 sure to stop that so because online they were saying like it's similar there you're somewhere is bombing in the in general let's say no hopefully not even we are going to talk about the emergency we are not in that situation okay that one's just about a bunch yeah we will take your name so when you got the mute button on that just foot no at the end but the problem is that uh uh we have this presentation and there is that it's a 345 yeah yeah so we should see we should try to end you know before okay but okay if you're ready to get going what we it's very high so I think we can start with us um we have a similar presentation in this uh uh session for uh we get used to when we use in the emergency so maybe we can uh get started so thank you very much for please hear me as well for the online attendance and I mean I want to put through a very big introduction as we are going to have a six different presentation and an introduction done as well by um by WHO uh colleague so normally you know with a emergency or response I mean it's a challenge to have system by way then the efficiency for the management is crucial on the response and as well in the after in the phase after the emergency so we saw how we are going to see how he chased through with his capacity of adaptability and implementation is going to play a key role on uh on this so without any further I want to introduce or to introduce sorry Carl Schenker from WHO which is going to do an introduction to the qualities of radiance for how the emergency preparedness response and resilience thank you thanks a lot so colleagues um I'm going to to provide you with a brief overview of the new strategic approach of WHO headquarters and regions where the integration of the regional approaches actually but it's the overarching principle and many things have already been said and stuff and actually I I don't have to to start again with this presentation one of the less I provided a brief overview I think there's going to be more um we look also presenting later on the integration of products of early warning and and that's why I'm not um emphasizing those aspects too much so there's going to be more later uh so I wanted to talk about um Schenker the health emergency preparedness response and response and resilience framework that the DG WHO has announced a while ago this is a framework that is meant to improve health a global health emergency preparedness and under this framework there have been five interconnected components defined and one of them is collaborative surveillance no collaborative surveillance on the right hand side you find on this slide your definition I won't spell it out but it's mainly about understanding surveillance in a new approach about multiple information sources so one of the major lessons learned not only from COVID-19 but also other major recent events such as Ebola in African countries has been that if you follow just a very autodox classical surveillance approach around indicator based surveillance and hopefully some elements of event based surveillance but it's not enough often to translate that into adequate timely public health action so we need to expand this concept towards other partial contextual components which are around or connect them to the information on the health system the availability of hospital beds ICU beds oxygen supplies vaccination coverage et cetera et cetera effectiveness effectiveness of the health workforce and many other things and all that needs to be contextualized and helps us to triangulate the existing surveillance information into the most effective public health action so the lessons learned are most others that we need to know about health services are the coping which are the most affected and most vulnerable population parts the decision making in the beginning of an event is this a true outbreak or is it a pseudo outbreak and how are we going to follow up this how many cases and deaths do we have to monitor each day on a day-to-day basis in the ongoing event monitoring and then how to adjust the response which are the additional resource needs that we have our interventions effective or do they need to have have need to be amended and last but not least all the biological information once virus have been birthed for other pathogens which variants are circulating which are the most dangerous ones and so on but at the heart of this concept is really that we are talking here about multiple information sources not only in the public health sector but also across the other sectors so you see this is clearly a concept that addresses equally the animal veterinary and agricultural sector and the environmental sector we're talking here about integration within uh between into uh indicator based surveillance and event based surveillance which ideally is integrated in in national health systems we're going beyond this this concept and integrate here healthcare availability information contextualized information also behavior and society in insights for example compliance to social distancing measures social mobility data um that you can derive from cell phones and and and specific hazards and threats in the so-called vertical disease silos integrating them across the horizontal early detection needs and able to better is at the heart of this concept of collaborative surveillance so the three main objectives here are once has been mentioned integration of integration has been mentioned here from Steph and neuroscience um number two um that is mainly around um the lab needs and lab strengthening capacities amongst others point of care testing and the need for strengthening national capacities for genomic surveillance number three is mainly talking about collaborative approaches for event detection that here means interoperability we need to make systems speak together uh across electronic platforms we need the necessary amount of standardization and integration also in the IT piece and I think the principles all those objectives are underpinned by certain angles around governance a sustainable financing culture of trust I think is quite mentionable and um under this framework we have a very comprehensive set of um very detailed capabilities defined and I'm going to show you a few of them in the next slides so again back to multisource surveillance um that has been mentioned a couple of times um lab surveillance needs event-based surveillance needs for early detection indicator-based surveillance including from other sectors such as the animal sectors economy social insights people's mobility health care availability and health and strain on health system information from hospitals hospitalization ICU admissions oxygen supplies vaccine coverage the effectiveness of the health workforce and drug outbreaks around that all that needs to be seen together as you kind of mentioned these different surveillance needs are different across the event life cycle so uh in the peacetime let's say you have very much an emphasis usually on something else of event systems and indicator-based surveillance there's an early event phase we have a huge emphasis on event-based surveillance and then later in the event you're pulling more and more information in around the burden on on the health systems for example and that improves decision-making process so different needs across different event times and how is this now being done on the IT side and I'm I have apologies here for an example from Uganda which is quite out there that I want to learn from to do you uh injustice prosper uh this is from 2010 it's a bit outdated but it's just illustrating I don't take this sort to seriously the different systems in one country only um how surveillance data and other data are captured across which levels and that platforms data collection tools then feeding into data warehouses and then tools for data visualization and that goes together and and then different APIs working together to make some of the systems speak together others not ever that occurs in one country as you can see this huge choice of solutions and options and forgive me if that is a bit outdated meanwhile so what is the pain what is what is the problem here with this data collection systems there's data fragmentation that has been mentioned a couple of times today we have multiple forms multiple formats multiple interests multiple winners behind different diseases with different standards uh some of them using suspect cases others not all these different case definitions need to harmonize uh that better then the publication of data collection efforts is quite different across all these different systems and tools there's limited guidance on standards and norms for unified and more harmonized indicators and the metadata around them how they can feed into systems last not least the later inconsistent adoption of tabular surveillance guidelines and again these surveillance guidelines given by tabular H4 are not necessarily harmonized they are different in methodology according to uh the vertical disease program needs and backgrounds for monitoring and then referring this approach of disease monitoring then the standardized approach for integrated surveillance now we're talking about these capabilities under the hyper collaborative surveillance framework we have 1.1 which is talking about integration and aspects and just picking here a few of them you can see how this all speaks now to those needs that I have mentioned before there's mentioning of the integration of routine surveillance capacities across disease and threat specific verticals that is between the vertical disease programs and then that being connected to the horizontal early detection needs that we have to event-based surveillance and I know there are good efforts here in DHIS2 of integrating those indicator-based surveillance data with event-based surveillance data for example and then Miroka is going to speak later on other specific early warning needs and a system provided by WHO very important aspect health service capacity access and usage monitoring there has been mentioning of theorems in emergency situations in the countries that is really one contextual information need that we can ideally integrate through DHIS2 because DHIS2 per se is a broader health information system that captures these kind of information and that is really an opportunity here for collaborative surveillance approach further contextual community and one health insights that are very interesting meeting a couple of weeks ago in Rome hosted by FAO Food and Agriculture Organization of the United Nations discussing here how can we bring together human public health surveillance information and animal information from the Empress I surveillance system in such countries hosting both of the systems or just one of the systems DHIS2 I'm talking here about very detailed about the data models and this is really a very concrete approach of integrating sectoral information from these two sectors at the human-animal interface that is ongoing and work in progress and further collaboration at the need to really strengthen digitalized data collection on the ground and bottom up around lab just one of many others integration of point of care diagnostic results into national surveillance systems that need to integrate best digitalized end of care lab results into existing surveillance databases and last but not least the inter-operational parts integrate with not an infrastructure scalable technology interfaces a lot has been mentioned here around API's integration of data systems but we also need and this is what we want to work on at least we want to in the next couple of months take the temperature what is talked with the global donors with the PDC's programs around that what is the appetite for better harmonizing the data standards and the metadata for all diseases for one integrated surveillance systems this is what we're going to start on also in discussion with the global donors of the very strong verticalized data systems but we're following here amongst others this is just one of the major overarching principles there's much more there's the it has been mentioned here the WHO data standards but we're also following here the global strategy on digital health which is talking and emphasizing about the consortium health data standards reusability reusable systems or assets digital technologies shared services and the good comparable quality of services through digital tools and last but not least the need to better harmonize syntactic and semantic interoperability between many different tools overarching principles are the smart guidelines also hosted by WHO not going too much into details here but it's mainly about prescription and the description of the existing data models and preparing them to go digitally and then really looking in the very granular details in whatever needs to make these components in digital systems interoperable and translating them to software these are the smart guidelines so the future of all this what we're thinking we're thinking first of all about harmonized case type emissions we don't know if we can achieve this but this is what we want to work about but also reporting standards for exposure to information for example screen exposure information around food safety food exposure sexual practices any kind of exposure that is important for reporting and contextualizing epidemiological information and so we're talking here about the non-functional requirements and how to make this data interoperable across many many systems and the concept we are following here is data normalization in the hl7 based fire interoperability technology that's leading into different various data warehouses and then connecting with data visualization tools across those tools and we have already started this work for example hl7 fire based on data dictionary and wireframes are coming from the WHO co-data application and we have here at least a framework and data capturing templates that are following this standard so last but not least I meant to just as a new division in Geneva and Berlin division for surveillance systems and how can we help and all those in all those attempts to make things better interoperable and harmonize and basically have three overarching activities connection innovation and strengthening so we're really here together with colleagues in Berlin in looking a lot into catalyzing efforts catalyzing funding convening communities of practice incubating cutting-edge initiatives and technologies very much emphasis in Berlin on open source information for public health intelligence but also strengthening standards and we are building up here repository of up-to-date best practices norms but also status standards we have in mind for surveillance that are better harmonized thank you very much and i'm open for your questions or after probably first this and this thank you very much i mean the other points we're touching during presentation talking about indicator brain surveillance even the surveillance this point i saw it will be touched by rebecca in the last in the last presentation as well integration with the response to an emergency with the other domain i mean an amazing response is really a huge word so thank you very much cut and now i want to introduce the expert we need to present the the experience of the response of the uh rebecca that was recently uh in the country we will at the end of the session if it's okay thank you very much and we prepare you the present okay yeah thank you very much uh good afternoon um just to share a little bit about the experience of using uh dhs2 in an outbreak we used the we the recent um a outbreak in Uganda that was a last year september october which had a few cases as i will share uh but with each of us to want to see what we are able to do so i'm going to talk a little bit about uh some rudimentary way of you know what most of you may now think is outdated that is the sms uh i know in this room very few people use sms to you know communicate here we have all moved to whatsapp and only other types of chats but um this church will be different uh in where you know it matters and these are the communities where you probably sometimes don't have connectivity you don't have for data you don't have a sms i also in the disease surveillance and imagines you really need to be able to reach such communities because this is where it all starts from so i will talk you through um a few things that we've been able to do over time that have really gotten us to being able to respond some of these emergencies uh quite in time to be able to you know shorten the the length um so um for Uganda for any time we've been trying to use details to uh for case-based surveillance but this case-based surveillance um looking at the journey since we started uh it's one of the implementation but it's quite very challenging and very expensive to implement the arrival so we switched a little bit to see how can we start to you know start generating some of the things so within the interest tool we have the um the tracker uh which is uh used for you know case notification lab result team and the you know analytics um really looking at also feedback and timely sms and emails notifications to the different stakeholders or the different players uh in an outbreak or in disease surveillance so this is part of the efforts that we have moved with um for since 2013 and i'm basically missing the whole flow of how our disease surveillance uh is meant to work some pieces may not be working very well but at least some pieces are working okay uh we do really look at what we call rumors for some of you who have been involved in the disease surveillance but what we call it alerts in in Uganda and this is basically based on an sms notification uh an unstructured sms that really gets us started to ensure that we are able to you know get to the person who is reporting and and be able to start the whole process so um this is the kind of thing uh as it is um um really just starting with an sms uh anybody sending an sms and then we are able to get back to them so to us it's more being able to register the phone number or the person who is trying to talk uh and then we can be able to call them and you know um and be able to get more information which information is really really key for for surveillance that you can even you know start and then you're able to to reach out to them so um this uh sms is uh it's not something that we've been able to add on so uh whichever system you have you will be able to you know in configure sms seems to be received by the chios too and be able to be rebroadcasted so that comes into our center database which we're calling the eid sr and um because these are uncoded sms uh so you will be able to write a number where it's coming from so it could be coming from uh you know a different district or different community and you now want to start doing the tracking and the and and try to find out where this comes from so that you guide it to the right people to be able to respond the nearby community and they respond as we can be able to communicate so once the message is received it's able to be viewed by different pillars and um just that text message is you know to have it configured trying to pick a few information sometimes you have to call this person and get you know to where they are located so that we direct this message into to the right um team which is nearby and can be able to respond immediately and I want to we are keeping the log of the actions that are happening uh from the time of receiving the message after the time of when the person or the case has been reached uh case investigation done even what's done so we have that log that we keep around and then uh the most biggest players are the district developers who are near uh some of these um uh points or for intervention so this is typically how it was um anybody who has a abandoned registered SIM card you can just go on your phone and just type a large and just send to six seven six seven now the six seven six seven code is a toll free uh government paid uh code so that also this allows us to reach multiple people um during the most people I looked out with even going they were to buy uh data bundles so with this kind of communication they could be able to communicate out of their bedrooms out of their laptops and we are able to reach out them into it to be able to get more information or people who are allowed to move while allowed to go into that location and be able to meet so actually is having um this irate even if somebody just stops there we'll be able to register the phone number and then we can get back to them and and and find out more information again in terms of feedback once that the message is sent the system automatically sends you a message telling you that your message has been received and somebody is going to reach out to you so at the central team and the different regions uh public and against regions you have for any users we are looking at this system and able to look at these messages as they come in so this is uh what we are able to add on each other so just the sms management all these reasons I have seen and stored within each other but the realisation of these reasons is what we are in for we have enhanced so that we have an easy to use platform and an equal form that can be able to help us to uh you know encourage the whole um the way through the investigation so um these are users it could be a natural removal of regional overseas or district I am able to see this message is already coming and you cannot see here one is able to arrive on a suspected apparatus uh just out in the community there and once it comes uh we are going to forward it to the right district by just clicking on this and then this is what your uh interface you are getting that feeds into your network of what you are tracking so at this point you are able to extract some more information from the message but also you can also be able to reach out to the reporter because they have their phone number and you will be able to fill this information but as the jurisdiction is going once the district has also started they has received this notification so once we receive this the notification is sent to the right district that we have selected here like for example this city here and you also be able to receive a message on their email and their dashboard and also on their uh uh phone that there is now an investigation that they need to carry on so at that point we are now the the the Cascade will continue and by the end of the day we should be able to see that what all the pieces have been touched and we can be able to tell what has happened sometimes these are false alerts or sometimes they are potential uh how it breaks the I mean potential cases that we need to follow up uh so this is when each of the districts this is basically what happens at the district so at the district they can follow up with the community the program to bring the information uh and this is you know the phone call back to them um support what to do I mean if it's a case that they need to isolate at that point you're already now beginning to you know put in some uh emergency measures to to be able to support this but if that requires that the district now goes in to investigate so they will get out with their case investigation form and they will go in the lab equipment to be able to collect the sample and at that point they are also able now to enter into a tracker and enter now the whole first case investigation and once that is entered again we have the notification to the different labs to be able to prepare for a sample that is coming their way for testing so this will be now handled at the district level uh so this is what our case notification form looks integrated cross case investigation group uh film for both human and uh and animal and artificial disasters and again this I'm trying to show that again with SMS we are able to quickly be able to notify the different the very different groups uh it is certainly like we have groups over uh the different disease domains uh to be able to notify them that there is something happening so it could be at the point of lab results it could be at the point of you know um the the the case has been not uh registered into the system and this again are the students which we will have for most of our case info uh flips uh for the different case investigation