 So, thank you very much. We see under as well for the online attendance. And I mean, I want to put through a very big introduction is we are going to have a six different presentation, and an introduction done as well by by WHO colleague. You know, the agency or response, I mean, it's challenge to have system by the end, the efficiency for management is crucial on the response and as well in the after in the phase after the emergency. So we saw, we are going to see how the chase through with his capacity of adaptability and implementation is going to play a key role on on this. So, without my father, I want to introduce, I want to introduce, sorry, Kyle Shankers from WHO, which is going to do an introduction to the communities to radiance for health emergency preparedness, response and resilience. Thank you. Thanks a lot. So colleagues. Thank you to provide you with a brief overview of the new strategic approach of WHO headquarters and regions will integrate many of the regional approaches actually but it's the overarching principle and many things have already been said, and stuff and actually I don't have to to start again with this presentation. So unless I provided a brief overview. I think there's going to be no real cause also presenting later on the integration of products of early warning. And that's why I'm not emphasizing those aspects too much so there's going to be more later. So I wanted to talk about her health emergency preparedness response and response and resilience framework that the DGW has announced a while ago, and 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. So surveillance on the right hand side you find on this slide, the definition I want to spread it out but it's mainly about understanding surveillance in a new approach about multiple information sources so one of the major lessons learned from COVID-19 but also other major recent events such as Ebola in African countries has been that if you follow just the very orthodox 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 part of contextual components, which are around or connect them to the information on the health availability of hospital beds, ICU beds, oxygen supplies, vaccination coverage, etc, etc, 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 hearts. 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. And that's how 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 the need to be amended. And last but not least, all the biological information once virus have been both for other pathogens, which variants are circulating, which are the most dangerous ones, and so on. So one 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 the environmental sector and the environmental sector. We're talking here about integration, we think, between into indicators of those surveillance and event based surveillance which I believe is integrated in national health systems. And beyond this, this concept and integrate here, health care availability information contextualized information also behavioral and society insights, for example, compliance to social distancing measures. And the social mobility data that you can derive from cell phones, and a specific hazard threats in the so called vertical disease silos, integrating them across the horizontal early detection needs. And that together is at the heart of this concept of collaborative surveillance. The three main objectives here are once has been mentioned integration, integration has been mentioned here from staff and neuroscience. Number two, that is mainly around the lab needs and that that strengthening capacities, amongst others, kind of clear 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 the probability. We need to make systems speak together across electronic platforms we need the necessary amount of standardization and integration also in the IT piece. For instance, but all those objectives are underpinned by certain English around governance, sustainable financing culture of trust I think is quite mentionable. And under this frame where we have a very comprehensive set of detailed capabilities defined and I'm going to show you a few of them in the next slides. Back to multi source surveillance. That has been mentioned a couple of times. Lab surveillance needs event based surveillance needs for early detection indicator based surveillance, including from other sectors, such as the animal sectors. There are many social insights people's mobility, health care availability and health and strain on health system information from hospitals, hospitalization I see your admissions, oxygen supplies, vaccine coverage. The effectiveness of the health workforce and drop out rates around that all that needs to be seen together. These different surveillance needs are different across the event life cycle so in the peacetime let's say you have very much an emphasis usually on something else over in systems and indicator surveillance. There's an early event phase. A huge emphasis on event based surveillance. And then later in your event, you're pulling more and more information around the burden 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 apologize here for example from Uganda which is quite out there that I want to learn from to do you injustice prosper. This is from 2010 it's a bit outdated but it's just illustrating. So it takes us to serious the different systems in one country only on 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. So that goes together. And, and then different API is working together to make some of the systems speak to whether others not ever that occurs in one country and as you can see this huge choice of solutions and options and forgive me if that is with outdated meanwhile. 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 firms multiple firm ones, multiple interests multiple winners behind different diseases with different standards. Some of them using suspect cases others not always different case definitions need to harmonize that better. The duplication of data collection efforts is quite different across all these different systems and tools. There's a lot of guidance on standards and norms for unified and more harmonized indicators and the metadata around them how they can feed into systems. These delayed and inconsistent adoption of tablet show surveillance guidelines and again these surveillance guidelines given by tablet show. I'm not necessarily harmonized they are different in methodology, according to the vertical disease program needs and backgrounds for monitoring and then referring this approach of disease monitoring than the standardized approach for integrated surveillance. These capabilities under the hyper collaborative surveillance framework, we have one point one 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 that I have mentioned before. One 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 the highest tool of integrating those indicator based surveillance data with event based surveillance data for example. And you guys can speak later on other specific early warning needs and a system provided by WHL. Very important aspect health service capacity access and use such monitoring there has been mentioned in our forums in emergency situations emerge into the countries. There is only one contextual information need that we can ideally integrate through the highest tool because the highest tool per se is a broader health information system that captures these kinds of information. And that is really an opportunity here for collaborative surveillance approach. So the contextual community and one health insights that are very interesting meeting a couple of weeks ago in Rome, hosted by a file 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. 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 I'm going and work in progress. And with our collaboration, the need to really strengthen digitalized data collection on the ground, and bottom up around lab just run amongst many others integration of point of care diagnostic results into national surveillance systems that need to integrate best digitalized end of care lap results into existing surveillance databases. And last but not least, the inter operational parts integrate with not an infrastructure scaleable technology interfaces a lot has been mentioned here around API is integration of data systems, but we also need and this is what we want to work on at least we want to take the next couple of months, take the temperature what is talked with the global donors with the pvc'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. And amongst others, and this is just one of the major overarching principles there's much more. There's the, it has been mentioned here that the WHO data standards. We're having here the strategy on digital health, which is talking and emphasizing about the source health data standards, reusability reusable systems or assets. Digital technologies shared services and the good comparable quality of services to digital tools. This is the need to better harmonize syntactic and semantic interoperability between many different tools. The overarching principles are the smart guidelines also hosted by the WHO and not going too much into details here. But it's mainly about prescription and the description of the system data models and preparing to go to digital digitally and then really looking in the very granular details in whatever needs to make these components in touch with systems in the operable 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 would be we don't know if we can achieve this but this is what we want to work about but also report them standard for exposure to information for example. So we're taking exposure information around food safety, food exposure, sexual practices, any kind of exposure that is important for reporting and contextualizing epidemiological information. We're talking here about the main functional requirements and how to make this data interoperable across many, many systems. And the concept they're following here is data normalization in the HL7 based fire interoperability technology. That's eating into different various state of the warehouses and then connecting the data visual visualization tools across those tools. We have already started this work for example, HL7 fire based on data dictionary and wireframes are coming from the WTO data application, and we have here at least a framework and data capturing templates that are following the standard. So last but not least I meant to adjust as a new division in Geneva and Berlin division for surveillance systems and how can we help and all those, you know those attempts to make things better interoperable and harmonize and basically have three over working activities, connection, innovation and strengthening. So we're really here together with colleagues in Berlin in looking a lot into catalyzing efforts catalyzing funding, community communities of practice, including cutting edge initiatives and technologies, very much emphasis 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. Thank you very much for this and this. Thank you very much. Thank you very much. Thank you for our indicator brains 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 response to emergency with other women. And Dr use the user is going to present us the, the experience of the response of the public that was recently in the country. The end of the session if it's okay. Thank you very much. Okay. Yeah, thank you very much. Good afternoon. Just to share a little bit about the experience of using DHS to in an outbreak. So we use the with the recent about breaking Uganda that was a last year, September, October, which had a few cases as I will share. But it was just to want to see what we are able to do. So I'm going to talk a little bit about some of the mentality way of, you know, what most of you may now think is out today that is the SMS. In this room, very few people use SMS to, you know, communicate here we have all moved to WhatsApp. I don't have a types of charts but I'm just trying to be different in a way, you know, it matters, and these are the communities where you probably sometimes don't have connectivity, you don't have data, you don't have a smart phone. And so in the disease surveillance and my guess you really need to be able to reach such communities because this is where it all starts from. So I will take you through 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, quite in time to be able to, you know, shorten the, the length. So for any time we've been trying to use details to focus best surveillance, but this case based surveillance, looking at the journey since we started. It's one of the implementation but it's quite very challenging and very expensive to implement to the level. So we've switched a little bit to see how can we start to, you know, start generating some of the things so we have the tracker, which is used for, you know, case notification, the resulting and analytics. We're looking at also feedback and timely SMS and emails notifications to the different stakeholders or the different players in an outbreak or in disease surveillance. So this is part of the efforts that we have moved with for since 2013. And basically this is the whole flow of how is this surveillance is meant to work. Some pieces may not be working very well, but at least some pieces are working okay. We do really look at what we call for some of you who have been involved in this surveillance, but what we call it alerts in Uganda and this is basically based on an SMS notification and unstructured SMS that really gets us started to ensure that we are able to, you know, get to the person who is reporting and be able to start the whole process. So this is the kind of thing as it is really just starting with an SMS, 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 of the person who is trying to report, and then we can be able to call them and be able to get more information. Which information is really, really key for surveillance that you can even start and then you're able to reach out to them. So this SMS is, it's not something that we've been able to add on, so whichever system you have, you will be able to, you know, in configure that SMS is to be received by the CHIS too, and be able to be re-broadcasted. So that comes into our center database which we are calling the EIDSR. And because these un-coded SMSs, so you may not write a link where it's coming from, so it could be coming from, you know, a different street or different community, and you don't want to start doing the charging and then, and try to find out where this comes from so that you guide it to the right people to be able to respond. So once that message is received, it's able to be viewed by different builders, and just that text message is, you know, to have it configured, try 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 the right team which is nearby and can be able to respond immediately. And I know that we are keeping the log of the actions that are happening from the time we're receiving the message, after the time of when the person or the case has been reached, the case investigation is done, even if that's done, so we have that log that we keep on. And then the most biggest players at the district, a lot of those who are near some of these points or for intervention. So this is typically how it was, anybody who has in Uganda registered SIM card you can just go in your phone and just type a large and just send to 6767. Now the 6767 code is a toll free government paid code so that also this allows us to reach multiple people. I know that most people are working on going to buy data bundles so with this kind of communication, they could be able to communicate out of their bedrooms, out of their lookups, and we are able to reach out to them to be able to get more information or people who are allowed to go into that location and be able to meet. The other thing is having this irate, even if somebody just stops there, we will be able to register the phone number and then we can get back to them and find out more information. Again, in terms of feedback once that the message is sent, the system automatically sends you. The message tells you that your message has been received and somebody is going to reach out to you. So at the same team, and the different regions, public management regions you have for any users who are looking at this system and they're able to look at these messages as they come in. So this is what we are able to add on which I used to, for just the SMS management, all these messages I've seen and stored within which I used to, but the realisation of these messages is what we have enhanced. So that we have an easy to use platform and an equal phone that can be able to help us to, you know, encourage the whole way through the investigation. So different 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 when it was able to arrive on a suspected apparatus just out in the community there. And once it comes, we are able to forward it to the right district by just clicking on this and then this is what your 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. And then as the jurisdiction is going, once the district has also started, it 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 will also be able to receive a message on their email and their dashboard, and also on their screen, that they use now an installation that they need to carry on. So at that point, we are now in the cascade we continue and we should be able to see that what 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 outbreaks, I mean potential cases that we need to fill up. So this is where the district, 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, and this is you know the phone call back to them. So what they want 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, putting some emergency measures to be able to support this. Then 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. So this is what our case notification form looks like in the case investigation form for both human and animal and artificial disasters. And again this is something to show that again with SMS we are able to quickly be able to notify the different, the very different groups. And certainly we have groups of the different disease domains 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, the case has been not registered into the system. This again are the stages which we will have for most of our case information for the different case investigation outcomes. So at this point again we are also using SMSs to be able to notify the different groups, even including the district responders who have started on this case. With this we will be able to at least sort by sort of scale. This may be its name in the scale because when you look at since 2013 and the whole country has not been covered. In the past we've been able to train about 112 and 12 districts out of 140 80 districts and the points of entry and then covered it really supported and expanded to more health centers and more and more community health workers. So this is the dashboard that the different groups will be monitoring as far as these SMSs are coming and the log is being updated. It will be around which signals are open, which have been closed on the understeering investigation and it will be showing the different actions that have been taken along the way. So if it was for the district, the district was able to go and pick samples that will also be reported in here. And also the kind of suspected decisions that have come out of this whole investigation. And you could see a lot of it was for last year was around for that particular period. It was around the age of the Ebola and then also the action taken. This dashboard is available to the national level for the different players for this surveillance, the imagines public lab center surveillance team, the division of health and also the other partners who are also involved this and the regional teams, the subnational teams will be able to see what is pending on their side to be able to quickly take action. So this is doing the timing and where is the actual coming from. And as you can see, all the timing, they are going into an area where we had the outbreak which is this region. But all the same, at least we're able to see signals across the entire country. And again, this was really helpful in trying to find out where the disease is now going and spreading. So we are able to send our disease surveillance into some kind of repository. My colleagues shared about the so many systems that have been used in Uganda, the situation may not have changed a lot. And essentially when it comes to outbreak and disease surveillance, there are quite a number of systems that come up and you know, and then the, you know, those which have been in the covers are coming up. So as, as a data store and you know, so we've, we've tried to at least work with the different systems to make this as a repository. So I study outbreak and for COVID and Ebola. Most of the data has been now deposited into here that we are using for dashboard presentation and also for file analysis and also the data warehouse that is being prepared. So this can happen without challenges and to the extent of having, you know, this number of Ebola cases, unfortunately there's about 56 and good recoveries of 86 survivors who actually were still using the tracker. We're tracking them over time for a given period of time. But the most challenges that we do first and first of course is the multiple systems, the new systems that come in, especially when the outbreak comes, that's when everybody now gets into development, gets into the country, and they bring in systems which are not, you know, not being used a little bit deprecative. And again, I don't know. I don't know. I don't know. Of course, the sources are always going to be the biggest challenge. This is not new in terms of the play, especially when they went in times of outbreak. It involves movement issues to be able to move to the areas where you can be able to train the printer and the field teams. Of course infrastructure becomes a big challenge. Again, I've shared that, much as we are all moving out of SNS, the lower levels still have challenges of internet connectivity for us to be able to enter these cases directly or even enter them offline and come and upload. So, as you can see, there are always new kinds of new sectors which are popping up because they also want to be involved in the response. Then again also, as for some of these outbreaks, they are very, very sensitive. A positive case will not be announced or published so quickly. So some of the systems in terms of integrating the lab becomes quite challenging. That's the best coordination of the multiple players. As I said, many players are now coming to play and able to support, but disorganize the whole data management. And in terms of lessons learned last week, we do learn that even if you are not in the public, you need to have your surveillance systems up and running. Most of us have always remembered our surveillance systems to come up when they have said, oh, there is an outbreak. That's when we pull them up. But if systems like as I shared, if we have children come up behind count and whatever, I think we've been able to pick that first case immediately. We need to make sure the systems are supported, even when there is an outbreak. So don't cut the monitor when the outbreak ends. Let's have it continuously forward to have these systems supported. Harmonization of these tools, again, we see that you didn't allow to break so many tools, so many requirements come up. We cannot harmonize to we still have this if it integrated systems, then the lab is a big key and a big role in terms of our direction. And this is where the connection is really, really key. Then also piece for data collection data management are very key for us to be able to manage during the emergencies. The intersex or intellectual sexual populations very key. We did find out that, you know, it's not only here that is in here, the children are in school, the farmers are printing. So you need to bring all your sectors, even when you are outside the, the, the, the margins where the output, but if you can start integrating with them along the way before the emergency that is very key. The one health we have been talking about is really key that we can be able to bring here. So last thing I want to appreciate and thank the team, the different partners that were supporting in this outbreak. And a lot of these partners really supported the SMS. I think at this point for the Ebola, this SMS platform really came out handy and very strongly that every of these partners was really eating it to eat because this was the first information from the different communities, reliable information and quick. So I'm grateful to be able to support this implementation. Thank you. Thank you very much. And it was super interesting to see how a system that is used, that was already used before the Ebola outbreaks in the, integrating the LHIS finally has been a key component in the response of an outbreak. So now I would like to call off and run a ship that is going to talk about the LHIS through integration during the Pakistani flu. So I will leave the floor to him. Thank you very much. Okay. Thank you so much for giving me the opportunity and maybe the non machine and I'm leading his Pakistan so we are a new his group, I mean we've been established like only two years ago but I would take up over where possible left that we need to prepare during the peace in order to fight in wars. So we need to keep our systems up and running whether it was an outbreak or not. So we learned this during our, I mean during the floods that happened in Pakistan. We had this IDSR system already in place by NIH it was it was being run there with the support of UKHS and WHS and one of my colleagues from UKHS is online he'll be presenting a very specific case of flooding in KPK province where there were a lot of losses so so this flooding I remember basically washed 70% of Pakistan and it didn't end there I mean when they reached the lower plains it's still there for like six to eight months and still we and then it all started you know small outbreaks happening everywhere in in camps and everything. So we thought of using the system that already had and we had it in place that was IDSR and then there was some system that Punjab implemented in terms of HMIS with the support of UNICEF. So just first I'll just give you a background with the whole IDSR was implemented and HMIS was implemented so it all started in 2018 with the support of CDC Atlanta and UKHS and NIH basically started implementing the IDSR. I used to work for CDC Atlanta at that time and I was the one who configured the system at that time. CDC provided some funding in the UKHS here so complemented it so we were able to pilot it around eight districts with the priority diseases that the government had decided at that time. Then after the piloting of these eight districts when the bloach came into action and they saw that this 24 diseases were required by them in five ground effective districts of Sindh and Balochistan. So there we started scaling up with this IDSR system. So in 2021 NIH decided to let's move from pilot phase and to the complete launch. So no districts were added and now currently if you see there are around 114 districts that are functioning on IDSR on weekly reporting and they are reporting on 33 communicable diseases that were prioritized by the government. So out of 152 only I mean they managed to activate 114 and only fewer left and hopefully they'll be done and then there was some government funding coming in from the government after realizing the fact that IDSR has been very productive in terms of data. So this is just an overview of the map of Pakistan. The group basically tells you the activated districts of Pakistan so there are a few districts in Punjab, few in Balochistan and some in KPK who are left. However, Sindh and Kashmir has been fully activated, which is a great success. So, I mean, we are in talks with IDSR and especially and we are trying to improve the program for it's an aggregate system with no linkage to laboratories. So we are basically suggesting to let's get some data out of the labs to get the confirmation cases. Finally, it represents the public sector health facilities which is which caters for like 30% of the population. So we are basically pushing them to let's integrate with the private sector as well. So when there are some integrations. I mean there have been a lot of talks around integration since morning so I will not go into that. Yeah, and then we have this another, not parallel but the horizontal system that UNICEF with the support of UNICEF Punjab was able to deploy it in 2018. It was piloted in five districts in Punjab and when it's spanned and now Punjab has been fully activated on these 33 on this horizontal program of HMIS in all of its 33 or 36 districts. Now, there are many of the other provinces are also showing interest. The good thing about HMIS is that instead of weekly reporting it's on daily reporting like for the specific programs like disease service and we have some for weekly reporting and then some for the monthly reporting. So, we do have colleagues from UNICEF sitting at the back you from UNICEF Punjab and UNICEF Blochistan. So UNICEF Blochistan is also supporting Blochistan to move forward with this HMIS of Blochistan and we will be piloting it in Blochistan soon. So, here's a wide, I would say, summary of that the SIN has been already piloted, whereas field evaluation for KPK, GB, Blochistan, and Azhar Jammu Kashmir have been completed so we'll be moving towards pilot for piloting and I'm sure that Blochistan will be leading on to this system because during the flooding in the two districts through provinces that were most affected were Blochistan and Sindh. So, I mean, again, we have a lot of plans for these HMIS in as well. I mean, this is something that we need to strengthen the current systems that we have so that we are able to. Move forward with, I would say, a more comprehensive health system in Pakistan. So, here we are also talking about integration of private hospitals. And then there are some electronic medical records and hospital management systems that needs to be linked. And then we have the two programs, IDSRM and HMIS that needs to be linked as well. And some linkages with labs. And logistic management systems. So, coming back to the main topic, I mean, we have these, we had these programs already in place. IDSR was there functioning in Blochistan and Sindh and even in KPK. We had HMIS. So, I mean, this flood basically occurred in 2022, June. I mean, as the stats say, I mean, the minister reported that it is 7% more in fall occurred. Last year, and then the melting of glaciers due to climate change added up a lot of water flowing in and washing. So there was an estimated that's also 1700 people throughout this flooding and this measurement of around 8 million people across Pakistan. So, if we just have a little bit talk about the stats like from July to October, the world on the 540,000 malaria cases reported in the flood affected districts is then in the dry. Daniel diseases, Jengie fever and measles outbreaks are all over there seem to best the government had to establish this national response and coordination center. It was basically getting better from the HIS to which which was again on emerging emergency cases were developed, and the frequency was changed from weekly to daily by naturally situates of health and UK HSA also help them with all of the this system is ready that they started emergency trainings all over the country, especially for the flood affected the world. I guess 13 severely flood affected districts that need needed priority support so you know, HSA US CDC WH and UNJSI were basically moving with NIH to support them and then to train them and to start collecting data or whatever. Some instances of the flooding. And then his team was basically there visiting those, those districts just to know that how the data flow is happening and how we can basically facilitate with the data flow and everything. We had a lack of historical data on the 13 priority water associated diseases that were basically due to front flood but still we had this ideas are depository with us. Although it was not a good comparison but still we managed to. We managed to basically see that how the diseases are, you know, spreading throughout these camps throughout these districts and anyone down to the health facility level. The data was being subsequently visualized. We had this dashboard developed on our very priority pieces. I remember at that time, I mean it was all so fast. I mean it was happening so fast that we couldn't even manage it was very difficult for us to manage so we had to develop this public dashboard that was then connected with the plan was just named dashboard so that he could view all the diseases that are basically all the outbreaks that are happening in a real time. Okay, so here's just a small screenshot of the difference between 2021 and 2022 and you can see the rise of rise of the acute diarrhea during week 37 week 3638 and it has been because of the flood caused to the diaries. This discussion with the health authorities and CDC was leading this discussion and we tried to present an idea of how DHIS to any emergency system should work so so so it all starts at down the health facility in the cancer level so maybe DHIS to build have this, I would say the ability of collecting data to SMS, you can upload Excel sheets of data on to DHIS to so it's it's it's kindly a kind of a hybrid system you can use the Android version as well. I think the city suggested that we might have worked. You can use of data transfer you use, because if we if you see the flood settings I mean there are no internet electricity. I mean, I've seen health facilities collapse down to earth and and people living in camps so so we cannot expect to have proper internet connections there or computers so even with the nascent the sword with the app or you can you can report the diseases that are required. So, this was supposed to go to DSR use DSR user basically district disease service units that were again already there before flood. These were established by JSI in all of the districts and then there are some pds are used well also established. So, all of these data was was being flown to ideas are DHIS to this letter could be seen by partners and by the Ministry of NFR CC. So this was basically an ideal or proposed data flow, definitely we couldn't achieve it because everything was happening so fast we need to move forward. And so, I mean, it's better that we collected help to the mutual and other partners to basically align resources where they are, and some diagnostic kits were also basically given to the flood affected districts. I mean, it's just two days ago, it's again happening. And we I hope that we are better prepared this time. So I now move to Dr. Wasif. He must be on so that he would present his presentation. Dr. Wasif, can you guys will match the nine? Yeah, we will have our live presenters. So, okay, if Dr. Wasif, can you share your screen please? Can you hear us? Can you try to speak in the microphone to see if you can hear you? Okay, maybe we are having some issue. Is sharing the screen now? Hello everyone, can you see my screen? Yeah, can you see my screen? Maybe a glance if you can help us. And as well we cannot hear you in a minute. Can you see my screen? We can see your screen once again that we are going to try to solve the microphone issue. Okay. Can you talk again please? Yeah. I mean, issue always happened during emergencies so. Always possible. Can you unmute yourself please? Okay. Okay, but yeah, we can still not hear you. Maybe you're probably there. Okay, so maybe while we are solving the issue, maybe we can jump to the next presenter. Okay, then we'll come back to you Dr. Wasif. Okay, maybe we are solving the issue. Okay. Okay, thank you very much. It's coming from here, but yeah, maybe we can just start. So if you can just talk to share the screen please. We can do after. Yeah, sure. Thank you very much. So here with us, we have a presentation. Mikhail and Mikhail. That will be Mikhail. We are going to talk about the use of DHS to with the International Red Cross in Ukraine emergency. So I will leave the field to you. Thank you. Cheers. Good afternoon. It's been a long way for everybody. So my presentation presentation is going to be very short. We are. We are just in a different context. So it's not a humanitarian assistance type of emergency. That's where use case has to do with repeat this presentation's ideas. Although it kind of touches on what's not presented. My name is Mikhail and with the Norwegian Red Cross. My colleague Mikhail was with the Ukrainian Air Cross. So he'll be doing most of the presentation. We have a use case where we've deployed the child's to for mental health units. The Ukrainian Red Cross and balance units who are using the child's to our point of care for consultation. So we'll just walk you through that. So just a brief review of the context setting what's really unique about this presentation is the context. And the tracker implementation, of course, just finish up some challenges and future direction. We'll skip over the style and we'll come back to this. So Mikhail will talk about URCS. Norwegian Red Cross is a humanitarian organization. We have different batches of course local activities with volunteers and search and rescue activities. And then we have on the humanitarian side. We have emergency response and long-term programming. So this is kind of on the long-term side that we're talking about three to five year projects. We work in 16 countries. We have five regional offices. We have approximately 70 projects currently in supporting the primary health care facility level. Community level as well in Africa primarily. We do water sanitation, we do community based surveillance. We actually have a use case of integration with POSPR's idea of self setup in Uganda. And then we have the SMS based tool, which maybe is a challenge as well. We do protection and gender-based balance. From a DHIS to point of view, we're kind of early to the game. We started about a year and a half ago. And we're pushing DHIS to kind of two streams. One is internally using it to do second level monitoring. And then the other is building a capacity of national society. So these are the local recross recross societies. So in Pakistan we make considerable progress and we're probably with his Pakistan, to implement the DHIS to the Pakistani recross society. We have some pilots in Syria. And that's kind of the two streams that we're pushing. So Michele, we jump in and he'll walk you through the presentation. Over to you. Hello, everybody. My name is Michele Susko. I am analytics coordinator. Do you hear me? Do you hear me? Where are you? Can we try? Can we try? Can you please speak again, please? Do you hear me? Yeah. Okay. I will continue. Okay. Hello again. Hello. Hello. My name is Michele Susko. I am analytics coordinator in the Ternopil branch of the Ukrainian recross society. First of all, I would like to share a few words about its history and recent activities. The Ukrainian recross society was founded in 1918 in Kyiv. Today it has more than 200 branches with 500 staff employed and 8,000 volunteers. The main direction of URCS are emergency preparedness and response first aid trainings, healthcare, home based care and other social services. See the pictures on the slide. Next slide, please. Okay. Since escalation of the armed conflict in Ukraine in February 2022, more than 5.4 million people were internally displaced. And almost 18 million people need assistance. The largest movements of internally displaced people, IDPs were toward the west and northwest of the country. Mainly women, children and elders. Next slide. This slide represents movement partner support to the URCS. These three rectangles with blue borders show us the Norwegian response to the Ukrainian crisis since 2022. Today the Norwegian Red Cross works in three Ukrainian regions such as Ternopil, Melnitsky and Nipro. The main support directions are health services, primary health care, genes and psychological support wash in shelter and evacuation services. Next slide. Today under support of Norwegian Red Cross, 21 mobile health units are operating in Melnitsky, Ternopil and Nipro to improve the access to primary health care. They provide access to primary health care to internally displaced people. Medical teams in the MHU consists of nurses, psychologists and gynecologists. They provide the following services basic primary health care, sexual and reproductive health, mental health and psychological support. Next slide. The MHIS2 system was implemented in each of three our regions. We use the following registers such as primary health care register, gynecology register and psychological support register. We have trained 74 and users, they are mostly clinicians. In each region we have data analysts that provide support and prepare the reports. We use the following functions of the MHIS2 system on daily basis such as offline data entry, daily stock dispense, Ukrainian localization and unique patients identifiers assigned for each patients based on their initials and year of birth. For example, we use the first three letters of surname, two first letters of name, two first letters of patronymic name and the year of birth. Next slide please. Let's take a quick look on our case statistics. The launch of the MHIS2 program in October 2022 more than 83,000 individual consultation were recorded with 50,000 unique patients. And nearly 38,000 consultation were provided to IDPs and 7.5,000 consultations were provided to persons with disabilities. So summarizing all above said, despite a few changes or challenges, I think the implementation of the MHIS2 tracker program in our three regions was successful. So for your attention, now my colleague Mikhail will continue the presentation. Thank you, Mikhail. I'll just conclude with some challenges and raise forward. Challenges are initially, you know, there's a lot of competing interests in Ukraine. In April, things were getting started in the US, yes, branches were not very well staffed, so there's quite a lot of work in terms of getting them ready. So data management and digitalization was kind of at the bottom of that, you know, on the list. So initially there was a lot of push to show the added value of having tools like this. Initially using Excel sheets, in some cases paper as well. Of course, they go to a lot of remiss sites, a lot of these IDPs are located with schools, colleges, some very rural kind of districts. So connectivity was also a challenging issue. So data protection was a concern that was raised. So we've tried to minimize collecting any kind of direct personal identifiers consent is required to a patient. The Android app has been really useful in terms of having authentic disability, but given we have three tracker programs where a patient entry can happen in one of three. So it's an issue of synchronization. So we've prioritized the primary healthcare doctors to have seniority in a way to register and then psychologists, gynecologists who are able to use Excel sheets or have you an import in cases where there's no connectivity. So the team that descriptions to the defense was also problematic given they have 120 drugs and setting up kind of a daily logistic management situation was also a bit complicated. So there's quite a bit of a process there as well where they're using aggregates at the moment. So calculating any patients again with three, three tracker programs was also a bit of a challenge. In terms of next steps, USCS is basically testing the system and their interest in scaling it up initially as you saw on the map. There's a lot of other partners who are also supporting the house units. So they're going to scale to 100 units and 20 regions. So we're supporting financially and technically with that effort and we're just getting started with that. And the idea is basically to transition the whole system to to to you are CS. And there's more efforts in terms of building capacity and so forth there. Thank you for the happy attention. Thank you very much. I think now with your presentation. Show your screen please. Yes. No, okay, I found it. Okay, perfect. Thank you. Okay, thank you very much. So I'm Dr. Wasif. I'm a field epidemiologist working with UKL security agency as a health advisor. So just conscious of the time, I will move quickly because she has the context of flooding in Pakistan. So, I'm talking specifically about the Northwestern province, which is known as habit of our province. So when the flooding emergency was announced. So to tackle the situation, the provincial government in KP declared flood emergency in August 2020 and develop a flood response plan to focus for major areas. Area number third presented to us the opportunity to extend the technical support of you can just say to provide to the Department of Health the area pertains to strengthen the disease surveillance for early detection and response to alerts clusters. Our outbreak of communicable diseases in the flood affected area. So the public health people have a clear understanding of the correlation between flooding and increased burden of communicable diseases due to the fact that people have to live in camps or damaged places with compromised water and sanitation conditions. Intaminated water sources contribute to high incidence of diarrheal diseases and acute viral hepatitis due to the accumulation of stagnant water vector born diseases like malaria, cutaneous Lysminiasis and dange fever might develop into an outbreak or epidemic. We are also living in camps or shelters in high numbers people got infected to respiratory pathogens skin infections and snake dog bites are also potential have this to the people affected by the floods. We have context so before the flood of August 2022 integrated disease surveillance and response which a non touch on his presentation was already established at the national level and also in the KP province to detect prevent and respond priority infectious diseases. We quickly collects analyze and disseminate disease data by using digital platform DHIS to UKL security agency and other development partners supported Department of Health KP to establish the system since 2017 as per requirement of international regulations. Let's go back to the flood and staying on the slide very quickly. So when Department of Health declare flood emergency in August 2020 health sector cluster meeting was held under the chairmanship of Health Department and co chaired by World Health Organization. In the participants of meeting were discussing the different options to establish disease data flow from flood affected basically areas. In the UK just in that meeting proposed to utilize already established ideas are in DHIS system as an emergency health information system. The proposed system was to collect daily disease related information from health facilities and emergency relief camps in the affected areas and share time with flood emergency operation centers at the district provincial and the national level. The system which you can just say proposed at that time was linked with provincial health reference labs to share the lab data of suspected samples sent for confirmation. The system was also linked with rapid response team working on the ground on the ground to record detailed information of cases in response to any disease alert cluster outbreaks. The system outputs in the form of analyzed data daily situation reports and heat may maps basically were shared daily with relevant stakeholder. The emergency health cluster group voted in favor of proposed system which was adopted immediately after you can just say it team made certain required technical tweaks to the system. Little bit of context on the UK just a work the reason you catch us it was proposing ideas are DHIS system to be adopted as an emergency information system because since 2017 UK just is working with Health Department Pakistan to strengthen disease surveillance by implementing real time integrated disease surveillance strategy by adopting three pillar approach. The rationale to use existing ideas are system as emergency information system was broadly based on the fact that the frontline surveillance stuff across the province and in flood affected areas were already trained on DHIS to system reporting. So it would be easy for them to adhere to data reporting elements and timeline and the DHIS to system itself offers excellent analytics to monitor the disease trends in the affected areas needed to guide and monitor response. The system ability to monitor disease thresholds and exceedances was instrumental to timely detect any disease alert clusters that outbreak. The DHIS to system offered wide range of solution to tackle information need related to flood emergency. The data and information was well secured in the system above all the DHIS to system since 2017 is a sustainable model because it is owned by the Department of Health with technical and logistical sports of development partners like you can just say WTO and other partners. So how DHIS to basically help us in flood emergency of August 2020 the heat map in the left shows you the isolated burden of suspected cholera before June 2020. On the right side after June 2020 and that is the period when frequent rainfall started you can clearly see the increase in the disease burden in up north central and southern region of the province. This is a trend of acute watery diarrhea, both for suspected cholera and non cholera during the flooding months. Also, these are the typhoid fever and acute viral hepatitis trends the spot map for typhoid fever clearly shows high burden of disease in northern flood affected areas due to the water and food contamination. Dengue and malaria cases were frequently reported during floods and you can see the high burden of vector bond disease in southern region of province because of water contamination due to the train of the southern areas. Respiratory diseases of both influenza like illness and sorry severe acute respiratory illnesses were well captured by the system during the flood time because people were leaving valley close to each other in numbers in the shelters and emergency leave camps. The DHIS to captured clustering of vaccine preventable disease especially measles cases in the central and southern regions during the floods and guided outbreak response in terms of moping up vaccine. Activity skin infections and baby trends are also well captured in the system and guided the response. At the end the modified basically DHIS to system during flood emergency response and for for the context I want to share that it was the first time and DHIS to was used as a as a emergency health information information system in Pakistan. So basically the flood emergency response in KP. It was well guided by the modified DHIS to system, and it also provide a best example of a sustainable health information system which can be used. During the emergencies and also in the routine surveillance or the peacetime the DHIS to was flexible to accommodate flood emergency related information because we included skin infection, I infection dog bite snake bite cases into already notifiable priority disease list. The DHIS to analytics supported the epidemiologist and surveillance staff to detect the communicable disease diseases to control the spread of infection. The system generated daily situation reports facilitated the decision makers and stakeholders to get the snapshot of health status and disease burden flood affected areas also interestingly the information captured by the DHIS to system. Was also used as a decision making tool to ensure the provision of medicines, safe drinking water and other facilities to the highest population and areas. So, at the end, I would like to acknowledge the support of these people, the contribution of all these people helped us to develop an independent system in a very difficult time. And with that, thank you very much. Thank you very much. Thank you very much for the positive. I think we run out a little bit of time because we're having as well another presentation for. I like to go for the third one. So, once again, thank you very much everybody for the presentation and for people for participation. I just want to make the equation that focus on a lot of things, but we really wanted to raise it will be another session for surveillance system. And with now, so I invite everybody is interested in the topic to join us rather than always the session. Thank you very much.