 My name is Dr. Sara Piyachika and the commissioner for planning, financing and policy at the Ministry of Health in Uganda. The use of DHIS-2 in Uganda started around 11 years ago, but when the DHIS-2 was introduced in 2011, that was a big jump for us in terms of digitizing the HMIS. Prior to that, we were using an AP info database, which was largely backed up by a paper-based system. Every month, the health facility in charge would have to deliver the physical report to the district health office and we had deadlines or timelines. By the seventh day of the following month, every facility should have delivered their report. I was a district health officer earlier and so I knew all those processes and then would record which facility has delivered by which date and when it comes to the district, the district HMIS fokopason, by then we actually didn't even have biostatitions but they were called HMIS fokopason. That person would now use an Excel database and populate to make a district report where you have a computer. If you did not have it, it had to be done manually at district level and then that report would be signed off by the district health officer who would then either personally or delegate somebody to deliver it to the ministry of health by the 28th day. At the end of the following month so that the ministry could also be able to enter it in the database. So it was physical transportation either by motorbike, taxi, then the district health officer had also to move that report, find a way of getting it to the ministry of health. So when the DHIS came in, we have now disaggregated data and some facilities actually now can directly enter their data into the DHIS too. The data quality verification starts from the facility level. Before the health facility in charge delivers or submits the report to the district, they have to look through and verify whether this is the actual performance. And then at the district level also the biostat has also to ensure that the data is verified. Prior also the district health officer had to physically endorse on the report that this is the report I'm submitting by this date. But with the digitalized system that authorization or clicking of the button now we can have those reports without much hassle and then do. So the timeliness of reporting has significantly improved. In this surveillance we get weekly like malaria surveillance reports which are bulletins with dashboards. Every Monday actually when I look in my email I see a weekly malaria surveillance report and we are now doing maternal and perinatal death reviews. The surveillance you get the information more easily and I think that is a very good development. These reports are shared for management level. Right from the minister of health, the permanent secretary, the program manager, other commissioners for information purposes, you know what is going on as far as different disease programs are concerned. It has helped us first of all to move from a district aggregated data to facility level and we can even tell which facility is performing better than the other if they are at the same level. And it can also help you, it helps us to highlight and identify where the data quality gaps are because sometimes you see spikes that are discrepancies and you can trace up to the last visit and say oh no you could not have carried out 1000 deliveries and that is the data entry issue. So we can navigate even myself because we have access so you can verify and navigate through that data comfortably and it has also helped on the utilization of that data with more confidence and also feedback to the local governments. It has also helped us in ensuring that we use it for planning. We have been implementing a results best financing program under a project mode focusing on reproductive maternal and child health indicators and through all the data that has been used over the last 4 years for the results best financing program was generated from the DHIS too and that has also strengthened the use and appreciation of the importance of ensuring that the DHIS to system captures accurate data. We are now moving forward to internalizing results best financing for primary healthcare financing so it is also helping us in development and also through that having financing based on results also is helping us to strengthen the DHIS because the data must be timely it must be accurate and almost all facilities should be able to report. Obviously the challenges are there starting from the capacity to be able to roll out the DHIS too. You needed the human resource we need the hardware, the computers internet connectivity but since we started with district level through support from our different partners we have been able to have all districts with the required infrastructure in terms of computers in terms of internet it may be using mobile data but at least they all have access to internet services and also in terms of human resource we have fairly competent people because our structure for data management at the district level at least in the previous structure we have the district biostatistician so the competencies and ability to learn capacity building was not a problem at district level but as you go down you find those capabilities are diminished so we have that appeal task to ensure that all health workers become computer literate because beyond DHIS too we have started actually rolling out the electronic medical record system so digitization is now the way to go so all these health workers have now to become computer literate and so that is one of the challenges that we need to address we still also need to ensure that much as we have the efficient system the data quality is very very important and I've talked to my DHIS to health information system people sometimes when I look through the data I see some things that are impossible to have in terms of that data and I always ask can we have quality checks validation rules if a certain disease condition like I can't have cancer of the prostate in a what? a female and then when I look I see cancer of the prostate in the female I ask cancer of cervix in a marriage what is happening so some of those things we need to really work them out to improve the quality of data then sustainability of this infrastructure technology keeps changing if you are having over 3000 or 6000 computers and laptops all over the place how do you ensure they are properly maintained service it comes with the cost but also eventually the disposal so all these things we have to start thinking about them the digital strategy our health information system and digital health strategy was developed it's a five year strategy which we launched recently this strategy is also to help us improve further in terms of our health information system but also in terms of digitalization of all this information system so that we can be able to achieve universal health coverage digitalization is like a tool that is going to help us improving inefficiency and quality of health service delivery but also in to access people being able to access timely information and for planning, for policy but also for the users electronic medical record system is part of that strategy and we have already started working on it DHIS2 is the platform and we are looking at all these other systems that we are developing should actually be linked to the DHIS2 and the electronic medical record system is right now one of the priorities that we are working on advancing because that will also help beyond the aggregate data that we have been collecting through the DHIS2 to go now to patient level data our current priority is to ensure that we actually implement what is in our digital health and strategy plan and to ensure that the DHIS2 is fully implemented the data that we collect is usable the issue of data use that is actually one of the priorities but also integration the interoperability with other systems for example right now in the last one year we have been focusing on having the national health information exchange registries we have developed the standards interoperability and so we really want support to ensure that the DHIS2 and the entire digitization process is up and running we require a lot of support both technical and financial support so that whatever we have built over the last 11 years actually is sustained and grows more and more we are really looking at having more and more people use the DHIS2 capacity building and if possible to go into pre-service if the training institutions can also appreciate for health workers to perform data use is very important and for data use they are systems that exist so how can we even have this appreciated in pre-service so that when people come to use and interact with the DHIS2 and other digital health systems this is not new so the issue of capacity building is very important in terms of training at all levels in terms of ensuring that we are using up to date systems so it's all required and we actually appreciate Hisp has been a very very good partner all from the beginning of really the DHIS2 any issue to do with DHIS2 we know Hisp has been a great partner I just have to continue appreciating because we couldn't have reached this far without working as a government and also emphasizing in one E-System as a country so that whoever wants to use the data from Uganda statistics DHIS2 is where to go I think it is one of the things that has made us shine or be able to respond to health, public health related emergencies because the timeliness of the data is one of the things that has actually made us shine for example we had the recent Ebola outbreak and we were able to quickly be able to trace through the information the DHIS2 and information system especially the IDSR to be able to quickly locate and also manage the Ebola the same applies to COVID we just learned recently that actually now Hisp is moving also to support the education management information system we have a school health program but we had not even thought of now how do we get better into the schools as health because right now our national development plan we are talking about human capital development which implies whereby minister of health minister of education minister of gender and social development we have to work together and see that whatever we are doing is towards improving the human capital and through these information systems once they are strong I can see that they can also foster that collaboration and understanding of what human capital development is all about when you look through some of the key people or drivers who are really running our DHIS2 technically they are women so they are the champions they have helped us with the configurations have been working on the master facility list one of my key technical persons has been a lady she has moved on she has grown but they have been passionate about it and the use of the DHIS2 I would like to say that in the ministry of health in Uganda it is not only women for the DHIS2 but women for health in Uganda because right from all our ministers are women permanent secretary is a woman commissioner who actually heads the division who oversees the division I'm a woman and we have so many ladies very many who are championing the DHIS2 It always makes us feel good and I think we are making a good contribution and actually which shows that in Uganda women are seen as equal partners in development so with that we have been able to work with various partners to be able to ensure that the DHIS2 is up and running so I use this opportunity to appreciate all the partners we have worked with both to support financially and technically and that still takes his as one of the lead partners whom we appreciate Thank you