 I think we need to start. We have a very exciting programme this morning, and we want to make sure we have enough time. So this week we've seen many great DHS2 innovations and achievements from across the world, and in this session we'll focus on the foundations that need to be in place to support these great achievements, and in particular on good governance processes and strong in-country capacity. And sharing experiences is what this DHS2 conference is all about. And today we've invited five countries with an impressive 62 years of DHS2 experience, and they will share lessons learned from their journey towards a sustainable and country-owned DHS2 implementation. But before we invite these countries to give a short presentation, I will hand it over to give a bit more background on what we mean by the foundations of a DHS2 implementation. So maybe your DHS2 implementation looks a bit like this, with a nice programme on top and a bit shaky foundation at the bottom. I hope not for these countries here who have been doing it for a long time. But in the past few months we have been working very closely within the HIST network to build a framework to understand a little bit more of what makes a DHS2 system or implementation mature and solid. And if we go to the next slide, you see the boxes here. The foundations at the bottom are the key things that people don't necessarily ask for. They don't necessarily pay for it directly, but it's very important for the system to work well over time. So today in this session and in the presentations here, we will have a panel conversation afterwards. We will talk about these two things, leadership and governance and building a strong core team in the country. Two things that we know are important for sustainable DHS2 systems over time. So I will introduce the panel. If you go to the next slide, Ola. We have on stage, we have Maurice Faisu from Cameroon. We have Oswal Bachaga from Ghana. We have Marcelo Amaral from Timor-Lest. We have Vulelo Chuboku from South Africa. And we have Andrew Mugir from Rwanda. And first we will hear some short presentations on how they have tackled these two challenges in their countries before we have them answer some questions together. So welcome. Good morning and thank you for this opportunity to give us to share a brief history of health information system reform in Cameroon. We have five rapid points. First of all, the country presentation, Cameroon is located in Central Africa. Close to 28 million in Avitan and 6,200 health facilities. In 2015, the health information ecosystem was set up. We witnessed the extension of the monthly activity report because the system was paper based and we witnessed an emerging new health information ecosystem made of parallel system. We had 13 parallel system collecting data or autonomous data to 28 different collecting tool. And at that time, the Ministry of Health was not receiving any data from health facilities. And what were the main causes of that? In 2000, we had a millennium site with millennium goals, a tree related to health that becomes subject of international policy. We had 2000 launching of GAVI, year 2002 launching of a global phone, 2003 launching of PEPFA, and 2005 we had the Paris declaration on health effectiveness. And that global environment where are based on a principle of raise money, spend it and prove it. Data was the oxygen of that new ecosystem. Our paper based system could not survive in social environment and we went through a reform. With three core principles. First, total digitalization, second principle integration, that is the DNA of Cameroon Health Health Information System and third core principle compliance with the Paris declaration on health effectiveness. Namely, ownership, alignment, harmonization, managing for result, mutual accountability. We implemented in many steps. The first step was the selection of DAIS2 as National Health Information System. November 2015 was the creation of the National Steering Committee in charge of DAIS2 implementation. And this second step was capacity building of local staff as we wanted the administrator account to permanently remain in Cameroon. It was urgent to rapidly build capacity of local human resources to ensure a total ownership of DAIS2 implementing process and to bridge the shortage of specialized human resources. The National Health Information Department became a permanent academic internship place for computer science engineers and statistician engineer students. As you can see, our staff were training DAIS2 academies, mainly with government financing and you can see here the internship room of our department. All we have interned from different country. Here you have interned from Cameroon, Chateau Goh, Democratic Republic of Congo, Burkina Faso and 80% of DAIS2 customization were done in that room. This step three was the digitalization of what is calling public health interest. So we're not a field to collect GP coordinate, GPS coordinate of settlements, health facilities, schools, market churches. And also we collect the GPS coordinate of the boundaries of district health areas that was never done before. And January 2016, Cameroon has his pro-digitalized health map with five levels as you can see here, facility health area. That was a new level that we introduced to be closer to the field. And the step four was the immunization of collecting tools. January 2016, we organized a workshop, including all programs and during which 28 autonomous firms were merged into one integrated monthly activity report for each level of health facilities. And the step five was the elaboration of a national denominator because each parallel system has had its own target population or denominator. And none of them had target population of the lower professional unit health area. And we start publishing that national document January 2017. And then we didn't pilot anything, we rapidly scale up. And we went from conceptions to scaling up and we have the support of two big partners. Firstly, the Global Fund who support the training of closely 2000 people and the Islamic Development Bank that support the training of other 2000 people. It was an immediate scale up. And we took two years to implement the reform and in November 2017, the minister signed a secular letter institutionalizing the AIS-2 as National Integrated Health Information System. And starting that date was 2018. So after the reform, the ecosystem changed and became this. All the parallel system became technologically obsolete and doomed to extinction like dinosaurs. So because after the reform, our system was technologically most perform under all parallel system. And the lesson behind this is that people easily line up behind success, not behind authority. Here are the main reason why parallel system definitely migrated into the national instance. The Health Information Unit of the Ministry of Public Health adopted a technological monopoly and abstained to follow many recommend good practice, even from Austro University. We abstained to share shapefile with parallel system and new actors, many unhappy partners. We abstained also to create a master facility release, not necessary when the system is integrated, many unhappy partners. Abstention to share the health area operational level, no existing in any parallel system architecture. Abstention to share administrator account with any external technical assistance, many unhappy partners. Obligation for all new application promoters to prove that the AIS-2 can do the job. The application are supposed to do many, many unhappy partners. So this is an example of transition from a parallel system to a national system. And this is the example of immunization program. Before the reform, they were using DVDMT and then the data element was customized in the national instance. And as from 2018, they were using the two system, DVDMT and AIS-2, and as from 2019, they made a total transition to the national instance. And that was, globally, the entity was first helpful for importation of program historical data from previous application to national GAS-2. This is the Cape of Performing Indicator of our unit before and after the reform. Before the reform, 2015, zero percent of data were sent to our unit, zero percent. And after the reform to this year, 2022, the completeness of report is always above 94 percent. And this concerns all the health facilities in the country, public, private, denominational, everything is integrated. And the data here are all the data. And after that, after the integration, integration has its problem because although the system was integrated, a parallel dashboard flourish created by programs, some public other heading, it was difficult for decision makers at this regional and national levels to visit that landscape of isolated dashboard. So we customize a national integrated dashboard. Including priority diseases, neglect diseases, and even forgotten diseases. So everything is there when you go to that national dashboard, you will see all the country, all the health system in the country. And this is a brief overview of that integrated dashboard. You can have malaria, hypertension, sickle cell disease, road accidents, and so forth. Then we went for community health and the approach for the same integration. So we elaborated an integrated monthly activity report for all activity, all community activity. We have only one document that you can see here. You was also a customer in the system. And we also customize an integrated dashboard to monitor all community health activities. And here you can see the land listing of community health workers and all the activities and so on. So they did an assessment recently with the support of Oslo University. The assessment was done using the tool developed by the University of Oslo in line with the DAIS2 maturity framework and with an overall wage proportion of 61 person. So Cameroon DAIS2 profiled an appreciation of adequate, although we didn't follow all good practices. So the next step we are launching next month, July. The track for KSB is management of two hundred eighty dinos in treatment centers. That is fully customized by local staff, the Minister of Public Health. Two hundred and eight phone books were purchased, two year budget secure and training. We start next month, July. So to conclude, DAIS2, a digital public goods, appear as the most appropriate solution for tele-informance system reform in Cameroon, driven by ownership and philosophy of technology and service of public health and not all the way around. Thank you very much. Thank you. So my name is Oswal Dachaga. I'm the Health Information Systems Manager with the Ghana Health Service. I think it's a good time to be here at this conference. The fact that Ghana have been with DHIS for the past 10 years, and it is a great milestone to be doing this presentation. As we all would already know, the Ghana Health Service is the biggest agency within the ministry in Ghana, charged with implementing the policies of the ministry, and have the bigger responsibility of collecting data for all public health facilities and other institutional facilities that exist in the country. We currently run a national aggregate system that is running on DHIS. We also have programmatic implementations of Tracker that is running the entire country, which is a subject in 2018. And then we also have maternal and child health implementations in some regions that has been ongoing. One of the key things that we have been able to do and do well have been to build on existing systems. Before the arrival of DHIS to Ghana, we were running an access-based HMIS system. And so upon introduction of DHIS to us, it was quite easier to adapt DHIS to build on the gains that we have chopped as far as the HMIS system is concerned. And this is a very important time to have that you already have an existing HMIS system that you are then using the technology to strengthen. And that's key. The Center for Health Information and that is charged with the responsibility of implementing HMIS solutions in Ghana had a very pivotal role in this whole process. In 2012, we had a very strong collaboration between the Ghana Health Service and the University of Oslo to adapt DHIS platform as our generic platform for HMIS in Ghana. How have we been able to do it for 10 years is all was built around HMIS capacity. And the very first statement in the MOU then between the Ghana Health Service and the University of Oslo was the fact that if you can teach us to do it ourselves, then we are not interested. And so we started with building a very core team that were staff of the Ghana Health Service that started the customer might. And there was also the identification of key officers from the various regions that formed as a second layer of exposure. We were able to have some technical capabilities in the regions to be able to support programs to buy in the idea of integration and getting all the data from one source and one key thing that also worked for us was the fact that we had a senior manager who was fronted as a champion of the system. And so he was able to do the engagement with other senior managers to be able to buy the idea of running DHIS too. Then we had a lot of standardization with the world time SOP for health information management. And then we also have the ministry having a health information strategy that then governs however how we want to run DHIS and our HMIS system in the country. Challenges with sustaining the games. One, you need to be able to gain the trust of the various stakeholders involved. You need to have local support system initiatives that is very critical. And then the managerial commitments at all levels becomes a very pivot out and if you are not able to deal with that then it is difficult to sustain the games that you have made over the years. What has been our key lessons we need to engage, engage and engage. You need to stop not to stop communicating because that is the only way you get people to understand what the vision and the idea is. And of course using DHIS to ask the main platform performance reviews then makes everybody interested in getting the quality improved on the system so that we are able to improve the general performance of the health care system. Thank you. Thank you very much for opportunity to present some issues related to the leadership and capacity development regarding to implementation of district health information system two in Timor-Leste. Next. Thank you. Okay, this is the history of implementation of DHIS 2 in Timor-Leste. Before 2013 we just using Excel to manage our information. I think this is very what we call it a simple system that we use. But we thank you for the introduction the district health information system to Timor-Leste to help us to better manage our health information system. So we start implementing 2013 and up to 2017 we fully adapted into the Timor-Leste health information system. So all the thin district that we have implemented what we call it Timor-Leste health information system using district health information system two. So in 2020 we conduct first national review for Timor-Leste health information system. And I think this is one of the first review that Dr. Asala was there is supporting us to conduct this review. And in 2021 we started using immunization COVID-19 immunization tracking and also point of entry more related to the prevention and mitigation COVID-19. And also in 2022 recently we upgraded into the version 2.36. So also we are doing the review on maternal health child health models so far. Next, sorry. Okay, this is that data flow that we have. We have only 70 community health centers that the data flow from the each programs in a community health center in help post. And also we call it the Saudina Familia and SISCA. SISCA is integrated community health service in the community integrated health services in the community. And we also get data from private clinics and we will be consolidated in 13 health municipal office and from the national it managed by health management information system department. So all referral hospitals and national hospitals, they submit their report to the each municipal data that hospital located. This is data collection formed that we have. I think we need some revision of this data collection, especially for the human resource that number 21 the human resources. Now WSO helping us to look at in the separate system. And we hope that it should be connected to the district health information system of the more or less the health information system. Other format that we are working now is for logistic management information system M supply to track all the pharmaceutical management. And we will we are still working on in these models and we hope that it will be integrated into the district health management information system. And this is the status of the implementation into more or less that we implement in all districts with over 100 users. Data entry mostly done by community health center level with the trained and dedicated health information system officer. We continue with the refreshing training to upgrade the skills of our users and also the server that managed by ICT department of minister of health. Now we work in with the IT agency, the IT national agency in order to also how to integrate it to the government ICT system. We also upgrading hosting services to accommodate the increasing number of the user. I think this is something that we need to evaluate annually in order to keep the performance of the system going on. In May 2022, as I mentioned before, district health information system two is updated. And all of this system managed by health management information system department minister of health with support from WSO country office leadership and governance challenges that we have. The recommitment of municipal management team is the one of the issues because the more or less that we are applying decentralization to the municipal all the district health management team appointed by municipal administrator. This is the command line under minister of state administration. So this is one thing that one of the challenges that we need to solve out integration to the laboratory hospital information system. We need to be also work on in order to harmonize with the HSS to system. The human resource and IT infrastructure is one of some of the areas that become challenging. So we need to give more attention to that area. Governance manual is still in development process and need sometimes for adaptive adaptation and refreshing training. This is very important because without proper governance manuals, the institutionalization it will become an issue. So when the last two days we just discussed about the government commitment, how the functionality is working. The more important thing is if you want to maintain functionality of the health information system in the country, we need to have the proper government tools and government structure in place. So I think this is one of the issues that we need to address. Governance structure and function each level health services need to be strengthened. What does mean all the structure from the national to the municipal and community health center level including the hospital, they need to aware that the health information system is very important as the part of the integration of the health system approach or health system thinking. So this is something that we need to address as well. What is the we need to do next? Leadership and governance. We need we developed a national policy and digital health system roadmap. This is thank establish national healthy health management information information system advisory committee and technical working group, including the human resources management information system proceeded into the interministerial contract between Minister of Health and Minister of State Administration. Establish a memorandum of understanding between MOH and a national IT agency. Develop all government manuals and needed needed, including conduct regular data quality assessment and the health as a maturity assessment. Develop framework and a standard for exchange integration sharing. Retrieval of electronic health information system training and capacity assessment conduct health management information system functional analysis at all level. This is very important in order to have the institution, institutionalization without proper functional analysis. It will be also one of the problem review and a standardized time of reference of health management information system staff, including ICT staff conduct a skill gaps analysis and training it analysis for development short and long time capacity development plan. Institutionalize health management information system training program at National Health Institute and including information system management into the performance management criteria for all health manager. I think this is all my presentation and thank you very much for your attention. Program director. Ladies and gentlemen, good morning. I'm greatly honored to be part of the DHS true community this morning to share the South African experience in the implementation of DHS. I'm the director for National Health Information System in South Africa. I'm here with Mrs. Milane Walmarans, who is the chief director for National Health Information Systems for National Health Information Systems in South Africa. And I'm also together with a very big team from East South Africa, who are also amongst us. Among us, we also have a Norwegian South African color was sort of sitting far from the team but is also part of us. I think we have adopted him many years ago. As countries have already presented here, I think South Africa has got more than two decades of DHS implementation. As you can see with this small note that we have attached, we have attached an evidence to show that the first contract when DHS implementation in South Africa was signed as far back as 1994. In the year that South Africa attained its democracy as we had our first democratic elections in 1994. This contract had just been a month signed. And therefore the building of DHS was led by a very small team with Kale as one of the lead pioneers for DHS in South Africa. With funding from NORAD, the Norwegian government played a very big role in this undertaking. And in terms of the implementation of South African DHS, I think it's important for us to just perhaps provide a bit of an understanding that South Africa is quite a very big country with an estimated 60.1 million people in terms of the 2021 media population estimates. And we have got nine provinces. And in terms of then the implementation of any system, including DHS, therefore in the country it relies upon a very strong legislative framework. We've got the National Health Act, which was promulgated in 1994, more or less the same time as we started with the DHS. And in terms of section 74 of that act, it then gives the minister the powers to determine the coordination of the National Health Information Systems and also then also to be able to prescribe the terms of data that can be reported. And in terms of the major push that the country is going towards is the move towards universal health coverage. And within that, the legislative framework that we are currently finalizing is the National Health Insurance Appeal, which is before cabinet now for for approval. And in terms of the implementation of the entire health information systems in 2012, there was an e-health strategy that was developed, which then included the direction for the DHS Health Information System in the country. And also, then that was reviewed in 2017, which resulted in the country then in line with the WHO adopting a national digital health strategy for South Africa. And we also in terms of the standards, the country has also then developed a national health normative standards framework, which then guide the country in terms of the various health standards that should be adopted. And the first publication of this health normative standards framework was in 2014. And in 2020, then we reviewed these so that they are more implementable. So we are in the path because the technology changes very fast and also the standards have to keep up. With regards to governance, as far back as 1960, then Director General realized that it was quite imperative that there is an overarching policy framework, hence then the development of the digital health management information systems policy was established. And this policy therefore gave the different roles to the various players in the system because we have got provinces, we have got the national director general, who has got the overall responsibility on the health information system, but we also have the heads of health in each province. So therefore this policy then determines the various roles that they have and the powers, but it also talks to the ownership of the data. It talks to the issues of privacy and security. And as you know that in the research community, we have a lot of stakeholders who have got an interest in the data. We also have the national treasury that also uses this data. So therefore it determines therefore the requirements for the integrity of the data that we use. We also have then the standard operating procedures. Then for the various levels of care, we've got the facility level SOPs, we've got district level SOPs, provincial level as well as the national SOPs to ensure that the implementation at an operational level is guided in line with the policy. We also have the very important national data dictionary then that guides the common use then of the DHIS in terms of the definitions that were used. And we also have the national indicator data set that every three years gets revised and it is presented yesterday. So we have got these governance mechanisms that assist us. We also have got the master facility list, which is quite huge, which has got all our facilities, both public and private. And we've also included now the the vaccination side, some of which are non health sites that are part of the master facility list for the country. In terms of the DHIS to implementation transition to DHIS to as we started we started in 2016 from the MS access from 2016 we started then the path of transitioning to the DHIS to but in terms of the daily data capturing the country at the moment by the end of March. When we are reporting for our annual report at the end of the 2021 financial year, we were at 77% implementation in terms of daily data capturing, but at the primary health care level we had 74% and hospitals there were almost 100%. The reason between the hospital and clinics is the issues of connectivity that not all our clinics are connected, which then limits our ability to move fast in terms of in terms of the daily data capturing. But with regards to then the aggregation of data from the nine provincial instances to the national instance, currently we are at over 12 million records per month. And also in terms of the DHIS meditation they are also known as standardized DHIS to use cases for instance, we use DHIS to as a platform for the allocation of intensive and community service position for our newly qualified professionals such as our young doctors. We also have using the platform also for the human resource information systems, as well as also for the malaria for the integrated disease surveillance and response. And also for one of the biggest I think mHealth implementations that has been done to scale which we call the Mumponnet, which then looks after the pregnant mothers and gives them a messages that are specific to their various stages as they of their pregnant. Then with regards to capacity building, earlier on capacity building was realized as very key in terms of our move as a country to ensure that we can then fully implement a DHIS. We started with the data capture us, which we then absorbed those people, we started with more than 3000 data capture us. But we also realized that for each level of care, we need to ensure that they strong capacity. So, but we use then an approach of train the trainer, because we realize that it's important that our partner his SA just trains these trainers so that then they can focus on more innovative work on on the DHIS to than to to maintain training and capacity building. So we have a very organized online and also in person training program for various levels, but we also have another training that is focused on on our expects, who have to ensure that at a technical level they can also then ensure that they are gradually taking over some of the the technical aspects of the management of the various instances at provincial level. So I will end there. Thanks. Thank you. I'm Andrew here from Rwanda. I'm happy to be here. So my presentation will be really looking at the Rwanda experience around DHIS implementation. So before I start, I just wanted to give you a quick my story. My first day in Oslo. When I came in Oslo, the first day, I didn't really have a move from Oslo city to my hotel. Everyone is attentive now. Okay, so when I went out of from Oslo city, I didn't know the only thing I knew was just the name of the hotel. Then I just walked. Then by chance, I was, I just, when I was walking, I just saw a phone hotel somewhere. Then I went in, I said, Andrew, yes, yes, yes, yes. Then by chance, I was at the hotel. Then was the one when I was in my room, I just said, Oh my goodness, I managed to make it, but it was by chance. The lesson here, you cannot implement this is too by chance. So everything you need to invest, the only investment that I did from Oslo city to hotel was just walking. But in the HS2, you have to invest in many things. You have to invest in capacity building, you have to invest in servers, you have to invest in what I'm going to present here. Okay, thank you for your attention. So I was seeing everyone was busy. So actually, like many other countries that presented, we also had this pressure in Rwanda where we wanted to have a system that is able to integrate the data from all his facilities, public and private. Then, but because of that pressure, we managed to come up with different options. In 2000, we tried to come up with access based system that we thought that is going to solve our problems, but unfortunately it was not really meeting the requirement. Then in 2007 after seven years, we also had another pressure that what we have implemented is not really responding to the needs and the needs from the programs. And it is not really improving the data quality and reporting rate. Then we also changed the system to SQL based. And here we thought that we have solved the problem from programs, but unfortunately it was not the better solution. Then there was again the pressure to have another system that is really where we're based, that is able to collect all that and integrate everything into one which was the like a data repository. So in 2010, we started the process. That's why I was telling you that we need to invest. We started the process of harmonizing all reporting forms to ensure that they are all harmonized integrated to avoid vertical reporting. Before even acquiring a system because most of the time we find we just go for the system before even harmonize the registers and reporting forms. So that exercise brought together all partners programs to discuss which are indicators. The main criteria was that they indicated to accommodate into our reporting form was supposed to be in any strategy, policy, global commitments and others. So with that exercise with all those criteria is managed to reduce our reporting form from 45 pages to 12 pages. When to as integrated with all programs. Then in 2012, we launched the case to when at least everything down the processes and other things are well harmonized. Then later we started developing all documents that that are needed in terms of indicator reference manual to ensure that you are you are defining indicator the same way. SOP standard operating procedures to ensure that all processes are really defines if there's anything that is required for data collection, data collection timeline everything is well defined the role and responsibility of every person. Then in 2012, we're ready to initiate different innovation on top of the HS to so you can see this photo I don't know if you're able to recognize me. This was 2011. I keep walking I was walking to the Academy the first Academy that we conducted in the recent Tanzania. I was with my colleague Adolf, who was trusting me but he didn't know that I reached there by chance. So you can see my colleague another person was just taking our pictures. So we are heading to that Academy this side. This was the first Academy. By that time it was two weeks Academy. There was no any packages and whatever the only package I remember was just grabbing everything in your head. Then, the reason why I brought this picture is that when we left Rwanda, the head of HMI department, because I became the head of department in 2013. By that time, we had another one. The head of department told us that you are going that you have to come and do those things and have to work. So you can see how we are really we're thinking how we're going to grab everything. So on this side. All of you will allow me to say you can see all of us and Lush and other guys they are busy. You're seeing them. I don't know if you're able to see them. That time there were no materials need. There was no material. They were working on materials and they come and present. They work on the material. They had pressure there. So it was really a good experience because it was an intensive one. But that was the best Academy that I turned it because we had to do exams. It was like academic ones. So we had to do you can see on the back of the back of all of these adults. Adolf was checking if we can get all of us in five minutes to ensure that the truck is well known. Because we knew that when we go back home, we will not have the global teams to work with us. So it was really tough. Then what were the key drivers to lead to this implementation? Of course, from those other pictures that I was showing, the first thing is always support from the leadership. We had good support from the leadership. But remember one time when I was in the senior management meeting, I was lucky that I was telling these senior management meetings. The minister told all program managers, I will not allow any other presentation without statistics. And again, I will not allow any source of data when you're not putting down HMI. Then he instructed me to be presenting weekly the progress of integration from programs. So you can imagine the lineup of programs coming to me, checking if we have integrated for the next meeting. And when you have a chance of that meeting, you always call a spoon a spoon. You don't go there and say they are working, they are working, no. You just throw them have integrated, but these are the ones that have not integrated. They can explain to us. Then next time you can see everyone integrating. So leadership is key. Then capacity building, of course, when you are really creating that kind of demand, you have to ensure that you have a team that are able to support all demands for the programs. I think first structure we're lucky that the government invested much more in infrastructure to ensure that at least we have that clear, because you know you cannot implement this solution when you don't have computers and other first stuff. Then SOP, as I said, standard operating procedures is very important because the reason why you can see me presenting here is because you have people there that have organized it. We have agenda that tells us to have to come to this meeting. So imagine when we implement all these solutions, then we just drop them to the health facility without defining what is the role of the nurse, what is the role of data manager was a lot of head of this facility. Then when it comes to accountability, you find them blaming each other. I remember in 2013, we had a low rate of reporting in system. Then we just did the investigation on some facilities that were not reporting. Do you know what we found? It was only role and responsibility. They didn't know who does what when. That's when we strengthened the use of this standard operating procedure to ensure that when someone didn't report, you know that you're asking Andrew. If Andrew didn't report, you can even be able to tell you what are other details. So SOP is very important. Then these are things that SOP defines when it comes to data management and data collection to ensure that the reporting rate is really at a high level. So this is an example of what we put in the reporting on this SOP. It's like on monthly basis, you have to conduct data check meeting, which is data management meeting, but there's also the meetings I do when they are checking the data. You can see these are the pictures that are down there and up there. This is how they do this meeting on monthly basis to ensure that all data they are reporting is really validated by the head of NAS. So that validation means accountability goes to the head of NAS to ensure that whatever they reported represent the reality from the facilities. Okay, so you can understand because you know these meetings have to you have to define it in your SOP that the meeting has to happen on weekly on monthly basis. It have to be chaired by this person. The timeline of reporting is this time, the timeline of checking that is this time, just all of these have to be in your SOPs. So again, here you can ask yourself what motivates programs to join you or to bring their data in DHS too. There are many things that you have to ensure that people first of all, is that you have to have a stronger internal capacity team that are able to support because someone can only trust you when you have skilled on him. But when you know these program teams, most of the time they attend different trainings, you find they are really very good people. So you have to have a stronger team to ensure that they are able to support them. Another one is data quality improvement. They have to see that there's improvements in the data for other programs so that when they are talking to other programs, they tell them that for us the reporting rate have increased. We are using these different features and others. Then ownership. This was the training in terms of capacity building. This was the training that we hosted in Randa. It was also two weeks. You can even read the first one. The minister of most of the Agnes Manuel has launched the two weeks at Cadim, but this time I don't think we're conducting two weeks. That time it was two weeks. So without taking long, I think the lesson learned from our implementation is that leadership is key. Governance and coordination, which is even part of the leadership infrastructure capacity building to ensure that you have a pool of experts. I remember we used to send many people to attend these academies and having these academies in Randa to ensure that at least we have program people trained. At the end of the day, when you have experts in the programs, you find that they are the ones supporting you when it comes to implementation of this IT solution. So this is the examples of how we do things. The academies, we share experience. I was in one of the posters in outside yesterday last day. Then I was in one poster when someone was explaining how they are reviewing their reporting form. Then he told me, you know, the way we are doing it is that thing that you presented in Randa. Then I presented, I didn't know that these stories that we present are making impact to the other side. So he was presenting exactly the same process, which was really very good, because if you are learning from each other, it's good. So people here that just say, I love DHS to always love what you're doing. It will be successful. Thank you. Okay, thank you so much to my mic is on, right? Yeah. Thank you so much to all the presenters. I think it was very interesting to hear your takes on what it takes to get where you are. So with your 62 years of good experience with DHS too, I guess there are also some fresh new countries here in the audience. Are there any one advice you would give to a new country starting up? Anybody want to answer? Thank you. I would perhaps advise as follows. I think the first slide that was showing the foundation, I think it's quite key that you establish your leadership, your governance, as well as also ensure that we have got the core team that will then assist you to implement DHS too. But I think over and above that, we ensure that then you bring all the stakeholders on board, because as you saw that that was a house that had that strong foundation, but we have to ensure that everybody feels that they are part of the process of the DHS to implementation. Then I think that way then you will succeed. Thank you. Do you have a good advice? Okay. I would say make sure that you are setting up something that's better than everything existing in the country at that time. If not just a line of what is existing, we cannot do better. Anybody else would like to give a good advice to new countries? Andrew? Actually, for me, I always emphasize on bringing pattern together. Then you have like a coordinated investment towards HMI, that's one. Secondly, ensure that you discourage vertical systems because most of the time when you have scattered efforts, you always fail. So vertical system means you have to sit down and come up with integrated reporting system that really responds to the needs from all stakeholders and partners. That in that way, you will just converge all your efforts together and it will lead to success. Thank you. I also have a question for Ghana, because you've been building your core team for many years and I think it was interesting how you explained how you have moved from the district and up to the national level. Maybe it's not always a smooth road if you talk about the nice things here, but maybe something has been bumpy. Like if you could start over again, is there anything you would have done differently? Thank you. So definitely if we had an opportunity to start again, two key things that we might want to do and do better. One has to do ownership data and the systems that we have built. We draw relations from how our HIV truck is currently performing because we've had real ownership of that system where people within the program are the ones running it and then we guess as a country technical team provide technical support to them. We do not have that much success with maternal and child health and it all comes down to how well we have been able to implement this issue of ownership and getting the program people to lead the process and then we just supply and give them the technical support. So given an opportunity it is one thing we will want to really do well. The other key thing that we would wish we do well has to do with adopting new features on the releases from the core DHIS core. We had quite an experience with a trucker implementation in 2018 where we had a drastic move from the initial design of the Android app to the new one. And the key lesson in there was that when you start a process you need to firm up with the users. Let them get familiar with what you have introduced before you adopt the new features. Otherwise you are going to throw them off board and then it discourages them and it becomes very difficult to then get them to follow what you are doing. So the new features are good. They come handy so flashy but you need to hasten slowly set up a migration process properly and then you can transition users gradually onto the new features that are coming in and you'll be able to sustain your system. I have a question for everyone. Is this on now? Yeah, perfect. Andrew, you talked about how you managed to get all the programs on board and now your system is going quickly. How do you manage all this demand for expansion from all the health programs? How do you keep up? That's a good question. Actually our initial investment was always on capacity building and our capacity building was towards having a pool of experts not only in HMIs but also inside the programs. So we've been hosting different academies with that aim to have many people attending. We've been sending people in academies outside to also have them trained on different customization of their chaser and others. So during that huge demand that we are pushing to have everything integrated, so we've been using people from programs. They became our resources to use. Then when we are like customizing tracker for malaria, we bring people from HIV, malaria and others, then we sit down. You can understand that you can even do like three to four trackers because the resource people were there and we are able to use them to come up with something. But again, another thing that we did was having the implementation, the budget to support trainings that was cross cutting. So in a way that that joint budget in case we have anything new, we just use the same budget to train people for the new modules. That is how we did it in Rwanda, but I will be happy to hear from the rest of the teams if they have an other way they did it. Thank you. Thank you Andrew. Let me pass it over to Dr. Fesu. So I have a question for Cameroon. Many ministers of health are under constant pressure from partners both inside outside the country to implement new technologies and new systems. How do you manage this pressure in a coordinated way? Okay. Thank you for that very important question. We have SOP for partner management with checklists of questions when you bring a new application. The first question on the checklist is, is it open source or patented? Okay. If it's open source, it's go. If it's patented, no go. The second question, if it's open source, what is the added value of your application compared to district health information software? And sometimes majority of times people cannot really explain what is the added value. But if it's possible to explain the added value, yes, it's go. If you cannot explain, it's no go. And the third question, if you can show the added value, the third question is, do you have budget to scale up because we are not implementing piloting? Anyway, we are not implementing pilot. We are not a research institute. We are a minister of public health. We are governed by the general interests and equity. So when something is good, it's good for everybody, for all people in the country. It's not just good for two district or three. So do you have money to scale up, budget to scale up the application? Do you have budget to train people to sustain it? It's not, we stop there. So it's very clear procedure and sometimes I just get feedback from the minister. He's telling me you are the most unpopular man in this ministry. Okay, so if I could just add a little item, one of the things that can help with all these partners and people introducing new system is the fact that you need to have a national HMI strategy. It's key. You need to know what you want as a country even before the partners come in. Otherwise, they will throw you off board. And then one other thing has to do with interoperability is good. But if you do not have a strategy, it can then also be exploited because at the start of the implementation of DHS, you harmonize all these hard copy tools to get integrated system. Then people come and the next thing they are accidentally done, but you say DHS is interoperable. So why don't you allow me to install, set up a new solution for A or B and then integrate onto your national system. And if you do not manage that process very well, you will find out that yes, you have been able to harmonize the paper based tools along the years, then you then have multiple systems that are all asking for integrations into the national HMI system. And that can also be a very difficult process to manage if you do not have the capacity for all those systems, even though the system may be interoperable. Thank you. Thank you. I think the next question is going to South Africa. You talked about these strong governance committees that you have in South Africa, especially this NISA governance committee. Could you elaborate a little bit more on why that is important for DHS to and especially with this goal of reaching universal health care in South Africa. Thank you and for that question. The National Health Information Systems Committee of South Africa. It's a technical committee that reports to the subcommittee of the National Health Council. So that committee that it reports to, it's a committee that is chaired by the General with the nine provincial heads of health. So therefore the NISA as a committee, it's a committee that is able then to make technical recommendations to the decision makers for DHS implementation, as well as the overall strategy, as well as the reforms that the currently is undertaking, for instance, the implementation of the National Health Insurance as part of the attainment of the universal health coverage. So therefore the that committee therefore has got people who implement on the ground. So they are able then to take then the decisions that are coming from the technical committee of the National Health Council. Take them down to the provinces to the districts, as well as the facility for the actual implementation, because these various levels are very key for the implementation of the National Health Insurance. So therefore that a link between the NISA committee and that committee of decision makers is very key for us for successful implementation of DHS to as well as the overall reform of our health system towards the universal health coverage. Thank you. Thank you. I have one more question for Timor Lester, but before we before I ask that question, we have time for some questions from the audience. So think about any question we'd like to ask and we'll get back to that in a few minutes. So for Timor Lester, we understand that you have a close working relationship with his Shilanka and that you've together achieved great things during the COVID pandemic. Can you say a little bit more about the longer term plan now for building that in-house expertise? Thank you very much. As I mentioned before that without proper institutionalization and the functional analysis, it should be also the capacity development will be fragmented. So what I mentioned before that we need to have something more systematic that come out with the proper long-term capacity development plan. And cooperation with Shilanka is one of the good models. We call it twin arrangement, but the twin arrangement need to be also adjusted with this long-term capacity building developments in order to build in-country capacity. If we are not really careful on this process, my worries is we will build the individual capacity but not build the institutional capacity. In order to sustain the district health information system to implementation in the country. But we are lucky because in the previous we don't have any system in place. So the district health information system too is currently the only option that we use in order to improve our health information system in the country. And of course that the cooperation with Shilanka and government minister of health we still need and how we will be assisting more or less to build our in-country capacity. Thank you very much. Thank you. So we have time. The questions from the audience. I think we let's prioritize these times before this in my cloud. Hands up here. My name is Abdrahman from UNICEF Somalia. I am Abdrahman from UNICEF Somalia. Just a quick question. I agree everyone here is labeling himself or herself DHS2 community member. So it seems like people who have been implementing a decade ago DHS2 are facing the same challenge. The newcomers are facing. And from my understanding when we say community means we need to help each other and maybe learn how to walk. So some of the problems are generic. What is the Oslo University or the core team for DHS2 doing so that we don't have to repeat in this saying we have this, we have that, that have been said 10 years ago. So what is the Oslo University doing about that? Cool. And then the second question. What are the resources available for countries that are starting DHS2 now so that they don't face the same challenge? What are the plans? How do you distribute the resources? Thank you. So I was hoping you were asking them a question. So you're very short, we could say that, you know, we're doing this. I mean, these guys know how to do it. And I think by allowing you to listen to them and share these ideas, I think that's a very important first step. We also organize a lot of academies. And we just told about, you know, that first Academy in 2011 where Andrew, Vinustra and Adolf worked very late every night working very hard to go back to their bosses in the ministry and show what they had learned and started implementing. I think that's a, but it's a journey. I think there's no shortcut to do this in six months of one year. You have to work very hard over many years. I hope that through some of these sessions this week with implementation guidance and discussions, you know, you're learning a bit how to do it. But we also have a lot of resources, of course, online and in the more formal Academy programs, training programs, we go through these topics. But I really want these guys to be asked questions now. So let's move over there. Hi, thanks for the presentation. I'm Rose from CHI. And I know many programs had mentioned that there was time performance to the reporting rate to help make sure everyone is doing what they're supposed to do and then making sure the system is working well. So a question that I had was, are there other metrics and measures of success that programs are able to track to help make that case for future investment? I'm wondering about if you've observed cost savings, time and staff, staff hours saved, access to care, any of those kind of metrics that are able to be linked back to this investment in DHIS too? Okay, thank you. So with regards to issue of cost saving and implementation strategies, I think one of the gaps we've had is that the supports countries have had with DHIS implementation have largely been programmatic. So you don't have a lot of partners supporting the core teams when it comes to the generic HMI solution, but that is really the hope around which all the other programs need to rely on to be able to perform functionally. So one cost saving mechanism that could be very beneficial to all of us is where there is targeted funding to the HMI team, then whatever capacity and implementation strategies are involved with the core team can then flow across all programs so that you don't have a situation where in a country where malaria is having enough funding, everybody's talking of malaria, then malaria is doing well and then HIV is struggling. Three years, four years down the line, you have to go through the same cycle with another program and that becomes a lot more expensive to do. So we should have some coordinated way of getting this core HMI team having enough capacity, having enough resources to be able to deploy the solutions across board because the track for HIV shouldn't be different from the tracker for malaria. So that's central way of managing the implementations and the solutions is really key to sort of saving costs across countries. May I add on this one? One thing that we need to look at is the health system thinking approach need to be applied in the country levels because when we talk about the district health information system models, this is part of the one pillar of the health system. So how it will be integrated and if you have very clear design in the health system thinking approach, I think at a saving cost it will be there. So this is something that we need to explore more. I will be working with the others, pillars of the health system. I think this is something that I need to add on. So we have a question from Kalla over here. Yeah, and I have a fundamental question actually to all five of you what was obvious to me when you talk was that you have all the last 10, 15, 20 years adopted an iterative evolutionary approach to your health information systems. And I've been involved a long time and I remember the days when people thought that they could leapfrog over all the problems and immediately implement a kind of cradle to grave electronic medical record system, right? We would have all our data at the fingertips, every all the statistical data could be extracted from patient data, etc. Now after a series of spectacular failures that faded into the background and one started a gradual approach. And South Africa is a good example. And Bolero mentioned that we are at 77% now but that's for the daily capture, right? We reach 100% in 2004 with monthly data capture. Then six, seven years ago we started implementing daily capture and we're still only at 77%. But it's a safe approach because your patients are not utterly dependent on that data. So nobody's dying if, you know, you don't have connectivity at that. My question then is it's clear now that electronic medical record systems are again, you know, being pushed strongly both from countries, from leaderships and from various global entities. So my question to you is what is your timeline now because you definitely have some kind of a timeline for implementing fully fledged electronic medical record systems where hospitals and primary healthcare facilities and other stakeholders are all interconnected. What is your timeline for that? When are you going to start implementing it? And how long time do you expect it will take before you have that super system in place? Okay, great question. So when we talk of timelines, I would say in Ghana, something has started already because in the past few years, the ministry have had an e-health policy that has translated into implementation of a national EMR that we've currently started. We've currently started some deployment, starting with the teaching hospitals and then the regional hospitals. What we are doing is to be able to integrate that with the national HMIS that is under these two platforms. I do know some test integrations have been successful. And so once we are able to roll this out for all the hospitals in the country, it would give us a very good basis to translate and get our data from the clinical perspective into the national HMIS. It may not come very quickly, but we have started and we hope we are able to go through it a lot more successfully. Thank you. Okay, thank you for the question. In Cameroon, we have timelines for the implementation of electronic registers, not EMR. The DEA, the DEA will have that feature on the planet. From Timor-Leste, we have a local system that developed by Minister of Health. This is about medical electronic records. And now we are trying to work with the health information system, how it should be linked to that system. So, if you ask what are the timelines, we are still in developing our roadmap and our expectation will be 2025 will be the timeline that we will expect to integrate all the electronic medical records into the health information system. Thank you. Thanks Carl. I think you always want to throw this tough one. But I think with South Africa, I think we have learned our lessons and there is no intention to go for a super electronic medical record right now. Why do I think what we have learned from COVID-19 response, it has showed us that it is possible to build linkages between various systems and to be able then to really within a very short space of time be able to have a national reporting from various existing systems. So I think a lot of efforts for that are being exploited right now is to build the various linkages. We have already successfully built linkages between the laboratory systems in South Africa, both the National Health Laboratory Services, the private health care laboratory systems and you are able to report case level data on a daily basis. And I think those are some of the then experiences and lessons that I think we are building upon. Thank you. Oh, we have to say something, all of us. Okay, good. Okay, in Rwanda, I think it's a good question. Actually, in Rwanda, we started long ago implementing the electronic medical record, but it requires much investment in terms of development, interconnection in the health facilities and sustaining the system. So the initial development we did was not really, we didn't follow the process, the required process, then there was a stage that reached the initials were not really user friendly. So we had to go back again into the process to ensure that we include clinicians. So currently we are revamping the system. We have at least most of the hospitals they are using like three modules, which is registration, OPD and others. But now we are really developing the comprehensive EMR to ensure that all health facilities will be having it. So in terms of timeline, I think this is something that we could just discuss. It has more details because it has different phases, but again, it's a good question for us to really think on. So the future plan in our digitalization. And I think that you have been done is that we have managed to bring all digitalization team into one directorate where I belong to have that coordination to ensure that there's no again scattered efforts around EMR. So that is why I was like Mia was in HMIS. I was pulled there from HMIS. Now we are overrolling all the digitalization implementation in the health sector, by the way. So thank you. Thank you so much. I think first of all, big thanks to the five panelists. And then, of course, as I mentioned in the very first presentation here, we have many more countries and ministries represented. We didn't have space for all of you on the stage. But can you please stand up and then we give you all a big praise? What are you? You work in a ministry, Arthur? We only had half hour for questions, but now we know their faces. We have many breaks and we have a big social event tomorrow, so please take the opportunity this week to talk to them and ask more questions. We have a coffee break now and we'll start 10.30 with another very interesting presentation. So enjoy your coffee and start talking to these guys. Thank you so much.