 and they go. So now we have the great pleasure to welcome Andrew Moir from Histo Rwanda. Hi, Andrew. Hi, hi. Thank you so much for being available during, for making this presentation. So Andrew will make a presentation, as you can see, which will focus on how to go paperless using Android app in Rwanda. And the good news is that Andrew, after this presentation, will stay a little bit with us to reply to all the questions that you may have about Android app, whether it's in Rwanda and this particular project implementation, or whether it's related to your own context. So Andrew has promised to stay with us at least until 2 to 30. So please do not hesitate to ask any questions that you may have. In the unslack, we have created this channel called the Experts' Lounge for Africa that most of you already know. So ask all your questions there and Andrew will be more than happy to reply on Zoom. And then just to say before Andrew starts that tomorrow morning, 9 a.m. of slow time, we have also the great pleasure to welcome Pamod Amarakun, who is one of the leaders for Rwanda, who will be with us to present his project on nutrition in Sri Lanka. So this is the same for all of you based in Asia. We hope, and the others as well, of course, we hope you will be able to join us to listen to Pamod as well. So now I will stop talking and I'm giving the floor to Andrew. Thank you so much, Andrew. And I'm sure your presentation will be very interesting, as usual. Thank you. Okay. Thank you, Alice. And thank you, the Academy Organizers. It's an opportunity for us to really present the work that we always do at the field. And I also would like to take opportunity to appreciate the efforts from the participants, from the one up to I think today is day four. So my presentation will not take long because we'll be focusing much more on COVID, how we went paperless using the Android app that we are learning now, because I like the title of the Academy, in the implementers, implementers. So I think this is the core of implementation of the Android app. So without taking long, I think Rwanda, like many other countries, we had that emergence situation or period where we had the country in the middle of COVID. And the government really established the national coordination structure to ensure that we have all my disciplinary team together in a way that if there is any action that is needed, it takes a little time. So here is the coordination structure of COVID. So I'm trying to give the overview of what we did in Rwanda. So you can see that this is what we call command post and that was part of command post. In the command post, we have different cells. We have epidemiology operation cell. We have a demonstration logistic cell, communication cell. And on my right side, we have the planning cell. So without reading every step, but you can see on epidemiology operation cell, we have the part called data management. This is the part that we are dealing with the digitalization of all COVID processes, services, and also ensuring that the laboratory distribution of results takes a little time as possible per standards. So this is the part of epidemiological operation, the part of data management, which was data science and IT solutions. Our main role was serving all these surrounding interventions like investigation team, contact tracing, laboratory treatment centers, rapid response, and then decision makers, because at the end of the day, whatever intervention or action we take was supposed to be, if it is best. So this is the flow for early detection of cases. It is straightforward, like I think in other countries like this. First of all, was testing the suspected cases. So while it was testing, then when we suspect you, you are either isolated and quarantined. Then when you are confirmed, automatically we send you to the treatment center. I mean COVID confirmation. Then immediately we were supposed to do contact tracing and then we test whoever were in contact with you. Then we do the follow-up, then we put you in the quarantine. In the case we see you have some symptoms, then we again test, then when you are positive, you are transferred to the treatment center. The whole flow were really manual and there was an urgent need of automating the process. So this is the current status for Rwanda, but I took the status on 23rd. You can see that there is a variation of COVID cases. It had been reducing previously, but now it's increasing. I think on 23rd we had 61 cases. Then you can see, but even the recovery will have high recovery. 90% of patients, they are recovered, which is good. But since we started up now, we have 47 deaths due to COVID. So coming back to my presentation, as I said, this is what we had, the manual process. On the overall early detection of the patient or cases, the process was really purely manual because during the testing, people were supposed to print the whole of this batch of papers and take them with these tubes that have some liquids for COVID. So imagine having like, you are testing like 5000 people and you have to have 5000 papers linking them and you have to also compare the tubes and the papers. So I remember it was even hectic for us to try to trace, like if there is one case that they need us to trace, so it was not easy for us to trace them. So this was a problem and another thing was that even these papers were putting our health workers at risk. So imagine people that are in emergency interventions when they get sick and it could even affect the overall flow. So that's why the government said, no, we don't want these papers. How could we move without papers? So the whole process, I'm pretty sure you are seeing it. The whole process was like this. We have this middle, you can see this middle stickers. These middle stickers were used to put the lab ID and just stick it on the tube. So they have to stick all of these tubes with unique lab ID for Andrew, unique lab ID for Jimmy, unique lab ID for Matter. So that was really manual. It was a process that used to take long and it was even affecting the overall distribution of results. So they turn around time of results. So you can see the batches of paper also there. Everything in the lab was linked to the papers because the papers were even, these are case investigation forms but they were also like a registry. So as soon as they asked us to really stop these papers, we went to the laboratory and we tried to review the process. You can see this was the process from the laboratory. Imagine the sample collectors were supposed to take the papers from this floor one. Then from there, they have to write on the tube and they bring the paper with the tube. Then at the laboratory, they have to put the lab ID manually on the paper and the tube. Then after even the processing, then the testing, they have to come back and link the tube with the paper, something like that. It was nine floors. So I think this is a good experience after the session of the Android Implementers Academy. Always before you implement your digital solutions, always try to review the process and try to see if the overall process could not be reduced by the technology. So what we did was to review the process towards nine steps that one sample for Andrew undergo in the laboratory. And this one were really affecting the results return because we used to have one week when the result is still undergoing the process. So what we did, these are the challenges with the manual process before digitalization. It was very long with unnecessary flaws. You can see it because there are some parts that it was good that the tablet could be doing it like the ID, sample ID. It was difficult process during specimen processing because even the health workers, we are not happy with the process. It was hard to trace urgent samples. I remember they used to tell us that this person, we need to know his information, his clinical diagnosis. Then tracing one person out of 5,000 people, it was a hectic and you had even to take the whole day, the whole night just searching for one person. So the other one that I didn't like, it was the manual process of lab ID. So imagine writing unique ID from one to 5,000. So writing manual with a pen on the sticker, then you have to stick it on the tube, you have to stick it on the paper. So it was really, you have to write two stickers. Then you stick it on the tube, you stick it in the paper so that you could be able to link the two. So the turnaround time, as I said, it was also affected because it was a very long one. You can imagine because if everything is in manual, it you have to affect the time. So time is always linked to the processes and the manual works. So of course, definitely delays of the resize. Then much work, it was put on goal, so much work to the lab technicians. So from sample collection to the result to return. So all of this, the leadership said, the minister of health leadership said, no, we need to have a digital way of doing it. So that's when we came in and after looking at the processes, we said no. For us to have everything done, we could reduce the process. So we said we could only remain with three steps. Then the remaining, because it was nine steps, now we were suggesting remain with three steps. You can imagine we are cutting off other six steps. So six steps, we are removing them in the steps because it was going to be integrated in the overall digitalization, the process, the tablet. So the suggestion was like this, the adjusted flow in the laboratory. It was sample collectors going to the field or going to the health facility with the tablet. Then this one replaces the other manual form. Then we just customize the tracker, then we put, we just link it with the Android app on the tablet. So from there, the tablet could be able to do the remaining work that was done at the laboratory like assigning the unique ID, the diagnosis, then that one was also sorted. So from the lab, they only take the tablet, then they check the code that was generated by the tablet, then they just process the sample. Three steps. So after doing that and customizing, because we were lucky that the overall, there was a global initiative of COVID module. So we just took that COVID module and we just to customize it or contextualize it based on the random needs. So we just linked it with the tablet. From there onwards, this was the form of sample collection that was turned into the tablet registry. So these were the, I think you're familiar with this one. These were the modules that were customized in the system. We had the clinical exam and the diagnosis. We have lab requests. We have sample reception and sample processing. And what we did was just assigning the user groups and the users. So it was like sample collectors, they had their forms. It means they had access on the modules. Then the other modules that were accessible to only laboratory teams. So when you're going to the sample collection, it was not possible for you to see the lab modules. So that's how we did it. So you can see that we have the confirmed cases. We have the COVID rapid test and hospitalization and health outcome. So this is how it was after customization. And we started and we took the decision of stopping the module sample collection. You can see people when they are collecting samples, they have the tubes. Then they have the Android app on the tablet. Then what they do when they create you, the system automatically generated the unique ID that they put on the tube here. So it means they only bring the tube and the tablet. The tablet is for the sample collectors, but they only bring the tube to the lab. So the lab people, what they do, they just take the unique code that was generated by the tablet and synchronize in the server. So you can see here my sisters and brothers, they are collecting the samples. You can see that everyone has the sample. You can see that my sister here is writing the unique code that was generated by the tablet. Then you can see the race are also busy filling on the tablet. So this one was really so fast because as soon as you feel at the ground, automatically data was synchronized to the lab. So they could be able to see it on the dashboard that we have this sample that are coming. Then as soon as you reach a deception, they could be able to see the samples. So the sample reception, what they were supposed to do, they had computers. They were just supposed to go into the system. Then they search the person. They find it's Andrew. Then they filled the rest of the information for Andrew. Automatically, that one was really very easier because searching on the computers was faster than searching on the papers. So on the sample processing workstation, these are the people. As soon as everything is sorted and checked from the sample reception, because at the sample reception and processing, their role is to receive samples and check if the sample they are corresponding with their ID in the system. Then again checking if the sample, they are of good quality before they are processed. Then in the processing, they started extraction. You can see that here they started extraction and this one was really faster because there was no paperwork on it. So this is how the system generated ID looks like. You can see that it generates this ID. Then they just bring the ID. The beauty of this one is that one, to reduce the risk of confidentiality because the tubes were only identified by the code. Secondly is that during the testing, they were also using these codes. So this one also was a strength. So another one is the, as soon as you simplify the process of the sample, as soon as we simplify the process of sample collection and sample processing, which was digitalized and there was no paper, we also had the team that were all there to ensure that as soon as we have the results, the result is also entered into the system. So it was easy because the code was there. It was just entering whether the person is negative or positive. For the positive results, they had their own channel, but for the negative, it was automatic. So this is how we used to distribute the results. It was as soon as the result is entered, the client always get this SMS that say in two languages, Kenyaranda and English, that dear us maybe Andrew, please note that you are tested negative for COVID-19 with the date. So it will link the system with the mobile provider's gateways to ensure that at least as soon as the result is out, you get it. As soon as the result is out, you get it on your SMS. So it was, this one was, it reduced the turnaround time because it was very easy to have results. As soon as you get to the results, then people when they're at home, they just get their results on their phones. But again, because we are preparing for the travelers, we had also to customize another way of results which was sending results on their emails. So this one, you can see that it's the email that sends the result to my email, which is Andrew, then it gives you the attachment, which is a certificate. Then another one was also having other, ensuring that every process is automated so that we speed up the process because the aim was not only automating the process of sample collection with the tablet, but also was ensuring that all process of COVID is automated. So we came up with a COVID-19 test result portal where you could be able to check your results online. So you just put your, when we are taking sample, during the sample collection with the tablet, when they click on the slab request, automatically the system sends you the unique code. Then that unique code is what you use on checking your results. So we also had the booking for COVID. If you want to be tested your book, then they give you the slot when you have to come so that we reduce the queue. Then we have also passenger locator form. Passenger locator form is that when you're traveling to Rwanda, I know most of you will be traveling to Rwanda. There is a passenger locator form that you have to fill before you come. So this one is also linked with the HS2. So this is the online portal. It looks like this. What it does is that you get the codes during the sample collection. Then that code, you use it with your phone number to access your results. So the beauty of this one is that it pulls the data. It's not something that is saved into the portal. It's something that it pulls. Then as soon as you leave the system, it doesn't keep anything within the portal. So we use the API. So we have this locator form. As I said, for the locator form, you have to put your passport number when you're traveling to Rwanda before you travel. Then when you put your passport number system, we'll check if you ever fill this form. If not, it will ask you to fill it. So what we did was linking the passenger locator form with the HS2. So it goes to the HS2 and fetch the latest unique ID like we do in the sample collection. This one is also sample collection. So it goes and fetch the latest ID, which is LaboID or unique ID. Then it gives it to the passenger. Then as soon as the passenger is in Rwanda, they will not again ask the same information from the passenger. They only take the unique ID and fill the rest of information because everything is synchronizing the HS2. So at the airport, you find the people there with the tablet. So what they do is just your unique ID. They put in, then they check on the tablet, then using the HS2. Then they just identify your information, then they fill the, they only take your sample. They don't again go through. So this locator form was really important in linking it with the HS2 and the tablet. So this is how it looks like. We have the HS2 API that are linked to all these other COVID systems to ensure that we facilitate clients or travelers to have everything online. So without taking long, this is the certificate. You can see that we also managed to devolve the custom app that is able to print whatever entered online, whatever entered in the HS2 into a certificate, into a COVID certificate. This was important when it comes to people that you are transferring from the hospital or you have people traveling. They were a requirement that they have to have a certificate that shows that the person is negative. So in Rwanda, we are using the certificate that comes directly from the HS2 and it have been really serving well. And we have also on the borders, like drivers coming from the bordering countries, they also use the same certificate. So it was customized in a way that it prints, they add the personal information then to print your results. So it also sends the email at the same time. So this one was also another thing that was like innovation to the HS2. So what happens, I'm pretty sure that many questions we'll be asking to be that, how do you show that people they are not really, they are not going and they make their own certificate, then they can be able to live. Because if it's a certificate that is in PDF or any format, you know that there's some software that can be able to edit it and they keep the same font. So what we did is that we have a scanning app that as soon as the scanning app is encrypted, you cannot scan our QR code with any app. So at the airport, the same template that they use for sample collection is the same template that you use to scan your certificate. So when you reach at the airport, they just scan your certificate to see that it's really the one that we generated from the system. So this one really served a lot because as soon as they scan it, they see your name, they see your result, they see your date of result. So in the case you change your name, the system will keep the previous name. It means if you change like it was my certificate and it changed from Muhirah Andrew to another person, when they scan, they will see Muhirah Andrew because you cannot be able to change the QR code. So that one also really helped us a lot and we got some of the cases, but I think as soon as people see that you are able to trace whether the certificate is not the correct one, it will also improve the process, the whole process of certificate generation. This is what I was saying because in the beginning, it was really hard to trace what is happening in the field because you can imagine, because sample collection was really growing and it was growing based on the cases identified. So you could imagine that if at night, they did then fail like 50 cases, they have to go and sample the contact tracing for 50 cases. If they identify three, so it was really hard to know that how many samples that you are expecting per day. So what we did was linking these dashboards. You can see that we have the monitoring dashboard in the reception, in the control room and the headway. So it was like people going to the field when they take the samples, they stabilize, synchronize, then the chart keep changing so that they know now we're going to receive like 200 samples, then they could be able to request for extra support stuff to come to the reception to ensure that there is no any delay. So this one also contributed a lot in terms of sample processing and reception. So we have many workstations and I would like also to thank the Android team, Jimmy and Martin, the rest of the team. They've been really working with us from day one from the beginning because as soon as we've been implementing, there are mad things that we are changing and there was also urgent need of changing things and leasing versions and something like that. So these are the workstations we had in the country. There's a national reference laboratory that is using the HS2 from the sample reception up to the result distribution and certificate and whatever. There is a COVID testing site that also have the same that you have at the airport. Then we have different borders, point of entry, isolation site, treatment center, hospitals, testing site for travelers and some selected hotels to autism. So we have almost 500 tablets that were in place active. Then around 200 smartphones that we're also working. So this one also could also encourage some of us that think that you may have problems when you have many devices working. So in Rwanda, we have experienced this that the system is really working well when even if you have 500 tablets. Another thing that I would also like to recognize is that the strengths of tablets is that it works offline. So imagine people, they just go and collect that without saying that there's no internet or something like that. So they work offline. So they can synchronize that any time they want. So beyond the COVID, we also had other IT solutions that the government invested in. There is this robot with the aim of minimizing the risk to our health providers. But also we had also these bracelets that they just put on you to ensure that we wanted to promote the home-based care of COVID. And it was just the purpose of stopping it. Currently, we don't have treatment centers. We have a few of them. We have like two, I think, if I'm not missing like three or four. But the rest of the patients, they are treated at home. They just put this bracelet. Then they keep monitoring you when you are at home. This one also sends the SMS of either we have a problem or anything. So the last one, Lance, I hope I still have time. The lesson, Lance, is that having a single uniform client or patient ID was really a strength. It was good for us because it was very easy for us to have a unified ID to really follow up with the patient from the sample collection from when you were being detected that you're positive up to the time you are in treatment center. Another one is that we reduced it to the average turnaround time. It was around 11 hours, even more than that. But now the turnaround between 11 hours to one day. But before, now it takes 11 hours or one day. But before, it was even more than that. It was almost a week. Improvement of 100 versions. This one is a strength that I would like to contribute to the joint team because we had everyone on board in the first of Oslo. So we kept changing the versions to ensure that it fits in the field needs or user needs. So it was, we had also ground pressure to ensure that everything is improved in a little time. So I learned that working together is a strength. When you need to move fast, you have to bring everyone on board. So multidisciplinary team was really a best approach in the emergence. Like you've been working with the University of Oslo, Hisp, Rwanda, Hisp, Uganda, global partners, government teams, everyone was on board. So that one was also a best platform to share experience and having things moving fast. So another thing is that is not, the land is that most of us were not experts in lab, but we managed it because it was, it is not easy to implement in a new domain. To sincerely speaking, it was my first time to implement in the lab information system. But it was easy to build on the workload due, because people were looking at it as a workload. So it was easy for us to build it when people wanted something that could reduce the workload. Another thing is what I said, it's always good to review the process because my experience is that people always run for the technology. But there's, sometimes they need to look at the process because sometimes the technology could be good. But when the process is not really harmonized well, it could also affect the overall process. In the, okay, it was, as I said, in this kind of emergency pressure, it's important to have a strong community like the one for the HS2. If it was not a strong community like this HS2, like you guys that are here attending this session, it could have not been easy because at least we had the global, the global module that was in place. Then the module was ready to be used by the countries. So it really reduced the time of customizing a new COVID module. So another one is the collaboration and communication around the field and the central level team, user support and engagement. Then it's, okay, what we did was also, another strength is that with the HS2, we managed to integrate all testing sites. We have more than eight testing sites. All of them, they are integrated into one system. It means the unique ID is generated from one system. So the different sites, they have tablets. What they do is just synchronizing information in one system. So even though we have all these, but we also had the challenge. The challenge is that one that I said, it was new domain of implementation with a lot of pressure. I could tell you that the beginning was tough because people were expecting us to have everything in place in just one day. I remember there is one day that we had, we lost some of the information. So it was, it is not a straightforward. So you have to stick on your vision. You have to stick on what you have, you started and you have to keep improving as you go. Good enough, we had like support from the leadership and they were saying that you have to go. Even if you have this one, but you can prove from the other side. So all implementation was not smooth. That was not good. I remember maybe Jimmy I've been working with Jim and the team. In the beginning, we didn't look at the specification of the server. So we ended up using the wrong server. So the wrong server was not really, the performance was not good. Then it ended up discouraging the users and the sample collectors. But again, this one is very good. Always you have to monitor your initiative and ensure that whatever is not, is not really making it to perform well. You just improve it. As I said, we had pressure because you know, we were given like three days to have the paper stopped. So this pressure also made us to have this success. We again, I thank the Android team because we've been pushing to have the backcode to be scanned from the field. Like instead of writing that code on the tube, we wanted to have the backcode written on the tube. We are now in the process of implementing it because we wanted to have the backcode readers that can be able to read the one that are generated by the tablet. So this one again, it was a challenge because of the codes have to be written manually. At the lab, they limited the code. Okay, in the lab, they wanted us to have six digits. And you can understand that the DHS to generate more digits to be able to have them reshuffled and they have a unique ID. So we had to have six digits. Then we keep changing the first letter and to ensure that, but it's working well, but it's a local innovation. But I think in the future, we need to have a way that the system could be able to change and you could be able to limit the digits. Then another one is entering the results. Currently, it was manual because there was two, the COVID machines were new. But now we are working with the vendors to ensure that we connect them with the DHS too. And the process is really moving fast and I think we're in the good process, in the good progress. So this is the question that most people may ask, the whole success or the whole process was implemented by this team. We had six statisticians at the command post and we had nine IT programmers. We had data managers too and we had his Miranda team that were also part of the whole process. So this is the end of my presentation and thank you for your time and I hope I used my, I didn't go beyond the time that was assigned to this presentation. Thank you Alice and Tim.