the feeling from the field was that the cost was at least similar to an ordinary survey. And it provides new logistical challenges even though the field said it wasn't the biggest issue in this particularly setting that probably is not something general to all the other places. So, well thanks for the attention after lunch. Thank you Victor. Any clarification questions for Victor? There's one up there but you're going to have to wait for a microphone. Try again. I'm from the International Committee of the Red Cross the ICRC. So just one question, it's about data protection meaning you had online data how can we guarantee the data protection and confidentiality of patient data because this is a big issue. Very good question. Victor can you come here to answer so the microphone. Well, I hope I'm not mistaken since I'm not completely into it. I understand that all the data was anonymized anonymized anonymized and the tool itself guarantees certain degrees of data protection. The idea was to use aggregated data so basically we're not having an actual record of the people. So I understand that it's not a big issue here. Of course, this web base is not accessible to everybody, only to the stakeholders that were interested in the data. There's one more clarification question. So can we move the microphone? Yeah. Please introduce yourself. Thank you. I'm Ula from the Serial Public Health Network. I spoke to the makers of the TAMA platform and actually the platform does comply with EU protection data regulations and also US ones which is a really positive thing about the app. And my question to you is this app is capable of doing longitudinal data for individual patients as well as just as a surveillance tool and I wondered if you had any experience of using that? Well, we don't. I'm afraid that I cannot answer more than that. I don't know more information about longitudinal data. I'm afraid that we don't have an experience using it for individual patients. I have one quick question. How long does the questionnaire take for a household? Because clearly you showed a lot of questions. Well, actually, yes. I can do a... I am trying to remember exactly the number that they told me about the... but they were talking about around 85 households per day. 10 teams. No, it has to be more. Well, it is 90... it's a thousand households in five days' time. So, I'm not exactly sure what to tell you but we can do the math. But the fact is that what they're related is that the fact that you ended up... you put age group of the patient, for example, and that immediately separated the branch of questions that you are going to use. And some questions regarding income and stuff like this was only done for one of the households. So, the volume of information was different for all the interviewers.