 covering introductions. Alice and also Mrs. Longway from Ministry of Health Malawi. Then our first session after that on an overview. Tomorrow we start at the same time. We start at the same time. That's 11 o'clock Oslo time every day. And then I will in the first session tomorrow take us through the brand new WHO standard supply chain data elements. WHO has been working over the past several months to develop a standardized list of key data elements. These are data values that should be captured for various supply chain commodities and reporting. So I have the honor to take us through that. We will take a break and then after the break we have Adam Kosi from HIST West Africa. He's going to take us through some really interesting use cases that they have been developing in Mali and Burkina Faso around supply chain monitoring using DHIS2. Day three, we have probably one of the leading world experts on supply change, George Maguire. He is going to, he works for the International Red Cross. He also consults with us and the WHO. He's going to take us through some of the LMIS indicators and walk us through, and this is again another collaboration with the World Health Organization where they developing standard indicators for supply chain. George has been an integral part of that. He's going to take us through what they've come up with and how some of that can actually be factored into your DHIS2 instances. After George, we have Mongini from HIST Malawi. She's going to take us through what Malawi has been doing to develop, connect their supply chain system to their HMIS, which is DHIS2 of course, and produce integrated analytics. So some really incredible dashboards and insights coming out of Malawi there. Day four is a lot about interoperability, a big topic when it comes to supply chain and be able to get the various supply chain data sources into DHIS2. So we're going to get started on day four. The morning session is going to be with what our interoperability, we're going to get started with Morton. Morton is our lead interoperability engineer here at the University of Oslo working on DHIS2. So he's going to take us through some of the basics of interoperability. Then we have a really interesting use case from John Lewis. He's coming to us from HIST Vietnam, where they've been able to connect DHIS2 with Msupply, a fairly popular LMIS product out there in the market. And he's going to take us through that process of how they're able to connect those two platforms. Then after the break, I think we have Anne-Marie from iPlus Solutions. She's going to take us through the platform Medexus. Medexus is a really excellent LMIS platform that's available. They have been connecting Medexus to DHIS2 in Burundi. And so that's going to be a really interesting case study of how we get these two systems, these LMIS systems and DHIS2, talking together, sharing data. One thing that I forgot to mention on day two after our Adam presents his case study, we actually have Adam staying on the line with us for an expert's lounge. So that's it. Or just around Africa and you want to understand how they've managed to build out these kinds of supply chain systems and DHIS2, the ones that Adam will be presenting on. Adam will be around for a little while longer to answer any and all questions that you have on how you can get something like what Adam and his team have done deployed in your country. So we've extended Adam's time a little bit here to make sure that he's available to answering your questions. And likewise, we also, if you're based in Southeast Asia or you're interested in knowing more about John Lewis's use case and his Vietnam, how they were able to connect with M-supply and get DHIS2 data flowing between those two platforms, John will stay on the line as well on day four from 1.15 to 2.15 Oslo time. Day five, which is Friday, we will have a fairly technical day. I will be presenting on how to configure DHIS2 to be able to calculate key supply chain indicators. It will be if you are not a DHIS2 technician, a lot of this may go over your head. We're going to get kind of deep quite quickly. But for those of you who are more technical in DHIS2, I think you're really going to get a lot out of this day going into the nitty gritty of how we actually configure these kinds of supply chain indicators in DHIS2. Then on day six, November 16th, that's next Monday, we have George McGuire coming back with us. And George is going to be taking us again through how to use some of these supply chain indicators. So how can you actually turn these values, the presentation of this data in these indicators into action, which is going to be really cool. After the break, George is then going to take us through some very much cutting edge applications of DHIS2 to build out stock catalogs using barcode scanning, using tracker, all of that in DHIS2, in a pilot project that they have going on in the Red Cross in Yim and Field hospitals. So that's going to be really interesting use case, very much cutting edge. And then on day seven, our last day, next Tuesday, we are going to be lucky enough to be joined by Aliyah. She is the new manager of the Stella Project out of the University of Basel. And I'll talk a little bit more about this later today, but this is a partnership that we have with the University of Basel and Swiss TPH to provide support to all of you all who want to implement and use DHIS2 for supply chain. So a lot of resources, a lot of a lot of excitement there. So Aliyah is going to come in and kind of round us out with what that partnership and those organizations, the Stella Project, can provide to all of you if you so choose to use the resources that are available. And then finally, the last session is a course review and a little bit of country planning feedback from any of you all, any questions that you have. So that is it for the program. I am now going to hand it over to the prestigious Alice who is going to who manages all of the academies at the University of Oslo to take us through the various tools and platforms that we're going to be using to communicate with you throughout the week. So Alice, I'll stop sharing and it's over to you. Thank you so much, Scott. Hi, everyone, and welcome to this first edition of the LMIS Academy. So as Scott mentioned, we will be using different tools during the academy. The first one is the LMIS Academy repository. I have sent the link to the to each of you prior to the academy. So I hope you have received it. And if not, please let me know. And I will share again the link. Do you all see my screen? Yeah, we can see it. Yes. Okay, great. So you will see it's basically a Google Drive. And in this drive, you will find a folder for every day. So let's click on the first day, which is actually today. So you will have the recording of the live sessions. So each session, including this one is recorded and will be made available as soon as possible after the academy and let's say within 13 minutes to one hour. So you will find the recording of each session here in this folder. And you have this folder for every day. Same goes for the presentations. Each facilitator will make sure to add the to upload the presentations in this folder as well. So you will be able to have a look after the academy finishes. And then the two forms which are very important to us is the feedback form. So basically, we are very interested in collecting your feedback and comments for every day. So once the academy ends, you will be invited to go in this folder and to complete the form that let me click, you will be able to click here. And then you will have a link and you will be able to give us your feedback, which are, as I said, very important. And then you will have the other form that would like you to fill in every day as well, which is the attendance form. So same process, you will click on the document and you will click on the link to the attendance form. So the thing is that for this academy, what we wanted to do to make sure that you all pay attention to the content, you will be given what we call the words of the day. So every day you will have a different word and we will ask you to include, to add this word into the attendance form. So yes, so that's it for this one. And for this, for today actually, it's only today you will have another form, which is the participant survey, which includes some specific questions we would like to ask you. Scott will develop on that one later on. So yes, so this is basically the repository. Once again, if one of you do not have access to the repository, please let us know and we'll send you the link. Then the second platform that we will heavily use, and I believe most of you are already on the Academy Slack channel that you can see here. So don't hesitate to join if you have not done so yet. On this, on the Slack, you will find different channels here. For instance, the announcements channel that we will be using to inform you about any specific topic you would like us to, would like you to be aware of. If you have specific questions about logistics, then you are invited to ask them on this channel as well. So really don't hesitate. If you want to ask anything, we are here for to reply to your questions to assist you. Scott and the facilitators team as well. So don't hesitate to ask any questions that you would have. Then as Scott mentioned when he was presenting the agenda, we will have two expert lounges. One expert lounge for Africa and another expert lounge for Asia. So depending on the region where you are based, if you have any questions related to logistics in your local context, you will be able to ask these questions during the expert lounge. The expert lounge for Africa is scheduled for Tuesday from 1.15 to 2.15. We will have one facilitator from East West and Central Africa, which will be probably either Edam Kossi or Sakebo Alassane for those of you who know them. So they will be available for one hour and they will be facilitating discussion on the expert lounge for Africa. So it will be tomorrow at 1.15. So any of you interested, don't hesitate to join them on this channel so that you can discuss with them and ask them for tips, advices related to your various projects. Then the same goes for Asia. We will have an expert lounge for Asia scheduled for Thursday, same time from 1.15 to 2.15. So same thing if you are based in Asia and you would like to ask any questions related to logistics in your local context. Don't hesitate to join this channel and to participate in the discussion. It will be facilitated by one of our colleagues from East Vietnam, probably John Lewis, who will be there for one hour to discuss with you. And then you have some overchannels like introduce yourself because we want to know where you are based, what are you doing exactly. So don't hesitate to say hi on this channel. Then if you have any technical issue in regards with, for instance, accessing the different documents, presentations, recordings, etc., don't hesitate to ask some help here. And Martin, who is also a member of the training team at his PIO, will be more than happy to help you. And then finally, the last tool that we will be using is Zoom. So you're all already on Zoom, obviously. I have shared with you some tips on how to use Zoom last week. So I believe you have read them. So it's very straightforward, basically. You are invited to keep to stay unmuted unless you have a questions and one of the facilitator is happy to give you the floor. We will also advise that you do not use your video. So just to make sure that we have enough bandwidth to conduct the academy. On the right side of your screen, at the bottom you have few, you have few buttons that you can use. For instance, you can click on yes or no if required. You can, for instance, raise your hand as well if you want to ask a question live. Even though for this academy for any questions related to the presentations, you are invited to use Slack as main tool to raise your questions. So yes. That's it for me. So once again, welcome all and I hope you will enjoy this academy. Thank you so much. No, thank you so much, Alice and team. Really great jobs organizing these academies, especially given the confines that we work under now with COVID. So we're very appreciative. Okay, so let's keep on chugging ahead. As Alice pointed out, please use Slack to ask any questions. I even see that Arthur Haywood, you raised your hand earlier. Maybe you had a question. Please, Arthur, do post that question in Slack. You're probably not the only one that has that question. And we will use Slack as our main vehicle or tool for you to ask any questions and for us to answer those questions. We have well over 100 people in this academy. We expect up to maybe 170 people. So it will be the largest academy that we have ever, or largest level two academy we've ever done, which is quite exciting. But it also means that we just have to be very careful about how we are communicating and how we keep things organized. So we will be using Slack not only to just keep things organized, but also to allow everyone to share their questions and be able to answer them a little bit more efficiently. Okay. So I think that, oh, and the other thing that I just run under to reiterate from what Alice pointed out was that we, this academy is, we will be giving out certificates of participation, certificates of participation. And in order to get that certificate of participation, you have to answer the attendance every day. And just to stress that the way that we are monitoring attendance is through this word of the day idea. First time we've ever done it, but it hopefully will work out where we will give you a word of the day. I'll give it to you later in the second half of the presentation this morning. And then you will have to go in and type that word of the day in into the attendance form. Today we'll do it together. Tomorrow I'll just give you the word and you'll have to do it on your own, but it just proves to us that you are actually here. You watch, you attended the session, or maybe you've, if you're, if you're, if you're doing this asynchronously, you've watched the video and that you're letting us know that you are actually, you're actually paying attention and engaged with the content for the day. Scott? Scott? Yes. Sorry. I forgot to mention something which is also important related to Zoom and the attendance. As you may have all noticed, you are requested to register before joining the Zoom session. So please, when you register, because we would like to see who is also taking part in these live sessions, it would be great if you could make sure, as most of you actually did, make sure that you, you mentioned your name and surname, basically the same information that you provided when you registered to the Academy. It's also very important to us. Thank you so much. Yeah. And I guess I should say that you're probably going to get tired of typing out your name, surname and email every day multiple times for us. I do apologize for that. We're all still adapting and getting used to the tools that we have to use to be able to provide these kinds of trainings. And right now we do ask that you do provide the same information every day, your name, surname and email address, just so that we can monitor who's joining each day. Okay. So now I have the unique pleasure to invite Kate Longway, again, the the director of policy and planning at the Ministry of Health in Malawi, to kick us off with opening remarks. And just a little bit of backstory. This Academy was originally scheduled to be run in May in the long way. And we were really excited to be able to have a lot of folks, Malawians from the ministries of health and the surrounding countries, to be in one place, to be able to share experiences and to kind of start to build this kind of community of practice around this, around logistics and supply chains and uses for DHS too. Of course, COVID hit all of us and we had to cancel that Academy. But we still held on to the best part, which is hopefully the opening remarks from Kate Longway. So Kate, I will invite you now to, I think I can unmute you and I'll give you, Martin, are you able to enable? Hello. Yeah, there you are. We can hear you fine. Yeah. Thank you, Scorch. And I welcome everyone. Good morning, afternoon to all the participants. And welcome to this very important forum. Representatives from various ministries of health, partners in health systems strengthening facilitators and participants. It gives me pleasure to welcome you all to this DHHIS2 Logistics Data Integration Academy. The Academy was originally scheduled to take place here in Malawi, as Scorch said, but due to COVID-19 pandemic, which is upon us and the travel restrictions, we are now hosting it virtually. With financial and technical support from the University of Oslo and of course other partners. I would like to congratulate the organizers for working hard to put this workshop together, despite the challenging environment brought about by the pandemic. The overall objectives of the Academy are to one, build capacity in DHHIS2 design and customization in various features, logistics information management system. Two, strengthen health information systems, HIS, by developing a network of high level DHHIS2 skilled personnel within the health sector. And three, provide a forum for sharing experiences in the design and customization of DHHIS2 and LMIS with global and regional experts. Ladies and gentlemen, you may wish to note that Malawi started using DHHIS2 in 2012. Since then, we have intensified efforts to ensure that the software is managing all aggregate level data in order to support evidence-based decision making. In particular, we have undertaken a number of important activities aimed at improving the management of routine health data using the DHHIS2 software, which includes extraction of program reporting rates, scorecard programs, to improve reporting rates. The configuration of national and program level indicators for improved visualization of data. See, updated the reporting forms in DHHIS2 and finally working towards incorporating more program reporting in DHHIS2. One of the challenges for the ministry is to ensure that the DHHIS2 is integrated and interoperable with patient-level data systems in order to reduce manual sharing of data between these systems. Considering that there are many systems operating in the health sector, they may provide relevant knowledge and skills for the design, development, and customization of eHealth systems, including routine HIS, hospital information system, and MHealth, not only in Malawi, but also in the participating countries. Distinguished participants, their focus on LMIS is particularly important because it is impossible to talk about achieving SDG3. That's ensure health, our health lives, and promote well-being of all at all ages without talking about the relevance of the chain of the supply chain. Ensuring that everyone has health coverage and access to safe and effective medicines and vaccines requires that key information on availability of commodities is available to facilitate delivery of effective health care services. It is for this reason that some of you may be aware, Malawi has integrated DHHIS2 with the open LMIS system, which is used for the supply chain management. A number of indicators and dashboards have been configured in DHHIS2, trying creating service, data, and commodity consumption. This is a big achievement, not only for Malawi, but the global community working on health systems strengthening. It is an important milestone towards having a single platform for visualization of health data. In this regard, let me take this opportunity to thank our partners for the financial and technical support that facilitated this week. These partners include USAID, Bill and Melinda Gates Foundation, who supported GUNICA Data for Action Project, University of Oslo, and also the Global Fund. Distinguished participants, it is important to understand and utilize what is possible within our health information systems in order to support planning and decision making across various levels of the health system. It is there for my sincere hope that in this academy we will be imparted with new understanding on various strategies for implementing and using LMIS data and of course, HMIS data, including how to configure relevant indicators and dashboards for use across various levels in our health care system. Finally, ladies and gentlemen, let me urge you all to take advantage of the experts we have in our midst to learn as much as we can, as well as share our country experiences. With these remarks, I would like to declare the academy officially open, and I wish you a successful academy. Thank you so much for your attention, over to you, Scott. Great, thank you so much, Mrs. Longway. We really appreciate that opening remark and it is a true shame that we were not able to all be together in Malawi this year. Hopefully, when we do this academy next year, you'll be the first country that we come to to try to see if we can't organize again to be together there in Malawi and have this academy again. Thank you so much and I think that is a wonderful way to get us started. With that, I will start presenting myself again. This will be our first presentation. Martin, you can go ahead and start recording this presentation. Looks like we already are. Great. Again, Scott Russ Patrick. I'm the DHS2 analytics product manager. I've also been largely responsible for coordinating the University of Oslo's response to the various requests and community needs around supply chain. Although, of course, the product manager working on supply chain is not my full-time job, but I'm actually very happy to announce that we will have full-time staff beginning next year working specifically on supply chain. There will be additional resources here at the University of Oslo, as well in our partner organizations. We will talk to you a little bit about how you can utilize those available resources to you in the near future. With that being said, I do have the honor to take us to our first presentation and give us a bit of an overview of how we consider and view DHS2's interaction with the supply chain system, what it can do, what it can't do, what we want it to be able to do, and give you a little bit of a background there. Before we get to that, though, it is time for the Word of the Day. The Word of the Day is welcome. Welcome, all of you. Let me just take you quickly through how you fill this out together. We'll do it together today. Tomorrow, you're on your own to complete the Word of the Day. I'm going to exit out of the presentation. I am going to go to the drive. We all see the Academy repository. I'm going to click on Day 1 today, November 9th. I'm going to go to the attendance form. Then I go into the attendance link document. I see that we have the attendance form here with this link. I see many of you already coming in, people streaming in as I speak. I'm going to click on the link. That's going to take me to attendance Day 1. I'm going to fill out my information, my email. By the way, my email is just scott at dhis2.org. If any of you ever need to email me about something, that's my email. The Word of the Day is welcome. Okay. That's all you have to do. Press submit. There you go. Now, we know that I have attended today. You have to do this. Again, we give out certificates of participation. If you're having issues with that, please post those issues that you're having in the Slack channel. The Slack is where we are getting any questions. You can use the technical support Slack channel. Martin is here working diligently to make sure that you have access to everything that you need access to. Let me jump back into the presentation then. Then moving right along. What is this academy actually about? Okay. We are going to be giving this academy in a seminar style, meaning that we will have presentations, multiple presentations every day. These presentations are being recorded. You can watch them later. You can rewatch them or you can share them amongst your friends, colleagues, other folks that you think it would be useful for them to see. We will not be having many exercises. I don't think we have any exercises or any kind of additional follow-on material or anything like that. It's really just a lecture style, seminar style presentation of the material. The reason that we're doing that, let you understand, is because the DHIS-2 in the supply chain space is still relatively new. Some countries have been doing it for quite a while, but most countries are still just getting started with using DHIS-2 for supply chain. In many respects, there's not necessarily a right way or a wrong way to actually use DHIS-2 for supply chain. Because that has not really been completely established yet. We do have some best practices, but we don't have a right way. We don't have a wrong way. Because there's not as much global guidance around this particular subject matter, we don't feel like we know enough, necessarily, yet to quiz you on or assess your abilities to use DHIS-2 in this way. Because, again, you could really use it for a lot of different ways. We're going to cover and you'll see. We'll cover many different use cases that are very distinct from one another. All of these are perfectly valid. You could use them. You could not use them. You could do something else. The goal of the Academy is just to present you on what DHIS-2 is able to do, not necessarily tell you that there's a right way or a wrong way necessarily. Again, produce, show you what DHIS-2 is able to do. We also want to make sure that you know what DHIS-2 really is not able to do. There are certainly some things in the supply chain space that DHIS-2 is very poorly equipped for. We want to make sure that you at least know that and that's very clear to you. We're going to make sure you again see several use cases and different models of how DHIS-2 has been used in supply chain and monitoring logistics. We are going to introduce you to the WHO supply chain indicators and data elements. These are brand new. I think you're probably the first group of people to actually see them. We're talking about they are maybe just a week old at this point. That's quite exciting that we have those now and that we're going to be able to present those to you. We are point four here going to try to establish a supply chain community of practice. This is already the largest level two academy that we have ever had. We want to channel this momentum that will be generated from this academy into a place where we can continue to grow and share ideas, thoughts, learn together and channel that into our community of practice. If you're not already a member of the DHIS-2 community of practice, which is community.dhis-2.org, I think hopefully by the end of this academy you definitely will have become a member. We want to show you how you can configure DHIS-2 today for some basic supply chain monitoring. That largely comes in on day four, day five. You will start to see how actually if you're a DHIS-2 technician you can use it to configure some basic reporting forms as well as the more advanced indicators. Then the last point is we want to provide you with the contacts for future support. Again, we're building actually quite a large team of technicians, of supply chain experts, of partners that are going to be available to provide you continued support post academy. We want to make sure that you know who these people are and how you're going to be able to interact with them. Martin, I see on the technical support channel a lot of folks saying they do not have access to the attendance form. Are you working on that? Yes, we are Scott. We are working on it. As soon as we get it open for everyone we will be sure to announce it both on the Slack and also in here. We will repeat the code phrase for today, the code word for today. The code word is welcome. Just bear with us. The first day of any of these academies we're always stumbling through a little bit of technical issues. I appreciate your patience. Don't worry. You can go back and fill out the attendance form at any point. It's not going to be taken down. Please make sure that you actually do it. Moving right along here, you've already seen this slide a little bit, but I just wanted to repost it. When we're talking about supply chain, what are we talking about? It's good to have an image in our brains of what is actually going on with supply chain. Here we see some very common issues. You've probably worked in the field. You've probably been to health facilities in rural places, even urban places, and you've seen similar setups for storing and monitoring of supplies, commodities, multiple bins. Here on the left side we see a bunch of vials of vaccines. Then in the middle we see a health facility store room, stock room, and then on the right we see a stock tally card or a stock card. All of these are very common pictures that we see when we go into the field when we visit health facilities and even hospitals. What you see is the systems that are monitoring these are very different. Different kinds of tally cards, bin cards across different districts or certainly between different countries, different processes and methodologies and different styles of storing drugs and keeping drugs and commodities organized. It really is quite a diverse world out there, but I just did want to present to you just a couple of pictures of this is what the world looks like. We have the challenge of building information systems that not only support what is currently happening, but also potentially improves what is happening. I think that's the most important thing to appreciate is that we're not building supply chain systems in DHIS to manage the status quo, to just keep things as they are. We want to build information systems and supply chain systems in DHIS to improve these pictures to make things more organized, to make sure that we have fewer stock outs. That's a unique challenge and hopefully in the course of this week you will appreciate some of the the strategies and the ways in which we can do that. Why do we keep talking about LMIS and DHIS too? This is a slide that I've actually presented probably half a dozen times. The point that I want to make with this slide is that over probably the last 10 years as DHIS too has really expanded into dozens and dozens of countries. Now I think we're at something like almost 100 countries using DHIS too in various forms and capacities. Certainly a lot more countries than that if you include all of the various NGO projects and multilateral projects and that kind of stuff. Many countries are struggling with supply chain and I actually have some slides on this later about what are the things that people are struggling with specifically from some good assessments that have been done recently. Many countries are struggling with supply chain, monitoring stocks, keeping stock amounts updated. Many of those countries already have DHIS too. They're using DHIS too to monitor the routine health service delivery, patient counts, disease surveillance. Maybe they're also using it to monitor other things like agricultural outputs. Education is a big one. They're saying we've got all of this DHIS too expertise. We've got all of these folks sitting in the Ministry of Health, sitting in the Ministry of Planning from various NGOs that are partnered with us that all know how to do DHIS too, build reporting forms and data elements and all this stuff in DHIS too. Why can't we just use DHIS too to monitor supply chains when we're still using Excel spreadsheets or really old systems that don't perform well? For the past five to 10 years, our response to that at the University of Oslo has been, well, yeah, of course, you can use DHIS too for this if you want, but we're not necessarily completely supporting that use case, meaning we're not building in functionality within DHIS too as a technology, as a platform, to support supply chain specifically, and we are not building out, you know, guidance documentations, academies like where you're sitting right now, reference materials, guidelines, you know, we're not doing those kind of things either. But still, the community demand has been there, and I think that's the key point is that there's been a lot of initiatives, grassroots initiatives, locally driven initiatives to use DHIS too for supply chain. And that has really been the driving force behind us kind of at the more global level, DHIS too, higher levels to say, okay, hey, the community is still, they've never stopped asking for this. They would get the questions all the time. The fact that this is the largest level two academy, I think is testament to that. And that we need to respond. The University of Oslo, we need to get ourselves organized, we need to get our acts together, and we need to respond to this community request, this, to be able to have DHIS to support supply chain more properly. And then there's another really key driving point here. And that key driving point is, and this is something that we have seen time and time again, WHO is really pushing on it, UNICEF is very much engaged with this. And that is that in order to have a strong health system, a strong health system, we need to have the HMIS data, which again is your disease case loads, your diagnostic, your treatments, your services being provided, and your supply chain data, your LMIS data in one place. We need to have that data side by side, so that when you build a map, a chart, a dashboard, any kind of report from your HMIS, you're also able to pull in your supply chain data. Why is this important? Because we know that a lot of the issues, people that countries and ministries are having in providing clinical services are because of issues in the supply chain. Stockouts are a big problem, understocks are a big problem, expiring medication is a big problem, inability to refill orders, these are all big problems, and these problems then have very real health consequences, meaning people do not receive the services that they need. Health facilities talk out of malaria medication, people are not treated for malaria, when people are not treated for malaria, malaria, morbidity, mortality spikes. And so if we actually want to use the health information system to improve health service delivery, we have got to get supply chain data in the HMIS, which means that DHIS2, again, serving as the HMIS and dozens and dozens of countries, has to be able to properly support this kind of data. And when I say properly support, I mean build the analytics, produce the indicators, and allow the decision makers to be able to see all of these data next to each other side by side, and be able to say, hey, I've got an issue in my coverage rates, it's because of this supply chain issue, and I'm able to go in and fix that supply chain issue, which then addresses my health issues. We call this root cause analysis or bottleneck analysis. And if you're working with UNICEF, I'm sure many of you are familiar with the concepts of root cause analysis or bottleneck analysis. Okay, so what is the somewhat of the problem statement here? And I've kind of alluded to this a few times already. But what we see is that we around the world have fairly poor quality logistic services in resource poor countries, so low and middle income countries, and even some high income countries have fairly poor logistic services. It's fairly universal. It's something that you kind of see from country to country, different solutions, different initiatives. Universally, a lot of money being spent on this, a lot of money being spent on this from partners, from ministries, from donors. And we still see a lot of the same chronic issues, still high stock out rates, low stock availability rates, issues with seasonal stock resupplying, just a lot of the issues, even despite the huge investments, still popping up. And some, you know, many places are of course getting better, but we still see some very pervasive issues that we are struggling to address, you know, mostly across the board. We still in the supply chain space have a massive reliance on paper records, on spreadsheets, on data being put into spreadsheets and being emailed or manually transferred between health facilities or up to district level, up to warehouse level, very slow and I'll say antiquated methods of recording and communicating and sharing data. And, you know, I often like to say that there is no DHS2 equivalent in the supply chain space, meaning DHS2 is the health information system again in some 90 plus countries. There is not an equivalent technology in the supply chain space. There is no DHS2 equivalent in supply chain, at least not yet. And so in lieu of that, you have a lot of local solutions you have, but still a lot of countries just working on the basics, paper records, spreadsheets. And those countries that do have solutions that have developed their own supply chain information systems, LMIS, or maybe they're using a something that's like an open source supply chain like open LMIS or maybe they're using Medexus or M supply. Those three specifically have just have a handful of countries using each one of them. But for the most part, you see a lot of different types of systems out there. You know, it's really kind of the wild west of logistics management information systems out there. Everyone's doing their own thing. Everyone has a fairly, has slightly different systems. And what does that mean? That actually usually means that when you want to connect it to DHS2 or to other systems, you want to get all of that data into one place. It makes it increasingly difficult because each country has its own unique system. It has its own unique process, which again is not necessarily a bad thing. You know, we're not trying to homogenize the world. We're not trying to say that there needs to be one LMIS to rule them all. But what we are saying is that for those of us who provide technical support to countries when they want to try to connect various systems to DHS2, it makes it nearly impossible for us to help each country because each country is very, very, very different from the others. And when you have, you know, nearly 100 countries asking for support, there's only a very limited amount that you can give to each one of them. And also donors, you know, they don't have the money to support 100 different interoperability layers and unique systems within each country. It makes it very difficult. So we do have a hodgepodge of different LMIS systems out there. We also lack integration between LMISs inside a country. So many countries actually have multiple or parallel supply chain systems within different groups or programs. So the malaria program may have its own supply chain system. The HIV program may have its own supply chain system. Or more complex than that, you may have a supply chain system that goes from facility to district, and then a entirely different one that goes from district to region, right? How do you get all of these to talk to each other? You know, how do you get all of these to share data? How do you, which is necessary for, again, efficiency and bottleneck analysis, root cause analysis? That becomes very difficult. It's nearly, seemingly nearly impossible. And yeah, so the second to last bullet point here was, again, that different programs have their own supply chain systems. And it's natural that somehow this does start to develop because, you know, different donors come in to support different programs. So USAID or PEPFAR will come in and support HIV. So what do they do? They make a supply chain system for HIV commodities because that's what they're supporting. And then maybe Global Fund comes in to support malaria. And so what do they do? They make a supply chain system that supports the malaria commodities. These are solutions. They do usually mean that you have improved service delivery commodities available and flowing down to health facilities for both HIV and malaria and whatever other program. But it does mean it does become difficult, often, for ministries to manage. And again, it doesn't get the data in one place so that we can see all of these various sources of data in, say, the HMIS. And so the long-term sustainability of this approach is something that we need to question. And finally, the last bullet here is there is a complete lack of logistics management at most health care facilities. You do see, I won't say, well, a complete lack is a bit of a strong statement, but they're most health care facilities and especially community health workers who are on the front lines. They are the folks interacting with the patients. They are the folks that are giving out the drugs. We see very poor, most places, information, logistics management, information systems, logistics management in general at those levels. And that's something that should be probably one of the strongest points and one of the biggest things that we need to try to rectify or solve with the development of these kinds of information systems and specifically with DHS2. So a little bit about a landscape analysis. So what are the current state of things? Right now, and we actually have this data because Gavi has published a report. Gavi is the global vaccine and immunization multilateral out there providing support to countries to administer vaccines. They published a guide on country guidance on selecting LMIS that was available last year. And then most recently, the World Health Organization in partnership with Global Fund did a 41-country assessment on the current state of supply chain systems. These are really great resources that I think they're both publicly available so you can go online and find them yourselves. But a quick summary of what they actually found. And that was that there are very there basically no established or accepted global LMIS standards available. What does that mean? That means that countries are making up their own data elements, their own indicators, and very difficult for the multilateral is that they're reporting on different things. They have different ways of defining the indicators. And that means that when the World Health Organization or Global Fund or Gavi, when they ask countries for data to be able to tell the drug manufacturers how many immunizations they need to produce, they're getting very different numbers from different countries because those countries are calculating those indicators in a different way. Which ultimately we have to appreciate that the supply chain doesn't end at the country level. It goes to the global level. Someone is making those drugs and we have to actually give that data to the drug manufacturer so that they know how many drugs they have to produce. There have been situations where the drug manufacturer did not produce enough drugs for the entire world. And then that was the first bottleneck. That was the original root cause. You track it all the way up to global level. And so the WHO now is trying to build out some standards and we're going to take you through those starting tomorrow on what some of those standard data elements and indicators are. Of course, in country context, it can be very unique. And we're not saying necessarily that you have to entirely adopt these standards, but we do want to make sure that you appreciate what is the global community trying to organize themselves around. And this will become kind of, again, the foundational data elements and indicators that folks at the global level are looking at to help make decisions and plan policy and budgets and that kind of thing. The next bullet point is here that we have very little global coordination or guidance, unfortunately. There are many different actors operating in the supply chain space, basically all donors, all multilaterals, many different NGOs. Everyone is coming out with different approaches and guidance, but there is very little coordination amongst them. And I think that that is quite evident when you actually get down to country level and see the many different actors and solutions that have been developed. And again, this makes it difficult for folks like myself who actually provide the technology, because if there are no global coordination and guidance, then we have to again have a very patchwork approach to providing support to countries. And we just go country by country. Sometimes we can help. Sometimes we can't help. And if there was global coordination and guidance, then hopefully maybe we can all be singing the same song. The technology providers like myself can build the technology to support this global guidance, and you yourselves can start to implement and utilize this guidance so that we can kind of be moving a little bit more together. Again, a patchwork of national solutions. We really saw this come out in the 41 country assessment where the vast majority of countries had completely different solutions. Many of them still just paper-based Excel, almost half of them. And then a large variety of applications in use. So the countries that did have technology in place, they were completely different from each other. They were using not only was the user experience very different, but also the software, the kind of the technologies they were built upon was very different. And because of that, it doesn't actually mean that many of these systems would actually even ever be able to talk to each other. For you non-technical folks out there, it's not magic that information systems can talk to each other. It has to be very intentionally developed in that way. And if these systems are not developed to be able to communicate with other systems, then it becomes very, very difficult down the road to get them to do that. It has to be a decision made from the beginning of the development of the technology. And because of the large variety of applications in use, it means that the burden of producing interoperability and sustaining it is largely on country's shoulders. And these interoperability layers and connections become extremely expensive and difficult to maintain over time. Again, yeah, a lot of countries with no real list supply chain information system, some with Excel, many with their own proprietary, more bespoke system, some not for profits, some commercial ERPs in use. And these various tools and solutions cover an extremely wide range level of sophistication where you have, again, some countries that are just recording things on paper records and that paper record eventually gets passed all the way up to the national warehouse. Very, very simple. Up to systems that are extremely advanced ERPs that are, say, like at the warehouse level, scanning every single barcode, updating automatically, doing routing and fleet updates and planning and communicating to DHS2, pushing data, really complex interoperability. There are countries that certainly have that as well. So very broad range of sophistication. Okay, so before I continue on and talk about what we actually do want to do, what are the solutions that we want to be able to provide to you using DHS2, let's now take time, let's take a 15 minute break.