 All right, everyone, if we can take our seats, we'll get started with the session. If you could please take your seats. Okay, so in this session, we're going to go through a couple more country presentations. So we're going to be hearing from Nepal, our team in Central Asia, and then two Pacific Island countries, virtually, Solomon Islands and Bangladesh. So I'm going to start with Nepal. So I'll ask them, please, if they can come up and share their presentation. Thank you. Very good morning, everyone. On behalf of my country, Nepal. Now I'm presenting about our DHS situation, what we are doing in DHS, what we are facing that challenges, and what we're forward for the coming years. Next. Next. Yeah. He's doing okay. So basically my presentation focus on this area, background of our HMI systems, introduce a different aspect of the HMIS and other status of DHS implementation. And beyond the HMIS, all the subsystem also use the DHS too. What are the subs here and how can they link to the HMIS? My presentation focus on that area. And then what are the opportunities and challenges in my country, I really want DHS too. And who for what for the coming years. Next. Yeah. Okay. This is the map of my country. Actually, Mike, based on the current constitution, my country divided in seven provinces. Basically, my country is the highly diverse city country in terms of the geographical terrain, in terms of the caste, ethnicity, as well as the languages. So basically, my country is famous for the two things. One is the my country is the workplace of the go to Buddha, which also called on the light of Asia. And another is the my country is the highest peak of the world. We call the mountain risk lies in my country. Basically, we have the high rates of the mountain in Himalayas and then the hill area and flat area. So it is the very high of the city country. Next. And all together 29.1 billion is the population of my country. And we have already reached the population recruitment level. Life expectancy is more than 71 years. So based on the current federal federalism on the basis of current constitutions, country divided in the three parts. Basically, if the federal law, we have the federal government, we have the provincial government. We have the local level governments. So we have the three types of government. All are the autonomous and constitutions provide their rights and also the mutual rights also. So if you look the federal systems, we have the minister of health and populations. And then in the health sectors, under the minister of health and population, we have the department of health services, which is the largest department in the federal systems. And the department of Ayurveda and alternative medicine, department of drug administration. These are the major department. Looks the quality and the standardize of the health system throughout the countries. And we have the universities, council and territories specialized hospitals under the federal systems. If you look the provincial systems, we have the seven provinces. And then each province have their one ministry. They have the one cabinet. They have the one parliament in each province. And under that health ministry, there is the health division. There is the health training centers, provincial lab centers. And then we have the 77 districts throughout the country. And if you look the local level governments, sometimes we also call the polygas. We have the 753 polygas we have. And under these polygas, we have the, in each polygas, there is the health unit. There is the health unit. And each health unit, in each health unit, there is the health post, primary health care center, basic health service center. All are comes under the local level governments. Next. Yes, this is the STMI, HMIS. Yes, HMIS established in 1993. And then in the 2007, our ministry has approved the HIIS, that means the health sector information strategy. And based on that strategy, we have piloted in the three districts, in 2007 to 2011. So after a period, we have the two parallel systems. One comes under the HMIS, another comes under the HIIS systems. So again, we started the online data intersystem in 2007, and web-based online data in 2013. And then in 2014, we merged both parallel systems and integrated into one single system. We, at that time, we totally revised our HMIS, recording, reporting, monitoring all the tools. And we started one single, integrated health information system throughout the country. And in 2016, yes, this is the time we started the HMIS as two platforms for the HMIS in 2016. But in 2016, we only reached the district level. We don't reach in the political levels, LSE levels. But in 2018, we covered all the political levels, all the LSE levels. So right now, every government health facility covers under the HMIS platform. And most of the private sector is going under the HMIS systems. And if you look the data, around 10,000 health facilities every year report in our HMIS platform. Every month report in the HMIS platform. Among the 10,000, around the 3,300, directly reporting, 3,300 health facilities directly report to the HMIS as two. That is going in. And our future aim is all health facilities should directly enter in the HMIS as two. That is the future objective of our HMIS systems. So, and we have already implemented the ICD-11 reporting systems, especially for the mortality and morbidity. But in the morbidity, it is going on very smoothly because ICD-11 is also the online reporting system. It is very good. And then WSO will share a support to us to launch in that part. But in the area of the mortality, especially yesterday, we also from the zone presentation cause update. Yes, we are facing some problem in the for the cause update. So we will further discuss with the hospital regarding this issue. So, and recently we measure HMIS device done. And it is the third time. And then based on that device tools, we already updated our DHS2 platform. Now we have the updated HMIS, all the recording reporting paper which tools. As well as we have based on those revision, we have already updated the DHS2 platform. And we started from the last in Nepali, our fiscal year started from just six months back. So we can we can start getting the fresh and revised variables information in our DHS2 platform. Next. Yes. This is the digital health journey of Nepal, which I already mentioned. Next. So yes, these are the guiding legal documents which support to us to strengthen our health information systems. We have the constitution. It is clearly mentioned in that constitution. Information is the fundamental right of the book. It is clearly mentioned. That's why it it it's support to us to provide the any type of the information any type of information demand by the stick. Basically in the sum of a special individual information, we cannot share individual information, but aggregate of the information, we can share the public's base on that constitution. And we have the statistical acts and then we have the health policy and strategy. It is clearly mentioned in the health policy and strategy. We should have the one single comprehensive integrated information system. And systems should should use the modern and high tech. It is clearly mentioned in that document. Based on that document, we are performing and we are improving our SMIS. And yes, we have the cabinet decisions, especially in the context of the federal transition period, Publical Service Act, we have regulations, regulation. We have the National E Health Study 2017. And recently our government passed the ISMS roadmap. And this roadmap for up to 2017. Based on that roadmap, we can perform any activities. So government has fully committed, committed for technically, financially every part, government is ready to support us based on that documents. So it is the one very, very good thing for us to performing better for upcoming years. Next. Yes. This is our SMIS system. Basically our SMIS system, the very large system, core routing web-based systems, information system that has been put place in the Minister of Health and Population. So it captures all the health facility related data. Basically all health services, deliveries, public health activities, morbidity, mortality, OPD, inpatient services, surgery, diagnosis services, all type of services. We collect the data from the each and every health facility from the community to national levels. So basically the health facility is the primary data generating point for us. I have already mentioned we have the 10,000 for health facility per month reporting to us. Among them 7,540, almost all government health facility report to us. And then the non-public sector is around the 2,463. We don't capture 100% private sector reporting. But we are trying our best. Yes. And then we are using the 7,3 different type of the recording reporting tools and multi-monitoring seats in the our systems. Next. Yes. DSH2 platform we use for the helotronical management of the DSMIS data I have already mentioned. Aggregate multi-data is submitted to the SMIS central database DSH2 platform from the health facility and their parental units. Those who are directly entered the data in the system and remaining are sending their report to our local level government. In each local level government we have the one dedicated trained equipped person we have. We call the focal person. And that focal person entered all the paper based report in the online system by health facilities. That is our system in my country. So, yes, three level of the governments, all three tire of the government, line ministry, all the line ministry, Nepal planning commission and external development partners, all the stakeholders are key data user of the SMIS. And one thing I want to very much clear here those program division who are using the tracker they are not eligible to send the report to the ministry. They have to come from our SMIS systems. Because it is clearly mentioned that what there is the only one system which report to the ministry, which report to the national planning commission, report to the ministry of finance, report to the WHO and other partners. So tracker users should must verify that data to our SMIS systems. After the verified then only SMIS shared the data to all the concerned stakeholders. That is the system. So that's why we sit together all the division and every first month of the first week of each month we sit together, SMIS focal person and program data focal person sit together and verify the data through the tracker and through our SMIS. And SMIS always keep the intricate of the data. We don't check the individual data. That's why after matching, then it is ready to send the concern division and centers. That is the process. And all, yes, next. Yeah. SMIS use the DHS platform I already mentioned and basically DHS 2 is right now it is the one system that coordinates all the theta of the governments in the federal system sometimes it clear the problem especially for the other program division facing some sort of the problems. It's due to the lack of the coordination collaboration due to the right of the things to theta of the autonomous governments. But DHS 2 and our SMIS is only that platform who link all the theta of the governments. That's why it is, that's why the Ministry of Health and Population always put very important to the IHMR systems. And yes, we have produced the 6th level of data national level, province level, district level, LHG level, even world level, health facility level. We can produce the data in our DHS 2 system and we are using the API many hospitals, many health facilities directly send to the report to our DHS 2 platform. And then use of the standard dashboard for monitoring program indicator in DHS 2 and we regularly provide the access to all the division and concern centers to look their data in the monthly basis. Yes, for the data quality, our concern is also the data quality. How can we make our data very high level of accuracy and then high level of the reliable and valid data. So for that, from the province level we send the amount and guideline to 753 polygons, budget to 753 polygons directly from the center level through the SMIS. And we provide the guideline to them. In that guideline, it is clearly mentioned how can they verify the data, how can they monthly meeting, how can they conduct, what are the tools they have to use and what are the procedure, everything they each and every LLG has conduct, perform conduct in that way. So that also very closely linked to LLG to our center levels and province levels. Because we provide the budget, we provide the guideline to all the local level government and based on our guideline and budget they are performing the things. And basically each every month they perform the data verification and then they perform the monthly review and quarterly review and annual review and they produce the annual report, annual report each month, each year. Every local level government and that is the good things for us and they share to that report to the province as well as the federal level. That is the system happening in my country and then regularly feedback follow-up data routinely system is conducted by the each and every levels. Regularly conducted, routinely data quality audit, data quality audit in health facilities, it is regularly going on. It done by the province as well as from the center levels and sometimes district level also perform the RDA for the health facilities and we have regularly monitoring on-site coaching through the R levels and we have also send some sort of the budget for especially monitoring and on-site coaching to the province as well as the districts. And data management committee and DHS2 are interested regularly at each level. Data quality are checked by the following major three indicators. These are the major four indicators. We always look basically timeliness of the reports, completeness of the reports, completeness interim of the institution, completeness interim of the programs. We always look basically at these two things and the validation rule. In our DHS2 we have already put validation, we already check the validation rule based on that validation. What are the feedback comes? We immediately immediately inform to them and after reducing all the validation then they have to send the report to the systems. That is the things happening in our system. And for the data analysis definitely we are producing the data analysis at the LLG level, district level and province level even in the national levels. And multi-analysis by major health indicators especially for the time-series based on the time-series analysis. Data analysis by major indicator by sex, age, caste, ethnicity and then based on the National Planning Commission report we divide our total caste and ethnicity in the six major blocks. So every data in DHS2 categorized by the caste and ethnicity. So we always provide those type of data to the concerned division and center who looks the equity and equality equality aspect. So and data are the presenting at the number, percentage bar, the graphs, it is the methods of the presentation we adopted in DHS2 systems. Yes, regarding the data dissemination and use every year we produce the annual report and send to all the function authorities and periodically we updated the sustainable development goal as a monthly basis we provide the data to the ministry and monthly basis update the sustainable development targets all those things and another part is the result framework. We have the national health strategy document and that document clearly mentioned the result framework and based on that result framework there are the large number of the indicator mentioned and based on those indicator we have to provide the information to the ministry and the National Planning Commission and another is the DLI indicators basically the World Bank provides some sort of the amount to us it is basically performance based performance based disbursement based indicators so based on our performance they provide the amount to us and they all lie on the based on the our HMIS data so annual planning monitoring evaluation project of all the health programs it is done on the basis of our DSS2 data Academia Journal article for the national international levels and the student researchers all are using our data basically university and then our NSRC National Research Council we have they are regularly using our data based on our data they publish the reports and in the decision making process at all the health facility levels they are using just some sort of our HMIS data this and this is the general reports and then these all are our stakeholders using our HMIS data next yes yes today morning I have the presentation and then from the zone yes we are facing same problem even the government already decide and all the legal documents say HMIS is the only one integrated comprehensive system but the parallel system are cons it is happening in my country too but the main objective of the government is to reduce all those type of the intimate systems so look these are all the subsystems subsystems so how we can integrate some of the system already integrate a link to us we have already started but other some of the remaining subsystems are not integrated with the HMIS but they have to mandatory to integrate legally it is mandatory to integrate so we are thinking how can we link how can integrate it in this in this particular area and based on that today's morning discussions I request to the concern export and the organization to support to us we are facing that problem yes next yes I have already mentioned all the health facility report to us those who are not online reporting they send the report to the LLG and LLG focal person enter the report as per the health facility base and it is online every province every consent division and every stakeholder can see our DHS to base data base one their user ID and password next yes these are the partners support basically WSO of course technically they have the technical support to us UNICEF and GIZ USAID, UNAP Global Fund and UNDP these are the major partners support to us and then other two but these are the major partners yes next so our HMIS already use the DHS decide the HMIS this system also use the DHS to yesterday the day before yesterday one of our colleagues also present regarding the HIV years of tracker model of our our NASA systems same in the EWS this is surveillance system it's called the EWS it is under the EDCD it is using the DHS to HIV years pass and tracking system it is already presented here also the management information system it is in the process it is in the process but they are they want to use the DHS to tracker and the COVID-19 vaccine reporting and now it is it is regular conducting our all the COVID related vaccine data comes through the DHS to and we report daily basis report to the ministry and then even even the Prime Minister office and drug resistant TV pass and tracker system we have and we that system also use the DHS to FCSB registry health facility registry OCMC on stock crisis management center and then SSU social service unit and xeratic services all these are already used the DHS to perform just one year back they started to using the DHS to and national health insurance system they using the DHS to but still some work has been remaining to perform and malaria system it is supported by the WHO and our friend he's in there also mentioned support for this malaria to make the malaria tracker for the malaria patient and it is in the process next yes now opportunity in my systems basically growing the DHS to community in the country we have already started to dialogue city and start dialogue with the research institutions to build our DHS to community so it is growing it is growing as compared to the previous now we have some sort of the IT experts some sort of the IT engineer who can interested to performing performing to work in the DHS to systems in country customized capacity now we have the IT expert and IT engineer who customize the our DHS to it is good platform for us wider interest on the open source software including the ministry and then the sound legal background we have and we have started already started the MOE with the Kathmandu University as well as the Trivon University and directly online reporting for from the 4000 plus health facility DHS to within the coming six months it is mandatory to complete this tax tax this tax is given given ministry to us so within the six month now it is 300 within the six month we have to reach another 700 so it is mandatory for us and we already revised our SOP of SMIS data sharing policies and user manual all are completed and it is in the process of endorsement next yes we have implemented the dashboard program by taking the support from the UNICEF we have already started in the 17 LLC especially for the dashboard program that dashboard is the mono indicators as well as the dichotomous indicators our composite indicators all type of indicators we provide in that systems and that system automatically generate the dashboards and that dashboard is there are two types of dashboards one is for the internal use and for another is the public use and it is highly demanded program from the our LLCs our mayor chief of the our LLC they are very much interested please very fast you have to expanded this programs right now we have we have the 33 using this dashboard related activities in the local level and we have to expand the RQA DQA in the districts implementation of the ESR EMR in the hospital and regarding the EMR in my country there are a lot of the software a lot of the software they are different type of software using different hospital using the different type of software right now already started to to make one standardized things these are the things based on these fundamental basic things only software can can fight in the bidding process we are going in that way because it create the complication for us so right now if every bidder should follow every software bidder should follow based on that is standardized and then that document and based on that document only he that party is eligible to to submit their document in the bidding process that is going on so for the EMR ESR for the ESR we have to work a lot so but the government already decided for the digital health systems it is already announced by the minister and it is also announced in the national planning commission so we are going into making the ESR throughout the country it is in the process and it started the illogical database recording system and we are also focusing not only for the reporting we are focusing on the all the recording tools should be paperless we are thinking and some of the our health facility already introduced the record-based SMIS system and incorporated the infestation management system in the SMIS new server setup in national data center with proper data security so right now the IPTW also support to us very very advanced very good recent software server to us so again the global fund support to it is in the planning to buy the very standardized very good modern software server to us based on that server and which previously we have all together now we are going to build a national data warehouse especially for the for the HMI systems that is in planning next yes these are the issues these are the issues we are facing in launching the DHS2 in our information system first is the calendar we have our own calendar so it is called the Nepalese fiscal year best calendars but right now our IT guys are already solved this issue and right now we have the calendar for the infinity year and then we already request to the Oslo University to incorporate that calendar in their systems when they upgrade our calendar also automatically upgraded so we are requesting them and it is in the process it is in the process hopefully very soon it will be solved and using the present DHS2 yes still we are in the 2.30 version and we have to go to 2.36 and to for the upgrading of 2.36 testing is going on it is in the process it is going on it is in the process hopefully very soon by taking the support from our Oslo team Oslo team we will perform to launching the DHS2.36 in near future and I am very much appreciate and I am very much glad to say to the University of Oslo team we have already conducted 2 or 3 Zoom meeting with them with my export and with all the program managers and based on their suggestion recommendation we are already start the testing so hopefully very soon we will reach our target so thanks to the Oslo team for their great support to us and collaboration with the academy this is I have already mentioned we have started to collaborate and establish the relationship to the Kathmandu University as well as the Trivandu University we have started and then in 3 areas we want to expand the DHS2 the program gives an ask to us they are interested to introduce the DHS2 especially for the immunization and other program telemedicine and this immunization they have dashboard related activities these are the core area program division and we are thinking to use the DHS2 platform that is our implant and then we have already implemented ICD-11 I have already mentioned in the morbidity part morbidity part it is good but in the mortality part especially in the cause of death underlying cause of all those things we are facing some sort of problem and then we start the dialogue to the poster team hopefully very soon we will solve that problem yes this is yes building of the DHS2 community it is very important and based on in Kathmandu University every year they produce the 400 IT engineers and Trivandu University also produce the IT engineers but the problem is some sort of the brain it is a very problem we are facing but in their course if we introduce the DHS2 if we if we provide the thesis in DHS2 in the university student and if we invited those student in my office in the honor of training in Trump then automatically we can build the DHS2 community we are thinking in that way and university agree to us and we are we are in that line yes so establishment of interoperative labs yes recently GIZ and the WHO they provide to establish the two interoperative labs and one lab will be recently will be built in the Kathmandu University and then from the technical support from the WHO we are very soon starting the establishment of interoperative labs in the Kathmandu University and for another interoperative lab we are still not decided and yes we have the one IMS system for COVID-19 related activities yes for the COVID related information especially for the area of the vaccine we use the DHS2 but all of the other COVID related information collect from the hospital all the labs information and all the POA point of information and CICT all information we collect by the separately our own software that is called the IMU information management unit for the COVID pandemic and that software built by the our IT export so it is going on very smoothly working working right now on the basis of that software we are providing all the information to all the concerned stakeholders even the prime minister office and then QR code certification also provided by that software and each and every LLG now produce the QR code certification and provide their citizens it is happening in my country so thinking of the previous software yes we are facing this problem so I can also request to the export and the Oslo team basically in the previous we are using the local software in the first we use the FoxPro and then we use the local software and in 2016 we started to use the DHS2 so we want to main streaming all the previous data based on the DHS2 platform how can we link is all the data in same stream that is the challenge for us so I am requesting to the technical export to support in that area and never ending and this is the one common problem we are facing never ending the revision and the emerging reporting requirements every division some change some sort of the activities and demand to collect the data and every time is not possible so based on based on that problem we have already mentioned in our SOP our user policy our other documents clearly mentioned we cannot revise every every month at least after the one year they send their demand to us we collect but every every one year after crossing the one year then we will sit together then if needed if they justify to us then we will put otherwise not and every two and half years we will midterm our systems and then every five years we will revise our SMS tools that is in process mentioned in our document and the IT infrastructure internet problem in the remote health facilities especially for the high Himalaya area there is no internet there is no city in some of the high peak mountain area so we are facing the problem basically this problem and the digital literacy among the healthcare workers yes it is also sometimes create the problem for us and they deny to report due to that facts next yes these are the way forward and this is my last presentation slide yes we have to scale out all the health facilities and 100% health facilities reporting in DHS2 in online that is our primary motto of SMIS continue to upgrade the DHS2 for the new version facilitate the open base interoperability continue expansion of the in country capacity country community for digital health engage the academia university research institute promote the standard base information system with interoperability features improve the data quality these are our way forward and based on our approved document which is called our SMIS roadmap 2022 2030 we will perform any activities based on this legal document which is approved by the minister of health and populace that is our primary of document to improve the SMIS systems yes this is a very beautiful place we call the Pokhara it is the lake city of our country and I invite you all and welcome to you all in my country please come and join to us thank you very much okay please oh yes sorry sir animal health sector thank you for question yes we have the one committee of department health services and animal department we have the jointly one committee and in that committee there is one advisory committee one is the technical committee we collect basically in the EOR systems we collect the data types of data one is the IPT related data yes immunization prevented disease related information we collect and yes we also collect some of the information related to the animals just like dango just like other epidemic other type of epidemic related data which is caused by the vectors especially for the animals it is in our system and it is under the EDCD it is under the EDCD yes we have thank you it is okay thank you basically regarding the interoperate actually I am not an IT expert but I am the manager position but I will answer to you look what happened basically when we go to the university especially in the IT department they demand to us in my country there is no interactive lab at all so they demand to us all the students who are studying in the IT they want to test there are some sort of apps there are some sort of anything in their own lab but there is no any lab that comes from the university for us so based on that demand and this year we are planning to establish the two interoperable labs one is supported by the WHO for the Kathmandu University and another is budgeted fix all fixed but the in where we established it is not fixed but this year we will build the two interoperable labs thank you madam yeah okay thank you for listening to me so Malin if you are there could you share your screen hi Nick yes I am here can you share your screen yes for a minute thank you and just introduce yourself as well Malin before you start your presentation can you see it now okay yep we are ready please go ahead okay thank you Nick so good afternoon thank you wonderful presentation that you also identified some of the opportunities that we also that can also enhance our HMIS system first of all I would like to acknowledge the committee members for organizing this meeting and also Nick for giving us this opportunity to share our DHS to implementation stories here in Phanwadu my name is Malin Dewey I work as the health information or HHS officer for the Ministry of Health here in Phanwadu I have been using DHS 2 for nine years as a data entry data analysis and at some point working with Nick and he's here now to test and implement some of the new module that we features within DHS 2 that I will be sharing with you today so on that picture that is our beautiful Portfila city so that is our capital city Malin can you just put it in presentation mode yes so Phanwadu first adopted the DHS 2 in 2014 to establish the routine health information system primary health that includes collecting outpatient visits and environmental health non-communicable disease and reproductive health most of the data has been collected on paper based and then they were ended by a provincial HHS officer on the DHS 2 Malin was the first public health program to develop their own specialized module using a combination of aggregated and event-based reporting to map case by philips and it was a success it was successfully implemented and now they were also applying the PRACA based system which they will be using next year 2020 other diseases such as TP EPI or immunization and neglected tropical disease also saw the value of integrating the standalone system into the DHS 2 to take advantage of the systems functionality security and also the community of practice and the efficiency gain by using the system and some of the major challenges that was not challenges but some of the major changes that are currently taking place on the DHS 2 are the configuration of the new HHS form development of the facility in federal form the school-based form the hospital form and other changes is also considered such as development of PRACA modules for public health program and linking the hospital patient information system and supply to the DHS 2 but this is a long-term plan a big lesson learned when we first introduced the DHS 2 in our countries that in country capacity and like Neville also mentioned DHS 2 community we are also having similar challenges also the changes in HHS management starts resulting significant loss of no later institutional memory and again we also lack technical capacity here in countries and the second one is similar reliant on development partners and external HHS 2 developers for modification to our system so this is some of the things that we find sometimes difficult and also poor design of data collection forms and absence of guidelines for data collection as a result in poor data collection poor data quality for some program but this has been solved thanks to Michael but so he has been doing a tremendous job here by reviewing some of the data elements that we have and strengthening this poor design of a data collection some of the context that we should take and also maybe the Pacific is to take a conservative approach as we build staff capacity and I try not to use any custom apps when possible and also direct user guides and SOV as much as possible stay maybe do a three facing back at all times and we also encountered this when we have the faxing several which was being crashed but we were so fortunate that we were able to back some of the successes that we had during the using was the implementation of the faxing which is to during the COVID-19 faxing which is to it has been most apprehensive and intensive help related data collection exercise of ever conducted in Vanuatu the next one DHS2 was developed to track all COVID-19 faxing in Vanuatu since the reload of the COVID-19 vaccination in 2021 of 145,000 people were almost registered and we have been registered of 2600,000 doses so our population is somewhere about 300,000 and we have managed to register 145,000 people in the DHS2 program for the faxing one of the successes is that over 100 users across the six province of Vanuatu have actively used the DHS2 faxing which is to system for analyzing data on daily basis still some of the success with the faxing faxing which is to using the event we put on the DHS2 elaborates the coverage we generated on weekly basis by the national and the provincial team. The analysis provided by this weekly report played a critical role in guiding the Ministry of Health especially to target the population that requires vaccination. We were also successfully work along with the department of civil registration we were able to call up the vaccination from history to identify and address gaps in the status of Vanuatu citizens. One of the major success that we had is working with HIPPS of Vietnam. The Vanuatu Ministry of Health has been able to produce and successfully deployed and encrypted COVID-19 faxing certificate which we are now using for office travels especially to Australia and New Zealand mostly. As of August this year 2022 certificate has been upgraded and verified from a publicly accessible website portal. Some of the challenges we had when we implement the Vanuatu faxing history is that adaptation of the Android app was challenging especially where it was needed most especially in remote areas and this was largely due to the limited amount of training that we were able to receive because it was only a week that we conducted the training that they used so it was quite difficult for them to use the Android app and that was one of the challenges that we had. The other one is identifying our defaults especially people who failed to turn up for their second shop directly from VHS2 platform was difficult and it required an automated work around using Excel and lastly users would often create an event and navigate without completing it resulting in consistency with the data that has been ended. We also experienced a few set across around October 2021 like I mentioned earlier but these were quickly identified by upgrading the server and users often ended in current faxing batch number requiring a bulk editing and we also think need for helping us with this and the user audit features sees functioning and we were unable to identify who incorrectly complete the event so this is something that we really want to be fixed the user audit features because this also helped us to track the users who made mistakes on the forms. Some of the lessons learned from the faxing registers that we quickly realized that making data field mandatory was essential for consistent data collection as you often skip fields and complete the event without ending the required information. Secondly, having a hard copy or paper based vaccination as a backup was critical critically important especially in places with low network coverage and to cross check that every vaccination event has correctly ended and complete and something that we are looking ahead for is the introduction of faxing certificate which we have already had and thank you to the wonderful job that Nick and his team has done so we now have the people, the public can now access and they can also download their own faxing certificate which is very helpful for us at the moment and we also did a depth analysis of the data and that also helped us to do a presentation on a symposium that was held last month October in October so we used some of the information on the data and faxing history to do a presentation on the symposium we are also looking ahead to explore the potential for integrating for the immunization but we also identify some of the challenges to do this but yes we are looking ahead for doing that but it requires a good consultation before we can introduce a tracker motive for immunization the other thing is to develop and publish dynamic dashboard via EPI using Power BI that can pull information from BHS to and visualizing information on Power BI this is some of the things that we are looking ahead of doing and developing the ability with other systems being used by the Ministry of Health for example the power data currently used for case management and contact processing especially for COVID-19 I think this is the end of my presentation and I thank you everyone for listening and I wish you everyone happy and a middle Christmas holiday thank you thank you Malin are there any questions for the Vanuatu team okay Malin there's no questions at this time so thank you very much for your presentation I'm going to ask the team from Central Asia if they can come up so Malin you can stop your screen sharing the presentation it's on the loss should we share the screen hello everyone oops thank you very much sorry for this technical issue today we wanted to tell you about experience of Central Asia in the DHS2 tracker and briefly we will talk a little bit about our team about our project background the tracker, the HIV tracker the mobile application and the integration possibilities with the RBI next presentation first of all I wanted to mention our backstopping team from FHI since we started the project they've been constantly supporting us and they help us a lot in adaptation of standard tracker help us to launch the instances in all three countries of Central Asia and we still have weekly consultations with them so they really help us a lot we have since the beginning of the project we are using this and we check all the updates and things we need to do on tracker a couple of words a small team not as big as your team but we have two persons in Kyrgyzstan one in Kazakhstan who are involved in adaptation and all those work with tracker experts our project is called EPIC we started in 2020 it is PEPFAR funded and we work about key populations on testing HIV and linking them treatment cascade and when we started in 2020 we had no database we were flat and we have adopted the database forms and other tools from the FHI 360 expertise and since then our CBOs were using them but we knew that we had some system to be able to check all the data and initially we had a couple of consultations because we in our previous project we were using MIS database not DHS database so we initially we planned to use that base but then after consultation with our backstop team the DHS2 database it was a new tool for Central Asia it was never used before as in many other countries so it was kind of a new experience and there were some challenges there were like a database of the serenity limitations that means that the national all the client's data should be stored in the country before that we wanted to store it somewhere in the cloud that's why we had to buy servers and it was also challenging because it was 2020 probably all the limitations and the server was purchased in the US and it was delivered to our country in I don't remember three or four months so it was also a challenge and after that when all the instances were installed on our services we started to adapt the standard HIV tracker to our project needs it was also a little bit challenging like when you sit at home during the lockdown so yes it was our initial steps and our three countries they were they received training from headquarter and we started to work on our own since then and my thought is to do next slide please next slide please our experience on using GHS2 is comparatively short we like infancy in using GHS2 but nevertheless we try to use it to constantly increase our capacity on using GHS2 and we use these resources to increase our capacity especially we use GEDEMIC courses GHS2 online GEDEMIC courses we use as online platforms to solve our issues using GHS2 next next as mentioned before we use standardize GHS2 checkup metadata package for HIV programs this package was provided by our HHU office of HHI 360 this package simplifies GHS2 configuration for HIV programs to support case management and also it contains automated reporting of more than 70 farm men and other custom indicators next slide this is advantage of using this HIV checkup package it is comprehensive it contains all of HIV services secondly it's easy to adapt it enables quick and cost effective deployment and also it uses promote we use policy collect once and use this data many times and also simplify reporting it reduces data entry burden by automatically completing common HIV indicators next slide moreover with this HIV program package metadata package contains additional supplementary programs like peer worker program this is a relationship between client and outreach worker the second supplement program is hotspot program builds a relationship between hotspots the place where our beneficiaries gather and index testing tool this is the third relationship program the next slide please also we localized our checker we translated our metadata package into Russian language in our countries we use Russian language mostly and also we adapted all metadata we adapted fields options data elements and also next slide also we we adapted our indicators as I mentioned before there are many program indicators but we modified some of them in order to meet requirements of our project we modified and check it and we use these indicators next slide please this is another part of customization we also modified and our units our units provincial districts and our settlements next slide also we added new additional stage whose is HIV HIV package where the demographics age and service plan stage for this HIV package next slide please also we added new special data to our units we added long-distance latitude and also we added some gem files to our some of units and we visualized our program data we visualized our testing data HIV testing data and data of our HIV cases which appeared in the settlements next slide please and also our countries building some DHS2 community so called some projects some projects used DHS2 for instance our epic project for our post on republican center for immunizations they also started to use DHS2 JZ use Pernatal project and in Kazakhstan they use the following project of strength and health care information system and it's interesting for instance in Tajikstan they also use DHS2 for registering medical status it's interesting but they also use this DHS2 for this project next slide please and this is our success story our team from post on epic project and also our specials from HQ they developed a presentation the public and health center and our RAC compared alternative software tools and their welcome plans to use DHS2 and soon RAC will adopt DHS2 for prevention programs that's a community based organizations level for the social partnership project the next slide please and also in order to build memory institutional memory we constantly deliver the trainings for our CBOs for our community based organizations for our NGOs in all three countries in Kazakhstan in Tajikstan we constantly train them consult them our partner and yours so let's move on a few months ago