 So I'm just going to start the session here. So my name is Shereji Dutta. For those of you who are online, many of you know me already. In the room, we have a couple other presenters. I won't be doing much of the speaking today. I'll invite a couple other guests to speak. So we have a Martellic here who will meet shortly. He's based in Australia. He's a Pacific Island coordinator for DHHIS2 and he'll introduce himself. We have a Molentari here from the Vanuatu Ministry of Health and Raldi and Rebecca also speaking on behalf of the Solomon Islands Ministry of Health. So I'm going to hand it over to Amar, actually. Who's just going to... Thank you, Shereji. Can everyone hear me? Yeah, thank you. So basically today, this slide is all presenting in the outline what we're going to discuss. For me, today I'll give a brief description of the DHHIS2 background in the Pacific and then Malone will go through a Vanuatu implementation. Malone from Vanuatu. And Rodly and Rebecca will go through a Solomon Island implementation and then Shereji will continue with the challenges and demos. So this next slide here is basically what I wanted to say is basically the Solomon Islands has transitioned to DHHIS2 since 2012 and we have implemented the HMIS Aggregate System, the ICD-10 Cause of Death Tracker program, the COVID-19 Vaccination Registry and the Adverse Event-Folding Immunization module. And the next slide here is all... It's a brief description of the implementation Vanuatu and technical support has been provided since 2014 to Vanuatu for routine HMIS, the Immunization Aggregate module and the COVID-19 Vaccination Registry and Surveillance Package module and as well as the Malaria events and tracker modules. So as we know, the COVID-19 in the Pacific has given an opportunity for the complimenting of the, for example, the COVID-19 Vaccination Registry which was first implemented in Solomon Island in March, 2022, 2021, sorry. And then it was all following that it was implemented in Vanuatu. And there was minimal need for reconfiguration of tracker modules and adaptation of training templates and the needs to local needs. And as there were similarities in the reporting and workflow in both Pacific islands. And then the technology for the use of the COVID-19 certificates was borrowed from the Laos DHIS implementation and HISP Vietnam and Surajit has been helping with that implementation. And I will hand over for the next slide to Malone for the DHIS to implementation Vanuatu. Thank you. Thank you Amir. So basically, DHIS to collect so next slide, Malone. I collect data from primary health facilities such as health center dispensary and a post collecting especially data within the outpatient NCD and government health and other health data. The system itself is both paper based and digital where health facilities complete the HMS then submitted the form to the provincial HHS officer to end the data. And furthermore, the Malawi program was the first public health program to develop its own module on the DHIS to that combines aggregated and even based reporting and also now they are also trailing the tracker based system. And next slide, Nick. As such, other diseases or disease programs saw the benefit of integrating their standalone information system into the DHS too so that they can take advantage of the system functionality. For example, we are integrating the routine immunization data collection, the TB and also the neglected tropical disease or NDD. Next, Nick. Next please. So in 2019, back Nick. In 2019, the final routine health immunization system had a major changes from the collection form, a data collection form. Unfortunately, the changes within the DHS to have been delayed due to COVID-19 but this year we managed to progress. Fortunately, with the support from Nick, John Lewis and the heaps Vietnam and also Michael Batsworth, a former WHO TA in Fanwatu, we should, I think we should expect some of the changes on the DHS to hopefully next month with the progress of changes currently taking place. Next. The DHS was extremely useful for Fanwatu and for eight years now, we have learned a lot on some of the lessons that we learned are in country capacity. Fanwatu has a few small HHS team. The challenges sometimes when the staff management are leave the office, it is, we lost significantly the institutional knowledge and memories. The other thing is the semi-reliant on development partners to an external HHS support that we usually depend to modify the system and also poor design of data collection form, which also affect our data collection and also the absence of guidelines and SOP that will guide us to collect quality data. And lastly, it requires a cleanup of metadata and data element to enhance our uses. Next slide, please. And some of the success and some of the success that we had this last year or this year is the COVID-19 vaccination rollout, which we use the Trager module. The COVID-19 vaccination history has been one of the most comprehensive and intensive health related data collection exercise ever conducted in Fanwatu. Since the reload of COVID-19 vaccine in June of 2021, over 140,000 people or almost half of Fanwatu total population have been registered and over 260,000 administered vaccine doses have been recorded in the system or the vaccine registered system. Of our 100 users across the six province of Fanwatu have actively used the DHS to fax simulation registered system and the ring and analyzing data on daily basis. Using the event report features of DHS to elaborate coverage report were generated on weekly basis by national and provincial team. The analysis provided by this weekly report played a critical role in guiding the Ministry of Health operation in order to reach maximum coverage of its target population. We have been also working along with other relevant stakeholders such as the Civil Registration. We were able to call up the vaccine which is to identify an address and gaps in the civil status of, civil status of Fanwatu citizen. With the assistance of HIPPS, the Fanwatu Ministry of Health has also been able to produce and successfully deployed a vaccine certificate that can be produced directly from the tracker module of the vaccine vaccination registry. And now, within that the Ministry of Health has managed to issue 7,700 copies of vaccine certificate for cross-border travel. Some of the challenges that we face when we implement the COVID-19 vaccine registration is adaptation of the Android or the mobile app was challenging, especially where it was most needed or in remote areas. This was largely due to the limited amount of training that the user were able to receive. Another one is identifying the folders. Example, people who failed to return for the second shot directly from the DHSD platform was difficult and required a semi-automated work around using Excel. And now the other one is users often created an event and then navigate out without completing the event. Sometimes it results to MA, incomplete events. We have also experienced some of the... A few server crash around October but it was quickly rectified by upgrading the server. And the second loss is the user often ended incorrect batch number, which requires a bulk editing. And lastly is the user edit feature sees functioning and we were not able to track those who end the incorrect information. Some of the lessons we have learned, we quickly realized that making data mandatory is essential for consistent data collection. And the other one is that keeping hard copies as a backup is critically important, especially with a low network coverage and also for a verified missing information. We are also looking ahead of introducing the online vaccination certificate, which will be on an online portal and can be verified on an app. And this will also help us to minimize the work that we were doing and recipient can download their own certificate at their own premises. And also this faxing register will also help us to make our contact and in-depth analysis so that it will help us in the future. We are also exploring the potential to integrate the tracker model to also capture other routine immunization faxing and also develop and publish dashboard within the Power BI reporting on key indicators from the DHS-2 and there's also planned to develop an interoperability with other systems such as the code data that we have been using to manage COVID-19 cases. Okay, thank you, Malin. I'm gonna hand it over to Rodley and Rebecca, who will speak to us about the Solomon Islands. As you can see COVID-19 vaccination, I feed that notification because of that was also implemented in the Solomon Islands. The next slide. So is the health information system history. In the early 2000s, Microsoft Access was a database originally used for health medical information system. The system was standalone and was used only to capture routine health activities from all health facilities. It has limited to integrate specific health program data requirements onto one single platform. In 2004, the database was implemented in all 10 provinces. However, the data entered into the system will have to be downloaded to a floppy disk on a monthly basis and then sent to the national HIS office where the national database system could be updated. The transition to the DHIS system started in 2011 and it was finally implemented in 2012. By 2014, DHIS was implemented in nine or 10 provinces in the Solomon Islands. With data entry performed at the province level, the HIS system was used to capture aggregate data for reporting of monthly reports of health activities, TB quarterly reports, syndromic surveillance. The HIS to even capture the malaria case management in 2015, there were nine provinces that implement that. In 2020-21, the COVID-19 pandemic outbreak causes a serious COVID-19 vaccine, IFE, and the cost of that as well, that we've seen added into the DHIS, too. The next slide, in the DHIS, too, we have a rise of three main components, that's the data entry, data analysis, and the dashboard with the users and users. The success and achievement that are accessible at the provincial and national level also, the data quality was improved by checking and verified. Also, the timeliness of data reporting was improved. The HIS dashboard provided an avenue for feedback reporting to be accessed by provincial staff as well as the data analysis and report can be accessed. The data analysis and report can be accessed by the DHIS to users. The system also analyzes to make it easier for the HIS unit to produce reports and share these reports with dissonant makers and donors. Now I can handle this presentation to Rodley to continue on. Thank you, Rodley. Thank you, Rebecca. So after a successful experience with the DHIS to aggregated system, we're looking on moving on to capturing like mortality information. So we can readjust new people and enter the causes of death and notification detail in the system as well. And also enroll existing people and enter the causes of death detail as well and search for existing record, both in death notification and cause of death, causes of death. And also pop up my basic analysis on the cause of death data that can be shared with the stakeholders and readjust the death from the COVID vaccination registry as well. Next slide, please. So for the COVID vaccination system, the COVID-19 pandemic has elevated the needs for the accurate and timely data for decision-making. And the COVID vaccination in Solomon Islands can be started on 24 of March, 2021. DHIS2 was identified as the main information system that can be used to track COVID vaccination in the country. DHIS2 was selected based on it's... It was a system that's been used to collect most of the health data in the country. And also the system has been implemented national wide in the country. So it's the main system that's been used in the country in widely used in the country. So DHIS2 tracker system is quite new to the DHIS users because it's a bit more familiar with the aggregated data. But when we implemented the tracker system into more new, but there's similarity to the aggregated system that it's a treatment component, which is the data entry component, the data analysis and the dashboard component. And in the data entry component, we have two sections which we have the enrollment section, the immunization section and the demographic information of the client, the intern, the enrollment section. And the immunization sex, immunization detail of the client was entered in the immunization section. So it capture the demographic information and the immunization information is next slide. So here on this screen, you can see the data entry component of the COVID vaccination system. So you can see on the enrollment section and the immunization section which collected the demographic information and the immunization information for the client who being vaccinated. Next slide. So for the success and achievement for implementing the system, we say that COVID-19 vaccination tracker system provide a timely data position making. The system provides a tool to verify status for vaccination status for international travel. Also we can track vaccination coverage and vaccination updates daily. And also we can track vaccination status for individual citizen in the country. Next slide. So despite of challenges and success, we have also have challenges and issues. So when the COVID vaccination tracker system is first used in the Solomon Island, there are a few systematic issues that we encounter. But this issue was quickly fixed by the DHS to support team at the University of Oslo. Also due to poor internet coverage in the province, in the provinces as particular in the remote areas where vaccination site are conducted, timely entry of COVID vaccination data is a challenge. Also we have few challenges where we face that sometimes the vaccination manufacturer information is usually missing in the system. So many record did not contain this information. So we have to end the information after the vaccination, the vaccination manufacturer information is there in the system. Next. So the other system that we implemented is the IP adverse event follow up immunization. So this system is very important for the safety purposes. The platform is usually to record and track people who have adverse reaction to the vaccine. It also recorded the adverse event outcome. The system also provide an information to the Solomon Allen government about the safety of the safety stages of the vaccine that been administered in the country. Next. So the other system that was implemented is the death notification and the medical certification of COVID. So then death notification and medical certification of COVID system was implemented in March 2020. This is the main system that will be used to record all death event in the country. And the system will be linked to the civil registration system managed by the civil registration office for registration of death. At the moment the system is currently accessed by the National HHS team or officer, but it will be rolled out to the province in future. The system has some component which is similar to the DHS2 aggregated system and the COVID vaccination track assist. The causes of death information, the causes of death section included the ICD-10 coding which is very useful for data analysis and sharing these analysis to the stakeholders as well. The COVID vaccination and death notification and certification of cause of death system also have the death notification platform that incorporates some of the relevant fuel for the verbal autopsy data. And you can see there's some of the fuel on the verbal autopsy incorporated with the platform as well to enable the linkage in future or linkage of the two system, the MCCOD, the medical certification cause of death module and the verbal autopsy module. So also the traffic system module is being implemented with data transport from the previous external database that we have in the country. Next. So here in front you can see the features, component and features of the death notification and medical certification of cause of death module. So here you can see how the death notification system just to show you that have the verbal autopsy features as well to enable the linkage of the two system. Next. And here you can see the medical certification platform of causes of death platform and you can see we have the enrollment section and we have the place with the death and cause of death and you can see the ICD 10 coding is incorporated with the platform or the module. Next. So for the implementation plan for the system we are currently using it at the national level but later on we will be implemented in the province so that data can be entered from the province and we can access it, access the data from the national office. More over the implementation of the DHIS2 death notification system at the provincial level is in line with the cross-cursor registration process that will be included in the new law. So at the moment currently we are reviewing the civil registration law. So this process has been included in the law that was reviewed. Next. Thank you very much. I will hand over to Nick. That's a bit of a technical challenge but also to support these devices out in the field became quite difficult. The sustainability of certificate solutions. So I'm going to demo one certificate solution now but, you know, Marlon mentioned, you know sometimes capacity can be challenging. There's a lot of turnover with staff. So, you know, this requires some understanding of cryptography, what a private and public key pairing is things of that nature. So, you know, we're not really at the point where we could realistically hand over these things to the country to manage these on their own. So we need to come up with some type of plan to get people there and we have some gaps to work through. In the Pacific Islands, we also have some competing technical advice, which is okay. It's good to have a robust discussion around things but often what we're finding because we don't have any local presence. You know, there's often some incorrect advice provided to the ministries about what DHS2 can and cannot do. And we're hoping now that MRs in the region this will help a little bit to mitigate that as you can attend some of these forums. But that has been a challenge for the ministries who then come to us and say, you know we were told X, Y and Z about DHS2 is this correct? And it's something we have to work through together. Server hosting is another kind of challenge in the Pacific Islands. The technical and the financial support for a lot of this is provided by various technical agencies and partners over quite an extended period of time at this point. And you know that the challenges regarding this is if only kind of intensified as the requirements to run DHS2 have become more complex. And the understanding of these technologies we still don't really have teams we can work with too much. We've tried engaging with some local agencies on this before but the discussions have been kind of stalled at this point in time. Another area and this is more of a principle I guess than a challenge. We try to stay away from any type of custom application development. There's not really anybody we could hand that over to at the moment. So we use the core DHS2 platform as much as possible. That's why in the screenshots you saw for example there was no custom forms. We try to use as much of the kind of core as we can and push it to the limit until we have something serious that we have to deal with. Also development of the national and country teams this has been quite challenging. There's some turnover in some cases. Doing this remotely has been extremely challenging of course with the internet connection and everything there. And just kind of getting people up to speed and making sure they can push along. We really push things a lot with the cause of death and COVID-19 in particular with tracker systems. It's the first time both these countries had implemented tracker and we did it all remotely. So it's a little bit challenging for us. Another area where we're kind of struggling still is also for this long-term financial support. Still very project based. We've been now supporting these countries for 10 years and eight years respectively. And there are some gaps I think there that we could handle a bit better. But with that being said there are some successes as the teams have mentioned. So I just wanted to demonstrate two things really quickly for you before we end this session here. So one is from the Solomon Islands and this is for cause of death data. And it's still something I think a lot of countries could learn from. We developed a very small tool basically to bring data into a WHO tool called ANACOD which is analysis of cause of death. And I'll show you that in a moment and also for the Vanuatu COVID-19 certificate. Brought it over from Laos. Actually then we're also bringing it over to many other places like Honduras and Negatorial Guinea. Working with those countries using the same framework. So I just wanted to show you those real quick. So, okay. So this might seem like a bunch of kind of unreadable kind of stuff to a lot of people and it mostly is. But if you can kind of see these are the ICD-10 codes here and we make this so we can basically bring this in to the WHO tool for analysis. So we have all the cause of death all the mortality codes from the codification of deaths. This data is from 2019. There's no names or anything it's just completely anonymous information. So what we do is then using this basically we then bring it over into this tool here. This is called ANACOD. It's the analysis of cause of death. It's a tool developed by WHO for mortality analysis specifically. This new version that they've released is actually quite nice. They just recently in 2021. So it was a nice update to the tool. So basically we use that kind of mix of codes that I showed you earlier and we import it essentially into this system and we can then perform some analysis and you select your type of data it is. It supports up to ICD-11 in Solomon Islands. We're using ICD-10. So we're not using ICD-11 yet. In this part here I don't know why they ask for your email. I'm not so happy about that but in any case they ask for your email. So just upload the data. And this allows then for all kinds of analyses and comparisons with countries of similar income, similar demographic characteristics and all kinds of other stuff. And for anyone familiar with this tool you'll be able to comment on that more but this is a very powerful tool I think for the Solomon's to really understand their cause of death data more especially because of this linkage of this external data sources and you have a lot of measures of data quality. You have the ability to analyze all your causes of death based on the codes that you've entered and there's quite a bit of advanced analyses and modeling that's been applied to this information. So we really hope that this will support the Solomon's to look at their cause of death data more. I think also it allows you to come up with measures and estimates of how incomplete your data is. For anyone who's familiar with mortality data you know that it's often very incomplete in many of these countries and it actually comes up with measures of completeness based on cause of death estimates that have been performed by other agencies and other services. So this is a very powerful tool and we think that this will be, we were trying to make this a bit more neater obviously you know you have this whole kind of manual process of uploading the data and things like that but at least now they support a standard file format before it was also a kind of Excel sheet that was very messy. So now that they support the standard file format we might be able to do this a bit cleaner than we have in the past. So this is one example and you know the team in Solomon's we're still working with them have to do some more training with them on this and you know they have you know their familiarity with the stool is increasing over time. So we're gonna kind of continue to work with them and we have some of our partners here from the CDC Foundation, Geerdra and Hafiz who've been supporting a lot of this work as well to kind of make them help them support this implementation. Okay so the other thing that I wanted to quickly talk about was the certificate implementation. This is the example I'm taking is from Laos but actually we're using a testing system obviously I don't wanna show anyone's name or anything like that but this is basically the same type of framework being used now in Laos, in Vanuatu and we brought it over to Latin America and are using it in Honduras and Equatorial Guinea as well. Well, Equatorial Guinea is in Africa just a Spanish speaking country. So what we're able to do is actually produce this certificate in two ways. One is directly inside of DHIs too. The other is through a web portal and this is supported through a, I'll just put this up real quick. I don't wanna go through all the details here but there's kind of a cryptographic component of the certificate being signed so it can be authenticated appropriately and the technology behind this is driving that signing. Suppose that. And you can see the certificate here inside of DHIs that's basically just done directly in the tracker capture application as an extra stage. Then we also have this information is this is a public web portal and this is what Malin was alluding to where we basically allow people to go on and get their own certificate, right? And many countries have this type of service so just a bit of an old one. And there's two services here we can generate the certificate. We can also use that key pairing to verify the certificate as well through that QR code that has been generated. So just see what it loads. Okay, I think the demo is not responding at the moment. I apologize for that. But yeah, so you are able to verify this though when you download it offline. It also works completely offline that's the advantage of this whole system. So the idea is that, using those key pairings you can verify this offline the internet connection in the Pacific is not that great. So there is a mobile app that's also been developed by the Hiss Vietnam team that basically allows you to store this on your mobile device and then you can verify this without an internet connection as well. So the web portal does use internet of course in order to generate and verify the certificate whereas the mobile device you can store these on your mobile device and you do not need an internet connection to store or verify the certificate. Of course you can print it out as a piece of paper as well and carry it around if you need to. So there's a couple of different mechanisms that are used. I apologize that I'm unable to show the portal at the moment. But this has been a bit of a success I think for Vanuatu. We are still working towards providing them with a more robust solution. They asked for the public portal as well and that's taking a little bit more time but that should be hopefully implemented soon. All right, so we're almost nearing the end of the time almost nearing the end of the time for the session. So I think we're going to wrap it up here. If there are questions, Martin has posted a link on the community of practice. Of course anyone in the room, if there are questions feel free to grab myself or Amar and we'll be happy to talk to you. But thank you very much to our presenters from the Solomon Islands and Vanuatu. It's late in the evening there and not so easy remotely but yeah, we'll talk soon. And if there are any questions please feel free to post them on the community. Thank you very much everyone for attending our small session.