 to carry out our deployment in all 260 districts in the country. And so currently, as we speak, yes, as we had earlier on deployed for HIV, we now also have TB Trapper running in all 216 districts of Ghana. Now, what were some of the objectives we thought to achieve? When we did this deployment, there were two key issues. And these issues were meant to solve problems for health information management, especially when it comes to omissions and errors during data collection and entry. And that is a problem that a traditional data capture using the Trapper system is able to help us resolve a lot more effectively. So key things we needed to solve was to introduce this automated traditional data collection system, and then use it to be able to generate our routine data indicators across all the levels of care. And these objectives were directly in line with the mandate of the Ghana Health Service for Insurance Investments. And so we had a buy-in from the managers across the service, and we were able to proceed with this deployment. As part of our deployment strategy, we were able to do some detailed documentation, including the development of a manual that guided end users on how to actually use the TB Trapper. Now, one of the critical things that we communicated during the training session was to provide hands-on training, because it's critical that during these trainings you are able to convince yourself that end users are able to use the system as you have taught them. So, practical sessions were organized during this training, where officers had the opportunity to actually even carry their live TV registers that have live data to the training sessions, and throughout the training sessions they were able to use this live data to purchase how to use the system. And then also during these training sessions, we were able to plan a routine monitoring research so that we are able to support the teams as we go back to the available utilities to continue to purchase data using the Trapper system. Another thing that we also were able to do was to do some post-training sessions, held with the program officers and our regional information officers across the country, so that they would be able to have enough capacity, support, and provide assistance remotely to end users, so that every user query don't have to be handled by the national team at a national level. These cascaded support levels were able to improve how we are able to respond to a number of the issues. Now, what was our TV Trapper system supposed to solve for us? It was to help us track all susceptible TV cases. It was also supposed to help us to track all treatment and outcome as far as TV is concerned, and then also multi-drug resistant TV cases in all our social level hospitals were also being trapped. Our scope of implementation as I have already mentioned is that we are able to implement Trapper in all 260 districts of Ghana, and currently we are able to see that all TV clients are being captured through the Trapper system, and we have also been able to generate the routine reports, that is the TV case registration report and TV treatment outcome report as well as the multi-drug resistant TV report, and so that process has also been automated, and we are currently going through that with facilities being able to capture the data quite effectively, and so you see this DSS screenshot of one of the automated reports that we picked from the system, this is on the TV outcome, and so it reduces drastically issues with data entries errors, if facilities have to enter this report manually by counting from the various registers, and Trapper have been able to help us do this quite effectively. Now, even though we had a number of successes and learning from a lot of the stages that we went through when we developed HIV Trapper, we needed to be a bit more cautious and put in a number of strategies to allow us to deploy this very successfully without the HIV that we had to overcome when we were deploying the HIV Trapper, but key among the issues that we identified from that deployment had to do with the acquisition of the electronic devices that is under-established because you need a lot of that to be able to do a nationwide deployment. And then funding for training of the healthcare providers across the facilities in the country was a challenge, and then of course the big thing is change management where you have to shift people from systems that they were using or they are always doing this back onto a new Trapper system. Then the stability of the Trapper for offline data capture was also one critical thing because once you roll out and then people are capturing data on the app and then it begins to misbehave there is some sort of property that sets in because you capture data and you are unable to send successfully onto the server. So that sometimes affects the enthusiasm with which facilities capture the data. So it was one of the critical things that came up when we deployed the HIV Trapper. So it was one of the things we were looking out for when we started with the CB Trapper as well. Then the abuse of devices by end users and that depends on the issue of MDNs to be able to restrict what the end users can put on these devices and all that. How did we overcome these challenges? It is important to engage your partners very well. When we say partners we need all development partners and then partners within the country who have interest in the capture of CB data or any other service that you want to use electronic systems to one end. So we needed those engagements. We also did a progressive deployment instead of a one-time deployment. So as far as CB Trapper is concerned, based on what we had learned from HIV we did a step-by-step across the districts in the country and so it made it a lot more easier to deploy than we had gone through when we first started with HIV. Then it was also critical to ensure that whatever deployment we were doing the tool itself that we were deploying was meeting the service provider's needs. So they could use it effectively to manage their cases without a lot of hindrance. So the content of the tool was reviewed drastically to make sure that what we are capturing was the very essential data that was needed as far as CB HIV is concerned. And then we had to try multiple versions of the identity wonder was stable for our case and be able to deploy that. Critical was the fact that as far as CB was concerned a lot of the facilities in Ghana that had a number of CB cases that were quite high were largely around the district capital. So most of them are stable internets. So in those districts where we have stable internet apart from deploying the Android app we also spend a lot of time building the capacity of the teams to be able to use the online version that is through the browser either through the Android app that was the Android device that was supplied to them or through any other electronic device that had internet connectivity and could develop into the system. And so whenever they are telling you through the Android app at the absolutely level they are able to switch to the online one to be able to still copy their data and report appropriately. In conclusion now one thing that electronic systems are good they always help solve a lot of problems especially with regards to including the data quality. But the most critical thing that we should always look at for has to be with the human beings that we are going to use to run the system. And when we say human beings it's not just the system developers or maintenance teams but then the end users because they are critical and you if you don't get their buy-in the system may be working effectively but they will simply still not use it. So it was critical for us to get district teams the health information also the facility managers case managers to be able to agree that TV tracker was a better way of managing our TV data as far as improving our information capture and the country was concerned. And when data quality is improved whether it is electronic or you are actually still supporting with some form of paper base it's so better with the attitude of the people that you are working with. So that was a great power lesson for us and we can see that we've gotten a lot more ambassadors at the facility level who have become champions and really push us to be able to improve the system as we go through these deployments. So in a nutshell it's not been too bad but it's been a success deploying TV tracker as well much improved than we did for HIV because as I said earlier when we did the HIV there were number of challenges that we had to go through. Number of iterations before we got the system moving but those ones were largely results when we moved on to the TV because there were certain mistakes or things we overlooked when we deployed that to to contribution to one way plan for TV drop the deployment and that made it quite effective for us. So thank you and I'm not sure this is what we have for you from Ghana. Thank you. Many thanks Oswald. It's very impressive how the deployment of the TV program was in Ghana. We have a question already in the expert launch so I would like to ask Alice if we have to move the discussion to the slide if we just how do you usually um what we can do we can just once again like encourage anyone who has any question to ask to raise them on to to to to write them on slide on this channel and then we would then we'll read them and Oswald will reply to them live. Is that okay Marta? Yes. Yes great um so as you were saying we have we have a first question for you Oswald. Do you have a biometric option for registering TV patients or do you have planned to do so? So with a biometric option for registering TV clients, currently we haven't considered that option largely due to infrastructure availability and some other challenges so as we speak now we are not at any consideration regarding implementing biometrics system for registering TV clients. Thank you and then do you have similar tracker program for HIV if yes is there any interconnectivity between the TB and HIV tracker programs? Yes because what we have done is to run both programs on the same instance so because we do have some data we are capturing in HIV that has some connection with what we have for TB as well so we are running both of them on the same instance. Thank you Oswald. We have another question. How are you dealing with patient identification especially where patients have to be classified? So with patient identification what we have done is to create a unique ID for each TB client that is registered on the system and that is all we are currently running. Again in country we have our national identification authority that is currently deploying the national identification system for all citizens in the country so for the time being we are implementing our own unique ID system for clients that are registered so hope that once the national identification system process is completed we will gradually replace these unique IDs with clients national IDs and that will largely improve how we are able to identify clients on the system. Thank you. Thank you. Another question for those areas that are without networking connectivity how are the facility staff submitting data? Yeah so for facilities that do not have internet connectivity or are quite unstable they largely have to depend on the offline Android app so they capture data offline and then periodically they will have to then move to a location that has better connectivity and then upload their data. Thank you. Then we have another question. What is the general acceptance of stakeholders in this deployment TB and HIV tracker as well as aggregate? Then is data coming from these sources and do they have any quality issue? And final question. Internet connection is a challenge in the third world but how areas with low connectivity are able to manage the Android device in reporting? Well with that to a stakeholder acceptance I can say generally it's been good because based on what we did for HIV and how the system is running now it was a good opportunity to always showcase what HIV is doing and so if we've been able to justify the challenges to deploy TB, a tracker for HIV and work well it was possible to do for TB. So for as far as stakeholder acceptance is concerned for Ghana I would say that it's largely very good and that's largely helped how we are able to deploy the system and talking of quality issues. Largely we have very minimal quality issues as far as the tracker is concerned because a lot of we're building a lot of queries and checks to be able to reduce the error that was literally had users capturing onto the system so data quality issues have largely improved as far as the tracker connection is concerned and as I indicated earlier with regard to internet connectivity where there is very good internet connectivity we deploy both systems both Android and then the online and users are able to see between them as when it is convenient for them. Thank you Zan I have another question. How large is the support team for TB tracker deployment and how many officers do they provide support for? We do have a national team that supports a TB tracker deployment and their team has members from both the DIMS to technical team as well as the national TB program so it's sort of a joint team the M and E listening component from the TB program. Then at the regional industry level then at the regional industry level we have also built capacity for the health information officer who provides direct support to the facilities that capture this data but basically at the national level we have a core team of 10 persons in there that are leading this support as far as the TB tracker deployment is concerned. Thank you so much as well. We don't have any other questions let's give a few seconds to participants so that they can then can write them. Actually what we're going to do because I see that we are now 60 on the call. Anyone who has a question you can just raise your hand here on zoom and you will have the opportunity to ask your question live directly to Oswald so don't hesitate to raise your hand if you have any questions. We have one Mohamed Bamoy you can unmute yourself please go ahead. Yeah I know getting funding for those areas those total counties like Ghana to buy tablets is a bit more difficult so how are you able to convince partners to get an Android device or tablet for all those facilities that are collecting TB data? Okay so if I may answer this question yeah it is true that it is difficult to get these tablets and get partners to be able to support the procurement of tablets for such last year deployment but uh well I say we're fortunate in the planning stage when we put up a proposal to Global Fund and other partners to be able to support part of the plans that we consider critical has to do with these devices for their deployment and so mostly we would always recommend that we do not even ask for the money to procure these devices but to ask them to be able to procure them from there and according to the specifications that we need to be able to deploy them so that's part of our proposal when we were starting a signal for funding to be able to do these deployments and that is how we're able to get that support but it is admittedly not easy to be able to get this partner to support with large scale deployment as we have done in Ghana but it has largely been successful in our case through proposal that we have submitted. Thank you Azad I have another question actually on Slack do you have a sustainability plan to replace tablets as they become damaged or obsolete? So we do have a sustainability plan for the new tablets in Ghana what we have done is that we have made uh managers at the various levels to understand that uh whatever tablets that we have provided at the first uh for the for the during the deployment stage is just a startup for you and so at the facility level if there is a need to increase the number of tablets you need to deploy you need to buy from your internally generated funds to be able to supplement what we have been able to take care of you don't have to afford and then we have also set up uh protocols to allow facilities to buy the device be damaged or it is stolen the facility then takes up the responsibility of replacing that again we have also agreed with the facilities to be able to get authorized service providers for these devices to be able to maintain them when there are damages that can be worked on so for instance if the devices we have to cure are Samsung devices we make sure that we have this maintenance agreements with authorized service outlets that the facilities can link up with to get these devices maintained for them but largely it's the duty of the facilities to replace damaged or stolen devices by uh extra work to be able to do their deploy uh their data capture as they need to arrive thank you as well um any other questions from the participants you can raise your hands and you would have the mic I have a question for Oswald actually I think Oswald you explained it in the early slides if you want to go back um but I would like to understand in a simple way the the how long did it take the deployment and how did you face it like how how did you organize your your implementation in terms of timing and scope I think you had a slide before but if you can share some details on that because I think for being a countrywide implementation it's being quite fast I I'm under the impression so I understand you you had the experience from HIV and probably some hardware already distributed but I think it would be very interesting to hear a bit about that okay so largely what we did was to have about five teams we created five teams where we had two kena card team members and then two from the M&E team from the national tv program and then we moved from one region to the other to carry out that deployment I think it took us about uh about about four to six weeks to do their deployment of course one of the challenges we face of course was the issue with COVID because by then we had COVID going on so the numbers that we could train per region had to be managed in a way that we are able to adhere to COVID protocols so we had multiple sessions in some regions to be able to carry out that deployment but it was largely successful within the time frame that we set out into it okay thank you let's give a few seconds to participants who want to to ask questions you can raise your hand okay I think there is no more questions now um just got too long response first sorry what did you say we just got too longer raised his hand oh sorry I didn't see that sorry Tiwongi just a minute and you have the pro yes please ask your question Tiwongi all right uh thank you sir I think you just wanted some clarification in terms of uh user support how are user support arrangements like in terms of let's say escalating issues or providing immediate uh response to users when they face challenges what are the arrangements that will make what issues are you facing if I got your question right you are talking of user support and so we uh gonna have uh we have levels across the country so uh at the facility level who are the end users at the district we have the first level of user support so you have the district health information officers and then the TBMAE officers who are the district level that is the first line of support and then at the regional level we have the regional health information officers that coordinate the support levels as far as the region is concerned then we have the national level where we have the core team that I mentioned earlier coordinating the support that goes out to the users so we largely uh will have issues travel as far back as far high to the national level if it becomes a major issue that is not able to uh district and regional officers are not able to resolve for any users then you will have the national teams coming in to be able to resolve them but we have clear uh documented rules for each of these levels on what they need to do or that what type of support that needs to end users thank you thank you thank you so much as well um I don't see any other questions so I think we can we can end the the lounge session now Marta Raimei is that okay yes yes that's uh that's very okay thank you so much uh Osvald for your availability and for replying to these questions and for this great presentation thank you so much oh now we see you as well hello thank you very much hi Marta thank you thank you all right no thank you it's it's been it's a great presentation and I was looking forward to see the presentation for your tv deployment which is a improved version of your hiv deployment right thank you thank you thank you very much thank you I'm sorry we'll be in contact so I think uh then um Alice I think we can because that was the content for today we will have more time for real cases and presentations on Thursday at the same time and then for questions we come out on Friday early morning but I think now we could stay for travel shooting um um uh if anyone hi me yes someone is speaking but it's very low I can't hear hi Marta should we um stop the recording now yes we can