 Thank you very much, Mike. And hello, everyone. Thank you, Mike, for your previous session. I thought that was very interesting. In this session, I am going to talk about the readiness assessment that you have received earlier via email. And let me just share my screen quickly. You'll see my presentation now. Yes. Perfect. So I'm going to give an introduction to this exercise that we have posted here to you earlier. So before starting your tracker project, it's really important to think through a few key questions that you have in this document, and we will talk through this in the session. And you can fill it out as you go during the session or you can just keep it with you for the next week or two or whenever you're starting your project and fill it in at that time. And we're also helpful, as we said in the previous session, to support you in the afternoons. There is a separate session for this project planning. If you want to discuss with us so you can discuss on Slack. One of the learning objectives for this session is to just be aware of the factors to assess before getting started with your tracker project. It's not an exhaustive list, but I would think that this will give you something to start your your thinking and also a like high level understanding of the consequences of not assessing preparedness properly for your project. And we will also give a short intro to this intro to this week's exercise. And here is the famous word of the day that has been requested in the Slack channel a few times I will leave this open for a few seconds. Digital development is the word of the day. The word of the day can come in any session during the day. So I was the lucky one to be to be given the word today. Okay, I hope that most people have have registered the word by now digital developments. So what we're talking about in this section it really links back to what Mike was speaking about in the previous section on the maturity model in this tracker house with some key foundational building blocks and some items to consider new projects. It links back to that. So you should have some background by now. And sessions again later in the Academy will give more insight into this topics. So we want you all to think through what is the end goal of your tracker adoption what are you trying to solve. What kind of IT support structure do you have in place to make sure that everyone is helped at a satisfactory level. In your tracker project, you need to think through issues such as connectivity and hardware and how the care or the service provision that you are mapping against mapping up against are being done today. So if there are existing information systems that your tracker program needs to interact interact with and also if there are privacy policies or legislation that you need to take into account. And to help me discuss this, it was nice to hear someone else's voice as well and some other projects. So I asked for some volunteers yesterday on the slack and these three wonderful men they volunteered to help me out. We have Shirzada Sadran from the Management Science for Health in Afghanistan. He is working on a tracker for keeping track of health worker training. We have a mojaveer Tluk from the Ministry of Health in Mauritius. He is working on a COVID-19 vaccine tracker. And we have Abdul Rahman Shahab from the Healthnet International TPO in Afghanistan. And he wants to work on a tracker for extended program on immunization in the clinics that they manage. So I think I will give the word to Shirzada first to quickly present his project so you can get to know them a little bit and then we will have a conversation as we walk through the readiness assessments. Thank you, thank you Anna and thank you Mike for the great session. So, hi everyone, I am Shirzada Sadran from Kabul working with the Ministry of Afghanistan as a data pioneer in visualization export. So hence, I just thought so we have decided that the MSH has a project with the name of AFIAD. So we have decided for the activity, one of the activities is to the festival building of health managers, health workers, and the 34 provinces of Afghanistan, I would say in all of Afghanistan. So, and the aim of this tracker program is to keep track of the participant and now we have Afghanistan in a different capacity development program so we can have the record of all the participants that who from where in which program he has participated. So based on this, it could be like giving us as a glance at the from each provinces which help the post which help or each NGO who have participated in different capacity development program or workshop or training. And this tracker we are planning that this tracker should be used on the workshop or training facilitators so they are the first school using the tracker program and what we are planning that maybe come after, we have changed the paperwork to the tracker. So then the next use will be the training participants so we are planning to they can register using the Android application for the specific training workshop and the data, the end the data will be used by MSH and any team in the central level. And also, the analysis and also we are planning to hold regarding the training we have conducted over Afghanistan, the list of participants and more detail to the donor. And the last thing which I would like to mention that we are still, we are still in the pause of assessment so we are assisting, we have assessment in Afghanistan in different health or district level. So what will, so we are assisting them to what is needed for the health worker, our Afghanistan what type of training they will need so based on those assessment will be preparing different kind of workshop, different kind of training so then still we don't know we can't exactly say how much the volume of the program that the participant of each specific program in general you can say our Afghanistan. So, so we, so this is what the plan for this is what will be my next assignment people will be doing my, my first tracker program so that's all from my side and thank you. And there's any question. Thank you so much for your introduction to your projects. The next one up is to hear about the Mauritius COVID-19 vaccine delivery project. Thank, thank you, Anna, and thank you, the DHS2 team for receiving me today here. And so today, I would like to just give a brief about what we've been doing here with DHS2 implementation basically, we started with implementation of DHS2 with with aggregate implementation of data for integrated disease surveillance and response and for expanded program organization that then with a COVID-19 situation, we are doing the, we are planning to use the COVID-19 surveillance package as well, but we have not implemented it yet. So for now we have implemented the COVID-19 vaccine delivery toolkit and also the AFE reporting in Mauritius and that started in March 2021. HISP Uganda and University of Oslo have provided technical assistance for setting up the server as well as design customization of a platform. WU2 has assigned myself as a national DHS2 national implementer in Mauritius, but I'm also the epidemiologist at the Ministry of Health and Wellness. And so for now we have collected track data for over 116,000 people out of a population of Mauritius, which is approximately 1.2 million people. However, we have been having some challenges with regards to we have a backlog of 120,000 tracker data to be collected. And this is because we are having some issues with regards to collection of data for profile for the patient profile. This is taking us a bit of time. Next slide please. I can't see the next slide. Do you want me to maybe go? Oh, thank you. Sorry about that. So what we have been planning to do to try to address this issue with regards to the time taken to collect data for patients who are coming for immunization. So the Ministry of IT in collaboration with WU2 and MOH have developed a prefere registration form and which is the pretty much the example that Laos has presented yesterday. And we are working on something like that and it has been linked to DHS2 for API. And also we are Ministry of IT has an info highway platform, which provides sharing of data amongst government agencies. Basically, we have a database of all every single individual here in Mauritius with regards to their name address and any other data that has already been collected and they have been collected on the platform. So this platform has been designed as a service platform which allows multiple government agencies to share data via e-services to other agencies. Also we have the data protection act here that has been established several years ago. And so with regards to the data protection act as well, like we are ensuring that the patient tracker data are being collected in an ethical way and also legally taking the legal aspect. This would allow that the info highway platform will allow users to input national ID and support autofill of names, address and contact details on the profile registration form. So what we basically do is like we type the ID and then over other details with us name address and any other information that's available for the patient will be automatically filled on the profile registration form, which hopefully will help with reducing the time taken to collect data. So we are currently assessing ways also to how to auto generate vaccination certificates and travel pass and to link with COVID-19 tracker vaccine registry. That's the importance. That's one thing I wanted to say about how important this COVID-19 tracker vaccine registry that has been developed by DHIS to because with this with this we can easily auto generate vaccine vaccination certificates or travel pass, which at one stage or the other will become an integrated report of traveling in the world. And so I've noticed that Wanda Wanda has already implemented such a program and we are very interested in developing such capabilities in Mauritius. Thank you very much. Thank you. Then I will give the word to Abdul on the Afghanistan API tracker. Thank you. And thank you everybody. Good morning. Good afternoon. As you have mentioned before, we will be developing tracker for the API services in health facilities which are currently operated by our organization health net tpo in Afghanistan currently we work in three provinces we manage around 150 clinics, which ranges from the basic health center to district and provincial hospitals. My plan would be to start the tracker in one clinic. And the purpose will be to strengthen the follow up and tracking of children and women who are enrolled in the API program. And the clinic which where we want to establish the API tracker would be Sarkhani CHC in one of the eastern provinces corner provinces. And it will only cover the API department at the moment we do not want to link it to mch services or others based on some constraints. So maybe later we can expand it to other departments in the same health facility. And the system will replace the existing paper based WTO and MOPH system for a collection of information which is based on registers and some individual cards given to the mothers and children. The idea comes from our health department and our organization to pilot this and maybe later we can advocate for expansion to other provinces and working with the ministry to to adopt it in other clinics. And the support in place in our organization for the tracker and for the aggregator DHS to which we currently have comes from the IT department and from the program development department and the monitoring devaluation HMS department. In Afghanistan, we have 3G and 4G mobile internet DSL internet and some other forms of internet provided by private providers. But unfortunately, we do not have some data protection laws at the moment I searched. Today, and I contacted some people but I couldn't find but there are some data protection laws or protocols by individual organization for example, the humanitarian assistance the old child they have their own data protection which we are following in humanitarian projects, but for this tracker, we will need to develop data protection protocol inside in our organization. The resources which we'll need at the moment will be the infrastructure hardware and software and the trainings and also we would need to add some dedicated stuff to the M&E, because the one person we have is responsible for the aggregate system and I assume that we will need some dedicated person. Next slide please. A little bit about the health facility. In that particular health facility we have around 2000 women and children attending API services on monthly basis, and the patient flow in that health facility is either the women go directly to the API department or they are channeled by other departments like MCH or the OPD and based on the current structure in the MOPH system, we have two vaccinators there and probably will think of adding another person to look after the tracker system. And as I said earlier, we are using the paper-based MOPH W2 registers. Fortunately, we have aggregate DHIS2 in that health facility. It's part of our 20 health facilities where we currently pilot aggregate HMIS data so maybe we link that to the tracker. And the clinic only has access to 3G and 4G mobile internet which we will also use for the tracker. So that's all from my side. Thank you. Thank you so much. I think this was very interesting. Three good examples of tracker projects either in production or in the making. So I hope this can feed us a bit of a good discussion background for the readiness assessment. The first sort of batch of questions in your Excel sheet is this objective. What is the objective of your tracker? These are sort of the very first issues to think through when you consider if tracker is even the best way to solve your problem. So the first question here is what is the objective? What is the problem that you are trying to solve? For example, if your objective is to better distribute books among students, for example, in a school, then you want to ensure that there is one book per pupil in the classroom. It might be tempting to have a tracker to ensure that every child has received a book, but perhaps you could do with just counting the number of students and the number of books and link it to a classroom where you don't necessarily need tracker. So really sort of think through what the objective of your tracker is. And also who is asking for the system? Is there a demand for the data? Is somebody asking specifically for this data? Can you sort of envision what kind of meetings, what kind of discussions around the data where the tracker data will be used in practice? And this can be ranging from a help worker using the tracker data for decision support, for example, up to the national level where you would like to understand the reasons for dropouts or who is missing services, for example. You would also have to consider the reach and scale of your project, so how many users, how many sites, the geographical spreads, and how many tracked entities approximately. Of course, you will not have all these answers 100% correct in the beginning, but it should be something that you think through to understand the load of the system, how you should train, etc, etc. And also you need to think through and assess before you start, what is if you're placing? How do they do the service today? How do you track books or students or pupils? Or how do you ensure that people get vaccinated? What are the current sort of way of gathering this data today? And what are the gaps? Because that's probably where you would like your tracker system to fill in because there is a gap in the information flow. So I then have a question to my three helpers. Who is asking for this new system? Do you have explicit sort of need saying that we would really like to make this type of decision that we are lacking the proper data to do so? Yeah, I can't in case of my tracker, so I will say so the first the need for the system is the requirement that the system you wanted is the organization I'm working for. So, and the main objective of this system that we want to change the paper based report keeping from paper based through the digital system. So this is the main objective. So the one major problem is that we are going to solve using this system as we are working in 24 provinces in their days. So we, before we were doing all these card in the paper based we were collecting different provinces, we were bringing it here to the main office and then we had a local system which was, which is developing a map of taxes and then we had a data entry guide and we were collecting all those data from paper to this access database and local. So the main objective is just to change, to just reduce, I would say, but for planning to 100% replace the paper based system to the digital or VHS tracker. And I think the initial stage we have 34 provinces so there will be 34 sites and we are planning this by using the Android so we will be having an early session, we will have a number of tablet, so during each training, during each workshop, all the participants will be filling their information or the facilitator will be entering the information regarding the training, regarding the workshop. So in the class I would say so we are replacing the manual system I would say to the digital system. Thank you for my side. Thank you, I'll do we had your hand up. Thank you, Anna. For our plan tracker system in Afghanistan. And the one health facility, and mainly comes from the health department, because they would like to track the defaulters and the women who missed children and women who missed their scheduled shots. So it has been a desire at the health system level from the last couple of years that we have to move to some electronic based systems for the various function inside health facilities. So this was something we have suggested in our proposal for the health services in that particular province and the first step was to establish the aggregate system and now we are trying to do the the remaining part so this is part of the process we have committed to and also there is a huge need. That's great. And then maybe I could ask more beer in Mauritius. Did you start out with like a paper based system for COVID vaccination or were you ready with tracker as soon as you had your first vaccine maybe you didn't really replace anything for this. So, so basically, you see like when we had the national action plan for COVID-19 vaccine vaccination. Basically what happened is like one of the real thing we mentioned in the national action plan is that we're going to going to collect it in the beginning both paper based and through DHIS to one. DHIS to was set up for the COVID immunization program. It was basically set up on time. Thank God, it was just on time for collection of data. But the thing is like at this, we had some issue with regard to the data collection was happening on yet central level because of a bit of we didn't have enough tablets and computers and all that to for all those vaccination centers because we have like approximately like when we started like probably 15 or 16 vaccination centers. So we had a bit of an issue with that because we had to import things and all that with the restricted border closure and all that we had some issues to get those equipments, but we are planning to get them and we will get them very soon. And that's so for now basically it's both paper based and through DHIS to So of course, like we are aiming to expand that collection to those vaccination centers instead of carrying those papers back to a central level and then collect the information there and then send those papers back to the vaccination centers again. Does that answer your question. Yeah, that's great. Thank you. I think I'll move over to the next topic. I think it's clicking in the right place. So, another topic that you need to assess before you get started with your tracker program is your IT support structure. We've mentioned this a bit earlier in the course as well, that there is a big difference of supporting maybe 1015 district data officers and a few selected sites in the country, down to a very huge number of districts for example if you aim to do data entry at every clinic providing mch services for example. So you've got to think through how do I provide support today for those giving a collecting aggregate numbers because that's the scenario you usually see is that you already collect this aggregate numbers but now you also want to know how do you do this today, who are the people involved do they have more capacity to support more people for example, and then how do you plan to support the tracker projects in the future. So you have to look at of course the number of the number of users you will have where they're placed in the country, can you manage to support everyone from a central location in the capital or do you need a distributed system like we talked about earlier very practically is like who will pick up the phone when someone calls who will fix the device that doesn't work, who will deliver a new device that is broken. Because at least if you do this point of care data entry where the healthcare worker is sitting with a patient and entering the data on the fly. Then you need that device today and not in three weeks time when you have procured it or fetched it from a central storage unit. So I'm thinking, which of you this project has the biggest reach perhaps it's the COVID vaccination project so I will ask you for this. How are you planning support and what's your experiences up to now I'm supporting these tracker users. Thank you, Anna. So basically, like what we're planning to do we are in the process of receiving as I mentioned early on we had some issues with regards to infrastructures we've providing enough computers, laptops and tablets but we are in a certain context thanks to the collaboration with the Indian Ocean Commission, where we're going to receive like probably approximately 50 tablets, which is will use the Android data data collection. And we've got to internet. It's not an issue in Mauritius we we have a pretty much good internet facilities here, and we, or we even can set up with the mobile spots hotspot that can be moved from one place to the others. And so we regards to that infrastructure is not an issue. We regards to server as well it wasn't an issue we we had support from HIV Uganda and who has helped us to find the right requirements, server requirements, and we have set up that and this is looking good as well we've not been really having much issue. And so what we're planning to do is like probably once we receive over tablets and overs hardware required we will, we will be able to collect data, instead of collecting data centrally, we will collect it in each individual vaccination site. So that will help us out with regards to catch up with that backlog that of 120,000 data that we have yet to enter. But if you're if your vaccinator is having trouble he drops the tablets on the ground and it breaks. Who does he call? Yes. Who helps this poor man in the middle of nowhere. Yeah, that's that's the thing like we are we have we have the people here who would assist with providing maybe laptops or anything as a replacement. But again, it is a major issue that we have to look into. And I agree with you, we really maybe even have to set up a proper plan, planning for that in case of something like that happen. And also, like, if I may take an example like we got the entry you might recently we had a COVID outbreak in a vaccination center, and we had to isolate everyone so data entry operators has to be isolated and everything. So no data entry is being done so there is a lot of things that, of course, a lot of challenges that's coming up but I think we're proper planning and we have a proper plan and SOP we can really deal with the situation. So another things like we need in terms of when you talk about IT support structure we talk about security as well. We need a server administrator to ensure the maintenance and the server like the database is being maintained properly, and also a database manager as well. So that's very, very good points to think about all these things. It's like, you want to, you want to make sure that everyone is up and running at all times and doing things that are not against the law or that you're losing data, for example, so being prepared to support Exactly. And the ministry. Sorry, sorry, sorry to interrupt. Please, go ahead. And with regards when you're talking about the legal aspect as well. And we have mentioned about the data protection protection authority, and the Ministry of Health has a data collector certificate. So all the data that are being collected or being ensured. The server is located also at the government center IT server center. It's called the government online center and basically all the servers are there. They are cloud based, but they are there and so they are being maintained by the government agencies. So this has will help. Maybe ensure that people are aware that the data are being collected not by any other external agencies or external servers. It's all here. That's great. Okay, thank you so much for sharing. Thank you. From team Afghanistan on this topic. Have you made any thoughts around how you plan to support your project. And if I start first so for the time being for this limited number of devices and only one facility will not face much problem because the existing it support we have in our organization and the administration support we have at the province. We can respond to those kind of issues promptly in terms of providing providing a hand on hands on support to the data anti officers, the vaccinators at the health facility. That can be done by the project supervisors who are located near to the health facilities and they will be trained as part of a cascading training program as earlier mentioned by Mike so we can have a few trainers at the national level and then some so some more trainers at the province level who can who can be assigned to a specific number of facilities to provide support. And in terms of for the server administration and other things related to the entire system that will be done by the IT department here in the M&E department but we will need some dedicated stuff at the moment. We do not need much financial or other kind of support for this one health facility but when we are expanding to the other health facilities definitely will need some hardware and IT additional IT support and that that will be part of the planning. Okay, great. Thank you for sharing. Shosada you want to share anything on this topic. Well, I think, I think this is very important that the question which you asked it who will and who will make your phone and will fix your device. This is the question I think asked by organization and by the developer tracker program proposed because it is a very small scale tracker program and the IT support infrastructure which will cost a lot. So, this is a, I think, very important in every tracker program to consider what you're going to do on what you're planning for the program will support anything in my case. This is just a start that this will be because we had another large scale tracker program and complex. The question is, because we have a huge support from our headquarter, MSH headquarter so we have a great IT support in terms of self or in terms of other facilities. The rest of the thing which will be doing like the support we will do, why problems is not only in this tracker program in the trackers we are planning the coming days, which is a huge complex level of analysis assessment and tracker program so so we have a, we have already discussed this before planning the tracker program with the central headquarter and also the MSH of Afghanistan so that the headquarter will provide support and we will have a details to instance specific for MSH of Afghanistan. And the main idea is that we will be having local and then later it will be syncing with the MSH headquarter because they are also in the DHS group for international data so this was my side I think because we have all these infrastructure, we have tools, we have a tablet, we have resources and also we have a great team here in Afghanistan as a team. Thank you. Right. That's amazing. Thank you. So yeah, who will pick up the phone keep that in the back of your mind when you're working on your readiness assessments. So we do see from, and I've read also plenty of research papers really showing to this, the value of doing supportive supervision, having people that can actually go out to the sites of the people who are using the system. Sit down with them help them in their daily day to day work it's not necessarily only sort of classroom training, but having people check in now and then now and again to see how things are going and if their problems that have shown up. So that's also something to keep in mind. The next topic that you need to consider when you are planning for your tracker project is connectivity and hardware. So while before maybe if you collected aggregate data at 15 district offices with relatively stable internet electricity and so on. So if you're planning your tracker project assuming that this now will go down to the lower levels of whatever service you're providing. You need to think through and understand what is the connectivity and hardware situation in these sites. For example, is electricity stable everywhere. Can they charge their device. But will that be a problem is electricity only available for certain hours of the day. If so, maybe it's a bad idea to plan for to plan for data entry at point of care I mean then it would be disastrous if your devices run out of electricity. You need to think through internet connectivity and also the varying degrees of connectivity as was mentioned in the previous session. So you have to think about using Android for example for parts of the country, or for all of the country for doing your tracker projects, or can you manage with a web version. If you have a stable connectivity wherever you are or it's not super critical that the data is entered exactly on time. That's also something you have to look, look at do you want to do direct data entry where the page when you're sitting with the patients, and you have an unstable internet connection then you maybe you should have some flashlights, blinking and thinking through how Android could help you out. And you also need to think through this, the current devices that you already have. You need to procure a lot of new devices, I will talk more in terms of budgeting in a later session, but what is really dragging costs up when doing tracker is devices and it's end user training. Do you have to buy 1000 new devices or can you reuse devices from other projects I've worked in countries where, where one health program for example have invested in in tablets to to track one type of disease if it's immunization or if it's HIV data for example, is it possible to link up with with the people who already have a device and add your tracker program to that device, or that the end user can access the tracker program through that existing device. So you have to map out the device situation. And in case you are using Android you need to make sure you know which version of Android that device is running, because it has implications for for how you set up Android that will also be covered in a later session. So from you said that in Mauritius the Internet connectivity was was pretty good and stable so maybe it would be interesting from Afghanistan to to hear what what is the connectivity situation in your site and how are you planning to mitigate those problems. I think we had a major the first two point which you have mentioned this is a, I think this is the biggest challenge for us, which is the first one's electricity. And in the digital instance which we are planning to implement it locally in Afghanistan in this so the first challenge we had an unstable electricity that because we can provide a backup but it will be also not for because sometimes the electricity going for 24 hours or 36 or 48. So this is the first challenge and the second challenge is a stable internet connectivity. As Mike mentioned in his session that if the aggregate level of data system has been down, the aggregate level of data is won't be a problem for the field but for the tracker it is a problem if the system down for a day or two days or more than two days because there will be a problem in tracking and tracker data. So we have to be faced these two, the first two electricity, stable electricity and stable internet connectivity we have in in a capital also but it is more in internet connectivity is a huge problem in provinces in a rural area so so yes, yes, yes. So the cases change in Afghanistan compared to other countries. And maybe also question maybe Abdul would like to answer this but do you have a plan for what to do in case you are out of connectivity or electricity for a while and do you have like a sort of a contingency maybe you're not that far yet in your project but do you have like a contingency plan for for okay we are out of we cannot use our devices for a week. How, how will you make that work. Thank you Anna. In addition to the points raised by share zada. Mostly their work, they are dealing with me be with the provincial headquarters where they have offices, but our system. The plant system would be in health facilities in the situation is somehow different. We have few options for electricity supply and health facilities. We have generators. Especially in health facilities where we have laboratories and we have operation theaters. And also we have solar panels and most of the health facilities. So, in terms of having a source for charging the devices. I think we will not face problem now or even if we expand, unless we we are the desktop computers which need instant electricity that would be a problem but still we can solve that through laptops which can store. But and in regards to having a backup plan for for entering data in case of for electricity outage. I think we can do that through sending the paper based records to the provincial. It's a nice person for a couple of days who can who can enter the data. And once the electricity is resumed or the problem is solved in the health facility they can go ahead with the usual instant data entry. So I think that that we can do other than that. I think we do not have any other option. Thank you so much. And Mauritius, are you all okay and they're the power is super stable and connectivity is not an issue with you. Well, sorry, just one moment. So basically, like, as you know, we're pretty small island and we regards to connectivity and all that it's not really an issue for us it's not the same as in the context of a bigger countries. And so we regards to electricity we are an internet it's pretty much stable. There has not been really an issue maybe sometimes drop out. Like, once in a while, like, you know, but like we don't lose connectivity. The speed might be reduced. Okay, like in some situation where they might be working on cables and they see what the cable and all that, but like, we don't really have much she will regards to electricity and Internet connectivity. Of course we regards when we talk about devices, I think I've already mentioned that early on, like we are getting new tablets and all that. Yeah, once we get that and we will hopefully have some progress with regards to collection of data, originally or in the vaccination centers. Thank you. Thank you. Thank you. I also stated on the slide. I mean, this impacts how your budgets, the cost how many devices do you have to buy, and how do you have to provide connectivity for your end users, do you buy have to factor in by airtime how are you going to do that practically. How will you provide training on Android versus web. How will you support them in the field. So it impacts many, many different things. So you need to think about what sort of is the current system for service provision, I have the example of health care but it can of course be tracking health worker training or it can be tracking students in school or it can be to track malaria hotspots or many different use cases but let's just use health as an example here. So, you need to think through, how does the facility give care today, what does the patient flow, what happens from the patients physically in the clinic walks through the doors, who do they speak to do they go to this desk first and then that do they speak to a nurse first and then to a doctor and what kind of paper is filled. What are the admissions for getting entered etc and trying to sort of scope out your tracker program. Is it something that covers the whole flow from walking in the door to leaving or is it just when you're sitting together with a health care provider and specifically discussing your disease. You need to sort of map out the whole flow and figuring out where does your tracker fit in in this whole in this whole chain. It's also important to assess the business and the patient load in the clinic. Is this very high volume place where you have lots and lots of people queuing and you're helping people like or is it a place where things are moving slower you have more time that can for example given indication whether you should do this point of care data entry or if you need to have a dedicated data clerk to do the data entry back office. You could typically think that if you have a very high volume clinic. It's more challenging to do the point of care data entry because if the system breaks you don't really have much room to fix it. If you need the you need the information to be available in those five minutes that you actually see that patient maybe it's easier to do to have a paper card and then you enter the data later. There's no right or wrong answers here but you have to make a decision based on on proper investigations of this of the of the current situation. And the same you should also assess the health worker burden and the staffing situation. So it's sort of related as well to the to the business but how how much work does the health worker have to do this data entry come on top of a lot of other tasks. Will this just lead to put another stone to the burden in a way or are you able to build a tracker system that also gives value to the health care worker that will help that person in their day to day work and rather taking the workload down instead of up if they can skip running one extra mile to the records office to fetch a file and then running back then you save them some time so try to sort of to assess these things and and also how information is currently captured today. What are the different artifacts that the health workers are using to capture data. Maybe the patient has a patient file or a patient card and then there's some paper in the health providers office there are some administrative documents, trying to understand the full picture of the information that is gathered about this patient and how can you make this more efficient using tracker maybe you can eliminate some of the paper tools, or maybe they are paper tools that are important to keep because they have some sort of value to maybe to the to the patient or to the provider in some sort. And I highly recommend to go out and doing some field work I mean go to a clinic sit there and observe spend the week in a basic clinic spend a couple of days in a quiet clinic and try to really understand sort of where are the pain points for the health worker, and where can we help them with the traffic program because making a traffic program and training a lot of people and buying devices it's a huge investment so make sure that you properly think through. What are the needs and how can this program helps the people on the ground. If you have more sort of answers to this ready, it will impact. How you design the workflow, if you choose to do secondary or point of care data entry, and how you link to paper tools. How you choose to train who should be trained who should support privacy considerations perhaps are there certain information that one part of the clinic should know about but not the other part. There are lots of different things that this will make it clear and from my own my own experience working with contact tracing in Norway. This was probably the area that not surprised us the most most but that really sort of added to the complexity of the project is how does the contact tracer work how do they identify who the COVID positive person have been in contact with. What questions do they ask. When do they pick up the phone versus starting the system maybe some people want to check some information first and they found and they go back to the system and work. So really do some field work in some be a researcher here and try to document as good as you can with text and pictures and whatever works for you. Anyone from the, from the team here that has any thoughts around these topics. Yeah, I think you pointed out to very critical considerations. You know, in our example, as I mentioned earlier, this will only be implemented at the API section at the moment, although we have to expand it to the entire infrastructure entire services. The structure of the health facility in future, the MCH services, the OPD, the midwife and other kind of services but at the moment it will be only inside the API section so women and children, they either go to the API section directly, because they were asked to go there. Or they come to the OPD first or to the MCH, the midwife, and then they refer to the API section once the doctor or the midwife see their car cards. So that's the way how the patient flow works. Now, and in terms of the patient load, yes, in some facilities we have a lot of patient loads and the two vaccinators, one of which mostly go to the field for outreach work and only one stays inside the health facility. They might not be able to also handle the data entry, the instant data entry. So we have to sort out, but in this particular facility I think we will not face much problem because of the moderate number of patients. And as I mentioned earlier, the currently the system is entirely paper based. Only the health facility in charge is doing aggregate data entry at the end of the day from the various registers and data he receives from the various sections. So the one clinic where you're trying this out first, is this you considering this like as a pilot project and you will see how it goes and then you will expand, do I understand? Yes, yes. Yeah, yeah, this will be a pilot exercise. Yeah, so it's very interesting though to see how this, how other sites differ from this site. So maybe something that works well in one context is not feasible in another context and so on. Yes, yes. We have to keep eye on all these factors once we expand. Yeah. Yeah. Thanks. Sure, Sarah, do you have any comments on this? No, okay. Moabir, any comments? How busy is the vaccination clinic in Mauritius? Are they, are they long-lasting? You basically read my mind and so basically that basically it's a very good question. You see, we are planning to reopen borders in July here 2021 and being Mauritius being a tourist destination so we are planning to achieve herd immunity by 60% herd immunity. But to achieve that, if we are at the rate that we are going, we need to get 13,000 vaccination done daily. So, yeah, it is a pretty much significant number and because we are planning, we need to open borders soon. There's no other way out, we have to open borders soon. And so what we have to do is like we do 13,000 vaccination daily. Now, when we put that in the context of data collection for DHIS2, at the moment we have approximately 100 data entry operators, okay. And those 100 data entry operators at the moment they're doing, each data entry operators are doing like probably approximately because of how extensive the form is, the data collection form is. Approximately maximum, minimum five minutes to collect, to put data entry on the DHIS2. And the issue with that is like, at that rate we are going, we are not doing, we don't know how we're going to do 13,000 collection, data collection daily with the amount of data entry operators that we have here. So, that's another thing that I wanted to mention back, probably in this context it's important to mention that. So, and also why we are, I didn't mention early on why we're doing paper based and electronic based is because if you look at our, if I share later on I might share it. But the data collection form for the vaccination, COVID-19 vaccination, there is a constant form attached to it. So there is a legal aspect of that form as well. So when the person is signing the form, we can't do it electronically. They have to sign the paper form. So that's why we need to collect the paper base and then we use that paper base to input the data on the system. And now some challenges with regards to the process of data collection. And I think you're not alone in this challenge. We see I support and coordinate a lot of our COVID efforts around the world through the DHIS2 network. And we see that many countries are struggling with this. You know, you collect an aggregate number of how many vaccines have you received and administered, and then you have tracker on the site collecting the individuals. Very often, especially if the country is large, there is a mismatch. So you have, you know that you have administered 200,000 doses, but you have 150,000 in tracker. And there is this gap because exactly what you're saying, it's busy, it's very time, it can be time consuming. And yeah, so for any tracker project you need to think through this and try to visualize how things will happen. Yeah, definitely. Thank you. Good. Thank you so much for your insight. Then I'm going to jump to a topic that is also super important during collecting individual level data is, you need to consider the privacy policies and the legislation I could have added that in your country. So, as also has been mentioned in the previous session this, you're potentially collecting very sensitive data. And you need to think through what kind of data are you allowed to collect. For example, as I said in one country, collecting, collecting religion and sexual orientation, for example, might be perfectly fine in another country it might be completely forbidden to collect that kind of data. You need to think about what happens when this, if this data is breached somebody finds out what kind of consequences is how for the for the individual. And sort of very concretely you need to figure out if there are existing legislation on collecting individualized sensitive data. If your country has policies or legislation for sharing individualized sensitive data between org units so again I can take an example from my own project where we are a small country between divided in like 300 different municipalities, and legally it's each municipality is responsible for collecting data about individualized sensitive and their contacts. But people, they don't care if they're living in municipality one or two so we have lots of cases where one person has infected or been in contact with people from 20 different municipalities, and they're all registering in their separate systems and they're not allowed to exchange data because of privacy laws. So you need to figure out what is the rules in your country and it might put some limitations on your system that you need to be aware of. And you also have to understand and know if there are policies or legislation for storing these digital records. Are there requirements for where the service hosted for example can you do, can you do cloud based hosting or does the server have to be located in the basement at the Ministry of Health. To figure out these things what kind of access control are the requirements for that authentication is it perhaps only authorized health personnel with some sort of government authorization who should be allowed to see this data. Do they have to be employed at the clinic to see the data, and so on. You can sort of say that the end goal is of course not to harm anyone and you don't want to end up in the newspaper and be like a scandal project because you haven't done your homework properly. Are there any considerations you said in Afghanistan you don't really have any and any of this legislation requested with nonexistent so how do you plan to solve this. I think yes this is one point which make me think much. You know, although we do not have such an infrastructure or legal infrastructure to restrict us or to direct us. But still we have to have this kind of protocols in our organization and that will be the guiding principles and we can also use some guidelines you or used by other projects we implement. The main problem comes in terms of the cultural setup here in Afghanistan around gender issues and the interaction between females from the community with male health workers and generally recording their particulars individual information. Those are the things which need some advocacy and consultation with the community and also you know that we are an active conflict everywhere in the country and position groups. This could be something that they would not allow or if they can get access to the devices which holds the personalized information that could be a problem so we have to sort that out but at the moment the health facility we have selected. It's relatively safe from interruption from the armed opposition groups and also we can do that advocacy easily because it's a relatively urban area. But when we go to a large scale expansion. These are the consideration we have to be very much careful of and we have to have some proper planning in the preparation. Thank you so much Mike you have your hand up. Yes thanks and I think that Afghanistan is a highlight of how challenging this can be in the absence of legislation or policies that determine for you what is possible but also having I think very challenging kind of environmental and cultural reasons why this is something to take very seriously. I think that the do no harm principle is something we should all keep in mind even in the context of legislation. So we as public health individuals I think we often have a tense to over emphasize data and what we want to make sure that it sounds very nice for us to include income levels we want to get at income inequality we want to know how every person in the system may be related to others and how that might impact disease we want to know about age and gender and all of these things which when it comes down to it you should really assess your specific program and see which of these really matters what part of it should we collect because once it is in your system. You should be protected forever. And so you should be careful about what you are willing to include in the system it should have a very clear reason for being there. And you should have mitigation strategies for how the data are protected. So for for many of you in your countries there isn't going to be adequate legislation or policies about what should or should not be done. But I that doesn't absolve us of the responsibility to really think through what is the worst case scenario. If this data were to get out what could it be used for inappropriately how bad would it harm an individual and way that worst case scenario against your health reason for having that information in the system. It's always possible in the future to add new data elements if you really realize okay it's it's very important that we start to collect this information, then it can always be included in the future. If it's being collected and it's in the system, then it's much harder to remove that data and you must remember that it's something to be protected forever. So again I'm just just wanting to emphasize how serious this is, and that when we sit down to configure a system and when we're having discussions with the national programs or with the care providers, always have a little bit of kind of skepticism or hesitancy about something that seems like very sensitive information and be thinking about the ways to try to mitigate problems with collecting that piece of information. Abdul. Yes, Mike. Thank you for pointing out these important points. You know, although we do not have some standard laws, data protection laws, but fortunately the humanitarian assistance or the humanitarian sector is much active here due to the different conflicts and other reasons. And just yesterday we submitted three proposals for health, nutrition, and protection, and part of the process was to comply with the AAP accountability to affected persons, a framework, and the protection min streaming, and many other things that were which were stipulated in the view of the data protection protocols used by UN Ocha. So the UN Ocha in the humanitarian sector somehow sensitized or informed people, although we do not have a government side legislation, but there are some other tools that sensitize us and also gives us a direction on how to take care of the protection issues. I think that that's a really important point. Yes, absolutely. And there are a number of humanitarian groups, NGOs and academic institutions that are putting out recommendations around these health data and what to do, especially in complex settings or especially with vulnerable individuals. I really do encourage you to look around. I know that there are groups that have come out of the Harvard School of Public Health that have published guidelines, the doctors without borders MSF have guidelines there are various groups that have put out guidelines so it is, it's really worth looking at those. Another two points that I would mention on this is you also have some confidence in your, your health worker or the people in the system that they already are managing. Without being guided or asked to ask every piece of information. So you may assume that because this seems like relevant information I should put it in the system. But it may be that that information is fine to stay out of the system that your care provider actually already is able to deal with issues of age or or incoming quality, because there are already kind of informal practices for doing so. And not having it in the system doesn't prevent it from being a factor in care it doesn't prevent it from being a factor in decision making. It's just something to think about is what are the current informal approaches of dealing with some of these sensitive issues. Another important point is to realize we do have two individual data models. One is tracker where everything is linked to a person and it's identifiable and it will be linked to that person forever in your system. But the other is event data where it is not necessarily linked to a person. So it may be that you really want to have a better understanding of the income strata in a given area. You don't need to attach that to vaccine records. You could actually do an anonymous event as well and collect that kind of information. If it's not something that really needs to be linked to a person, but rather is an important piece of data that you could collect anonymously, you can make use of the event capture data model. Now I said there you could typically collect like male 44 years old earning X amount of dollars. You don't know who that person is but you can add maybe a couple of characteristics that could give interesting statistics in the end if that's again who is asking for the data and what settings will this data be used. Will there be any decisions based on this data. Yeah. It's a good way of collecting sort of additional information if it is irrelevant for some sort of decision making. And remembering maybe also that just the the presence of a person in your system itself could be confidential and sensitive information so there are many health programs that focus on specific groups of vulnerable people. Men who have sex with men commercial sex workers undocumented migrants that these are vulnerable groups that often have health programs that are trying to provide services, but by simply registering them in a program that is focused on men who have sex with men that may put them at risk. You do want to think again about the value of having a named individual versus being able to to collect some of the anonymous event data. But if you do have a named individual in a sensitive program like that, then your access controls become very important that who are the people that should be trusted to have access to the individual level data. And report out aggregate data that doesn't include the identifying information as as analytics to be shared more broadly. But who has the authority in the system to actually open up an individual's record and see their name see their ID numbers see that they're enrolled in an HIV program. That's something that you want to put serious thought into when you're designing the access controls. As a platform has very strong access controls, but only if you use them, if you create one type of user that accesses everything, then nothing is protected. Sorry, do you have any examples Mike of projects where I'm not even sure this has happened that I was just thinking about it projects where you have. You don't necessarily register the person's name, but you just register them with a certain ID and then you, you coupling the identifier with the name outside of tracker in a separate I don't know encrypted system summer. Yeah, I think there are various ways of trying to handle this one very kind of straightforward way would be that the system can generate a unique ID. ID is only known to the system it's not linked to any national ID database it's not linked to the person. So you could register an individual with a generated ID that you give to them only. And then it's not something that anybody else has access to work could follow up. There are still of course risks there's risks that somebody could find their paper or their printed version with that ID and would be able to identify them. There's risk with all of these things but what I guess is the most important thing is to take it very seriously and design an approach that is comfortable in your setting and the people feel good about. Kind of keep in mind that one of the privacy ethics is the idea that we would do minimum data requirements. Again in health we're often feeling excited about collecting all data possible to collect. But the best thing to do would be to collect the minimum amount of data that you need, because any data that isn't there also isn't vulnerable, and you can worry less about it. So it's something to just keep in mind. But I see Sherzada has a has a hand up maybe I should let them speak some more. Thanks Mike. In case of mine, you have pointed out really important thing. But the tracker I'm planning that we have. I think I'm going to be also known for this because we have a detailed information each head manager. So, in this case, I think this is the reason she's the main objective of our tracker that we want to have good information like a profile from men, other men ID, national ID address and the place he work or she work. So, so every single detail we are keeping that over the card. Which train is participating in. And here, in all case I think the privacy is very important. This is what we can discuss before because this is the information of each individual. The situation is a bit like a tricky. So, but this we have learned the details to different privacy level, different access level that we want to suppose that people who will be accessing the details to get the message training trigger. And probably say speed they will be having access to register of the end of the data, and in central level, we will be accessing the whole data but I think this is just like a, I was having some point to the privacy policy. This is very important. I think we are not able to, like as Mike mentioned that supposing immunization and other program health program maybe we have the DJS to regenerated ID will use but in case of mine, because our objective is to have a complete profile of each participant with specific training, and maybe the data at the end of two, three, four, five years it become or 10, we don't know, but we are still keeping all those we are. And for the privacy, what we are doing what we will be using different level of access to the data, the message training on Jacob. Thank you. I'm sorry I was on mute. Yeah, no I said this is a very interesting, very interesting topic they will be a separate separate session on security next week. And we can go on discussing this forever and ever. I have one more. One more topic in this presentation. And then we have a little exercise from from the Academy team here that I will turn over to them. The last session or their last slide I have is that you need to think through your interoperability needs. Think through sort of which other systems you need to link to if you do need to link to them. You have to fetch data from another system or deliver data to another system. So try to map that out and again think through why are you doing this interoperability is it worth the effort is it worth the cost doing interoperability work can be complex challenging it can be costly. And you have to think through that you would have to sort of maintain the system on both sides for the entirety of the of the program. So just in one place you might have to make changes in your tracker program. So it's really worth thinking through interoperability in a conscious way. I think I will end it there.