 Good morning everyone. I hope you are all doing well for this final day of this amazing Academy on Android Implementers. So we're happy to see you at this first session. And it's also a great pleasure to welcome Pamod Amarakoum, who is one of the lead implementers from his Skelanka. Hi Pamod. Hi everyone. Yes. Thank you. Thank you for being here with us. So we are very excited because Pamod is going to do a presentation on how to use mobile for nutrition in Skelanka at the field level. So it's going to be very, very exciting and interesting. So Pamod thank you for being available to do this presentation for us. Also dear participants, if you have any questions, do not hesitate to ask them on the Experts Lounge for Asia channel that you can find on Slack. So if you don't see it, the only thing that you need to do is basically click on the plus sign and then browse the different channels and you will see Experts Lounge for Asia. So really if you have any questions for Pamod, you can ask them on this channel and then Pamod will reply to each of your questions during this session. So yes, looking forward to reading your questions. Pamod, thank you once again and you have now the floor. Right. Good morning. Good afternoon. Good evening to all of you. And first of all, a big thank you to the University of Oslo team for inviting me to join in this session on the final day of the Android Implementers Academy. I was just a while ago reminding Martha that the last academy about Android implementation we had in Sri Lanka exactly around one year back. So it's kind of like a coincidence that I'm getting the opportunity to join this session just after one year from the last academy. Right. So first of all, let me share my presentation. Right. So what I will be doing in this next 30 minutes or so is to briefly describe the use case where we use the mobile, the DHS to mobile for nutrition monitoring in Sri Lanka. But I will try to make it generic as much as possible because this is a kind of a different use case to as what you will be, what you have discussed so far in this academy because here we are talking about a custom mobile application that was developed about five years back and has been in use in use in Sri Lanka over the last few years with of course a lot of challenges. So we will discuss about these challenges towards the end of the presentation and of course the lessons learned out of these challenges. Right. So I'm Pramod Amrakorn representing his Sri Lanka and this project is specifically in Sri Lanka but I will try to make it as generic as possible. Right. So first of all, a little bit of background about the use case. Now when it comes to South Asia region, Sri Lanka generally has very good public health indicators compared to other countries in the region. But one issue that Sri Lanka has been struggling over the last two decades is about some few indicators related to nutrition. So for example, you can see severe wasting, wasting, overweight and stunting. We do not have that advantage that we had over the other countries. When it comes to these particular public health indicators, I mean that has been the trend over the last one decade or so. So what happened about seven, eight years back was that this issue has been discussed in detail and the presidential secretariat itself formed a multi-sector committee to address this the issue of nutrition at feed level. And then of course, like they decided several things, one was in fact to identify the real issue and then get proper information for decision making. And then of course to integrate all this information into a national system so that when we want to do health and other sectoral planning, this information could be incorporated. Okay, so how we joined this project was that to fulfill the information requirement and basically the presidential secretariat wanted the information solution to capture these requirements. So the basic requirements were to register the children who are having malnutrition into this nutrition monitoring program and this had to take place at the field level. I mean not at the hospitals or at health facilities but at field level when the healthcare workers in Sri Lanka, we call them public health midwives who are actually in charge of nutrition. So when they do the field level visits they wanted to get registered. And then once these children with malnutrition have been registered in the program, they wanted to monitor nutrition parameters such as height and weight on a regular fashion. And also they wanted to identify household risk factors. So these risk factors could have been directly health related or maybe related to other sectors such as agriculture, social welfare, things like that. And then they also wanted to obtain household geolocations and then in the mobile app, I mean like in this particular solution itself, they wanted to have some basic visualizations. So for the mobile user that is a field health worker so that they can get an idea. And then once this data is collected at field level, it had to be as soon as possible synchronized with the central data repository so that data is available to everyone else. Right. So how we approach this use case, now I'm talking about five years back was that we decided to give a smart mobile device to the field health worker that is a public health midwife. And then once this data is collected, we thought because we had a strong DHS to infrastructure in Sri Lanka that we will synchronize this information collected in the mobile device into a central DHS to base data repository. And once that happens, the data had to be kind of overseen and approved by the medical officer of health. He's kind of like the supervising officer of all these field health staff supervising public health doctoring fact at field level. So there are like about 50 of these public health midwives who may be under the supervision of this public health doctor. And once that is done, the data had to be available with the other stakeholders that is the I mean the ministries and the other multi sector stakeholders and the parents. Right. So this of course, five years back was a major task because we did not have a very sophisticated Android application thankfully to our Android team. I mean, we have a very good application right now but those days it was not so. So what we basically did was we designed a custom mobile application which transmits information back and forth with the DHS to central server using the DHS to web API. And again, we also had had another issue like they voted some custom user interfaces which were not available in the standard DHS to web applications. So we also had to do another custom web application also to support this scenario. So we did that and then of course, our entire information landscape was full. So this was our solution which we designed that time. Right. So let me just now quickly go through a few of the screen, the interfaces that that is that where they are in our initial application. So first of all, I mean, we had this use authentication. And once that is done, one important feature we had was because we were using the public health midwives. These are the few level health workers to collect this data. We needed the application to be available in in all three languages that are used in Sri Lanka. So we had the trident who are using interface. And then followed by that, of course, once you are logged in, you can select an area very much similar to data capture workflow. And then of course, we had from their onwards, kind of a custom interface where we use a lot of colors to identify whether a particular child who's who's listed here is a child who's being actively monitored or it's a child whose nutrition status is now okay. So to indicate this, we were using a lot of colors, as you are seeing here. And then these are of course, the standard, you know, like the registration process. And then we had a few options to identify what is the main nutrition issue the child is having. And of course, we had the child's profile. And this is a basic basic search criteria. And here I'm going to mention again, another user interface where I use where we use a lot of colors. So for example, those days, we had a major issue about the deletion process, like once the, say in DHS terms, when a track entity instance is deleted, how it should be updated with the central server and like there's a time delay and then and how to indicate this in mobile applications. So we again used different colors for this one. Right. And then this interface is a bit important one. So here, of course, what we do is like, you know, as you can see here, here the particular child is 16 months old and value has been entered for the height and weight. So what we wanted was to give a visual indication to the field health worker once that person is entering a particular figure, where that figure stands, because these are just numbers. So for example, what you see here is like, when the field health worker enters this value 78, what the app does is it kind of verifies with the WHO, we have the standard deviation values for height for age, weight for age, things like that. And it verifies and it gives a visual indication with the color code saying, okay, this 78 is kind of a okay value. So if it is okay, it's usually light green or dark green. And here, of course, it's amber color. So the weight is not that okay. And if it is really less than two SD, it gives you a visual verification with color like bright red. So that way, we try to enhance the data quality at the point of capture itself by giving the application of what they actually entered. And then again, the same visual indication we had in another instance. So this is kind of like you are leaving event data. So in the event data itself, we had a background color change to indicate where this value stands with regard to WHO standard deviation values. And here, of course, we had another interface to capture the household risk factors. So they do a household visit and then and there they capture what they see as the deficits, which is contributing to the child's malnutrition. And then the most important thing is the charting. So let me show you another screen. So as you can see here, in the mobile app itself, the public health midwives, the field health workers were able to visualize three types of charts. First one is height for age, the second is weight for age, and the third is weight for height. So these kind of charts kind of it gives a visual verification about where the child's nutrition is heading. It's a longitudinal visualization. So it's not just a snapshot idea about what is today's height and weight and not like that. So when we have this kind of charting, you can see whether this is a child whose nutrition status is improving over the last two to three months, or it's deteriorating, or this one needs a special attention, maybe needs to be seen by a pediatrician, there may be some underlying clinical issue. So this you can identify just by looking at the charts for height as well as weight. So this we incorporated into the mobile application itself. And then again, the field health workers, another thing they had to do was they needed to do some kind of a presentation, a briefing to the public health doctor who supervised in them on a monthly basis. So for that one, they needed some statistics because the thing is these field health workers, for most of them, they did not have any kind of access to a laptop or desktop device. And the mobile device was the only device that they are using for data entry as well as visualization. So this is where, in fact, like we might have a requirement in the DHS to mobile application itself to provide them with some kind of analytics in the application because the issue is there are a lot of health workers who don't get access to a desktop or laptop. So the mobile device is not only for the data capture for these users. So they would like to have it enabled with some visualizations and analytic features as well. So this is why we had a very, very brief analytics or some report that was available in the mobile app. So here you can see how many children under this particular midwives care are having each of these nutrition issues. And again, they wanted this one also like to see how many were under each of these standard deviations so that they can, this is something that they have to submit to for official statistics purposes. So these kind of basic reporting was also available inside the mobile application itself. And now another requirement was that the health sector administrators or district level administrators, they wanted a few other visualizations which were not available in DHS to about five years back. So one was this donor chart and also the progression of how the number of children with each of these risk factors were evolving over time. So this kind of longitudinal charting was also not available that time. And so we had to design a separate web application to serve this purpose. And you can do a trend analysis. And then again, yeah, there are like different kind of tools available in this web applications that I'm mentioning. So once again, I must mention you. So this is some work that I have been, I mean, that that was initiated about five years back. But now, of course, if there are any, any, any Android developers here, if you want to develop a custom Android application, it is not at all that difficult. So our Android team has done SDK and I mean, it has already been discussed during the academy itself. So things are much, much easier compared to the difficult process I have mentioned, which was started about five years back. Right. So this is in fact a few screenshots of our revamped application, which was done about two years back with kind of different interfaces. Okay. So this is a brief timeline. We started, of course, the design and development in 2015, but formally started in 2016 January. And thereafter, we have been implementing in few districts in Sri Lanka over the next few years. Of course, this year, everything has been kind of in a halt. We could not expand at all due to the pandemic situation. But this is what has happened during the last five years. Of course, the implementation, the biggest challenge. We, I mean, like what we did was we went up to the sub district level or else a level where we had, which was under supervision of a public health doctor, we call it a medical office of health area. So our team went to each of these medical office of health area, we may have about 10 of them per a district, and we conducted one full day training program on how to use the device. I mean, what is the device? I mean, to start with, I mean, what is this mobile device and some idea about how to protect the device and hardware, how to turn it on, things like that. And also how to use different applications, like, I mean, maybe the email and how to set up a Google account, things like that. So basically, in fact, like two to three hours was consumed to describe about this device and how to use it. And thereafter, of course, the workflow, one advantage was that because we were following the same workflow, the workflow was very, I mean, it was not complicated at all because it was what they have been doing over the years. And then we showed them the application and how they can use it to match their requirements in the workflow. And then, of course, towards the latter part, we had this kind of small group discussion within, like, I mean, within groups of like six public health midwives and discussed what other challenges they might encounter. And we kind of gave them individual attention. So this is practically how it is used at field level. And as of now, we had more than 20,000 children who have been registered in the application and monitored in the monitored, the nutrition status is monitored at field level. Right. So let me now discuss about something important about the experience, because the technology might, I mean, it'll all keep on changing because I mean, the even the application development process that we started five years back is much different, because we have better technology nowadays and the DHS to mobile is very streamlined and better documentation. So I mean, it has really so everything has enhanced over the five years. But what will not change is the lessons learned. So what actually worked? One thing was the interface design, because what we understood was that interfaces means a lot. Because when we are doing a mobile implementation, we compared to a web interface where we have a we are when we are using a laptop or desktop device, we are really restricted by the screen size. So we have to optimally utilize the screen area that we have. So that I mean, we have to use a lot of color coding. And as I mentioned to you, and we might have to, you know, like if you want to highlight something, then that also we have to focus on how to do it. And then again, if you are using multiple languages, we have to incorporate it. And we did not try to create brand new interfaces. So whatever the interfaces that we use, for example, this charting, the color coding, things like that, they were already there in the workflow. So this, because we also did a qualitative study, research study, going parallel. And what we identified was that one stadium feature that was highlighted by the end users was that the interfaces what we used was very familiar. And then of course offline functionality, which is really required when you are doing a three level implementation, because there are so many areas where you don't get good internet connectivity, and maybe some some areas no connectivity at all. So data has to be, of course, stored offline, which is of course, I mean, supported by default in our data capture application that we have now. And the troubleshooting mechanisms at field level, because now here the issue is unlike the web, the application is just running on the user's device. And our experience is that it is not in a controlled environment. There are so many other applications that are installed in that device. And there are so many variables. So there has to be some kind of capacity building at field level. So what we did was we identified at least like two to three public health bidwifes from an area during this training program, and we kind of isolated them and we provided them with some additional technical information on how to troubleshoot and help other users. This was really helpful because it was kind of filtering out a lot of issues, which should have otherwise come all the way up to the national level, implementers and the supporting staff, because then things become very complicated, they I mean, like we are getting so much of so many requests, which could have been handled at field level all the way up to the national level if the field level doesn't have the sufficient capacity. So we built up capacity at field level to address these mine issues. And then again, regarding repair and maintenance of devices, so when these devices were procured by the Ministry of Health, we ensured that it is procured through, I mean, like when they are deciding on a supplier, we selected a supplier who has a countrywide service network so that when there is issue, the field level health worker doesn't have to come to a larger town or a district level capital to get it repaired, which kind of cost them another maybe a full day. But that again means you are losing one precious day where they could have done so much of other field work. So we made sure that this maintenance service, they in fact reach out to the end user, the field level health worker and collect the device and repairs it and hand it over again. But then again, they are like challenges because of course, the service providers, they tend to increase the cost to cover these as well. Right. Then of course, incorporating solution into operational review process. So what we actually tried to do was like, it was not just for data capture. Once this data is captured, we had this monthly review meeting at this Medical Officer of Health who is kind of the surprising public health doctor level. So in that one, that I mean, all these midwives will have to make some comments about whether the nutrition status is progressing in her area or whether there are any deficits. If so, what is actually contributing, what can be improved. So there will be kind of a critical evaluation on the data entry process which happens in this monthly meeting. So this was providing them a very good feedback. And this in turn, it had so many positives. So one thing is that it will provide feedback. So if a person has done some mistake, they'll be guided on how to prevent that from happening again. And again, it will also provide some kind of motivation to the people who have been collecting data because they know that their data that the data that they're collecting is again going to be useful at a higher level. So this was again, something that we found as very useful. So what you're seeing here is one of these monthly review meetings. In fact, one professor from University of Oslo also attended in one of these reviews. This is again in Jaffna districts, which was troubled by three decades of war. So we kind of had a lot of challenges in implementing this district, but it has been really successful. Right. Okay. Then coming back to what did not work, first of all, the mobile data plan because I mean, it is not that in these kind of projects that we can do 100 percent. I mean, the entire process we can do in the 100 percent optimal way. It doesn't happen because there are so many compromises we have to make because we may be just one party who's advising the government stakeholders on what should be done. But then again, we might have to be happy with what we are receiving. So here, of course, the implementing parties could not come come into a good consensus about how to manage this data plan. So what was decided was that they will be providing an incentive to the end users for their mobile data. But this didn't kind of turn out to be working that well, because what happened was that they were kind of overusing the data for different personnel, I mean, whatever the requirements so that there was a chance that the data court is over within like two weeks, the one month data code. So how we in fact tackle this was that we were asking these the end users because they were supposed to pay a visit to this field level of we call it the MOH office at least once a week for other routine purposes. So all these offices, they had the Wi-Fi connectivity. So what we ask them most, if you don't have mobile data, at least when you come to the office, use the Wi-Fi and try to synchronize. So that was again, I mean, there was a delay in getting the data, but I mean, that was a compromise we had to make. And then again, the replacement of devices. So we had a service plan implemented, but then again, the lifetime of a mobile device is pretty short, like maybe maximum two to three years. Then whether you will have sufficient funding in the state sector to replace these devices, when they are out of order is again an issue that we faced and which we have not been able to successfully address. Then again, the technical capacity at district level. So thing is, as I mentioned, like we tried to build up some level of capacity at field level, but then again, after that, we did not have sufficient technical capacity at all districts. So sometimes if something could not be addressed at the field level, the request had to come all the way up to the national level, which again, is kind of a cumbersome process because there's a lot of delays. And we are sometimes not able to understand what these users are meaning by the different issues that they're having. So this again is a problem. And then again, the version upgrades, of course, we did not, I think it may have been discussed about the use of MDM. Unfortunately for this one, we have not been able to use MDM so far. So we have issues because we are using the Google Play Store even up to this moment. We have been trying to use other options, but I mean, it has not been materialized. So with that, of course, we are not really sure when we do a proper, I mean, we didn't really do a version upgrade, whether all end users will be on the same version is again an issue. But then again, the positives is that usually we are talking about field health workers who are carrying this large pile of papers or books in the field visit. So as you can see, this is one in a rural area, one of the midwives who are going, who is going for a field visit. But then again, rather than carrying this large pile of papers, if they have this field health records in their mobile devices, things become much, much easier. So this is what we have heard from the end users. But then again, there are a lot of practical issues. So the lessons learned, in fact, come into the last part of my presentation. Now, what we understood was the mobile technology has a lesser learning curve compared to learning how to use a computer. Because one thing is that people are really familiar with mobile devices, not that everyone in the household has a smart mobile phone, but chances are such that nowadays, even in rural areas, at least the household head will have a smartphone and so at least the midwife, I mean, the spouse may have at least used this device and they are kind of familiar. So we are kind of starting off with the technology that people are familiar at the base level. So with that, of course, they have minimal learning to do on how to use the application rather than learning how to use a computer. And then again, use of familiar interfaces will increase the compliance and acceptability. So here, what we try to minimize is the complication of learning. Because if you have, for some field health workers who are not tech savvy or who have not used technology at all, learning how to use a mobile device, a smart device itself is a major task. So if we try to even introduce some new workflows with new interfaces, this will further complicate things. And what will happen is that they will kind of reject the solution. So this is what we have understood that you have to keep the interfaces simple and whichever familiar to them so that they will, I mean, the acceptability at that level will be more. And then again, scaling up the technology has to be carefully planned, like we may be too ambitious to launch an island kind of countrywide implementation of mobile technology, which may be, I mean, too ambitious, I must say, because what we have found out is that to do a successful mobile implementation, there's a lot of infrastructure and capacity building that is required. And again, not only infrastructure and capacity building and the supervision and evaluation also has to be placed well ahead prior to implementation. Otherwise, implementations don't tend to sustain. Because here, rather than using the web technology, lot depends on the mobile technology itself, which is very challenging. So you have to carefully plan the implementation. Maybe you will have to plan a few years ahead on how to get a proper funding, even to get the devices, if they stop working. So those things also needs to be planned well in advance prior to implementation in a new district. And then empowering the field health workers helps for better adoption of technology and sustaining the solution. So sometimes you may be the pioneer to introduce a technology like mobile technology. But what it does is like it kind of motivates the field health worker to learn technology because what we understood, like there were field health workers who were more than 50 years of age who tend to be generally not too keen to learn new things because they are towards the end of their career. So they don't feel like learning new things. But here, when we try to introduce the mobile technology becomes kind of a mandatory tool they have to use to do the routine work. And with that, because they had to learn it and learning on how to use a mobile phone is not that difficult. And also because there is peer support available at households. So sometimes there are user stories where these field health workers, they just take the device at home and they try to learn how to use it from their children because the children finds it much easier to use. And in initial few days, the data entry was even done by their children. So but then again, what it ultimately does is that it builds the capacity and again motivate the end user so that subsequently, if someone comes to introduce a new program, maybe administration program, something else, or else try to teach them on how to use the web interfaces of DHS2, the adoption and the compliance will be much more. So these are a few lessons that we have learned from this implementation. And again, this entire project has been recognized with few awards at global level also because of course received the United Nations World Summit Award in year 2016 for the innovation. All right, so thank you so much. I guess I kind of tried to introduce you something a new way of looking at implementation of a mobile solution, not on a particular use case. So this is a kind of a different use case because we are using a custom mobile application. But what I think you can take as the take home message would be the final few slides about the challenges and how to address them. So thank you so much. Thank you so much, Pamod, for this presentation. Very, very interesting as usual. Thank you. Now I'm going to ask first to my colleagues, Marta or Rosé, would you have any questions for Pamod? Thank you, Alice. And thank you, Pamod. I think every time I see you presenting this work, I learn something new. It's really impressive. So I have two questions today or maybe three. One is that you made a very important point on that troubleshooting and supporting users is very different when you have a web system or a mobile system. So if you had to identify or to highlight two or three main differences for supporting national implementation on web or national implementation in mobile, what would be your key recommendations with this difference when someone is moving to mobile? All right. Good question. So what happens is now this is one reason like we have a MCH, RMNCH program, which has been well established and they are using DHS to web for like last three to four years. They have been thinking when to go for mobile and when I ask from the program staff, why are you not moving to mobile? They explain it in a really nice way. So the thing is here, of course, now when you are using the DHS to web, you have much better control because what we do is like, okay, so for example, a classic issue about from a sub district level, if someone is complaining, okay, I'm not seeing the data or this screen is not loading and they contact us through a mobile call, something like that. We try to explain and try to figure out what has gone wrong. In case if we really fail to understand what we do is we have all taught them on how to use this remote desktop software. So we try to connect to these devices and see what is going wrong. But then again, I mean, I'm trying to apply the same to a mobile situation. This is not at all feasible because like nobody is usually willing to give access to their mobile device for a national level user. And then again, we are never guaranteed whether that person will have a proper internet connection. And then due to different challenges, we might not be able to capture, we might not be able to capture the exact requirement. So this is where you need to like, if all these fail, there should be some mechanism to analyze that field level, because otherwise the device, entire device has to come to the national level. So this itself is very challenging. So this is what we can minimize by having some capacity available for troubleshooting at that sub-district level. So without building the capacity, and if we try to implement the same program, which is running nationally at web using the DHS2 web and try to use the mobile, it's going to fail because we have had some experience in the past. We tried to do that and it didn't sustain that. Thank you. And maybe some howling to this, you also had a line highlighting repair and maintenance. So this is kind of sounds a bit like touching hardware. Sounds a bit like repair and maintenance of the devices. So we are not talking only right now of the app is not syncing, it cannot open, or these kind of things, but about the devices themselves. So did you have any kind of strategy for this and where the device is, did the device belong to the country or to the users? Yeah. So here, of course, in this use case, mainly the device was owned by the ministry. So it's not user's device. But then again, the issue is, like as I mentioned, during the first two, three years of implementation, we had this, the warranty support. So in that time, the repair was, I mean, well organized. But then again, when we, but there was a time in some certain areas, as I mentioned, we could not, we were not in a position to replace the device after the devices, the hardware reaching the end of life. So in these cases, we ask the users if they are willing to use their own devices and we'll be providing them with the same incentive that is a mobile data incentive will be providing. So here again, if what we advise was that if they were going to purchase the device, always try to purchase with, I mean, some supplier who's providing good support and service repairs, which is available at their own, in that area. Because otherwise, we highlighted the issues they might encounter if you try to go for a cheaper device with minimal support. So this is one thing we have been emphasizing even to the ministry people as well as if someone was actually going to buy a device to be more concerned about the repair and services. That's interesting. I don't think we see many projects with these years of experience already being implemented with mobile. So it's always very interesting. So my last question is now, I mean, after five years, you have that project up and running for a long time. So for those users, did the fact that having the mobile already deployed open the door for other programs being mobile as well, did you expand somehow the use of the mobile at the level of the community health worker? I mean, apart from nutrition or it's still a mainly nutrition only. Yeah, so what happened was in all these districts, we were planning to implement the MCH program early this year. So that was all planned because that we have built the capacity. But unfortunately, due to COVID, we have not been able to implement the MCH. But in one of these districts, which is the Jaffna districts, they have been using this for two other programs. One is post of death and the other one is for verbal autopsy. So these two programs, they have been using the same mobile devices. Then again, I mean, these are not national programs that have been installed. So they had some provincial level. We have a provincial health ministry also. So that particular district, the province that it belongs, they implemented these two programs. So for those programs, the same device was used and because they had already some understanding on how to use the device and the application, it was helpful. Okay. Yeah, very, very, very good to see that in some places it allows for expanding and reaching more, more of the minds. So that was my last question. Alice, if you want to... And thank you, Pamod. Thank you again. Thank you both. We have one question from a participant that I'm going to read. But I wanted also to mention, like, if any of our participants, if you would like to ask a question live to Pamod, please raise your hand and I will give you the floor. So if you're interested in asking a question, you can ask it directly here. Just raise, click on the raise hands button so that I know that you want to ask a question. In the meantime, we have one question on Slack, Pamod. A participant is asking about monthly data bundle being used for before and on month. Okay. So he's asking how was addressed this problem? Okay. If I understand the question properly, is he asking, like, in case you have a monthly data bundle that you provide to be used the entire month and it is finished before the end of month, how I address it? Yes. Yeah. Okay. So what we did was like, what could have been, I mean, the options that were available, either we have to ask, okay, sorry, I'm sorry, you can't do anything till next month. Of course, that's sort of good option. Then option number two would have been, we could have considered giving them a top up, which again is not an administratively easy decision to take because I mean, there can be so many variables that they have to consider. So what we just asked all of them was that like these health workers, they were supposed to report to the medical, public health, medical doctor's office at least once a week for different official matters. And these officers, we made sure that they have a good internet connectivity and the Wi-Fi is available. So what we said was okay. I mean, yeah, true enough, we are not getting daily synchronization fine. But at least like when you pay that visit at least once a week to that office, use the Wi-Fi facility that is available in that office and try to synchronize. And in case if they are not able to do so, we instructed the medical doctors who are supervising them to ask them, question them why it was not done during this review meetings. So with these two mechanisms, we were able to get the data from the mobile device into our DHS to Centro Repositive Play at least once a week. So this is the strategy that we have used. Thank you so much, Pamad.